Neomycin: sources of contact and sensitization evaluation in 1162 patients treated at a tertiary service

Abstract Background: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. Objective: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. Method: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. Results: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. Study limitations: Retrospective study. Conclusion: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.

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.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial / Fração soro do látex de Hancornia speciosa: um biomaterial não alergênico

Abstract Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Resumo Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis ​​pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial / Fração soro do látex de Hancornia speciosa: um biomaterial não alergênico

Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

Hancornia speciosa serum latex fraction: a non-allergenic biomaterial

Abstract Plant-derived products can assist in the healing process of dermal wounds. It has been demonstrated that Hancornia speciosa latex present angiogenic, osteogenic, anti-inflammatory, and antioxidant activities. Then, it could contribute to the wound healing process. However, natural products in contact with skin may cause dermatitis. The objective of this work was to evaluate the allergic and irritant potential of H. speciosa serum fraction latex using in vitro assays. The obtained results showed that the H. speciosa serum fraction latex has a slightly irritant potential and is not cytotoxic neither allergenic for human cells. Moreover, we identified a remarkable low amount of proteins in this material in comparison to Hevea brasiliensis latex. This result could explain the non-allergenic potential of H. speciosa serum fraction latex because proteins present in latex are the main responsible for allergy. This biomaterial could be used as a non-allergenic source for development of new medicines.

Resumo Produtos derivados de plantas podem auxiliar no processo de cicatrização de feridas cutâneas. Foi demonstrado que o látex de Hancornia speciosa apresenta atividades angiogênicas, osteogênicas, antiinflamatórias e antioxidantes. Então, este biomaterial pode contribuir para o processo de cicatrização de feridas. No entanto, produtos naturais em contato com a pele podem causar dermatites. O objetivo deste trabalho foi avaliar o potencial alérgico e irritante do látex da fração soro de H. speciosa por meio de ensaios in vitro. Os resultados obtidos mostraram que o látex da fração do soro de H. speciosa possui um potencial pouco irritante e não é citotóxico nem alergênico para células humanas. Além disso, foi identificado uma notável baixa quantidade de proteínas neste material em comparação ao látex de Hevea brasiliensis. Esse resultado poderia explicar o potencial não alergênico do látex da fração soro de H. speciosa, pois as proteínas presentes no látex são as principais responsáveis pela alergia. Este biomaterial pode ser utilizado como fonte não alergênica para desenvolvimento de novos medicamentos.

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.

Allergic contact hand dermatitis due to constituents of nitrile gloves

Purpose: This report of a case of allergic contact hand dermatitis due to constituents of nitrile gloves is to bring to the attention of practitioners four important practice points: 1) allergic contact dermatitis may occur due to exposure to chemicals in nitrile gloves; 2) skin patch testing is used to identify the causative allergens; 3) targeted allergens may be necessary in addition to the baseline European standard series if the standard series is unhelpful; and 4) there are potential interventions to manage nitrile glove dermatitis. Findings: A laboratory analyst had occupational exposure to several allergens and had worn latex gloves. She was exposed to laboratory chemicals and powdered ore dust, containing precious metals. She developed hand dermatitis and was relocated to administrative duties not requiring glove use. Her dermatitis cleared but recurred when she returned to the laboratory and started using nitrile gloves. On history, nitrile gloves and platinum group metal ore dust were consistently associated with her hand dermatitis, but laboratory chemicals were not. Latex-specific immunoglobulin E (IgE) was negative, as were skin patch tests for 13 allergens in the metal series, including salts of platinum group metals. She had positive allergic reactions to cobalt chloride, formaldehyde, nickel sulphate, and quaternium 15 in the European standard series patch tests. She did not react to the rubber chemicals in the European standard series, including thiuram mix. The patient was then tested with the rubber additives series because of the glove-relatedness of her hand dermatitis. She had positive reactions to three thiuram compounds used as accelerators in rubber gloves. The patient went on vacation during which time her dermatitis improved. She was relocated to a position without glove use or ore contact and her dermatitis did not recur. Conclusions: An analytic laboratory worker developed hand allergic contact dermatitis due to nitrile glove constituents. The diagnosis is supported by the improvement in her dermatitis after cessation of glove use, negative metal series patch tests, and positive patch tests to accelerators found in rubber gloves. Nevertheless, a contribution to the dermatitis by metals in the platinum group metal ore dust cannot be excluded. Recommendations: Nitrile glove constituents should be considered in wearers who develop hand dermatitis. Skin patch testing is recommended to investigate putative agents. Specific patch test series for more targeted testing may be required

