Patch tests and hand eczema: retrospective study in 173 patients and literature review

Abstract Background Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease. Objectives To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology. Methods A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020. Results A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%). Study limitations The number of treated cases and socioeconomic profile was limited to a vulnerable population group. Conclusion HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix.

Patch tests and hand eczema: retrospective study in 173 patients and literature review.

BACKGROUND: Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease. OBJECTIVES: To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology. METHODS: A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020. RESULTS: A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%). STUDY LIMITATIONS: The number of treated cases and socioeconomic profile was limited to a vulnerable population group. CONCLUSION: HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix.

Nickel exposure from keys: a Brazilian issue.

Keys are a significant source of exposure to metal allergens and can be a relevant problem for nickel-allergic individuals. This study aimed to perform nickel and cobalt spot testing among the 5 most common Brazilian brands of keys. Among the tested keys, 100% showed positive result to nickel spot test, 83,3% presented strong positive reaction. 50% exhibited cobalt release as well. Nickel release from keys is very common in our country and may cause a negative impact on sensitized individual's quality of life. Study's results highlight the importance of establishing directives to regulate nickel release in Brazil.

Nickel exposure from keys: a Brazilian issue

Abstract: Keys are a significant source of exposure to metal allergens and can be a relevant problem for nickel-allergic individuals. This study aimed to perform nickel and cobalt spot testing among the 5 most common Brazilian brands of keys. Among the tested keys, 100% showed positive result to nickel spot test, 83,3% presented strong positive reaction. 50% exhibited cobalt release as well. Nickel release from keys is very common in our country and may cause a negative impact on sensitized individual's quality of life. Study's results highlight the importance of establishing directives to regulate nickel release in Brazil.

Ultraviolet radiation emitted by lamps, TVs, tablets and computers: are there risks for the population?

The frequent human exposure to various types of indoor lamps, as well as other light sources (television monitors, tablets and computers), raises a question: are there risks for the population? In the present study the emission of UVA and UVB radiation by lamps and screens of electronic devices were measured in order to determine the safe distance between the emitting source and the individual. We concluded that the lamps and electronic devices do not emit ultraviolet radiation; so they pose no health risk for the population.

An evaluation of the treatment of parapsoriasis with phototherapy.

Whether parapsoriasis represents an early stage of T-cell cutaneous lymphoma is still the subject of controversy. We evaluated the efficacy of phototherapy in the treatment of parapsoriasis and its relation with TCCL. Patients diagnosed with parapsoriasis and treated with phototherapy PUVA or UVB-NB were selected. Between 1 to 8 years following treatment the evolution of their disease was evaluated. In 62 patients the cure rate was 79.3% and 17.2% showed improvement of the lesions. Only two patients developed full blown T-cell cutaneous lymphoma. Phototherapy is an excellent treatment for parapsoriasis, with high cure rates, regardless of the type of phototherapy employed. Of the 62 patients under study, parapsoriasis showed no general tendency to progress to T-cell cutaneous lymphoma.

Patch test standard series recommended by the Brazilian Contact Dermatitis Study Group during the 2006-2011 period.

A retrospective study was carried out between 2006-2011. Six hundred and eighteen patients with suspected allergic contact dermatitis underwent the standard patch test series recommended by the Brazilian Contact Dermatitis Research Group. The aim of our study was to evaluate the variation of positive patch-test results from standard series year by year. The most frequently positive allergens were: nickel sulfate, thimerosal and potassium bichromate. Decrease of positive patch-test results over the years was statistically significant for: lanolin (p=0.01), neomycin (p=0.01) and anthraquinone (p=0.04). A follow-up study should be useful in determining which allergens could be excluded from standard series, as they may represent low sensitization risk.

Allergic contact dermatitis among construction workers detected in a clinic that did not specialize in occupational dermatitis.

