Lupus eritematoso cutáneo crónico
Palabras clave:
lupus eritematoso, lupus eritematoso cutáneo crónico, lupus discoideResumen
El lupus eritematoso cutáneo crónico (LECC) es una dermatosis inflamatoria de causa no clara, probablemente de origen autoinmune; hace parte de las
lesiones cutáneas específicas del lupus eritematoso, junto con el lupus eritematoso agudo (LEA) y el subagudo (LECS), conformando el lupus eritematoso cutáneo. Tiene varios subtipos basados en la morfología de las lesiones y características histopatológicas. El más frecuente es el lupus discoide (LD), y muchos autores utilizan este término como sinónimo del LECC. Su enfoque terapéutico se hace de forma escalonada. La primera línea es la fotoprotección
y los corticoides tópicos, con los cuales se obtiene mejoría en un 70% de los casos.
Biografía del autor/a
Andres Vidal C., Universidad del Valle
RII Dermatología Universidad del Valle, Cali, Colombia.
Referencias bibliográficas
1. Cardinali C, Caproni M, Bernacchi E, et al. The spectrum of cutaneous manifestations in lupus erythematosus - The ltalian experience. Lupus 2000; 9:417-423.
https://doi.org/10.1191/096120300678828569
2. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25:271-277.
https://doi.org/10.1002/art.1780251101
3. Gilliam JN. The cutaneous signs of. lupus erythematosus. Continuing Education for the Family Physician 1977, 6:34-70.
4. Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol 1981; 4:471-475.
https://doi.org/10.1016/S0190-9622(81)80261-7
5. Yell JA, Buagbaw JM, Burge SM. Cutaneous manifestation of systemic lupus erythematosus. Br J Dermatol 1996; 135: 355-362.
https://doi.org/10.1111/j.1365-2133.1996.tb01495.x
6. Sontheimer RD. The lexicon of cutaneous lupus erythematosus: a review and personal perspective on the nomenclature and classification of the cutaneous manifestation of lupus erythematosus. Lupus 1997; 6:84-95.
https://doi.org/10.1177/096120339700600203
7. Sontheimer RD. Lupus erythematosus. En: Freedberg IM, Eizen AZ., Wolff K, et al. Fitzpatrick's. Dermatology in General Medicine. McGraw-Hill, New York 1999:2109-2126.
8. McCauliffe D. Cutaneous lupus erythematosus. Seminars in Cutaneous Medicine and Surgery 2001; 20: 14-26.
https://doi.org/10.1053/sder.2001.23091
9. Ng PP, Tan SH, Koh ET, et al. Epidemiology. of cutaneous lupus erythematosus in a tertiary referral center in Singapure. Australas J Dermatol 2000; 41 :229-233.
https://doi.org/10.1046/j.1440-0960.2000.00443.x
10. Patel P, Werth V. Cutaneous lupus erythematosus: A Review. Dermatol Clin 2002; 20:373-385.
https://doi.org/10.1016/S0733-8635(02)00016-5
11. Chlebus E, Wolska H, Blaszczyk M, et al. Subacute cutaneous lupus erythematosus versus systemic lupus erythematosus: Diagnostic criteria and therapeutic implications. J Am Acam Dermatol 1998; 38:405-412.
https://doi.org/10.1016/S0190-9622(98)70497-9
12. Parodi A, Caproni M, Cardinali C, et al. Clinical, histological and immunopathological features of 58 patients with subacute cutaneous lupus erythematosus: a review by the ltalian group of lmmunodermatology. Dermatol 2000; 200:6-10.
https://doi.org/10.1159/000018307
13. Rowell NR, Goodfield MJD. The connective tissue diseases. En: Champion RH, Burton JL, Burns DA, et al. Rook Textbook of Dermatology, Londres, Blackwell Science 1998:2437-2577.
