Case Letter
Treatment of alopecia areata with Diphenylcyclopropenone: methodology based on the principles of allergic contact dermatitis
Andressa Sato de Aquino Lopes
, Rosana Lazzarini
Corresponding author
Medical Department of Clínica de Dermatologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
Read
5979
Timeswas read the article
2353
Total PDF
3626
Total HTML
Share statistics
array:23 [ "pii" => "S0365059621002701" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.08.036" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "478" "copyrightAnyo" => "2021" "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:18 [ "pii" => "S2666275221002721" "issn" => "26662752" "doi" => "10.1016/j.abdp.2020.08.021" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "478" "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" => "Tratamento da alopecia areata com difenilciclopropenona: metodologia baseada nos preceitos da dermatite alérgica de contato" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "127" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => 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" => 1481 "Ancho" => 1007 "Tamanyo" => 111625 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Leitura do teste de contato após 72 horas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andressa Sato de Aquino Lopes, Rosana Lazzarini" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Andressa Sato de Aquino" "apellidos" => "Lopes" ] 1 => array:2 [ "nombre" => "Rosana" "apellidos" => "Lazzarini" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059621002701" "doi" => "10.1016/j.abd.2020.08.036" "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/S0365059621002701?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221002721?idApp=UINPBA00008Z" "url" => "/26662752/0000009700000001/v1_202202030913/S2666275221002721/v1_202202030913/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0365059621002634" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.05.010" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "471" "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" => "Vandetanib induced phototoxic reaction progressed to toxic epidermal necrolysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "128" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2130 "Ancho" => 1667 "Tamanyo" => 210798 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Diffuse epidermal detachment was seen on arms.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Busra Demirbag Gul, Nilgun Senturk, Deniz Baycelebi, Levent Yildiz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Busra Demirbag" "apellidos" => "Gul" ] 1 => array:2 [ "nombre" => "Nilgun" "apellidos" => "Senturk" ] 2 => array:2 [ "nombre" => "Deniz" "apellidos" => "Baycelebi" ] 3 => array:2 [ "nombre" => "Levent" "apellidos" => "Yildiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275221002794" "doi" => "10.1016/j.abdp.2021.11.022" "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/S2666275221002794?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621002634?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000001/v1_202201230559/S0365059621002634/v1_202201230559/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0365059621002671" "issn" => "03650596" "doi" => "10.1016/j.abd.2020.08.035" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "475" "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" => "Seborrheic-like dermatitis and liver dysfunction in an infant: signs of Langerhans cell histiocytosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "125" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1636 "Ancho" => 2507 "Tamanyo" => 374539 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A), Erythematous-desquamative, infiltrated lesions covered by hematic and meliceric crusts all over the scalp and the ear pinna. (B), Coalescent erythematous papules under hematic and meliceric crusts, extending from the temporal to the retroauricular region.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniela Antoniali, Helena Barbosa Lugão, Daniel Elias, Cacilda da Silva Souza" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Daniela" "apellidos" => "Antoniali" ] 1 => array:2 [ "nombre" => "Helena Barbosa" "apellidos" => "Lugão" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Elias" ] 3 => array:2 [ "nombre" => "Cacilda da Silva" "apellidos" => "Souza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275221002691" "doi" => "10.1016/j.abdp.2021.11.013" "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/S2666275221002691?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621002671?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000001/v1_202201230559/S0365059621002671/v1_202201230559/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Treatment of alopecia areata with Diphenylcyclopropenone: methodology based on the principles of allergic contact dermatitis" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "127" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Andressa Sato de Aquino Lopes, Rosana Lazzarini" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Andressa Sato de Aquino" "apellidos" => "Lopes" "email" => array:1 [ 0 => "dressa_sato@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Rosana" "apellidos" => "Lazzarini" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Medical Department of Clínica de Dermatologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1487 "Ancho" => 2507 "Tamanyo" => 309015 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A), At start of treatment; (B), after 24 weeks of DPCP treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diphenylcyclopropenone (DPCP) is a chemical substance that induces a cellular immune response and, therefore, allergic contact dermatitis (ACD). Its action is based on the concept of antigenic competition, inducing the formation of TCD8 lymphocytes, which inhibit the active perifollicular immune response, allowing hair growth.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">DPCP is a therapeutic option for alopecia areata (AA), especially in extensive cases, with a variable response, but repilation rates in more than 50% of cases.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Side effects are common, sometimes severe, such as acute eczematous reactions, in addition to lymphadenopathy, pruritus, hyperpigmentation, and flu-like symptoms, among others.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Drug utilization varies, lacking methodological standardization.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> This service uses a methodology based on the principles of ACD. This case report aims to demonstrate the steps of DPCP use in AA. This standardization allowed comparing data and reducing side effects due to drug inappropriate use.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The product is purchased at 2% in acetone and stored in the refrigerator in a dark bottle. The dilutions are prepared during the appointments and applied weekly with moistened flexible swabs.