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No histology was available from the intervention&#46; Later&#44; at the age of 9&#44; she had been diagnosed with Crohn&#8217;s disease after intestinal biopsy and was treated with azathioprine and infliximab&#46; However&#44; the cheilitis persisted&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination showed crusty lesions and flaccid blisters on both lips&#44; as well as erythema with fissures on the gums and jugal mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> A and B&#41;&#46; A biopsy of the labial mucosa was performed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histology showed epidermal hyperplasia without atypia with lichenoid pattern inflammation and lymphangiectasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The presence of numerous podoplanin-positive subepithelial dilated vessels with a lymphatic appearance is noteworthy &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Further investigations&#44; including patch testing with the European standard and cosmetics series&#44; and a facial MRI were normal&#46; Topical corticosteroid treatment was prescribed with the intention of reducing the associated inflammation&#44; followed by topical rapamycin 0&#46;2&#37; to decrease the lymphatic component&#44; with no clear improvement after two months&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Granulomatous cheilitis presents as orofacial inflammation secondary to non-necrotizing granulomas&#46; It can present isolated or in the context of granulomatous systemic disease&#46; In children&#44; granulomatous cheilitis is more often associated with CD than in adults&#44; being the first manifestation in 5&#37;&#8210;10&#37; of cases of inflammatory bowel disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Acquired lymphangiectasia in CD is thought to develop as a consequence of chronic granulomatous inflammation&#46; It is described most often in the genital area&#46; In a literature review&#44; we found four cases of acquired orofacial lymphangiectasia associated with CD &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> As in the case presented here&#44; in two of these patients no granulomas were observed on histology&#44; and in another case&#44; they were only observed in the second biopsy&#46; The medical treatment could have reduced the inflammation&#44; leaving only the residual lymphangiectasia&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the absence of granulomatous inflammation&#44; lymphangiectasia can be treated with cryotherapy&#44; sclerotherapy&#44; surgical excision&#44; laser ablation&#44; or photocoagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In our case&#44; topical rapamycin was attempted with no results at 2 months&#46; No cases of acquired lymphangiectasia have been successfully treated with topical rapamycin&#44; but 0&#46;1&#37; topical sirolimus has been effective in cutaneous microcystic lymphatic malformations in children and adults&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; the presence of orofacial acquired lymphangiectasia could be an early marker of inflammatory bowel disease even in the absence of granulomatous cheilitis or digestive symptoms&#46; Its diagnosis could help in the early detection of CD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Llull-Ramos&#58; Concepcion&#59; design&#59; acquisition of data&#59; drafting the article&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Juan Garc&#237;as-Ladaria&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In&#233;s Gracia-Darder&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aniza Giacaman&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</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&#46;</p></span></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;Ref&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#47;Sex&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LIP histological findings&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Widely dilated superficial lymphatic channels&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Azathioprine&#44; mesalazine&#44; infliximab&#44; 0&#46;03&#37; topical tacrolimus and lip cryotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Good cosmetic result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Superficial dilated lymphatics and patchy inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Triamcinolone injections&#44; 1&#37; topical hydrocortisone cream&#44; oral mesalazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No treatment needed&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">3<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></td><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">2020</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">29&#47;F</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1st biopsy&#58; superficial dilated vessels and dense inflammatory infiltrate with a tiny granuloma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Infliximab</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Improvement</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2nd biopsy&#58; superficial lymphangiectasia&#44; inflammatory infiltrate and small granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">4<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></td><td class="td-with-role" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">30&#47;F</td><td class="td" title="\n
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                  \t\t\t\t">1st biopsy&#58; proliferation of ectatic lymphatic channels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5 &#40;present case&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Lichenoid pattern inflammation and lymphangiectasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Azathioprine&#44; infliximab&#44; topical corticosteroids and 0&#46;2&#37; topical rapamycin&nbsp;\t\t\t\t\t\t\n
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Letter - Clinical
Acquired lymphangiectasia of the lip in a patient with Crohn’s disease
Ana Llull-Ramos
Autor para correspondência
anallullramos@gmail.com

Corresponding author.
