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Nifli A, Liakopoulou A, Mourelatou E, Avgoustakis K, Hatziantoniou S. Liposomal propranolol for treatment of infantile hemangioma at compounding pharmacies. J Liposome Res 2024:1-12. [PMID: 38335203 DOI: 10.1080/08982104.2024.2313452] [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: 11/06/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Infantile hemangiomas (IH) are common benign soft tissue tumors, frequently affecting infants. While Propranolol Hydrochloride (Pro HCl) has emerged as a promising treatment for IH, its topical application remains challenging due to the need for stable and efficacious carriers. This study investigates the potential of preformulated liposomes as carriers for topical delivery of Pro HCl for the treatment of IH in compounding pharmacies. Liposomes loaded with Pro HCl were prepared using active pharmaceutical ingredient or commercially available propranolol tablets and various dilution media, including Water for Injection (WFI), Dextrose 5%, and NaCl 0.9%. The physicochemical properties of the liposomal formulations (Pro HCl content, encapsulation efficiency, loading capacity, and colloidal stability) were assessed over a 90-day storage at 4 °C. In vitro release kinetics and transdermal permeation of Pro HCl from liposomes were also evaluated. Liposome properties were influenced by the dilution medium. Pro HCl content remained stable in liposomes encapsulating API (Lipo-Pro), regardless of the dilution medium. Lipo-Pro showed sustained drug release over time, suggesting its potential for maintaining therapeutic levels. Pro HCl exhibited enhanced transdermal permeability from Lipo-Pro compared to aqueous solution, indicating its potential for topical IH treatment. Preformulated liposomes offer a stable and effective carrier for Pro HCl, potentially suitable for extemporaneous preparations in compounding pharmacies. Their enhanced transdermal permeability presents a promising alternative for topical IH treatment. This study provides valuable insights into the development of innovative and effective drug delivery strategies for managing IH, with future research focusing on in vivo applications and therapeutic potential.
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Affiliation(s)
- Antigone Nifli
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Aggeliki Liakopoulou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Elena Mourelatou
- Department of Health Sciences, School of Life and Health Sciences, Pharmacy Program, University of Nicosia, Nicosia, Cyprus
- Bioactive Molecules Research Center, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Konstantinos Avgoustakis
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
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2
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Meyer-Mueller C, Nicholson C, Polcari I, Boull C, Maguiness S. Worsening ulceration of infantile hemangioma after initiation or escalation of propranolol. Pediatr Dermatol 2022; 39:255-259. [PMID: 35178750 DOI: 10.1111/pde.14933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/01/2022] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Abstract
For infantile hemangiomas (IH) requiring treatment, including those in high-risk locations or in the setting of ulceration, oral propranolol is first-line therapy. Here, we present three cases of infantile hemangioma with worsening ulceration following initiation or escalation of oral propranolol at standard doses.
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Affiliation(s)
- Cameron Meyer-Mueller
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cynthia Nicholson
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ingrid Polcari
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christina Boull
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheilagh Maguiness
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Abstract
Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, affecting about 5% of infants. It has a characteristic growth pattern of early rapid proliferation followed by progressive involution. Although most IH evolve favorably, complications are observed in 10-15% of cases, justifying treatment. For over 10 years now, propranolol has become the first-line therapy for complicated IH, revolutionizing their management and their prognosis. In this article, we review the clinical features, associations, complications/sequelae and therapeutic approaches for IH, focusing on current medical therapy. Indications for treatment and various treatment options, including propranolol and other oral β-blockers, topical timolol, and corticosteroids are presented. Current controversies regarding oral propranolol such as pre-treatment screening, in- vs out-patient initiation of treatment, early and potential long-term side effects and recommended monitoring are discussed.
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Affiliation(s)
- Caroline Colmant
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada.
