Case report
Nodular (keloidal) scleroderma
Esclerodermia nodular (queloidea)
Leído
1340
Vecesse ha leído el artículo
262
Total PDF
1078
Total HTML
Compartir estadísticas
array:22 [ "pii" => "S1699258X23001018" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2023.02.009" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "1686" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2023;19:463-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:18 [ "pii" => "S2173574323001077" "issn" => "21735743" "doi" => "10.1016/j.reumae.2023.02.009" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "1686" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2023;19:463-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Nodular (keloidal) scleroderma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "463" "paginaFinal" => "464" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esclerodermia nodular (queloidea)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1026 "Ancho" => 2507 "Tamanyo" => 316575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple firm hyperpigmented nodules on the chest (a) of a 27-year-old woman (b) Proliferation of myofibroblasts and haphazardly arranged thick hyalinized collagen bundles (H&E ×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natalia Gabriela Sanchez, Natalia Rebollo Domínguez, Eduwiges Martínez Luna, Pablo Villaseñor Ovies" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Natalia Gabriela" "apellidos" => "Sanchez" ] 1 => array:2 [ "nombre" => "Natalia" "apellidos" => "Rebollo Domínguez" ] 2 => array:2 [ "nombre" => "Eduwiges" "apellidos" => "Martínez Luna" ] 3 => array:2 [ "nombre" => "Pablo" "apellidos" => "Villaseñor Ovies" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1699258X23001018" "doi" => "10.1016/j.reuma.2023.02.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X23001018?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574323001077?idApp=UINPBA00004M" "url" => "/21735743/0000001900000008/v3_202311021029/S2173574323001077/v3_202311021029/en/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S1699258X22002881" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2022.12.006" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "1669" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Reumatol Clin. 2023;19:455-62" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Utilidad del ultrasonido para el diagnóstico de enfermedad pulmonar intersticial en enfermedades difusas del tejido conectivo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "455" "paginaFinal" => "462" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ultrasound for diagnosis of interstitial lung disease in diffuse connective tissue diseases" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1320 "Ancho" => 2500 "Tamanyo" => 233241 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imagen de ultrasonido normal realizado en paciente sano, obtenida con equipo GE Logiq 3 con transductor lineal multifrecuencia de 10-14<span class="elsevierStyleHsp" style=""></span>MHz, en el tercer espacio intercostal derecho, con paciente en posición decúbito supino y transductor en orientación longitudinal. A) Imagen original. B) Resaltado en amarillo piel y tejido celular subcutáneo; en rojo, capas miofasciales; en verde, costillas y la sombra acústica qgenran; en morado, línea pleural, y en azul, líneas A.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bruno Alexander Velazquez Guevara, Carlos Abud Mendoza, Lesly Rocío de Jesús Avilés Ramírez, Eva Santillán Guerrero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Bruno Alexander" "apellidos" => "Velazquez Guevara" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Abud Mendoza" ] 2 => array:2 [ "nombre" => "Lesly Rocío de Jesús" "apellidos" => "Avilés Ramírez" ] 3 => array:2 [ "nombre" => "Eva" "apellidos" => "Santillán Guerrero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574323000874" "doi" => "10.1016/j.reumae.2022.12.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574323000874?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X22002881?idApp=UINPBA00004M" "url" => "/1699258X/0000001900000008/v1_202309210609/S1699258X22002881/v1_202309210609/es/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Nodular (keloidal) scleroderma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "463" "paginaFinal" => "464" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Natalia Gabriela Sanchez, Natalia Rebollo Domínguez, Eduwiges Martínez Luna, Pablo Villaseñor Ovies" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Natalia Gabriela" "apellidos" => "Sanchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Natalia" "apellidos" => "Rebollo Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Eduwiges" "apellidos" => "Martínez Luna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "Pablo" "apellidos" => "Villaseñor Ovies" "email" => array:1 [ 0 => "pablovo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Digital Pathology Laboratory, Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Angeles Tijuana, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clínica Dermamedics, Morelia, Michoacán, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital General de Tijuana, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esclerodermia nodular (queloidea)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 634 "Ancho" => 1555 "Tamanyo" => 163320 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple firm hyperpigmented nodules on the chest (a) of a 27-year-old woman (b) Proliferation of myofibroblasts and haphazardly arranged thick hyalinized collagen bundles (H&E ×100).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">LS is a chronic autoimmune disease characterized by single or multiple sclerotic plaques in the skin and subjacent tissues. It is distinct from SSc, an autoimmune disease in which diffuse cutaneous sclerosis is accompanied by systemic manifestations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the classification proposed by Kreuter and upheld by the European Dermatology Society, LS has five phenotypic variants: plaque, generalized, bullous, linear, and deep.