Pediatric Allergic Contact Dermatitis: Clinical and Epidemiological Study in a Tertiary Hospital. / Dermatitis alérgica de contacto pediátrica. Estudio clínico-epidemiológico en un hospital terciario.

BACKGROUND: Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children. Underdiagnosis has been observed in some studies, with many cases in which the condition is not suspected clinically and patch tests are not performed. However, the prevalence of pediatric sensitization to allergens has been reported to be as high as 20%, and the diagnosis should therefore be contemplated as a possibility in this age group. MATERIAL AND METHODS: We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia. Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years (between 2000 and 2015) were included in the analysis. Epidemiological (age, sex, history of atopy) and clinical (site of the lesions, allergen series applied, positive reactions, and their relevance) variables were gathered. RESULTS: Patch tests had been performed on 4,593 patients during the study period. Of these, 265 (6%) were children aged between 0 and 16 years. A positive reaction to at least one of the allergens tested was observed in 144 (54.3%) patients in that group. The allergens most frequently identified were the following (in decreasing order of frequency): thiomersal, cobalt chloride, colophony, paraphenylenediamine, potassium dichromate, mercury, and nickel. The sensitization was considered relevant in 177 (61.3%) cases. CONCLUSIONS: More than half of the children studied showed sensitization to 1 or more allergens, with a high percentage of relevant sensitizations. All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing. As no standardized test series have been developed for this age group, a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested.

Allergic contact dermatitis due to cosmetics: A clinical and epidemiological study in a tertiary hospital. / Dermatitis alérgica de contacto a cosméticos, estudio clínico-epidemiológico en un hospital terciario.

The incidence of allergic contact dermatitis (ACD) to cosmetics in the general population is rising with the increasing use of cosmetic products and their proliferation and diversification. The aims of this study were to determine the prevalence of ACD to cosmetics in our setting, analyze changes over time, describe the clinical and epidemiological features of this allergic reaction, and identify the allergens and cosmetics involved. We performed a prospective study at the skin allergy unit in Hospital General Universitario de Valencia in Spain between 2005 and 2013 and compared our findings with data collected retrospectively for the period 1996 to 2004. The 5419 patients who underwent patch testing during these 2 periods were included in the study. The mean prevalence of ACD to cosmetics increased from 9.8% in the first period (1996-2004) to 13.9% in the second period (2005-2013). A significant correlation was found between ACD to cosmetics and female sex but not atopy. Kathon CG (blend of methylchloroisothiazolinone and methylisothiazolinone), fragrances, and paraphenylenediamine were the most common causes of ACD to cosmetics during both study periods, and acrylates and sunscreens were identified as emerging allergens during the second period.

Postsurgical contact dermatitis due to povidone iodine: a diagnostic dilemma.

We present 7 cases of postsurgical contact dermatitis due to povidone iodine. The diagnosis was based on the clinical manifestations, the history of exposure, the site of the lesions, and the results of patch tests. This type of dermatitis can develop in the area of surgery or at distant sites exposed to povidone iodine during the surgical intervention. Patch tests with 10% povidone iodine in petrolatum were positive in all patients. Based on the results of the same tests in a control group, we recommend the use of petrolatum rather than water as the vehicle for the diagnosis of this form of contact dermatitis. Repeated open application tests with a commercially available solution of povidone iodine were negative. We conclude that the presence of the solution under occlusion during surgery is necessary both for the symptoms to develop and for the diagnosis to be made. This condition may be underdiagnosed.

Allergic contact dermatitis due to nickel: descriptive study in a tertiary hospital, 2000-2010.

OBJECTIVE: The aim of this study based on the records of the dermatology department of a tertiary referral hospital was to describe patients treated for allergic contact dermatitis induced by nickel between 2000 and 2010. MATERIALS AND METHODS: From records of the skin allergy section of the dermatology department we extracted and analyzed information for patients who underwent patch testing with the standard series of the Spanish Contact Dermatitis Research Group (GEIDAC), which includes a patch with 5% nickel sulfate in petroleum jelly. The possibility that nickel release from various objects might have triggered the patient's dermatitis was assessed with the dimethylglyoxime spot test, which reveals a reddish precipitate if the metal is present. RESULTS: A total of 3,404 patients underwent GEIDAC patch testing during the study period; 24.2% had positive reactions to the patch containing 5% nickel sulfate in petroleum jelly. However, the contact dermatitis could be attributed to nickel in only 57 of the 824 patients (6.9%) who showed sensitization to nickel. CONCLUSIONS: Patch-test evidence of sensitization was found to be clinically relevant in only a small percentage of patients. We emphasize the usefulness of the dimethylglyoxime test to help establish the relevance of a positive nickel patch test. This test is even useful for identifying the specific object responsible for a patient's dermatitis.

