Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010*
Identifieur interne : 000000 ( Pmc/Corpus ); suivant : 000001Patch test results in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010*
Auteurs : Dulcilea Ferraz Rodrigues ; Eugênio Marcos Andrade GoulartSource :
- Anais Brasileiros de Dermatologia [ 0365-0596 ] ; 2015.
Abstract
Patch testing is an efficient method to identify the allergen responsible for allergic contact dermatitis.
To evaluate the results of patch tests in children and adolescents comparing these two age groups' results.
Cross-sectional study to assess patch test results of 125 children and adolescents aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology clinic in Brazil. Two Brazilian standardized series were used.
Seventy four (59.2%) patients had "at least one positive reaction" to the patch test. Among these positive tests, 77.0% were deemed relevant. The most frequent allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin (6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002). There was no relevant statistical difference concerning contact sensitizations among patients with or without atopic history. However, there were significant differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042) between the two age groups under study, while adolescents were the most affected.
Nickel and fragrances were the only positive (and relevant) allergens in children. Nickel and tosylamide formaldehyde resin were the most frequent and relevant allergens among adolescents.
Url:
DOI: 10.1590/abd1806-4841.20153902
PubMed: 26560213
PubMed Central: 4631233
Links to Exploration step
PMC:4631233Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Patch test results in children and adolescents. Study from the Santa Casa
de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010<xref ref-type="fn" rid="fn01">*</xref></title><author><name sortKey="Rodrigues, Dulcilea Ferraz" sort="Rodrigues, Dulcilea Ferraz" uniqKey="Rodrigues D" first="Dulcilea Ferraz" last="Rodrigues">Dulcilea Ferraz Rodrigues</name><affiliation><nlm:aff id="aff01">Santa Casa de Misericórdia de Belo Horizonte – Belo Horizonte (MG), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Goulart, Eugenio Marcos Andrade" sort="Goulart, Eugenio Marcos Andrade" uniqKey="Goulart E" first="Eugênio Marcos Andrade" last="Goulart">Eugênio Marcos Andrade Goulart</name><affiliation><nlm:aff id="aff02">Universidade Federal de Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26560213</idno><idno type="pmc">4631233</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631233</idno><idno type="RBID">PMC:4631233</idno><idno type="doi">10.1590/abd1806-4841.20153902</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000000</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000000</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Patch test results in children and adolescents. Study from the Santa Casa
de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010<xref ref-type="fn" rid="fn01">*</xref></title><author><name sortKey="Rodrigues, Dulcilea Ferraz" sort="Rodrigues, Dulcilea Ferraz" uniqKey="Rodrigues D" first="Dulcilea Ferraz" last="Rodrigues">Dulcilea Ferraz Rodrigues</name><affiliation><nlm:aff id="aff01">Santa Casa de Misericórdia de Belo Horizonte – Belo Horizonte (MG), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Goulart, Eugenio Marcos Andrade" sort="Goulart, Eugenio Marcos Andrade" uniqKey="Goulart E" first="Eugênio Marcos Andrade" last="Goulart">Eugênio Marcos Andrade Goulart</name><affiliation><nlm:aff id="aff02">Universidade Federal de Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Anais Brasileiros de Dermatologia</title><idno type="ISSN">0365-0596</idno><idno type="eISSN">1806-4841</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND</title><p>Patch testing is an efficient method to identify the allergen responsible for
allergic contact dermatitis.</p></sec><sec><title>OBJECTIVE</title><p>To evaluate the results of patch tests in children and adolescents comparing these
two age groups' results.</p></sec><sec><title>METHODS</title><p>Cross-sectional study to assess patch test results of 125 children and adolescents
aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology
clinic in Brazil. Two Brazilian standardized series were used.</p></sec><sec><title>RESULTS</title><p>Seventy four (59.2%) patients had "at least one positive reaction" to the patch
test. Among these positive tests, 77.0% were deemed relevant. The most frequent
allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin
(6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most
frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002).
There was no relevant statistical difference concerning contact sensitizations
among patients with or without atopic history. However, there were significant
differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042)
between the two age groups under study, while adolescents were the most
affected.</p></sec><sec><title>CONCLUSION</title><p>Nickel and fragrances were the only positive (and relevant) allergens in children.
Nickel and tosylamide formaldehyde resin were the most frequent and relevant
allergens among adolescents.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Goon, At" uniqKey="Goon A">AT Goon</name></author><author><name sortKey="Goh, Cl" uniqKey="Goh C">CL Goh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Manzini, Bm" uniqKey="Manzini B">BM Manzini</name></author><author><name sortKey="Ferdani, G" uniqKey="Ferdani G">G Ferdani</name></author><author><name sortKey="Simonetti, V" uniqKey="Simonetti V">V Simonetti</name></author><author><name sortKey="Donini, M" uniqKey="Donini M">M Donini</name></author><author><name sortKey="Seidenari, S" uniqKey="Seidenari S">S Seidenari</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brasch, J" uniqKey="Brasch J">J Brasch</name></author><author><name sortKey="Geier, J" uniqKey="Geier J">J Geier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fernandez 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<front><journal-meta><journal-id journal-id-type="nlm-ta">An Bras Dermatol</journal-id><journal-id journal-id-type="iso-abbrev">An Bras Dermatol</journal-id><journal-id journal-id-type="publisher-id">abd</journal-id><journal-title-group><journal-title>Anais Brasileiros de Dermatologia</journal-title></journal-title-group><issn pub-type="ppub">0365-0596</issn><issn pub-type="epub">1806-4841</issn><publisher><publisher-name>Sociedade Brasileira de Dermatologia</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26560213</article-id><article-id pub-id-type="pmc">4631233</article-id><article-id pub-id-type="doi">10.1590/abd1806-4841.20153902</article-id><article-categories><subj-group subj-group-type="heading"><subject>Investigation</subject></subj-group></article-categories><title-group><article-title>Patch test results in children and adolescents. Study from the Santa Casa
de Belo Horizonte Dermatology Clinic, Brazil, from 2003 to 2010<xref ref-type="fn" rid="fn01">*</xref></article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Rodrigues</surname><given-names>Dulcilea Ferraz</given-names></name><xref ref-type="aff" rid="aff01">1</xref><xref ref-type="corresp" rid="c01"></xref></contrib><contrib contrib-type="author"><name><surname>Goulart</surname><given-names>Eugênio Marcos Andrade</given-names></name><xref ref-type="aff" rid="aff02">2</xref></contrib></contrib-group><aff id="aff01"><label>1</label>Santa Casa de Misericórdia de Belo Horizonte – Belo Horizonte (MG), Brazil.</aff><aff id="aff02"><label>2</label>Universidade Federal de Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil.</aff><author-notes><corresp id="c01">MAILING ADDRESS: Dulcilea Ferraz Rodrigues, Av Bernardo Monteiro, 890,
sala 603 - Santa Efigênia, 30150 281 - Belo Horizonte - MG, Brazil. E-mail:
<email>dulcilea.ferraz@gmail.com</email></corresp></author-notes><pub-date pub-type="epub-ppub"><season>Sep-Oct</season><year>2015</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><season>Sep-Oct</season><year>2015</year></pub-date><volume>90</volume><issue>5</issue><fpage>671</fpage><lpage>683</lpage><history><date date-type="received"><day>03</day><month>8</month><year>2014</year></date><date date-type="accepted"><day>12</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>© 2015 by Anais Brasileiros de
Dermatologia</copyright-statement><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.</license-p></license></permissions><abstract><sec><title>BACKGROUND</title><p>Patch testing is an efficient method to identify the allergen responsible for
allergic contact dermatitis.</p></sec><sec><title>OBJECTIVE</title><p>To evaluate the results of patch tests in children and adolescents comparing these
two age groups' results.</p></sec><sec><title>METHODS</title><p>Cross-sectional study to assess patch test results of 125 children and adolescents
aged 1-19 years, with suspected allergic contact dermatitis, in a dermatology
clinic in Brazil. Two Brazilian standardized series were used.</p></sec><sec><title>RESULTS</title><p>Seventy four (59.2%) patients had "at least one positive reaction" to the patch
test. Among these positive tests, 77.0% were deemed relevant. The most frequent
allergens were nickel (36.8%), thimerosal (18.4%), tosylamide formaldehyde resin
(6.8%), neomycin (6.4%), cobalt (4.0%) and fragrance mix I (4.0%). The most
frequent positive tests came from adolescents (p=0.0014) and females (p=0.0002).
