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BACKGROUND: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are inflammatory skin conditions whose association is not clearly defined. OBJECTIVES: To identify differences in ACD profile between patients with and without AD among those referred for patch testing. Additionally, to determine the prevalence of sensitisation to standard Spanish contact allergens in both groups. METHODS: We analysed two groups (AD and non-AD) within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). Contact allergy, clinical relevance and epidemiological data were compared between them. RESULTS: A total of 5055 patients were included. Among them, 23% (1168) had a history or final diagnosis of AD. At least one positive reaction was seen in 468 (40%) of AD patients and 1864 (48%) of non-AD patients. In both groups, the most common positive reactions were to nickel sulphate, methylchloroisothiazolinone/methylisothiazolinone and cobalt chloride. Age-adjusted OR for sensitisation to nickel sulphate was 0.72 (95% CI: 0.61-0.86), indicating a decreased likelihood of sensitisation in AD patients compared to non-AD individuals. CONCLUSIONS: We did not find an increased presence of ACD in patients with AD referred for patch testing, exhibiting similar profiles to non-AD population, except for a negative relationship between AD and sensitisation to nickel sulphate.

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BACKGROUND: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. OBJECTIVE: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. METHODS: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. RESULTS: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001). CONCLUSIONS: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.

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Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.

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El eccema de manos es una patología frecuente con un fuerte impacto en la calidad de vida de los pacientes y un alto coste social y laboral. Su manejo por los médicos de atención primaria y de medicina del trabajo es complejo debido a la variedad de etiologías, la evolución difícilmente predecible de la enfermedad y la respuesta al tratamiento. El diagnóstico precoz y las medidas protectoras adecuadas son esenciales para evitar la cronificación, que es mucho más difícil de tratar. Una correcta derivación a un especialista y la valoración de una baja laboral en el momento adecuado resultan cruciales para un buen manejo de estos pacientes. En esta guía sobre el eccema crónico de manos analizamos el proceso diagnóstico, las medidas preventivas y los tratamientos, con especial énfasis en el papel del médico de atención primaria y de medicina del trabajo en los estados iniciales de su manejo

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease

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El Museo Olavide, desde su inauguración en 1882 hasta su desaparición en 1965, ha sufrido múltiples vicisitudes, algunas de ellas no contrastadas de forma oficial debido a la desaparición durante la Guerra Civil de la documentación existente en la Diputación de Madrid. El museo estaba localizado inicialmente en el Hospital de San Juan de Dios en Atocha. El hecho de que en este hospital predominasen las enfermedades venéreas hizo que muchas «noticias» que hoy tenemos sea a través de periódicos o revistas de la época, en muchos casos con cierto carácter sensacionalista. Con la recuperación de las figuras del museo en diciembre de 2005 encontramos abundante documentación que sirvió para que se pudiera identificar a los 3 escultores, Zofío, Barta y López Álvarez, así como historiales clínicos de las figuras. Con ello se pudo desmitificar leyendas existentes en torno al museo, a los escultores y a los enfermos, una de estas es la del «muchacho de la tiña favosa» (AU)

From the moment the Olavide Museum opened its doors in 1882 until its content was packed up around 1965 and lost sight of for a time, it underwent a succession of changes. Some of those changes cannot be fully documented now because the archives of the Provincial Council (Diputación) of Madrid were lost during the Spanish Civil War. The museum was initially housed in Hospital de San Juan de Dios, in the neighborhood of Atocha. Because this hospital treated mainly venereal diseases, much of the information we have about it comes from newspapers or magazines of the period, and their accounts were often sensationalistic. When a large number of the museum’s wax figures were rediscovered, along with a great many accompanying documents, in December 2005, the material allowed 3 sculptors -Zofío, Barta, and López Álvarez- to be identified. Case histories corresponding to the figures were also among the papers found. As a result, the truth about certain legends associated with the museum, the sculptors, and the patients could be unraveled. Among the patients whose stories were brought to light was one referred to as the boy with generalized tinea favosa, or crusted ringworm (AU)

