array:23 [
  "pii" => "S1578219010706417"
  "issn" => "15782190"
  "doi" => "10.1016/S1578-2190(10)70641-7"
  "estado" => "S300"
  "fechaPublicacion" => "2010-05-01"
  "aid" => "70641"
  "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L."
  "copyrightAnyo" => "2010"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2010;101:315-22"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2207
    "formatos" => array:3 [
      "EPUB" => 40
      "HTML" => 1447
      "PDF" => 720
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1578219010706429"
    "issn" => "15782190"
    "doi" => "10.1016/S1578-2190(10)70642-9"
    "estado" => "S300"
    "fechaPublicacion" => "2010-05-01"
    "aid" => "70642"
    "copyright" => "Academia Española de Dermatología y Venereología and Elsevier España, S.L."
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2010;101:323-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2151
      "formatos" => array:3 [
        "EPUB" => 39
        "HTML" => 1403
        "PDF" => 709
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Dermatology Service Utilization and Reasons for Consultation by Spanish and Immigrant Patients in the Region Served by Hospital Son Ll&#224;tzer&#44; Palma de Majorca&#44; Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "323"
          "paginaFinal" => "329"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Motivos de consulta dermatol&#243;gicos en la poblaci&#243;n inmigrante y espa&#241;ola del &#225;rea de salud del Hospital Son Ll&#224;tzer &#40;Mallorca&#41;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Taberner, C&#46; Nadal, A&#46; Llambrich, A&#46; Vila, I&#46; Torn&#233;"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Taberner"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Nadal"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Llambrich"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Vila"
            ]
            4 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Torn&#233;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219010706429?idApp=UINPBA000044"
    "url" => "/15782190/0000010100000004/v1_201304241521/S1578219010706429/v1_201304241521/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1578219010706405"
    "issn" => "15782190"
    "doi" => "10.1016/S1578-2190(10)70640-5"
    "estado" => "S300"
    "fechaPublicacion" => "2010-05-01"
    "aid" => "70640"
    "copyright" => "Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a and Elsevier Espa&#241;a&#44; S&#46;L&#46;"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2010;101:307-14"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2186
      "formatos" => array:3 [
        "EPUB" => 40
        "HTML" => 1192
        "PDF" => 954
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Practical dermatology</span>"
      "titulo" => "Digital Photograph Storage Systems in Clinical Dermatology"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "307"
          "paginaFinal" => "314"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Sistemas de almacenamiento en fotograf&#237;a cl&#237;nica dermatol&#243;gica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Taberner, T&#46; Contest&#237;"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Taberner"
            ]
            1 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Contest&#237;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219010706405?idApp=UINPBA000044"
    "url" => "/15782190/0000010100000004/v1_201304241521/S1578219010706405/v1_201304241521/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Controversies in dermatology</span>"
    "titulo" => "Studies of Methyl Aminolevulinate Photodynamic Therapy for Actinic Keratosis"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "315"
        "paginaFinal" => "322"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Fern&#225;ndez-Guarino, A&#46; Harto, P&#46; Ja&#233;n"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Fern&#225;ndez-Guarino"
            "email" => array:1 [
              0 => "montsefdez&#64;msn&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Harto"
          ]
          2 => array:2 [
            "nombre" => "P&#46;"
            "apellidos" => "Ja&#233;n"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Universidad de Alcal&#225; de Henares&#44; Madrid&#44; Spain"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Terapia fotodin&#225;mica&#58; estudios con metilaminolevulinato en queratosis act&#237;nicas"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-09-02"
    "fechaAceptado" => "2009-12-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec84745"
          "palabras" => array:2 [
            0 => "Photodynamic therapy"
            1 => "Methyl aminolevulinate"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec84744"
          "palabras" => array:2 [
            0 => "Terapia fotodin&#225;mica"
            1 => "Metilaminolevulinato"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photodynamic therapy &#40;PDT&#41; for the treatment of actinic keratosis has been shown to be effective and safe in large clinical trials published in the last 5 years&#46; However&#44; evidence has since emerged that raises questions or that introduces new issues&#44; such as the management of field cancerization&#44; fluorescence diagnosis and results in transplant recipients&#46; There also remains a need for more studies comparing PDT to additional treatments&#46; We review the literature on these new topics in PDT&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La terapia fotodin&#225;mica &#40;TFD&#41; se ha mostrado eficaz y segura en el tratamiento de las queratosis act&#237;nicas &#40;QA&#41; en importantes estudios en los &#250;ltimos 5 a&#241;os&#46; Sin embargo&#44; desde entonces&#44; se han publicado varios trabajos con alguna evidencia contradictoria o a&#241;adiendo nuevos aspectos de esta terapia para su discusi&#243;n&#44; como es el tratamiento del campo de cancerizaci&#243;n&#44; el diagn&#243;stico de fluorescencia&#44; los resultados en pacientes trasplantados o la ausencia de estudios comparativos con otros tratamientos&#46; En este trabajo revisamos estos nuevos aspectos de la TFD&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:49 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy using topical methyl 5-aminolaevulinate compared with cryotherapy for for actinic keratosis&#58; a prospective&#44; randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Szeimies"
                            1 => "S&#46; Barrer"
                            2 => "S&#46; Radakovic-Fijan"
                            3 => "A&#46; Tanew"
                            4 => "P&#46;G&#46; Calzavara-Pinton"
                            5 => "C&#46; Zane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2002"
                        "volumen" => "47"
                        "paginaInicial" => "258"
                        "paginaFinal" => "262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of photodynamic therapy using topical methyl aminolaevulinate &#40;Metvix<span class="elsevierStyleSup">&#174;</span>&#41; with single cycle cryotherapy in patients with actinic keratosis&#58; a prospective&#44; randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Freeman"
                            1 => "C&#46; Vinciullo"
                            2 => "D&#46; Francis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dermatol Treat"
                        "fecha" => "2003"
                        "volumen" => "14"
                        "paginaInicial" => "99"