14. Millard TP, McGregor M. Molecular genetics of cutaneous lupus erythematosus. Clin Exp Dermatol 2001; 26:184-191.
https://doi.org/10.1046/j.1365-2230.2001.00793.x
15. Orteu C, Sontheimer R, Dutz J. The pathophysiology of photosensitivity in lupus erythematosus. Photodermatol, Photoinmmunol, Photomed 2001; 17:95-113.
https://doi.org/10.1034/j.1600-0781.2001.170301.x
16. Toro J, Finlay D, Dou X, et al. Detection of type 1 cytokines in discoid lupus erythematosus. Arch Dermatol 2000; 136:1497-1501.
https://doi.org/10.1001/archderm.136.12.1497
17. Tebbe B, Mansmann U, Wollina U, et al. Markers in cutaneous lupus erythematosus indicating systemic involvement: a multicenter study on 296 patients. Acta Derm Venereol 1997; 77:305-308.
18. Hansan T, Nyberg F, Stephanson E, et al. Photosensivity in lupus erythematosus, ·uv photoprovocation results compared with history of photosensivity and clinical finding. Br J Dermatol 1997; 136:699-705.
https://doi.org/10.1111/j.1365-2133.1997.tb03655.x
19. Fabbri P, Cardinali C, Giomi S et al. Cutaneous Lupus Erythematosus. Am J Clin Dermatol 2003; 4:449-465.
https://doi.org/10.2165/00128071-200304070-00002
20. Wilson CL, Surge SM, Dean D, et al. Scarring alopecia in discoid lupus erythematosus. Sr J Dermatol 1992; 126: 307-314.
https://doi.org/10.1111/j.1365-2133.1992.tb00670.x
21. Surge SM, Frith PA, Juniper RP, et al. Mucosa! involve- ment in systemic and chronic cutaneous lupus erythe-matosus. Sr J Dermatol 1989; 121 :727-741.
https://doi.org/10.1111/j.1365-2133.1989.tb08215.x
22. Pianigiani E, Andreassi A, Giovambattista A, et al. Chro-nic erythematosus desquamative plaques of the eye-lids. Arch Dermatol 2002; 138:527-532.
https://doi.org/10.1001/archderm.138.4.527
23. Cyran S, Douglass MC, Silverstein JL. Chronic cuta-neous lupus erythematosus presenting as periorbital edema and erythema. J Am Dermatol 1992; 26:334-338.
https://doi.org/10.1016/0190-9622(92)70049-L
24. Sraun RP, French LE, Massouye 1, et al. Periorbital oedema and erythema as a manifestation of discoid lupus erythematosus.Dermatology 2002; 205:194-197.
https://doi.org/10.1159/000063915
25. Selva D, Chen C, James C et al. Discoid lupus erythe- matosus presenting as madarosis. Am J Ophthalmol 2003; 136:545-546.
https://doi.org/10.1016/S0002-9394(03)00231-9
26. Goyal S, Nousari HG. Treatment of resistant discoid lu-pus erythematosus of the palms and soles with myco-phenolate mofetil. J Am Acad Dermatol 2001; 45: 142- 144.
https://doi.org/10.1067/mjd.2001.114297
27. Wollina U, Sarta U, Uhlemann C, et al. Lupus erythe-matosus-associated red lunula. J Am Acad Dermatol 1999; 41:419-421.
https://doi.org/10.1016/S0190-9622(99)70115-5
28. Zeitouni NC, Funaro D, Cloutier RA. Redefining Rowell's syndrome. Sr J Dermatol 2000; 142:343-346.
https://doi.org/10.1046/j.1365-2133.2000.03306.x
29. Cherif F, Mebazaa A, Moukni M, et al. Chilhood discoid lupus erythematosus: A Tunisian retrospective study of 16 cases. Pediatr Dermatol 2003; 20:295-298.
https://doi.org/10.1046/j.1525-1470.2003.20402.x
30. Moises C, Serrón R, Carrasco D, et al. Discoid lupus erythematosus in children: clinical, histopathologic and follow features in 27 cases. Pediatr Dermatol 2003; 20:103-107.
https://doi.org/10.1046/j.1525-1470.2003.20201.x
31. George PM, Hood AF, Rest ES. Histopathology and im- munofluorescence of discoid lupus erythematosus in children. Pediatr Dermatol. 1996 Jul-Aug;13(4):269-73.
