Perfil de sensibilização de pacientes submetidos ao teste de contato no Instituto Lauro de Souza Lima no período de 2017 a 2023 / Sensitization profile of patients undergoing patch testing at the Lauro de Souza Lima Institute from 2017 to 2023

Introdução: O teste de contato (patch teste) é o padrão ouro para diagnóstico de dermatites alérgicas de contato (DACs), possibilitando a identificação do agente desencadeante. Mudanças nos hábitos de vida e exposição a novos agentes sensibilizantes presentes em medicamentos, cosméticos e outros produtos podem induzir mudanças no perfil de sensibilização da população. Objetivo: Realizar um levantamento do perfil dos pacientes que efetuaram o teste de contato no Instituto Lauro de Souza Lima (ILSL) no período entre 2017 e 2023, bem como a frequência de sensibilização aos elementos testados, para identificar alterações devido à pandemia de COVID-19. Material e Métodos: Foi realizado um estudo retrospectivo no ILSL, analisando os registros dos testes realizados de julho de 2017 a junho de 2023. Parâmetros como sexo, idade, atividade profissional, localização das lesões e sensibilização aos elementos testados da bateria padrão (n=30) e de cosméticos (n=10) foram avaliados. As reações foram classificadas de acordo com as recomendações do International Contact Dermatitis Research Group e os dados foram analisados usando o teste do qui-quadrado. Resultados: O estudo incluiu 738 indivíduos, sendo 67,9% do sexo feminino, com idade média de 45,4 anos. As regiões mais afetadas foram mãos (62,45%), pés (45,99%) e braços (26,58%). 75,80% apresentaram reação positiva a pelo menos uma das 40 substâncias testadas. O sulfato de níquel foi o elemento mais prevalente (35,91%), seguido por cloreto de cobalto (24,12%) e timerosol (15,04%). Na análise da bateria de cosméticos, verificamos maior prevalência de sensibilização ao amerchol L-101 (11,24%), bronopol (3,79%) e tonsilamida (3,11%). A sensibilização ao amerchol L-101 mostrou-se crescente a partir de 2020 com maior incidência em 2021 e permaneceu elevada até o final do período avaliado. Conclusão: O perfil de sensibilização a substâncias da bateria padrão no ILSL permaneceu semelhante ao observado em estudo anterior. Entretanto, houve um aumento na sensibilização ao amerchol L-101 no período da pandemia de COVID-19 o que pode estar associado a mudança de hábitos de higiene como aumento da frequência de lavagem de mãos e uso de produtos antissépticos

ABSTRACT: Patch testing is considered the gold standard for the diagnosing allergic contact dermatitis (ACD) and allows the identification of triggering allergens. Changes in lifestyle as well as exposure to new sensitizers present in medications, cosmetics, and other products, may induce changes in the sensitization profile of the population. Objective: To investigate the sensitization profile of patients who underwent patchtesting at the Lauro de Souza Lima Institute (ILSL) between 2017 and 2023, and the frequency of sensitization to the elements tested, to identify changes due to the COVID-19 pandemic. Materials and Methods: A retrospective study was conducted at the ILSL, analyzing medical records of tests performed from July 2017 to June 2023. Parameters such as sex, age, occupation, location of the lesion, and sensitization to the elements of the standard battery (n=30) and the cosmetic battery (n=10) were evaluated. Reactions were classified according to the recommendations of the International Contact Dermatitis Research Group, and the data were analyzed using the chi-squared test. Results: The study included 738 subjects, 67.9% female, mean age 45.4 years. The most commonly affected areas were the hands (62,4%), feet (46.0%), and arms (26.6%). 75.8% had a positive reaction to at least one of the 40 substances tested. Nickel sulfate was the most prevalent element (35.9%), followed by cobalt chloride (24.1%) and thimerosal (15.0%). Regarding the cosmetic battery, we found a higher prevalence of sensitization to amerchol L-101 (11.2%), bronopol (3.8%), and tonsilamide (3.1%). There was an increasing trend for sensitization to amerchol L-101 from 2020 onwards, reaching a peaking in 2021 and remaining at an elevated level until the end of the evaluated period. Conclusion: The sensitization profile to the standard series at ILSL remained similar to that observed in a previous study. However, there was an increase in sensitization to amerchol L-101 during the pandemic period, possibly related to changes in hygiene habits such as increased hand washing and the use of antiseptic products

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.

