Case Letter
Cyclosporine-induced childhood generalized hypertrichosis
Karilena Fernandes Souza
, Paulo Fernando Barbosa de Camargo Andrade, Flávia de Freire Cassia, Maria Cristina Ribeiro de Castro
Corresponding author
Department of Dermatology, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brazil
Read
7866
Timeswas read the article
2961
Total PDF
4905
Total HTML
Share statistics
array:24 [ "pii" => "S0365059620300696" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.08.027" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "158" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:19 [ "pii" => "S2666275220301399" "issn" => "26662752" "doi" => "10.1016/j.abdp.2019.08.006" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "158" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta – Caso clínico</span>" "titulo" => "Hipertricose generalizada infantil induzida por ciclosporina" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "403" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 905 "Tamanyo" => 90139 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Crescimento difuso de pelos terminais espessos no membro superior e abdômen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Karilena Fernandes Souza, Paulo Fernando Barbosa de Camargo Andrade, Flávia de Freire Cassia, Maria Cristina Ribeiro de Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Karilena Fernandes" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Paulo Fernando Barbosa de Camargo" "apellidos" => "Andrade" ] 2 => array:2 [ "nombre" => "Flávia de Freire" "apellidos" => "Cassia" ] 3 => array:2 [ "nombre" => "Maria Cristina Ribeiro de" "apellidos" => "Castro" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059620300696" "doi" => "10.1016/j.abd.2019.08.027" "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/S0365059620300696?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301399?idApp=UINPBA00008Z" "url" => "/26662752/0000009500000003/v1_202006250813/S2666275220301399/v1_202006250813/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059620300714" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.11.002" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "160" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Primary melanoma of leptomeninge in a patient with giant congenital melanocytic nevus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "404" "paginaFinal" => "406" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2141 "Ancho" => 1417 "Tamanyo" => 259547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Giant congenital melanocytic nevus in garment with multiple satellite lesions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adriana Kamilly Leitão Pitman Machado, Débora Bacellar Cruz Nunes, Francisca Regina Oliveira Carneiro, Alena Margareth Darwich Mendes" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Adriana Kamilly Leitão Pitman" "apellidos" => "Machado" ] 1 => array:2 [ "nombre" => "Débora Bacellar Cruz" "apellidos" => "Nunes" ] 2 => array:2 [ "nombre" => "Francisca Regina Oliveira" "apellidos" => "Carneiro" ] 3 => array:2 [ "nombre" => "Alena Margareth Darwich" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301417" "doi" => "10.1016/j.abdp.2019.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301417?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300714?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300714/v4_202007210853/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059620300775" "issn" => "03650596" "doi" => "10.1016/j.abd.2019.07.011" "estado" => "S300" "fechaPublicacion" => "2020-05-01" "aid" => "166" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Herpes zoster incognito: an immunohistochemical diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "401" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1088 "Ancho" => 1500 "Tamanyo" => 310115 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Inflammatory infiltrate surrounding follicular epithelium and sebaceous gland. Initial bullous detachment at the dermo-epidermal junction (Hematoxylin & eosin, ×40). B, The primary involvement of the skin is on the sebaceous epithelium, as shown by immunohistochemistry specific for varicella zoster virus (Hematoxylin & eosin, ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gianluca Nazzaro, Stefano Veraldi" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gianluca" "apellidos" => "Nazzaro" ] 1 => array:2 [ "nombre" => "Stefano" "apellidos" => "Veraldi" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275220301478" "doi" => "10.1016/j.abdp.2019.07.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275220301478?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300775?idApp=UINPBA00008Z" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300775/v4_202007210853/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Cyclosporine-induced childhood generalized hypertrichosis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "403" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Karilena Fernandes Souza, Paulo Fernando Barbosa de Camargo Andrade, Flávia de Freire Cassia, Maria Cristina Ribeiro de Castro" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Karilena Fernandes" "apellidos" => "Souza" "email" => array:1 [ 0 => "fs.kari@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Paulo Fernando Barbosa de Camargo" "apellidos" => "Andrade" ] 2 => array:2 [ "nombre" => "Flávia de Freire" "apellidos" => "Cassia" ] 3 => array:2 [ "nombre" => "Maria Cristina Ribeiro de" "apellidos" => "Castro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 905 "Tamanyo" => 90139 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Diffuse growth of thick terminal hairs on upper limb and abdomen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypertrichosis is defined as disproportionate hair growth in body areas with no action of androgen hormones and shows no effects of race, age, and gender.