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> NS is a rare variant characterized by sclerotic lesions that rise above the surrounding skin.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe a 27-year-old female with a history of limited cutaneous systemic sclerosis (lcSSc) presenting with multiple keloidal nodules.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 27-year-old Hispanic female with a medical history of lcSSc presented for the evaluation of multiple hyperpigmented nodules in her skin. She was diagnosed with lcSSc five years earlier after developing sclerodactyly, Raynaud's phenomenon, esophageal dysmotility, and positive anti-centromere antibodies. Shortly after, she developed multiple asymptomatic nodules on her thorax, slowly increasing in size and number. There was no history of trauma or surgery in any affected site and no personal or family history of keloid formation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Physical examinations revealed classic findings of lcSSc: sclerodactyly, telangiectasias, fingertip scars, and characteristic facies. Additionally, she presented multiple (25–30), non-tender, firm, hyperpigmented, well-circumscribed nodules scattered on the chest and back; the largest lesion was 4.5<span class="elsevierStyleHsp" style=""></span>cm in diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Some nodules appeared within areas of sclerotic skin changes, and others in normal skin.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">An excisional biopsy of a nodule in the back revealed dermal fibrosis with haphazardly arranged thickened and compact collagen bundles with loss of interfibrillar space, sclerotic appearance, and loss of adnexal structures. These findings confirmed the diagnosis of NS.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">In 1854, Addison first described firm, nodular elevations in sclerodermatous skin.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Over the next century, this entity received different names: “keloid-like scleroderma”, “tuberous morphea”, and “fibromes miliares folliculaires, sclérodermie consécutve”. In 1960 Cabré and Landes concluded that flat nodules and keloid-like plaques were part of the same spectrum and rendered the terms nodular and keloidal scleroderma interchangeable.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are only a few cases of NS published to date,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> and like this case, most occur in individuals with a diagnosis of lcSSc. In clinical practice, the association of LS with lcSSc is an unusual observation, and the idea that the first may progress to the latter has been abandoned.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Soma et al. observed LS in 9 out of 135 patients with lcSSc and found that male gender and a negative antinuclear antibody, two very unusual features in lcSSc, were significantly correlated with this association.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Some authors have argued that cases of concurrent LS and lcSSc and patients that report progression may be lcSSc mistakenly identified as LS or vice versa.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Hence, it is remarkable that most cases of NS, a condition considered a rare form of LS, have been described in patients with lcSSc.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The spectrum of histopathologic findings in NS comprises 1. Keloid (hyalinized collagen bundles), 2. Scleroderma (dermal horizontal sclerotic bands), and 3. Mixed findings,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> such as this case. The main differential diagnoses include keloid/hypertrophic scar, storiform collagenoma, sclerotic dermatofibroma, sclerosing perineuroma, and keloidal fibroxanthoma.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A few anecdotal reports have informed lack of success with <span class="elsevierStyleSmallCaps">d</span>-penicillamine, corticosteroids, methotrexate, and triamcinolone in NS. Our patient denied all treatment options and was further lost to follow-up.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0060" class="elsevierStylePara elsevierViewall">NS can be a diagnostic challenge due to its rarity, unknown pathogenesis, and similar differential diagnoses. It must be suspected when a firm nodule resembling a keloid is encountered in patients with no known risk factors for keloid formation or in patients with lcSSc. The association of NS and lcSSc is rare but well-described and must therefore be recognized by rheumatologists. The current knowledge of its pathogenesis and treatment options is limited.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Source of funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1971967" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1696591" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1971968" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1696590" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Source of funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-18" "fechaAceptado" => "2023-02-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1696591" "palabras" => array:4 [ 0 => "Keloidal scleroderma" 1 => "Nodular scleroderma" 2 => "Systemic sclerosis" 3 => "Scleroderma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1696590" "palabras" => array:4 [ 0 => "Esclerodermia queloidea" 1 => "Esclerodermia nodular" 2 => "Esclerosis sistémica" 3 => "Esclerodermia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Keloidal or nodular scleroderma (NS) is a variant of localized scleroderma (LS) frequently seen in patients with limited or diffuse systemic sclerosis (SSc). It presents as raised, firm plaques or nodules with extensive dermal fibrosis and hyalinized collagen bundles. We present a patient with SSc who presented with this rare entity.