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Romita P, Foti C, Stingeni L, Hansel K, Magrone T, Belsito DV, Bonamonte D. Contact Allergy in Children with Atopic Dermatitis: A Retrospective Study. Endocr Metab Immune Disord Drug Targets 2019; 19:1083-1087. [DOI: 10.2174/1871530319666190211123342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/22/2022]
Abstract
Background:
The relationship between atopic dermatitis and allergic contact dermatitis is
frequently debated, particularly in children. The impaired skin barrier of atopic subjects can facilitate
the penetration of exogenous agents and its mutations in the filaggrin gene might be implicated in an
increased risk to develop contact dermatitis. Moreover, atopic children are protractedly exposed to
chemical substances contained in skin care products from an early age.
Patients And Methods:
The aim of this retrospective study is to determine if atopic children are more
prone to allergic contact dermatitis and which substances are more frequently related to this disease.
From 2014 to 2016, a total of 268 children under 14 years with a history of eczematous dermatitis, of
whom 141 (52.6%) were affected, and 127 (47.4%) were not affected by AD, underwent patch testing
with the baseline S.I.D.A.P.A standard series.
Results:
Based on the results of our study, the prevalence of contact allergy in atopic children is comparable
to that noted in non-atopic children. The most frequent causes of contact allergy in children are
fragrances, and their prevalence is significantly higher in atopic children (19.9%) than in non-atopic
ones, (11.8%; p < .05).
Conclusion:
Our study highlights the importance of patch testing in atopic children for continuously
monitoring the trends and changes of contact allergies that are a common disease and is even significantly
increasing for some allergens, as fragrances. We may speculate that the protracted use of skincare
products, associated with the impaired skin barrier of atopic children, enhances the risk of sensitization
to the ingredients of these products.
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Affiliation(s)
- Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, IT-70124 Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, IT-70124 Bari, Italy
| | - Luca Stingeni
- Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, IT-06129 Perugia, Italy
| | - Katharina Hansel
- Clinical, Allergological and Venereological Dermatology Section, Department of Medicine, University of Perugia, IT-06129 Perugia, Italy
| | - Thea Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, School of Medicine, Bari, Italy
| | - Donald V. Belsito
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Domenico Bonamonte
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, IT-70124 Bari, Italy
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Zafrir Y, Trattner A, Hodak E, Eldar O, Lapidoth M, Ben Amitai D. Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review. Pediatr Dermatol 2018; 35:76-86. [PMID: 29143366 DOI: 10.1111/pde.13333] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature. METHODS The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files. RESULTS Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively). CONCLUSION Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.
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Affiliation(s)
- Yaron Zafrir
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Akiva Trattner
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmillia Hodak
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Eldar
- Department of Dermatology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Moshe Lapidoth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laser Unit, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Dan Ben Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Bender JK, Faergemann J, Sköld M. Skin Health Connected to the Use of Absorbent Hygiene Products: A Review. Dermatol Ther (Heidelb) 2017; 7:319-330. [PMID: 28667496 PMCID: PMC5574741 DOI: 10.1007/s13555-017-0189-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
Over the past 50 years, absorbent hygiene products such as baby diapers and incontinence products have become essential features of modern day life. Through innovation and enhanced technology, their design, composition and performance have been dramatically upgraded from their early forms, and they have transformed the lives of millions of people, improving their quality of life. Skin health related to the use of absorbent hygiene products has accordingly also greatly improved. Still, the wearing of absorbent hygiene products will affect the skin, and for some users the changes in microclimate, mechanical interactions and the exposure to urine and faeces may result in irritant contact dermatitis, i.e. diaper dermatitis (DD) or incontinence-associated dermatitis (IAD). Babies with developing skin and the elderly with deteriorating skin functions who are the most frequent users of absorbent hygiene products are more vulnerable to the causal factors. Although irritant reactions are the most common, allergic contact dermatitis should be considered if a DD/IAD fails to improve by recommended actions. There is also a connection between IAD and pressure ulcer development of which it is important to be aware. A holistic approach of using high-quality absorbent hygiene products in combination with appropriate skin care will help maintaining good skin health.