                        "paginaFinal" => "106"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy with topical methyl aminolevulinate &#40;Metvix<span class="elsevierStyleSup">&#174;</span>&#41; is effective and safe in the treatment of actinic keratosis&#58; results of a prospective randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Pariser"
                            1 => "N&#46;J&#46; Lowe"
                            2 => "D&#46;M&#46; Stewar"
                            3 => "M&#46;T&#46; Jarratt"
                            4 => "A&#46;W&#46; Lucky"
                            5 => "R&#46;J&#46; Pariser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mjd.2003.49"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2003"
                        "volumen" => "48"
                        "paginaInicial" => "227"
                        "paginaFinal" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12582393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized multicenter study to compare two treatment regimens of topical methyl aminolevulinate &#40;Metvix<span class="elsevierStyleSup">&#174;</span>&#41; in actinic keratosis on the face and scalp"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Tarstedt"
                            1 => "I&#46; Rosdahl"
                            2 => "B&#46; Berne"
                            3 => "K&#46; Svanberg"
                            4 => "A&#46;M&#46; Wennberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/00015550510032887"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2005"
                        "volumen" => "85"
                        "paginaInicial" => "424"
                        "paginaFinal" => "428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16159735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraindividual right-left comparison of topical methyl-aminolevulinate-photodynamic therapy &#40;MAL-PDT&#41; and cryotherapy in subject with actinic keratosis&#58; a multicentre&#44; randomized controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Morton"
                            1 => "S&#46; Campbell"
                            2 => "G&#46; Gupta"
                            3 => "S&#46; Keohane"
                            4 => "J&#46; Lear"
                            5 => "I&#46; Zaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07470.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "155"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1036"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17034536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacology of protoporphyrin IX in nude mice after application of ALA and ALA esters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Moan"
                            1 => "L&#46;W&#46; Ma"
                            2 => "A&#46; Juzeniene"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ijc.10802"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cancer"
                        "fecha" => "2003"
                        "volumen" => "103"
                        "paginaInicial" => "132"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12455066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microscopic localization of protoporphyrin IX in normal mouse skin after topical application of 5-aminolaevulinic acid or methyl-aminolaevulinic acid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Bruijn"
                            1 => "C&#46; Meijers"
                            2 => "A&#46; van der Ploeg-van den Heuvel"
                            3 => "H&#46;J&#46; Sterenborg"
                            4 => "D&#46;J&#46; Robinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Photochem Photobiol"
                        "fecha" => "2008"
                        "volumen" => "92"
                        "paginaInicial" => "91"
                        "paginaFinal" => "97"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized&#44; double blind&#44; prospective study to compare topical 5-aminolaevulinic acid methylester with topical 5-aminolaevulinic acid photodynamic therapy for extensive scalp actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;J&#46; Moloney"
                            1 => "P&#46; Collins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.07946.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "paginaInicial" => "87"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17501954"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy induces less pain in patients treated with methylamino levulinate compared to aminolevulinic acid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Kasche"
                            1 => "S&#46; Luderschmidt"
                            2 => "J&#46; Ring"
                            3 => "R&#46; Hein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2006"
                        "volumen" => "5"
                        "paginaInicial" => "353"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16673803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terapia fotodin&#225;mica en dermatolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Gilaberte"
                            1 => "C&#46; Serra-Guill&#233;n"
                            2 => "M&#46;E&#46; de las Heras"
                            3 => "R&#46; Ruiz-Rodr&#237;guez"
                            4 => "M&#46; Fern&#225;ndez-Lorente"
                            5 => "C&#46; Benvenuto-Andrade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2006"
                        "volumen" => "97"
                        "paginaInicial" => "83"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16595110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy for actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Kalisiak"
                            1 => "J&#46; Rao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.det.2006.09.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Clin"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "15"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17126738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effective photodynamic therapy of actinic keratoses on the head and face with a novel&#44; self-adhesive 5-aminolaevulinic acid patch"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Hauschild"
                            1 => "G&#46; Popp"
                            2 => "E&#46; Stockfleth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0625.2008.00770.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Exp Dermatol"
                        "fecha" => "2009"
                        "volumen" => "18"
                        "paginaInicial" => "116"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18643849"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimization of photodynamic therapy with a novel self-adhesive 5-aminolaevulinic acid path&#58; results of two randomized controlled phase II studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Hauschild"
                            1 => "E&#46; Stockfleth"
                            2 => "G&#46; Popp"
                            3 => "F&#46; Borrosch"
                            4 => "H&#46; Br&#252;ning"
                            5 => "R&#46; Dominicus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09040.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "160"
                        "paginaInicial" => "1066"
