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      Claves diagnósticas en el eccema diseminado: experiencia de una unidad de Dermatitis de Contacto (2003-2019) Translated title: Diagnostic keys for disseminated eczema: experience of a Dermatitis Contact unit (2003-2019)

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          Resumen

          El objetivo de este estudio fue establecer los diagnósticos de los pacientes con eccema diseminado y analizar los alérgenos implicados en el eccema diseminado por dermatitis alérgica de contacto. Para ello, se analizaron los datos de los pacientes con diagnóstico de eccema diseminado/generalizado a los que se les había realizado anamnesis, exploración física y pruebas epicutáneas en una consulta de Dermatitis de Contacto en el periodo 2003-2019.

          El diagnóstico más frecuente fue dermatitis alérgica de contacto, seguido de dermatitis atópica, eccema asteatósico y eccema gravitacional. Los alérgenos más frecuentemente implicados en dermatitis de contacto alérgica fueron las isotiazolinonas, los medicamentos tópicos, la parafenilendiamina y las fragancias.

          La dermatitis alérgica de contacto causó casi la mitad de los casos de eccema diseminado. Por ello, consideramos conveniente que los pacientes con eccema diseminado sean valorados en una Unidad de Contacto y se sometan a la realización de pruebas epicutáneas.

          Abstract

          The aim of this study was to establish the diagnoses of patients with disseminated eczema and analyze the allergens involved in disseminated eczema due to allergic contact dermatitis. We analyzed the data from patients with a diagnosis of disseminated / generalized eczema who had undergone anamnesis, physical examination and patch tests in a Contact Dermatitis consultation from 2003 to 2019.

          Allergic contact dermatitis was the most frequent diagnosis, followed by atopic dermatitis, asteatotic eczema, and gravitational eczema. The allergens most frequently involved in allergic contact dermatitis were isothiazolinones, topical medications, paraphenylenediamine, and fragrances.

          Allergic contact dermatitis caused almost half of the cases of disseminated eczema. It would be therefore advisable for patients with disseminated eczema to be assessed at a Contact Dermatitis unit and undergo patch tests.

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          Most cited references17

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          European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice.

          The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
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            Povidone iodine in wound healing: A review of current concepts and practices

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              Systemic Contact Dermatitis.

              Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals.
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                Author and article information

                Journal
                An Sist Sanit Navar
                An Sist Sanit Navar
                assn
                Anales del Sistema Sanitario de Navarra
                Gobierno de Navarra. Departamento de Salud
                1137-6627
                2340-3527
                27 April 2022
                Jan-Apr 2022
                : 45
                : 1
                : e0987
                Affiliations
                [1] originalServicio de Dermatología. Hospital Universitario de Navarra. Pamplona. España. orgdiv1Servicio de Dermatología orgnameHospital Universitario de Navarra Pamplona, España
                Author notes
                [Correspondencia ] Jorge Aróstegui Aguilar. C/ Francisco Alesón, 6, 8ºC, 31008, Pamplona. E-mail: jarosteguiaguilar@ 123456gmail.com

                Conflictos de interés: Los autores declaran no tener conflictos de intereses.

                Article
                10.23938/ASSN.0987
                10114009
                35037913
                da02c3b0-68aa-4548-8946-99cc344b2795

                Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons

                History
                : 31 March 2021
                : 14 July 2021
                : 25 August 2021
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 13, Pages: 0
                Categories
                Artículos Originales Breves

                eccema,prurito,pruebas epicutáneas,dermatitis alérgica de contacto,alérgeno,eczema,pruritus,epicutaneous patch test,dermatitis,allergic contact

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