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Affiliation(s)
| | - Jan Faergemann
- Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden
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Bonitsis NG, Tatsioni A, Bassioukas K, Ioannidis JPA. Allergens responsible for allergic contact dermatitis among children: a systematic review and meta-analysis. Contact Dermatitis 2011; 64:245-57. [DOI: 10.1111/j.1600-0536.2010.01860.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Allergic contact dermatitis (ACD) in childhood was considered rare until recently. However, reports are increasing, which may reflect an increased incidence and/or more frequent patch testing of children. It is also likely that allergen exposure in children has changed with time. AIMS To determine the most common contact allergens and the rate of positive patch-test reactions among children with suspected contact allergy. METHODS We carried out a retrospective case study of 114 children (66 girls and 48 boys) aged from 3 to 15 years (median 11.5) patch tested over a 3-year period. Indications for patch testing included uncontrolled or deteriorating atopic dermatitis, localized dermatitis or a history of reacting to a specific allergen. RESULTS Of 110 children for whom we had notes, 83 (75%) had a history of atopy. Positive reactions that were of current, past or possible relevance were seen in 61 children (54%); in 58 (52%) of 111 tested with the standard series (SS) and in 6 (10%) of 60 tested with the medicament series. None of the children patch tested to the corticosteroid (n = 47), shoe (n = 15), fragrance (n = 12), cosmetic (n = 10) or rubber (n = 5) series had a positive reaction. However, 11 (10%) reacted to rubber allergens within the SS and one of five to their own shoes. The lowest rate of relevant positive reactions was among those with deteriorating atopic dermatitis (22%) and facial (33%) or perioral dermatitis (40%), and the highest rate amongst those with eyelid (86%) or hand (71%) dermatitis. Nickel was the most common allergen (20%) in line with previous reports (82% female), followed by rubber chemicals (10%), fragrance (7.2%), cobalt (5.4%) and lanolin (wool alcohol) (4.5%). CONCLUSIONS The reported incidence of ACD among children, in particular nickel and rubber allergy, appears to be increasing, which may relate to changing fashions and hobbies. Contact allergy should be considered in all children with dermatitis, particularly with eyelid or hand dermatitis, and patch testing carried out more frequently.
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Affiliation(s)
- P E Beattie
- Department of Dermatology, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
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Buckley DA, Rycroft RJG, White IR, McFadden JP. The frequency of fragrance allergy in patch-tested patients increases with their age. Br J Dermatol 2003; 149:986-9. [PMID: 14632803 DOI: 10.1111/j.1365-2133.2003.05491.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most likely age of sensitization to fragrance chemicals is unknown. OBJECTIVES To investigate the frequency of allergy to the 8% fragrance mix (FM) in each decade of life in patients undergoing patch testing for the investigation of skin symptoms. METHODS Patients (n = 23 846; 14 104 female and 9742 male) underwent patch testing to a standard series between 1 January 1984 and 31 December 1998. All data were recorded on a computerized database. RESULTS We found that 8.4% of females and 6.4% of males were allergic to the FM. The frequency of fragrance allergy was low in the first two decades of life (2.5-3.4%). It gradually increased in females after the age of 20 years to peak in the 60s at 14.4% of those tested, with a decline to 11.6% in the 80s. The prevalence in males rose more slowly and peaked at 13.7% in the 70s, declining to 10.8% in the 80s. The youngest patients sensitized were aged 2 years. CONCLUSIONS These findings support the hypothesis that allergy to fragrance results from a combination of repeated environmental exposure and age-related susceptibility factors.
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Affiliation(s)
- D A Buckley
- St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH, UK.
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Tosti A, Voudouris S, Pazzaglia M. Contact sensitization to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one in children. Contact Dermatitis 2003; 49:215-6. [PMID: 14996074 DOI: 10.1111/j.0105-1873.2003.0206d.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonella Tosti
- Department of Dermatology, University of Bologna, Bologna, Italy.
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Duus Johansen J. Contact allergy to fragrances: clinical and experimental investigations of the fragrance mix and its ingredients. Contact Dermatitis 2002; 46 Suppl 3:4-31. [PMID: 11903392 DOI: 10.1046/j.1395-3907.2002.codsupplement.doc.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- R Wolf
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
From a clinical point of view, the prevalence of allergic contact dermatitis (ACD) among children and adolescents seems to be low. However, many children have dermatitis, most often atopic dermatitis. In selected cases, ACD is suspected, and the child is tested. The question remains, whether the prevalence of ACD in children really is low or whether the possibility of ACD is not sufficiently considered. During the last decade, reports have appeared on series of children and adolescents with contact allergy and ACD. Few cases have been reported in infants, but the development of contact allergy and ACD increases with age. Most studies include selected groups of children and adolescents with suspected ACD. Few studies have examined unselected populations, and most consider only the prevalence of contact allergy without evaluating the clinical relevance, e.g., the prevalence of ACD. Furthermore, no follow-up studies exist. Therefore, the incidence and prevalence of contact allergy and ACD in children and adolescents is largely unknown.
