Occupational contact dermatitis caused by methyl chlorobutyrate:a clinical analysis of 5 cases / 中华全科医师杂志

The clinical data of 5 patients with occupational contact dermatitis caused by methyl chlorobutyrate treated in the Affiliated Hospital of Jining Medical College and Mamiao Township Hospital of Jinxiang County from September to October 2021 were retrospectively analyzed. Patients were all males aged 33-47 years with a history of exposure to methyl chlorobutyrate 1 to 4 d before the onset of symptoms. Three patients were hospitalized and 2 patients were treated in outpatient clinic. The clinical manifestations were erythema on the trunk or extremities of varying degrees, scattered with blisters and bullae of different sizes, with thin and clear blisters, local ulceration and exudation; no erosion or ulceration was found in the oral cavity and vulva. All 5 patients had elevated white blood cell counts, and 2 patients had abnormal liver function. All patients received symptomatic treatment with topical drugs. Three hospitalized patients were given methylprednisolone and loratadine; in addition, 1 case also received human immunoglobulin and moxifloxacin hydrochloride injection and 2 cases received hepatoprotective drugs. Two outpatients were given prednisone acetate and loratadine for treatment. Three hospitalized patients were all improved and discharged after 14-30 d of treatment. The rash of 2 outpatients subsided after 14 d of treatment, and there was no recurrence after 1-month follow-up. The occupational contact dermatitis caused by methyl chlorobutyrate is primary irritant contact dermatitis, often manifested as erythema and blisters on the trunk or limbs, and timely anti-allergic treatment can effectively control 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.

Dermatoses associadas ao trabalho em profissionais de saúde de um centro hospitalar português / Occupational dermatoses among healthcare workers in a hospital center in Portugal

Introdução: As patologias cutâneas representam mais de 35% das doenças relacionadas com o trabalho, afetando anualmente 1/1.000 trabalhadores. Objetivos: Caracterizar as dermatoses associadas ao trabalho em profissionais de um centro hospitalar e identificar possíveis agentes desencadeantes e fatores de suscetibilidade. Métodos: Estudo transversal com recolha da informação registrada no processo clínico eletrônico dos trabalhadores observados em exame de saúde periódico no período de um ano. Resultados: Nos 1.741 trabalhadores estudados, 3,56% tinham registro de dermatoses associadas ao trabalho, a maioria mulheres (76,85%). Dos profissionais com dermatoses, 34 (54,84%) tinham dermatite de contato irritativa, 17 (27,42%) urticária ao látex, seis (9,68%) dermatite de contato alérgica e cinco (8,06%) duas dermatoses concomitantes. Encontrou-se diferença estatisticamente significativa entre os vários grupos profissionais (p=0,008), sendo os auxiliares de enfermagem os mais afetados (5,11%). Verificou-se também maior prevalência (8,47%) em profissionais de blocos operatórios (p=0,001). Os principais agentes desencadeantes foram desinfetantes cutâneos, látex, luvas de nitrilo e contato prolongado com água (4,84%). Conclusões: Por tratar-se de um estudo baseado em registros clínicos, a informação está dependente da qualidade destes. Para além disso, os auxiliares de enfermagem foram a maioria representada na amostra no que se refere à população do centro hospitalar, o que limita a extrapolação dos resultados. Este estudo encontrou prevalência de dermatoses de somente 3,56%, o que talvez se deva à implementação de medidas preventivas. Os profissionais mais afetados foram os de blocos operatórios e os auxiliares de enfermagem. Os desinfetantes cutâneos foram os principais agentes apontados como desencadeantes.

Background: Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. Objective: To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. Methods: Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. Results: About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). Conclusion: The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

