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Shao K, Hooper J, Feng H. Racial/Ethnic Health Disparities in Dermatology in the United States Part 2: Disease-specific Epidemiology, Characteristics, Management, and Outcomes. J Am Acad Dermatol 2022; 87:733-744. [PMID: 35143915 DOI: 10.1016/j.jaad.2021.12.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Racial and ethnic disparities in dermatology negatively affect outcomes such as mortality and quality of life. Dermatologists and dermatologic surgeons should be familiar with disease-specific inequities that may influence their practice. The second article in this two-part continuing medical education series highlights gaps in frequency, clinical presentation, management, and outcomes by race and ethnicity. We review cutaneous malignancies including basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, and cutaneous T cell lymphoma, and inflammatory disorders including atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, and rosacea.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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Rohmer E, Mitcov M, Cribier B, Lipsker D, Lenormand C. [Clinical heterogeneity of poikilodermatous mycosis fungoides: A retrospective study of 12 cases]. Ann Dermatol Venereol 2020; 147:418-428. [PMID: 32229035 DOI: 10.1016/j.annder.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 01/08/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Poikilodermatous mycosis fungoides is a rare and indolent clinical variant of mycosis fungoides (MF). It can be difficult to distinguish from poikilodermatous parapsoriasis, a group of chronical dermatoses that may sometimes progress to MF. We aimed to specify the clinical, histopathological and developmental features of these entities by means of a retrospective study of 12 cases followed in our center. PATIENTS AND METHODS We identified cases of poikiloderma for which a diagnosis of MF or parapsoriasis was made by the physician. Photographs and histological slides were reviewed, and a final diagnosis of MF was made if the International Society for Cutaneous Lymphoma criteria for the diagnosis of early MF were fulfilled. RESULTS Twelve patients were included, 10 of whom met of the MF criteria. 5 patients had large poikilodermatous patches or thin, well-defined plaques ; 3 patients had the same lesions associated with classical MF lesions ; finally, 4 patients had widespread ill-defined erythematous lesions in a net-like pattern, described as parakeratosis variegata, including 3 MF. 2 patients with well-defined lesions (one associated with classical MF lesions) progressed to the tumoral stage whereas none of the patients with parakeratosis variegata presented such progression. A total of 5 patients had a high skin phototype (IV and V). Two patients had squamous cell carcinoma on poikilodermatous lesions. DISCUSSION Our study suggests that poikilodermatous MF covers a heterogeneous clinical spectrum comprising on one hand a presentation of delimited lesions sharing classical MF risk of progression, and on the other, an entity similar to parakeratosis variegata, an entity overlooked in the French nomenclature, which was particularly benign in our small series, raising the question of its affiliation to the MF group. This question merits further investigation in a larger-scale study.
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Affiliation(s)
- E Rohmer
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - M Mitcov
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - C Lenormand
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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Hypertrophic Discoid Lupus Erythematosus of the Vulva Mimicking Lichen Simplex Chronicus: A Case Report and Review of the Literature. Am J Dermatopathol 2020; 42:191-195. [DOI: 10.1097/dad.0000000000001549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Obayomi A, Maghfour J, Murina A. Rapidly growing tumor on the scalp. JAAD Case Rep 2019; 5:991-993. [PMID: 31709294 PMCID: PMC6834999 DOI: 10.1016/j.jdcr.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Jalal Maghfour
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Andrea Murina
- Tulane University School of Medicine, New Orleans, Louisiana
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Abstract
BACKGROUND Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer. OBJECTIVE To detail the unique demographic and clinical features of nonmelanoma skin cancer (NMSC) in patients with skin of color, including Hispanic, African American, and Asian patients. MATERIALS AND METHODS A complete PubMed search was conducted spanning dates from 1947 to June 2017 yielding a total of 185 manuscripts, from which 45 were included in this review. RESULTS Relative to Caucasians, NMSC, comprised squamous cell carcinoma and basal cell carcinoma, has unique demographic and clinical features in African Americans, Hispanics, and Asians. CONCLUSION Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.
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Squamous Cell Cancer Arising in an African American Male Cheek from Discoid Lupus: A Rare Case and Review of the Literature. Case Rep Surg 2016; 2016:9170424. [PMID: 27610262 PMCID: PMC5005532 DOI: 10.1155/2016/9170424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 07/17/2016] [Indexed: 11/17/2022] Open
Abstract
A 50-year-old African American male with Discoid Lupus Erythematosus (DLE) presented to the dermatology clinic for a rapidly enlarging left cheek mass. The mass failed to resolve with conservative measures. A biopsy revealed poorly differentiated Squamous Cell Carcinoma (SCC). He was referred to Head and Neck Surgery and successfully underwent a resection with free flap reconstruction. Postoperatively he did well. Squamous cell skin carcinomas arising from lesions of Discoid Lupus are rare and aggressive tumors with greater likelihood of metastases. Cases have been reported among patients with different clinical characteristics; we present a rare case arising in an African American male on the face and involving the ear.