Effects of slime toy poisoning in children and teenagers / Efeitos da intoxicação por slime em crianças e adolescentes

Abstract Objective: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. Data source: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. Data synthesis: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. Conclusions: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults.

Resumo Objetivo: Identificar quais tipos de reações de pele e ingredientes do brinquedo slime estão frequentemente envolvidos em relatos de intoxicação. Fontes de dados: Entre janeiro e julho de 2021, ocorreu a seleção dos artigos, utilizando-se as bases de dados: United States National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Foram utilizados os seguintes descritores: (dermatitis OR rash OR eczema OR inflammation) AND slime. Incluíram-se artigos disponíveis na íntegra, em português, inglês ou espanhol, publicados entre janeiro de 2000 e 31 julho de 2021, que relatassem casos de crianças e adolescentes que apresentaram reação cutânea após a manipulação do brinquedo slime. Foram excluídos artigos sem aderência ao tema e textos duplicados nas bases de dados. Síntese dos dados: Identificaram-se 65 publicações, sendo 16 utilizadas para a elaboração desta revisão. Isso resultou no total de 22 crianças (duas do sexo masculino, 20 do feminino), com idades entre quatro e 13 anos, que teriam sido intoxicadas por slime, a maioria dos casos ligado a preparações caseiras. Estudos relataram a ocorrência de dermatite de contato ou alérgica nas mãos, dedos, unhas, antebraços e bochechas. Os ingredientes mais alergênicos e/ou irritantes foram detergentes líquidos e sabão. Ademais, o patch test identificou reações positivas para metilisotiazolinona e metilcloroisotiazolinona, que são conservantes utilizados em produtos como cola, sabão, detergente, etc. Conclusões: Ainda que o brinquedo slime seja importante para o desenvolvimento motor e das relações parentais, receitas caseiras incluem vários ingredientes alergênicos e irritantes, que podem ser expostos a crianças vulneráveis e causar intoxicações. Sendo assim, as preparações do slime devem ser feitas com cautela e sob supervisão de adultos.

Photosensitive rash induced by nivolumab

Abstract The therapeutic approach to metastatic melanoma has revolutionized the clinical course of this disease. Since 2011, different immunotherapeutic drugs have been approved. Nivolumab is a humanized immunoglobulin IgG4 monoclonal antibody that binds to the PD-1 receptor, blocking its interaction with his ligand PD-L1. The authors present a new case of photosensitivity induced by nivolumab. The photo exposed distribution of the eruption, the sun exposure prior to the beginning of the eruption, and the chronological relationship with the beginning of the treatment are data that have allowed us to confirm the suspected clinical diagnosis.

Photosensitive rash induced by nivolumab.

The therapeutic approach to metastatic melanoma has revolutionized the clinical course of this disease. Since 2011, different immunotherapeutic drugs have been approved. Nivolumab is a humanized immunoglobulin IgG4 monoclonal antibody that binds to the PD-1 receptor, blocking its interaction with his ligand PD-L1. The authors present a new case of photosensitivity induced by nivolumab. The photo exposed distribution of the eruption, the sun exposure prior to the beginning of the eruption, and the chronological relationship with the beginning of the treatment are data that have allowed us to confirm the suspected clinical diagnosis.

Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery.

BACKGROUND: Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. OBJECTIVES: To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. METHODS: Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. RESULTS: The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). STUDY LIMITATIONS: Sample size and selection, absence of a control group. CONCLUSIONS: A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery

Abstract Background Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. Objectives To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. Methods Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. Results The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). Study limitations Sample size and selection, absence of a control group. Conclusions A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Allergic contact cheilitis caused by propolis: case report

ABSTRACT Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.

Usefulness of dermoscopy in the evaluation of patch test reactions

Abstract Background: Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions. Objectives: To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions. Method: Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy. Results: 77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001). Study limitations: The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed. Conclusion: Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.

Usefulness of dermoscopy in the evaluation of patch test reactions.

BACKGROUND: Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions. OBJECTIVES: To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions. METHOD: Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy. RESULTS: 77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area​​ greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001). STUDY LIMITATIONS: The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed. CONCLUSION: Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.

[Contact dermatitis caused by diagnostic devices and surgical orthopedic treatment]. / Dermatitis de contacto causada por dispositivos de diagnóstico y tratamiento quirúrgico ortopédico.