Investigation of contact dermatitis caused by hard metal dust / 中华劳动卫生职业病杂志

Objective@#To investigate the incidence of contact dermatitis among workers in cemented carbide production enterprises.@*Methods@#From October 1997 to October 2017, an occupational epidemiological survey was conducted on a large-scale cemented carbide production enterprise, and occupational health examinations were conducted for employees. 152 people were exposed to hard metal dust (hard metal raw material dust and alloy dust) . The employees in the work group were contact groups, and 142 employees in the non-dusting operation of the company were in the control group. A detailed retrospective survey of hard metal production workers with contact dermatitis history in the two groups was conducted to analyze the risk factors of contact dermatitis exposure to hard metal dust.@*Results@#The incidence of allergic diseases in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=23.793, P<0.05) . The incidence of contact dermatitis in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=24.659, P<0.05) ; the changes of contact dermatitis in the contact group were mainly allergic contact dermatitis, and some showed irritative contact dermatitis; the operator had respiratory symptoms (including work-related nasal congestion, cough, wheezing) , difficulty breathing may be the influencing factors of contact dermatitis (RR=2.60, 95%CI: 1.10-6.20, P<0.05) .@*Conclusion@#Hard metal alloy enterprises are exposed to hard metal dust. The incidence of contact dermatitis is high in workers, and the occurrence of contact dermatitis may be associated with those with respiratory symptoms.

Evaluation of the profile of inflammatory cytokines, through immunohistochemistry, in the skin of patients with allergic contact dermatitis to nickel in the acute and chronic phases

Abstract: Background: Allergic contact dermatitis to ion nickel (Ni+2) is an inflammatory dermatosis, common in industrialized countries. It involves the activation of nickel-specific T-cells, followed by proliferation and induction of a mixed profile of both proinflammatory and regulatory cytokines, suggesting that several T-cell subtypes (helper - Th and cytotoxic - Tc) are involved. A broader understanding of the cytokine profile may lead to new therapeutic approaches. Objectives: This study aimed to analyze the cytokines TNF-α, INF-γ, IL-2, IL-4, IL-10, IL-13, IL-17 and IL-23 using the immunohistochemistry technique in order to try to identify their prevalence in chronic and acute eczema of patients with allergic contact dermatitis to Ni+2. Methods: We performed an immunohistochemical study for eight cytokines in 20 patients with Ni+2 allergic contact dermatitis, biopsied at the site of chronic eczema, triggered by the patient's daily contact with Ni+2, and at the site of acute eczema caused by nickel sulfate, 48 hours after applying the contact test. Results: The stained samples showed positive results for the eight cytokines studied. TNF-α, IFN-γ, IL-4, IL-13 and IL-17 had a higher prevalence in chronic eczema, IL-2 and IL-23 in acute eczema, and IL-10 presented a similar prevalence in both acute and chronic eczema. However, these prevalences were statistically significant only for IL-4 and IL-13. Study Limitations: Small sample size. Conclusions: In chronic and acute eczema, we observed the presence of a mixed cytokine profile of the T cell subtypes (Th/Tc), suggesting that the responses are expressed at the same time.

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.

Evaluation of the presence of allergens in children's products available for sale in a big city

Abstract: Children's products are considered safe by the general population and doctors. Labels with terms such as "hypoallergenic" or "dermatologically recommended and tested" denote trust and credibility with the idea that they can be used by any individual. Patients with allergic contact dermatitis may be sensitive to allergens present in any product, including children's. There is insufficient knowledge about allergens in these products in our country. We evaluated 254 children's products, and at least one allergen was present in 236 (93%) of them. The indication of a topical product should be careful and based on contact tests.

Innate immunity and effector and regulatory mechanisms involved in allergic contact dermatitis

Abstract: Skin's innate immunity is the initial activator of immune response mechanisms, influencing the development of adaptive immunity. Some contact allergens are detected by Toll-like receptors (TLRs) and inflammasome NLR3. Keratinocytes participate in innate immunity and, in addition to functioning as an anatomical barrier, secrete cytokines, such as TNF, IL-1β, and IL-18, contributing to the development of Allergic Contact Dermatitis. Dendritic cells recognize and process antigenic peptides into T cells. Neutrophils cause pro-inflammatory reactions, mast cells induce migration/maturation of skin DCs, the natural killer cells have natural cytotoxic capacity, the γδ T cells favor contact with hapten during the sensitization phase, and the innate lymphoid cells act in the early stages by secreting cytokines, as well as act in inflammation and tissue homeostasis. The antigen-specific inflammation is mediated by T cells, and each subtype of T cells (Th1/Tc1, Th2/Tc2, and Th17/Tc17) activates resident skin cells, thus contributing to inflammation. Skin's regulatory T cells have a strong ability to inhibit the proliferation of hapten-specific T cells, acting at the end of the Allergic Contact Dermatitis response and in the control of systemic immune responses. In this review, we report how cutaneous innate immunity is the first line of defense and focus its role in the activation of the adaptive immune response, with effector response induction and its regulation.

