Images in Clinical Rheumatology
Hyperkeratotic Lesions and Pruritus in an Immunosuppressed Patient
Lesiones hiperqueratósicas y prurito en paciente inmunodeprimida
Ana Varela-Veiga
, Alejandro Vilas-Sueiro, Benigno Monteagudo, Beatriz Fernández-Jorge
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain
Read
5244
Timeswas read the article
1892
Total PDF
3352
Total HTML
Share statistics
array:24 [ "pii" => "S2173574316000204" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.05.004" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "792" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:107-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 928 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 689 "PDF" => 190 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X15000789" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2015.05.004" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "792" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:107-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5061 "formatos" => array:3 [ "EPUB" => 174 "HTML" => 3956 "PDF" => 931 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Reumatología clínica en imágenes</span>" "titulo" => "Lesiones hiperqueratósicas y prurito en paciente inmunodeprimida" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "108" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hyperkeratotic lesions and pruritus in an immunosuppressed patient" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figuras 1-2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 850 "Ancho" => 1300 "Tamanyo" => 145934 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">1) Placas hiperqueratósicas y numerosas lesiones lineales distribuidas en tronco, con predominio en área facial y mamas. 2) Placas hiperqueratósicas y lesiones lineales en dorso de manos, predominando en pliegues interdigitales.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Varela-Veiga, Alejandro Vilas-Sueiro, Benigno Monteagudo, Beatriz Fernández-Jorge" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Varela-Veiga" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Vilas-Sueiro" ] 2 => array:2 [ "nombre" => "Benigno" "apellidos" => "Monteagudo" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Fernández-Jorge" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574316000204" "doi" => "10.1016/j.reumae.2015.05.004" "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/S2173574316000204?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000789?idApp=UINPBA00004M" "url" => "/1699258X/0000001200000002/v1_201603290234/S1699258X15000789/v1_201603290234/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574316000198" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.05.003" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "791" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2016;12:109-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1073 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 805 "PDF" => 222 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Pott's Disease: An Uncommon Cause of Thoracolumbar Pain Nowadays" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "109" "paginaFinal" => "111" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mal de Pott: una causa infrecuente de dolor dorsolumbar en nuestros días" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 654 "Ancho" => 975 "Tamanyo" => 371522 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presence of multiple granulomas formed by the accumulation of epithelioid histiocytes (arrow), surrounded by central caseous necrosis (star) (hematoxylin and eosin, 400×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marco Aurelio Ramírez Huaranga, Rocío Arenal López, Joaquín Anino Fernández, Natalia Villasanti Rivas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marco Aurelio" "apellidos" => "Ramírez Huaranga" ] 1 => array:2 [ "nombre" => "Rocío" "apellidos" => "Arenal López" ] 2 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Anino Fernández" ] 3 => array:2 [ "nombre" => "Natalia" "apellidos" => "Villasanti Rivas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X15000777" "doi" => "10.1016/j.reuma.2015.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000777?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316000198?idApp=UINPBA00004M" "url" => "/21735743/0000001200000002/v1_201604080059/S2173574316000198/v1_201604080059/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574316000162" "issn" => "21735743" "doi" => "10.1016/j.reumae.2015.03.018" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "773" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Reumatol Clin. 2016;12:103-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1197 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 750 "PDF" => 400 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "A Classic Mimicker of Systemic Vasculitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "103" "paginaFinal" => "106" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un simulador clásico de vasculitis sistémica" ] ] "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" => 741 "Ancho" => 1800 "Tamanyo" => 114632 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiogram with an apical view of 3 chambers showing a tumor in left atrium, in diastole (left) and in systole (right).