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.

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

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.

Behçet's disease: review with emphasis on dermatological aspects.

Behçet's disease is a systemic vasculitis characterized by attacks of acute inflammation, which can affect almost every vascularized area of the body. There is a close correlation between the geographical distribution of HLA-B51 and its prevalence. In the etiopathogenesis there are indications of genetic susceptibility associated with environmental influence. Among the involved genes are those that encompass innate and adaptive immunities. Polymorphisms and epistatic interactions in several genes are described, as well as the presence of imbalance lineage between HLA-B51 and A (MICA). Herpes simplex and Streptococcus sanguinis may be important extrinsic factors. An increase of Th1 response and of IL-21 is observed. The production of IL-21 is positively related to Th17 cells and negatively to T-regs. The mucocutaneous manifestations are Behcet´s disease markers, and their earlier onset indicates a worse prognosis. Recurrent oral ulcers have varied sizes and arrangements, genital ulcers are recurrent, leaving scars, skin lesions are multivaried, and pathergy, although not so frequent, is important for the diagnosis. There are numerous attempts to validate indexes that can evaluate the disease activity and among them the Mucocutaneous Activity Index. This is a specific score that can help with therapeutic decisions and to reduce morbidity, but still lacks validation. The clinical manifestations of other organs are described as well as treatment options.

Behçet's disease: review with emphasis on dermatological aspects

Abstract: Behçet's disease is a systemic vasculitis characterized by attacks of acute inflammation, which can affect almost every vascularized area of the body. There is a close correlation between the geographical distribution of HLA-B51 and its prevalence. In the etiopathogenesis there are indications of genetic susceptibility associated with environmental influence. Among the involved genes are those that encompass innate and adaptive immunities. Polymorphisms and epistatic interactions in several genes are described, as well as the presence of imbalance lineage between HLA-B51 and A (MICA). Herpes simplex and Streptococcus sanguinis may be important extrinsic factors. An increase of Th1 response and of IL-21 is observed. The production of IL-21 is positively related to Th17 cells and negatively to T-regs. The mucocutaneous manifestations are Behcet´s disease markers, and their earlier onset indicates a worse prognosis. Recurrent oral ulcers have varied sizes and arrangements, genital ulcers are recurrent, leaving scars, skin lesions are multivaried, and pathergy, although not so frequent, is important for the diagnosis. There are numerous attempts to validate indexes that can evaluate the disease activity and among them the Mucocutaneous Activity Index. This is a specific score that can help with therapeutic decisions and to reduce morbidity, but still lacks validation. The clinical manifestations of other organs are described as well as treatment options.

Contact dermatitis to methylisothiazolinone.

Methylisothiazolinone (MI) is a preservative found in cosmetic and industrial products. Contact dermatitis caused by either methylchloroisothiazolinone/methylisothiazolinone (MCI/MI or Kathon CG) or MI has shown increasing frequency. The latter is preferably detected through epicutaneous testing with aqueous MI 2000 ppm, which is not included in the Brazilian standard tray. We describe a series of 23 patients tested using it and our standard tray. A case with negative reaction to MCI/MI and positive to MI is emphasized.

[The dermatoscopy in the skin pathergy testing: case series in patients with suspected Behçet's Disease]. / Dermatoscopia no teste cutâneo da patergia: série de casos de pacientes com suspeita de Doença de Behçet.

Behçet's disease is a multisystemic disease consisting of a varying combination of ocular, mucocutaneous, neurologic, cardiovascular, gastrointestinal and other manifestations. Its diagnosis is based on clinical criteria, in which a positive pathergy test scores 1. A case series with 26 suspected patients is presented, and the skin pathergy test was performed in 23. The results were read in 48hours, and they were considered negative when without papule, and positive with a papule or pustule. Positive results were divided by papule size, and dermatoscopy was done to measure and observe its clinical aspects. After the readings, a biopsy was performed, with annotation of histopathological aspects. The test was negative in 2 (8.7%) and positive in 21 (91.3%) patients. The results and the literature review are presented.

Increasing trend of sensitization to Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI).