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 44-year-old male with universal AA was sensitized with 2% DPCP on 2 × 2 cm filter paper on the back for 48 hours, inducing the ACD induction phase. After 2 weeks, he was submitted to a patch test with DPCP, at 0.1%; 0.05%, and 0.02% concentrations, with readings after 48 and 96 hours, and responses 3+, 2+ and 2+ (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) respectively, according to the previously established standardization. The 0.02% concentration was used on the scalp, where it remained covered and unwashed for 48 hours. The concentration was increased weekly to 0.1% when moderate pruritus and erythema were obtained. Repilation was acceptable after 24 weeks, without severe reactions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patch test assesses whether there was sensitization to the product and predicts the best concentration with which to start treatment, choosing the one with the lowest positivity, minimizing adverse effects. If the responses are intense, the concentrations are reduced, and sometimes the applications are spaced out at intervals of two to four weeks. The concentrations depend on the response of each individual.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapeutic failure, that is, the absence of repilation, is considered after 180 days of regular application. If there is a response, the applications are maintained until the best possible effect is attained (up to one year).</p><p id="par0040" class="elsevierStylePara elsevierViewall">DPCP is a drug that provides good response rates in severe cases; however, the protocols are not yet standardized. Due to common and sometimes severe side effects, strict monitoring of sensitization and control of the concentrations are necessary throughout the treatment. Moreover, no industry manufactures DPCP in accordance with regulatory standards for drug development.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present environment, there is no regulation for its use, although it has been part of the therapeutic arsenal for AA treatment for many years.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Andressa Sato de Aquino Lopes: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rosana Lazzarini: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied case; effective participation in research orientation; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 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:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Clínica de Dermatologia, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2467 "Ancho" => 1674 "Tamanyo" => 230944 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reading of the patch test after 72 hours.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1487 "Ancho" => 2507 "Tamanyo" => 309015 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A), At start of treatment; (B), after 24 weeks of DPCP treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of topical sensitizers in the treatment of alopecia areata" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.K. Rokhsar" 1 => "J.L. Shupack" 2 => "J.J. Vafai" 3 => "K. Washenik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(98)70048-9" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1998" "volumen" => "39" "paginaInicial" => "751" "paginaFinal" => "761" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9810892" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hair regrowth outcomes of contact immunotherapy for patients with alopecia areata: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Lee" 1 => "B.J. Kim" 2 => "Y.B. Lee" 3 => "W.S. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2018.2312" "Revista" => array:7 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "1145" "paginaFinal" => "1151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30073292" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0167527318322009" "estado" => "S300" "issn" => "01675273" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subclinical sensitization with diphenylcyclopropenone is sufficient for the treatment of alopecia areata: retrospective analysis of 159 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Choe" 1 => "S. Lee" 2 => "L.Q. Pi" 3 => "D.I. Keum" 4 => "C.H. Lee" 5 => "B.J. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.10.042" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "515" "paginaFinal" => "521" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29108907" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alopecia areata: an appraisal of new treatment approaches and overview of current therapies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.C. Strazzulla" 1 => "E.H.C. Wang" 2 => "L. Avila" 3 => "K.L. Sicco" 4 => "N. Brinster" 5 => "A.M. Christiano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.04.1142" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "15" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29241773" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diphencyprone treatment of alopecia areata: postulated mechanism of action and prospects for therapeutic synergy with RNA interference" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.G. Bulock" 1 => "J.P. Cardia" 2 => "P.A. Pavco" 3 => "W.R. Levis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jidsymp.2015.33" "Revista" => array:7 [ "tituloSerie" => "J Investig Dermatol Symp Proc" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "16" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26551938" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109799001400" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009700000001/v1_202201230559/S0365059621002701/v1_202201230559/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/03650596/0000009700000001/v1_202201230559/S0365059621002701/v1_202201230559/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621002701?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 120 | 72 | 192 |
| 2024 September | 173 | 99 | 272 |
| 2024 August | 210 | 120 | 330 |
| 2024 July | 165 | 110 | 275 |
| 2024 June | 149 | 97 | 246 |
| 2024 May | 91 | 73 | 164 |
| 2024 April | 127 | 88 | 215 |
| 2024 March | 116 | 97 | 213 |
| 2024 February | 147 | 109 | 256 |
| 2024 January | 118 | 72 | 190 |
| 2023 December | 71 | 60 | 131 |
| 2023 November | 105 | 77 | 182 |
| 2023 October | 102 | 104 | 206 |
| 2023 September | 117 | 73 | 190 |
| 2023 August | 90 | 38 | 128 |
| 2023 July | 90 | 64 | 154 |
| 2023 June | 88 | 35 | 123 |
| 2023 May | 84 | 26 | 110 |
| 2023 April | 79 | 22 | 101 |
| 2023 March | 71 | 45 | 116 |
| 2023 February | 71 | 29 | 100 |
| 2023 January | 89 | 51 | 140 |
| 2022 December | 66 | 42 | 108 |
| 2022 November | 90 | 46 | 136 |
| 2022 October | 193 | 64 | 257 |
| 2022 September | 57 | 69 | 126 |
| 2022 August | 51 | 46 | 97 |
| 2022 July | 50 | 50 | 100 |
| 2022 June | 60 | 62 | 122 |
| 2022 May | 64 | 48 | 112 |
| 2022 April | 85 | 52 | 137 |
| 2022 March | 105 | 86 | 191 |
| 2022 February | 138 | 61 | 199 |
| 2022 January | 140 | 97 | 237 |
| 2021 December | 49 | 66 | 115 |
Show all