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marc Moreno-Ariño, Vera Ortiz-Santamaria, Aída Deudero Infante, Montserrat Ayats Delgado, Francesc Novell Teixidó" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Marc" "apellidos" => "Moreno-Ariño" ] 1 => array:2 [ "nombre" => "Vera" "apellidos" => "Ortiz-Santamaria" ] 2 => array:2 [ "nombre" => "Aída" "apellidos" => "Deudero Infante" ] 3 => array:2 [ "nombre" => "Montserrat" "apellidos" => "Ayats Delgado" ] 4 => array:2 [ "nombre" => "Francesc" "apellidos" => "Novell Teixidó" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X15000534" "doi" => "10.1016/j.reuma.2015.03.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X15000534?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316000162?idApp=UINPBA00004M" "url" => "/21735743/0000001200000002/v1_201604080059/S2173574316000162/v1_201604080059/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Hyperkeratotic Lesions and Pruritus in an Immunosuppressed Patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "108" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Varela-Veiga, Alejandro Vilas-Sueiro, Benigno Monteagudo, Beatriz Fernández-Jorge" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Varela-Veiga" "email" => array:1 [ 0 => "ana.varela.veiga@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Vilas-Sueiro" ] 2 => array:2 [ "nombre" => "Benigno" "apellidos" => "Monteagudo" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Fernández-Jorge" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones hiperqueratósicas y prurito en paciente inmunodeprimida" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figs. 4 and 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4v5.jpeg" "Alto" => 1247 "Ancho" => 977 "Tamanyo" => 211790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(4) Image from the histological study under direct vision (at 400×) showing a mite (arrows) and feces. (5) Histological study under direct vision (at 400×) showing eggs (arrows) and feces.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Scabies is a parasitosis caused by <span class="elsevierStyleItalic">Sarcoptes scabiei</span> var. <span class="elsevierStyleItalic">hominis</span>; Norwegian scabies is a rare, highly contagious subtype that is common in immunosuppressed patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an 82-year-old woman with a history of hypertension, insulin-dependent diabetes mellitus and polymyalgia rheumatica, being treated with oral corticosteroids. She was referred to the dermatology department with a 9-month history of generalized pruritus, accompanied by hyperkeratotic plaques and numerous lesions in the form of linear burrows, predominantly on her scalp and breasts and in the interdigital spaces of both hands.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> She had applied topical corticosteroids, which had had a negative effect on her clinical status.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> It was also interesting to know that individuals with whom she lived were also affected (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The suspected diagnosis was reached on the basis of the clinical signs and the results of dermatoscopic examination. The microscopic study of skin scales disclosed the presence of mites and their feces and eggs, and the diagnosis was confirmed. It important to include diseases such as ichthyosis and psoriasis in the differential diagnosis (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 3–5</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment is based on oral ivermectin, 5% salicylate vaseline in hyperkeratotic lesions and, in certain lesions, surgical debridement to facilitate the penetration of the topical treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As a result of her comorbidities, the patient died of a respiratory tract infection before treatment for scabies could be initiated.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">When a patient receiving immunosuppressive therapy has generalized pruritus—predominantly at night—with crusted lesions,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> and the individuals with whom the patient lives are affected, it is essential to perform a differential diagnosis that includes Norwegian scabies, which occurs relatively frequently in these individuals. Moreover, the incidence is rising as a consequence of the increasingly widespread use of immunosuppressive agents.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical Disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of human and animal subjects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Confidentiality of data</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 4 => array:2 [ "identificador" => "xack211244" "titulo" => "Acknowledgments" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-22" "fechaAceptado" => "2015-05-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Varela-Veiga A, Vilas-Sueiro A, Monteagudo B, Fernández-Jorge B. Lesiones hiperqueratósicas y prurito en paciente inmunodeprimida. Reumatol Clin. 2016;12:107–108.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figs. 1 and 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1v2.jpeg" "Alto" => 654 "Ancho" => 1000 "Tamanyo" => 108051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(1) Hyperkeratotic plaques and numerous linear burrow tracks distributed on the patient's trunk, predominantly in the facial area and on her breasts. (2) Hyperkeratotic plaques and linear burrows on the back of the hands, predominantly in the interdigital spaces.