Ozonated oil alleviates dinitrochlorobenzene-induced allergic contact dermatitis via inhibiting the FcεRI/Syk signaling pathway / 中南大学学报(医学版)

OBJECTIVES@#Ozone is widely applied to treat allergic skin diseases such as eczema, atopic dermatitis, and contact dermatitis. However, the specific mechanism remains unclear. This study aims to investigate the effects of ozonated oil on treating 2,4-dinitrochlorobenzene (DNCB)-induced allergic contact dermatitis (ACD) and the underling mechanisms.@*METHODS@#Besides the blank control (Ctrl) group, all other mice were treated with DNCB to establish an ACD-like mouse model and were randomized into following groups: a model group, a basal oil group, an ozonated oil group, a FcεRI-overexpressed plasmid (FcεRI-OE) group, and a FcεRI empty plasmid (FcεRI-NC) group. The basal oil group and the ozonated oil group were treated with basal oil and ozonated oil, respectively. The FcεRI-OE group and the FcεRI-NC group were intradermally injected 25 µg FcεRI overexpression plasmid and 25 µg FcεRI empty plasmid when treating with ozonated oil, respectively. We recorded skin lesions daily and used reflectance confocal microscope (RCM) to evaluate thickness and inflammatory changes of skin lesions. Hematoxylin-eosin (HE) staining, real-time PCR, RNA-sequencing (RNA-seq), and immunohistochemistry were performed to detct and analyze the skin lesions.@*RESULTS@#Ozonated oil significantly alleviated DNCB-induced ACD-like dermatitis and reduced the expressions of IFN-γ, IL-17A, IL-1β, TNF-α, and other related inflammatory factors (all P<0.05). RNA-seq analysis revealed that ozonated oil significantly inhibited the activation of the DNCB-induced FcεRI/Syk signaling pathway, confirmed by real-time PCR and immunohistochemistry (all P<0.05). Compared with the ozonated oil group and the FcεRI-NC group, the mRNA expression levels of IFN-γ, IL-17A, IL-1β, IL-6, TNF-α, and other inflammatory genes in the FcεRI-OE group were significantly increased (all P<0.05), and the mRNA and protein expression levels of FcεRI and Syk were significantly elevated in the FcεRI-OE group as well (all P<0.05).@*CONCLUSIONS@#Ozonated oil significantly improves ACD-like dermatitis and alleviated DNCB-induced ACD-like dermatitis via inhibiting the FcεRI/Syk signaling pathway.

Occupational distribution and management strategies of occupational contact dermatitis / 环境与职业医学

Occupational contact dermatitis (OCD) is an occupational inflammatory skin disease. According to its pathogenesis, it can be divided into irritant contact dermatitis and allergic contact dermatitis. This review introduced the high-risk occupations of OCD, its incidence, common irritants and allergens, and corresponding treatments. Agriculture workers, construction workers, production workers, hairdressers, and medical workers are high-risk occupations of OCD who should be paid attention to.