                        "paginaFinal" => "1074"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19222455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Szeimies RM&#44; Stokleft E&#44; Popp G&#44; Borrosh F&#46; Long-term follow-up of photodynamic therapy with a self-adhesive 5-aminolaevulinic acid patch&#58; 12 months data&#46; Br J Dermatol 2009&#46; In press&#46;"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser mediated photodynamic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Alexiades-Armenakas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clindermatol.2005.10.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Dermatol"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "16"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16427502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical 5-aminolaevulinic acid photodynamic therapy for cutaneous lesions&#58; outcome and comparison of light sources"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Clark"
                            1 => "A&#46; Bryden"
                            2 => "R&#46; Dawe"
                            3 => "H&#46; Moseley"
                            4 => "J&#46; Ferguson"
                            5 => "S&#46;H&#46; Ibbotson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Photodermatol Photoimmunol Photomed"
                        "fecha" => "2003"
                        "volumen" => "19"
                        "paginaInicial" => "134"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12914598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical methyl aminolevulinate photodynamic therapy using red light emitting diode light for multiple actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;M&#46; Szeimies"
                            1 => "R&#46;T&#46; Matheson"
                            2 => "A&#46; Steven"
                            3 => "A&#46;C&#46; Bhatia"
                            4 => "Y&#46; Frambach"
                            5 => "W&#46; Kl&#246;vekorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2009.01096.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "586"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19309347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Split-face study using two different light sources for topical PDT of actinic keratosis&#58; non inferiority of the LED system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Babilas"
                            1 => "R&#46; Travnik"
                            2 => "A&#46; Werner"
                            3 => "M&#46; Landthaler"
                            4 => "R&#46;M&#46; Szeimies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dtch Dermatol Guest"
                        "fecha" => "2008"
                        "volumen" => "6"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of different light sources for 5-aminolaevulinic acid photodynamic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Juzeniene"
                            1 => "P&#46; Juzenas"
                            2 => "L&#46;W&#46; Ma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10103-004-0314-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lasers Med Sci"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "139"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15503248"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variable pulsed light is less painful than light emitting diodes for topical photodynamic therapy of actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Babilas"
                            1 => "R&#46; Knobler"
                            2 => "S&#46; Hummel"
                            3 => "C&#46; Gottschaller"
                            4 => "T&#46; Maisch"
                            5 => "M&#46; Koller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.07959.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "paginaInicial" => "111"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17542980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic photorejuvenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Ruiz-Rodr&#237;guez"
                            1 => "T&#46; Sanz-S&#225;nchez"
                            2 => "S&#46; C&#243;rdoba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "742"
                        "paginaFinal" => "744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12174070"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous activation of PpIX by daylight is as effective and less painful than conventional photodynamic therapy for actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;R&#46; Wiegell"
                            1 => "M&#46; Haedersdal"
                            2 => "P&#46;A&#46; Philipsen"
                            3 => "P&#46; Eriksen"
                            4 => "C&#46;D&#46; Enk"
                            5 => "H&#46;C&#46; Wulf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.08450.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "158"
                        "paginaInicial" => "740"
                        "paginaFinal" => "746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy of actinic keratosis with 8&#37; and 16&#37; methyl aminolaevulinate and home-based daylight exposure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;R&#46; Wiegell"
                            1 => "M&#46; Haedersdal"
                            2 => "P&#46; Eriksen"
                            3 => "H&#46;C&#46; Wulf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09119.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "160"
                        "paginaInicial" => "1308"
                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19416257"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory photodynamic therapy&#44; a new concept in delivering photodynamic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Moseley"
                            1 => "J&#46;W&#46; Allen"
                            2 => "S&#46; Ibbotson"
                            3 => "A&#46; Lesar"
                            4 => "A&#46; McNeill"
                            5 => "M&#46;A&#46; Camacho-L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07145.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "154"
                        "paginaInicial" => "747"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16536822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An open pilot study of ambulatory photodynamic therapy using a wearable low-irradiance organic light-emitting diode light source in the treatment of nonmelanoma skin cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;K&#46; Attili"
                            1 => "A&#46; Lesar"
                            2 => "A&#46; Mc Neill"
                            3 => "M&#46; Camacho-L&#243;pez"
                            4 => "H&#46; Moseley"
                            5 => "S&#46; Ibbotson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09096.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "161"
                        "paginaInicial" => "170"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19302071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short incubation with methyl aminolevulinate photodynamic therapy of actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Braathen"
                            1 => "B&#46;E&#46; Paredes"
                            2 => "O&#46; Sakleka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermatol"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "550"
