{"id":606,"date":"2007-07-19T21:19:23","date_gmt":"2007-07-20T01:19:23","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=606"},"modified":"2007-07-19T21:20:02","modified_gmt":"2007-07-20T01:20:02","slug":"revision-de-dynamed-pemphigus-vulgaris","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/606","title":{"rendered":"Revision de Dynamed: Pemphigus vulgaris"},"content":{"rendered":"<p><span><font face=\"Arial\"><font>En esta edici\u00f3n les ofrecemos una  revision tomada de Dynamed sobre Penfigo asimismo una revision tomada de Pubmed  con 390 resumenes de art\u00edculos sobre Penfigo Vulgar en los \u00faltimos dos  a\u00f1os.<\/font><\/font><\/span><\/p>\n<p><!--more--> <\/p>\n<p><font face=\"Arial\"><strong><span><font><font face=\"Times New Roman\">Revision de  Dynamed<\/font><\/font><\/span><\/strong><\/font><\/p>\n<p><font face=\"Arial\"><strong><span><font face=\"Times New Roman\">Pemphigus vulgaris<\/font><\/span><\/strong><\/font><\/p>\n<p><font face=\"Arial\"><strong><font face=\"Times New Roman\"><span><span><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/mail.google.com\/mail\/?attid=0.0.1&amp;disp=emb&amp;view=att&amp;th=113dbde58a88adf3\" width=\"12\" height=\"12\" \/><\/span><\/span><span><font>Diagnosis<\/font><\/span><\/font><font><font face=\"Times New Roman\"> <\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">history and physical, IgG (and C3) on cell membranes by    direct immunofluorescence &#8211; perilesional skin biopsy, indirect    immunofluorescence of serum for circulating Ab    <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><font><font face=\"Times New Roman\"><strong>Rule  out<\/strong>:<\/font><\/font><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">drug-induced (penicillamine, captopril, rifampin)    <\/font><\/font><\/span><\/li>\n<li><a href=\"http:\/\/dynamed102.ebscohost.com\/Detail.aspx?style=1&amp;docid=\/dynamed\/e2f3e2dbf5bde950852562890052e01e\" target=\"_blank\"><font face=\"Times New Roman\">toxic epidermal necrolysis<\/font><\/a><font><font face=\"Times New Roman\"> <\/font><\/font><\/li>\n<li><a href=\"http:\/\/dynamed102.ebscohost.com\/Detail.aspx?style=1&amp;docid=\/dynamed\/545473d5aef54688852562890052e01d\" target=\"_blank\"><font face=\"Times New Roman\">Stevens-Johnson syndrome<\/font><\/a><font><font face=\"Times New Roman\"> <\/font><\/font><\/li>\n<li><span><font face=\"Times New Roman\">paraneoplastic pemphigus; removal of localized hyaline vascular-type    Castleman&#39;s tumor in 6 patients with paraneoplastic pemphigus led to    resolution of cutaneous lesions in 6-11 weeks and mucosal lesions in 5-10    months (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=14975615&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">Lancet 2004 Feb    14;363(9408):525<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">    &nbsp;<\/font><\/font><\/span><\/li>\n<li><font><font face=\"Times New Roman\">Testing to    consider:<\/font><\/font><\/li>\n<p> <\/font><\/ul>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">skin biopsy for histology and direct    immunofluorescence, serum for indirect immunofluorescence    <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Blood tests:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><font><font face=\"Times New Roman\">80-90% + IgG (indirect immunofluorescence)    <\/font><\/font><\/li>\n<li><span><font face=\"Times New Roman\">desmoglein 3-ELISA had 90% sensitivity and 91% specificity in series of    97 patients with skin diseases (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=10052398\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 1999    Feb;135(2):143<\/font><\/span><\/a><span><font face=\"Times New Roman\"> in JAMA    1999 Jun 2;281(21):1970v), summary can be found in <\/font><\/span><a href=\"http:\/\/www.aafp.org\/afp\/990700ap\/tips.html#New\" target=\"_blank\"><span><font face=\"Times New Roman\">Am Fam Physician 1999 Jul;60(1):273<\/font><\/span><\/a><span><font face=\"Times New Roman\">,    editorial can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=10052407\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 1999    Feb;135(2):195<\/font><\/span><\/a><span><font face=\"Times New Roman\">,    commentary can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=10566852\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 1999    Nov;135(11):1418<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Pathology tests:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">intraepidermal acantholysis, severe intraepidermal    bullae, sparing of basal layer (&quot;row of tombstone appearance&quot;)    <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Other diagnostic  testing:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">detached keratinocytes in Tzanck prep (acanthocytes)    <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Prognosis:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><font><font face=\"Times New Roman\">60-90% mortality before steroids, now    5-15% <\/font><\/font><\/li>\n<li><span><font face=\"Times New Roman\">paraneoplastic pemphigus tends to be rapid and fatal despite    immunosuppressive therapy (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8065187&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">Mayo Clin Proc 1994    Sep;69(9):851<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">)    <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Treatment overview:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">local skin care, treat like burn patients to prevent    infections <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Medications:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font face=\"Times New Roman\">sublesional steroids were sufficient (sparing need for systemic    steroids or immunosuppressive agents) in 8 of 18 patients &gt; 65 years old    followed 3-15 years (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9434672&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">J Am Geriatr Soc 1998    Jan;46(1):92<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">)    <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">steroid-sparing immunosuppressives are mainstay of    treatment <\/font><\/font><\/span><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">options include azathioprine, cyclophosphamide,      dapsone, mycophenolate mofetil <\/font><\/font><\/span><\/li>\n<li><font><font face=\"Times New Roman\"><strong><span>azathioprine and mycophenolate mofetil may      have similar efficacy and corticosteroid-sparing effects <\/span><\/strong><span><span>&nbsp;<\/span><\/span><\/font><\/font><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">based on unblinded randomized trial with        non-significant trend <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">33 patients with pemphigus vulgaris and 7 patients        with pemphigus foliaceus were treated with oral methylprednisolone 2        mg\/kg\/day and randomized to azathioprine (Imurek) 2 mg\/kg once daily vs.        mycophenolate mofetil (CellCept) 1,000 mg twice daily        <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">after blister formation ceased, crusts and erosions        disappeared and reepithelialization of previous lesions started, then        methylprednisolone was tapered <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">after methylprednisolone was discontinued, then        azathioprine or mycophenolate mofetil was tapered and ultimately        discontinued <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">therapy increased or restarted if new blister        formation <\/font><\/font><\/span><\/li>\n<li><font><font face=\"Times New Roman\">comparing azathioprine vs.        mycophenolate mofetil <\/font><\/font><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">100% vs. 100% had inhibition of disease          progression within 30 days <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">72% vs. 95% had complete healing of lesions (NNT          5 favoring mycophenolate mofetil but not statistically significant)          <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">mean time to complete remission 74 vs. 91 days          (not significant) <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">mean time from complete remission to recurrence          of lesions 258 vs. 123 days (not significant)          <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">median cumulative steroid dose 8,916 vs. 9,334 mg          (not significant) <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">33% vs. 19% grade 3 (severe) or 4          (life-threatening) adverse effects (not          significant)<\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p> <font face=\"Arial\"> \t<\/p>\n<li><font face=\"Times New Roman\">Reference &#8211; <\/font><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=17116835\" target=\"_blank\"><font face=\"Times New Roman\">Arch Dermatol 2006        Nov;142(11):1447<\/font><\/a><\/li>\n<p> <\/font><\/ul>\n<\/ul>\n<p> <font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">steroid pulse therapy may not be effective    <\/font><\/font><\/span><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><font><font face=\"Times New Roman\"><strong><span>oral dexamethasone 300 mg for 3 days per      month no more effective than placebo in patients on conventional treatment      <\/span><\/strong><\/font><\/font><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">20 patients with pemphigus vulgaris treated with        prednisolone 80 mg\/day tapered over 19 weeks and azathioprine 3 mg\/kg\/day        were randomized to oral dexamethasone 300 mg vs. placebo for 3-day pulses        every month <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">8 of 11 dexamethasone vs. 9 of 9 placebo patients        had remission <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">no differences in mean time to remission (173 vs.        176 days) or mean duration of remission within first year (151 vs. 141        days) <\/font><\/font><\/span><\/li>\n<li><span><font><font face=\"Times New Roman\">weight gain &gt; 5% occurred in 8 of 11        dexamethasone vs. 1 of 9 placebo patients        <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">Reference &#8211; PEMPULS trial (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=16702494\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 2006        May;142(5):570<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">)<\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p> <font face=\"Arial\"> \t<\/p>\n<li><font><font face=\"Times New Roman\"><strong><span>high-dose pulse therapy with      glucocorticoids might produce long-lasting benefits <\/span><\/strong><span>, based on retrospective study      of 9 patients with pemphigus vulgaris treated with very high dose IV      methylprednisolone sodium succinate (Solu-Medrol) and 6 patients not treated      with pulse therapy (<\/span><\/font><\/font><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=8961871\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 1996      Dec;132(12):1435<\/font><\/span><\/a><span><font face=\"Times New Roman\"> in Am      Fam Physician 1997 Apr;55(5):1924), commentary can be found in      <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=8961881\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 1996      Dec;132(12):1499<\/font><\/span><\/a><\/li>\n<p> <\/font><\/ul>\n<p> <font face=\"Arial\"> \t<\/p>\n<li><span><font><font face=\"Times New Roman\">intravenous immunoglobulin (IVIG) not recommended due    to very limited and conflicting evidence<span>&nbsp;    <\/span><\/font><\/font><\/span><\/li>\n<p> <\/font> <\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font face=\"Times New Roman\">IVIG 400 mg\/kg\/day for 5 days plus cyclophosphamide 100-150 mg\/day      led to &gt; 80% reduction in skin lesions within 2 weeks in 5 of 6 patients      with pemphigus vulgaris unresponsive to conventional therapy with high-dose      steroids (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12196744&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">J Am Acad Dermatol 2002      Sep;47(3):358<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">      in JAMA 2002 Nov 27;288(20):2520) <\/font><\/font><\/span><\/li>\n<li><font><font face=\"Times New Roman\"><strong><span>IVIG reported to be ineffective in small      series (<\/span><\/strong><span>;      retrospective series of 7 patients with pemphigus vulgaris treated with      IVIG, 1 had partial response and 6 had no response (<\/span><\/font><\/font><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=15667028\" target=\"_blank\"><span><font face=\"Times New Roman\">Mayo Clin Proc 2005      Jan;80(1):41<\/font><\/span><\/a><span><font face=\"Times New Roman\">      &nbsp;IVIG costs about $40-$55 per gram, plus cost of administration      (<\/font><\/span><a href=\"http:\/\/www.themedicalletter.com\/scripts\/toc.cgi?type=2006&amp;inst=null\" target=\"_blank\"><span><font face=\"Times New Roman\">The Medical Letter 2006<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> Dec 4\/18;48(1249\/1250):101)      <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">use of IV immunoglobulin (IVIG) not recommended (University      HealthSystem Consortium guidelines on IVIG preparations which were withdrawn      from <\/font><\/span><a href=\"http:\/\/www.guideline.gov\/whatsnew\/whatsnew_GuidelineArchive.aspx\" target=\"_blank\"><span><font face=\"Times New Roman\">National Guideline      Clearinghouse<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">      on 2004 Dec 20 as no longer current) <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">expert consensus statement on use of IVIG in treatment of autoimmune      mucocutaneous blistering diseases can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12925395&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 2003      Aug;139(8):1051<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">      (JAMA 2003 Nov 5;290(17):2240)<\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<p> <font face=\"Arial\"> \t<\/p>\n<li><span><font face=\"Times New Roman\">rituximab (anti-CD20 monoclonal antibody) associated with clinical    response in 3 patients with refractory pemphigus vulgaris    <strong>(<\/strong>(<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=14732665\" target=\"_blank\"><span><font face=\"Times New Roman\">Arch Dermatol 2004    Jan;140(1):91<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> in    JAMA 2004 Apr 