Patch testing with expired Indian patch test kits: Results of a pilot study

Background: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. Methods: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. Results: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. Limitations: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. Conclusion: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation

A comparative study of two methods to construct allergic contact dermatitis in mice / 中国药理学通报

Abstract; Aim To explore the differences of 2,4-dinitrofluoro- benzene ( DNFB) -induced allergic contact demiatitis (ACD) models with different modeling cycles for the study of skin itch¬ing and inflammation, so as to provide reference and basis for the identification and selection of a more suitable animal model.Methods DNFB was used as a sensitizer, 0.5% DNFB was used to build a 2-week ACD model, and after 5-day sensitiza¬tion, the modeling site was administered once every other day and repeated four times.0.15% DNFB was used to build a 5- week ACD model, and after one week of treatment, DNFB was applied to the modeling site twice a week for four weeks.Behav¬ioral videos were recorded for 60 minutes alter each application of DNFB on the back of the neck for 24 hours.After modeling, Ig-K levels in serum were detected by KLISA, and the skin at the modeling site was stained for histopathology and observed.Results The entire modeling process of both modeled ACD mice was accompanied by severe scratching response after re¬peated skin exposure to DNFB, and the number of scratching significantly increased (P <0.01).Histopathological results showed epidermal thickening ( P < 0.01 ) , hyperkeratosis and inflammatory cell infiltration (P <0.01) in both modeling meth¬ods, and senmi Ig-F levels were significantly elevated ( P < 0.01).Conclusions The contact dennatitis model caused by DNFB is very stable, showing typical pruritus symptoms, severe dermatitis injury and inflammatory immune response, but the 5- week model may have more typical symptoms and allow enough time to observe the effect of the drug, which provides further ex¬perimental basis and evidence for pruritus and inflammation re¬lated drug research.

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.

Perfil demográfico e clínico de casos ocupacionais de sensibilização a metilisotiazolinona e Kathon CG: estudo seccional / Demographic and clinical profile of occupational cases of sensitization to methylisothiazolinone and Kathon CG: a cross-sectional study

Resumo Introdução: a metilisotiazolinona isolada ou associada à metilcloroisotiazolinona (Kathon CG) é um conservante relacionado à dermatite de contato alérgica ocupacional. Objetivos: avaliar o perfil demográfico e clínico dos casos ocupacionais de sensibilização a isotiazolinonas no município do Rio de Janeiro e descrever a presença desses preservativos em tintas nacionais. Métodos: estudo transversal baseado em informações de prontuários de trabalhadores submetidos a testes de contato entre 2013-2017. Descreveu-se a prevalência de características clínicas, demográficas e ocupacionais e utilizou-se um modelo não-ajustado para investigar a associação entre variáveis. Buscou-se a presença e a concentração de isotiazolinonas nas fichas de composição química de tintas nacionais. Resultados: dentre os 768 trabalhadores submetidos aos testes, 68 apresentavam dermatose ocupacional com resultado positivo para sensibilização à metilisotiazolinona/Kathon CG. As profissões mais acometidas foram as relacionadas a atividades domésticas e limpeza. Houve maior chance de sensibilização às isotiazolinonas nas mulheres e naqueles com acometimento das mãos e das pernas. Entre as 61 tintas avaliadas, 26 possuíam alguma isotiazolinona, sendo a metilcloroisotiazolinona a mais comum. Conclusões: a sensibilização às isotiazolinonas pode impactar a saúde do trabalhador e demanda maior vigilância com materiais de limpeza e cosméticos, assim como a discussão da regulação da composição de tintas comercializadas no país.

Abstract Introduction: methylisothiazolinone alone or associated with methylchloroisothiazolinone (Kathon CG) is a preservative related to occupational allergic contact dermatitis. Objectives: to evaluate the demographic and clinical profile of occupational cases of sensitization to isothiazolinones in the city of Rio de Janeiro and to describe the presence of these preservatives in national paints. Methods: cross-sectional study based on information from medical records of workers who underwent patch testing between 2013-2017. The prevalence of clinical, demographic and occupational characteristics was described and an unadjusted model was used to investigate the association between variables. We sought the presence and concentration of isothiazolinones in the chemical composition sheets of national paints. Results: among the 768 workers submitted to the tests, 68 had occupational dermatosis with a positive result for sensitization to methylisothiazolinone/Kathon CG. The most affected occupations were those related to domestic activities and cleaning. There was a greater likelihood of sensitization to isothiazolinones in women and in those with involvement of the hands and legs. Among the 61 paints evaluated, 26 had some isothiazolinone, with methylchloroisothiazolinone being the most common. Conclusions: sensitization to isothiazolinones can impact workers' health and demands greater vigilance on cleaning materials and cosmetics, as well as discussing the composition regulation of the paints sold in Brazil.

