Excited skin syndrome associated with patch-test application technique.
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Biomedical subjects
Ida Duarte
Publications and source records attributed to Ida Duarte.
Contact dermatitis of the feet: a study of 53 cases.
BACKGROUND: Contact dermatitis of the feet is a common dermatosis that very often makes patients unable to perform daily activities. The differential diagnosis should be made with other dermatoses, such as tinea, atopic dermatitis, psoriasis, dyshidrosis, and nummular eczema. It is clinically difficult to establish a true diagnosis of contact dermatitis, and the results of epicutaneous tests may not be definite. However, studies undertaken to identify the etiologic agent may lead to a cure for patients. OBJECTIVES AND METHODS: The objectives of this study were (1) to verify the frequency of contact dermatitis of the feet among a group of patients seen at a public clinic, (2) to determine the type of contact dermatitis, and (3) to determine the most common sensitizers. We selected only patients with eczematous dermatitis from among 1,027 patients at the clinic, and they were patch tested with the Brazilian series. RESULTS: Of 1,027 patients who submitted to patch tests, 53 (5.2%) presented with dermatosis of the feet. Out of these 53 patients, 37 (70%) had at least one positive patch-test reaction, and the remaining 16 (30%) had negative results. CONCLUSION: The presence of dermatosis on the dorsal region of the foot in the majority of the patients with a positive test result was statistically significant (chi2 = 6.02; p < .05). The compounds that caused positive tests more often were rubber-vulcanizing agents, followed by metals and topical medications. The epicutaneous tests were found to be indispensable for the etiologic diagnosis of contact dermatitis of the feet.
Adolescent↗
Contact dermatitis in adolescents.
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.
Adolescent↗
Excited skin syndrome: study of 39 patients.
BACKGROUND: Excited skin syndrome (ESS) is an adverse reaction obtained when carrying out epicutaneous patch tests, characterized by multiple positive test results, associated with one or more strongly positive tests, which are not all reproduced when the patient is tested afterward. OBJECTIVE: The aim of this study was (1) to determine the frequency of ESS in patients submitted to patch testing, (2) to confirm the influence of the evolution time of the primary dermatosis with ESS induction, (3) to determine differences among patients according the rate of positive test loss, and (4) to compare the number of positive tests for each substance between the first test, when all allergens in the test battery were applied, and the second test, when only the allergens with positive tests on the first occasion were applied at a greater distance from one another. METHODS: Epicutaneous tests were carried out in 630 patients with a suspected diagnosis of allergic contact dermatitis. Patients presenting 2 or more positive test results were considered to have ESS and were submitted to a second patch test. RESULTS AND CONCLUSIONS: ESS developed in 39 of the 630 patients tested, corresponding to a frequency of 6.2%. Analysis of data found a longer duration of the primary dermatitis in patients who in whom ESS developed compared with those who did not. Parabens, fragrance mix, and thimerosal had more positive patch test reactions using standard application techniques relative to the retest procedure, which placed the substances at a greater distance from one another, suggesting that, in addition to the factors previously reported to influence the reduction of ESS, the position of the allergens in the testing procedure also should be considered.
Adolescent↗
Interference of the position of substances in an epicutaneous patch test battery with the occurrence of false-positive results.
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 <.05). In the group V1-V3, 134 results were positive in V1 and 207 in V3, with the difference also being significant (P <.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.
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