Research letter
Occupational airborne contact dermatitis caused by usnic acid in a domestic worker
D. Pacheco
, A.R. Travassos, J. Antunes, L. Soares de Almeida, P. Filipe, T. Correia
Corresponding author
Clínica Universitária de Dermatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal
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"apellidos" => "Yamazaki-Nakashimada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002819?idApp=UINPBA00004N" "url" => "/03010546/0000004200000001/v1_201402140100/S0301054612002819/v1_201402140100/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0301054613000037" "issn" => "03010546" "doi" => "10.1016/j.aller.2012.11.001" "estado" => "S300" "fechaPublicacion" => "2014-01-01" "aid" => "475" "copyright" => "SEICAP" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Allergol Immunopathol (Madr). 2014;42:78-80" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1354 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 844 "PDF" => 500 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Successful treatment of severe delayed pressure angio-oedema with omalizumab" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "78" "paginaFinal" => "80" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 672 "Ancho" => 900 "Tamanyo" => 51536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pressure test was performed using a forearm sling with a 4<span class="elsevierStyleHsp" style=""></span>kg weight attached for 10<span class="elsevierStyleHsp" style=""></span>min and local forearm angio-oedema was observed 6<span class="elsevierStyleHsp" style=""></span>h after pressure had been applied.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Rodríguez-Rodríguez, D. Antolin-Amerigo, J. Barbarroja-Escudero, M.J. Sánchez-González, M. Alvarez-Mon" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Rodríguez-Rodríguez" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Antolin-Amerigo" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Barbarroja-Escudero" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Sánchez-González" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Alvarez-Mon" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613000037?idApp=UINPBA00004N" "url" => "/03010546/0000004200000001/v1_201402140100/S0301054613000037/v1_201402140100/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Research letter</span>" "titulo" => "Occupational airborne contact dermatitis caused by usnic acid in a domestic worker" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "80" "paginaFinal" => "82" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Pacheco, A.R. Travassos, J. Antunes, L. Soares de Almeida, P. Filipe, T. Correia" "autores" => array:6 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Pacheco" "email" => array:1 [ 0 => "pachecocas@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.R." "apellidos" => "Travassos" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Antunes" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Soares de Almeida" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Filipe" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Correia" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Clínica Universitária de Dermatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN), Lisbon, Portugal" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 669 "Ancho" => 900 "Tamanyo" => 83769 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positivity to usnic acid, after UVA irradiation with 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichens are composite organisms consisting of the permanent association between a fungus and an alga. The fungus component is called mycobiont and the algal component is called phycobiont; both grow in a symbiotic relationship<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, usnic acid is one of their main components and it is found in different types of lichens.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In Portugal, there are four predominant species of lichens: <span class="elsevierStyleItalic">Parmelia reticulata</span>, <span class="elsevierStyleItalic">P. caperata</span>, <span class="elsevierStyleItalic">Ramalina lusitana</span>, and <span class="elsevierStyleItalic">R. usnea</span>, which grow mainly on olive trees.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Airborne allergic contact dermatitis (AACD) caused by lichens<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> may simulate photodermatitis due to its preferential location in exposed areas of the skin. In rural workers, AACD may appear in the context of an occupational dermatitis, which is sometimes disabling, or it may affect those involved in outdoor leisure activities.