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Background Cosmetics are part of the daily life of the population, and their use can lead to allergic contact dermatitis. Objectives To assess the profile of patients diagnosed with allergic contact dermatitis to cosmetics treated at a referral center for 13 years, as well as the characteristics of the clinical picture and allergens involved. Methods This was a retrospective study, with analysis of medical records of patients attended at this service. The individuals included had a diagnostic hypothesis of allergic contact dermatitis to cosmetics and had previously been submitted to epicutaneous tests. Results A total of 1405 medical records were analyzed, 403 (28.7%) with suspected allergic contact dermatitis to cosmetics and 232 (16.5%) with confirmed diagnosis. Of these, 208 (89.7%) were women, and the age group most affected was 31 − 60 years. The most common locations were face in 195 cases (25.8%), cervical region in 116 (15.3%), and trunk in 96 (12.6%). The main allergens in the contact tests were toluene-sulfonamide-formaldehyde resin in 69 cases (29.7%), paraphenylenediamine in 54 (26.3%), Kathon CG® in 41 (20.7%), and fragrance-mix 1 in 29 (16.4%). In 154 (66.4%) of the 232 patients with a confirmed diagnosis of allergic contact dermatitis to cosmetics it was possible to specify the cosmetic product responsible for the lesions. Study limitations The absence of some allergens considered important in the world as causes of allergic contact dermatitis, which are not readily accessible among us. Conclusions The data of the analyzed population (predominance of young women), as well as the location of the lesions (face and cervical area) and the main allergens involved were consistent with those from the world literature.

Nickel and cobalt are often responsible for metal-induced allergic contact dermatitis. With the increasing use of cell phones, we observed an increase in cases reports on telephone-related allergic contact dermatitis. The present study evaluated nickel and cobalt release from mobile phones used in Brazil. We evaluated devices of 6 brands and 20 different models using nickel and cobalt allergy spot tests. Of the 20 models, 64.7% tested positive for nickel, with 41.1% positive results for the charger input and 23.5% for other tested areas. None of them was positive for cobalt. Nickel release was more common in older models.

Keys are a significant source of exposure to metal allergens and can be a relevant problem for nickel-allergic individuals. This study aimed to perform nickel and cobalt spot testing among the 5 most common Brazilian brands of keys. Among the tested keys, 100% showed positive result to nickel spot test, 83,3% presented strong positive reaction. 50% exhibited cobalt release as well. Nickel release from keys is very common in our country and may cause a negative impact on sensitized individual's quality of life. Study's results highlight the importance of establishing directives to regulate nickel release in Brazil.

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.

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

FUNDAMENTOS: A dermatite de contato e uma das dermatoses comumente relacionadas ao trabalho. Entre os pedreiros o cimento pode causar tanto a Dermatite Alergica de Contato quanto a Dermatite de Contato por Irritacao Primaria. Os equipamentos de protecao individual (luvas de borracha) podem favorecer o desenvolvimento de Dermatite Alergica de Contato. OBJETIVOS: 1) avaliar a frequencia de Dermatite Alergica de Contato entre os pedreiros entre Janeiro de 2005 e Dezembro de 2009; 2) determinar os principais agentes sensibilizantes; e 3) comparar os resultados obtidos entre o grupo de pedreiros com um grupo sem pedreiros. METODOS: analise retrospectiva de testes de contato. Pacientes foram separados em 2 grupos: 1) pedreiros e 2) nao pedreiros. RESULTADOS: dentre os 525 testes de contato analisados, 466 (90%) eram de nao pedreiros e 53 (10%) de pedreiros. As maos foram acometidas em 38 (61%). 13 pacientes (24%) tinham Dermatite de Contato por Irritacao Primaria e 40 (76%) tinham Dermatite Alergica de Contato. O grupo de pedreiros apresentou alta frequencia de sensibilizacao ao cimento, e 29 (54,7%) tinham sensibilizacao a agentes vulcanizadores da borracha. 23 pacientes (43,4%) pedreiros tinham sensibilizacao tanto ao cimento quanto a borracha. CONCLUSOES: entre os pedreiros a presenca de Dermatite Alergica de Contato ao cimento e a borracha no mesmo paciente foi comum e demonstrou a importância do teste de contato.

The main allergen responsible for contact dermatitis to nail polish is tosylamide-formaldehyde resin. The so-called hypoallergenic nail polishes are suposedly free of agents that commonly trigger reactions. The commercially available products and their compositions were studied. It was observed that most brands present at least one component capable of triggering the disease; therefore, allergic reaction may occur even when hypoallergenic polishes are used. There should be a proper investigation of the specific allergen through a patch test, because more than one component can cause an allergy, and we need to check the exact composition of each product.