https://doi.org/10.1111/j.1525-1470.1996.tb01236.x
32. George P, Tunnessen W. Childhood discoid lupus erythematosus. Arch Dermatol 1993; 129:613-617.
https://doi.org/10.1001/archderm.1993.01680260083012
33. Green JJ, Saker DJ. Linear chilhood discoid lupus erythematosus following the lines of Slashko: a case report with review of the linear manifestation of LE. Pediatr Dermatol 1999; 16: 128-133.
https://doi.org/10.1046/j.1525-1470.1999.00030.x
34. Abe M, lshikawa O, Miyachi Y. Linear cutaneous lupus erythematosus following the lines of Slashko. Sr J Der- matol 1998; 139:307-310.
https://doi.org/10.1046/j.1365-2133.1998.02373.x
35. Crowson AN, Magro C. The cutaneous pathology of lupus erythematosus: a review. J Cutan Pathol 2001; 28:1-23.
https://doi.org/10.1034/j.1600-0560.2001.280101.x
36. Cardinali C, Caproni M, Fabbri P. The utility of the lu- pus band test on sun-protected non-lesiona! skin in pa-tients with cutaneous lupus erythematosus. Lupus 1999; 8:755-760.
https://doi.org/10.1191/096120399678840945
37. Segura S, Mascaró JM, Herrero C. Paniculitis en las enfermedades del tejido conectivo. Piel 2003; 18:488-493.
https://doi.org/10.1016/S0213-9251(03)72763-4
38. González M, González R, Soloeta R. Perniosis lúpica. Piel 2002; 17:254-258.
https://doi.org/10.1016/S0213-9251(02)72585-9
39. Cribier S, Djeridi N, Peltre S, et al. A histologic and in- mmunohistochemical study of chilblains J Am Acad Der-matol 2001; 45:924-929.
https://doi.org/10.1067/mjd.2001.117861
40. Kuhn A, Richter-Hintz D, Oslislo C, et al. Lupus erythe-matosus tumidus. A neglected subset of cutaneous lu- pus erythematosus: report of 40 cases. Arch Dermatol 2000; 136: 1033-1041.
https://doi.org/10.1001/archderm.136.8.1033
41. Dekle C, Mannes K, Davis L, et al. Lupus tumidus. J Am Acad Dermatol 1999; 41 :250-253.
https://doi.org/10.1016/S0190-9622(99)70056-3
42. Lever WF, Schaumberg-Lever G. Connective tissue di- seases. En: Lever WF, Schaumberg-Lever G. Histopa-thology of the Skin, Philadelphia, JS Lippincot Co 1990:494-522.
43. Tercedor J. Enfoque terapéutico del lupus eritematoso cutáneo. Piel 2002; 17:386-390.
https://doi.org/10.1016/S0213-9251(02)72621-X
44. Ting WW, Sontheimer RD. Local therapy for cutaneous and systemic lupus erythematosus: practica! and theori-cal considerations. Lupus 2001; 10: 171-184.
https://doi.org/10.1191/096120301667674688
45. Callen J. Management of skin disease in patients with lupus erithematosus. Sest Practice & Research Clini-cal Rheumatology 2002; 16:245-264.
https://doi.org/10.1053/berh.2001.0224
46. Sielsa l. Uso de los antimaláricos en dermatología. Piel 2003; 18:515-518.
https://doi.org/10.1016/S0213-9251(03)72770-1
47. Van Seek M, Piette W. Antimalarials. Dermatol Clin 2001; 19:147-160.
https://doi.org/10.1016/S0733-8635(05)70236-9
48. Karim MY, Ruiz G, Khamashta MA, et al. Update on therapy - Thalidomide in the treatment of lupus. Lupus 2001; 10: 188-192.
https://doi.org/10.1191/096120301677213822
49. Ruzicka TSC, Goerz G, Kind P, et al. Treatment of cu-taneous lupus erythematosus with acitretin and hi-droxycloroquine. Sr J Dermatol 1992; 127:513-518.
https://doi.org/10.1111/j.1365-2133.1992.tb14851.x
50. Walker SI, Kirby S, Chalmers R. The effect of topical tacrolimus on severe recalcitrant chronic discoid lupus erythematosus. Sr J Dermatol 2002; 147:405-406.
https://doi.org/10.1046/j.1365-2133.2002.488616.x
51. Yoshimasu T, Ohtani T, Sakamoto T, et al. Topical ta-crolimus therapy for facial erythematosus lesions of cu- taneous lupus erythematosus and dermatomyositis. Eur J Dermatol 2002; 12:50-52.