, Juan Garcías-Ladaria, Inés Gracia-Darder, Aniza Giacaman
Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Spain
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No histology was available from the intervention&#46; Later&#44; at the age of 9&#44; she had been diagnosed with Crohn&#8217;s disease after intestinal biopsy and was treated with azathioprine and infliximab&#46; However&#44; the cheilitis persisted&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination showed crusty lesions and flaccid blisters on both lips&#44; as well as erythema with fissures on the gums and jugal mucosa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> A and B&#41;&#46; A biopsy of the labial mucosa was performed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Histology showed epidermal hyperplasia without atypia with lichenoid pattern inflammation and lymphangiectasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The presence of numerous podoplanin-positive subepithelial dilated vessels with a lymphatic appearance is noteworthy &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Further investigations&#44; including patch testing with the European standard and cosmetics series&#44; and a facial MRI were normal&#46; Topical corticosteroid treatment was prescribed with the intention of reducing the associated inflammation&#44; followed by topical rapamycin 0&#46;2&#37; to decrease the lymphatic component&#44; with no clear improvement after two months&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Granulomatous cheilitis presents as orofacial inflammation secondary to non-necrotizing granulomas&#46; It can present isolated or in the context of granulomatous systemic disease&#46; In children&#44; granulomatous cheilitis is more often associated with CD than in adults&#44; being the first manifestation in 5&#37;&#8210;10&#37; of cases of inflammatory bowel disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Acquired lymphangiectasia in CD is thought to develop as a consequence of chronic granulomatous inflammation&#46; It is described most often in the genital area&#46; In a literature review&#44; we found four cases of acquired orofacial lymphangiectasia associated with CD &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a> As in the case presented here&#44; in two of these patients no granulomas were observed on histology&#44; and in another case&#44; they were only observed in the second biopsy&#46; The medical treatment could have reduced the inflammation&#44; leaving only the residual lymphangiectasia&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2&#44;4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the absence of granulomatous inflammation&#44; lymphangiectasia can be treated with cryotherapy&#44; sclerotherapy&#44; surgical excision&#44; laser ablation&#44; or photocoagulation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In our case&#44; topical rapamycin was attempted with no results at 2 months&#46; No cases of acquired lymphangiectasia have been successfully treated with topical rapamycin&#44; but 0&#46;1&#37; topical sirolimus has been effective in cutaneous microcystic lymphatic malformations in children and adults&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; the presence of orofacial acquired lymphangiectasia could be an early marker of inflammatory bowel disease even in the absence of granulomatous cheilitis or digestive symptoms&#46; Its diagnosis could help in the early detection of CD&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Llull-Ramos&#58; Concepcion&#59; design&#59; acquisition of data&#59; drafting the article&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Juan Garc&#237;as-Ladaria&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In&#233;s Gracia-Darder&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aniza Giacaman&#58; Acquisition of data&#59; analysis of data&#59; final approval of the version to be published&#46;</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&#46;</p></span></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely dilated superficial lymphatic channels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azathioprine&#44; mesalazine&#44; infliximab&#44; 0&#46;03&#37; topical tacrolimus and lip cryotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good cosmetic result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Superficial dilated lymphatics and patchy inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Triamcinolone injections&#44; 1&#37; topical hydrocortisone cream&#44; oral mesalazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No treatment needed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">3<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">2020</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">29&#47;F</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st biopsy&#58; superficial dilated vessels and dense inflammatory infiltrate with a tiny granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Infliximab</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Improvement</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2nd biopsy&#58; superficial lymphangiectasia&#44; inflammatory infiltrate and small granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="middle">4<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="2" align="left" valign="middle">2021</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">30&#47;F</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1st biopsy&#58; proliferation of ectatic lymphatic channels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Methotrexate and infliximab</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Improvement</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2nd biopsy&#58; granulomata adjacent to dilated lymphatic channels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;present case&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lichenoid pattern inflammation and lymphangiectasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Azathioprine&#44; infliximab&#44; topical corticosteroids and 0&#46;2&#37; topical rapamycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No clear improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                      "doi" => "10.1111/cup.13834"
                      "Revista" => array:6 [
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                        "fecha" => "2020"
                        "volumen" => "47"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32761835"
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                  "contribucion" => array:1 [
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                        "tituloSerie" => "Int J Dermatol"
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                      "titulo" => "Lip swelling with lymphangiectasia"
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                        "tituloSerie" => "JAAD Case Rep"
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                      "titulo" => "Groupe de Recherche de la Soci&#233;t&#233; Fran&#231;aise de Dermatologie P&#233;diatrique&#46; Topical sirolimus 0&#46;1&#37; for treating cutaneous microcystic lymphatic malformations in children and adults &#40;TOPICAL&#41;&#58; protocol for a multicenter phase 2&#44; within-person&#44; randomized&#44; double-blind&#44; vehicle-controlled clinical trial"
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Informação do artigo
ISSN: 03650596
Idioma original: Inglês
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