BACKGROUND: Acrylates are plastic materials that are formed by the polymerization of monomers that are derived from acrylic or methacrylic acid; they have a wide range of applications, and they are increasingly used in medicine. CASE REPORT: We are reporting two clinical cases of contact dermatitis in the hospital environment; the first one is about a nurse (occupational exposure) and, the second one, about a patient who experienced contact dermatitis after a diagnostic procedure was performed. CONCLUSION: New sources of acrylates are identified every year due to the multiple uses of these synthetic resins; these materials are included in medical devices, both for orthopedic diagnosis or follow-up (telemetry, electrodes of electroencephalographs) and treatment (bone cement), as well as for surgery.

Antecedentes: Los acrilatos son materiales plásticos que se forman por la polimerización de monómeros derivados del ácido acrílico o metacrílico; tienen una amplia gama de aplicaciones y cada vez son más usados en el campo de la medicina. Casos clínicos: Presentamos dos casos clínicos de dermatitis de contacto en el entorno hospitalario: el primero se trata de una enfermera (exposición ocupacional) y el segundo, de un paciente a quien se le realizó un procedimiento diagnóstico. Conclusión: Cada año se identifican nuevas fuentes de acrilatos debido a las múltiples utilidades de estas resinas sintéticas; estos materiales se incluyen en dispositivos médicos, tanto para el diagnóstico o seguimiento (telemetría, electrodos de electroencefalógrafos) como para el tratamiento (cemento óseo) y cirugía ortopédica.

Allergic contact dermatitis to cosmetics: retrospective analysis of a population subjected to patch tests between 2004 and 2017

Abstract Background: Cosmetics are part of the daily life of the population, and their use can lead to allergic contact dermatitis. Objectives: To assess the profile of patients diagnosed with allergic contact dermatitis to cosmetics treated at a referral center for 13 years, as well as the characteristics of the clinical picture and allergens involved. Methods: This was a retrospective study, with analysis of medical records of patients attended at this service. The individuals included had a diagnostic hypothesis of allergic contact dermatitis to cosmetics and had previously been submitted to epicutaneous tests. Results: A total of 1405 medical records were analyzed, 403 (28.7%) with suspected allergic contact dermatitis to cosmetics and 232 (16.5%) with confirmed diagnosis. Of these, 208 (89.7%) were women, and the age group most affected was 31 − 60 years. The most common locations were face in 195 cases (25.8%), cervical region in 116 (15.3%), and trunk in 96 (12.6%). The main allergens in the contact tests were toluene-sulfonamide-formaldehyde resin in 69 cases (29.7%), paraphenylenediamine in 54 (26.3%), Kathon CG® in 41 (20.7%), and fragrance-mix 1 in 29 (16.4%). In 154 (66.4%) of the 232 patients with a confirmed diagnosis of allergic contact dermatitis to cosmetics it was possible to specify the cosmetic product responsible for the lesions. Study limitations: The absence of some allergens considered important in the world as causes of allergic contact dermatitis, which are not readily accessible among us. Conclusions: The data of the analyzed population (predominance of young women), as well as the location of the lesions (face and cervical area) and the main allergens involved were consistent with those from the world literature.

Allergic contact dermatitis to cosmetics: retrospective analysis of a population subjected to patch tests between 2004 and 2017.

BACKGROUND: Cosmetics are part of the daily life of the population, and their use can lead to allergic contact dermatitis. OBJECTIVES: To assess the profile of patients diagnosed with allergic contact dermatitis to cosmetics treated at a referral center for 13 years, as well as the characteristics of the clinical picture and allergens involved. METHODS: This was a retrospective study, with analysis of medical records of patients attended at this service. The individuals included had a diagnostic hypothesis of allergic contact dermatitis to cosmetics and had previously been submitted to epicutaneous tests. RESULTS: A total of 1405 medical records were analyzed, 403 (28.7%) with suspected allergic contact dermatitis to cosmetics and 232 (16.5%) with confirmed diagnosis. Of these, 208 (89.7%) were women, and the age group most affected was 31 - 60 years. The most common locations were face in 195 cases (25.8%), cervical region in 116 (15.3%), and trunk in 96 (12.6%). The main allergens in the contact tests were toluene-sulfonamide-formaldehyde resin in 69 cases (29.7%), paraphenylenediamine in 54 (26.3%), Kathon CG® in 41 (20.7%), and fragrance-mix 1 in 29 (16.4%). In 154 (66.4%) of the 232 patients with a confirmed diagnosis of allergic contact dermatitis to cosmetics it was possible to specify the cosmetic product responsible for the lesions. STUDY LIMITATIONS: The absence of some allergens considered important in the world as causes of allergic contact dermatitis, which are not readily accessible among us. CONCLUSIONS: The data of the analyzed population (predominance of young women), as well as the location of the lesions (face and cervical area) and the main allergens involved were consistent with those from the world literature.