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
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Sebaratnam DF, Rodríguez Bandera AL, Wong LCF, Wargon O. Infantile hemangioma. Part 2: Management. J Am Acad Dermatol 2021; 85:1395-1404. [PMID: 34419523 DOI: 10.1016/j.jaad.2021.08.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
The majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before 5 weeks of age to mitigate the risk of sequelae. Propranolol can commence for most infants in the outpatient setting and the most frequently employed dosing regimen is 1 mg/kg twice daily. In the future, β-blockers with a more-selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered. For small, superficial IHs, topical timolol maleate or pulsed dye laser may be considered. Where the IH involutes with cutaneous sequelae, a range of interventions have been reported, including surgery, laser, and embolization. IHs have a well-described clinical trajectory and are readily diagnosed and managed via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID-19 pandemic.
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Affiliation(s)
- Deshan F Sebaratnam
- The Children's Hospital at Westmead, Sydney, Australia; Liverpool Hospital, Sydney, Australia.
| | | | | | - Orli Wargon
- Sydney Children's Hospital, Sydney, Australia
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Chelleri C, Monzani NA, Gelmetti C, Milani GP, Fossali EF, Galeone C, Cavalli R. Residual Lesions After Pharmacological and Dye-Laser Treatment of Infantile Hemangiomas: Critical Review of 432 Cases. Lasers Surg Med 2019; 52:597-603. [PMID: 31828809 DOI: 10.1002/lsm.23205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Infantile hemangiomas (IHs) are the most common benign tumors in infanthood. Although they are often self-limiting, management of IHs is still controversial because residual lesions may persist in some cases. The aim of this study is to report our experience with patients affected with IH and investigate the frequency of residual lesions in treated versus untreated patients. STUDY DESIGN/MATERIALS AND METHODS This retrospective observational study enrolled patients with IHs evaluated over the past 10 years. Patients were managed with systemic or local pharmacotherapy, laser therapy, a combination of them, or with observation only. RESULTS A total of 432 patients were included: 71% received one or more therapies for IHs; 75.2% of untreated patients had at least one residual lesion compared with 41.4% of treated patients (P < 0.001). Patients treated with laser therapy or topical timolol had the lowest rate of residual lesions. CONCLUSIONS This rather large case series suggests that IHs management with pharmacotherapy and especially laser therapy is associated with a lower number of residual lesions than observation only. Although propranolol can be very useful to avoid life-threatening complications and severe tissue impairment, laser therapy and topical timolol are potential effective treatments to decrease the incidence of residual lesions, mostly associated with superficial IHs. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Cristina Chelleri
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Nicola Adriano Monzani
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Carlo Gelmetti
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Gregorio Paolo Milani
- Department of Pediatric Emergency, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Emilio Filippo Fossali
- Department of Pediatric Emergency, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Riccardo Cavalli
- Department of Pediatric Dermatology, IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, 20122, Italy
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Abstract
Infantile hemangiomas (IH) are a common benign tumor of infancy, most being uncomplicated and not requiring therapy. Some IH may require treatment; the pediatric provider must be familiar with morphology, distribution, natural history, and associations of IH. Several treatment options are available for IH: current standard of care, oral propranolol. Other therapies include wound care; topical beta-blocker therapy for small, superficial, and uncomplicated IH; treatment of IH residua. In addition to functional compromise and other complications, potential for permanent deformity and eventual psychosocial stigmatization are important when considering the need for treatment of IH in a neonate or infant.
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Polites SF, Rodrigue BB, Chute C, Hammill A, Dasgupta R. Propranolol versus steroids for the treatment of ulcerated infantile hemangiomas. Pediatr Blood Cancer 2018; 65:e27280. [PMID: 29932302 DOI: 10.1002/pbc.27280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND There has been a paradigm shift from steroids to propranolol for the pharmacologic treatment of infantile hemangiomas (IH); however, the outcomes for ulcerated IH are not well studied. The purpose of this study was to compare the efficacy of steroids and propranolol specifically for ulcerated IH. METHODS A retrospective review was conducted on patients with ulcerated IH treated with propranolol or steroids at a single tertiary care institution between 2007 and 2014. Patient characteristics, hemangioma features, and outcomes, including time to heal and medication complications, were compared between propranolol and steroid patients. RESULTS There were 29 patients treated with propranolol and 23 with steroids. There were no significant differences in the two treatment groups including age, race, sex, size, or insurance status. There were more head/neck IH in the steroid group. There was no significant difference in the percentage of healed lesions (93 vs. 74%, P = 0.12) or the median time to heal (80 vs. 126 days, p = 0.21) between groups. Overall complication rates also did not vary between medications (24 vs. 44%, P = 0.14). CONCLUSION Propranolol is noninferior to steroids for the treatment of ulcerated IH; however, healing time is lengthy regardless of treatment. While side effect profiles differed between medications, the overall complication rate was similar.
