Letter - Clinical
Papulopustular infantile acne treated with oral isotretinoin
Read
4487
Timeswas read the article
1466
Total PDF
3021
Total HTML
Share statistics
array:23 [ "pii" => "S0365059623000028" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.05.026" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "703" "copyright" => "Sociedade Brasileira de Dermatologia" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "pt" => array:18 [ "pii" => "S2666275223000280" "issn" => "26662752" "doi" => "10.1016/j.abdp.2023.02.001" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "703" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cartas ‐ Caso clínico</span>" "titulo" => "Acne papulopustulosa infantil tratada com isotretinoína oral" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "402" ] ] "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" => 1630 "Ancho" => 2508 "Tamanyo" => 321824 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acne infantil. (A) Aos 2 meses de idade, pápulas, pústulas e comedões na face. (B) Aos 7 meses, mesmo com a terapia instituída, com cisto drenante, cicatrizes, e lesões papulopustulosas ativas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Grasielle Silva Santos, Mayra Ianhez, Hélio Amante Miot" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Grasielle Silva" "apellidos" => "Santos" ] 1 => array:2 [ "nombre" => "Mayra" "apellidos" => "Ianhez" ] 2 => array:2 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0365059623000028" "doi" => "10.1016/j.abd.2021.05.026" "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/S0365059623000028?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000280?idApp=UINPBA00008Z" "url" => "/26662752/0000009800000003/v3_202305121556/S2666275223000280/v3_202305121556/pt/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S0365059623000053" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.10.016" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "704" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Post-COVID-19 lichen planus annularis: report of a rare association" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "402" "paginaFinal" => "404" ] ] "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" => 1221 "Ancho" => 3341 "Tamanyo" => 218336 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Violaceous lesions, with raised edges and an atrophic center, with a shiny, lichenoid surface on the lower limbs, ranging in size from 0.5 to 2 cm. (B) Lichenoid lesion in greater detail, showing its annular aspect.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Murari Mondadori, Helena Barbosa Lugão, Fernanda André Martins Cruz Perecin, Marco Andrey Cipriani Frade" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Laura Murari" "apellidos" => "Mondadori" ] 1 => array:2 [ "nombre" => "Helena Barbosa" "apellidos" => "Lugão" ] 2 => array:2 [ "nombre" => "Fernanda André Martins Cruz" "apellidos" => "Perecin" ] 3 => array:2 [ "nombre" => "Marco Andrey Cipriani" "apellidos" => "Frade" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000309" "doi" => "10.1016/j.abdp.2023.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000309?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000053?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000053/v3_202305121633/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059623000041" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.10.017" "estado" => "S300" "fechaPublicacion" => "2023-05-01" "aid" => "705" "copyright" => "Sociedade Brasileira de Dermatologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Case for diagnosis. Multiple infiltrated plaques in a patient with human immunodeficiency virus and hepatitis C co-infection: lichen myxedematosus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "398" "paginaFinal" => "400" ] ] "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" => 1045 "Ancho" => 1675 "Tamanyo" => 186374 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, confluent plaques with an infiltrated appearance, in the gluteal region, bilaterally.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nathalia Hoffmann Guarda, Renan Rangel Bonamigo, Renata Heck" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nathalia Hoffmann" "apellidos" => "Guarda" ] 1 => array:2 [ "nombre" => "Renan Rangel" "apellidos" => "Bonamigo" ] 2 => array:2 [ "nombre" => "Renata" "apellidos" => "Heck" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275223000310" "doi" => "10.1016/j.abdp.2023.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223000310?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000041?idApp=UINPBA00008Z" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000041/v3_202305121633/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter - Clinical</span>" "titulo" => "Papulopustular infantile acne treated with oral isotretinoin" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "402" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Grasielle Silva Santos, Mayra Ianhez, Hélio Amante Miot" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Grasielle Silva" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Mayra" "apellidos" => "Ianhez" "email" => array:1 [ 0 => "ianhez@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Hélio Amante" "apellidos" => "Miot" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital de Doenças Tropicais Dr Anuar Auad, Goiânia, GO, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology and Radiotherapy, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "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" => 1743 "Ancho" => 2508 "Tamanyo" => 331683 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infantile acne treated with oral isotretinoin. (A/B) One year after the end of treatment with oral isotretinoin, the patient shows residual normochromic scars.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infantile acne is considered when it occurs between one and 16 months of age.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Topical retinoids, benzoyl peroxide at low concentrations, and oral antibiotics (except tetracyclines) are used in the treatment of children.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This report describes the case of a two-month-old boy who presented papules, pustules, and a cyst on the malar region, bilaterally, as well as closed and open comedones, compatible with the diagnosis of infantile acne (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The laboratory hormonal evaluation of the child and mother (who also had severe acne) was normal. Initially, oral erythromycin was used for two months, oral cephadroxyl for another two months, as well as the fixed combination of adapalene and benzoyl peroxide associated with non-comedogenic emollients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Despite the prolonged use of oral antibiotics and topical medications, progression of lesions and scar formation occurred. At seven months of age, oral isotretinoin was started at a dose of 0.5 mg/kg/day (target dose 960‒1200 mg). The 10 mg capsule was frozen and half of the tablet was administered to the child in the milk.