Case for Diagnosis
Morphea Following Radiation Therapy in a Patient With Breast Cancer
Morfea tras radioterapia en paciente con cáncer de mama
M. García-Arpaa,
, E. Lozano-Martínb, C. Ramos-Rodríguezc, M. Rodríguez-Vázquezd
Autor para correspondencia
a Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
b Servicio de Oncología Radioterápica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
c Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
d Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, Spain
Leído
6625
Vecesse ha leído el artículo
2341
Total PDF
4284
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219015000293" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.01.016" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1056" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:243-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1455 "formatos" => array:3 [ "EPUB" => 53 "HTML" => 773 "PDF" => 629 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731014004153" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.07.005" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1056" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:243-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1420 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 650 "PDF" => 767 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Morfea tras radioterapia en paciente con cáncer de mama" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "245" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Morphea Following Radiation Therapy in a Patient With Breast Cancer" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => 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" => 1200 "Ancho" => 900 "Tamanyo" => 109374 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reducción notable de la mama izquierda. Presenta placa muy indurada y bien delimitada. La superficie es brillante y se observan áreas hiperpigmentadas y otras marfileñas, sin anejos. Destaca el borde eritematoso alrededor de toda la placa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. García-Arpa, E. Lozano-Martín, C. Ramos Rodríguez, M. Rodríguez-Vázquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "García-Arpa" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Lozano-Martín" ] 2 => array:2 [ "nombre" => "C. Ramos" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015000293" "doi" => "10.1016/j.adengl.2015.01.016" "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/S1578219015000293?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004153?idApp=UINPBA000044" "url" => "/00017310/0000010600000003/v3_202209240525/S0001731014004153/v3_202209240525/es/main.assets" ] ] "itemAnterior" => array:20 [ "pii" => "S1578219015000281" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.01.015" "estado" => "S300" "fechaPublicacion" => "2015-04-01" "aid" => "1048" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:241-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1150 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 570 "PDF" => 525 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "A Tumor in Images: Anetodermic Pilomatrixoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "241" "paginaFinal" => "243" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un tumor en imágenes: pilomatrixoma anetodérmico" ] ] "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" => 1584 "Ancho" => 1584 "Tamanyo" => 177985 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatoscopic image showing a lesion with homogeneous red areas, irregular while-yellow structures, areas covered with a blue-white veil, irregular linear vessels on the periphery, and some chrysalides.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Martínez-Morán, B. Echeverría-García, L. Nájera, J. Borbujo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Martínez-Morán" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Echeverría-García" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Nájera" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014004074" "doi" => "10.1016/j.ad.2014.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004074?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000281?idApp=UINPBA000044" "url" => "/15782190/0000010600000003/v3_202209240641/S1578219015000281/v3_202209240641/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Morphea Following Radiation Therapy in a Patient With Breast Cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "245" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. García-Arpa, E. Lozano-Martín, C. Ramos-Rodríguez, M. Rodríguez-Vázquez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "García-Arpa" "email" => array:1 [ 0 => "mgarciaa73@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Lozano-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Ramos-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Rodríguez-Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Radioterápica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Albacete, Albacete, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morfea tras radioterapia en paciente con cáncer de mama" ] ] "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" => 2001 "Ancho" => 1501 "Tamanyo" => 261546 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Notable reduction in left breast size. The plaque is highly indurated and well-demarcated. The skin surface is shiny, some areas are hyperpigmented while others are pearly, and adnexal structures are absent. Note the erythematous border surrounding the entire plaque.