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"documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Med Clin. 2016;147:250-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Medical indications for acupuncture: Systematic review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "256" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Indicaciones médicas de la acupuntura: revisión sistemática" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1692 "Ancho" => 2123 "Tamanyo" => 201797 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Flowchart of reviews.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Muñoz-Ortego, Maite Solans-Domènech, Carme Carrion" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juan" "apellidos" => "Muñoz-Ortego" ] 1 => array:2 [ "nombre" => "Maite" "apellidos" => "Solans-Domènech" ] 2 => array:2 [ "nombre" => "Carme" "apellidos" => "Carrion" ] 3 => array:1 [ "colaborador" => "on behalf of ABE Working Group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775316001822" "doi" => "10.1016/j.medcli.2016.02.029" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775316001822?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616306040?idApp=UINPBA00004N" "url" => "/23870206/0000014700000006/v1_201612070134/S2387020616306040/v1_201612070134/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Morpheiform sarcoidosis as atypical manifestation of sarcoidosis. Review of the literature and differential diagnosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "261" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Castellanos-González, María Remedios Picazo Talavera" "autores" => array:2 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Castellanos-González" "email" => array:1 [ 0 => "maria.castellanos.gonzalez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María Remedios" "apellidos" => "Picazo Talavera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología y Venereología, Hospital del Sureste, Arganda del Rey, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital del Sureste, Arganda del Rey, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis morfeiforme como manifestación atípica de sarcoidosis. Revisión de la bibliografía y diagnóstico diferencial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 891 "Ancho" => 1001 "Tamanyo" => 117660 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patient had bilateral induration in both arms, symmetrically, as the only clinical feature, with no erythema or signs of inflammation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a systemic disease of unknown cause, mainly characterized by the formation of non-necrotizing granulomas in the affected organs. There is skin involvement in up to 25–30% of cases.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Due to the variety of cutaneous manifestations, traditionally they have been classified into specific and non-specific, considering specific the appearance of non-necrotizing granulomas in the histopathological study. By contrast, non-specific manifestations correspond with lesions reactive to systemic sarcoidosis, but without being able to show granulomas on biopsy.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most frequent specific lesions are papules, plaques, nodules, ulcers and scars,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> although they can be so different that it has come to be known as a “great imitator” because it can simulate a variety of systemic diseases. In many cases, establishing the diagnosis is a real clinical challenge.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> Among these conditions, we would like to highlight morpheaform sarcoidosis for its infrequency, its diagnostic difficulty and its similarity to other diseases. Since its first description in 1990 by Hess et al.,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> there have been only 7 cases reported to date.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5–9</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows a summary of all of them and one additional patient recently diagnosed in our centre.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical signs and symptoms</span><p id="par0015" class="elsevierStylePara elsevierViewall">The morpheaform sarcoidosis is a very unusual and rare manifestation of sarcoidosis. Of the 8 cases described, the vast majority are women (7 of 8 patients) and have been observed mostly in white patients. The average age at diagnosis was 57.8<span class="elsevierStyleHsp" style=""></span>years, but the range is very wide, going from 17 to 81<span class="elsevierStyleHsp" style=""></span>years of age. The common finding in all of them, which characterizes the condition, is the clinical appearance of the lesions, which are indistinguishable to those produced by classical morphea. That is, these patients present with skin lesions in different locations, as indurated and infiltrated plaques, erythematous or purplish appearance initially, that acquire a brownish appearance with the passage of time, typical of morphea. Some have been described as having an atrophic appearance<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> and, in some cases, a linear distribution.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5,7</span></a> The patient valued at our centre presented with a significant bilateral and symmetrical induration of the forearms, without erythema or increased temperature, sclerodermiform and with a groove sign (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>), being the first case with these characteristics to date. Only 2 of them had a previous diagnosis of sarcoidosis<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> and the progression time varied from 3 months to 40<span class="elsevierStyleHsp" style=""></span>years. In all cases, including ours, typical sarcoid granulomas were found in the biopsy, which was essential to establish the diagnosis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and B). In addition, a significant fibrosis in the dermis stands out as a finding which is very characteristic of morphea and responsible for the indurated appearance of the lesions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Although, in some cases, the additional study did not result in significant changes, most patients presented findings in the lab tests, additional symptoms and/or accompanying pulmonary disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), resulting in the definitive diagnosis of sarcoidosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism by which fibrosis occurs in this form of sarcoidosis is unknown. It has been postulated that activated T cells and macrophages coming from sarcoid granulomas release cytokines that could stimulate the formation of collagen.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Diagnosis and differential diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">In patients with these signs and symptoms, seems unlikely to think of sarcoidosis as the first suspected diagnosis. This was made based on clinical manifestations, biopsy findings (presence of typical granulomas), laboratory abnormalities (e.g. elevated angiotensin converting enzyme, hypercalcemia or hypercalciuria) and chest radiography (mainly hilar lymphadenopathy, among others). It is important to note that the fact of having a compatible biopsy as the only finding is not sufficient to establish the diagnosis, so, conducting a complementary study and making a good differential diagnosis is essential.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">If lesions are isolated, the first clinical screening should be done with classical morphea or, as it happened in our case, if the features are broader, such as with sclerodermiform symptoms, mainly with localized systemic sclerosis, but also with eosinophilic fasciitis, lupus panniculitis or lipodermatosclerosis, among others.