52. Gerdsen R, Wenzel J, Uerlich T, et al. Successful treat-ment of chronic discoid lupus erythematosus of the scalp with imiquimod. Dermatology 2002; 205:416-418.
https://doi.org/10.1159/000066428
https://doi.org/10.1191/096120300678828569
2. Tan EM, Cohen AS, Fries JF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25:271-277.
https://doi.org/10.1002/art.1780251101
3. Gilliam JN. The cutaneous signs of. lupus erythematosus. Continuing Education for the Family Physician 1977, 6:34-70.
4. Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol 1981; 4:471-475.
https://doi.org/10.1016/S0190-9622(81)80261-7
5. Yell JA, Buagbaw JM, Burge SM. Cutaneous manifestation of systemic lupus erythematosus. Br J Dermatol 1996; 135: 355-362.
https://doi.org/10.1111/j.1365-2133.1996.tb01495.x
6. Sontheimer RD. The lexicon of cutaneous lupus erythematosus: a review and personal perspective on the nomenclature and classification of the cutaneous manifestation of lupus erythematosus. Lupus 1997; 6:84-95.
https://doi.org/10.1177/096120339700600203
7. Sontheimer RD. Lupus erythematosus. En: Freedberg IM, Eizen AZ., Wolff K, et al. Fitzpatrick's. Dermatology in General Medicine. McGraw-Hill, New York 1999:2109-2126.
8. McCauliffe D. Cutaneous lupus erythematosus. Seminars in Cutaneous Medicine and Surgery 2001; 20: 14-26.
https://doi.org/10.1053/sder.2001.23091
9. Ng PP, Tan SH, Koh ET, et al. Epidemiology. of cutaneous lupus erythematosus in a tertiary referral center in Singapure. Australas J Dermatol 2000; 41 :229-233.
https://doi.org/10.1046/j.1440-0960.2000.00443.x
10. Patel P, Werth V. Cutaneous lupus erythematosus: A Review. Dermatol Clin 2002; 20:373-385.
https://doi.org/10.1016/S0733-8635(02)00016-5
11. Chlebus E, Wolska H, Blaszczyk M, et al. Subacute cutaneous lupus erythematosus versus systemic lupus erythematosus: Diagnostic criteria and therapeutic implications. J Am Acam Dermatol 1998; 38:405-412.
https://doi.org/10.1016/S0190-9622(98)70497-9
12. Parodi A, Caproni M, Cardinali C, et al. Clinical, histological and immunopathological features of 58 patients with subacute cutaneous lupus erythematosus: a review by the ltalian group of lmmunodermatology. Dermatol 2000; 200:6-10.
https://doi.org/10.1159/000018307
13. Rowell NR, Goodfield MJD. The connective tissue diseases. En: Champion RH, Burton JL, Burns DA, et al. Rook Textbook of Dermatology, Londres, Blackwell Science 1998:2437-2577.
14. Millard TP, McGregor M. Molecular genetics of cutaneous lupus erythematosus. Clin Exp Dermatol 2001; 26:184-191.
https://doi.org/10.1046/j.1365-2230.2001.00793.x
15. Orteu C, Sontheimer R, Dutz J. The pathophysiology of photosensitivity in lupus erythematosus. Photodermatol, Photoinmmunol, Photomed 2001; 17:95-113.
https://doi.org/10.1034/j.1600-0781.2001.170301.x
16. Toro J, Finlay D, Dou X, et al. Detection of type 1 cytokines in discoid lupus erythematosus. Arch Dermatol 2000; 136:1497-1501.
https://doi.org/10.1001/archderm.136.12.1497
17. Tebbe B, Mansmann U, Wollina U, et al. Markers in cutaneous lupus erythematosus indicating systemic involvement: a multicenter study on 296 patients. Acta Derm Venereol 1997; 77:305-308.