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Postirradiation morphea is a rare complication that may develop in areas treated for cancer with radiation therapy, usually in breast cancer patients. We present the case of a patient with carcinoma of the breast treated with surgery and radiation therapy who developed postirradiation morphea 1 year later.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 56-year-old woman who had been diagnosed with infiltrating ductal carcinoma of the left breast and treated with lumpectomy. Sentinel node biopsy results were negative. The patient had received adjuvant treatment consisting of chemotherapy, letrozole endocrine therapy, and external beam radiation therapy applied to the mammary gland using 6- and 18-MeV photons at a dose of 50<span class="elsevierStyleHsp" style=""></span>Gy followed by boost irradiation of the tumor bed at a dose of 66<span class="elsevierStyleHsp" style=""></span>Gy. Treatment was well tolerated. One year after completion of radiation therapy, there was a sudden onset of painful induration of the left breast, which also decreased in size. Physical examination revealed asymmetry of the two breasts and a well-demarcated woody plaque with an erythematous border in the irradiated area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Biopsy showed slight atrophy of the epidermis, hyperpigmentation of the basal layer, thickening of dermal collagen, loss of adnexal structures, and a discrete perivascular and interstitial lymphoplasmacytic inflammatory infiltrate that was both deep and superficial, with few interstitial eosinophils in the deep dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immune status was normal and serological testing for <span class="elsevierStyleItalic">Borrelia</span> was negative. Magnetic resonance imaging and mammography showed no abnormalities of the mammary gland. After treatment with oral prednisone at a dose of 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d tapered over 2 months and topical treatment with clobetasol, the patient's pain disappeared, induration and erythema decreased, and occasional vesicles developed. One year later the patient remained stable without tumor recurrence.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Radiation dermatitis, both acute and chronic, is a frequent reaction to treatment, whereas postirradiation morphea is a much rarer occurrence. The first cases of postirradiation morphea were described in 1989 by Colver et al<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> in 9 patients. Breast-conserving surgery with adjuvant radiation therapy has become the standard treatment in patients with early-stage breast cancer, who have the highest rate of postirradiation morphea. In one series of female patients with breast cancer the incidence rate was found to be 3 per 6000 patients, which was clearly higher than the 2.7 cases per 100 000 persons per year for the general population.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our review of the literature found 68 cases of postirradiation morphea in patients aged 34 to 85 years,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–9</span></a> an older population than that with idiopathic morphea. Most patients were white. The majority were women with carcinoma of the breast treated with breast-conserving surgery, though some had undergone mastectomy. One patient also had carcinoma of the endometrium,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and a small minority of patients had nonbreast cancer (2 had cervical cancer,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3</span></a> 1 had axillary adenocarcinoma of unknown origin,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and 1 had cancer of the endometrium<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>). There were 4 men with personal histories of subcutaneous lymphoma, carcinoma of the tongue,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> gastric cancer,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and neck node metastatic cancer of unknown primary site.