RESUMO

OBJECTIVE: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. DATA SOURCE: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. DATA SYNTHESIS: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. CONCLUSIONS: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults.

Assuntos

RESUMO

BACKGROUND: Methylisothiazolinone (MI) and Methylchloroisothiazolinone (MCI) are among the most common skin sensitizers, yet the immunological events that occur during MCI/MI allergic contact dermatitis (ACD) are still poorly understood. OBJECTIVES: To analyse dendrocytes, macrophage subtypes and T cells in skin during the elicitation phase of MCI/MI ACD. METHODS: Thirteen patients with positive patch test reactions to MCI/MI (ACD group) and 11 individuals with negative patch test results were selected. Skin biopsies were only performed at 48 hours of patch testing. Immunohistochemistry was conducted to assess T cells, dendrocytes (Factor XIIIa), M1 (p-Stat1, CD68) and M2 (c-Maf, CD163) macrophages. Transcriptional analyses were performed for cytokines and related factors, and further compared to atopic dermatitis samples (n=4). Immunofluorescence assays addressed T cells location, along with IL-4 or IL-13, within the skin. RESULTS: MCI/MI elicited dermal dendrocytes and macrophages, pronouncedly the M2 subtype. T cells, majorly CD4+ T cells, accumulated in the perivascular areas. Similarly, abundant IL-4 protein was detected in these areas. There was an upregulation of IL-4 and IL-13 mRNA expression, a mild increase in IFNG mRNA levels and a down-regulation of RORC in the ACD group. Immunofluorescence revealed dermal clusters of T cells co-localized with IL-4. CONCLUSIONS: M2 macrophages and Th2 cells participate in the immunopathogenesis of MCI/MI ACD. Dermal dendrocytes and M2 macrophages may assist the formation of CD4+ T cells perivascular clusters. These findings render a mechanistic insight into the MCI/MI reaction. Further analysis at different timepoints of patch testing is required to fully comprehend this ACD kinetics.

Assuntos

RESUMO

Erythema multiforme is generally associated with infections and drugs. Although less common, there are also reported cases of this disorder after patch testing. We described a 22 year-old female patient who, 24 hours after patch testing, progressed to erythematous iris-shaped plaques and papules with central crust, symmetrically distributed over her hands, arms, and back, with severe itch. The erythema multiforme-like lesions presented in the case were interpreted as a manifestation of systemic allergic contact dermatitis secondary to the exam. Allergic contact dermatitis may be manifested as an erythema multiforme in a hypersensitive person. Few cases of systemic allergic contact dermatitis after patch testing have been reported, for example, due to diethyl thiourea, some textile disperse dyes, and povidoneiodine. The development of erythema multiforme is not noted in most literature references as a complication after patch testing. Although unusual, this disorder needs to be considered as a potential adverse effect of this exam.

O eritema multiforme está associado comumente a infecções e medicamentos. Embora menos comum, também há casos relatados dessa doença após aplicação do teste de contato. Descrevemos uma paciente de 22 anos que evoluiu, em 24 horas após o teste, com placas e pápulas eritematosas, em formato de íris e crosta central, distribuídas simetricamente nas mãos, braços e costas, além de prurido intenso. As lesões eritema multiformesímile presentes no caso foram interpretadas como uma manifestação alérgica secundária ao exame. Dermatite de contato alérgica pode se manifestar como um eritema multiforme em pessoas hipersensíveis. Poucos casos de dermatite alérgica de contato sistêmica foram relatados após este exame, por exemplo, devido às seguintes substâncias: dietil tioureia, corantes dispersos têxteis e iodopovidona. O desenvolvimento do eritema multiforme não é usualmente apontado como uma complicação do teste de contato alérgico, na maioria das referências literárias. Embora incomum, o surgimento dessa desordem após este exame necessita ser considerado como um efeito adverso.

Assuntos

RESUMO

BACKGROUND: Excited skin syndrome (ESS) is an adverse reaction obtained when carrying out epicutaneous patch tests, characterized by multiple positive test results, associated with one or more strongly positive tests, which are not all reproduced when the patient is tested afterward. OBJECTIVE: The aim of this study was (1) to determine the frequency of ESS in patients submitted to patch testing, (2) to confirm the influence of the evolution time of the primary dermatosis with ESS induction, (3) to determine differences among patients according the rate of positive test loss, and (4) to compare the number of positive tests for each substance between the first test, when all allergens in the test battery were applied, and the second test, when only the allergens with positive tests on the first occasion were applied at a greater distance from one another. METHODS: Epicutaneous tests were carried out in 630 patients with a suspected diagnosis of allergic contact dermatitis. Patients presenting 2 or more positive test results were considered to have ESS and were submitted to a second patch test. RESULTS AND CONCLUSIONS: ESS developed in 39 of the 630 patients tested, corresponding to a frequency of 6.2%. Analysis of data found a longer duration of the primary dermatitis in patients who in whom ESS developed compared with those who did not. Parabens, fragrance mix, and thimerosal had more positive patch test reactions using standard application techniques relative to the retest procedure, which placed the substances at a greater distance from one another, suggesting that, in addition to the factors previously reported to influence the reduction of ESS, the position of the allergens in the testing procedure also should be considered.

Assuntos

Assuntos

Assuntos