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Timpane S, Brandling-Bennett H, Kristjansson AK. Autoimmune collagen vascular diseases: Kids are not just little people. Clin Dermatol 2016; 34:678-689. [PMID: 27968927 DOI: 10.1016/j.clindermatol.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Morphea, dermatomyositis (DM), and discoid lupus erythematosus (DLE) are autoimmune collagen vascular diseases that can present at any age. In all three of these diseases, the tenants of diagnosis and treatment are largely the same in both children and adults, with a few notable differences. Children with morphea are more likely to present with the linear subtype and have a higher incidence of extracutaneous manifestations. Children often need early aggressive systemic treatment to try to prevent long-term sequelae of morphea. In DM, adult disease has a clear association with malignancy that is not seen in children. Adults have a higher rate of pulmonary involvement and increased mortality, whereas calcinosis is more common in juvenile DM. DLE in adults is generally considered to have a low rate of progression from discoid lesions alone to systemic lupus erythematosus (SLE). DLE is less common in children, but several studies have suggested a higher rate of progression from DLE to SLE in children compared with adults.
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Affiliation(s)
- Sean Timpane
- Resident, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Heather Brandling-Bennett
- Assistant Professor, Department of Pediatrics, Division of Dermatology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Arni K Kristjansson
- Assistant Professor of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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Mostaghimi A, Qureshi S, Joyce C, Guo Y, Huang KP. Reduced incidence of skin cancer in patients with alopecia areata: A retrospective cohort study. Cancer Epidemiol 2016; 41:129-31. [DOI: 10.1016/j.canep.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Gamble M, Tocci E, Venna S, Reserva J, Radfar A, Dugan EM. Poorly differentiated squamous cell carcinoma arising within a lesion of discoid lupus erythematosus in an African-American woman. JAAD Case Rep 2015; 1:138-40. [PMID: 27051710 PMCID: PMC4808703 DOI: 10.1016/j.jdcr.2015.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Misty Gamble
- Department of Dermatology, Medstar Washington Hospital Center, Washington, DC; Department of Cutaneous Oncology, Washington Cancer Institute-Melanoma Center, Washington, DC
| | - Elizabeth Tocci
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Suraj Venna
- Melanoma & Skin Oncology Center, Inova Fairfax Hospital, Fairfax, Virginia
| | - Jeave Reserva
- Department of Dermatology, Medstar Washington Hospital Center, Washington, DC; Department of Cutaneous Oncology, Washington Cancer Institute-Melanoma Center, Washington, DC
| | - Arash Radfar
- Division of Dermatopathology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, DC
| | - Elizabeth M Dugan
- Division of Dermatopathology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, DC
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Abstract
The incidence of nonmelanoma skin cancer (NMSC) continues to rise, partly because of aging, the frequency of early childhood sunburns, and sporadic extreme recreational sun exposure. A nonsurgical approach to selected cutaneous malignancy could possibly reduce the cost as well as morbidity of surgical treatment for NMSC. There has been growing interest in isolating compounds that could suppress or reverse the biochemical changes necessary for cutaneous malignancies to progress by pharmacologic intervention. By targeting diverse pathways recognized as important in the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple agents or addition of chemopreventative agents to topical sunscreens may offer the potential for novel and synergistic therapies in treating nonmelanoma skin cancer. This preliminary information will expand to include more therapeutic options for NMSC in the future.
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Affiliation(s)
- Prasan R Bhandari
- Department of Pharmacology, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Varadraj V Pai
- Department of Dermatology, Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
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De Francesco V, Errichetti E, Pegolo E, Stinco G. Atypical fibroxanthoma arising in a scar of discoid lupus erythematosus. J Cutan Med Surg 2014; 18:353-5. [PMID: 25186998 DOI: 10.2310/7750.2013.13144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Malignant change in the scars of discoid lupus erythematosus (DLE) is a well-known event. In most cases, tumors are of epithelial origin, particularly squamous cell carcinomas and, less frequently, basal cell carcinomas and keratoacanthomas. The onset of soft tissue sarcomas in a DLE scar is a very rare event, however, because only one case of malignant fibrous histiocytoma has been described in the literature. OBJECTIVE We describe the first documented report of atypical fibroxanthoma (AFX) arising in an old scar of DLE. RESULTS Although we cannot exclude an accidental association between AFX and DLE, our case emphasizes that patients with DLE may develop AFX in the context of an old scar. CONCLUSION Our finding further underlines the importance of strict and long-term surveillance of people with DLE to identify and remove eventual tumors at an early stage.
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Mortazavi H, Baharvand M, Mehdipour M. Oral potentially malignant disorders: an overview of more than 20 entities. J Dent Res Dent Clin Dent Prospects 2014; 8:6-14. [PMID: 25024833 PMCID: PMC4091702 DOI: 10.5681/joddd.2014.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 08/07/2013] [Indexed: 12/13/2022] Open
Abstract
Cancer of the oral cavity accounts for approximately 3% of all malignancies diagnosed annually in 270,000 patients world-wide. Oral cancer is the 12th most common cancer in women and the 6th in men. Many oral squamous cell carcinomas develop from potentially malignant disorders (PMDs). Lack of awareness about the signs and symptoms of oralPMDs in the general population and even healthcare providers is believed to be responsible for the diagnostic delay of these entities. The aim of this article is to update and improve the knowledge of healthcare providers about oral PMDs.
