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Background: Hand eczema (HE) is a chronic multifactorial dermatosis with the presence of endogenous and exogenous factors in its pathogenesis. The etiologic diagnosis of hand eczema is often difficult. Objectives: The objectives of this study were (1) to detect clinical history and clinical examination data capable of differentiating HE types; (2) to determine the importance of patch tests for the etiologic diagnosis of HE; and (3) on the basis of the definitive diagnosis of HE type with the aid of patch tests, to obtain relevant data for appropriate patient guidance for the control of HE. Methods: A total of 250 patints with HE were studied over a period of 3 years (1993 to 1995). All patients were submitted to the battery of patch tests. Results and Conclusions: The results obtained led to the following conclusions: (1) Women are more predisposed to HE. (2) Work under moist conditions favors HE. (3) With respect to the regional location of HE, any region may be involved in any type of HE; however, involvement of the dorsal region is more common in allergic contact dermatitis (ACD), followed by contact dermatitis owing to primary irritation (ICD) and atopic dermatitis (AD). Location of HE on the dorsal surface of the fingers was mainly observed in ACD, followed by ICD and AD. (4) Patch tests should be part of the investigative routine of HE etiology. (5) The presence of allergy to metals in the clinical history of the patient in a relevant feature, because patch tests confirmed sensitization to nickel in 89% of cases. (6) Rubber components have high sensitization frequency in patients with HE. (7) When the patient reports worsening of HE after the use of rubber gloves, this indicates a probable sensitization to rubber components, mainly in patients with AD.

Background: Excited skin syndrome (ESS) occurs when, after a battery of patch tests is applied to patients with suspect allergic contact dermatitis, an excessive number of positive patch tests is obtained that are no longer reproduced when the patient is retested. Objective: This study was performed to verify the occurence of ESS when patch tests were applied to a population with a hypothetical diagnosis of allergic contact dermatitis, to determine the rate of positive test result loss among the tested patients who developed ESS, and to try to identify factors that might initiate the ESS. Methods: From January 1985 to May 1990, patch tests were performed on 1,500 patients referred to the Allergy Sector of the Dermatology Clinic of Santa Casa de Sao Paulo with a hypothetical diagnosis of contact dermatitis. Thirty-four of the 1,500 patients were considered because they showed three or more positive test results during the first phase of the patch tests. These patients were submitted to the retesting of substances with positive test results in the first phase. Results and Conclusions: Analysis of the results allowed us to conclude that the frequency of ESS in the 1,500 patients tested was 2.2% and that the number of lost test results between the first and the second phase was 175, showing a loss rate of positive test results of 63.5%. Regarding the facts that might interfere with the ESS, it was shown that (1) the loss rate of positive test results varied among patients, ie, polysensitized patients showed a lower rate of test result losses than monosensitized or bisensitized patients; (2) the longer the time of evolution of the chronic eczematous dermatitis, the higher the tendency to develop ESS; (3) ESS might be initiated by positive test results of weak, medium, or high intensity; (4) when the patch tests are applied close to one another, the positive test results may induce additional responses in the area; and (5) it was not possible to show statistically that the nature of certain substances interferes with the induction of ESS.