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 661 "Ancho" => 974 "Tamanyo" => 51199 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic image showing brownish structures, in the form of a “hang glider” at the end of the burrows (arrows).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figs. 4 and 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4v5.jpeg" "Alto" => 1247 "Ancho" => 977 "Tamanyo" => 211790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(4) Image from the histological study under direct vision (at 400×) showing a mite (arrows) and feces. (5) Histological study under direct vision (at 400×) showing eggs (arrows) and feces.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crusted scabies in two old-age home residents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.Y. Chan" 1 => "W.Y. Tang" 2 => "H.H. Ho" 3 => "K.K. Lo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hong Kong Med J" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "428" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11177168" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crusted (Norwegian) scabies following systemic and topical corticosteroid therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Binic" 1 => "A. Jankovic" 2 => "D. Jovanovic" 3 => "M. Liubenovic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3346/jkms.2010.25.1.188" "Revista" => array:6 [ "tituloSerie" => "J Korean Med Sci" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "188" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20052371" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Norwegian crusted scabies: an unusual case presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Maghrabi" 1 => "S. Lum" 2 => "A.T. Joba" 3 => "M.J. Meier" 4 => "R.J. Holmbeck" 5 => "K. Kennedy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jfas.2013.09.002" "Revista" => array:6 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2014" "volumen" => "53" "paginaInicial" => "62" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24370484" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack211244" "titulo" => "Acknowledgments" "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">The authors thank Juan Carlos Álvarez of the Pathology Department of Complejo Hospitalario Universitario de Ferrol. Ferrol Health Area, SERGAS, Ferrol, A Coruña, Spain.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000002/v1_201604080059/S2173574316000204/v1_201604080059/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000002/v1_201604080059/S2173574316000204/v1_201604080059/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316000204?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 14 | 19 |
| 2024 October | 36 | 19 | 55 |
| 2024 September | 46 | 16 | 62 |
| 2024 August | 47 | 28 | 75 |
| 2024 July | 49 | 33 | 82 |
| 2024 June | 56 | 22 | 78 |
| 2024 May | 68 | 51 | 119 |
| 2024 April | 71 | 14 | 85 |
| 2024 March | 73 | 32 | 105 |
| 2024 February | 36 | 34 | 70 |
| 2024 January | 53 | 17 | 70 |
| 2023 December | 60 | 26 | 86 |
| 2023 November | 45 | 33 | 78 |
| 2023 October | 40 | 24 | 64 |
| 2023 September | 69 | 36 | 105 |
| 2023 August | 45 | 11 | 56 |
| 2023 July | 75 | 28 | 103 |
| 2023 June | 62 | 23 | 85 |
| 2023 May | 46 | 21 | 67 |
| 2023 April | 36 | 6 | 42 |
| 2023 March | 65 | 31 | 96 |
| 2023 February | 47 | 30 | 77 |
| 2023 January | 49 | 21 | 70 |
| 2022 December | 55 | 25 | 80 |
| 2022 November | 63 | 34 | 97 |
| 2022 October | 73 | 32 | 105 |
| 2022 September | 51 | 33 | 84 |
| 2022 August | 41 | 44 | 85 |
| 2022 July | 43 | 38 | 81 |
| 2022 June | 42 | 39 | 81 |
| 2022 May | 42 | 40 | 82 |
| 2022 April | 65 | 45 | 110 |
| 2022 March | 48 | 56 | 104 |
| 2022 February | 47 | 24 | 71 |
| 2022 January | 62 | 31 | 93 |
| 2021 December | 31 | 46 | 77 |
| 2021 November | 40 | 51 | 91 |
| 2021 October | 60 | 56 | 116 |
| 2021 September | 54 | 47 | 101 |
| 2021 August | 58 | 40 | 98 |
| 2021 July | 39 | 33 | 72 |
| 2021 June | 42 | 21 | 63 |
| 2021 May | 54 | 60 | 114 |
| 2021 April | 101 | 105 | 206 |
| 2021 March | 52 | 19 | 71 |
| 2021 February | 39 | 23 | 62 |
| 2021 January | 33 | 25 | 58 |
| 2020 December | 37 | 16 | 53 |
| 2020 November | 27 | 27 | 54 |
| 2020 October | 21 | 17 | 38 |
| 2020 September | 38 | 22 | 60 |
| 2020 August | 23 | 14 | 37 |
| 2020 July | 29 | 11 | 40 |
| 2020 June | 30 | 19 | 49 |
| 2020 May | 13 | 14 | 27 |
| 2020 April | 17 | 18 | 35 |
| 2020 March | 13 | 7 | 20 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 29 | 10 | 39 |
| 2018 March | 47 | 7 | 54 |
| 2018 February | 37 | 2 | 39 |
| 2018 January | 17 | 4 | 21 |
| 2017 December | 36 | 6 | 42 |
| 2017 November | 18 | 3 | 21 |
| 2017 October | 25 | 8 | 33 |
| 2017 September | 24 | 5 | 29 |
| 2017 August | 26 | 8 | 34 |
| 2017 July | 29 | 8 | 37 |
| 2017 June | 38 | 11 | 49 |
| 2017 May | 35 | 12 | 47 |
| 2017 April | 28 | 7 | 35 |
| 2017 March | 22 | 6 | 28 |
| 2017 February | 17 | 6 | 23 |
| 2017 January | 18 | 9 | 27 |
| 2016 December | 51 | 14 | 65 |
| 2016 November | 39 | 14 | 53 |
| 2016 October | 40 | 10 | 50 |
| 2016 September | 50 | 7 | 57 |
| 2016 August | 32 | 3 | 35 |
| 2016 July | 25 | 10 | 35 |
| 2016 April | 3 | 20 | 23 |
Show all