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> According to the disease onset age, it can be classified as congenital or acquired, and to the extension, as localized or generalized. Among the causes of acquired generalized hypertrichosis is the use of certain drugs, and the most frequently involved agents are phenytoin, cyclosporin, and minoxidil. Unlike hirsutism, hypertrichosis in prepubertal children is not related to underlying endocrinopathies, with the main triggering factor being adverse effects of medications.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This case report highlights this association, illustrating an exuberant clinical presentation related to the use of Cyclosporin A (CsA).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 6-year-old white female patient with a history of nephrotic syndrome for five years was using CsA because she had shown no improvement to corticosteroid therapy alone. There was a recent worsening of proteinuria, so pediatric nephrology decided to increase the dosage of CsA to 5<span class="elsevierStyleHsp" style=""></span>mg/kg/day. Three months later, the child developed a diffuse increase of terminal hairs on the face, trunk, limbs (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) and trichomegaly (excessive growth of eyelashes) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), and was referred to the dermatology department.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The hormonal profile did not show abnormalities. Abdomen ultrasonography exam was also normal and the hirsutism hypothesis was discarded clinically and by laboratorial analysis. There were no ocular or oral cavity changes and the child's neuropsychomotor development was normal. However, the serum level of CsA was increased (467<span class="elsevierStyleHsp" style=""></span>ng/mL; Reference value: 150–300<span class="elsevierStyleHsp" style=""></span>ng/mL). These findings allowed the diagnosis for acquired generalized hypertrichosis related to Cyclosporin A. The proposed therapeutic measures included a reduction in daily medication dosage and temporary chemical epilation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cyclosporin is an immunosuppressive, calcineurin inhibitor whose mechanism of action is to selectively inhibit the function of the helper T lymphocytes (CD4+), consequently blocking the production of interleukins, especially IL-2.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It is widely used in dermatology, including the treatment of psoriasis and atopic dermatitis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and in other specialties, such as steroid-resistant nephrotic syndrome. Among the main adverse effects of dermatological interest are hypertrichosis, gingival hyperplasia, increased incidence of cutaneous neoplasia and infections.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathogenesis of cyclosporin-induced hypertrichosis is not well established, but the literature describes that it is a dose-dependent side effect most commonly observed in children within the first six months of medication.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Our patient had used CsA for a long time but developed generalized hypertrichosis specifically when a significant increase in cyclosporinemia was identified.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Xu et al. defend that CsA induces the anagen phase and inhibits the catagenic phase of the hair follicle and have demonstrated in animal models that the drug stimulates hair growth by promoting matrix cells proliferation, in addition to increasing the expression of growth factors such as Vascular Endothelial Growth Factor (VEGF).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> On the other hand, Ponticelli et al. attribute this adverse reaction to a possible induction in the alpha-reductase enzyme activity increase, responsible for the conversion of androgens to dihydrotestosterone in tissues.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Other changes in the pilosebaceous unit such as sebaceous hyperplasia, keratosis pilaris, and acne are described and probably result from the elimination of the drug by the sebaceous glands because it is a lipophilic medication.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, the patient did not present cutaneous manifestations besides the exuberant hypertrichosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Drug-induced hypertrichosis is reversible with the suspension of the drug and may take from months to years to complete resolution, depending on the hair cycle of the affected area (face: about three months, arms about one year).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Regarding this case, neuropediatrics chose to reduce the dosage of the drug until normalization of the serum level of cyclosporine was achieved, resulting in improvement of the skin changes, but we preferred to associate temporary chemical epilation until complete resolution of the dermatological changes since the child was suffering from bullying because of her appearance.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In renal transplant or nephropathic patients tacrolimus can be substituted for CsA, since both act similarly and tacrolimus causes fewer cutaneous abnormalities and does not trigger gingival hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The reported case illustrates exuberant cyclosporin-induced hypertrichosis that, despite being a well-documented adverse effect, is poorly observed by dermatologists.