There was no relevant statistical difference concerning contact sensitizations
among patients with or without atopic history. However, there were significant
differences regarding sensitization to nickel (p=0.029) and thimerosal (p=0.042)
between the two age groups under study, while adolescents were the most
affected.</p></sec><sec><title>CONCLUSION</title><p>Nickel and fragrances were the only positive (and relevant) allergens in children.
Nickel and tosylamide formaldehyde resin were the most frequent and relevant
allergens among adolescents.</p></sec></abstract><kwd-group><kwd>Adolescent</kwd><kwd>Allergens</kwd><kwd>Child</kwd><kwd>Dermatitis</kwd><kwd>Dermatitis, allergic contact</kwd><kwd>Patch tests</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Several studies have been published in the last 15 years describing the profile of patch
tests in children and adolescents with suspected allergic contact dermatitis (ACD),
showing a variation in contact sensitization (26.0-95.6%) and in the positive tests'
clinical relevance (30.5-100.0%).<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup></p><p>However, most of these studies are European and few data on the subject exist in
Brazil.<sup><xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r31" ref-type="bibr">31</xref></sup> Furthermore, few studies provide the respective data on
both age groups for comparison.<sup><xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r30" ref-type="bibr">30</xref>,<xref rid="r32" ref-type="bibr">32</xref></sup> Most of the services mentioned use the standard allergens
series.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup> In Brazil, there are two available standard patch test
series: standard and cosmetics. Usually, patients undergo patch testing with the
standard series. When necessary, the cosmetics series is also applied. Using this
complementary cosmetics series increases costs and complicates the technique in children
due to their smaller back surfaces for test application and the increased annoyance
caused by the greater number of substances administered.</p><p>This study seeks to evaluate patch test results in children and adolescents from a
dermatology clinic in Brazil, identifying the most frequent allergens, comparing them
across both age groups and evaluating the need to apply the complementary cosmetics
series.</p></sec><sec sec-type="materials|methods"><title>MATERIALS AND METHODS</title><p>An observational, cross-sectional study was undertaken to assess the patch test results
of 125 children and adolescents aged 1-19 years, with suspected ACD, at the Dermatology
Clinic of the <italic>Santa Casa de Belo Horizonte</italic> Charity Hospital, Minas
Gerais, Brazil.</p><p>We examined records containing data on patch test results for children and adolescents
carried out between 01/07/2003 and 30/06/2010. The sample was non-probabilistic and
intentional, while patients were selected in sequential fashion according to the
excluision and inclusion criteria established.</p><p>The data were collected and stored in the EpiInfo 3.5.1. Statistical program. The Chi-
square test was used to analyze the categorical variables, along with Fisher Exact Test,
when needed. The significance level for all analyses was 0.05.</p><p>The materials used for the patch tests comprised two series (FDA-Allergenic, Rio de
Janeiro, Brazil) standardized by the Brazilian Contact Dermatitis Study Group
(<italic>Grupo Brasileiro de Estudo em Dermatite de Contato</italic>-GBEDC): the
Brazilian Standard Patch Test Series, composed of 30 allergens, and the Brazilian
Cosmetics Standard Patch Test Series, made up of 10 allergens, and the Finn Chambers
(Epitest Ltd Oy Tuusula, Finland) on Scanpor tapes. Test procedures and readings were
conducted in accordance with international recommendations from the ICDRG (International
Contact Dermatitis Research Group).<sup><xref rid="r36" ref-type="bibr">36</xref></sup>The tests were applied and left on patients' backs for 48 hours. The reading was carried
out 48 and 96 hours after the test application. Only the latter reading was considered
for the statistical analysis. Substance concentrations were the same as in adults.</p><p>Only current clinical relevance was considered in order to calculate the frequency of
positive tests' relevance (if tests were positive for a certain substance and where it
was possible, known, or proved that the substance was a component from products patients
had contact with). Past clinical relevance was not considered to calculate the tests'
relevance. Atopic history was taken into account if the patient had a history of at
least one of the following items: allergic rhinitis, atopic dermatitis or asthma.</p><p>This study was approved by The Ethics Committee of the Charity Hospital of Belo
Horizonte (<italic>Santa Casa de Misericórdia de Belo Horizonte</italic>) and The
Ethics Committee of the Federal University of Minas Gerais (Universidade Federal de
Minas Gerais-UFMG).</p></sec><sec sec-type="results"><title>RESULTS</title><sec><title>Characteristics of the patients:</title><p>Patch test results were evaluated in 125 patients, 96 girls (76.8%) and 29 boys
(23.2%), aged 1-19, including 18 children, aged 1-9, in addition to 107 adolescents
aged 10-19, with a mean age of 14.3 ±3.8 years (<xref ref-type="table" rid="t01">Table 1</xref>).</p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><p>Distribution of children’s and adolescents’ characteristics studied at the
Santa Casa de Belo Horizonte Dermatology Clinic (n=125)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variables</th><th align="left" rowspan="1" colspan="1">Category</th><th align="left" rowspan="1" colspan="1">Age</th><th align="left" rowspan="1" colspan="1">Age</th><th align="left" rowspan="1" colspan="1">Total</th><th align="left" rowspan="1" colspan="1">Statistical</th><th align="left" rowspan="1" colspan="1">p</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">1 to 9 years</th><th align="left" rowspan="1" colspan="1">10 to 19 years</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">Test</th><th align="left" rowspan="1" colspan="1">value</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n=18</th><th align="left" rowspan="1" colspan="1">n=107</th><th align="left" rowspan="1" colspan="1">n=125</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Gender</td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">12 (66.7)</td><td align="left" rowspan="1" colspan="1">84 (78.5)</td><td align="left" rowspan="1" colspan="1">96 (76.8)</td><td align="left" rowspan="1" colspan="1">Fisher<xref ref-type="table-fn" rid="TFN01">*</xref></td><td align="left" rowspan="1" colspan="1">0.36</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">6 (33.3)</td><td align="left" rowspan="1" colspan="1">23 (21.5)</td><td align="left" rowspan="1" colspan="1">29 (23.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Dermatitis</td><td align="left" rowspan="1" colspan="1">1 to < 6 months</td><td align="left" rowspan="1" colspan="1">1 (5.5)</td><td align="left" rowspan="1" colspan="1">9 (8.4)</td><td align="left" rowspan="1" colspan="1">10 (8.0)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>=10.50<xref ref-type="table-fn" rid="TFN02">†</xref></td><td align="left" rowspan="1" colspan="1">0.0328</td></tr><tr><td align="left" rowspan="1" colspan="1">evolution</td><td align="left" rowspan="1" colspan="1">6 months to <1year</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">15 (14.0)</td><td align="left" rowspan="1" colspan="1">15 (12.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">time prior</td><td align="left" rowspan="1" colspan="1">1 year to < 5years</td><td align="left" rowspan="1" colspan="1">12 (66.7)</td><td align="left" rowspan="1" colspan="1">60 (56.0)</td><td align="left" rowspan="1" colspan="1">72 (57.6)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">to the</td><td align="left" rowspan="1" colspan="1">5 years to10 years</td><td align="left" rowspan="1" colspan="1">5 (27.8)</td><td align="left" rowspan="1" colspan="1">9 (8.4)</td><td align="left" rowspan="1" colspan="1">14 (11.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Patch test</td><td align="left" rowspan="1" colspan="1">> 10 years</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">14 (13.0)</td><td align="left" rowspan="1" colspan="1">14 (11.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Personal</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">11 (61.1)</td><td align="left" rowspan="1" colspan="1">54 (50.5)</td><td align="left" rowspan="1" colspan="1">65 (52.0)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>=0.34</td><td align="left" rowspan="1" colspan="1">0.56</td></tr><tr><td align="left" rowspan="1" colspan="1">Atopy</td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">7 (38.9)</td><td align="left" rowspan="1" colspan="1">53 (49.5)</td><td align="left" rowspan="1" colspan="1">60 (48.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Family</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">7 (38.9)</td><td align="left" rowspan="1" colspan="1">49 (45.8)</td><td align="left" rowspan="1" colspan="1">56 (44.8)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>=0.0</td><td align="left" rowspan="1" colspan="1">0.96</td></tr><tr><td align="left" rowspan="1" colspan="1">Atopy</td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">9 (50.0)</td><td align="left" rowspan="1" colspan="1">56 (52.3)</td><td align="left" rowspan="1" colspan="1">65 (52.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Not reported</td><td align="left" rowspan="1" colspan="1">2 (11.1)</td><td align="left" rowspan="1" colspan="1">2 (1.8)</td><td align="left" rowspan="1" colspan="1">4 (3.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="TFN01"><label>*</label><p>Fisher Exact Test;</p></fn><fn id="TFN02"><label>†</label><p>Chi-Square Test</p></fn></table-wrap-foot></table-wrap><p>Dermatitis evolution time prior to the patch test varied from 1 month to over 10
years. In 72 (57.6%) children and adolescents, the time varied from 1 year to under 5
years, while among 100 patients it was equal to or over 1 year (<xref ref-type="table" rid="t01">Table 1</xref>).</p><p>Personal and family atopic history were detected in 65 (52.0%) and 56 (44.8%) of the
children and adolescents (<xref ref-type="table" rid="t01">Table 1</xref>). No
significant differences were found upon examining atopic association with the age
groups of patients to be tested.</p><p>Among the patients studied, 102 (81.6%) were students, 8 (6.4%) were cleaners, 3
(2.4%) were cooks, 3 (2.4%) worked in esthetic care, 3 (2.4%) were office workers and
2 (1.6%) worked in construction.</p><p>The head and hands were the sites most affected by dermatitis, followed by the feet,
trunk and neck. There were significant statistical differences concerning dermatitis
rates in the neck and hands and the age groups studied, with a higher frequency of
dermatitis in these locations among adolescents and greater absence of dermatitis in
these locations among children (<xref ref-type="table" rid="t02">Table 2</xref>).