Dermatite de contato por cloreto de benzalcônio / Contact dermatitis from benzalkonium chloride

O cloreto de benzalcônio é um conservante encontrado em produtos de higiene pessoal e preparações farmacêuticas há mais de seis décadas. Antes tido como irritante; porém, evidências crescentes apontam que ele possa induzir alergia de contato em uma taxa mais elevada do que o previsto. Os autores apresentam um caso de um adulto de 71 anos, com reação alérgica ao cloreto de benzalcônio contido em solução tópica oftalmológica. Pretende-se, com este caso, alertar sobre as possíveis hipersensibilidades aos conservantes de medicamentos e cosméticos.

Benzalkonium chloride is a preservative found in personal care products and pharmaceutical preparations for over six decades. It was previously thought to be an irritant, but a growing body of evidence suggests that it may induce contact allergy at a higher rate than anticipated. The authors describe the case of a 71-yearold male patient with allergic reaction to benzalkonium chloride present in a topical ophthalmic solution. With this case report we intend to warn about possible hypersensitivity reactions to preservatives contained in medicines and cosmetics.

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.

Occupational dermatoses reported in Brazil from 2007 to 2014

Abstract: Background: Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil. Objectives: To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns. Methods: We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses. Results: All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability. Study limitations: The amount of missing information for various items in the system draws attention. Conclusions: Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

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.

Patch-test results in children and adolescents: systematic review of a 15-year period

Abstract The number of studies on patch-test results in children and adolescents has gradually increased in recent years, thus stimulating reviews. This paper is a systematic review of a 15-year period devoted to studying the issue. Variations pertaining to the number and age groups of tested children and/or adolescents, the number of subjects with atopy/atopic dermatitis history, the quantity, type and concentrations of the tested substances, the test technique and type of data regarding clinical relevance, must all be considered in evaluating these studies, as they make it harder to formulate conclusions. The most common allergens in children were nickel, thimerosal, cobalt, fragrance, lanolin and neomycin. In adolescents, they were nickel, thimerosal, cobalt, fragrance, potassium dichromate, and Myroxylon pereirae. Knowledge of this matter aids health professionals in planning preventive programs aimed at improving children's quality of life and ensuring that their future prospects are not undermined.

Adverse reactions to cosmetics: an analysis of surveillance data from 2005 to 2014 in China / 中华皮肤科杂志

Objective To investigate the prevalence and characteristics of adverse reactions to cosmetics in China,and to provide a basis for further supervision.Methods The diagnosis of adverse reactions to cosmetics was according to 7 national standards (GB17149.1-7-1997) including the A general rule for the diagnosis and management of skin diseases induced by cosmetics.Data regarding gender,age,occupation,educational background,disease types,cosmetic types,and so on,were collected from patients with adverse reactions to cosmetics at 13 surveillance sites in China during 2005-2014.A descriptive statistical analysis was carried out.Results During 2005-2014,a total of 13 534 cases of adverse reactions to cosmetics were reported to the monitoring system.Of these cases,95.40％ (12 912/13 534) were female,and 80.85％ were young or middle-aged (20-44 years).Finally,5 446 cases were confirmed to be adverse reactions to cosmetics,among which,94.66％ (5 155/5 466) were contact dermatitis to cosmetics,and 132 were other types that were not included in the A general rule for the diagnosis and management of skin diseases induced by cosmetics.Among these confirmed cases,14 209 cosmetic products were involved,and ordinary skin care products predominated in these products.The proportion of imported cosmetic products (48.79％,6 932/14 209) was slightly higher than that of domestic products (43.21％,6 139/14 209).The number of reported eases increased by 13.16％ per year from 2005 to 2009,but decreased by 17.96％ per year from 2010 to 2014.Conclusion Adverse reactions to cosmetics are a complicated and important public health issue,and effective measures should be taken based on their characteristics.