Recent reports have shown increased sensitization to Methylchloroisothiazolinone/methylisothiazolinone. We report a retrospective study conducted at the Hospital das Clínicas--UFMG, based on the results of patch tests with the Brazilian standard series, performed on referred patients. The positive results in 359 patients from November 2009 to October 2012 were analyzed and compared with the previous data collected from March 2006 to October 2009 (447 patients). The data showed 11.14% sensitization to Methylchloroisothiazolinone/ methylisothiazolinone during 2009-2012, contrasting with the previous period (3.35%). A positive association was found between its positivity and the period of 2009-2012.

Increasing trend of sensitization to Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI)

Recent reports have shown increased sensitization to Methylchloroisothiazolinone/methylisothiazolinone. We report a retrospective study conducted at the Hospital das Clínicas - UFMG, based on the results of patch tests with the Brazilian standard series, performed on referred patients. The positive results in 359 patients from November 2009 to October 2012 were analyzed and compared with the previous data collected from March 2006 to October 2009 (447 patients). The data showed 11.14% sensitization to Methylchloroisothiazolinone/ methylisothiazolinone during 2009-2012, contrasting with the previous period (3.35%). A positive association was found between its positivity and the period of 2009-2012.

Thimerosal: current sources of contact in Brazil.

Thimerosal is an organic mercury derivative found in ophthalmic solutions and certain vaccines in Brazil. Although most studies suggest the prevalence of thimerosal sensitivity to be quite high, this condition does not currently have any clinical relevance. The present article surveyed 184 Brazilian products (151 topical medications and 33 vaccines) and found that thimerosal was only present in 3 ophthalmic solutions and 5 vaccines.

Doença de Behçet: revisäo baseada na 6a. Conferência Internacional - Paris, 1993 / Behçet's disease: review established on 6th International Conference - Pris, 1993

Breve revisäo sobre aspectos etiopatogênicos, epidemiológicos, dermatológicos, critérios de classificaçäo e terapêutica da doença de Behçet, abordados na 6a. Conferência Internacional da Doença de Behçet, em Paris, França, em 30 de junho e 01 de julho de 1993

Morte após uso de antimonial pentavalente em leishmaniose tegumentar americana / Death after the use of pentavalent antimonial in american cutaneous leishmaniasis

Apresenta-se um caso de uma paciente feminina de 56 anos de idade, natural e procedente de André Fernandes (MG), com quadro clínico e histopatológico de Leishmaniose Tegumentar Americana (LTA), portadora de lesäo única na glabela. Foi medicada com antimoniato de N-metil-glucamina intravenoso na dose de 20mgSbV/Kg/dia, diluído em 250 ml de SGI (tempo de infusäo: 3-4 horas), por 30 dias seguidos. A pacientes era hígida, exceto por uma leve hipertensäo arterial sistêmica e durante todo o tratamento, apenas apresentou como efeito colateral a ocorrência de tremores que desapareceram com a continuiçäo da terapêutica. Três dias após o término do tratamento a paciente apresentou quadro convulsivo generalizado e perda de consciência de instalaçäo abrupta. Exames laboratoriais revelaram-se compatíveis com insuficiência hepática e renal graves. Sete dias após o início do quadro convulsivo, a paciente foi a óbito. Levando-se em conta o largo uso dos antimoniais pentavalentes na LTA, a ocorrência de insuficiências renal e hepática concomitantes é rara e deve ser relatada. Questionamos também se as manifestaçöes neurológicas observadas no caso näo seriam diretamente causadas pela droga

Contribuiçäo ao estudo das manifestaçöes dermatológicas e oftalmológicas da Síndrome de Behçet / Contribution of study the skin and ocular manifestations of the Behçet's syndrome

Realizamos um estudo retrospectivo em 16 pacientes com Síndrome de Behçet completa e em 9 do tipo incompleto, enfatizando principalmente o acometimento mucocutâneo e ocular. Entre os pacientes com síndrome completa, encontramos 93,7% de lesöes de mucosa oral, principalmente do tipo ulceraçäo aftosa menor; 87,5% de lesöes de mucosa genital; 50% de lesöes cutâneas, em geral muito polimorfas; 75% de lesöes oculares, predominantemente bilaterais, e com comprometimento uveal difuso: 56,2% de lesöes articulares, 6,25% de lesöes neurológicas e 32,5% de outros tipos de lesöes, tais como renais, febre, orquite epididimite. Entre aqueles do tipo incompleto, todos apresentavam lesöes oculares típicas, seguindo o mesmo padräo do tipo completo, e lesöes de mucosa oral, mas nenhum tinha lesöes genitais ou cutâneas