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Affiliation(s)
- C G Mortz
- Department of Dermatology, Odense University Hospital, Denmark
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Rastogi SC, Johansen JD, Menné T, Frosch P, Bruze M, Andersen KE, Lepoittevin JP, Wakelin S, White IR. Contents of fragrance allergens in children's cosmetics and cosmetic-toys. Contact Dermatitis 1999; 41:84-8. [PMID: 10445687 DOI: 10.1111/j.1600-0536.1999.tb06231.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fragrances are one of the major causes of allergic contact dermatitis from use of cosmetics. The aim of the current study was to assess the possible exposure of infants and children to fragrance allergens from cosmetic products and "toy-cosmetics". 25 children's cosmetics or toy-cosmetic products were analysed by gas chromatography - mass spectrometry. Target substances were the fragrance allergens from the fragrance mix and 14 other fragrance substances, most of which have been described as contact allergens. The fragrance mix ingredients were either not present in children's shampoos/shower gels and cream/lotions, or they were present in fairly low concentrations. In hydro-alcoholic products, such as eau de parfum, eau de toilette, several ingredients of the fragrance mix were found: geraniol was present in 7/7 products, hydroxycitronellal in 6/7 and isoeugenol in 2/7 products. Isoeugenol was present in a maximum concentration of 0.07%. In one cosmetic-toy, cinnamic alcohol was present at 3.7% which exceeds the current industry guideline for safe products by a factor of 5. In all types of products other fragrance allergens were frequently found. In conclusion, children are already exposed at an early age to well-known allergens, sometimes at concentrations which are considered to be unsafe. As contact allergy usually persists for life, manufacturers of children's cosmetics should be aware of their special responsibility and apply the highest possible safety standards.
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Affiliation(s)
- S C Rastogi
- Department of Environmental Chemistry, National Environmental Research Institute, Roskilde, Denmark
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Abstract
We report the results of patch tests carried out over the last 6 years (1992 1997) on 141 children. This corresponds to 2.8% of the total patients who were patch tested in our Allergy Department (5,014). These 141 children were patch tested using the TRUE Test standard series and an additional allergen, metallic mercury. Allergens from the Chemotechnique medicaments, cosmetics, plants and shoe series were added in some. The most frequent localization of eczema was to the feet, face and hands and the most frequent suspected causes were costume jewelry, footwear, topical medicaments and cosmetics. The most frequent allergens, assessed by degree of relevance, were first, nickel, followed by cobalt, mercurials (thimerosal and metallic mercury), fragrance and rubber chemicals (naphthyl mix, mercapto mix, carba mix and PPD mix). 13 children, 18% of the total, between the ages of 12 and 14 years, showed positivities relevant to some occupation, i.e., metalworking, building, hairdressing, catering, etc. Once patch tests had been carried out and relevant positive patch tests assessed, the most frequent diagnoses were contact dermatitis 45%, atopic dermatitis 25%, juvenile plantar dermatitis 15%, and other diagnoses in the remaining 15%.
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Affiliation(s)
- C Romaguera
- Allergy Department, Hospital Clínico, Barcelona, Spain
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Brasch J, Geier J. Patch test results in schoolchildren. Results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG). Contact Dermatitis 1997; 37:286-93. [PMID: 9455632 DOI: 10.1111/j.1600-0536.1997.tb02466.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Our aim was to explore the current spectrum of contact allergens in schoolchildren, as a basis for diagnosis and prevention of allergic contact dermatitis. Results of patch tests in children 6-15 years old, performed in the years 1990-1995 by 22 centres of the German Contact Dermatitis Research Group and filed by the Information Network of Departments of Dermatology, were analysed and evaluated retrospectively, including epidemiologic data. Children with positive tests (62 out of 156 boys and 108 out of 260 girls tested) had a higher frequency of allergic contact dermatitis and a lower frequency of atopic dermatitis than patch test negative ones. 16 distinct allergens elicited positive reactions in > or = 1% of the children tested. Reactions to nickel sulfate occurred in 15.9% of all children tested, but in 25.0% of girls 14/15 years old, and in only 4.5% of boys 6-13 years old. Double-sensitizations with cobalt salts, potassium dichromate and palladium were seen. Mercury compounds were found in 2nd place (thimerosal: all children: 11.3%; 6-13 years old: 14.3%; 14/15 years old: 8.0%), followed by fragrance allergens. We conclude that contact allergy in children is related to their sex and age. Prophylaxis against nickel, mercury, and fragrance allergy needs to be improved. A shortened standard series may be sufficient for testing children.