Unexpected patch test complication: onset of erythema multiforme-like lesions / Complicação inesperada após teste de contato: aparecimento de lesões eritema multiforme-símile

Erythema multiforme is generally associated with infections and drugs. Although less common, there are also reported cases of this disorder after patch testing. We described a 22 year-old female patient who, 24 hours after patch testing, progressed to erythematous iris-shaped plaques and papules with central crust, symmetrically distributed over her hands, arms, and back, with severe itch. The erythema multiforme-like lesions presented in the case were interpreted as a manifestation of systemic allergic contact dermatitis secondary to the exam. Allergic contact dermatitis may be manifested as an erythema multiforme in a hypersensitive person. Few cases of systemic allergic contact dermatitis after patch testing have been reported, for example, due to diethyl thiourea, some textile disperse dyes, and povidoneiodine. The development of erythema multiforme is not noted in most literature references as a complication after patch testing. Although unusual, this disorder needs to be considered as a potential adverse effect of this exam.

O eritema multiforme está associado comumente a infecções e medicamentos. Embora menos comum, também há casos relatados dessa doença após aplicação do teste de contato. Descrevemos uma paciente de 22 anos que evoluiu, em 24 horas após o teste, com placas e pápulas eritematosas, em formato de íris e crosta central, distribuídas simetricamente nas mãos, braços e costas, além de prurido intenso. As lesões eritema multiformesímile presentes no caso foram interpretadas como uma manifestação alérgica secundária ao exame. Dermatite de contato alérgica pode se manifestar como um eritema multiforme em pessoas hipersensíveis. Poucos casos de dermatite alérgica de contato sistêmica foram relatados após este exame, por exemplo, devido às seguintes substâncias: dietil tioureia, corantes dispersos têxteis e iodopovidona. O desenvolvimento do eritema multiforme não é usualmente apontado como uma complicação do teste de contato alérgico, na maioria das referências literárias. Embora incomum, o surgimento dessa desordem após este exame necessita ser considerado como um efeito adverso.

Positive results of patch tests with fragrance markers: analysis of a 15-year period at a Brazilian dermatology center

Abstract: Fragrances may cause allergic contact dermatitis. Data on patients who were patch tested, between 2000 and 2015, with fragrance allergens included in the Brazilian baseline series (balsam of Peru, colophony and fragrance mix I), were collected and analyzed. Of these patients, 258 (13.8%) were positive for fragrance markers, 9.8% being positive for fragrance mix I. Among these 258 there was a predominance of women in their 40s, with hand eczema. The frequency of sensitization to fragrances, as well as the epidemiological profile, was supported by the literature. Fragrance mix I was the main marker. It is important to expand the fragrance markers used in the Brazilian baseline series of patch tests.

Assessment of patch test results carried out during ten years in a city in southern Brazil

Abstract: Background: Contact dermatitis affects up to 20% of the population. Patch testing for contact allergy may be needed to confirm the diagnosis. Objectives: To describe and discuss the results of patch tests performed in a city in southern Brazil. Methods: A cross-sectional analysis was performed on all skin test results over ten years. Variables such as gender, age at the time of testing, and test results were evaluated. Triggering factors, duration of complain, and previous medications used related to the clinical history were retrieved for some patients by reviewing their medical records. Results: The sample was composed of 539 patch tests, of which 411 (76.2%) were from women. The age of the tested subjects ranged from 5 to 87 years. The prevalence of positive reactions in the patch tests was 391 (72.5%). The most prevalent positive reaction was to nickel sulfate (196; 36.4%), which had statistical significance when associated with female gender (p<0,001). Study limitations: Database obtained through secondary sources (the reports of the exams and the medical records), occurring the incomplete registration of some information. Conclusions: Data analysis at the local level is important to define preventive policies.

Allergic contact dermatitis to shoes: contribution of a specific series to the diagnosis

Abstract: Background: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. Objectives: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. Methods: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. Results: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. Study limitation: Small sample size. Conclusions: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.

Nickel, chromium and cobalt: the relevant allergens in allergic contact dermatitis. Comparative study between two periods: 1995-2002 and 2003-2015

Abstract: Background: Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects. Objectives: To analyze and compare with previous studies the profile of metal sensitization between 2003-2015. Methods: Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology. Results: Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001). Study limitations: The study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives. Conclusion: The sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.