Alergia al látex en trabajadores de la salud / Allergy to latex in health workers / Alergia ao látex em trabalhadores da saúde

Introducción: un problema común y creciente en el ámbito hospitalario es la hipersensibilidad a los antígenos del látex de caucho, ya que muchos productos, entre ellos los guantes, se fabrican con este material, con la consecuente posibilidad de producir alergia en quienes los usan. Objetivo: averiguar si el personal de la salud de una clínica de cuarto nivel en Bogotá, Colombia, presenta alergia al látex relacionada con el uso de guantes. Materiales y métodos: estudio descriptivo de corte transversal, con muestreo no probabilístico de tipo intencional en cuatro unidades hospitalarias. Se aplicó una encuesta a los participantes. Resultados: 16 de las 26 personas (61,5%) que presentaban procesos alérgicos manifestaron algún tipo de reacción cuando tenían contacto con guantes de látex; el problema fue más significativo en el personal de enfermería que en los médicos. Conclusiones: la exposición al látex de los guantes puede estar participando en la aparición de alergias de origen laboral en los trabajadores de la salud.

Introduction: A common and growing problem in hospitals is hypersensitivity to rubber latex antigens, since many products, including gloves, are manufactured from this material, with the consequent possibility of producing allergy in persons who use them. Objective: To find out if health workers at a fourth level clinic in Bogotá, Colombia, are allergic to rubber latex, in relation to the use of gloves. Materials and methods: Descriptive, cross-sectional study of a non-probabilistic intentional-type sample in each one of four hospital units. A survey was applied to participants. Results: 16 of the 26 persons (61.5%) with history of allergic processes manifested some kind of reaction when they had contact with latex gloves; the problem was more significant in the nursing personnel compared to physicians. Conclusions: The exposure to latex gloves may be generating the appearance of allergic occupational disease in health workers.

Introdução: um problema comum e crescente no âmbito hospitalar é a hipersensibilidade aos antígenos do látex de borracha, já que muitos produtos, entre eles as luvas, fabricam-se com este material, com a consequente possibilidade de produzir alergia em quem os usam. Objetivo: averiguar se o pessoal da saúde de uma clínica de quarto nível em Bogotá, Colômbia, apresenta alergia ao látex relacionada com o uso de luvas. Materiais e métodos: estudo descritivo de corte transversal, com amostragem não probabilística de tipo intencional em quatro unidades hospitalares. Aplicou-se uma enquete aos participantes. Resultados: 16 das 26 pessoas (61,5%) que apresentavam processos alérgicos manifestaram algum tipo de reação quando tinham contato com luvas de látex; o problema foi mais significativo no pessoal de enfermagem que nos médicos. Conclusões: a exposição ao látex das luvas pode estar participando na aparição de alergias de origem trabalhista nos trabalhadores da saúde.

Fitofotodermatite por Ruta graveolens com manifestação cutânea extensa / Phytophotodermatitis due to Ruta graveolens with extensive cutaneous manifestation

Dermatite de contato por planta ou fitodermatite é uma erupção cutânea resultante do contato com substâncias produzidas por diferentes espécies de vegetais. Ruta graveolens, popularmente conhecida como arruda, é uma planta da família das Rutaceae, que inclui algumas frutas cítricas, e contém inúmeras substâncias químicas fotossensíveis, incluindo os furocumarínicos. Relatamos um caso de reação de fitofototoxicidade grave em uma paciente que usou uma infusão de arruda pelas supostas qualidades ”místicas e purificadoras” da planta com extensa erupção cutânea.

Plant dermatitis or phytodermatitis is a cutaneous eruption resulting from contact with substances produced by different plant species. Ruta graveolens, popular known as common rue, is an herbal plant from the Rutaceae family, which includes the citrus fruits, and contains numerous photosensitizing substances, including furocoumarins. We report a severe case of phytophototoxicity reaction in a patient who used a common rue infusion because of its “powerful and purification” qualities.

Poikilodermatous changes on the forearms of a woman practicing aroma-therapy: extracervical poikiloderma of Civatte?

We report the case of a 48-year-old, Caucasian female who presented with slowly progressing asymptomatic poikilodermatous changes of the extensor aspects of the forearms. She also had typical Poikiloderma of Civatte on the V of the neck and erythemato-telangiectatic rosacea of the central face. The patient had been practicing aroma-therapy for many years. Histologic examination revealed findings consistent with PC. Patch-testing revealed positive reactions to Fragrance mix and Nickel sulphate. Based on clinical and histological findings, a diagnosis of extracervical PC was suggested. PC with extra-cervical or extra-facial involvement is rare. In addition, this case supports the theory that contact sensitization to fragrances may contribute to the development of PC.