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Morphea typically develops within a year of radiation therapy, but has been seen up to 32 years later (range, 1 month to 32 years). Onset is sudden with an inflammatory stage that involves a rapidly growing, generally painful erythematous or violaceous plaque in the irradiated area. Progression leads to plaque induration and pigmentation. Ultimately, these changes cause breast retraction and size reduction, although the mammary gland is not affected. Vesicles and bullae may develop,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> as in our patient's case. In over 25% of cases, induration extends beyond the irradiated area or even spreads to distant areas. One case report describes linear lesions on the lower limbs.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> As with idiopathic morphea, histology varies with disease progression.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The etiology of postirradiation morphea is unknown at present, but age, total radiation dose, dose per fraction, number of fractions, and grade of acute radiodermatitis do not appear to matter. However, risk appears to be higher for patients with connective tissue disorders, chiefly lupus erythematosus and scleroderma.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The reason for the predominant location on the breast is also unknown, but may have to do with the abundance of fatty tissue and the radiation dose received on overlying skin. Thanks to modern linear accelerators and techniques that achieve dose conformity by modulating the intensity of the radiation beam, skin damage from radiation therapy is minimal. In the breast, however, the skin and fat are included in the irradiated volume because they are close to the irradiation field and become the target organ in postmastectomy patients. This may explain the higher rate of postirradiation morphea on the breast.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Many adverse skin reactions to radiation therapy have been described (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Some are included in the differential diagnosis for postirradiation morphea. In the inflammatory phase, differential diagnosis includes infection, radiation recall dermatitis, and above all tumor recurrence (erysipelas-like cutaneous metastasis, carcinoma en cuirasse, or carcinomatous mastitis)<span class="elsevierStyleItalic">.</span></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">For follow-up of postirradiation morphea patients, ultrasound imaging is recommended instead of mammograms. While the natural history of this condition is poorly understood, it may improve after months or years, although asymmetry and pigmentation will persist. No effective treatment has been described. Treatment is as for idiopathic morphea, but immunosuppressive agents are not recommended. Treatments attempted include topical, intralesional, and systemic corticosteroids, topical calcipotriol, intravenous penicillin, hydroxychloroquine, phototherapy, and methotrexate (2.5-15<span class="elsevierStyleHsp" style=""></span>mg/wk). In extreme cases with very severe pain, palliative mastectomy may be necessary, but reconstructive surgery is contraindicated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Arpa M, Lozano-Martín E, Ramos-Rodríguez C, Rodríguez-Vázquez M. Morfea tras radioterapia en paciente con cáncer de mama. Actas Dermosifiliogr. 2015;106:243–245.</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" => 2001 "Ancho" => 1501 "Tamanyo" => 261546 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Notable reduction in left breast size. The plaque is highly indurated and well-demarcated. The skin surface is shiny, some areas are hyperpigmented while others are pearly, and adnexal structures are absent. Note the erythematous border surrounding the entire plaque.</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" => 1233 "Ancho" => 1668 "Tamanyo" => 604916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Low-magnification view showing decreased adnexal structures as well as an interstitial and mildly perivascular lymphoplasmacytic inflammatory infiltrate, both superficial and deep. Hematoxylin-eosin, original magnification ×40. B, Higher magnification shows collagen thickening. Hematoxylin-eosin, original magnification ×100.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><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"><span class="elsevierStyleItalic">Acute radiodermatitis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>In the early weeks. Erythema, edema, alopecia, changes in color. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Chronic radiodermatitis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Months or years after radiation therapy<span class="elsevierStyleItalic">.</span> Poikiloderma. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Radiation-induced fibrosis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Within the spectrum of chronic radiodermatitis. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Within the first 3 months. Dose-dependent. Deep tissues in the irradiated area are affected without inflammation. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Histology: Deep subcutaneous fibrosis, involving even the fascia and muscles. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Panniculitis following radiation therapy</span><a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Possible variant of postirradiation morphea. Women with breast cancer, months after radiation therapy. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Histology: Lobular panniculitis with adipocyte necrosis and dense inflammatory infiltrate of foamy histiocytes. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Primary skin malignancies: angiosarcoma, dermatofibrosarcoma protuberans, basal cell carcinoma, Merkel cell carcinoma</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Changes in melanocytic nevi</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Vascular lesions</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Radiation recall dermatitis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Lichen sclerosus et atrophicus</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Cutaneous and mucosal lichen planus</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Polymorphic, itchy, eosinophilic rash</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Psoriasis</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Vitiligo</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Autoimmune bullous disorders (pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Autoimmune diseases of connective tissue (lupus erythematosus, dermatomyositis)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Sweet syndrome</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adverse Skin Reactions to Radiation Therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-irradiation morphoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.B. Colver" 1 => "A. Rodger" 2 => "P.S. Mortimer" 3 => "J.A. Savin" 4 => "S.M. Neill" 5 => "J.A.A. Hunter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.1989.tb01382.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1989" "volumen" => "120" "paginaInicial" => "831" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2757944" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized scleroderma in breast cancer patients treated with supervoltage external beam radiation: Radiation port scleroderma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Davis" 1 => "P.R. Cohen" 2 => "M.D. McNeese" 3 => "M. Duvis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0190-9622(96)90116-4" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1996" "volumen" => "35" "paginaInicial" => "923" "paginaFinal" => "927" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8959951" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exaggerated fibrosis in patients with systemic sclerosis (scleroderma) following radiation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Abu-Shakra" 1 => "P. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "1993" "volumen" => "20" "paginaInicial" => "1601" "paginaFinal" => "1603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8164225" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unrecognized radiation-induced localized scleroderma: a cause of postoperative wound-healing disorder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Kreft" 1 => "J. Wohlrab" 2 => "K. Radant" 3 => "B. Danz" 4 => "W.C. Marsch" 5 => "E. Fiedler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "383" "paginaFinal" => "384" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progressive systemic sclerosis (diffuse scleroderma) and radiotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.G. Cooper" 1 => "J.W. Denham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/0007-1285-63-754-804" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "1990" "volumen" => "63" "paginaInicial" => "804" "paginaFinal" => "805" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2242481" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postirradation linear morphoea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.N. Akay" 1 => "H. Sanli" 2 => "A.O. Heper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Exp Dermatol" "fecha" => "2010" "volumen" => "35" "paginaInicial" => "106" "paginaFinal" => "108" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized scleroderma in a woman irradiated at two sites for endometrial and breast carcinoma: A case history and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Ullén" 1 => "E. Björkholm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1525-1438.2003.13006.x" "Revista" => array:6 [ "tituloSerie" => "Int J Gynecol Cancer" "fecha" => "2003" "volumen" => "13" "paginaInicial" => "77" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12631225" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Irradiation-induced morphea: X-rays as triggers of