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Affiliation(s)
- Stephanie F Polites
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bentley B Rodrigue
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Carol Chute
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adrienne Hammill
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Wang JY, Ighani A, Ayala AP, Akita S, Lara-Corrales I, Alavi A. Medical, Surgical, and Wound Care Management of Ulcerated Infantile Hemangiomas: A Systematic Review [Formula: see text]. J Cutan Med Surg 2018; 22:495-504. [PMID: 29673261 DOI: 10.1177/1203475418770570] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Ulcerated infantile hemangiomas may present a therapeutic challenge, especially if there is concurrent hemorrhage or infection. The aim of this study was to systematically review the published evidence on the treatment of ulcerated hemangiomas, focusing on wound healing as the outcome of interest. We searched MEDLINE, Embase, SCOPUS, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science from inception to July 2016. Seventy-seven studies met our inclusion criteria. One study was a randomized controlled trial, 30 were observational studies, and 46 were case reports or case series. There is significant heterogeneity among the methods used. We reviewed 1239 patients in total. Of the 197 treated with oral propranolol, 191 (97.0%) achieved complete ulcer healing. Thirty-one patients failed corticosteroid therapy (oral, intralesional, or topical) and were subsequently successfully treated with other therapies. Surgical resections were typically performed for larger hemangiomas and those causing complications. None of the therapies discussed appear to offer significant advantages over others. Therefore, treatment decisions should be individualized based on location of disease, extent, symptoms, feasibility, cost, and parental preference.
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Affiliation(s)
- Jane Y Wang
- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arvin Ighani
- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ana P Ayala
- 2 Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | - Sadanori Akita
- 3 Department of Plastic Surgery, Wound Repair and Regeneration, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Irene Lara-Corrales
- 4 Department of Pediatric Medicine, Section of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Afsaneh Alavi
- 5 Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Grzesik P, Wu JK. Current perspectives on the optimal management of infantile hemangioma. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:107-116. [PMID: 29388636 PMCID: PMC5774589 DOI: 10.2147/phmt.s115528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infantile hemangiomas (IHs) are the most common benign tumor of infancy. As our understanding of their pathobiology has evolved, treatment has become more focused and tailored to specifically treat IH while minimizing adverse effects. Propranolol has gained FDA approval as the first medical therapy for a traditionally surgical disease. This review provides readers with an overview of IH, treatment modalities, and addresses specific considerations in IH disease management.
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Affiliation(s)
- Peter Grzesik
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - June K Wu
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
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10
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Lokmic Z, Grainger T, Atapattu NV, Phillips RJ, Penington AJ. Wound management of ulcerated haemangioma of infancy - an audit. Int Wound J 2017; 14:967-972. [PMID: 28251817 DOI: 10.1111/iwj.12740] [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: 11/15/2016] [Revised: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 12/01/2022] Open
Abstract
Haemangioma of infancy, a benign tumour of blood vessels, is the most common tumour of infancy. Ulceration, the most common complication, presents a unique wound care challenge. A retrospective audit of medical records of children with haemangioma of infancy who presented to the Royal Children's Hospital, Melbourne, Australia, between January 2000 and December 2014 was undertaken with an aim to examine wound management of ulcerated haemangioma of infancy. In total, 535 hospital medical records were identified as suitable, of which 352 were randomly selected and audited, of which 84 patients had ulcerated haemangioma of infancy, and 62 were subject to wound management. Of these, 35 were successfully managed by wound dressings, 9 were not fully healed at the time of last review, and 18 were referred for surgical excision. Patients attended an average of five outpatient visits, and the average time from presentation to documented healing was 105 days. There were a total of 225 episodes of wound dressing, for which there was a documented follow-up appointment at which healing could be assessed. Although a wide range of dressings were used, there was no clear pattern of benefit of one dressing over another. Wounds were less likely to be healed after the use of a silver-impregnated dressing. Pain was poorly documented. Clinical assessment of whether wounds were infected was of no help in planning treatment. There is considerable variability in the management of this difficult wound group, and further prospective studies are required.