                        "paginaFinal" => "555"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multicenter intraindividual randomized trial of topical methyl aminolevulinate-photodynamic therapy vs cryotherapy for multiple actinic keratosis on the extremities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Kaufmann"
                            1 => "L&#46; Spelman"
                            2 => "W&#46; Weightman"
                            3 => "J&#46; Reifenberger"
                            4 => "R&#46;M&#46; Szeimies"
                            5 => "E&#46; Verhaeghe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.08488.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2008"
                        "volumen" => "158"
                        "paginaInicial" => "994"
                        "paginaFinal" => "999"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18341663"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio retrospectivo&#44; descriptivo y observacional del tratamiento de m&#250;ltiples queratosis act&#237;nicas con metilaminolevul&#237;nico y luz roja"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Fern&#225;ndez-Guarino"
                            1 => "A&#46; Harto"
                            2 => "M&#46; S&#225;nchez-Ronco"
                            3 => "B&#46; P&#233;rez-Garc&#237;a"
                            4 => "A&#46; Marquet"
                            5 => "P&#46; Ja&#233;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Actas Dermosifiliog"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "779"
                        "paginaFinal" => "787"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short incubation PDT versus 5-fluorouracil in treating actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Smit"
                            1 => "D&#46; Piacquiadio"
                            2 => "V&#46; Morhenn"
                            3 => "D&#46; Atkin"
                            4 => "R&#46; Fitzpatrick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2003"
                        "volumen" => "2"
                        "paginaInicial" => "629"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14711141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on actinic keratosis in clinical trial experience with imiquimod"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46; Ferr&#225;ndiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.08270.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "numero" => "Suppl 2"
                        "paginaInicial" => "32"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18067629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Becker"
                            1 => "J&#46;M&#46; Mac Gregor"
                            2 => "B&#46;R&#46; Hushes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07692.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "222"
                        "paginaFinal" => "230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the management of actinic keratosis&#58; developed by the Guideline Subcommittee of the European Dermatology Forum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Stockfleth"
                            1 => "H&#46; Kerl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "16"
                        "paginaInicial" => "599"
                        "paginaFinal" => "606"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17229598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy for actinic keratoses&#58; survey of patient perceptions of treatment satisfaction and outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;P&#46; Tierney"
                            1 => "M&#46;J&#46; Eide"
                            2 => "G&#46; Jacobsen"
                            3 => "D&#46; Ozoq"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/14764170802056117"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cosmet Laser Ther"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "81"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18569260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complicaciones en la terapia fotodin&#225;mica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Huerta Brogeras"
                            1 => "A&#46; Romero Mate"
                            2 => "O&#46; Nieto Perea"
                            3 => "J&#46;M&#46; Borbujo Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Piel"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "309"
                        "paginaFinal" => "313"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of post-transplant premalignant skin disease&#58; a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;M&#46; Perrett"
                            1 => "J&#46;M&#46; Mc Gregor"
                            2 => "J&#46; Warwick"
                            3 => "P&#46; Karran"
                            4 => "I&#46;M&#46; Leigh"
                            5 => "C&#46;M&#46; Proby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07616.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "320"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17223873"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cold water and pauses in illumination reduces pain during photodynamic therapy&#58; a randomized clinical study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;R&#46; Wiegell"
                            1 => "M&#46; Haedersdal"
                            2 => "H&#46;C&#46; Wulf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2340/00015555-0568"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol"
                        "fecha" => "2009"
                        "volumen" => "89"
                        "paginaInicial" => "145"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19325998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparative study between cold air analgesia and supraorbital and supratrochlear nerve block for the management of pain during photodynamic therapy for actinic keratoses of theof frontotemporal zone"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Serra-Guill&#233;n"
                            1 => "L&#46; Hueso"
                            2 => "E&#46; Nagore"
                            3 => "M&#46; Vila"
                            4 => "B&#46; Llombart"
                            5 => "C&#46; Requena Caballero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2009.09184.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "161"
                        "paginaInicial" => "353"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19438468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nerve blocks enable adecuate pain relief during photodynamic therapy of field cancerization of the forehead and scalp"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;B&#46; Halldin"
                            1 => "J&#46; Paoli"
                            2 => "C&#46; Sandberg"
                            3 => "H&#46; Gozalez"
                            4 => "A&#46;M&#46; Wennberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.09024.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2009"
                        "volumen" => "160"
                        "paginaInicial" => "795"
                        "paginaFinal" => "800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19210497"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized controlled trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Dagrieva"
                            1 => "B&#46;M&#46; Prinz"
                            2 => "J&#46; Hafner"
                            3 => "R&#46; Dummer"
                            4 => "G&#46; Burg"