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Herein, we described the case of a 46-year-old Caucasian woman, rural domestic worker, who carried oak and olive wood for fireplaces, mainly between the months of October and March.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was referred to the dermatology department because of an intensely pruritic erythematous scaling dermatitis, involving the face, neckline, and extensor surface of the hands, forearms and lower limbs. On the face, the eyelids, earlobes, and retroauricular fold were affected. The extensor surface of the forearms and hands showed extensive lichenification (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The dermatitis had started in the autumn, and persisted throughout the winter, with worsening on the uncovered areas in the beginning of the spring.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient had a history of asthmatic bronchitis and allergic rhinitis in childhood and had been followed for her respiratory allergies since 1993. Her most recent laboratory investigations showed: D2-<span class="elsevierStyleItalic">Dermatophagoides farinae</span> specific IgE 90.10<span class="elsevierStyleHsp" style=""></span>kU/L (class 5); D1 <span class="elsevierStyleItalic">D. pteronyssinus</span> specific IgE<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>kU/L (class 6), and total Ig E 1977<span class="elsevierStyleHsp" style=""></span>U/mL (ref<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>87).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient underwent patch testing with the Basic Series adopted by the GPEDC (Grupo Português das Dermites de Contacto), and the Gloves and Clothing Series, all of which were negative.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Faced with the possibility of photodermatitis, the patient performed tests with the Photo Allergen Series, which showed the following positivities: lichen acid mix and usnic acid, after UVA irradiation with 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with lichen allergies may be photosensitive and score positively on photoepicutaneous tests. The clinical relevance of this phenomenon is yet to be established.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Our patient was a rural worker who carried oak and olive wood during the cold months, and who developed dermatitis of sun-exposed areas, with accentuated lichenification of the dorsal hands and forearms, which worsened with exposure to sunlight. When faced with a rash on photo-exposed areas, and outdoor activity, one should always think of photosensitivity or AACD. In this case, the study with the Photo Allergen Series revealed positivity to lichen acid mix and usnic acid, which increased after UVA irradiation, thus confirming the diagnostic hypothesis of AACD.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Immediate hypersensitivity after exposure to lichens has also been described, which is usually manifested through respiratory symptomatology.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, even though our patient had a history of respiratory allergies, there is no evidence to support that they occurred in this setting.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Usnic acid is a lichen component which is found in species such as: <span class="elsevierStyleItalic">Parmelias</span>, <span class="elsevierStyleItalic">Evernia</span>, <span class="elsevierStyleItalic">Usnea</span>, <span class="elsevierStyleItalic">Lecanora</span>, <span class="elsevierStyleItalic">Cladonia</span> or <span class="elsevierStyleItalic">Ramalina</span>, and which may be photosensitising (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). These types of lichens are epiphytic, i.e. grow on tree trunks, and only a few survive in the polluted air of the cities, contaminated with sulphur dioxide. When lichens are fragmented by handling, they release particles that can settle on the exposed skin and may cause AACD,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> an occupational dermatitis that affects rural workers who cut tree trunks, or individuals with sporadic exposure during outdoor leisure activities.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> There may be concomitant reactions with the <span class="elsevierStyleItalic">Frullania</span> family due to cohabitation of both species. The existence of contact dermatitis caused by allergy to the <span class="elsevierStyleItalic">Frullan</span>'s sesquiterpene lactones may predispose subjects to being sensitive to lichen chemical compounds.