Lesiones cutáneas asociadas al uso de bombas de insulina y sistemas de monitoreo: un problema desafiante / Insulin pumps and glucose monitors related cutaneous lesions: a challenging problem

Los cuidados actuales de la diabetes incluyen altos niveles de tecnología y los pacientes utilizan diferentes dispositivos que pueden ayudar en su control metabólico, pero pueden impactar negativamente en su piel. Sensores de glucosa como el Freestyle, Dexcom, el Enlite de Medtronic y los sistemas de infusión continua de insulina contienen diferentes productos químicos que están en contacto directo con la piel del paciente y pueden causar una dermatitis irritativa o de contacto alérgica. Las lesiones incluyen eczema, prurito, heridas, cicatrices y cambios en la pigmentación de la piel. Los productos químicos involucrados que pueden ocasionarlas son el isobornil acrilato, N, N- dimetilacrilamida, etil cianoacrilato y colophonium, forzando a los pacientes a cambiar los sitios de infusión, el set de infusión o el sensor mismo más pronto de lo esperado, para reducir el nivel de daño en la piel. Existe gran número de productos que permiten proteger la piel y reducir el contacto de la piel con la cánula de la bomba o el sensor. Para reducir o prevenir el daño existen productos como cremas o spray y parches de hidrocoloide que actúan como barrera y existen técnicas para aplicar y retirar cuidadosamente los parches y adhesivos de los dispositivos. Una vez que las lesiones se han producido, el tratamiento incluye pomadas y a veces corticoides tópicos y/o antibióticos. Para prevenir o reducir el daño de la piel asociado al sensor y uso de la bomba de insulina, la industria que los produce debería incluir la información en relación a los productos químicos incluidos en cada dispositivo.

Diabetes care nowadays includes a high level of technology and patients use different devices which can help them in their glycemic control, but can have a negative impact on their skin. Glucose sensors such as Freestyle, Dexcom, Medtronic Enlite and also continuous subcutaneous insulin infusion systems contain different chemical products which are in direct contact with the patient's skin and can cause irritative or allergic contact dermatitis. Lesions include eczema, pruritus, wounds, scars and changes in skin pigmentation. The chemical products which can induce them are isobornyl acrylate, N, N- dimethylacrylamide, ethyl cyanoacrylate and colophonium, forcing patients to change the infusion site, set or the sensor itself, earlier than expected, in order to reduce the level of skin damage. There are a number of products which can protect the skin and reduce it's contact with the pump cannula or the sensor. To reduce or prevent damage, we have products such as barrier cream or spray films and hydrocolloid blister plasters and actions such as careful application and removal of device's patches and adhesives. Once lesions are established, treatment includes ointments and sometimes topical steroids and/ or antibiotics. In order to prevent or reduce skin damage related to sensor and insulin pump use, the manufacturers should include the information related to the chemicals included in each device.

Pharmacological mechanism of traditional Chinese medicine in the treatment of allergic contact dermatitis / 中国药房

Allergic contact dermatitis （ACD）is a common type Ⅳ allergic disease ，which has a wide range of patients ，and seriously affects the quality of patients ’lives. To understand the pharmacological mechanism of traditional Chinese medicine （TCM）in the treatment of ACD ，and to provide reference for clinical application and new drug research and development ，the relevant research literatures were reviewed from aspects of pathogenesis of ACD ，traditional Chinese medicine that can be used to treat ACD and its mechanism of action. TCM for the treatment of ACD mainly include heat-clearing medicines （Sophora flavescens，Dictamnus dasycarpus ），exterior-releasing medicines （Cinnamomum cassia ，Xanthium sibiricum ，Saposhnikovia divaricata），antirheumatic medicines （Tripterygium wilfordii ，Cynanchum paniculatum ），and damp-draining medicines （Plantago asiatica，Kochia scoparia ），etc. The main mechanisms include inhibition of IgE secretion ，regulation of Th 1/Th2 cell and Th 17/ Treg balance ，reduction of mast cells degranulation ratio ，inhibition of pERK 1/2/TLR4/NF-κ B pathway，AIM2/caspase-1 inflammasome signaling pathway ，Wnt/β-catenin pathway ，STAT3 pathway and MAPK pathway.

