RESUMO
BACKGROUND: In the contact dermatitis literature, it is regularly stated that the patch test reactivity on various areas of the back differs, which might have a large impact on the reproducibility of patch testing. OBJECTIVES: To investigate the reproducibility of patch testing on the upper back with regard to the left as opposed to the right side, and the medial as opposed to the lateral part of the upper back. The reproducibility over time and with regard to the reactivity pattern was also investigated. METHODS: Thirty-one subjects with contact allergy to the metals gold (n = 19) or nickel (n = 12) were patch tested with serial dilutions, in triplicate applications, on different locations on the upper back. The Friedman test was used for statistical calculations. RESULTS: No significant differences in the reactivity of the back were found. In all gold-allergic patients and 11 of 12 nickel-allergic patients, the allergy could be reproduced with regard to previous patch testing, but the degree of reactivity differed. CONCLUSIONS: When a high level of standardization of the patch test technique with the same test system was used, there were no differences in patch test reactions and sites of application on the upper back.
Assuntos
Dorso , Dermatite Alérgica de Contato/diagnóstico , Testes do Emplastro/métodos , Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Feminino , Ouro/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Níquel/efeitos adversos , Reprodutibilidade dos TestesRESUMO
Comunicamos un caso de dermatitis por contacto severa debida al Árnica montana, en una paciente con antecedentes de hipertensión arterial tratada regularmente y controlada; se enfatiza la importancia de un control evolutivo, examen físico semiológico completo y los diagnósticos diferenciales, de estas variantes severas e infrecuentes.
The presentation of a case of irritant contact dermatitis in a patient with a history of high blood pressure regularly treated and controlled, who starts on 19.04.13 with fever of 39º5 which ceded with use of current antipyretic; accompanied by myalgia, retro-ocular pain, arthralgias, headache of strong intensity, complete haematology reports thrombocytopenia and leukocytosis at the expense of segmented, picture that remained for 48 hours; later is associated with stabbing pain and right lower limb rigidity. 22.04.13 presents increase in volume and signs of phlogosis of elevated erythematous edges that extends to the sural region, with blister on right twin region of approximately 10x10 cm with functional limitation of that member. The patient is hospitalized under the diagnosis of Bullous erysipelas, receives broad spectrum antibiotics to Gram +, Gram - and anaerobic. 29.04.13 blister hatches draining not foul-smelling yellowish secretion; it is cultivated and Gram, reporting no bacterial growth. Refers to Central Hospital of Maracay entering it with the diagnosis of cellulitis blistering, where it performed second Gram and cultivation reported without bacterial growth; they perform a biopsy which reports epidermal necrotic dermatitis superficial and deep compatible with dermatitis irritant contact. The case is reevaluated, interrogating again to the patient and the dermal symptoms coincide with the use of Árnica montana product (this data was not reported or questioned in the initial history). Update about the product reported that exists extensive reference on cases of dermatitis contact, mainly by the use of Árnica montana and one of its components; methylparaben, these cases have been reported by prolonged use of the product described as excited skin syndrome or angry back. The patient after to the second questioned referred the use of this product frequently for several years topically and even concerned using infusions of the flower of Árnica montana orally. It was decided to deal with steroids intravenously, resulting in evident improvement with egress to the fifth day and outpatient follow-up, which reported complete remission of picture.
RESUMO
Comunicamos un caso de dermatitis por contacto severa debida al Arnica montana, en una paciente con antecedentes de hipertensión arterial tratada regularmente y controlada; se enfatiza la importancia de un control evolutivo, examen físico semiológico completo y los diagnósticos diferenciales, de estas variantes severas e infrecuentes.(AU)
The presentation of a case of irritant contact dermatitis in a patient with a history of high blood pressure regularly treated and controlled, who starts on 19.04.13 with fever of 39º5 which ceded with use of current antipyretic; accompanied by myalgia, retro-ocular pain, arthralgias, headache of strong intensity, complete haematology reports thrombocytopenia and leukocytosis at the expense of segmented, picture that remained for 48 hours; later is associated with stabbing pain and right lower limb rigidity. 22.04.13 presents increase in volume and signs of phlogosis of elevated erythematous edges that extends to the sural region, with blister on right twin region of approximately 10x10 cm with functional limitation of that member. The patient is hospitalized under the diagnosis of Bullous erysipelas, receives broad spectrum antibiotics to Gram +, Gram - and anaerobic. 29.04.13 blister hatches draining not foul-smelling yellowish secretion; it is cultivated and Gram, reporting no bacterial growth. Refers to Central Hospital of Maracay entering it with the diagnosis of cellulitis blistering, where it performed second Gram and cultivation reported without bacterial growth; they perform a biopsy which reports epidermal necrotic dermatitis superficial and deep compatible with dermatitis irritant contact. The case is reevaluated, interrogating again to the patient and the dermal symptoms coincide with the use of Arnica montana product (this data was not reported or questioned in the initial history). Update about the product reported that exists extensive reference on cases of dermatitis contact, mainly by the use of Arnica montana and one of its components; methylparaben, these cases have been reported by prolonged use of the product described as excited skin syndrome or angry back. The patient after to the second questioned referred the use of this product frequently for several years topically and even concerned using infusions of the flower of Arnica montana orally. It was decided to deal with steroids intravenously, resulting in evident improvement with egress to the fifth day and outpatient follow-up, which reported complete remission of picture.(AU)