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">After reaching the 150 mg/kg dose nine months later and with gradual adjustment according to weight gain (up to ¾ of the tablet), there was no disease activity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) throughout a 12-month follow-up. During treatment, the patient had mild cheilitis and xerosis, without laboratory alterations. As post-isotretinoin maintenance therapy, the fixed combination of adapalene and benzoyl peroxide was prescribed, as well as non-comedogenic emollients.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The androgenic hormonal laboratory investigation is mandatory in cases of refractory infantile acne, although most cases are not related to underlying endocrine diseases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Oral isotretinoin, as well as topical therapy, are off-label treatments at this age; however, the many recently published cases demonstrate not only important clinical improvement in refractory cases but also their safe use in infants.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Acitretin is used in recessive congenital ichthyosis throughout life, since birth, being the confirmation test of retinoid safety in childhood. Early closure of epiphyses in children treated with oral retinoids is a rare event, associated with previous diseases, use of high doses, or prolonged treatment.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the meantime, oral isotretinoin, when prescribed for refractory infantile acne, is a short-term treatment that requires low doses.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The oral isotretinoin dose for infantile acne varies among publications between 0.2 and 2.0 mg/kg/day, with a total treatment period of five up to 14 months.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to the latest acne consensus, the cumulative dose of isotretinoin should be the one in which complete clearing of lesions is attained, with drug maintenance for two more months, in contrast to the strict recommendation of reaching 120‒150 mg/kg in all patients.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Delay in the diagnosis of infantile acne is mainly due to the rarity of the disease at this age, as well as undertreatment and delay in the introduction of oral isotretinoin in these children.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is therefore important that infants with severe, chronic acne, refractory to conventional treatment, be evaluated for underlying endocrinological disorders, not delaying drug use when there is resistance to oral antibiotics as well as the formation of scars.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors' contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Grasielle Silva Santos: Design and planning of the study; data survey, analysis, and interpretation of data; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Mayra Ianhez: Design and planning of the study; data survey, analysis, and interpretation of data; critical review of important intellectual content; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Helio Amante Miot: Critical review of important intellectual content; analysis and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" 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 "fechaRecibido" => "2021-05-03" "fechaAceptado" => "2021-05-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital de Doenças Tropicais Dr. Anuar Auad, Goiânia, GO, 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" => 1630 "Ancho" => 2508 "Tamanyo" => 321824 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infantile acne. (A) At two months of age, papules, pustules, and comedones on the face; (B) At seven months, even with the implemented therapy, the patient had a draining cyst, scars, and active papulopustular lesions.</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" => 1743 "Ancho" => 2508 "Tamanyo" => 331683 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infantile acne treated with oral isotretinoin. (A/B) One year after the end of treatment with oral isotretinoin, the patient shows residual normochromic scars.</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" => "A practical approach for the use of oral isotretinoin for infantile acne" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.J. Barnes" 1 => "L.F. Eichenfield" 2 => "J. Lee" 3 => "B.B. Cunningham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1525-1470.2005.22224.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2005" "volumen" => "22" "paginaInicial" => "166" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15804310" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Acne and Rosacea Society. Evidence-based recommendations for the diagnosis and treatment of pediatric acne" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.F. Eichenfield" 1 => "A.C. Krakowski" 2 => "C. Piggott" 3 => "J. Del Rosso" 4 => "H. Baldwin" 5 => "S.F. Friedlander" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2013-0490B" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "S163" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23637225" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infantile acne treated with oral isotretinoin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.M. Miller" 1 => "B. Echeverría" 2 => "A. Torrelo" 3 => "G.B. Jemec" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12069" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "513" "paginaFinal" => "518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23278140" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the side effects of acitretin on children with ichthyosis - a one-year study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.F.M. Brito" 1 => "I.P. Sant’Anna" 2 => "F. Figueiroa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2004" "volumen" => "79" "paginaInicial" => "283" "paginaFinal" => "288" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.M. Thiboutot" 1 => "B. Dréno" 2 => "A. Abanmi" 3 => "A.F. Alexis" 4 => "E. Araviiskaia" 5 => "M.I.B. Cabal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.09.078" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2018" "volumen" => "78" "paginaInicial" => "S1" "paginaFinal" => "S23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29127053" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000003/v3_202305121633/S0365059623000028/v3_202305121633/en/main.assets" "Apartado" => array:4 [ "identificador" => "95691" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter – Clinical" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000003/v3_202305121633/S0365059623000028/v3_202305121633/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000028?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 33 | 11 | 44 |
| 2024 October | 175 | 79 | 254 |
| 2024 September | 268 | 86 | 354 |
| 2024 August | 268 | 115 | 383 |
| 2024 July | 210 | 106 | 316 |
| 2024 June | 148 | 69 | 217 |
| 2024 May | 200 | 73 | 273 |
| 2024 April | 138 | 100 | 238 |
| 2024 March | 162 | 78 | 240 |
| 2024 February | 135 | 85 | 220 |
| 2024 January | 103 | 61 | 164 |
| 2023 December | 117 | 69 | 186 |
| 2023 November | 113 | 113 | 226 |
| 2023 October | 129 | 77 | 206 |
| 2023 September | 111 | 76 | 187 |
| 2023 August | 84 | 30 | 114 |
| 2023 July | 117 | 30 | 147 |
| 2023 June | 157 | 55 | 212 |
| 2023 May | 194 | 49 | 243 |
| 2023 April | 88 | 13 | 101 |
| 2023 March | 48 | 61 | 109 |
| 2023 February | 23 | 30 | 53 |
Show all