Alopecia areata is a non-scarring form of alopecia that can be localized or widespread. Its etiology is unknown, but immunological factors are implicated in its pathogenesis. With the more frequent use of anti TNFα biologic drugs, some alopecia areata cases during their use have been described. We report a case of universal alopecia in a patient with rheumatoid arthritis while using adalimumab and leflunomide.

BACKGROUND Liquid nail varnish has been used since 1919, and allergic contact dermatitis (ACD) has been recognized for at least 80 years, but it is difficult for nonspecialists to identify this condition. OBJECTIVES (1) To verify the frequency of ACD from nail varnish in patients with a presumptive diagnosis of contact dermatitis seen at an outpatient clinic, (2) to characterize the groups studied according to site of skin disorder, and (3) to determine the main sensitizer related to varnish. METHODS Patients with a final diagnosis of ACD caused by nail varnish were assessed by means of retrospective analysis of medical charts and protocols used in the clinic from January 1996 to December 2006. Patch tests with the Brazilian standard series and a complementary series were applied to all patients. RESULTS Diagnosis of ACD from nail varnish was made in 8% of cases (157 of 1,971). The most affected sites were the face and neck; however, involvement of some uncommon areas, such as periungual and perianal regions, was also observed. CONCLUSIONS ACD from nail polishes is a common event and recognition of the condition must be improved. Toluenesulfonamide formaldehyde resin (TSFR) was the most common allergen in the group studied.

Alopecia areata is an autoimmune disease characterized by non-scaring hair loss. The onset in over 50-year-old patients is rare and has barely been studied. Cases of this disease have been retrospectively analyzed – according to clinical forms, extension, and associated diseases – to assess alopecia areata characteristics in a group of patients whose disease onset was after the age of 50. 30 patients were studied; a few of them presented with autoimmune-related diseases or family history. The disease onset after the age of 50 seems to have different characteristics from those found in young people.

The authors present a case of a 44-year-old patient with a disseminated dermatosis diagnosed as acanthosis nigricans. The patient was a smoker and investigation of the cause of her skin lesions resulted in discovery of an asymptomatic metastatic carcinoma in the laryngopharanx, probably of pulmonary origin.

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.

A retrospective study was carried out between 2006-2011. Six hundred and eighteen patients with suspected allergic contact dermatitis underwent the standard patch test series recommended by the Brazilian Contact Dermatitis Research Group. The aim of our study was to evaluate the variation of positive patch-test results from standard series year by year. The most frequently positive allergens were: nickel sulfate, thimerosal and potassium bichromate. Decrease of positive patch-test results over the years was statistically significant for: lanolin (p=0.01), neomycin (p=0.01) and anthraquinone (p=0.04). A follow-up study should be useful in determining which allergens could be excluded from standard series, as they may represent low sensitization risk. Estudo retrospectivo foi realizado entre 2006 e 2011 em 618 pacientes com hipótese diagnóstica de dermatite de contato submetidos à bateria padrão de testes de contato preconizada pelo Grupo Brasileiro de Estudos em Dermatite de Contato com o objetivo de avaliar a variação, a cada ano, da frequência de positividade para as substâncias da bateria. Os principais sensibilizantes foram sulfato de níquel, timerosal e bicromato de potássio. As substâncias com diminuição da frequência de sensibilização estatisticamente significante foram lanolina (p = 0,01), neomicina (p = 0,01) e antraquinona (p = 0,04). A continuação deste trabalho poderá contribuir para verificar aqueles componentes que poderão ser eliminados da bateria, por representarem pouco risco de sensibilização.

Whether parapsoriasis represents an early stage of T-cell cutaneous lymphoma is still the subject of controversy. We evaluated the efficacy of phototherapy in the treatment of parapsoriasis and its relation with TCCL. Patients diagnosed with parapsoriasis and treated with phototherapy PUVA or UVB-NB were selected. Between 1 to 8 years following treatment the evolution of their disease was evaluated. In 62 patients the cure rate was 79.3% and 17.2% showed improvement of the lesions. Only two patients developed full blown T-cell cutaneous lymphoma. Phototherapy is an excellent treatment for parapsoriasis, with high cure rates, regardless of the type of phototherapy employed. Of the 62 patients under study, parapsoriasis showed no general tendency to progress to T-cell cutaneous lymphoma. Há controvérsias se parapsoríase pode evoluir para linfoma Cutâneo de Células T. Neste trabalho avaliou-se eficácia da fototerapia no tratamento da parapsoríase e sua relação com linfoma Cutâneo de Células T. Selecionaram-se pacientes com parapsoríase tratados com PUVA ou UVB-NB. Após um-oito anos do tratamento, pacientes foram contatatos para avaliar a evolução da doença. Em 62 pacientes, a taxa de cura foi de 79,3%;17,2% apresentaram melhora de lesões. Apenas dois pacientes evoluíram para linfoma Cutâneo de Células T. A fototerapia mostrou-se eficaz no tratamento da parapsoríase, independente do tipo de fototerapia utilizada. Nos casos estudados, parapsóríase não mostrou tendência a se desenvolver em linfoma Cutâneo de Células T.