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From the moment the Olavide Museum opened its doors in 1882 until its content was packed up around 1965 and lost sight of for a time, it underwent a succession of changes. Some of those changes cannot be fully documented now because the archives of the Provincial Council (Diputación) of Madrid were lost during the Spanish Civil War. The museum was initially housed in Hospital de San Juan de Dios, in the neighborhood of Atocha. Because this hospital treated mainly venereal diseases, much of the information we have about it comes from newspapers or magazines of the period, and their accounts were often sensationalistic. When a large number of the museum's wax figures were rediscovered, along with a great many accompanying documents, in December 2005, the material allowed 3 sculptors-Zofío, Barta, and López Álvarez-to be identified. Case histories corresponding to the figures were also among the papers found. As a result, the truth about certain legends associated with the museum, the sculptors, and the patients could be unraveled. Among the patients whose stories were brought to light was one referred to as the boy with generalized tinea favosa, or crusted ringworm.

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Introducción y objetivos: En el año 2010 la energía eólica en España incrementó su capacidad de cobertura un 16%, lo que posiciona al país en el cuarto lugar del mundo en este sector industrial, de gran desarrollo económico y fuente de empleo. Las dermatosis profesionales en este campo han sido poco estudiadas. Con el presente estudio se pretende describir las principales características de la afectación cutánea en sus trabajadores y los alérgenos implicados. Material y método: Se realiza un estudio descriptivo y observacional de trabajadores de la industria eólica con sospecha de dermatitis de contacto remitidos a consulta de Dermatología Laboral de la Escuela Nacional de Medicina del Trabajo entre 2009 y 2011. Se realizó historia clínica, historia laboral, exploración física y pruebas epicutáneas según los materiales manipulados por estos trabajadores. Resultados: Se estudiaron 10 trabajadores (8 hombres, 2 mujeres) pertenecientes a esta industria. La media de edad fue de 33,7 años. El cuadro principal fue eccema que afectaba a la cara, a los párpados, a los antebrazos y a las manos. En 4 trabajadores se encontró una sensibilización a resinas epoxi, uno de ellos presentó, además, sensibilización a sus endurecedores. Un paciente se encontraba sensibilizado a la resina de bisfenol F, con negatividad de la resina epoxi de la batería estándar. En los 5 casos restantes el diagnóstico final fue el de dermatitis de contacto irritativa por fibra de vidrio. Conclusiones: Las dermatosis ocupacionales en la industria eólica son cada vez más frecuentes. Las resinas epoxi son sus principales alérgenos, mientras que la fibra de vidrio suele producir cuadros irritativos (AU)

Background and objectives: In 2010, wind energy coverage in Spain increased by 16%, making the country the world’s fourth largest producer in a fast-developing industry that is also a source of employment. Occupational skin diseases in this field have received little attention. The present study aims to describe the main characteristics of skin diseases affecting workers in the wind energy industry and the allergens involved. Material and methods: We performed a descriptive, observational study of workers from the wind energy industry with suspected contact dermatitis who were referred to the occupational dermatology clinic of the National School of Occupational Medicine (Escuela Nacional de Medicina del Trabajo) between 2009 and 2011. We took both a clinical history and an occupational history, and patients underwent a physical examination and patch testing with the materials used in their work. Results: We studied 10 workers (8 men, 2 women), with a mean age of 33.7 years. The main finding was dermatitis, which affected the face, eyelids, forearms, and hands. Sensitization to epoxy resins was detected in 4 workers, 1 of whom was also sensitized to epoxy curing agents. One worker was sensitized to bisphenol F resin but had a negative result with epoxy resin from the standard series. In the 5 remaining cases, the final diagnosis was irritant contact dermatitis due to fiberglass. Conclusions: Occupational skin diseases are increasingly common in the wind energy industry. The main allergens are epoxy resins. Fiberglass tends to produce irritation (AU)