Twenty-eight patients had dermatitis in more than three body areas.</p><table-wrap id="t02" orientation="portrait" position="float"><label>Table 2</label><caption><p>Body locations affected by dermatitis in the children and adolescents studied
at the Santa Casa de Belo Horizonte Dermatology Clinic (n=125)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Body</th><th align="left" rowspan="1" colspan="1">Dermatitis</th><th align="left" rowspan="1" colspan="1">1 to 9 years</th><th align="left" rowspan="1" colspan="1">10 to 19 years</th><th align="left" rowspan="1" colspan="1">Total</th><th align="left" rowspan="1" colspan="1">Statistical</th><th align="left" rowspan="1" colspan="1">p Value</th></tr><tr><th align="left" rowspan="1" colspan="1">Location</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n=18</th><th align="left" rowspan="1" colspan="1">n=107</th><th align="left" rowspan="1" colspan="1">n=125</th><th align="left" rowspan="1" colspan="1">test</th><th align="left" rowspan="1" colspan="1"> </th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1">n (%)</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Head</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">7</td><td align="left" rowspan="1" colspan="1">50</td><td align="left" rowspan="1" colspan="1">57 (45.6)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 0.13<xref ref-type="table-fn" rid="TFN03">*</xref></td><td align="left" rowspan="1" colspan="1">0.720</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">11</td><td align="left" rowspan="1" colspan="1">57</td><td align="left" rowspan="1" colspan="1">68 (54.4)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Neck</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">39</td><td align="left" rowspan="1" colspan="1">40 (32.0)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 5.41</td><td align="left" rowspan="1" colspan="1">0.020</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">17</td><td align="left" rowspan="1" colspan="1">68</td><td align="left" rowspan="1" colspan="1">85 (68.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Trunk</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">38</td><td align="left" rowspan="1" colspan="1">41 (32.8)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 1.70</td><td align="left" rowspan="1" colspan="1">0.190</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">69</td><td align="left" rowspan="1" colspan="1">84 (67.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Feet</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">46 (36.8)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 0.98</td><td align="left" rowspan="1" colspan="1">0.320</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">9</td><td align="left" rowspan="1" colspan="1">70</td><td align="left" rowspan="1" colspan="1">79 (63.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Hands</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">47</td><td align="left" rowspan="1" colspan="1">49 (39.2)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 5.65</td><td align="left" rowspan="1" colspan="1">0.017</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">60</td><td align="left" rowspan="1" colspan="1">76 (60.8)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Forearms</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">33</td><td align="left" rowspan="1" colspan="1">35 (28.0)</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 2.08</td><td align="left" rowspan="1" colspan="1">0.150</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">74</td><td align="left" rowspan="1" colspan="1">90 (72.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Arms</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">23</td><td align="left" rowspan="1" colspan="1">25 (20.0)</td><td align="left" rowspan="1" colspan="1">Fisher<xref ref-type="table-fn" rid="TFN04">†</xref></td><td align="left" rowspan="1" colspan="1">0.520</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">84</td><td align="left" rowspan="1" colspan="1">100 (80.0)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Legs</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">20</td><td align="left" rowspan="1" colspan="1">23 (18.4)</td><td align="left" rowspan="1" colspan="1">Fisher</td><td align="left" rowspan="1" colspan="1">1.000</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">87</td><td align="left" rowspan="1" colspan="1">102 (81.6)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Thighs</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">12</td><td align="left" rowspan="1" colspan="1">16 (12.8)</td><td align="left" rowspan="1" colspan="1">Fisher</td><td align="left" rowspan="1" colspan="1">0.240</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">14</td><td align="left" rowspan="1" colspan="1">95</td><td align="left" rowspan="1" colspan="1">109 (87.2)</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="TFN03"><label>*</label><p>Chi-Square Test;</p></fn><fn id="TFN04"><label>†</label><p>Fisher Exact Test</p></fn></table-wrap-foot></table-wrap><p>Regarding the initial dermatitis site, the greatest frequencies occurred on the face
(n=31; 24.8%), feet (n=31; 24.8%), hands (n=21; 16.8%) and trunk (n=16; 12.8%).</p></sec><sec><title>Results of patch test performed:</title><p>Out of the 125 patients tested, 74 had "at least one positive reaction" (one or more
positive tests), while the contact sensitization rate was 59.2% (74/125). The
frequency of negative tests was 40.8% (51/125).</p><p>Among the 74 patients who had "at least one positive reaction", 57 (57/74; 77.0%) had
presented current clinical relevance to their positive tests and had received a
diagnosis of ACD (57/125; 45.6%). The frequency of clinical relevance (current)
calculated from the total number of studied patients was 45.6%. Irritant contact
dermatitis was diagnosed in 32 (25.6%) patients, while other dermatoses were
diagnosed in 36 (28.8%) patients.</p><p>Positive tests were more common among females (p=0.0002) than males (<xref ref-type="table" rid="t03">Table 3</xref>). Further, there was a higher frequency
of positive tests among adolescents (p=0.0014) than children (<xref ref-type="table" rid="t03">Table 3</xref>).</p><table-wrap id="t03" orientation="portrait" position="float"><label>Table 3</label><caption><p>Association of the variables studied in relation to the positivity of "at least
one positive patch test" (n=125)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variables</th><th align="left" rowspan="1" colspan="1">Category</th><th align="left" rowspan="1" colspan="1">Negative</th><th align="left" rowspan="1" colspan="1">One or more</th><th align="left" rowspan="1" colspan="1">Statistical</th><th align="left" rowspan="1" colspan="1">p Value</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">test</th><th align="left" rowspan="1" colspan="1">Positive tests</th><th align="left" rowspan="1" colspan="1">test</th><th align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Gender</td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">30</td><td align="left" rowspan="1" colspan="1">66</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>=13.97<xref ref-type="table-fn" rid="TFN05">*</xref></td><td align="left" rowspan="1" colspan="1">0.0002</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">21</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Age groups</td><td align="left" rowspan="1" colspan="1">Children</td><td align="left" rowspan="1" colspan="1">14</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>=10.18</td><td align="left" rowspan="1" colspan="1">0.0014</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Adolescents</td><td align="left" rowspan="1" colspan="1">37</td><td align="left" rowspan="1" colspan="1">70</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Only Standard</td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">16</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 4.32</td><td align="left" rowspan="1" colspan="1">0.0377</td></tr><tr><td align="left" rowspan="1" colspan="1">Series</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">17</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Standard Series</td><td align="left" rowspan="1" colspan="1">Female</td><td align="left" rowspan="1" colspan="1">15</td><td align="left" rowspan="1" colspan="1">50</td><td align="left" rowspan="1" colspan="1">Fisher</td><td align="left" rowspan="1" colspan="1">0.19</td></tr><tr><td align="left" rowspan="1" colspan="1">and Cosmetics</td><td align="left" rowspan="1" colspan="1">Male</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Personal Atopy</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">25</td><td align="left" rowspan="1" colspan="1">40</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 0.14</td><td align="left" rowspan="1" colspan="1">0.71</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">26</td><td align="left" rowspan="1" colspan="1">34</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Family Atopy</td><td align="left" rowspan="1" colspan="1">Yes</td><td align="left" rowspan="1" colspan="1">20</td><td align="left" rowspan="1" colspan="1">36</td><td align="left" rowspan="1" colspan="1">χ<sup>2</sup>= 1.78</td><td align="left" rowspan="1" colspan="1">0.41</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">No</td><td align="left" rowspan="1" colspan="1">30</td><td align="left" rowspan="1" colspan="1">35</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Not reported</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="TFN05"><label>*</label><p>Chi-Square Test</p></fn></table-wrap-foot></table-wrap><p>There was no significant statistical difference concerning contact sensitization
among patients with atopic history (personal and family) and those without atopic
history (<xref ref-type="table" rid="t03">Table 3</xref>).</p><p>All children and adolescents (n=125) in this study were tested using the Brazilian