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We cannot forget that sarcoidosis can simulate these disorders but can also be associated with them, constituting overlap syndromes. In fact, in recent decades, sarcoidosis concomitant with other autoimmune diseases (lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome) has been reported more often, and published cases of systemic sclerosis associated with sarcoidosis<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13,14</span></a> are already numerous. It is therefore vital to determine whether the symptoms can be explained by sarcoidosis or whether it is an overlap because the prognosis and treatment will be different. For example, while lung involvement in systemic sclerosis can be progressive and fatal, the one caused by sarcoidosis usually has a more favourable course.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Following this line, the result of the biopsy will be decisive and crucial. The presence of non-necrotizing granulomas is the key to consider the cutaneous manifestation as a possible symptom of sarcoidosis and not as a sarcoidosis-sclerodermiform symptoms overlap syndrome. In the latter, there is a prevalence of a very significant sclerosis and loss of skin appendages with poor lymphocytic infiltrate, but without the presence of granulomas. In the case of eosinophilic fasciitis further thickening of the fascia will be observed, together with positive immunofluorescence and IgM deposition along the basement membrane, as well as eosinophils, and, in the case of a lupus panniculitis, typical lupus alterations will be seen in the dermal-epidermal junction.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition, clinical and laboratory findings will guide us to the proper diagnosis. So, if in addition of indurated or sclerodermiform lesions there are periungual telangiectasia, Raynaud, decreased mouth opening or dyspnoea and positive anti-centromere and anti-SCL-70 antibodies, probably we will be facing a systemic sclerosis.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> If the patient, however, presents peripheral eosinophilia and hypergammaglobulinaemia and induration is spacious with an active erythematous edge, it is more likely to be an eosinophilic fasciitis.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> On the other hand, if the patient has brownish indurated lesions with irregular borders, small, circumferential ulcers, mainly located around the ankle, with typical “champagne bottleneck” image, a lipodermatosclerosis should be the first diagnostic option.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Finally, other diseases with granulomas should also be ruled out such as tuberculosis, atypical mycobacterial infections, fungal infections, leishmaniasis, rheumatoid nodules or foreign body reactions. The presence or absence of necrosis, special histological stains, the tuberculin test, sputum and urine cultures, as well as chest radiography and laboratory findings will help us to rule out these entities.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Treatment</span><p id="par0060" class="elsevierStylePara elsevierViewall">Treatment is mainly established taking into account the systemic manifestations, with special emphasis on pulmonary, ocular, cardiac or neurological disease, requiring a multidisciplinary approach.</p><p id="par0065" class="elsevierStylePara elsevierViewall">With regard to the skin, the signs and symptoms, the location and the distribution of lesions will be taken into account, so that the treatment will be aimed at reducing the symptoms or prevent deformity, joint stiffness or the appearance of scars. To date there are many therapeutic options for the treatment of cutaneous sarcoidosis, but there is little evidence about what is the best management.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In general, if lesions are very localized, the first-line treatment is topical or intralesional corticosteroids, which are the most widely used, although there is little evidence to support their use.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> There are promising results regarding the treatment with pulsed-dye laser for more localized lesions of sarcoidosis and lichen sclerosus, which could be useful in some cases if other treatments have not worked.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> When the skin condition is more extensive or the signs and symptoms are more limiting, it will be necessary to establish a systemic treatment. Oral glucocorticoids are currently the therapy of choice for those cases where there is rapid progression or where topical therapy was not satisfactory. As alternatives or with the aim of reducing the dose of oral corticosteroids, methotrexate and antimalarial agents, mainly hydroxychloroquine, are among the most widely used treatments. In selected cases, the use of tetracyclines or thalidomide may be beneficial.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">18,19</span></a> In recalcitrant cases, benefit has been described with tumour necrosis factor inhibitors such as infliximab, etanercept and adalimumab.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, the majority of patients, including the patient assessed at our centre, received systemic glucocorticoid treatment and/or hydroxychloroquine, with very good progress.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Sarcoidosis has a broad spectrum of skin manifestations. Because of its ability to simulate typical morpheaform or sclerodermiform clinical features, it is necessary to consider this diagnosis when considering an approach for a patient of these characteristics.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres768777" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec769753" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres768778" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec769752" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical signs and symptoms" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Diagnosis and differential diagnosis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Treatment" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-08" "fechaAceptado" => "2016-02-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec769753" "palabras" => array:3 [ 0 => "Sarcoidosis" 1 => "Granuloma" 2 => "Sclerosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec769752" "palabras" => array:3 [ 0 => "Sarcoidosis" 1 => "Granulomas" 2 => "Esclerosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sarcoidosis is an idiopathic multisystem granulomatous disease that commonly involves the skin in 25% of affected patients. Because lesions assume a vast array of morphologies, a classification dividing them into specific (with presence of typical granulomas in the biopsy) or nonspecific (not containing granulomas) has been proposed. In the first group the variant morpheaform is considered exceptional. We review the cases reported in the literature and describe the possible differential diagnosis. We highlight the importance of recognizing the very atypical presentation of sarcoidosis and its ability to mimic morpheaform or sclerosis diseases in our patients.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La sarcoidosis se considera una enfermedad multisistémica, idiopática que se caracteriza por la formación de granulomas en los órganos afectados. Las manifestaciones clínicas son muy diversas y tradicionalmente se han clasificado como específicas (con presencia de granulomas típicos en la biopsia) y no específicas (sin granulomas). Dentro del primer grupo, la variante de sarcoidosis morfeiforme se considera excepcional y puede suponer un auténtico reto diagnóstico para el clínico. Hacemos una revisión de todos los casos descritos hasta la fecha y planteamos los posibles diagnósticos diferenciales. Resaltamos la importancia de conocer las formas atípicas de sarcoidosis y la capacidad para simular cuadros morfeiformes o esclerodermiformes en los pacientes que la padecen.