Principais sensibilizantes em pacientes idosos e não idosos com dermatite de contato / Main allergens in elderly and non-elderly patients with contact dermatitis

OBJETIVOS: Avaliar a prevalência dos principais sensibilizantes da dermatite de contato alérgica em pacientes idosos e não idosos. MÉTODOS: Estudo retrospectivo com revisão dos prontuários de pacientes com diagnóstico clínico de dermatite de contato, atendidos no período de agosto de 2000 a janeiro de 2012 no Ambulatório de Alergia da Faculdade de Medicina de Marília e em clínica particular de Alergia e Dermatologia na cidade de Marília, estado de São Paulo. Os critérios de inclusão foram diagnóstico clínico de dermatite de contato, realização de teste cutâneo de contato (patch test) no período do estudo e não uso de corticosteroide sistêmico ou outra medicação imunossupressora. Foram analisados idade, sexo, história de outros tipos de alergia e sensibilizantes utilizados. Os resultados do patch test foram lidos 48 horas e 72 horas após a colocação dos contensores. RESULTADOS: Foram incluídos 362 pacientes, entre o quais 60 idosos (idade maior ou igual a 60 anos) e 302 não idosos. Além da dermatite de contato foram observados outros tipos de alergias em 20 (33,3%) dos idosos e em 113 (37,4%) dos não idosos (p=0,54). Houve um total de 162 reações positivas ao patch test entre os idosos e 738 reações positivas entre os não idosos (p=0,24). Quanto às reações positivas fortes ocorreram 41 (68,3%) entre os idosos e 156 (51,6%) entre os não idosos (p=0,02). Somando-se reações positivas fortes e muito fortes, foram 44 (73,3%) em idosos e 214 (70,8%) em não idosos (p=0,69). As substâncias mais sensibilizantes foram o sulfato de níquel (em 33,3% dos idosos e 38 % dos não idosos) e o perfume mix (em 25% dos idosos e 27,8% dos não idosos), sem diferença estatística entre os dois grupos etários. CONCLUSÕES: A taxa de positividade do patch test entre os pacientes com dermatite de contato foi alta, não havendo diferença entre idosos e não idosos, sendo o sulfato de níquel e o perfume mix as substâncias mais sensibilizantes. Na investigação etiológica da dermatite de contato deve-se pensar principalmente na possibilidade de sensibilização aos perfumes e ao níquel, independentemente da faixa etária.

AIMS: To evaluate the prevalence of the main allergens found in allergic contact dermatitis among elderly and non-elderly patients. METHODS: Retrospective study of the medical records of patients clinically diagnosed with contact dermatitis treated from August 2000 to January 2012 at the Allergy Outpatient Clinic of Marília Medical School and at an Allergy and Dermatology private clinic in Marília, state of São Paulo, Brazil. The inclusion criteria were clinical diagnosis of contact dermatitis, patch test performed during the study period, and no treatment with systemic corticosteroids or any other immunosuppressants. Age, sex, history of other types of allergy and allergens used were assessed. The patch test results were read 48 hours and 72 hours after application of the test chambers. RESULTS: A total of 362 patients were included in the study: 60 elderly patients (aged 60 years or older) and 302 non-elderly patients. In addition to contact dermatitis, other types of allergies were observed in 20 (33.3%) of elderly patients and in 113 (37.4%) of non-elderly patients (p=0.54). There were 162 positive reactions on the patch test among elderly patients and 738 positive reactions among non-elderly patients (p=0.24). Strong positive reactions were present in 41 (68.3%) elderly patients and in 156 (51.6%) non-elderly patients (p=0.02). Strong and very strong positive reactions, when assessed together, were detected in 44 (73.3%) elderly patients and in 214 (70.8%) non-elderly patients (p=0.69). The most common allergens were nickel sulfate (in 33.3% of elderly and 38% of non-elderly patients) and fragrance mix (in 25% of elderly and 27.8% of non-elderly patients), with no statistical difference between the groups. CONCLUSIONS: There was a high rate of positive reactions on the patch test among patients with contact dermatitis, with no difference between elderly and non-elderly individuals, and the most common allergens were nickel sulfate and fragrance mix. Therefore, it is important that allergy to nickel and fragrances be included in the etiologic investigation of contact dermatitis, regardless of age.