Standard Patch Test Series. Seventy-three patients were tested with both series (the
Brazilian Standard and Brazilian Cosmetics Standard Patch Test Series). Fifty-two
patients were tested with the Brazilian Standard Series alone, while no patient was
tested only with the Brazilian Cosmetics Series.</p><p>Regarding the number of substances tested, among the 52 patients who were tested only
with 30 substances (Brazilian Standard Series), just 20 (38.5%) patients had positive
tests and there was a significant statistical difference related to gender (<xref ref-type="table" rid="t03">Table 3</xref>). Out of 73 patients tested with 40
substances (Brazilian Standard Series and Standard Cosmetics), 54 (74.0%) had
positive tests, with no significant statistical difference concerning gender (<xref ref-type="table" rid="t03">Table 3</xref>).</p><p>One hundred and seventeen positive tests were found: 111 from the Brazilian Standard
Series and 6 from the Cosmetics Series (<xref ref-type="table" rid="t04">Tables
4</xref> and <xref ref-type="table" rid="t05">5</xref>). In patients with positive
tests, the average number of positive tests per patient was 1.58 (117/74).
Polysensitization ocurred in 29 patients (29/125; 23.2%).</p><table-wrap id="t04" orientation="portrait" position="float"><label>Table 4</label><caption><p>Distribution of patch test results from the Brazilian Standard Series for
children and adolescents, according to the age groups studied (n= 125)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Substances/</th><th align="left" rowspan="1" colspan="1">Test Results</th><th align="left" rowspan="1" colspan="1">1 to 9 years</th><th align="left" rowspan="1" colspan="1">10 to 19 years</th><th align="left" rowspan="1" colspan="1">Total n=125 n (%)</th><th align="left" rowspan="1" colspan="1">p<xref ref-type="table-fn" rid="TFN06">*</xref> Value</th></tr><tr><th align="left" rowspan="1" colspan="1">Concentration</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n=18 n (%)</th><th align="left" rowspan="1" colspan="1">n=107 n (%)</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Nickel sulfatef</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">2 (11.1)</td><td align="left" rowspan="1" colspan="1">44 (41.1)</td><td align="left" rowspan="1" colspan="1">46 (36.8)</td><td align="left" rowspan="1" colspan="1">0.029</td></tr><tr><td align="left" rowspan="1" colspan="1">5.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">16 (88.9)</td><td align="left" rowspan="1" colspan="1">63 (58.9)</td><td align="left" rowspan="1" colspan="1">79 (63.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Thimerosal</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">23 (21.5)</td><td align="left" rowspan="1" colspan="1">23 (18.4)</td><td align="left" rowspan="1" colspan="1">0.042</td></tr><tr><td align="left" rowspan="1" colspan="1">0.05%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">84 (78.5)</td><td align="left" rowspan="1" colspan="1">102 (81.6)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Neomycin</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">8 (7.5)</td><td align="left" rowspan="1" colspan="1">8 (6.4)</td><td align="left" rowspan="1" colspan="1">0.60</td></tr><tr><td align="left" rowspan="1" colspan="1">20.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">99 (92.5)</td><td align="left" rowspan="1" colspan="1">117 (93.6)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Cobalt chloride</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">5 (4.7)</td><td align="left" rowspan="1" colspan="1">5 (4.0)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">102 (95.3)</td><td align="left" rowspan="1" colspan="1">120 (96.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Fragrance mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">2 (11.1)</td><td align="left" rowspan="1" colspan="1">3 (2.8)</td><td align="left" rowspan="1" colspan="1">5 (4.0)</td><td align="left" rowspan="1" colspan="1">0.15</td></tr><tr><td align="left" rowspan="1" colspan="1">7.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">16 (88.9)</td><td align="left" rowspan="1" colspan="1">104 (97.2)</td><td align="left" rowspan="1" colspan="1">120 (96.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Formaldehyde</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">4 (3.7)</td><td align="left" rowspan="1" colspan="1">4 (3.2)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">103 (96.3)</td><td align="left" rowspan="1" colspan="1">121 (96.8)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Potassium</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">3 (2.8)</td><td align="left" rowspan="1" colspan="1">3 (2.4)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">dichromate 0.5%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">104 (97.2)</td><td align="left" rowspan="1" colspan="1">122 (97.6)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Ethylenediamine</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">3 (2.8)</td><td align="left" rowspan="1" colspan="1">3 (2.4)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">104 (97.2)</td><td align="left" rowspan="1" colspan="1">122 (97.6)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Myroxylon</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">2 (1.9)</td><td align="left" rowspan="1" colspan="1">2 (1.6)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">pereirae 25.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">105 (98.1)</td><td align="left" rowspan="1" colspan="1">123 (98.4)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">PPD mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">2 (1.9)</td><td align="left" rowspan="1" colspan="1">2 (1.6)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">0.4%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">105 (98.1)</td><td align="left" rowspan="1" colspan="1">123 (98.4)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Quinoline mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">2 (1.9)</td><td align="left" rowspan="1" colspan="1">2 (1.6)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">6.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">105 (98.1)</td><td align="left" rowspan="1" colspan="1">123 (98.4)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Antraquinone</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">2.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Hydroquinone</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Kathon CG</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">0.5%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Mercapto mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">2.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Quaternium-15</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">0.5%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Carba mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">3.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Promethazine</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Colophony</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (0.9)</td><td align="left" rowspan="1" colspan="1">1 (0.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">20.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">106 (99.1)</td><td align="left" rowspan="1" colspan="1">124 (99.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Propylene glycol</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0,0)</td><td align="left" rowspan="1" colspan="1">-<xref ref-type="table-fn" rid="TFN07">‡</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">10.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125(100,0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">p-tert-Butylphenol</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100,0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Irgasan</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Lanolin</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">30.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Thiuram mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Benzocaine</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">5.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Nitrofurazone</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Paraben mix</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">15.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Epoxy resin</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Turpentine</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">10.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">para-Phenylene</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">diamine 1.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">18 (100.0)</td><td align="left" rowspan="1" colspan="1">107 (100.0)</td><td align="left" rowspan="1" colspan="1">125 (100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="TFN06"><label>*</label><p>Fisher Exact Test;†The vehicle used is solid petrolatum, except for
formaldehyde, for which water is used.</p></fn><fn id="TFN07"><label>‡</label><p>Statistical Test not applicable MIX composition: PPD mix (N-isopropyl,
N-phenyl, paraphenylenediamine, N-N-diphenyl-, paraphenylenediamine); Kathon
CG (methylchloroisothiazolinone, methylisothiazolinone); Thiuram mix
(tetramethylthiuram disulfite, tetramethyltiuram monosulfite); Fragrance mix
I (eugenol, isoeugenol, geraniol, cinnamic alcohol, alpha aldehyde amyl
cinnamic, absolute oak moss, hydroxycitronellal; Mercapto mix (NCyclohexyl 2
benzothiazolesulfenamide, morpholinylmercaptobenzothiazole, dibenzothiazyl
disulfide, mercaptobenzothiazole); Quinoline mix (clioquinol,
clorquinaldol); Paraben mix (butyl, ethyl, propyl, benzyl, methyl parabens);
Carba mix (diphenylguanidine, zinc dimethhylcarbamate, zinc