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castellanos-González M, Picazo Talavera MR. Sarcoidosis morfeiforme como manifestación atípica de sarcoidosis. Revisión de la bibliografía y diagnóstico diferencial. Med Clin (Barc). 2016;147:257–261.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 891 "Ancho" => 1001 "Tamanyo" => 117660 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patient had bilateral induration in both arms, symmetrically, as the only clinical feature, with no erythema or signs of inflammation.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 752 "Ancho" => 1002 "Tamanyo" => 86880 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In addition to the marked induration on forearms, the presence of a depressed longitudinal groove stood out.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1538 "Ancho" => 999 "Tamanyo" => 671124 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) H–E 40×: numerous epithelioid granulomas located in dermis were observed in the biopsy. (B) H–E 120×: at increased magnification, in addition to granulomas, multinucleated giant cells and Langhans type cells were observed, surrounded by a discrete lymphocyte crown.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ANA, antinuclear antibodies; ACE, angiotensin converting enzyme; RF, rheumatoid factor; SCT, subcutaneous cellular tissue.</p>" "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"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Publication year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Race \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical signs and symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Known sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Progression time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biopsy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lab tests/autoimmunity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lung disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment and progression \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hess et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1990 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Linear morphea in arms/shoulders/thighs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arthralgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>colchicine<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>hydroxychloroquine sulphate. Torpid progression until the introduction of hydroxychloroquine sulphate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Burov et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Black \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiple atrophic plaques in the buttocks, sacrum, legs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (20 years earlier) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomas<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>sclerosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High ACE. ANA<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1/40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral hilar lymphadenopathy. Restrictive lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone and high potency topical corticosteroids. Good progression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Burov et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Black \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indurated plaque in the left thigh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (at 35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarcoid granulomas. Thickened collagen. Subcutaneous fat sclerosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RF+. Rest normal or negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Restrictive lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyarthralgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone and azathioprine. Hydroxychloroquine, suspended due to poor tolerance. Chloroquine and topical and intralesional corticosteroids. Partial response \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Burov et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Black \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Plaques in hands, forearms and anterior thighs, initially erythematous and indurated through progression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Typical sarcoid granulomas and sclerosis in dermis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">High ACE. Rest negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polyarthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical corticosteroids and hydroxychloroquine. Good progression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ginarte et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Induration left leg, knee, thigh and ipsilateral buttock. Palpation of 2 nodules in right knee and right buttock, indurated. Fibrotic plaque in trunk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomas in upper and lower dermis and SCT. Dermis collagenisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal or negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stage III pulmonary sarcoidosis: thickening of interlobular septa in upper and middle lobes. Restrictive pattern in pulmonary function tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral uveitis 3<span class="elsevierStyleHsp" style=""></span>años before \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone 2 months<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>hydroxychloroquine 6 months. Good progression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Choi et al.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Morphea plaque in arm, in the form of erythematous plaque that gradually becomes indurated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomas in deep dermis and SCT and prominent dermal sclerosis, asteroid bodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal or negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal Rx. Restrictive pattern in functional tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intralesional triamcinolone. Good progression after two months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vasaghi and Kalafi<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiple morphoeic plaques in face, arms and feet, with yellowish halo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granulomatous chronic inflammation, severe fibrosis, calcification foci \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Impaired liver function (MTX tox) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Initially diagnosed as leishmania and then morphea (without biopsy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prednisolone<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>hydroxychloroquine. Good performance after only 2 weeks of treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Castellanos-González and Picazo-Talavera \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral and symmetrical tightening of arms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Non-necrotizing granulomas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ANA<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>(1/1280). High ACE. Hypercalcemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mediastinal lymph nodes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral prednisone<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1272310.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cases of morpheaform sarcoidosis published to date.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin manifestations of sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. 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