                            5 => "U&#46; Binswnger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06054.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2004"
                        "volumen" => "151"
                        "paginaInicial" => "196"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15270891"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical photodynamic therapy of actinic keratosis in renal transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Piaserico"
                            1 => "A&#46; Belloni Fortina"
                            2 => "P&#46; Rigotti"
                            3 => "B&#46; Rossi"
                            4 => "N&#46; Baldan"
                            5 => "M&#46; Alaibac"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.transproceed.2007.05.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplant Proc"
                        "fecha" => "2007"
                        "volumen" => "39"
                        "paginaInicial" => "1847"
                        "paginaFinal" => "1850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17692630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy does not prevent cutaneous squamous carcinoma in organ transplant recipients&#58; results of a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;G&#46; De Graaf"
                            1 => "C&#46; Kennedy"
                            2 => "R&#46; Wolterbeek"
                            3 => "A&#46;F&#46; Collen"
                            4 => "R&#46; Willemze"
                            5 => "J&#46;N&#46; Bouwes Bavinck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.jid.5700098"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2006"
                        "volumen" => "126"
                        "paginaInicial" => "569"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16374480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy with methyl aminolevulinate for prevention of new skin lesions in transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Wennberg"
                            1 => "B&#46; Stenquist"
                            2 => "E&#46; Stockfleth"
                            3 => "S&#46; Keohane"
                            4 => "J&#46;T&#46; Lear"
                            5 => "G&#46; Jemec"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TP.0b013e318180731e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2008"
                        "volumen" => "86"
                        "paginaInicial" => "423"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18698246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Field cancerization in oral stratified squamous epithelium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;P&#46; Slaughter"
                            1 => "H&#46;W&#46; Southwick"
                            2 => "W&#46; Smejkal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1953"
                        "volumen" => "6"
                        "paginaInicial" => "963"
                        "paginaFinal" => "968"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13094644"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of field change in actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Vatve"
                            1 => "J&#46;P&#46; Ortonne"
                            2 => "Birch-Marchin"
                            3 => "G&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.08268.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "157"
                        "paginaInicial" => "21"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18067627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of actinic keratosis with sequential use of photodynamic therapy and imiquimod"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Shaffelburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Drugs Dermatol"
                        "fecha" => "2009"
                        "volumen" => "8"
                        "paginaInicial" => "35"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19180894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Photodynamic therapy of actinic keratosis at varying fluence rates&#58; assessment of photobleaching&#44; pain and primary clinical outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;B&#46; Ericson"
                            1 => "C&#46; Sandberg"
                            2 => "B&#46; Stenquist"
                            3 => "F&#46; Gudmundson"
                            4 => "M&#46; Karlsson"
                            5 => "A&#46;M&#46; Ros"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2004.06211.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2004"
                        "volumen" => "151"
                        "paginaInicial" => "1204"
                        "paginaFinal" => "1212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15606516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacoeconomics considerations in treating actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;W&#46; Neidecker"
                            1 => "M&#46;L&#46; Davis-Ajami"
                            2 => "R&#46; Balkrishnan"
                            3 => "S&#46;R&#46; Feldman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/00019053-200927060-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacoeconomics"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "451"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19640009"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic evaluation of methyl aminolaevulinic acid-based photodynamic therapy in the management of actinic keratosis and basal cell carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Caekelbergh"
                            1 => "L&#46; Annemans"
                            2 => "J&#46; Lambert"
                            3 => "R&#46; Roelandts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07483.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2006"
                        "volumen" => "155"
                        "paginaInicial" => "784"
                        "paginaFinal" => "790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16965429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An economic evaluation of topical treatments for actinic keratosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Muston"
                            1 => "A&#46; Downs"
                            2 => "V&#46; Rives"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Dermatol Treat"
                        "fecha" => "2009"
                        "volumen" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010100000004/v1_201304241521/S1578219010706417/v1_201304241521/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6176"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Controversies in Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010100000004/v1_201304241521/S1578219010706417/v1_201304241521/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219010706417?idApp=UINPBA000044"
]
Compartir
Información de la revista
Vol. 101. Núm. 4.
Páginas 315-322 (mayo 2010)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 101. Núm. 4.
Páginas 315-322 (mayo 2010)
Controversies in dermatology
Acceso a texto completo
Studies of Methyl Aminolevulinate Photodynamic Therapy for Actinic Keratosis
Terapia fotodinámica: estudios con metilaminolevulinato en queratosis actínicas
Visitas
5899
M. Fernández-Guarino
Autor para correspondencia
montsefdez@msn.com

Corresponding author.