diethylcarbamate).</p></fn></table-wrap-foot></table-wrap><table-wrap id="t05" orientation="portrait" position="float"><label>Table 5</label><caption><p>Distribution of patchtest results from the Brazilian Cosmetics Series for
children and adolescents, according to the age groups studied (n=73)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Substances/</th><th align="left" rowspan="1" colspan="1">Test Results</th><th align="left" rowspan="1" colspan="1">1 to 9 years</th><th align="left" rowspan="1" colspan="1">10 to 19 years</th><th align="left" rowspan="1" colspan="1">Total</th><th align="left" rowspan="1" colspan="1">p<xref ref-type="table-fn" rid="TFN08">*</xref></th></tr><tr><th align="left" rowspan="1" colspan="1">Concentration</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n= 4 n (%)</th><th align="left" rowspan="1" colspan="1">n= 69 n (%)</th><th align="left" rowspan="1" colspan="1">n=73 n (%)</th><th align="left" rowspan="1" colspan="1">Value</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Tosylamide</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">5 (7.2)</td><td align="left" rowspan="1" colspan="1">5 (6.8)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1">formaldehyde resin10.0%f</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">64 (92.8)</td><td align="left" rowspan="1" colspan="1">68 (93.2)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Chloroacetamide 0.2%</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">1 (1.4)</td><td align="left" rowspan="1" colspan="1">1 (1.4)</td><td align="left" rowspan="1" colspan="1">1.00</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">68 (98.6)</td><td align="left" rowspan="1" colspan="1">72 (98.6)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Germal 115</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-<xref ref-type="table-fn" rid="TFN09">‡</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">(imidazolidinylurea) 2.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">BHT (Butylhydroxy-</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">toluene) 2.0%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Triethanolamine 2.5%</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Bronopol (2-Bromo-2-</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">nitropropane-1,3-diol) 0.5%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Sorbic acid 2.0%</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Ammonium thioglycolate</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1">2.5%</td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Amerchol L- 101 100.0%</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1">Chlorhexidine 0.5%</td><td align="left" rowspan="1" colspan="1">Positive</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td><td align="left" rowspan="1" colspan="1">-</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Negative</td><td align="left" rowspan="1" colspan="1">4 (100.0)</td><td align="left" rowspan="1" colspan="1">69 (100.0)</td><td align="left" rowspan="1" colspan="1">73(100.0)</td><td align="left" rowspan="1" colspan="1"> </td></tr></tbody></table><table-wrap-foot><fn id="TFN08"><label>*</label><p>Fisher Exact Test; †the vehicle used is solid petrolatum, except for
chlorhexidine, for which water is applied;</p></fn><fn id="TFN09"><label>‡</label><p>Statistical Test not applicable</p></fn></table-wrap-foot></table-wrap><p>In the Brazilian Standard Series, the substances with the highest sensitization
frequency in children and adolescents (n=125), were as follows (in descending order):
nickel sulfate (n=46; 36.8%), thimerosal (n=23, 18.4%), neomycin (n=8; 6.4%), cobalt
chloride and fragrance mix (n=5; 4.0% each), formaldehyde (n=4; 3.2%), potassium
dichromate and ethylenediamine (n=3; 2.4% each). The less frequent substances,
showing no positive reaction to this series, were as follows: propylene glycol,
p-tert-Butylphenol, irgasan, lanolin, thiuram mix, benzocaine, nitrofurazone, paraben
mix, epoxy resin, turpentine and para-Phenylenediamine (<xref ref-type="table" rid="t04">Table 4</xref>).</p><p>Children (n=18) had positive reactions only to nickel and fragrance mix (two positive
tests each), both components of the Brazilian Standard Series (<xref ref-type="table" rid="t04">Table 4</xref>).</p><p>There was a significant statistical difference (p=0.029) between the two age groups
concerning sensitization to nickel: 2 positive tests (2/18; 11.1%) in children
<italic>versus</italic> 44 positive tests (44/107; 41.1%) in adolescents. The same
occurred with thimerosal (p=0.042): no positive test (0/18; 0.0) in children
<italic>versus</italic> 23 (23/107; 21.5%) in adolescents (<xref ref-type="table" rid="t04">Table 4</xref>).</p><p>Among the substances tested with the Brazilian Cosmetics Series, with respect to
children and adolescents (n= 73), no positive reactions emerged in children and only
two substances entailed positive reactions in adolescents: tosylamide formaldehyde
resin (n=5; 6.8%) and chloroacetamide (n=1; 1.4%) (<xref ref-type="table" rid="t05">Table 5</xref>).</p><p>As for the allergen sources concerning the positive tests, not all the information
was available in the patients' records (<xref ref-type="table" rid="t06">Table
6</xref>).</p><table-wrap id="t06" orientation="portrait" position="float"><label>Table 6</label><caption><p>Sources of the most common allergens in the children and adolescents tested</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Allergens</th><th align="left" rowspan="1" colspan="1">Allergen sources</th><th align="left" rowspan="1" colspan="1">Number of children and adolescents</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Nickel sulfate</td><td align="left" rowspan="1" colspan="1">jewelry, piercings</td><td align="left" rowspan="1" colspan="1">13</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">metals on clothes and shoes</td><td align="left" rowspan="1" colspan="1">6</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">nail clippers</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">razor blade</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">cosmetics</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Thimerosa!</td><td align="left" rowspan="1" colspan="1">vaccines</td><td align="left" rowspan="1" colspan="1">23</td></tr><tr><td align="left" rowspan="1" colspan="1">Tosylamide formaldehyde<xref ref-type="table-fn" rid="TFN10">*</xref></td><td align="left" rowspan="1" colspan="1">nail polish</td><td align="left" rowspan="1" colspan="1">5</td></tr><tr><td align="left" rowspan="1" colspan="1">Neomycin</td><td align="left" rowspan="1" colspan="1">topical medicine</td><td align="left" rowspan="1" colspan="1">8</td></tr><tr><td align="left" rowspan="1" colspan="1">Cobalt chloride</td><td align="left" rowspan="1" colspan="1">jewelry</td><td align="left" rowspan="1" colspan="1">4</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">metals on clothes</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Fragrance mix</td><td align="left" rowspan="1" colspan="1">cosmetics, fragrances</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">Formaldehyde</td><td align="left" rowspan="1" colspan="1">cosmetics, nail polish</td><td align="left" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Potassium dichromate</td><td align="left" rowspan="1" colspan="1">cement</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">magnet</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">shoes</td><td align="left" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Ethylenediamine</td><td align="left" rowspan="1" colspan="1">cosmetics</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">Myroxylon pereirae</td><td align="left" rowspan="1" colspan="1">cosmetics, fragrances</td><td align="left" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1">Carba mix, PPD mix</td><td align="left" rowspan="1" colspan="1">rubber glove</td><td align="left" rowspan="1" colspan="1">2</td></tr></tbody></table><table-wrap-foot><fn id="TFN10"><label>*</label><p>tosylamide formaldehyde resin</p></fn></table-wrap-foot></table-wrap><p>With respect to the nine most frequent allergens, positive tests were more common in
females. Potassium dichromate was more common among males. Out of 46 positive tests
for nickel, 37 were deemed relevant. It was difficult to determine the relevance of
cobalt as it had no positivity alone (4 of its 5 positive tests were found in the
same patients who also had positive tests for nickel). All the positive tests for
potassium dichromate, Myroxylon pereirae and tosylamide formaldehyde resin, were
deemed relevant. However, positive tests for thimerosal and neomycin had no current
clinical relevance (<xref ref-type="table" rid="t07">Table 7</xref>).</p><table-wrap id="t07" orientation="portrait" position="float"><label>Table 7</label><caption><p>Most frequent allergens and current clinical relevance in children and