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Affiliation(s)
- Zerina Lokmic
- The Royal Children's Hospital, Department of Plastic and Maxillofacial Surgery, Murdoch Childrens Research Institute and the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Taya Grainger
- The Royal Children's Hospital, Department of Plastic and Maxillofacial Surgery, Murdoch Childrens Research Institute and the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Nadeeja V Atapattu
- The Royal Children's Hospital, Department of Plastic and Maxillofacial Surgery, Murdoch Childrens Research Institute and the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Roderic J Phillips
- The Royal Children's Hospital, Department of Plastic and Maxillofacial Surgery, Murdoch Childrens Research Institute and the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Children's Hospital, Department of General Medicine, Murdoch Childrens Research Institute and Department of Paediatrics, Monash University, Clayton, Victoria Australia
| | - Anthony J Penington
- The Royal Children's Hospital, Department of Plastic and Maxillofacial Surgery, Murdoch Childrens Research Institute and the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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The changing face of complicated infantile hemangioma treatment. Pediatr Radiol 2016; 46:1494-506. [PMID: 27450406 DOI: 10.1007/s00247-016-3643-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/11/2016] [Accepted: 05/17/2016] [Indexed: 01/16/2023]
Abstract
Infantile hemangiomas are the most common vascular tumors of infancy. A multidisciplinary approach including dermatologists, otolaryngologists, plastic surgeons, hematologists/oncologists and interventional/diagnostic radiologists is crucial for appropriate management of children with complicated infantile hemangiomas. Since its unforeseen discovery in 2008, propranolol has become the first-line treatment for infantile hemangiomas, eclipsing systemic corticosteroids and radiologic intervention. There are still, however, uncommon indications for more aggressive interventional management. We review the 2014-updated International Society for the Study of Vascular Anomalies (ISSVA) classification for vascular anomalies. Additionally, we suggest management algorithms for complicated lesions, including recommendations for radiologic and surgical intervention.
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12
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Li Y, Hu Y, Li H, Deng L. Successful treatment of ulcerated hemangiomas with a dual-wavelength 595- and 1064-nm laser system. J DERMATOL TREAT 2016; 27:562-567. [DOI: 10.3109/09546634.2016.1164287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Adamič M, Pavlović MD, Troilius Rubin A, Palmetun-Ekbäck M, Boixeda P. Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology. J Eur Acad Dermatol Venereol 2015; 29:1661-78. [PMID: 25931003 DOI: 10.1111/jdv.13177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/07/2015] [Indexed: 12/16/2022]
Abstract
AIM Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. METHODS These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. RESULTS Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.
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Affiliation(s)
- M Adamič
- Dermatology Center Parmova, Ljubljana, Slovenia
| | - M D Pavlović
- Dermatology Center Parmova, Ljubljana, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - A Troilius Rubin
- Department of Dermatology, Centre for Laser and Vascular Anomalies, Skåne University Hospital, Malmö, Sweden
| | - M Palmetun-Ekbäck
- Department of Dermatology, University Hospital Örebro, Örebro, Sweden
| | - P Boixeda
- Laser Service, Department of Dermatology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain
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14
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Blei F. Update December 2013. Lymphat Res Biol 2013. [DOI: 10.1089/lrb.2013.1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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