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Bjarnesen Mølstrøm AP, Chakari W, Thomsen JB. Reduction cheiloplasty with lateral wedge excisions in cheilitis granulomatosa. BMJ Case Rep 2024; 17:e261439. [PMID: 39256174 DOI: 10.1136/bcr-2024-261439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024] Open
Abstract
This case presents a method of reductive cheiloplasty: Conway's method with lateral and bilateral wedge excisions contained to the vermillion. It was performed on a female patient with cheilitis granulomatosa after 4 years of trying different medical therapies without effect. The surgery successfully reduced the increased volume, facilitating improved aesthetics and function while preserving oral function, muscle strength as well as sensitivity with no recurrence at the 15-month follow-up. We encourage early collaboration between dermatologists and plastic surgeons regarding the timing of a potential surgery when treating cheilitis granulomatosa.
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Affiliation(s)
| | - Wahida Chakari
- Department of Plastic and Reconstructive surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic and Reconstructive surgery, Odense University Hospital, Odense, Denmark
- Research Unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Wang Y, Xu H, Wei M, Wang Y, Wang W, Ju J, Liu Y, Wang X. Identification of Putative Bacterial Pathogens for Orofacial Granulomatosis Based on 16S rRNA Metagenomic Analysis. Microbiol Spectr 2023; 11:e0226622. [PMID: 37227290 PMCID: PMC10269498 DOI: 10.1128/spectrum.02266-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
Orofacial granulomatosis (OFG) is a chronic inflammatory disease characterized by nontender swelling of the orofacial tissues, the underlying cause of which remains unknown. Our previous study demonstrated that tooth apical periodontitis (AP) is involved in the development of OFG. To characterize the AP bacterial signatures of OFG patients and identify possible pathogenic bacteria that cause OFG, the compositions of the AP microbiotas in OFG patients and controls were compared using 16S rRNA gene sequencing. Pure cultures of putative bacterial pathogens were established by growing bacteria as colonies followed by purification, identification, and enrichment and then were injected into animal models to determine the causative bacteria contributing to OFG. A specific AP microbiota signature in the OFG patients was shown, characterized by the predominance of phyla Firmicutes and Proteobacteria, notably members of the genera Streptococcus, Lactobacillus, and Neisseria, were found. Streptococcus spp., Lactobacillus casei, Neisseria subflava, Veillonella parvula, and Actinomyces spp. from OFG patients were isolated and successfully cultured in vitro and then injected into mice. Ultimately, footpad injection with N. subflava elicited granulomatous inflammation. IMPORTANCE Infectious agents have long been considered to play a role in the initiation of OFG; however, a direct causal relationship between microbes and OFG has not yet been established. In this study, a unique AP microbiota signature was identified in OFG patients. Moreover, we successfully isolated candidate bacteria from AP lesions of OFG patients and assessed their pathogenicity in laboratory mice. Findings from this study may help provide in-depth insights into the role of microbes in OFG development, providing the basis for targeted therapeutic approaches for OFG.
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Affiliation(s)
- Yuanyuan Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Hao Xu
- Shaanxi Key Laboratory of Brain Disorders & School of Basic Medical Sciences, Xi'an Medical University, Xi’an, China
| | - Minghui Wei
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Yuhong Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Wenzhe Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
| | - Jia Ju
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
- Department of Pharmacy, School of Stomatology, the Fourth Military Medical University, Xi’an, China
| | - Yuan Liu
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
- Department of Oral Histology and Pathology, School of Stomatology, the Fourth Military Medical University, Xi’an, China
| | - Xinwen Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi’an, China
- Shaanxi Clinical Research Center for Oral Diseases, the National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology, Xi’an, China
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Wei M, Xie C, Liu Y, Wang Y, Wang Y, Wang X, Liu Y. Characterizing disease manifestations and treatment outcomes among patients with orofacial granulomatosis in China. JAAD Int 2021; 1:126-134. [PMID: 34409334 PMCID: PMC8362245 DOI: 10.1016/j.jdin.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Racial variation exists in the incidence of orofacial granulomatosis (OFG). The epidemiology and clinical characteristics of OFG in Asian countries are poorly described. Objective To describe the epidemiologic and clinical features of OFG in China from data collected on chronic odontogenic infection and studied in actual practice regarding the long-term outcome of OFG patients receiving different treatments. Methods Data on demographics, medical history, chronic odontogenic infection, and the extent of disease were collected, and long-term outcomes after the end of treatments were evaluated. Results Of the 165 OFG patients, 118 (71.5%; 95% CI 64.6%-78.5%) had a chronic odontogenic infection. There was a variety of difference between OFG with and without chronic odontogenic infection. Approximately 98.3% (95% confidence interval 94.8%-100%) of OFG patients with chronic odontogenic infection who received dental treatment showed a marked response, of whom 31 patients (53.4%; 95% confidence interval 40.2%-66.7%) had complete remission. Limitations Endoscopic investigations were not performed for most of the patients, and more detailed data were not collected, which might have demonstrated additional systemic problems. Conclusions OFG with chronic odontogenic infection is the major clinical pattern of OFG in China, which may be a subtype of OFG. Dental treatment should necessarily be the preferred first-line therapy for such patients.