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Lichen contact allergy is an old and often overlooked dermatitis that should be considered for subjects in contact with barked wood or wood dust. It is important to know the native species from each country to have a certain aetiological factor. In Portugal, several studies have been published in which the main aetiological sources of this type of dermatitis, both occupational and leisure-related, are described.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Moreover, numerous lichen components, such as usnic acid and atranorin (“oak moss”), are used in perfumery. Nowadays, this is the main cause of sensitisation to this type of substances.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human subjects and animals in research</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients’ data protection</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human subjects and animals in research" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients’ data protection" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1098 "Ancho" => 900 "Tamanyo" => 115243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythemato-squamous dermatitis, involving the face, eyelids, earlobes, retroauricular fold, neckline, extensor surface of the hands and forearms.</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" => 669 "Ancho" => 900 "Tamanyo" => 83769 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positivity to usnic acid, after UVA irradiation with 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 676 "Ancho" => 900 "Tamanyo" => 134189 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Parmelia</span> species. This genus of lichens is common in olive and cork trees.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">96<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \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" style="border-bottom: 2px solid black">Irrad UVA 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><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">Lichen acid mix \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">+ \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">+ \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">++ \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">Usnic acid \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">+ \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">+ \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">++ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab458698.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Series of photo allergens after UVA irradiation of 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lovell: plants and the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Christopher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "1st ed." "fecha" => "1993" "editorial" => "Blackwell Scientific Publications" "editorialLocalizacion" => "Boston" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usnic acid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Ingolfsdottir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Phytochemistry" "fecha" => "2002" "volumen" => "61" "paginaInicial" => "729" "paginaFinal" => "737" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12453567" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact dermatitis to lichens" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Gonçalo" 1 => "M. Born" 2 => "A. Pereira dos Santos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermat" "fecha" => "1981" "volumen" => "7" "paginaInicial" => "118" "paginaFinal" => "120" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airborne contact dermatitis to plants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Manuela Pecegueiro" 1 => "M. Brand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermat" "fecha" => "1985" "volumen" => "13" "paginaInicial" => "277" "paginaFinal" => "279" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update on airborne contact dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Huygens" 1 => "A. Gossens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermat" "fecha" => "2001" "volumen" => "44" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational allergic contact dermatitis from lichens in present-day Finland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Aalto-Korte" 1 => "A. Lauerma" 2 => "K. Alanko" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermat" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "36" "paginaFinal" => "38" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photosensitivity