18. Hansan T, Nyberg F, Stephanson E, et al. Photosensivity in lupus erythematosus, ·uv photoprovocation results compared with history of photosensivity and clinical finding. Br J Dermatol 1997; 136:699-705.
https://doi.org/10.1111/j.1365-2133.1997.tb03655.x
19. Fabbri P, Cardinali C, Giomi S et al. Cutaneous Lupus Erythematosus. Am J Clin Dermatol 2003; 4:449-465.
https://doi.org/10.2165/00128071-200304070-00002
20. Wilson CL, Surge SM, Dean D, et al. Scarring alopecia in discoid lupus erythematosus. Sr J Dermatol 1992; 126: 307-314.
https://doi.org/10.1111/j.1365-2133.1992.tb00670.x
21. Surge SM, Frith PA, Juniper RP, et al. Mucosa! involve- ment in systemic and chronic cutaneous lupus erythe-matosus. Sr J Dermatol 1989; 121 :727-741.
https://doi.org/10.1111/j.1365-2133.1989.tb08215.x
22. Pianigiani E, Andreassi A, Giovambattista A, et al. Chro-nic erythematosus desquamative plaques of the eye-lids. Arch Dermatol 2002; 138:527-532.
https://doi.org/10.1001/archderm.138.4.527
23. Cyran S, Douglass MC, Silverstein JL. Chronic cuta-neous lupus erythematosus presenting as periorbital edema and erythema. J Am Dermatol 1992; 26:334-338.
https://doi.org/10.1016/0190-9622(92)70049-L
24. Sraun RP, French LE, Massouye 1, et al. Periorbital oedema and erythema as a manifestation of discoid lupus erythematosus.Dermatology 2002; 205:194-197.
https://doi.org/10.1159/000063915
25. Selva D, Chen C, James C et al. Discoid lupus erythe- matosus presenting as madarosis. Am J Ophthalmol 2003; 136:545-546.
https://doi.org/10.1016/S0002-9394(03)00231-9
26. Goyal S, Nousari HG. Treatment of resistant discoid lu-pus erythematosus of the palms and soles with myco-phenolate mofetil. J Am Acad Dermatol 2001; 45: 142- 144.
https://doi.org/10.1067/mjd.2001.114297
27. Wollina U, Sarta U, Uhlemann C, et al. Lupus erythe-matosus-associated red lunula. J Am Acad Dermatol 1999; 41:419-421.
https://doi.org/10.1016/S0190-9622(99)70115-5
28. Zeitouni NC, Funaro D, Cloutier RA. Redefining Rowell's syndrome. Sr J Dermatol 2000; 142:343-346.
https://doi.org/10.1046/j.1365-2133.2000.03306.x
29. Cherif F, Mebazaa A, Moukni M, et al. Chilhood discoid lupus erythematosus: A Tunisian retrospective study of 16 cases. Pediatr Dermatol 2003; 20:295-298.
https://doi.org/10.1046/j.1525-1470.2003.20402.x
30. Moises C, Serrón R, Carrasco D, et al. Discoid lupus erythematosus in children: clinical, histopathologic and follow features in 27 cases. Pediatr Dermatol 2003; 20:103-107.
https://doi.org/10.1046/j.1525-1470.2003.20201.x
31. George PM, Hood AF, Rest ES. Histopathology and im- munofluorescence of discoid lupus erythematosus in children. Pediatr Dermatol. 1996 Jul-Aug;13(4):269-73.
https://doi.org/10.1111/j.1525-1470.1996.tb01236.x
32. George P, Tunnessen W. Childhood discoid lupus erythematosus. Arch Dermatol 1993; 129:613-617.
https://doi.org/10.1001/archderm.1993.01680260083012
33. Green JJ, Saker DJ. Linear chilhood discoid lupus erythematosus following the lines of Slashko: a case report with review of the linear manifestation of LE. Pediatr Dermatol 1999; 16: 128-133.
https://doi.org/10.1046/j.1525-1470.1999.00030.x
34. Abe M, lshikawa O, Miyachi Y. Linear cutaneous lupus erythematosus following the lines of Slashko. Sr J Der- matol 1998; 139:307-310.
https://doi.org/10.1046/j.1365-2133.1998.02373.x
35. Crowson AN, Magro C. The cutaneous pathology of lupus erythematosus: a review. J Cutan Pathol 2001; 28:1-23.
https://doi.org/10.1034/j.1600-0560.2001.280101.x
36. Cardinali C, Caproni M, Fabbri P. The utility of the lu- pus band test on sun-protected non-lesiona! skin in pa-tients with cutaneous lupus erythematosus. Lupus 1999; 8:755-760.