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BACKGROUND AND OBJECTIVES: In 2010, wind energy coverage in Spain increased by 16%, making the country the world's fourth largest producer in a fast-developing industry that is also a source of employment. Occupational skin diseases in this field have received little attention. The present study aims to describe the main characteristics of skin diseases affecting workers in the wind energy industry and the allergens involved. MATERIAL AND METHODS: We performed a descriptive, observational study of workers from the wind energy industry with suspected contact dermatitis who were referred to the occupational dermatology clinic of the National School of Occupational Medicine (Escuela Nacional de Medicina del Trabajo) between 2009 and 2011. We took both a clinical history and an occupational history, and patients underwent a physical examination and patch testing with the materials used in their work. RESULTS: We studied 10 workers (8 men, 2 women), with a mean age of 33.7 years. The main finding was dermatitis, which affected the face, eyelids, forearms, and hands. Sensitization to epoxy resins was detected in 4 workers, 1 of whom was also sensitized to epoxy curing agents. One worker was sensitized to bisphenol F resin but had a negative result with epoxy resin from the standard series. In the 5 remaining cases, the final diagnosis was irritant contact dermatitis due to fiberglass. CONCLUSIONS: Occupational skin diseases are increasingly common in the wind energy industry. The main allergens are epoxy resins. Fiberglass tends to produce irritation.

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BACKGROUND AND OBJECTIVES: In 2010, wind energy coverage in Spain increased by 16%, making the country the world's fourth largest producer in a fast-developing industry that is also a source of employment. Occupational skin diseases in this field have received little attention. The present study aims to describe the main characteristics of skin diseases affecting workers in the wind energy industry and the allergens involved. MATERIAL AND METHODS: We performed a descriptive, observational study of workers from the wind energy industry with suspected contact dermatitis who were referred to the occupational dermatology clinic of the National School of Occupational Medicine (Escuela Nacional de Medicina del Trabajo) between 2009 and 2011. We took both a clinical history and an occupational history, and patients underwent a physical examination and patch testing with the materials used in their work. RESULTS: We studied 10 workers (8 men, 2 women), with a mean age of 33.7 years. The main finding was dermatitis, which affected the face, eyelids, forearms, and hands. Sensitization to epoxy resins was detected in 4 workers, 1 of whom was also sensitized to epoxy curing agents. One worker was sensitized to bisphenol F resin but had a negative result with epoxy resin from the standard series. In the 5 remaining cases, the final diagnosis was irritant contact dermatitis due to fiberglass. CONCLUSIONS: Occupational skin diseases are increasingly common in the wind energy industry. The main allergens are epoxy resins. Fiberglass tends to produce irritation.

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Trabajador de 58 años, en industria aeronáutica desde el año 1966 (chapa y montaje), donde se manejan resinas epoxi. Estudiado en 2001 por eccema de manos y antebrazos, se realizaron pruebas epicutáneas, que fueron positivas a la resina epoxi. Diagnosticado de eccema alérgico de contacto por esta resina, se llevó a cabo un cambio de puesto de trabajo, destinándose al paciente a las oficinas. Tras 9 años en este puesto, presentó brotes de intenso eccema en la cara, el cuello, los miembros superiores y los pliegues inguinales. Unas nuevas pruebas epicutáneas observaron la persistencia de la sensibilización a resina epoxi (bisfenol F), que se había agravado en el tiempo. Los eccemas causados por resinas epoxi no suelen reaparecer si se evitan los ambientes en que se manipula dicha resina. Sin embargo, en casos excepcionales, como el que aquí presentamos, una mínima cantidad de resina vehiculizada a través de la documentación que había permanecido previamente en el taller de la fábrica desencadenó lesiones (AU)

A 58 year old aeronautical industry worker, since 1966 (in maintenance), using epoxy resin composite material was studied in 2001 for presenting eczema in hands and forearm. He showed positive path test reactions to epoxy resin. Patient was diagnosed of contact allergic eczema, and was changed to administrative duties. Nine years later (2010) he presents intense eczema on face, neck, arms and groins. Patch test with epoxy resin (bisphenol F) was done, showed increasing positive results compared to previous ones. Eczemas caused by epoxy resins tend to disappear in a short period of time since the contact with the allergen decreases. However, despite the change to administrative duties and reduced contact with epoxy resin in the current work environment, the eczema that the patient presented was more significant than before, with higher sensitivity in the path test (AU)