BACKGROUND: Background: Patch tests are an efficient method to confirm the etiological diagnosis of allergic contact dermatitis. OBJECTIVES: 1) To determine the permanence of results between two tests performed with an interval of at least one year, in patients with allergic contact dermatitis; 2) To compare the positive results according to rates of intensity; 3) To evaluate the permanence of sensitization according to each substance that was tested. METHODS: Patients with previous diagnosis of allergic contact dermatitis, confirmed by patch tests carried out between the years 2005 and 2008, underwent new testing, using the same methodology, and data was compared. RESULTS: A total of 1470 results of both tests on 49 patients were analyzed. The negative results remained in the second test in a rate of 96%, and 4% became positive (+) without relevance to the clinical history. Moreover, moderately (++) and strongly (+++) positive results were also maintained in, respectively, 86% and 100%. Nevertheless, weakly (+) positive results became negative in 65%. By ignoring all weakly (+) positive tests, the calculation of Kappa Index of Agreement Statistics between the two tests showed a value of 0.88. CONCLUSION: Patch tests showed to be reliable for negative, moderately (++) positive and strongly (+++) positive results, by reproducing the same standard of individual response to allergens. However, for weakly (+) positive results, tests were not reliable.

Progressive macular hypomelanosis is a common dermatosis in various continents. Its cause is unknown and proposed treatments have had little effect.To determine epidemiological aspects of progressive macular hypomelanosis in patients referred to a phototherapy clinic between 1997 and 2008 and to evaluate therapeutic response to PUVA (psoralen + UVA) photochemotherapy or narrowband UVB phototherapy.Eighty-four patients with progressive macular hypomelanosis were evaluated. After 16 phototherapy sessions, therapeutic response was classified as: unchanged, slightly improved (50% of repigmentation), moderately improved (50-79% of repigmentation), much improved (80-99%) or cured (100%). After a minimum of three months, patients whose response was classified as cured or much improved were contacted by telephone to evaluate the persistence of the therapeutic response.Most of the patients were women (79%) and white (85%). Age at onset of progressive macular hypomelanosis ranged from 13 to 36 years. PUVA was prescribed for 27 patients and narrowband UVB phototherapy for 57. No significant difference was found between the outcomes obtained with PUVA and those obtained with narrowband UVB phototherapy (Fisher's exact test; p0.05). The majority of patients (81%) had 50% or more repigmentation, with 65% being classified as cured or much improved. Nevertheless, there was a recurrence of the lesions in 72% of patients.The fact that no patients were over 40 years of age suggests that progressive macular hypomelanosis is a self-limiting disease. Both PUVA and narrowband UVB are effective therapeutic options; however, they do not prevent recurrence of the disease.

Moderate and severe forms of psoriasis require phototherapy and / or systemic medications. Both UVA and UVB can be used to treat cases of moderate and severe psoriasis, and the effectiveness of both has been proven.to access the prescription behavior relating to two types of phototherapy for treating psoriasis refractory to topical treatment: narrowband UVB (NB-UVB) or psoralen plus UVA phototherapy (PUVA).Between January 2006 and December 2007, patients referred to two phototherapy services were included in this study. Data on the cases and on the type of prescription were collected retrospectively.Among the 67 studied patients, 51 (76%) were treated with narrowband UVB. The reasons for the indication were the presence of the guttate type of psoriasis (22%), the presence of thin plaques (15%), the use of drugs that affected photosensitivity (15%), age less than 20 years (9%), skin type I (9%), and liver disease (6%). The remaining 16 (24%) were treated with PUVA. The main indication for this therapy was the severity of the disease (15%), followed by the presence of skin type IV (9%).Prescriptions of narrowband UVB exceeded those of PUVA because of fewer contraindications and fewer possible side effects, and because it was a more practical option.