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Affiliation(s)
- Minghui Wei
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Cheng Xie
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Outpatient Department, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Yubo Liu
- Department of Stomatology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yuhong Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Yuanyuan Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Xinwen Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
| | - Yuan Liu
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Department of Pathology, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
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Panneer Selvam N, Sadaksharam J, Chehal H. Chronic macrocheilia in an adolescent-diagnostic work-up and management. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e170-e174. [PMID: 32978078 DOI: 10.1016/j.oooo.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Niranzena Panneer Selvam
- Assistant Professor, Diagnostic Sciences, Creighton University School of Dentistry, Omaha, NE, USA.
| | - Jayachandran Sadaksharam
- Professor & Head, Oral Medicine and Radiology, Tamil Nadu Government Dental College & Hospital, Chennai, Tamil Nadu, India
| | - Hardeep Chehal
- Professor, Diagnostic Sciences, Creighton University School of Dentistry, Omaha, NE, USA
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Affiliation(s)
- J M Placke
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - M Moelleken
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
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Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
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Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
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Vibhute NA, Vibhute AH, Daule NR. Cheilitis granulomatosa: a case report with review of literature. Indian J Dermatol 2013; 58:242. [PMID: 23723497 PMCID: PMC3667309 DOI: 10.4103/0019-5154.110858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cheilitis granulomatosa (CG) is a chronic swelling of the lip due to granulomatous inflammation. It is a rare inflammatory disorder first described by Miescher in 1945. It is a monosymptomatic form or an incomplete variant of Melkersson-Rosenthal syndrome; a triad of recurrent orofacial edema, recurrent facial nerve palsy and fissuring of the tongue. As the etiology remains unknown, treatment of CG is challenging. We present a case of CG in a 43-year-old female patient secondary to allergy to certain food items. The present case highlights the importance of thorough investigations in the diagnosis of this lesion as the findings mimic many other granulomatous conditions.
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Affiliation(s)
- Nupura A Vibhute
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, India
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Banks T, Gada S. A comprehensive review of current treatments for granulomatous cheilitis. Br J Dermatol 2012; 166:934-7. [DOI: 10.1111/j.1365-2133.2011.10794.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T. Banks
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889‐5600, U.S.A
| | - S. Gada
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889‐5600, U.S.A
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Cheilitis granulomatosa treated with intralesional corticosteroids and anti-inflammatory agents. J Am Acad Dermatol 2011; 65:e101-e102. [PMID: 21839300 DOI: 10.1016/j.jaad.2011.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/12/2011] [Accepted: 04/22/2011] [Indexed: 02/08/2023]
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Sasaki R, Suzuki K, Hayashi T, Inasaka H, Matsunaga K. Improvement of Cheilitis granulomatosa after Dental Treatment. Case Rep Dermatol 2011; 3:151-4. [PMID: 21941479 PMCID: PMC3177833 DOI: 10.1159/000330731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 38-year-old male suffered from swelling of the lower lip for 3 months. Neither facial nerve palsy nor fissuring of the tongue was present. Histological examination of a biopsy taken from the lower lip revealed non-caseous epithelioid cell granulomas, suggestive of cheilitis granulomatosa. Patch testing revealed positive reactions to mercury chloride and amalgam. His symptoms markedly improved 3 months after treatment of the apical periodontitis and replacement of dental crowns. As his dental crowns did not contain mercury, we believe that the cheilitis granulomatosa may have been related to the focal dental infection.