[Results and assessment of photopatch testing in Spain: towards a new standard set of photoallergens]. / Resultados y evaluación del fotoparche en España: hacia una nueva batería estándar de fotoalergenos.

INTRODUCTION: While the standardization of exploration with photoallergy tests or photopatch testing runs its course in Europe, we have carried out an epidemiological study about the current situation of photoallergy in our country. MATERIAL AND METHODS: We have gathered the results of photopatch testing in seven hospital centres of Madrid, Cataluña, Galicia and Comunidad Valenciana during the years 2004 and 2005. The exploration has included, at least, the standard set of the Spanish Photobiology Group (GEF), with 16 (photo) allergens, that have been irradiated with 10 joules/cm(2). We have assessed the total number of explored patients, their sex, present, past or unknown relevance of positive photopatch testing, cross reactions, and allergens responsible for photosensitization. RESULTS: Of 224 patients explored by photopatch testing, 39.3 % show one or more positive tests. Seventy-one percent (103) were considered relevant with respect to clinical history, 14 cases (9.6 %) were cross reactions, and 28 (19.3 %) were considered of unknown relevance. The most prevalent allergens were nonsteroidal antiinflammatory drugs, specially ketoprophen (43 patients), followed by bencydamine (7 patients) and etofenamate (5 patients). The mixture of four sunscreens from the standard set of the GEF only detected 10 of 16 patients with photoallergy to sunscreens. Photopatch testing of unknown relevance was mainly due to antiseptics (fenticlor) and topical antihistamines. CONCLUSIONS: We propose the modification of the standard set of photoallergens from the GEF, that should include the majority of nonsteroidal antiinflammatory drugs and sunscreens available in Spain. Ketoprophen continues to be the most frequent photoallergen in our country. It is also important for the cross sensitizations that may present. Sunscreens should be explored separately and not in form of a mixture.

[Contact urticaria and latex anaphylaxis. A review of 15 cases]. / Urticaria de contacto y anafilaxia al látex. Revisión de 15 casos.

BACKGROUND: Since the recent description of immediate hypersensitivity to latex, many cases have been reported, some of them with anaphylactic reactions. The aim of this study is to analyze the clinical findings, diagnostic management and therapeutic procedures in these patients. METHODS: We reviewed the clinical findings in 15 patients with contact urticaria to latex from our files. Use-test with a surgical glove, prick-test trough a rubber glove, RAST to latex and standard patch-tests were performed in each case. RESULTS: We found a M:F ratio of 1:4 (3 males and 12 females) and the mean age at diagnosis was 33 years. Atopic background was present in 60% of cases and 46% were health care workers. Systemic manifestations of allergy were found in 25% of patients. Two cases developed anaphylactic shock. Cutaneous manifestations included localized contact urticaria in 33% of cases, chronic hand eczema and urticaria in 46%, and immediate contact dermatitis in 20%. All cases showed a positive use-test, while prick-test and RAST showed positive results in only 75% of patients. Positive patch-test to rubber accelerators were found in 33% of cases. CONCLUSIONS: Latex immediate hypersensitivity is frequently seen at present. Its prevalence in health care workers is high. Atopic constitution, chronic hand eczema, continuous gloves usage, and contact dermatitis to rubber additives are predisposing factors. Diagnosis can be assessed by clinical findings and use-test, confirming by prick-test and RAST.

[Prevalence of sensitivity to contact allergens among atopic and non atopic children without dermatitis]. / Prevalencia de la sensibilización a alergenos de contacto entre la población infantil atópica y no atópica sin dermatitis.

Epicutaneus tests were used to study 168 children without dermatitis (aged 6 months to 14 years) divided into two groups: 88 atopic cases (53 males and 35 females) and 76 non atopic children (44 males and 31 females). Epicutaneous testing proved positive in 22.7 of atopic children, and in 17.3 por 100 of non atopic cases; there were no statistically significant differences between the two groups, and vesicular reactions predomined in both. Nickel was the contact allergen of greatest predominance among the atopic and non atopic children (17 and 9.3% respectively), followed by mercury derivatives (5.5%), neomycin (2.4%) and dichromates (1.8%).

[Contact allergic dermatitis in childhood: 1972-1987]. / Dermatitis alérgica de contacto en la infancia: 1972-1987.

We have carried out retrospective study of 190 children with dermatitis, aged from 2 to 14 years old. 67 (35%) of these children showed positive patch-test reactions. Nickel sulphate (35%) was the first allergen. Form 1979, once mercury was introduced in the GEIDC standard series, it becomes the more common iatrogenic allergen in childhood in our country. Other allergens also responsible for the dermatitis were mercaptobenzothiazole (12%), cobalt (9%) and p-phenylenediamine (7%).