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En 1909, el dermatólogo español Juan de Azúa publica un trabajo donde recoge las principales características de las lesiones cutáneas de la dermatitis artefacta. En él, también presta una especial atención a la psicología de estos pacientes, al entorno familiar que los rodea y a la compensación que pretende conseguir el enfermo con la patomimia. Azúa confrontaba directamente al paciente con el diagnóstico, que demostraba mediante una cura oclusiva. Redactado en un estilo literario, al modo de la época, el artículo incluye las apreciaciones subjetivas de Azúa, que consiguen transmitir una imagen de estos enfermos mucho más cercana a la realidad que el lenguaje aséptico que tendemos a emplear hoy en día en la literatura médica (AU)

In 1909, the Spanish dermatologist Juan de Azúa published a study of the main features of skin lesions in dermatitis artefacta. In the article, he paid particular attention to the psychological state of these patients, their family situation, and what they were hoping to gain with pathomimicry. Azúa directly confronted the patients with the diagnosis, which he demonstrated by applying an occlusive dressing. Written in a literary style typical of the times, the article includes the subjective impressions of Azúa, through which he manages to transmit a much more realistic image of these patients than that portrayed with the sterile language we tend to use in current medical literature (AU)

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In 1909, the Spanish dermatologist Juan de Azúa published a study of the main features of skin lesions in dermatitis artefacta. In the article, he paid particular attention to the psychological state of these patients, their family situation, and what they were hoping to gain with pathomimicry. Azúa directly confronted the patients with the diagnosis, which he demonstrated by applying an occlusive dressing. Written in a literary style typical of the times, the article includes the subjective impressions of Azúa, through which he manages to transmit a much more realistic image of these patients than that portrayed with the sterile language we tend to use in current medical literature.

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Las aplicaciones de las diferentes resinas epoxi basadas en bisfenol A y F son extensas. Las resinas epoxi basadas en bisfenol F son más nuevas y resistentes que las de bisfenol A, y ambas son causa conocida de dermatitis de contacto alérgica. Se estudian 39 casos de sensibilización a resinas epoxi en los últimos 5 años. Los resultados obtenidos son: prevalencia de sensibilización a resinas epoxi entre los pacientes estudiados del 2%, 27 varones y 8 mujeres, con una edad media de 42.77, un período de medio sensibilización de 23,8 meses. La sensibilización a bisfenol F desde que se incluye para las pruebas del parche en la batería de resinas epoxi es del 100% para los casos sensibilizados a la resina. La localización mayoritaria se dio en las manos, con una relevancia actual del 84%. Se recomendó un cambio de puesto en el trabajo al 46% de estos pacientes. El aumento de la sensibilización encontrada a bisfenol F puede explicarse por una sensibilización concomitante con bisfenol A, una declaración incorrecta de la composición de la resina o una reactividad cruzada de ambos

The applications of epoxy resins based on bisphenol A and F are extensive. Epoxy resins based on bisphenol F are new and more resistant than epoxy resins based on bisphenol A. Both of them cause allergic contact dermatitis. In the last 5 years, we have studied 39 cases of sensitization to epoxy resin. The results of our study were these: the global prevalence of epoxy resin sensitization was 2%, 27 men and 8 women. The mean age was 42.77 years and the sensitization period was 23.8 months. The most frequent localization of the lesions were hands (84% of the patients). Since bisphenol F was included in epoxy resin battery for patch testing, a 100% of positives responses in patients sensitized to epoxy resin have been found. Sensitization to epoxy resins was a cause of change in workplace in 46% of cases in our series. There has been an increase in sensitization of bisphenol F that could be explained by a concomitant sensitization with bisphenol A, cross-reactivity between bisphenol A and F or because an incorrect chemical compound information of the resin

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