BACKGROUND: Contact dermatitis is one of the common work-related dermatoses. Among bricklayers, cement can cause both allergic contact dermatitis and primary contact irritative dermatitis. The personal protective equipment (rubber gloves) may favor the development of allergic contact dermatitis. OBJECTIVES: 1) to evaluate the frequency of allergic contact dermatitis among construction workers between January 2005 and December 2009; 2) to determine the major sensitizing agents in the study group; and 3) to compare the data obtained from the construction workers to that of a group of patients who were not construction workers. METHODS: A retrospective analysis of patch tests. Patients were separated into two groups: 1) bricklayers and 2) non-bricklayers. RESULTS: Of the 525 patch tests analyzed, 466 (90%) were from non-bricklayers and 53 (10%) from bricklayers. The hands were affected in 38 (61%) of them. 13 patients (24%) had irritative contact dermatitis and 40 (76%) had allergic contact dermatitis. The group of construction workers had a high frequency of sensitization to cement, and 29 (54.7%) had sensitization to rubber vulcanizing agents. 23 patients (43.4%) had sensitization to both cement and rubber. CONCLUSIONS: Among the bricklayers the presence of allergic contact dermatitis to rubber and cement in the same patient is common and demonstrates the importance of the patch test.

Allergic contact dermatitis among construction workers detected in a clinic that did not specialize in occupational dermatitis / Dermatite alérgica de contato entre pedreiros, num serviço não especializado em dermatoses ocupacionais

BACKGROUND: Contact dermatitis is one of the common work-related dermatoses. Among bricklayers, cement can cause both allergic contact dermatitis and primary contact irritative dermatitis. The personal protective equipment (rubber gloves) may favor the development of allergic contact dermatitis. OBJECTIVES: 1) to evaluate the frequency of allergic contact dermatitis among construction workers between January 2005 and December 2009; 2) to determine the major sensitizing agents in the study group; and 3) to compare the data obtained from the construction workers to that of a group of patients who were not construction workers. METHODS: A retrospective analysis of patch tests. Patients were separated into two groups: 1) bricklayers and 2) non-bricklayers. RESULTS: Of the 525 patch tests analyzed, 466 (90%) were from non-bricklayers and 53 (10%) from bricklayers. The hands were affected in 38 (61%) of them. 13 patients (24%) had irritative contact dermatitis and 40 (76%) had allergic contact dermatitis. The group of construction workers had a high frequency of sensitization to cement, and 29 (54.7%) had sensitization to rubber vulcanizing agents. 23 patients (43.4%) had sensitization to both cement and rubber. CONCLUSIONS: Among the bricklayers the presence of allergic contact dermatitis to rubber and cement in the same patient is common and demonstrates the importance of the patch test.

FUNDAMENTOS: A dermatite de contato é uma das dermatoses comumente relacionadas ao trabalho. Entre os pedreiros o cimento pode causar tanto a Dermatite Alérgica de Contato quanto a Dermatite de Contato por Irritação Primária. Os equipamentos de proteção individual (luvas de borracha) podem favorecer o desenvolvimento de Dermatite Alérgica de Contato. OBJETIVOS: 1) avaliar a freqüência de Dermatite Alérgica de Contato entre os pedreiros entre Janeiro de 2005 e Dezembro de 2009; 2) determinar os principais agentes sensibilizantes; e 3) comparar os resultados obtidos entre o grupo de pedreiros com um grupo sem pedreiros. MÉTODOS: análise retrospectiva de testes de contato. Pacientes foram separados em 2 grupos: 1) pedreiros e 2) não pedreiros. RESULTADOS: dentre os 525 testes de contato analisados, 466 (90%) eram de não pedreiros e 53 (10%) de pedreiros. As mãos foram acometidas em 38 (61%). 13 pacientes (24%) tinham Dermatite de Contato por Irritação Primária e 40 (76%) tinham Dermatite Alérgica de Contato. O grupo de pedreiros apresentou alta freqüência de sensibilização ao cimento, e 29 (54,7%) tinham sensibilização a agentes vulcanizadores da borracha. 23 pacientes (43,4%) pedreiros tinham sensibilização tanto ao cimento quanto à borracha. CONCLUSÕES: entre os pedreiros a presença de Dermatite Alérgica de Contato ao cimento e à borracha no mesmo paciente foi comum e demonstrou a importância do teste de contato.

Localized scleroderma: assessment of the therapeutic response to phototherapy.

