ABSTRACT
INTRODUCTION: Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mainly affecting children. Similarly, Allergic contact dermatitis (ACD) is an inflammatory skin disease, but unlike AD it results from direct exposure to an external agent. Theoretically, the impaired skin barrier facilitates the penetration of potential allergens. Therefore, AD patients are at risk for an associated ACD, exacerbating their skin condition. Because eczema is similar, performing a patch test (PT) for the differential diagnosis is essential. METHODS: In this cross-sectional transversal study, we performed a PT with 30 sensitizers in 26 children with AD, selected according to established criteria for suspected ACD, and treated at an AD center of a pediatric university hospital in Rio de Janeiro. Clinical presentation, patient profile, main sensitizers, and frequency of ACD caused by therapeutic skincare products were evaluated. RESULTS: In all, 23 (88.5%) patients reacted to at least one allergen, 21 (80.7%) had a relevant positive patch test, and 15 (57.7%) were polysensitized. The main positive sensitizers were nickel (38.5%), blue disperse (30.8%), fragrance mix (30.8%), and neomycin (23.1%). Nineteen (73%) patients reacted to substances present in therapeutic or skincare products. CONCLUSION: Our data underscore the importance of performing a PT in AD children whose eczema has atypical distribution. The expressive percentage of positive tests, especially of allergens in skincare products, indicates the constant need to review the proposed treatments. Therefore, we recommend a specific and expanded PT battery for pediatric AD patients, including a negative control, to increase sensitivity for diagnosing ACD.
Subject(s)
Allergens , Dermatitis, Atopic , Patch Tests , Humans , Patch Tests/methods , Cross-Sectional Studies , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/immunology , Child , Female , Male , Brazil , Allergens/immunology , Child, Preschool , Adolescent , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/immunology , Infant , Diagnosis, DifferentialABSTRACT
A nine-week-old infant presenting with cholesatis was found to have neonatal hepatitis caused by cytomegalovirus. This was confirmed serologically and by a liver biopsy. Four weeks after discharge, she still had acolic feces. Another liver biopsy was performed, and it suggested now extrahepatic biliary atresia. Because this disease can co-exist with congenital infections and inborn errors of metabolims, evaluation for an obstructive cause of jaundice in infants with a recognized cvause of intrahepatic cholestasis is necessary, and close observation of these infants is important because we still don't have a test that completely excludes Extrahepatic Biliary Atresia in an infant with cholestasis