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Affiliation(s)
- J Brasch
- Department of Dermatology, University of Kiel, Germany
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Affiliation(s)
- R M Adams
- Department of Dermatology, Stanford University School of Medicine, California, USA
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Wantke F, Hemmer W, Jarisch R, Götz M. Patch test reactions in children, adults and the elderly. A comparative study in patients with suspected allergic contact dermatitis. Contact Dermatitis 1996; 34:316-9. [PMID: 8807222 DOI: 10.1111/j.1600-0536.1996.tb02214.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The age- and sex-related distribution of positive patch test reactions was investigated in 234 children (0-7 years, n = 72 and 8-14 years, n = 162), 1200 adults (20 to 50 years) and 295 elderly patients (> or = 70 years) with suspected allergic contact dermatitis using a European standard series. In girls from 0 to 7 years, the most frequent contact allergens were thimerosal (37.5%) and nickel (27.5%), in girls from 8 to 14 years, nickel (28.7%) and thimerosal (26.6%), in women, thimerosal (25.3%) and nickel (25.2%), and in elderly women, nickel (12.6%) and balsam of Peru (9.7%). The most frequent contact allergens in boys from 0 to 7 years were ethylmercuric chloride (28.1%) and thimerosal (25.0%), in boys from 8 to 14 years, thimerosal (30.9%) and ethylmercuric chloride (14.7%), in men, thimerosal (21.1%) and ethylmercuric chloride (13.7%) and in elderly men, nickel (11.2%) and balsam of Peru (6.7%). Females showed more positive reactions than males. Whilst 0 to 7 year-old girls and boys showed relatively more frequent reactions, the elderly of both sexes were clearly less affected. Nickel is the most frequent contact allergen in females of 8 years and more. In men, thimerosal is most frequent and reactions to balsam of Peru show a peak incidence in the elderly. Results indicate that patch testing should be considered in children and elderly patients with appropriate indications.
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Affiliation(s)
- F Wantke
- Dermatologic and Pediatric Allergy Clinic, Vienna, Austria
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Abstract
92 children (45 girls, 47 boys), mean age 9.3 years (3-14.75), were referred to the Contact Dermatitis Investigation Unit, Belvidere Hospital, Glasgow, for patch testing during the period 1979-93 for the investigation of allergic contact dermatitis (ACD). The diagnoses at the time of referral were atopic dermatitis (45), non-atopic with localized dermatitis (26), juvenile plantar dermatosis (15), orofacial granulomatosis (2), vaccination reaction (2) and atypical psoriasis (2). In total, there were 55 positive reactions in 30 children. The commonest allergens were metals (18), fragrances (11) and rubber compounds (6). The patient groups with the highest yield of positive patch tests were those patients with atopic dermatitis who had a good history of a precipitating contact factor (4/5), and non-atopic patients with dermatitis of hand and/or feet (7/14). Our findings suggest that allergic contact dermatitis is more common in children than generally appreciated and that patch testing is a practicable and clinically worthwhile procedure in children.
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Affiliation(s)
- G I Stables
- Department of Dermatology, Royal Hospital for Sick Children, Glasgow, UK
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Katsarou A, Koufou V, Armenaka M, Kalogeromitros D, Papanayotou G, Vareltzidis A. Patch tests in children: a review of 14 years experience. Contact Dermatitis 1996; 34:70-1. [PMID: 8789239 DOI: 10.1111/j.1600-0536.1996.tb02125.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Katsarou
- Department of Dermatology, University of Athens, Greece
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Affiliation(s)
- E Rudzki
- Department of Dermatology, Warsaw School of Medicine, Poland
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Abstract
By and large, positive patch tests with thimerosal lack clinical relevance and should cause concern neither to the dermatologist nor to the patient. The substance should be retained in standard test series for scientific purposes, but on clinical grounds its inclusion does not seem to be indicated. Nevertheless, the phenomenon is intriguing in its own right.
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Affiliation(s)
- H Möller
- Department of Dermatology, Lund University, Malmö, Sweden
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