adolescents</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Substances</th><th align="left" rowspan="1" colspan="1">Patients</th><th align="left" rowspan="1" colspan="1">Positive</th><th colspan="2" align="left" rowspan="1">Positive</th><th align="left" rowspan="1" colspan="1">Positive</th><th align="left" rowspan="1" colspan="1">Relevance*</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">tested</th><th align="left" rowspan="1" colspan="1">tests</th><th colspan="2" align="left" rowspan="1">tests</th><th align="left" rowspan="1" colspan="1">tests</th><th align="left" rowspan="1" colspan="1">present</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">F<xref ref-type="table-fn" rid="TFN12">†</xref></th><th align="left" rowspan="1" colspan="1">M<xref ref-type="table-fn" rid="TFN13">‡</xref></th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">n</th><th align="left" rowspan="1" colspan="1">%</th><th align="left" rowspan="1" colspan="1">n (%)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Nickel sulfate</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">46</td><td align="left" rowspan="1" colspan="1">43</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">36.8</td><td align="left" rowspan="1" colspan="1">37 (80.4)</td></tr><tr><td align="left" rowspan="1" colspan="1">Thimerosal</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">23</td><td align="left" rowspan="1" colspan="1">20</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">18.4</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Tosylamide resin<xref ref-type="table-fn" rid="TFN14">§</xref></td><td align="left" rowspan="1" colspan="1">73</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">6.8</td><td align="left" rowspan="1" colspan="1">5 (100.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Neomycin</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">8</td><td align="left" rowspan="1" colspan="1">6</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">6.4</td><td align="left" rowspan="1" colspan="1">0 (0.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Cobalt chloride</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">4.0</td><td align="left" rowspan="1" colspan="1">5 (100.0)<xref ref-type="table-fn" rid="TFN15">|</xref></td></tr><tr><td align="left" rowspan="1" colspan="1">Fragrance mix</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">5</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">4.0</td><td align="left" rowspan="1" colspan="1">2 (40.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Formaldehyde</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">4</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">3.2</td><td align="left" rowspan="1" colspan="1">3 (75.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Potassium dichromate</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">2.4</td><td align="left" rowspan="1" colspan="1">3 (100.0)</td></tr><tr><td align="left" rowspan="1" colspan="1">Ethylenediamine</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">2.4</td><td align="left" rowspan="1" colspan="1">2 (66.7)</td></tr><tr><td align="left" rowspan="1" colspan="1">Myroxylon pereirae</td><td align="left" rowspan="1" colspan="1">125</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">1.6</td><td align="left" rowspan="1" colspan="1">2 (100.0)</td></tr></tbody></table><table-wrap-foot><fn id="TFN11"><label>*</label><p>Relevance calculated based on the number of positive tests ;</p></fn><fn id="TFN12"><label>†</label><p>female;</p></fn><fn id="TFN13"><label>‡</label><p>male;</p></fn><fn id="TFN14"><label>§</label><p>tosylamide formaldehyde resin;</p></fn><fn id="TFN15"><label>|</label><p>relevance of cobalt together with another metal: relevance questioned</p></fn></table-wrap-foot></table-wrap><p>As regards the intensity of the relevant positive reactions, 48 relevant tests were
found, with intensity reaction 1+, including the 27 nickel tests and all the 5
positive tosylamide formaldehyde resin tests.</p><p>In patients with positive tests, the head and trunk were the body areas most commonly
affected by dermatitis. There was a significant difference concerning dermatitis
location in the thighs of patients who had positive tests, with higher positivity in
children's thighs than in other areas (p=0.0068). Among the most frequent and
relevant allergens, nickel, tosylamide formaldehyde resin and formaldehyde were
particularly prominent in head involvement; nickel, potassium dichromate and PPD mix
significantly affected the feet, while nickel and fragrances had clear impacts on the
forearms and thighs (<xref ref-type="fig" rid="f01">Graph 1</xref>). Twenty-eight
patients had four or more areas affected, regarded as dermatitis
generalization,<sup><xref rid="r37" ref-type="bibr">37</xref></sup> out of
which 16 had relevant positive tests (12 for nickel), while 3 had irrelevant positive
tests and 9 had negative tests.</p><fig id="f01" orientation="portrait" position="float"><label>Graph 1</label><caption><p>Positive reactions of the most frequent allergens in relation to body location
affected by dermatitis in the children and adolescents tested (n=74)</p></caption><graphic xlink:href="abd-90-05-0671-g01"></graphic></fig><p>With respect to the frequency of relevant positive tests and the initial dermatitis
location, all cases that presented initial involvement on the neck entailed relevant
positive tests (100.0%). Twelve out of 16 patients (75.0%) whose lesions appeared
initially on the trunk had relevant positive tests, especially those with initial
lesions on the armpit (71.0% cases; 5/7). The thighs and legs also exhibited high
positivity: 66.7% (6/9) of cases of initial dermatitis in the thighs and legs
returned relevant positive tests. About half the initial dermatitis on the face
entailed relevant positive tests, particularly lesions in the periorbital
area/eyelids (71.0% of cases; 10/14).</p></sec></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>This study uncovered a frequency of 59.2% for "at least one positive reaction" (74/125),
consistent with the literature regarding patch test results in selected samples
(children and adolescents suspected of ACD) that showed a variation of
26.0-95.6%.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup> The clinical relevance (current) frequency of 77.0%,
calculated based on the number of patients with one or more positive tests (57/74;
77.0%) proved to be consistent with the literature data, which varied from 30.5% to
100.0%.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup> These relatively high frequencies may be due to: the
sample type selected, the number of substances tested and the age group studied. Between
30 and 40 substances were tested and this study included children as young as 12 months,
as well as adolescents aged up to 19 years. Several studies have been carried out in
patients with suspected ACD. Of these, some focused only on children<sup><xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r28" ref-type="bibr">28</xref></sup>, others examined mostly
children and adolescents aged up to 12 years<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r31" ref-type="bibr">31</xref></sup> whereas another study analyzed only
adolescents<sup><xref rid="r15" ref-type="bibr">15</xref></sup>. Others studied
patients from both age groups, aged up to 19-20<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r03" ref-type="bibr">3</xref>-<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r18" ref-type="bibr">18</xref>-<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r24" ref-type="bibr">24</xref>-<xref rid="r27" ref-type="bibr">27</xref>,<xref rid="r29" ref-type="bibr">29</xref>,<xref rid="r30" ref-type="bibr">30</xref>,<xref rid="r32" ref-type="bibr">32</xref>,<xref rid="r33" ref-type="bibr">33</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup>, and tested a smaller or greater number of substances
than in this study: 17 substances for children under 5 years old<sup><xref rid="r11" ref-type="bibr">11</xref></sup>; a pediatric series of 30
substances<sup><xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r24" ref-type="bibr">24</xref>,<xref rid="r25" ref-type="bibr">25</xref></sup>; 30 substances
for children under 10 years old<sup><xref rid="r12" ref-type="bibr">12</xref></sup>; and
series of 10 substances.<sup><xref rid="r30" ref-type="bibr">30</xref></sup> Other
studies have used standardized series for adults<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r05" ref-type="bibr">5</xref>-<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r13" ref-type="bibr">13</xref>-<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r19" ref-type="bibr">19</xref>-<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r27" ref-type="bibr">27</xref>,<xref rid="r28" ref-type="bibr">28</xref>,<xref rid="r31" ref-type="bibr">31</xref>,<xref rid="r33" ref-type="bibr">33</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup>, with variation in the
number of substances tested.</p><p>A diagnosis of ACD occurred in 45.6% of the patients tested, virtually half the total
number of cases, thus demonstrating the importance of carrying out the contact test when
this diagnosis is suspected so as to differente it from other, common childhood skin
diseases such as atopic dermatitis, and check their concomitance.</p><p>In this study, there was a higher frequency of positive tests among female adolescents,
perhaps attributable to the use of piercings, cosmetics, fragrances, etc., which are
common in this age group and gender. Three studies showed a significant difference
concerning contact sensitization frequency and gender, two of which revealed a higher
frequency in girls<sup><xref rid="r14" ref-type="bibr">14</xref></sup>, while the other
found a greater frequency in boys.<sup><xref rid="r23" ref-type="bibr">23</xref></sup>However, there are five studies that did not uncover any significant difference in this
respect.<sup><xref rid="r03" ref-type="bibr">3</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r29" ref-type="bibr">29</xref></sup> Furthermore, as regards age, seven studies demonstrated that there
was no difference regarding contact sensitization related to this aspect.<sup><xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r29" ref-type="bibr">29</xref></sup> Three studies found a greater frequency of positive tests among
higher age groups: 11-16 years old<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r14" ref-type="bibr">14</xref></sup>, and three in children under 3.<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref></sup></p><p>The lengthy evolution of dermatitis prior to the patch test (equal to or higher than one
year in 100 patients), can be explained by: the lack of suspected ACD diagnosis,
non-differentiation between ACD and atopic dermatitis, ignorance about the patch test's
relevance, reluctance to refer children for the test due to its technical difficulties.