Occupational contact dermatitis (OCD) corresponds to 80% of the cases of skin diseases related to work.To determine: the frequency of OCD in an ambulatory of allergy not specific for occupational dermatosis; the profile of these patients according to age, gender, color, profession, atopic history, duration and localization of the dermatosis; the diagnosed types of contact dermatitis; the main allergens and to compare the frequency of the main antigens with the results obtained from patients examined in the same period of time, without DCO.During the three-year period from 2003 to 2006, 630 patients were examined and submitted to a battery of standardized contact patch tests and those who were diagnosed with OCD were selected.Sixty-nine out of the 630 patients were diagnosed with OCD. The average age was 44.5 years. Forty-eight patients (70%of the cases) presented the disease on the hands. The most prevalent activities of patients suffering from the disease were household tasks (39%) and building construction (33%). The allergic contact dermatitis (ACD) occurred in 48 cases which represent 70% of the total number of cases and irritant contact dermatitis in 21 cases corresponding to 30% of the total number of cases. The main allergens were potassium dichromate 28 (41%), nickel sulfate 16 (23%) and carba-mix 16 (23%).OCD was present in 10.9% of the patients. Concerning age the group in which the disease was more commonly found corresponded to the most productive group of the population. ACD corresponded to 48 cases, probably influenced by the long period of evolution of the dermatosis. Metal and rubber chemicals were the commonest allergens.

Allergic Contact Dermatitis is a common type of dermatitis, but its multiple etiologies hinder its management.the objective of this study was to evaluate the frequency of sensitization to topical drugs in a university center, to study the main characteristics of the affected population, and to identify the allergens related with the dermatitis.a retrospective and descriptive study with patients submitted to patch tests. The study was conducted with subjects whose patch test to topical drugs was positive.329 patients were submitted to patch tests and 42 (13%) had positive and relevant patch tests to topical drugs. Among these patients, 36 (85.7%) had positive patch tests to the principal component and 28 (66.7%) to the other components. Some patients had more than one sensitization. Neomycin was the most important allergen.Among the studied patients, sensitization to topical agents happened in 13% of the cases, with slight preference for females and Caucasians. There was elevated sensitization to neomycin, a popular agent among patients and medical doctors.

We present a case of a healthcare professional that developed type I and IV hypersensitivity reactions to rubber. During the clinical examination the patient showed eczematous dermatitis of the hands. The patch test was positive for thiuram group and an open test with a piece of glove was positive after 20 minutes of exposure. Allergen-specific IgE test (RAST) was relevant. Reactions to rubber allergens are frequent among healthcare professionals due to constant contact with this material.

Background: Adolescents between the ages of 10 and 19 are exposed to a series of substances capable of causing contact dermatitis. Objectives: (1) To study the frequency and characteristics of allergic contact dermatitis in adolescents, (2) to characterize the group being studied, and (3) to verify the main sensitizing substances among this age group. Methods: From 1996 to 2001, 1,027 patients with a suspicion of contact dermatitis were analyzed, and patients between 10 and 19 years of age were selected. These patients were submitted to contact tests. Results: Among the 102 adolescents, 93 (91%) were female and 9 (9%) were male. The face was the area most affected by dermatosis. The contact tests were positive in 64 patients (56%), whereas in 45 (44%) they were negative. The main location of the contact dermatitis was the face (36%). The substances with higher frequencies of sensitization were nickel sulfate in 33 (31%) patients and tosylamide-formaldehyde resin in 13 (12%) patients. Conclusion: Contact dermatitis in adolescents was more frequent in white girls and on the face. The substances with greater frequency of sensitization were nickel sulfate and tosylamide-formaldehyde resin. These two substances are related to adolescent habits and behavior.

Background: Epicutaneous patch tests represent a practical and objective method that help in the etiologic diagnosis of allergic contact dermatitis. The technique of patch test application is an important factor in obtaining good results. Objectives: The aims of this study were (1) to determine whether the substances that form the test battery interfere with the patch test result and (2) to establish a rule for positioning the substances during patch test application. Methods: Two hundred patients were studied. The standard patch test battery was applied in 3 versions. The original, with the substances applied in alphabetical order was called version 1 (V1) and tested on the left back in all patients In 100 patients, on the right side, the same substances were tested but applied at different positions, avoiding the proximity of elements with a tendency to cross reaction and/or cosensitizing. This version of the battery was named version 2 (V2). Another 100 patients had V1 applied to the left back, and, on the right side, the version 3 of the battery (V3) was applied, consisting of the same allergens but placed close to those with a tendency for cross reaction and/or cosensitization. Results: In the group V1-V2, 163 results were positive in V1 and 124 in V2, with the difference being statistically significant ( P [lt ] .05). In the group V1-V3, 134 results were positive in V1 and 207 in V3, with the difference also being significant ( P [lt ] .005). The substances with the largest number of positive results, when tested close to other elements with a tendency for chemical affinity, were parabens, fragrance-mix, thimerosal, balsam of Peru, potassium dichromate, cobalt chloride, mercapto mix, and propylene glycol. Conclusions: (1) The substances of a patch test battery eliciting positive responses may interfere with test positivity to neighboring substances. (2) In addition to the already established techniques, the position of the substances forming the test battery needs to be determined; substances with a tendency to cross reaction or cosensitizing substances should be tested distant from one another, thus preventing the occurrence of false-positive results.