BACKGROUND: Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES: This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS: Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS: Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS: The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

Localized scleroderma: assessment of the therapeutic response to phototherapy / Esclerodermia cutânea: avaliação da resposta terapêutica à fototerapia

BACKGROUND: Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES: This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS: Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS: Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS: The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

FUNDAMENTOS: A esclerodermia é uma doença autoimune caracterizada pela esclerose progressiva do tecido conjuntivo e alterações da microcirculação. A forma cutânea é considerada uma doença autolimitada. No entanto, em alguns casos, ocorrem lesões atróficas, deformantes, que dificultam o desenvolvimento normal. Relatos da literatura apontam a fototerapia como uma modalidade terapêutica com resposta favorável nas formas cutâneas da esclerodermia. OBJETIVOS: Este trabalho teve como objetivo avaliar o tratamento da esclerodermia cutânea com fototerapia. MÉTODOS: Foram selecionados pacientes com diagnóstico de esclerodermia cutânea para o tratamento com fototerapia, os quais foram classificados de acordo com o tipo clínico e o estágio evolutivo das lesões. Utilizou-se o exame clínico e a ultrassonografia da pele como metodologia para demonstrar os resultados obtidos com o tratamento proposto. RESULTADOS: Foi observado o início da melhora clínica das lesões com média de 10 sessões de fototerapia. A palpação clínica mostrou amolecimento em todas as lesões estudadas, com redução nos escores de avaliação estabelecidos. No exame de ultrassom, a maioria das lesões avaliadas mostrou diminuição da espessura da derme, e apenas cinco mantiveram sua medida. Não se observou diferença na resposta ao tratamento de acordo com o tipo de fototerapia instituída. CONCLUSÕES: O tratamento proposto foi efetivo em todas as lesões, independentemente do tipo de fototerapia realizada. A melhora foi observada em todas as lesões tratadas e comprovada pela avaliação clínica e pelo exame de ultrassom da pele.

Dermatosis frequency evaluation in the ambulatorial attendance of dermatology.

The objective was to evaluate the prevalence of skin diseases in patients seen at the Dermatology outpatients' clinic of the Santa Casa de São Paulo during the period from June to October 2005, comparing the results with a similar survey conducted at the same center in 1977. During the period of study, the electronic medical charts of 3011 patients seen in a first visits were analyzed.

Avaliação da frequência de dermatoses no serviço ambulatorial de dermatologia / Dermatosis frequency evaluation in the ambulatorial attendance of Dermatology

O objetivo do trabalho foi avaliar a prevalência das dermatoses dos pacientes atendidos no ambulatório de Dermatologia da Santa Casa de São Paulo, no período de junho a outubro de 2005, e comparar os resultados com levantamento semelhante realizado no mesmo serviço, no ano de 1977. Foram analisados os prontuários eletrônicos de 3.011 pacientes atendidos em primeira consulta.

The objective was to evaluate the prevalence of skin diseases in patients seen at the Dermatology outpatients' clinic of the Santa Casa de São Paulo during the period from June to October 2005, comparing the results with a similar survey conducted at the same center in 1977. During the period of study, the electronic medical charts of 3011 patients seen in a first visits were analyzed.

Pimecrolimus cream 1%: a potential new treatment for chronic hand dermatitis.

A multicenter, randomized, vehicle-controlled, 3-week study was conducted in patients with chronic hand dermatitis (HD) of various etiologies and locations to identify subgroups particularly responsive to twice-daily application of pimecrolimus cream 1% with overnight occlusion. A total of 294 patients were randomized to the study. By the final visit on day 22, there was a trend toward greater clearance in patients who received pimecrolimus than in those treated with vehicle cream. An analysis of treatment success by various stratification factors was performed, and it was found that palmar involvement had notable impact on response (P = .033). Patients in the pimecrolimus group continued to improve throughout the study; however, in the vehicle group, improvement plateaued after 15 days. Pimecrolimus was well tolerated, with a low rate of application-site reactions such as burning. Pimecrolimus cream 1%, when used twice daily with overnight occlusion, may be of benefit in the management of chronic HD.