This delay in performing the patch test can delay improvement of these patients' quality
of life.</p><p>The number of tested patients with atopic history was similar to the number of tested
patients without atopic history. Our study revealed no significant statistical
difference regarding contact sensitization between patients with or without atopic
history, which is consistent with other studies.<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r10" ref-type="bibr">10</xref>-<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r35" ref-type="bibr">35</xref></sup> A study of adults (with no suspected ACD) showed that
contact sensitization was significantly correlated with atopic dermatitis (nickel and
thimerosal were excluded to avoid bias), though the reading only occurred 48 hours after
the patch test application, favoring false-positive and false-negative
results.<sup><xref rid="r38" ref-type="bibr">38</xref></sup></p><p>Polysensitization occurred in 29 (23.2%) of the 125 patients under study, consistent
with the literature. Six studies had the following polysensitization rates: 51.0%,
42.0%, 29.6%, 19.6%, 17.8% of the tested children and 54.0%, 51.0% of the positive test
cases.<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r07" ref-type="bibr">7</xref>,<xref rid="r12" ref-type="bibr"> 12</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r35" ref-type="bibr">35</xref></sup></p><p>In our study, the most common allergens were nickel, thimerosal, tosylamide formaldehyde
resin, neomycin, cobalt, fragrance mix, formaldehyde, potassium dichromate,
ethylenediamine and Myroxylon pereirae. Except for the tosyilamide formaldehyde resin
and ethylenediamine, these findings are consistent with most studies of selected samples
for these age groups. Other allergens are mentioned in the literature among the ten most
frequent in children and adolescents' patch-tests: lanolin,<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r27" ref-type="bibr">27</xref>,<xref rid="r28" ref-type="bibr">28</xref>,<xref rid="r31" ref-type="bibr">31</xref>,<xref rid="r33" ref-type="bibr">33</xref>,<xref rid="r34" ref-type="bibr">34</xref></sup> para-Phe nylenediamine,<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r05" ref-type="bibr">5</xref>,<xref rid="r07" ref-type="bibr">7</xref>,<xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r13" ref-type="bibr">13</xref>-<xref rid="r06" ref-type="bibr">6</xref>,<xref rid="r28" ref-type="bibr">28</xref>,<xref rid="r29" ref-type="bibr">29</xref></sup>colophony,<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r05" ref-type="bibr">5</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r29" ref-type="bibr">29</xref>-<xref rid="r31" ref-type="bibr">31</xref>,<xref rid="r33" ref-type="bibr">33</xref>,<xref rid="r34" ref-type="bibr">34</xref></sup> quaternium-15,<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r31" ref-type="bibr">31</xref></sup> p-tert-Butylphenol,<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r05" ref-type="bibr">5</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r33" ref-type="bibr">33</xref>,<xref rid="r34" ref-type="bibr">34</xref></sup> Kathon CG,<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r30" ref-type="bibr">30</xref>,<xref rid="r35" ref-type="bibr">35</xref></sup> rubber derivatives<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r06" ref-type="bibr">6</xref>-<xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup> gold
thiosulphate,<sup><xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r21" ref-type="bibr">21</xref></sup> disperse
dyes,<sup><xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup> cocamidopropylbetaine,<sup><xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup> tixocortol
pivalate<sup><xref rid="r07" ref-type="bibr">7</xref>,<xref rid="r33" ref-type="bibr">33</xref>,<xref rid="r34" ref-type="bibr">34</xref></sup>propolis<sup><xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r32" ref-type="bibr">32</xref>,<xref rid="r35" ref-type="bibr">35</xref></sup> and paraben
mix.<sup><xref rid="r28" ref-type="bibr">28</xref>,<xref rid="r29" ref-type="bibr">29</xref></sup> Five of these last allergens mentioned as the most common in the
literature (p-tert-Butylphenol, lanolin, thiuram mix, paraben mix and
para-Phenylenediamine) had no positive reaction at all for children and adolescents in
this study and some have not been tested with the Brazilian Series (gold thiosulphate,
disperse dyes, cocamidopropylbetaine, tixocortol pivalate and propolis).</p><p>The most frequent allergens found in children were nickel and fragrance mix, whereas in
adolescents, the most common were nickel, thimerosal, tosylamide formaldehyde resin,
neomycin, cobalt, formaldehyde, potassium dichromate, fragrance mix and ethylenediamine.
The statistical difference between the two age groups as regards nickel can be explained
by the greater use of piercings among adolescents. Studies show a significant
association between nickel and piercing<sup><xref rid="r39" ref-type="bibr">39</xref>,<xref rid="r40" ref-type="bibr">40</xref></sup> and demonstrate that
multiple piercings increase the risk of contact sensitization to nickel.<sup><xref rid="r41" ref-type="bibr">41</xref></sup> In addition, the statistical difference
between the two age groups studied with respect to thimerosal is attributable to the
higher number of vaccinations received by the adolescents compared with
children.<sup><xref rid="r42" ref-type="bibr">42</xref>,<xref rid="r43" ref-type="bibr">43</xref></sup></p><p>Nickel was the most common allergen in this study, for both age groups, with a contact
sensitization frequency of 36.8%, thus consistent with the literature about suspected
ACD patients, in which frequency varies from 7.76% to 46.0%.<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r08" ref-type="bibr">8</xref></sup> Its clinical
relevance in this study was 80.4% of the positive tests, and can be explained by the use
of jewelry, clothing accessories and footwear, nail clippers, razor blade and cosmetics.