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Affiliation(s)
- Hamed Mortazavi
- 1Associate Professor, Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- 1Associate Professor, Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mehdipour
- 1Associate Professor, Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Garrido Colmenero C, Martín Castro A, Valenzuela Salas I, Martínez García E, Blasco Morente G, Tercedor Sánchez J. Squamous cell carcinoma in lichen planopilaris. J Dermatol Case Rep 2013; 7:84-7. [PMID: 24133562 DOI: 10.3315/jdcr.2013.1147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/08/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lichen planopilaris (LPP) is a rare variant of cutaneous lichen planus that preferentially involves hair follicles. OBSERVATION We describe the case of an 87-year-old woman with cicatricial alopecia due to lichen planopilaris. The diagnosis was based on clinical evaluation, histopathology and trichoscopy. Squamous cell carcinoma developed within the hairless area after 18 years of evolution. CONCLUSION It is necessary to consider the association between lichen planopilaris and squamous cell carcinoma and to ensure a close follow-up of LPP patients, especially when there is a long history of the disease or new a lesion develops, which does not correspond clinically or in trichoscopy to lichen planopilaris.
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Abstract
Darker skin differs from white skin in presentation, a tendency toward pronounced scarring, and pathophysiology of skin diseases common to those with skin of color. Recent studies highlight differences beyond the surface, which include issues of treatment, scar formation, collagen production, basic structure, and skin cancer development.
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Affiliation(s)
- Victor Czerkasij
- Skin Cancer and Cosmetic Dermatology, PC of Cleveland, Tenn., USA
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15
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Squamous cell carcinoma on the upper lip of a patient with discoid lupus erythematosus. Arch Plast Surg 2013; 40:155-7. [PMID: 23529265 PMCID: PMC3605561 DOI: 10.5999/aps.2013.40.2.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/23/2012] [Accepted: 12/01/2012] [Indexed: 11/22/2022] Open
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Chang YC, Werth VP. Update on Epidemiology and Clinical Assessment Tools of Cutaneous Lupus Erythematosus and Dermatomyositis. CURRENT DERMATOLOGY REPORTS 2013; 2:48-57. [PMID: 33585073 PMCID: PMC7880122 DOI: 10.1007/s13671-012-0037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cutaneous Lupus Erythematosus (CLE) and Dermatomyositis (DM) are cutaneous autoimmune diseases that have been among the least systematically studied, due in part to the lack of validated outcome instruments in the past. More recent epidemiologic studies have elucidated the incidence and prevalence of these diseases and their subtypes. In addition, the advent of validated clinical outcome measures, including the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), has led to an objective means of measuring activity and damage of the disease. These outcome measures have established the framework for evaluating responsiveness and therapeutic efficacy in clinical trials as well as longitudinal studies to study disease course.
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Affiliation(s)
- Yunyoung C Chang
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Victoria P Werth
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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Ghauri AJ, Valenzuela AA, O'Donnell B, Selva D, Madge SN. Periorbital Discoid Lupus Erythematosus. Ophthalmology 2012; 119:2193-2194.e11. [DOI: 10.1016/j.ophtha.2012.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022] Open
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Grönhagen CM, Fored CM, Granath F, Nyberg F. Increased risk of cancer among 3663 patients with cutaneous lupus erythematosus: a Swedish nationwide cohort study. Br J Dermatol 2012; 166:1053-9. [PMID: 22175767 DOI: 10.1111/j.1365-2133.2011.10773.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Other autoimmune diseases have been associated with higher risks for cancer, and numerous case reports of cutaneous lupus erythematosus (CLE) and different cancer types are available. OBJECTIVES To estimate the overall and specific cancer risks in a nationwide cohort study of patients diagnosed with CLE in Sweden and compare that risk with that in a control cohort without CLE. METHODS A cohort of 3663 individuals with CLE and a matched control cohort from the general population (three controls to each CLE case) without a diagnosis of CLE were derived from the Swedish National Patient Register, 1997-2007, and were electronically linked to the Swedish Cancer Register and the Swedish Cause of Death Register. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to compare the observed vs. the expected numbers of cancers. RESULTS A total of 183 incident cancers occurred within the observation interval, yielding a HR of 1·8 (95% CI 1·5-2·2) for cancer overall. Median follow-up was 4·1 years. About a fourfold risk increase was seen for buccal cancer, lymphomas, respiratory cancer and nonmelanoma skin cancer. CONCLUSIONS Patients with CLE appear to have an elevated risk for certain cancer types, an increase that remains when excluding patients also diagnosed with systemic lupus erythematosus. Our findings point to the importance of counselling about not smoking and sun avoidance, and underscore the need for specialized monitoring of this patient group along with bench-to-bedside research efforts to clarify pathogenesis.
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Affiliation(s)
- C M Grönhagen
- Department of Clinical Sciences, Karolinska Institutet, Dandery Hospital, Stockholm, Sweden.
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