Role of mast cells in the pathogenesis of allergic contact dermatitis / 中华皮肤科杂志

Allergic contact dermatitis (ACD) is a T cell-mediated inflammatory skin disease induced by contact allergens. The role of mast cells in ACD remains controversial. In the sensitization phase, mast cells play a pro-inflammatory role by releasing inflammatory cytokines to promote recruitment of neutrophils, and affect the sensitization process by stimulating or inhibiting the migration of dendritic cells. During the elicitation phase, mast cells promote non-allergen-specific inflammation, and enhance allergen-specific inflammation in moderate ACD, but inhibit allergen-specific inflammation in severe and chronic ACD. In addition to the IgE-Fcε receptor I-histamine pathway, Mas-related G-protein coupled receptor B2/X2 (MrgprB2/X2) can mediate the activation of mast cells, leading to the release of tryptase to drive non-histaminergic itch, and may serve as a new target for the treatment of ACD.

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.

Oral Lichenoid Reactions and Contact Sensitization: A 5-year Review in the Department of Dermatology, Hospital Kuala Lumpur, Malaysia

Background@#Oral lichen planus is an idiopathic autoimmune inflammatory condition and oral lichenoid reactions are lesions that resemble oral lichen planus clinically and histopathologically, but develop secondary to various underlying causes. Oral lichenoid reactions have been reported to be caused by contact allergy to dental materials. This study aims to describe the characteristics of patients with a clinical and/or histopathological diagnosis of oral lichen planus who underwent patch testing in Hospital Kuala Lumpur, Malaysia.@*Methods@#This is a 5-year retrospective study of patients who had oral lichen planus and had undergone patch testing at the Department of Dermatology, Hospital Kuala Lumpur, Malaysia between January 2015 and Cecember 2019. Patch tests were performed with European Baseline Series and relevant extended series, which include dental and metal series as well as patients’ own products. Patch test results were recorded according to the International Contact Dermatitis Research Group recommendation.@*Results@#There were 41 patients with oral lichen planus who underwent patch test. The median age was 56 (range 21 to 73) with 70.7% of patients being female. There were 29 (70.7%) patients who developed at least one positive reaction. The most frequent sensitizing allergens were nickel sulfate (34.1%), gold(I)sodium thiosulphate dihydrate (22.0%), fragrance mix I (19.5%), cobalt chloride (14.6%), Peru balsam (12.2%) and sodium tetrachloropalladate (II) hydrate (12.2%). Current relevance was recorded in 16 patients (39.0%) and of these patients, 12 of them had positive patch test reactions to allergens found in dental materials such as dental fillings, dental implants, orthodontic braces, dentures and dental crowns.@*Conclusion@#Contact sensitization was detected in about 70% of our patients with oral lichen planus. The most common sensitizing allergen was nickel sulfate. Current relevance was found mainly towards dental materials.

Alergia à Metilisotiazolinona: Relato de caso / Methylisothiazolinone Allergy: Case Report

A metilisotiazolinona (MI) é um conservante presente em produtos químicos de limpeza e cosméticos na forma isolada ou associada à metilclorotiazolinona (MCI/MI). Seu uso tem sido associado ao aumento progressivo de casos de dermatite alérgica de contato (DAC) no mundo, constituindo uma das principais causas dessa entidade. O diagnóstico padrão-ouro de DAC a essa substância é realizado pelo teste de contato. No Brasil, a bateria padrão contempla apenas o composto MCI/MI, não avaliando isoladamente a MI. Relatamos caso clínico de uma paciente com eczema crônico predominante em mãos, que possuía nexo ocupacional com utilização de produtos de limpeza, tendo apresentado teste de contato, através da bateria Latino-Americana, fortemente positivo (+++) à MI 0,2% e negativo para MCI/MI. Objetivamos demonstrar a importância da inclusão da metilisotiazolinona, de forma isolada, na bateria padrão brasileira para maior sensibilidade diagnóstica, além da necessidade de especificação da presença desse conservante em produtos de limpeza.