autoimmunity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Laetsch" 1 => "T. Hofer" 2 => "N. Lombriser" 3 => "S. Lautenschlager" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000330324" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2011" "volumen" => "223" "paginaInicial" => "9" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21865672" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esclerodermia cutánea localizada secundaria a radioterapia en cáncer de mama" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A.G. Ferreira" 1 => "J.L.M. García" 2 => "D. de Argila Fernández-Durán" 3 => "L.C. Barroso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Oncol" "fecha" => "2002" "volumen" => "4" "paginaInicial" => "506" "paginaFinal" => "507" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sclerosing postirradation panniculitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Requena" 1 => "C. Ferrándiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Clin" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "505" "paginaFinal" => "508" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000003/v3_202209240641/S1578219015000293/v3_202209240641/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000003/v3_202209240641/S1578219015000293/v3_202209240641/en/main.pdf?idApp=UINPBA000044&text.app=https://www.actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015000293?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 108 | 41 | 149 |
| 2024 Septiembre | 113 | 18 | 131 |
| 2024 Agosto | 154 | 52 | 206 |
| 2024 Julio | 156 | 35 | 191 |
| 2024 Junio | 126 | 29 | 155 |
| 2024 Mayo | 147 | 27 | 174 |
| 2024 Abril | 109 | 23 | 132 |
| 2024 Marzo | 105 | 32 | 137 |
| 2024 Febrero | 116 | 33 | 149 |
| 2024 Enero | 79 | 29 | 108 |
| 2023 Diciembre | 82 | 17 | 99 |
| 2023 Noviembre | 100 | 30 | 130 |
| 2023 Octubre | 98 | 27 | 125 |
| 2023 Septiembre | 62 | 34 | 96 |
| 2023 Agosto | 45 | 24 | 69 |
| 2023 Julio | 94 | 41 | 135 |
| 2023 Junio | 69 | 30 | 99 |
| 2023 Mayo | 63 | 32 | 95 |
| 2023 Abril | 72 | 27 | 99 |
| 2023 Marzo | 67 | 38 | 105 |
| 2023 Febrero | 40 | 24 | 64 |
| 2023 Enero | 47 | 22 | 69 |
| 2022 Diciembre | 45 | 29 | 74 |
| 2022 Noviembre | 33 | 23 | 56 |
| 2022 Octubre | 34 | 23 | 57 |
| 2022 Septiembre | 33 | 51 | 84 |
| 2022 Agosto | 36 | 32 | 68 |
| 2022 Julio | 50 | 32 | 82 |
| 2022 Junio | 19 | 28 | 47 |
| 2022 Mayo | 57 | 27 | 84 |
| 2022 Abril | 71 | 30 | 101 |
| 2022 Marzo | 55 | 40 | 95 |
| 2022 Febrero | 33 | 26 | 59 |
| 2022 Enero | 38 | 36 | 74 |
| 2021 Diciembre | 26 | 37 | 63 |
| 2021 Noviembre | 50 | 51 | 101 |
| 2021 Octubre | 67 | 54 | 121 |
| 2021 Septiembre | 43 | 52 | 95 |
| 2021 Agosto | 36 | 40 | 76 |
| 2021 Julio | 51 | 22 | 73 |
| 2021 Junio | 57 | 32 | 89 |
| 2021 Mayo | 39 | 24 | 63 |
| 2021 Abril | 47 | 46 | 93 |
| 2021 Marzo | 73 | 37 | 110 |
| 2021 Febrero | 73 | 30 | 103 |
| 2021 Enero | 36 | 26 | 62 |
| 2020 Diciembre | 44 | 23 | 67 |
| 2020 Noviembre | 36 | 17 | 53 |
| 2020 Octubre | 23 | 15 | 38 |
| 2020 Septiembre | 26 | 15 | 41 |
| 2020 Agosto | 40 | 24 | 64 |
| 2020 Julio | 33 | 25 | 58 |
| 2020 Junio | 46 | 24 | 70 |
| 2020 Mayo | 27 | 30 | 57 |
| 2020 Abril | 36 | 26 | 62 |
| 2020 Marzo | 39 | 16 | 55 |
| 2020 Febrero | 7 | 5 | 12 |
| 2020 Enero | 4 | 7 | 11 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 1 | 5 | 6 |
| 2019 Septiembre | 6 | 12 | 18 |
| 2019 Agosto | 4 | 6 | 10 |
| 2019 Julio | 4 | 10 | 14 |
| 2019 Junio | 6 | 14 | 20 |
| 2019 Mayo | 4 | 56 | 60 |
| 2019 Abril | 2 | 53 | 55 |
| 2019 Marzo | 5 | 17 | 22 |
| 2019 Febrero | 5 | 11 | 16 |
| 2019 Enero | 4 | 10 | 14 |
| 2018 Diciembre | 3 | 8 | 11 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 4 | 1 | 5 |
| 2018 Agosto | 0 | 7 | 7 |
| 2018 Julio | 0 | 11 | 11 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 14 | 14 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 4 | 8 | 12 |
| 2018 Febrero | 28 | 6 | 34 |
| 2018 Enero | 45 | 9 | 54 |
| 2017 Diciembre | 49 | 8 | 57 |
| 2017 Noviembre | 33 | 13 | 46 |
| 2017 Octubre | 57 | 8 | 65 |
| 2017 Septiembre | 28 | 12 | 40 |
| 2017 Agosto | 29 | 8 | 37 |
| 2017 Julio | 36 | 23 | 59 |
| 2017 Junio | 40 | 23 | 63 |
| 2017 Mayo | 18 | 18 | 36 |
| 2017 Abril | 29 | 12 | 41 |
| 2017 Marzo | 15 | 24 | 39 |
| 2017 Febrero | 13 | 11 | 24 |
| 2017 Enero | 42 | 18 | 60 |
| 2016 Diciembre | 41 | 10 | 51 |
| 2016 Noviembre | 56 | 19 | 75 |
| 2016 Octubre | 43 | 29 | 72 |
| 2016 Septiembre | 0 | 2 | 2 |
| 2016 Agosto | 0 | 4 | 4 |
| 2016 Julio | 7 | 2 | 9 |
| 2016 Junio | 16 | 1 | 17 |
| 2016 Mayo | 9 | 2 | 11 |
| 2016 Abril | 10 | 29 | 39 |
| 2016 Marzo | 8 | 2 | 10 |
| 2016 Febrero | 8 | 19 | 27 |
| 2016 Enero | 9 | 20 | 29 |
| 2015 Diciembre | 9 | 1 | 10 |
| 2015 Noviembre | 6 | 1 | 7 |
| 2015 Octubre | 5 | 5 | 10 |
| 2015 Septiembre | 0 | 1 | 1 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 4 | 2 | 6 |
| 2015 Junio | 0 | 5 | 5 |
| 2015 Mayo | 3 | 4 | 7 |
| 2015 Abril | 2 | 11 | 13 |
Mostrar todo