, A. Harto, P. Jaén
Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain
Este artículo ha recibido
Información del artículo
Abstract

Photodynamic therapy (PDT) for the treatment of actinic keratosis has been shown to be effective and safe in large clinical trials published in the last 5 years. However, evidence has since emerged that raises questions or that introduces new issues, such as the management of field cancerization, fluorescence diagnosis and results in transplant recipients. There also remains a need for more studies comparing PDT to additional treatments. We review the literature on these new topics in PDT.

Keywords:
Photodynamic therapy
Methyl aminolevulinate
Resumen

La terapia fotodinámica (TFD) se ha mostrado eficaz y segura en el tratamiento de las queratosis actínicas (QA) en importantes estudios en los últimos 5 años. Sin embargo, desde entonces, se han publicado varios trabajos con alguna evidencia contradictoria o añadiendo nuevos aspectos de esta terapia para su discusión, como es el tratamiento del campo de cancerización, el diagnóstico de fluorescencia, los resultados en pacientes trasplantados o la ausencia de estudios comparativos con otros tratamientos. En este trabajo revisamos estos nuevos aspectos de la TFD.

Palabras clave:
Terapia fotodinámica
Metilaminolevulinato
El Texto completo está disponible en PDF
References
[1.]
R.M. Szeimies, S. Barrer, S. Radakovic-Fijan, A. Tanew, P.G. Calzavara-Pinton, C. Zane, et al.
Photodynamic therapy using topical methyl 5-aminolaevulinate compared with cryotherapy for for actinic keratosis: a prospective, randomized study.
J Am Acad Dermatol, 47 (2002), pp. 258-262
[2.]
M. Freeman, C. Vinciullo, D. Francis, et al.
A comparison of photodynamic therapy using topical methyl aminolaevulinate (Metvix®) with single cycle cryotherapy in patients with actinic keratosis: a prospective, randomized study.
J Dermatol Treat, 14 (2003), pp. 99-106
[3.]
D.M. Pariser, N.J. Lowe, D.M. Stewar, M.T. Jarratt, A.W. Lucky, R.J. Pariser, et al.
Photodynamic therapy with topical methyl aminolevulinate (Metvix®) is effective and safe in the treatment of actinic keratosis: results of a prospective randomized trial.
J Am Acad Dermatol, 48 (2003), pp. 227-232
[4.]
M. Tarstedt, I. Rosdahl, B. Berne, K. Svanberg, A.M. Wennberg.
A randomized multicenter study to compare two treatment regimens of topical methyl aminolevulinate (Metvix®) in actinic keratosis on the face and scalp.
Acta Derm Venereol, 85 (2005), pp. 424-428
[5.]
C. Morton, S. Campbell, G. Gupta, S. Keohane, J. Lear, I. Zaki, et al.
Intraindividual right-left comparison of topical methyl-aminolevulinate-photodynamic therapy (MAL-PDT) and cryotherapy in subject with actinic keratosis: a multicentre, randomized controlled study.
Br J Dermatol, 155 (2006), pp. 1029-1036
[6.]
J. Moan, L.W. Ma, A. Juzeniene.
Pharmacology of protoporphyrin IX in nude mice after application of ALA and ALA esters.
Int J Cancer, 103 (2003), pp. 132-135
[7.]
H. Bruijn, C. Meijers, A. van der Ploeg-van den Heuvel, H.J. Sterenborg, D.J. Robinson.
Microscopic localization of protoporphyrin IX in normal mouse skin after topical application of 5-aminolaevulinic acid or methyl-aminolaevulinic acid.
J Photochem Photobiol, 92 (2008), pp. 91-97
[8.]
F.J. Moloney, P. Collins.
Randomized, double blind, prospective study to compare topical 5-aminolaevulinic acid methylester with topical 5-aminolaevulinic acid photodynamic therapy for extensive scalp actinic keratosis.
Br J Dermatol, 157 (2007), pp. 87-91
[9.]
A. Kasche, S. Luderschmidt, J. Ring, R. Hein.
Photodynamic therapy induces less pain in patients treated with methylamino levulinate compared to aminolevulinic acid.
J Drugs Dermatol, 5 (2006), pp. 353-356
[10.]
Y. Gilaberte, C. Serra-Guillén, M.E. de las Heras, R. Ruiz-Rodríguez, M. Fernández-Lorente, C. Benvenuto-Andrade, et al.
Terapia fotodinámica en dermatología.
Actas Dermosifiliogr, 97 (2006), pp. 83-102
[11.]
M. Kalisiak, J. Rao.
Photodynamic therapy for actinic keratosis.
Dermatol Clin, 25 (2007), pp. 15-23
[12.]
A. Hauschild, G. Popp, E. Stockfleth.
Effective photodynamic therapy of actinic keratoses on the head and face with a novel, self-adhesive 5-aminolaevulinic acid patch.
Exp Dermatol, 18 (2009), pp. 116-121
[13.]
A. Hauschild, E. Stockfleth, G. Popp, F. Borrosch, H. Brüning, R. Dominicus, et al.
Optimization of photodynamic therapy with a novel self-adhesive 5-aminolaevulinic acid path: results of two randomized controlled phase II studies.