Methylisothiazolinone (MI) is a preservative present in cleaning and cosmetic products, in the isolated form or associated to methylchloroisothiazolinone (MCI/MI). Its use has been associated with the progressive increase in cases of allergic contact dermatitis (ACD) in the world, constituting one of the main causes of this entity. The gold standard diagnosis of ACD for this substance is performed by the patch test. In Brazil, the baseline series only includes the MCI / MI compound, not evaluating the MI alone. We case report of a patient with predominant chronic eczema on the hands, who had an occupational nexus with the use of cleaning products, having presented a patch test, through the Latin American series, extremely positive for 0.2% MI (+++) and negative for the MCI/MI. We aim to demonstrate the importance of including methylisothialzoninone, in isolation, in the Brazilian baseline series for greater diagnostic sensitivity, in addition to the need to specify the presence of this preservative in products.

Dermatite alérgica de contato revelada pela pandemia de COVID-19: relato de caso / Allergic contact dermatitis revealed by pandemic: case report

OBJETIVO: Dermatite de contato é doença inflamatória cutânea, não infecciosa, prevenível, que afeta a qualidade de vida do indivíduo, ocorrendo após exposição de substâncias prejudiciais à pele. Pode ser alérgica ou irritativa. É a principal causa de doença cutânea ocupacional. A pandemia de Covid-19 afeta as pessoas de diferentes maneiras mexendo com paradigmas laborais e recreacionais. Objetivamos alertar que importantes alergias inaparentes podem se manifestar pela alteração da rotina individual transformando hobby em atividade ocupacional decorrente da epidemia global causada pelo SARS-CoV-2. DESCRIÇÃO DO CASO: Relatamos um caso do sexo masculino que desenvolveu há 8 meses, intenso eczema de mãos após mudança de hábito relacionado ao isolamento social. Negava atopia. Clinicamente apresentava marcada dermatite com hiperemia, fissuras, erosões, num padrão conhecido como de pinçamento. Ele que exercia atividade laboral extradomiciliar, passou a ficar recluso trocando sua atividade anteriormente de lazer para atividade ocupacional. Feito teste de contato, utilizando-se da bateria padrão Latino-Americana, constatou-se forte reação em 48 e 96 horas para a resina epóxi de bisfenol A. CONCLUSÃO: Mostramos que a pandemia do Covid-19, mesmo indiretamente, é capaz de revelar alergias ocultas pela alteração das atividades ocupacionais desempenhadas pelos indivíduos.

AIMS: Contact dermatitis is a non-infectious, preventable skin inflammatory disease that affects the quality of life of the individual, occurring after exposure to substances harmful to the skin. It can be allergic or irritating. It is the main cause of occupational skin disease. The Covid-19 pandemic affects people in different ways by messing with occupational and recreational paradigms. We aim to warn that important unapparent allergies can manifest themselves by the alteration of the individual routine transforming hobby into occupational activity due to the global epidemic caused by SARS-CoV-2. CASE DESCRIPTION: We report a male case that developed eigth months ago, severe hand eczema after a habit change related to social isolation. He denied atopy. Clinically he presented marked dermatitis with hyperemia, cracks, erosions, in a pattern known as clamping. He, who exercised extradomic labor activity, became a recluse changing his previous activity from leisure to occupational activity. A patch test, using the Latin American baseline series, showed a strong reaction in 48 and 96 hours for the bisphenol A epoxy resin. CONCLUSION: We have shown that the Covid-19 pandemic, even indirectly, can reveal hidden allergies due to altered occupational activities performed by individuals.