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Affiliation(s)
- Ryosuke Sasaki
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake
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Coskun B, Saral Y, Cicek D, Akpolat N. Treatment and follow‐up of persistent granulomatous cheilitis with intralesional steroid and metronidazole. J DERMATOL TREAT 2009; 15:333-5. [PMID: 15370404 DOI: 10.1080/09546630410015538] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Granulomatous cheilitis (GC) is a chronic edema which frequently affects the upper lip due to granulomatous inflammation. Its etiology is currently unknown. This rare disease is generally accompanied by Melkersson-Rosenthal syndrome (MRS), characterized by scrotal tongue, orofacial edema and facial paralysis. However, it is also known to develop only with orofacial edema. Granulomatous cheilitis is a difficult disease to treat because of recurrences. There are contradictory reports about the results of treatment without surgical intervention and the rates of recurrence. Our case was a 57-year-old female patient who was characterized by orofacial edema only. The edema and erythema had persisted for 1 year before admission. In the present case, application of intralesional corticosteroid treatment as a total of three injections over 3 consecutive months (one injection per month) and the accompanying metronidazole treatment brought about successful results. No recurrence was observed in the follow-up.
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Affiliation(s)
- B Coskun
- Department of Dermatology, Firat University Faculty of Medicine, Elazig, Turkey.
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Pérez-Calderón R, Gonzalo-Garijo MA, Chaves A, de Argila D. Cheilitis granulomatosa of Melkersson-Rosenthal syndrome: Treatment with intralesional corticosteroid injections. Allergol Immunopathol (Madr) 2004; 32:36-8. [PMID: 14980194 DOI: 10.1016/s0301-0546(04)79221-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melkersson-Rosenthal syndrome may manifest as the classical triad (orofacial edema, facial nerve palsy and stable lingua plicata) but monosymptomatic manifestations or combinations of typical symptoms are not infrequent. The available therapeutic options provide only limited success or temporary benefit. CASE REPORT A 20-year-old man presented with a 7-month history of recurrent episodes of swelling of the upper lip without pain, burning or local pruritus. No causative factors, such as food, drugs or latex, or physical, chemical or emotional conditions could be identified. The patient had been treated with oral antihistamines and corticosteroids with no clinical improvement. Physical examination showed firm edema without fovea, limited to the central area of the upper lip without epidermal changes or symptoms on palpation. The patient had a previous history of facial palsy 6 years previously and recurrent episodes of herpes simplex labialis. Skin prick tests with inhalant aeroallergens, food, latex and Anisakis allergens were negative. Laboratory investigation revealed normal complete blood count, erythrocyte sedimentation rate, thyroid hormones, biochemistry, complement components (C3, C4 and C1-esterase inhibitor) and CH50, rheumatoid factor, antinuclear antibodies, immune complexes, protein electrophoresis and immunoglobulins. Thorax and paranasal sinus radiographs were clear. Biopsy of the involved area of the lip showed edema with lymphocytic and plasma cell infiltration and mononuclear perivascular infiltrates without granulomas, suggesting initial granulomatous cheilitis. Because the patient showed lack of response and/or poor tolerance to prior treatments (deflazacort, clofazimine and metronidazole), intralesional triamcinolone injections were administered with satisfactory response from the first session. CONCLUSIONS Response to available treatments for Melkersson-Rosenthal syndrome is highly variable. In the present case, intralesional triamcinolone injections were effective.
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Affiliation(s)
- R Pérez-Calderón
- Allergology Department, Infanta Cristina University Hospital, Badajoz, Spain
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Tadokoro T, Ozawa K, Muso Y, Ito H, Itami S, Yoshikawa K. Melkersson-Rosenthal syndrome caused by saprodontia: a case report. J Dermatol 2003; 30:679-82. [PMID: 14578558 DOI: 10.1111/j.1346-8138.2003.tb00457.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Accepted: 05/20/2003] [Indexed: 11/30/2022]
Abstract
A 24-year-old female patient with Melkersson-Rosenthal syndrome (MRS) in association with saprodontia is reported. She presented with lower labial swelling and left facial edema. Histological examination of the involved oral mucosa showed a noncaseating epithelioid granuloma. Results from the laboratory and imaging examinations were normal or negative. Her orofacial swelling disappeared after treatment of the saprodontia of the left first molar.
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Affiliation(s)
- Taketsugu Tadokoro
- Department of Dermatology, Osaka University School of Medicine, Suita, Japan
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Querings K, Wagner A, Tilgen W. [Lower-lip swelling in a 15-year-old patient]. DER HAUTARZT 2003; 54:869-70. [PMID: 12955266 DOI: 10.1007/s00105-003-0576-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- K Querings
- Hautklinik und Poliklinik, Universitätskliniken des Saarlandes.
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Martínez-Menchón T, Mahiques L, Pérez-Ferriols A, Febrer I, Vilata JJ, Fortea JM, Aliaga A. Síndrome de Melkersson-Rosenthal. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76668-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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