28;291(16):1944) <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">combination of rituximab and IVIG reported to be effective<strong>)<\/strong> in 9    of 11 patients (<\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=17065638\" target=\"_blank\"><span><font face=\"Times New Roman\">N Engl J Med 2006 Oct    26;355(17):1772<\/font><\/span><\/a><span><font face=\"Times New Roman\">),    commentary can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=17267915\" target=\"_blank\"><span><font face=\"Times New Roman\">N Engl J Med 2007 Feb    1;356(5):521<\/font><\/span><\/a><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\"><span><span><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/mail.google.com\/mail\/?attid=0.0.1&amp;disp=emb&amp;view=att&amp;th=113dbde58a88adf3\" width=\"12\" height=\"12\" \/><\/span><\/span><span>Prevention and Screening<\/span><\/font><\/font><font><font face=\"Times New Roman\"> <\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><font><font face=\"Times New Roman\">not    applicable<\/font><\/font><\/li>\n<p> <\/font><\/ul>\n<p><font face=\"Arial\"><strong><font><font face=\"Times New Roman\">Reviews:<\/font><\/font><\/strong><\/font><\/p>\n<ul><font face=\"Arial\"> \t<\/p>\n<li><span><font face=\"Times New Roman\">review of pemphigus can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=pubmed&amp;dopt=Abstract&amp;list_uids=15993235\" target=\"_blank\"><span><font face=\"Times New Roman\">Lancet 2005 Jul    2;366(9479):61<\/font><\/span><\/a><span><font face=\"Times New Roman\">    &nbsp;review of pemphigus can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=10450720\" target=\"_blank\"><span><font face=\"Times New Roman\">JAMA 1999 Aug    11;282(6):572<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">review of autoimmune bullous dermatoses can be found in    <\/font><\/span><a href=\"http:\/\/www.aafp.org\/afp\/20020501\/1861.html\" target=\"_blank\"><span><font face=\"Times New Roman\">Am Fam Physician 2002 May    1;65(9):1861<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">review of autoimmune bullous (blistering) diseases can be found in    <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=9191456\" target=\"_blank\"><span><font face=\"Times New Roman\">Am Fam Physician 1997    Jun;55(8):2709<\/font><\/span><\/a><span><font><font face=\"Times New Roman\"> <\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">review can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=10466686&amp;dopt=Abstract\" target=\"_blank\"><span><font face=\"Times New Roman\">Lancet 1999 Aug    21;354(9179):667<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">    &nbsp;<\/font><\/font><\/span><\/li>\n<li><span><font face=\"Times New Roman\">case presentation can be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=15581441\" target=\"_blank\"><span><font face=\"Times New Roman\">J Fam Pract 2004    Dec;53(12):981<\/font><\/span><\/a><span><font face=\"Times New Roman\">    &nbsp;correction can be found in J Fam Pract 2005 Jan;54(1):36, commentary can    be found in <\/font><\/span><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?db=pubmed&amp;cmd=Retrieve&amp;dopt=Abstract&amp;list_uids=15833227\" target=\"_blank\"><span><font face=\"Times New Roman\">J Fam Pract 2005    Apr;54(4):355<\/font><\/span><\/a><span><font><font face=\"Times New Roman\">&nbsp;&nbsp; <\/font><\/font><\/span><\/li>\n<p> <\/font><\/ul>\n<div><font color=\"#000000\"><span><font face=\"Arial\"><font><font face=\"Times New Roman\">Abrir aqui la revision de Pubmed de  Penfigo:<\/font><\/font><\/font><\/span><\/font><\/div>\n<div>&nbsp;<\/div>\n<div>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tr>\n<td><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/mail.google.com\/mail\/images\/doc.gif\" width=\"16\" height=\"16\" \/><\/td>\n<td width=\"7\">&nbsp;<\/td>\n<td><strong>penfigopubmed.doc<\/strong><br \/> 1320K    <a href=\"\/blog\/wp-content\/uploads\/2007\/07\/164\/penfigopubmed.doc\" target=\"_blank\">Descargar documento<\/a> <\/td>\n<\/tr>\n<\/table>\n<p> &nbsp;<\/p><\/div>\n<div>&nbsp;<\/div>\n<div>&nbsp;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>En esta edici\u00f3n les ofrecemos una revision tomada de Dynamed sobre Penfigo asimismo una revision tomada de Pubmed con 390 resumenes de art\u00edculos sobre Penfigo Vulgar en los \u00faltimos dos a\u00f1os.<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-606","post","type-post","status-publish","format-standard","","category-articulos-cientificos"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/606","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=606"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/606\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=606"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=606"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}