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Karilena Fernandes Souza: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Paulo Fernando Barbosa de Camargo Andrade: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Flávia de Freire Cassia: Approval of the final version of the manuscript; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Maria Cristina Ribeiro de Castro: Approval of the final version of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:2 [ "identificador" => "xack473885" "titulo" => "Acknowledgment" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-22" "fechaAceptado" => "2019-08-20" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Souza KF, Andrade PFBC, Cassia FF, Castro MCR. Cyclosporine-induced childhood generalized hypertrichosis. An Bras Dermatol. 2020;95:403–5.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1052 "Ancho" => 905 "Tamanyo" => 101192 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis on the back and upper limbs.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 905 "Tamanyo" => 90139 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Diffuse growth of thick terminal hairs on upper limb and abdomen.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 483 "Ancho" => 905 "Tamanyo" => 58939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ciliary hypertrichosis (trichomegaly).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes and manegement of hypertrichosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.M. Trüeb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00128071-200203090-00004" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2002" "volumen" => "3" "paginaInicial" => "617" "paginaFinal" => "627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12444804" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary generalizad and localized hypertrichosis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.A. Vashi" 1 => "A.J. Mancini" 2 => "A.S. Paller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2001" "volumen" => "137" "paginaInicial" => "877" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11453806" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cyclosporine – a eye drop-induced elongated eyelashes: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.L. Lei" 1 => "W.C. Ku" 2 => "M.H. Sun" 3 => "K.J. Chen" 4 => "J.Y. Lai" 5 => "C.C. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000335281" "Revista" => array:6 [ "tituloSerie" => "Case Rep Ophthalmol" "fecha" => "2011" "volumen" => "2" "paginaInicial" => "398" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22291642" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cyclosporine A stimulated hair growth from mouse vibrissae follicles in an organ culture model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "W. Xu" 1 => "W. Fan" 2 => "K. Yao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7555/JBR.26.20110067" "Revista" => array:6 [ "tituloSerie" => "J Biomed Res" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "372" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23554774" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonneoplastic mucocutaneous lesions in organ transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Ponticelli" 1 => "P.L. Bencini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1432-2277.2011.01308.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "1041" "paginaFinal" => "1050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21806688" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack473885" "titulo" => "Acknowledgment" "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">To Dr. Marcela Gomes Pinheiro, for referring the patient to the department of dermatology and kindly assisting in the management and resolution of the case.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000003/v4_202007210853/S0365059620300696/v4_202007210853/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000003/v4_202007210853/S0365059620300696/v4_202007210853/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620300696?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 10 | 35 |
| 2024 October | 117 | 52 | 169 |
| 2024 September | 168 | 101 | 269 |
| 2024 August | 192 | 99 | 291 |
| 2024 July | 154 | 112 | 266 |
| 2024 June | 137 | 90 | 227 |
| 2024 May | 135 | 72 | 207 |
| 2024 April | 116 | 89 | 205 |
| 2024 March | 121 | 68 | 189 |
| 2024 February | 116 | 68 | 184 |
| 2024 January | 92 | 53 | 145 |
| 2023 December | 104 | 47 | 151 |
| 2023 November | 116 | 72 | 188 |
| 2023 October | 136 | 100 | 236 |
| 2023 September | 119 | 80 | 199 |
| 2023 August | 81 | 35 | 116 |
| 2023 July | 95 | 58 | 153 |
| 2023 June | 112 | 70 | 182 |
| 2023 May | 71 | 31 | 102 |
| 2023 April | 115 | 30 | 145 |
| 2023 March | 110 | 51 | 161 |
| 2023 February | 105 | 43 | 148 |
| 2023 January | 79 | 48 | 127 |
| 2022 December | 101 | 24 | 125 |
| 2022 November | 111 | 60 | 171 |
| 2022 October | 154 | 56 | 210 |
| 2022 September | 103 | 65 | 168 |
| 2022 August | 96 | 58 | 154 |
| 2022 July | 79 | 51 | 130 |
| 2022 June | 103 | 53 | 156 |
| 2022 May | 82 | 51 | 133 |
| 2022 April | 83 | 46 | 129 |
| 2022 March | 109 | 72 | 181 |
| 2022 February | 89 | 31 | 120 |
| 2022 January | 91 | 76 | 167 |
| 2021 December | 56 | 57 | 113 |
| 2021 November | 80 | 51 | 131 |
| 2021 October | 96 | 77 | 173 |
| 2021 September | 63 | 47 | 110 |
| 2021 August | 122 | 64 | 186 |
| 2021 July | 74 | 45 | 119 |
| 2021 June | 45 | 47 | 92 |
| 2021 May | 56 | 76 | 132 |
| 2021 April | 97 | 176 | 273 |
| 2021 March | 64 | 67 | 131 |
| 2021 February | 47 | 16 | 63 |
| 2021 January | 44 | 17 | 61 |
| 2020 December | 49 | 14 | 63 |
| 2020 November | 50 | 15 | 65 |
| 2020 October | 16 | 14 | 30 |
| 2020 September | 32 | 12 | 44 |
| 2020 August | 11 | 5 | 16 |
| 2020 July | 54 | 6 | 60 |
| 2020 June | 16 | 19 | 35 |
| 2020 May | 16 | 9 | 25 |
| 2020 April | 0 | 5 | 5 |
Show all