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La esclerodermia nodular o queloidea es una variante de esclerodermia localizada que se encuentra predominantemente en pacientes con esclerosis sistémica limitada o difusa (SSc). La presentación clínica es de placas o nódulos firmes y sobreelevados con fibrosis dérmica y haces de colágeno hialinizados. En este reporte de caso presentamos a una paciente con SSc con esta entidad rara.</p></span>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 634 "Ancho" => 1555 "Tamanyo" => 163320 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Multiple firm hyperpigmented nodules on the chest (a) of a 27-year-old woman (b) Proliferation of myofibroblasts and haphazardly arranged thick hyalinized collagen bundles (H&E ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Controversy around the morphea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Dańczak-Pazdrowska" 1 => "P. Cieplewicz" 2 => "R. Żaba" 3 => "Z. Adamski" 4 => "A. Polańska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5114/ADA.2021.106242" "Revista" => array:5 [ "tituloSerie" => "Postepy Dermatol Alergol" "fecha" => "2021" "volumen" => "38" "paginaInicial" => "716" "paginaFinal" => "720" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AWMF-leitlinie Nr 013/066 diagnostik und therapie der zirkumskripten sklerodermie" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kreuter" 1 => "T. Krieg" 2 => "M. Worm" 3 => "J. Wenzel" 4 => "T. Gambichler" 5 => "A. Kuhn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/J.1610-0387.2009.07178_SUPP.X" "Revista" => array:5 [ "tituloSerie" => "JDDG" "fecha" => "2009" "volumen" => "7" "paginaInicial" => "S1" "paginaFinal" => "S14" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin. Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Knobler" 1 => "P. Moinzadeh" 2 => "N. Hunzelmann" 3 => "A. Kreuter" 4 => "A. Cozzio" 5 => "L. Mouthon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/JDV.14466" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2017" "volumen" => "31" "paginaInicial" => "1581" "paginaFinal" => "1594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28786499" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "On the keloid of alibert, and on true keloid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Addison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/095952875403700106" "Revista" => array:5 [ "tituloSerie" => "Med Chir Trans" "fecha" => "1854" "volumen" => "37" "paginaInicial" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20896031" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ein beitrag zur nodulären sklerodermie (keloidähnliche sklerodermie unna)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.J. Cabré" 1 => "E. Landes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Z Hautkr" "fecha" => "1960" "volumen" => "28" "paginaInicial" => "359" "paginaFinal" => "364" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of the clinically distinguishing features of nodular or keloidal scleroderma in systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.A. Richarz" 1 => "A. Olivé" 2 => "V. García-Patos" 3 => "B. Quirant" 4 => "M.T. Fernández Figueras" 5 => "I. Bielsa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/AJD.13239" "Revista" => array:5 [ "tituloSerie" => "Aust J Dermatol" "fecha" => "2020" "volumen" => "61" "paginaInicial" => "e269" "paginaFinal" => "e273" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nodular scleroderma presenting as multiple spontaneous keloidal scars" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.R. Heath" 1 => "J.N. David" 2 => "S.C. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.JAAD.201106031" "Revista" => array:3 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "paginaInicial" => "66" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognosis of localized scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Curtis" 1 => "T.G. Jansen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/ARCHDERM.1958.01560120069011" "Revista" => array:6 [ "tituloSerie" => "AMA Arch Derm" "fecha" => "1958" "volumen" => "78" "paginaInicial" => "749" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13593870" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coexistence of morphea and systemic sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Soma" 1 => "T. Tamaki" 2 => "K. Kikuchi" 3 => "M. Abe" 4 => "A. Igarashi" 5 => "K. Takehara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000247317" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "1993" "volumen" => "186" "paginaInicial" => "103" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8428037" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and treatment of scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.M. Wigley" 1 => "F. Boin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "edicion" => "11th ed." "titulo" => "Firestein & Kelley's Textbook of Rheumatology" "fecha" => "2021" "paginaInicial" => "1499" "paginaFinal" => "1538" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/1699258X/0000001900000008/v1_202309210609/S1699258X23001018/v1_202309210609/en/main.assets" "Apartado" => array:4 [ "identificador" => "46460" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Caso clínico" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/1699258X/0000001900000008/v1_202309210609/S1699258X23001018/v1_202309210609/en/main.pdf?idApp=UINPBA00004M&text.app=https://www.reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X23001018?idApp=UINPBA00004M" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 86 | 28 | 114 |
| 2024 Septiembre | 172 | 27 | 199 |
| 2024 Agosto | 199 | 42 | 241 |
| 2024 Julio | 161 | 36 | 197 |
| 2024 Junio | 160 | 39 | 199 |
| 2024 Mayo | 129 | 39 | 168 |
| 2024 Abril | 149 | 42 | 191 |
| 2024 Marzo | 7 | 5 | 12 |
| 2023 Diciembre | 1 | 0 | 1 |
| 2023 Noviembre | 2 | 2 | 4 |
| 2023 Octubre | 3 | 0 | 3 |
| 2023 Septiembre | 5 | 2 | 7 |
| 2023 Agosto | 4 | 0 | 4 |
Mostrar todo