Patch tests / Testes de contato

Patch tests were introduced as a diagnostic tool in the late nineteenth century. Since then, they have improved considerably becoming what they are today. Patch tests are used in the diagnostic investigation of contact dermatitis worldwide. Batteries or series previously studied and standardized should be used in patch testing. The methodology is simple, but it requires adequate training for the results to be correctly interpreted and used. Despite having been used for over a century, it needs improvement like all other diagnostic techniques in the medical field.

Os testes de contato foram introduzidos, como ferramenta diagnóstica, no final do século XIX. Desde então passaram por diversos aprimoramentos tornando-os o que são hoje. Eles são utilizados na investigação diagnóstica das dermatites de contato em diferentes partes do mundo. Devem ser aplicados com a utilização de baterias ou séries previamente estudadas e padronizadas. A metodologia é simples, mas requer treinamento adequado para sua interpretação e bom aproveitamento dos resultados obtidos. Apesar de ser utilizado há mais de um século, necessita de aprimoramentos como todas as outras técnicas utilizadas para investigação diagnóstica na área médica.

Cytokine detection for the diagnosis of chromium allergy / Deteccao de citocinas no diagnostico de pacientes alergicos ao cromo

BACKGROUND: Patch testing remains the gold standard method for the identification of the etiologic agent of allergic contact dermatitis. However, it is a subjective, time-consuming exam whose technique demands special care and which presents some contraindications, which hamper its use. In a recent study, we showed that the proliferation assay can suitably replace patch testing for the diagnosis of chromium allergy, which had been previously demonstrated only for nickel allergy. In this study, we try to refine the method by reducing the incubation period of cultures for lymphocyte proliferation assays in response to chromium. OBJECTIVE: Develop an alternative or complementary diagnostic test for chromium allergic contact dermatitis. METHODS: We compared the production of 9 cytokines (IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17 and RANTES) between 18 chromium-allergic patients and 19 controls. RESULTS: Chromium increased the production of IFN-y, IL-5, IL-2 and IL-13 in allergic patients, but only IL-2 and especially IL-13 helped discriminate allergic patients from controls. The sensitivity, specificity and accuracy found with IL-13 were about 80%. CONCLUSIONS: IL-13 and IL-2 detection may be used to diagnose chromium allergy in 2-day cultures. However, in general, the 6-day cultures seem to be superior for this purpose. .

FUNDAMENTOS: O teste de contato permanece como padrão ouro para a identificação do agente causal da dermatite de contato alérgica, mas é um exame subjetivo, que demanda considerável tempo do paciente e do medico, exige cuidados na sua técnica e apresenta algumas contra-indicações que dificultam o seu uso. Em um estudo recente demonstramos que o teste de proliferação pode adequadamente substituir o teste de contato no diagnóstico de alergia ao cromo, algo previamente demonstrado apenas para o níquel. Neste estudo tentamos refinar o método reduzindo o período de incubação das culturas do teste de proliferação para o cromo. OBJETIVO: Desenvolver um método alternativo ao teste de contato para o diagnóstico dermatite de contato alérgica ao cromo. MÉTODOS: Comparamos o estímulo provocado pelo cromo na produção de nove citocinas (IFN-γ, IL2, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17 e RANTES) no sobrenadante das culturas de células do sangue periférico de 18 pacientes alérgicos ao cromo e 19 controles. RESULTADOS: O cromo aumentou a produção de IFN-y, IL-5, IL-2 e IL-13, mas apenas as citocinas IL-2 e principalmente IL-13 foram capazes de discriminar pacientes de controles. A sensibilidade, especificidade e acurácia encontradas com a IL-13 foram de aproximadamente de 80%. CONCLUSÕES: Concluímos que a detecção de IL-2 e IL-13 podem ser útil para o diagnóstico de alergia a cromo na cultura de 2 dias. Todavia, as culturas de 6 dias parecem, de um modo geral, superiores as de 2 dias para esse fim. .