Br J Dermatol, 160 (2009), pp. 1066-1074
[14.]
Szeimies RM, Stokleft E, Popp G, Borrosh F. Long-term follow-up of photodynamic therapy with a self-adhesive 5-aminolaevulinic acid patch: 12 months data. Br J Dermatol 2009. In press.
[15.]
M. Alexiades-Armenakas.
Laser mediated photodynamic therapy.
[16.]
C. Clark, A. Bryden, R. Dawe, H. Moseley, J. Ferguson, S.H. Ibbotson.
Topical 5-aminolaevulinic acid photodynamic therapy for cutaneous lesions: outcome and comparison of light sources.
Photodermatol Photoimmunol Photomed, 19 (2003), pp. 134-141
[17.]
R.M. Szeimies, R.T. Matheson, A. Steven, A.C. Bhatia, Y. Frambach, W. Klövekorn, et al.
Topical methyl aminolevulinate photodynamic therapy using red light emitting diode light for multiple actinic keratosis.
Dermatol Surg, 35 (2009), pp. 586-592
[18.]
P. Babilas, R. Travnik, A. Werner, M. Landthaler, R.M. Szeimies.
Split-face study using two different light sources for topical PDT of actinic keratosis: non inferiority of the LED system.
J Dtch Dermatol Guest, 6 (2008), pp. 25-33
[19.]
A. Juzeniene, P. Juzenas, L.W. Ma.
Effectiveness of different light sources for 5-aminolaevulinic acid photodynamic therapy.
Lasers Med Sci, 19 (2004), pp. 139-149
[20.]
P. Babilas, R. Knobler, S. Hummel, C. Gottschaller, T. Maisch, M. Koller, et al.
Variable pulsed light is less painful than light emitting diodes for topical photodynamic therapy of actinic keratosis.
Br J Dermatol, 157 (2007), pp. 111-117
[21.]
R. Ruiz-Rodríguez, T. Sanz-Sánchez, S. Córdoba.
Photodynamic photorejuvenation.
Dermatol Surg, 28 (2002), pp. 742-744
[22.]
S.R. Wiegell, M. Haedersdal, P.A. Philipsen, P. Eriksen, C.D. Enk, H.C. Wulf.
Continuous activation of PpIX by daylight is as effective and less painful than conventional photodynamic therapy for actinic keratosis.
Br J Dermatol, 158 (2008), pp. 740-746
[23.]
S.R. Wiegell, M. Haedersdal, P. Eriksen, H.C. Wulf.
Photodynamic therapy of actinic keratosis with 8% and 16% methyl aminolaevulinate and home-based daylight exposure.
Br J Dermatol, 160 (2009), pp. 1308-1314
[24.]
H. Moseley, J.W. Allen, S. Ibbotson, A. Lesar, A. McNeill, M.A. Camacho-López, et al.
Ambulatory photodynamic therapy, a new concept in delivering photodynamic therapy.
Br J Dermatol, 154 (2006), pp. 747-750
[25.]
S.K. Attili, A. Lesar, A. Mc Neill, M. Camacho-López, H. Moseley, S. Ibbotson, et al.
An open pilot study of ambulatory photodynamic therapy using a wearable low-irradiance organic light-emitting diode light source in the treatment of nonmelanoma skin cancer.
Br J Dermatol, 161 (2009), pp. 170-173
[26.]
L. Braathen, B.E. Paredes, O. Sakleka, et al.
Short incubation with methyl aminolevulinate photodynamic therapy of actinic keratosis.
J Eur Acad Dermatol, 23 (2008), pp. 550-555
[27.]
R. Kaufmann, L. Spelman, W. Weightman, J. Reifenberger, R.M. Szeimies, E. Verhaeghe, et al.
Multicenter intraindividual randomized trial of topical methyl aminolevulinate-photodynamic therapy vs cryotherapy for multiple actinic keratosis on the extremities.
Br J Dermatol, 158 (2008), pp. 994-999
[28.]
M. Fernández-Guarino, A. Harto, M. Sánchez-Ronco, B. Pérez-García, A. Marquet, P. Jaén.
Estudio retrospectivo, descriptivo y observacional del tratamiento de múltiples queratosis actínicas con metilaminolevulínico y luz roja.
Actas Dermosifiliog, 99 (2008), pp. 779-787
[29.]
S. Smit, D. Piacquiadio, V. Morhenn, D. Atkin, R. Fitzpatrick.
Short incubation PDT versus 5-fluorouracil in treating actinic keratosis.
J Drugs Dermatol, 2 (2003), pp. 629-635
[30.]
C. Ferrándiz.
Update on actinic keratosis in clinical trial experience with imiquimod.
Br J Dermatol, 157 (2007), pp. 32-33
[31.]
D. Becker, J.M. Mac Gregor, B.R. Hushes.
Guidelines for the management of actinic keratosis.