and allergy to aromatic lichen acids. Compositae oleoresins and other plant substances" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.O. Thune" 1 => "Y.J. Solberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermat" "fecha" => "1980" "volumen" => "6" "paginaInicial" => "81" "paginaFinal" => "87" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact sensitivity to lichens and compositae in Frullania dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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Gonçalo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Cut I L A" "fecha" => "1992" "volumen" => "XXII/94" "paginaInicial" => "251" "paginaFinal" => "256" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004200000001/v1_201402140100/S030105461200300X/v1_201402140100/en/main.assets" "Apartado" => array:4 [ "identificador" => "5561" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004200000001/v1_201402140100/S030105461200300X/v1_201402140100/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461200300X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 17 | 5 | 22 |
| 2024 September | 21 | 14 | 35 |
| 2024 August | 29 | 1 | 30 |
| 2024 July | 17 | 4 | 21 |
| 2024 June | 22 | 9 | 31 |
| 2024 May | 22 | 8 | 30 |
| 2024 April | 27 | 20 | 47 |
| 2024 March | 51 | 13 | 64 |
| 2024 February | 47 | 15 | 62 |
| 2024 January | 43 | 3 | 46 |
| 2023 December | 41 | 9 | 50 |
| 2023 November | 37 | 10 | 47 |
| 2023 October | 52 | 23 | 75 |
| 2023 September | 18 | 5 | 23 |
| 2023 August | 41 | 5 | 46 |
| 2023 July | 31 | 9 | 40 |
| 2023 June | 44 | 3 | 47 |
| 2023 May | 42 | 7 | 49 |
| 2023 April | 37 | 6 | 43 |
| 2023 March | 41 | 6 | 47 |
| 2023 February | 38 | 11 | 49 |
| 2023 January | 45 | 6 | 51 |
| 2022 December | 36 | 5 | 41 |
| 2022 November | 27 | 4 | 31 |
| 2022 October | 33 | 14 | 47 |
| 2022 September | 41 | 13 | 54 |
| 2022 August | 25 | 13 | 38 |
| 2022 July | 34 | 12 | 46 |
| 2022 June | 30 | 17 | 47 |
| 2022 May | 30 | 17 | 47 |
| 2022 April | 20 | 12 | 32 |
| 2022 March | 18 | 11 | 29 |
| 2022 February | 12 | 9 | 21 |
| 2022 January | 14 | 8 | 22 |
| 2021 December | 17 | 17 | 34 |
| 2021 November | 24 | 8 | 32 |
| 2021 October | 24 | 12 | 36 |
| 2021 September | 15 | 12 | 27 |
| 2021 August | 14 | 9 | 23 |
| 2021 July | 14 | 8 | 22 |
| 2021 June | 16 | 11 | 27 |
| 2021 May | 22 | 5 | 27 |
| 2021 April | 77 | 18 | 95 |
| 2021 March | 19 | 13 | 32 |
| 2021 February | 10 | 11 | 21 |
| 2021 January | 7 | 7 | 14 |
| 2020 December | 1 | 4 | 5 |
| 2020 November | 0 | 2 | 2 |
| 2020 October | 2 | 1 | 3 |
| 2020 September | 0 | 3 | 3 |
| 2020 August | 0 | 3 | 3 |
| 2020 July | 0 | 1 | 1 |
| 2020 June | 0 | 3 | 3 |
| 2020 May | 0 | 4 | 4 |
| 2020 April | 0 | 4 | 4 |
| 2020 March | 0 | 4 | 4 |
| 2020 February | 0 | 6 | 6 |
| 2020 January | 0 | 3 | 3 |
| 2019 December | 0 | 3 | 3 |
| 2019 November | 0 | 2 | 2 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 0 | 4 | 4 |
| 2019 August | 0 | 6 | 6 |
| 2019 July | 0 | 14 | 14 |
| 2019 June | 0 | 13 | 13 |
| 2019 May | 0 | 13 | 13 |
| 2019 April | 0 | 15 | 15 |
| 2019 March | 0 | 2 | 2 |
| 2019 February | 0 | 3 | 3 |
| 2018 February | 8 | 1 | 9 |
| 2018 January | 9 | 5 | 14 |
| 2017 December | 10 | 2 | 12 |
| 2017 November | 14 | 4 | 18 |
| 2017 October | 12 | 4 | 16 |
| 2017 September | 13 | 7 | 20 |
| 2017 August | 19 | 16 | 35 |
| 2017 July | 20 | 7 | 27 |
| 2017 June | 12 | 6 | 18 |
| 2017 May | 31 | 7 | 38 |
| 2017 April | 23 | 6 | 29 |
| 2017 March | 21 | 9 | 30 |
| 2017 February | 30 | 10 | 40 |
| 2017 January | 12 | 3 | 15 |
| 2016 December | 23 | 7 | 30 |
| 2016 November | 44 | 7 | 51 |
| 2016 October | 55 | 10 | 65 |
| 2016 September | 77 | 5 | 82 |
| 2016 August | 38 | 23 | 61 |
| 2016 July | 8 | 7 | 15 |
| 2016 June | 25 | 13 | 38 |
| 2016 May | 19 | 8 | 27 |
| 2016 April | 25 | 16 | 41 |
| 2016 March | 20 | 18 | 38 |
| 2016 February | 22 | 20 | 42 |
| 2016 January | 18 | 18 | 36 |
| 2015 December | 28 | 16 | 44 |
| 2015 November | 22 | 17 | 39 |
| 2015 October | 41 | 13 | 54 |
| 2015 September | 21 | 7 | 28 |
| 2015 August | 34 | 7 | 41 |
| 2015 July | 24 | 5 | 29 |
| 2015 June | 13 | 6 | 19 |
| 2015 May | 7 | 7 | 14 |
| 2015 April | 19 | 11 | 30 |
| 2015 March | 12 | 16 | 28 |
| 2015 February | 11 | 18 | 29 |
| 2015 January | 35 | 6 | 41 |
| 2014 November | 1 | 2 | 3 |
| 2014 October | 1 | 0 | 1 |
| 2014 August | 0 | 1 | 1 |
| 2014 July | 1 | 1 | 2 |
| 2014 June | 0 | 1 | 1 |
| 2014 May | 1 | 0 | 1 |
| 2014 April | 0 | 1 | 1 |
| 2014 March | 27 | 12 | 39 |
| 2014 February | 8 | 5 | 13 |
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