Nickel was the most frequent allergen in 30 studies and was among the 10 most common in
35 studies of suspected ACD patients.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup> Most studies tested nickel at 5.0% but
others tested it at 2.5%,<sup><xref rid="r21" ref-type="bibr">21</xref>,<xref rid="r30" ref-type="bibr">30</xref>,<xref rid="r32" ref-type="bibr">32</xref></sup> which can interfere in the allergen's sensitization frequency.</p><p>The second most frequent allergen in this study was thimerosal, with a sensitization
frequency of 18.4%, in line with the literature (0.9-37.6%).<sup><xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r32" ref-type="bibr">32</xref></sup> This
relatively high frequency can be explained by thimerosal-containing vaccines.<sup><xref rid="r42" ref-type="bibr">42</xref>,<xref rid="r43" ref-type="bibr">43</xref></sup> The current clinical relevance of these positive tests was null in
this study. Thimerosal was the most common substance in 4 studies, placed among the 10
most frequent allergens in 29 studies, among 35 studies in selected samples.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r34" ref-type="bibr">34</xref></sup>It was deemed clinically irrelevant in most of these studies. Thimerosal test
concentration varied in some studies: in most, it was 0.1%, while in others it was 1.0%
and 0.05%, which might have affected the allergen's sensitization frequency
variation.<sup><xref rid="r03" ref-type="bibr">3</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r31" ref-type="bibr">31</xref>,<xref rid="r32" ref-type="bibr">32</xref></sup></p><p>The third most frequent allergen in this study was tosylamide formaldehyde resin with a
contact sensitization frequency of 6.8%, in line with some studies where the frequency
was 0.0%, 0.8%, 3.8%, 4.8% and 12.0%.<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r21" ref-type="bibr">21</xref>,<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r31" ref-type="bibr">31</xref></sup> Its clinical relevance was 100.0% in this study, showing
this test's importance when there is suspected ACD, especially in the eyelids and
periorbital region lesions. This can be explained by the frequent use of nail polish by
adolescents. Tosylamide formaldehyde resin was placed among the eight most common
allergens in two Brazilian studies, but it was tested only in some of the studies
published between 1997 and May 2012.<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r21" ref-type="bibr">21</xref>,<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r31" ref-type="bibr">31</xref></sup></p><p>Neomycin was the fourth most common allergen in this study, with a frequency of 6.4%,
consonant with the literature. It was the most common allergen in one study<sup><xref rid="r12" ref-type="bibr">12</xref></sup> and was placed among the 10 most
frequent allergens in 19 studies, with a frequency variation of 2.6-16.3%.<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r05" ref-type="bibr">5</xref>,<xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r20" ref-type="bibr">20</xref>-<xref rid="r24" ref-type="bibr">24</xref>,<xref rid="r26" ref-type="bibr">26</xref>,<xref rid="r29" ref-type="bibr">29</xref>,<xref rid="r31" ref-type="bibr">31</xref>,<xref rid="r33" ref-type="bibr">33</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup> Interestingly, in this study, positive
tests for neomycin only occurred concomitantly with other substances and its current
clinical relevance was null, perhaps due to the sensitization passed on to the neomycin
present in topical medications (pure or associated with corticosteroids) used to treat
the eczema provoking dermatological consultation, as well as in vaccines.<sup><xref rid="r42" ref-type="bibr">42</xref></sup></p><p>Cobalt was the fifth most frequent allergen in this study, with a frequency of 4.0%. Its
clinical relevance was difficult to establish as it had no positivity alone, suggesting
co-reaction with metals, as described in other studies.<sup><xref rid="r44" ref-type="bibr">44</xref></sup> There were reports in the literature of positive
reactions to cobalt together with nickel in 68.0% and 71.0% of cases.<sup><xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r22" ref-type="bibr">22</xref></sup> Pure sensitization to cobalt was uncommon.<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r15" ref-type="bibr">15</xref></sup></p><p>Fragrance mix and Myroxylon pereirae were among the 10 most common allergens in this
study, with frequencies of 4.0% and 1.6% and clinical relevance of 40.0% and 100.0%,
respectively. These findings can be explained by the use of personal hygiene products
and perfumed cosmetics and fragrances, among the age groups concerned. In the
literature, fragrance mix and Myroxylon pereirae were among the 10 most frequent
allergens in 29 and 12 studies, respectively.<sup><xref rid="r01" ref-type="bibr">1</xref>-<xref rid="r35" ref-type="bibr">35</xref></sup></p><p>Several positive and relevant tests were related to allergen sources, as previously
described, though data were incomplete, probably because of errors in the notes from
patients' medical records and the non-confirmation of these sources due to a lack of
patient follow-up.</p><p>Regarding the number of substances tested and frequencies for positive tests, the
percentage of patients with positive tests increased when the patch test was performed
with 40 substances instead of 30 (38.5% <italic>versus</italic> 74.0%). This may be a
coincidence as it cannot be justified by the number (only 6) of positive reactions from
the Cosmetics Series.</p><p>Since there were only six positive reactions to the test with the Brazilian Cosmetics
Series in the two age groups studied, and given that 6.8% of these positive tests
concerned tosylamide formaldehyde resin, this substance can be considered more important
than the other substances in this series, for the purposes of evaluating the necessary
screening in patients.</p><p>Given the high proportion of positive and relevant tests with reaction intensity 1+
(48/57; 84.2%), tests with intensity reaction 1+ were not excluded from the positive
results of this study, although a recent study considered positive tests with intensity
1+ unreliable when compared in two tests, with an interval of 12-60 months in 49
patients.<sup><xref rid="r45" ref-type="bibr">45</xref></sup></p><p>In this study, although no significant differences emerged regarding atopic and
non-atopic sensitization, among the 32 relevant positive tests for patients who had
personal atopic histories, 20 had relevant positive tests for nickel, linked to jewelry,
metal accessories in clothing and footwear, etc., suggesting that children and
adolescents with atopic histories should avoid contact with metal.</p><p>With respect to occupation, most patients were students and their relevant positive
tests were for nickel. Some patients' positive tests were attributable to their
activities (masons, hairdressers, manicurists, for instance).</p><p>In patients with positive tests, the body areas most frequently affected by dermatitis
were the head and trunk. There was a significant difference regarding dermatitis
location in the thighs of patients with positive tests, with higher positivity in
children's thighs than other areas (p=0.0068). In similar studies in children and
adolescents with suspected ACD, the main locations were as follows: the trunk,<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r23" ref-type="bibr">23</xref></sup> followed by the face,<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r12" ref-type="bibr">12</xref></sup> hands,<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r14" ref-type="bibr">14</xref></sup> feet<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r14" ref-type="bibr">14</xref></sup> and generalized dermatitis<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r23" ref-type="bibr">23</xref></sup> This study involved 28 patients who had 4 or more
affected areas. In another study of tested children and adults presenting generalized
dermatitis caused by suspected ACD, the most common allergens came from personal use
items and cosmetics (fragrances, propylene glycol and preservatives).<sup><xref rid="r37" ref-type="bibr">37</xref></sup></p><p>In cases where the initial dermatitis locations were the neck and trunk, the frequency
of relevant positive tests was high, followed by the thighs/legs and face, especially
the eyelids/ periorbital region. Most of the relevant positive tests for patients
presenting dermatitis on the neck, trunk and face as initial locations, were due to
nickel. In the eyelids and periorbital regions, nickel and tosylamide formaldehyde resin
were especially prevalent. Other studies found that the initial dermatitis location did
not correspond to any specific allergen.<sup><xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r16" ref-type="bibr">16</xref></sup></p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>In our study, the rates for contact sensitization (59.2%) and the clinical relevance of
positive tests (77.0%) in children and adolescents indicate that contact sensitization
and ACD are not uncommon in these age groups.</p><p>The most frequent allergens were nickel, thimerosal, tosylamide formaldehyde resin,
neomycin, cobalt, fragrance mix I. There was a higher frequency of positive tests among
adolescents and females. Furthermore, there was no relevant statistical difference
regarding contact sensitization among patients with or without atopic history. However,
there was a significant difference between the two age groups studied concerning
sensitization to nickel and thimerosal, as adolescents were more affected.</p><p>Nickel and fragrances were the only positive (and relevant) allergens in children, while
nickel and tosylamide formaldehyde resin were the most frequent and relevant allergens
among adolescents.</p><p>The study's findings suggest that children and adolescents should avoid contact with
metals, fragrances and nail cosmetics, in particular.</p><p>Follow-up of tested patients is necessary to verify effectively the likely sources of
allergens and the clinical relevance of positive tests.</p><p>A multicenter study of children and adolescents in Brazil is recommended in order to
better assess this issue.</p></sec></body><back><fn-group><fn fn-type="conflict"><p>Conflict of Interest: None.</p></fn><fn fn-type="supported-by"><p>Financial Support: None.</p></fn><fn fn-type="other"><p><bold>How to cite this article:</bold> Rodrigues DF, Goulart EMA. Patch test results
in children and adolescents. Study from the Santa Casa de Belo Horizonte Dermatology
Clinic, Brazil, from 2003 to 2010. An Bras Dermatol. 2015;90(5):671-83.</p></fn><fn fn-type="other" id="fn01"><label>*</label><p>Work performed at the Outpatient Center of the Santa Casa de Belo Horizonte
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