https://doi.org/10.1191/096120399678840945
37. Segura S, Mascaró JM, Herrero C. Paniculitis en las enfermedades del tejido conectivo. Piel 2003; 18:488-493.
https://doi.org/10.1016/S0213-9251(03)72763-4
38. González M, González R, Soloeta R. Perniosis lúpica. Piel 2002; 17:254-258.
https://doi.org/10.1016/S0213-9251(02)72585-9
39. Cribier S, Djeridi N, Peltre S, et al. A histologic and in- mmunohistochemical study of chilblains J Am Acad Der-matol 2001; 45:924-929.
https://doi.org/10.1067/mjd.2001.117861
40. Kuhn A, Richter-Hintz D, Oslislo C, et al. Lupus erythe-matosus tumidus. A neglected subset of cutaneous lu- pus erythematosus: report of 40 cases. Arch Dermatol 2000; 136: 1033-1041.
https://doi.org/10.1001/archderm.136.8.1033
41. Dekle C, Mannes K, Davis L, et al. Lupus tumidus. J Am Acad Dermatol 1999; 41 :250-253.
https://doi.org/10.1016/S0190-9622(99)70056-3
42. Lever WF, Schaumberg-Lever G. Connective tissue di- seases. En: Lever WF, Schaumberg-Lever G. Histopa-thology of the Skin, Philadelphia, JS Lippincot Co 1990:494-522.
43. Tercedor J. Enfoque terapéutico del lupus eritematoso cutáneo. Piel 2002; 17:386-390.
https://doi.org/10.1016/S0213-9251(02)72621-X
44. Ting WW, Sontheimer RD. Local therapy for cutaneous and systemic lupus erythematosus: practica! and theori-cal considerations. Lupus 2001; 10: 171-184.
https://doi.org/10.1191/096120301667674688
45. Callen J. Management of skin disease in patients with lupus erithematosus. Sest Practice & Research Clini-cal Rheumatology 2002; 16:245-264.
https://doi.org/10.1053/berh.2001.0224
46. Sielsa l. Uso de los antimaláricos en dermatología. Piel 2003; 18:515-518.
https://doi.org/10.1016/S0213-9251(03)72770-1
47. Van Seek M, Piette W. Antimalarials. Dermatol Clin 2001; 19:147-160.
https://doi.org/10.1016/S0733-8635(05)70236-9
48. Karim MY, Ruiz G, Khamashta MA, et al. Update on therapy - Thalidomide in the treatment of lupus. Lupus 2001; 10: 188-192.
https://doi.org/10.1191/096120301677213822
49. Ruzicka TSC, Goerz G, Kind P, et al. Treatment of cu-taneous lupus erythematosus with acitretin and hi-droxycloroquine. Sr J Dermatol 1992; 127:513-518.
https://doi.org/10.1111/j.1365-2133.1992.tb14851.x
50. Walker SI, Kirby S, Chalmers R. The effect of topical tacrolimus on severe recalcitrant chronic discoid lupus erythematosus. Sr J Dermatol 2002; 147:405-406.
https://doi.org/10.1046/j.1365-2133.2002.488616.x
51. Yoshimasu T, Ohtani T, Sakamoto T, et al. Topical ta-crolimus therapy for facial erythematosus lesions of cu- taneous lupus erythematosus and dermatomyositis. Eur J Dermatol 2002; 12:50-52.
52. Gerdsen R, Wenzel J, Uerlich T, et al. Successful treat-ment of chronic discoid lupus erythematosus of the scalp with imiquimod. Dermatology 2002; 205:416-418.
https://doi.org/10.1159/000066428
Cómo citar
1.
Vidal C. A. Lupus eritematoso cutáneo crónico. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de diciembre de 2004 [citado 26 de abril de 2024];12(4):25-40. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/601
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Cómo citar
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Vidal C. A. Lupus eritematoso cutáneo crónico. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de diciembre de 2004 [citado 26 de abril de 2024];12(4):25-40. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/601
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