Br J Dermatol, 156 (2007), pp. 222-230
[32.]
E. Stockfleth, H. Kerl.
Guidelines for the management of actinic keratosis: developed by the Guideline Subcommittee of the European Dermatology Forum.
Eur J Dermatol, 16 (2006), pp. 599-606
[33.]
E.P. Tierney, M.J. Eide, G. Jacobsen, D. Ozoq.
Photodynamic therapy for actinic keratoses: survey of patient perceptions of treatment satisfaction and outcomes.
J Cosmet Laser Ther, 10 (2008), pp. 81-83
[34.]
M. Huerta Brogeras, A. Romero Mate, O. Nieto Perea, J.M. Borbujo Martínez.
Complicaciones en la terapia fotodinámica.
Piel, 22 (2007), pp. 309-313
[35.]
C.M. Perrett, J.M. Mc Gregor, J. Warwick, P. Karran, I.M. Leigh, C.M. Proby, et al.
Treatment of post-transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy.
Br J Dermatol, 156 (2007), pp. 320-328
[36.]
S.R. Wiegell, M. Haedersdal, H.C. Wulf.
Cold water and pauses in illumination reduces pain during photodynamic therapy: a randomized clinical study.
Acta Derm Venereol, 89 (2009), pp. 145-149
[37.]
C. Serra-Guillén, L. Hueso, E. Nagore, M. Vila, B. Llombart, C. Requena Caballero, et al.
Comparative study between cold air analgesia and supraorbital and supratrochlear nerve block for the management of pain during photodynamic therapy for actinic keratoses of theof frontotemporal zone.
Br J Dermatol, 161 (2009), pp. 353-356
[38.]
C.B. Halldin, J. Paoli, C. Sandberg, H. Gozalez, A.M. Wennberg.
Nerve blocks enable adecuate pain relief during photodynamic therapy of field cancerization of the forehead and scalp.
Br J Dermatol, 160 (2009), pp. 795-800
[39.]
G. Dagrieva, B.M. Prinz, J. Hafner, R. Dummer, G. Burg, U. Binswnger, et al.
A randomized controlled trial of topical photodynamic therapy with methyl aminolaevulinate in the treatment of actinic keratoses in transplant recipients.
Br J Dermatol, 151 (2004), pp. 196-200
[40.]
S. Piaserico, A. Belloni Fortina, P. Rigotti, B. Rossi, N. Baldan, M. Alaibac, et al.
Topical photodynamic therapy of actinic keratosis in renal transplant recipients.
Transplant Proc, 39 (2007), pp. 1847-1850
[41.]
Y.G. De Graaf, C. Kennedy, R. Wolterbeek, A.F. Collen, R. Willemze, J.N. Bouwes Bavinck.
Photodynamic therapy does not prevent cutaneous squamous carcinoma in organ transplant recipients: results of a randomized controlled trial.
J Invest Dermatol, 126 (2006), pp. 569-574
[42.]
A.M. Wennberg, B. Stenquist, E. Stockfleth, S. Keohane, J.T. Lear, G. Jemec, et al.
Photodynamic therapy with methyl aminolevulinate for prevention of new skin lesions in transplant recipients.
Transplantation, 86 (2008), pp. 423-429
[43.]
D.P. Slaughter, H.W. Southwick, W. Smejkal.
Field cancerization in oral stratified squamous epithelium.
Cancer, 6 (1953), pp. 963-968
[44.]
M. Vatve, J.P. Ortonne, Birch-Marchin, G. Gupta.
Management of field change in actinic keratosis.
Br J Dermatol, 157 (2007), pp. 21-24
[45.]
M. Shaffelburg.
Treatment of actinic keratosis with sequential use of photodynamic therapy and imiquimod.
J Drugs Dermatol, 8 (2009), pp. 35-39
[46.]
M.B. Ericson, C. Sandberg, B. Stenquist, F. Gudmundson, M. Karlsson, A.M. Ros, et al.
Photodynamic therapy of actinic keratosis at varying fluence rates: assessment of photobleaching, pain and primary clinical outcome.
Br J Dermatol, 151 (2004), pp. 1204-1212
[47.]
M.W. Neidecker, M.L. Davis-Ajami, R. Balkrishnan, S.R. Feldman.
Pharmacoeconomics considerations in treating actinic keratosis.
Pharmacoeconomics, 27 (2009), pp. 451-464
[48.]
K. Caekelbergh, L. Annemans, J. Lambert, R. Roelandts.
Economic evaluation of methyl aminolaevulinic acid-based photodynamic therapy in the management of actinic keratosis and basal cell carcinoma.
Br J Dermatol, 155 (2006), pp. 784-790
[49.]
D. Muston, A. Downs, V. Rives.
An economic evaluation of topical treatments for actinic keratosis.
J Dermatol Treat, 1 (2009), pp. 1-10
Copyright © 2010. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?