Research Letter
Photoepicutaneous tests: a series of 37 Brazilian patients
Maria Antonieta Rios Scherrer, Vanessa Barreto Rocha
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Dermatology Sector, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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37 Brazilian patients" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "766" "paginaFinal" => "767" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria Antonieta Rios Scherrer, Vanessa Barreto Rocha" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Maria Antonieta Rios" "apellidos" => "Scherrer" ] 1 => array:4 [ "nombre" => "Vanessa Barreto" "apellidos" => "Rocha" "email" => array:1 [ 0 => "vanessabarreto.vbr@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Sector, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1159 "Ancho" => 1508 "Tamanyo" => 132919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive reactions on the irradiated side of the photo epicutaneous test.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Photoepicutaneous tests or photopatch tests (PPT) are indicated for the diagnosis of allergic contact photodermatitis (ACPD), a delayed hypersensitivity reaction that occurs when a photoallergen is applied to the skin that is subsequently exposed to ultraviolet (UV) and/or visible radiation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a> Its incidence is unknown; it is estimated to range from 2% to 10% of patients referred for investigation of photodermatoses.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients treated at the Contact Dermatitis Outpatient Clinic, Dermatology Annex, Hospital das Clínicas, UFMG between 2007 and 2019, with diagnostic suspicion of photodermatosis due to eczematous lesions in exposed areas, exacerbated after sun exposure, were selected to undergo PPT for diagnostic purposes after the epicutaneous test with the standard Brazilian panel revealed no clinical relevance. Allergens from FDA-Allergenic, Rio de Janeiro and Chemotechnique Diagnostics, Sweden (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) were used in Finn Chambers® with Scanpor® (Smartpractice, United States) or Allergochambers® (Neoflex, São Paulo) applied in duplicate on the skin of the back. The set of allergens tested was chosen based on the literature and availability in this service.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> The allergen panel was removed after 48<span class="elsevierStyleHsp" style=""></span>h, read, and covered with surgical dressing and aluminum foil. As no patient presented a minimal erythematous dose less than 10<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> of UVA, the other set of allergens was irradiated with 10<span class="elsevierStyleHsp" style=""></span>J, followed by immediate reading and subsequent occlusion. New readings were performed 48<span class="elsevierStyleHsp" style=""></span>h later, following the International Contact Dermatitis Research Group criteria.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> If only the irradiated side showed a positive reaction, the diagnosis of photoallergic contact reaction was made. If both sides had positive reactions, but there was a stronger reaction on the irradiated side, the diagnosis was photodermatitis and allergic contact dermatitis; if the reactions were equal on both sides, the diagnosis was allergic contact dermatitis (ACD).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Among 1712 patients undergoing epicutaneous tests, 37 (2.2%) were selected: 19 men (51.4%) and 18 women (48.6%), aged 30–80 years, 22 (59.4%) of phototypes II and III, seven (19%) of IV and V, and eight (21.6%) of VI. Six patients (16.2%) had a history of atopy, 15 (40.5%) used sunscreens, 31 (84%) had varied occupations, four (11%) were bricklayers, and two (5.4%) were farmers. The time of evolution of the lesions ranged from five months to 20 years and the most affected sites were exposed areas, predominantly the face (33%–89%), upper limbs (25%–67%), and neck (24%–65%). Three patients (8%) had disseminated lesions. Prior patch test indicated Kathon and quaternium-15 reaction in one patient, formaldehyde in one, and potassium bichromate in two; one patient reacted to nickel, thimerosal, and hydroquinone. A total of 74 positive reactions were observed, 54 on the irradiated side and 20 on the non-irradiated side, which led to the diagnosis of ACDP in 23 (62%) patients, and ACD in 12 (32%) (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The photoallergic reactions detected were due to chlorpromazine (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9; 24%), balsam of Peru (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6; 16%), perfume mix (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5; 13.5%), promethazine, chlorhexidine, and potassium bichromate (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4; 11%), oxybenzone and BHT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3; 8%), paraphenylenediamine and <span class="elsevierStyleItalic">Compositae</span> mix (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2; 5.4%), sesquiterpene lactone mix, thiourea, and butyl methoxybenzoylmethane (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1; 2.7%). Six patients (16%) tested negative on both sides.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Positive reactions to PPT are mainly caused by topical anti-inflammatory drugs such as ketoprofen, widely used in Europe. Studies show co-sensitization with benzophenones, fenofibrate, and perfume mix. Reactions to other anti-inflammatory drugs, such as etofenamate and diclofenac, have been described in the literature. These are the most frequent photoallergens in Europe.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the United States, sunscreens and antibacterials are the most frequent photoallergens, and a progressive reduction in the incidence of fragrances is being observed. In India, <span class="elsevierStyleItalic">Parthernium</span> is the most common.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> There are no data published in Brazil.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the present patients, reactions to chlorpromazine were the most frequent, similarly to the findings of a Chinese series.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It is an antipsychotic derived from phenothiazine whose analogs, such as dihydrochlorothiazide and promethazine, are widely used as diuretics and antipruritics in Brazil.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Promethazine was the fourth most common photoallergen, tied for fourth place with chlorhexidine and potassium bichromate, but only one patient showed a co-reaction between chlorpromazine and promethazine. The second in frequency was balsam of Peru, followed by perfume mix. In the Chinese research, potassium bichromate was also the fourth most frequently identified photoallergen, showing one more similarity with the present study, in addition to chlorpromazine.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pattern of photopositivity varies according to the area and population studied. This is a preliminary investigation, which reflected the population's habits, such as the use of oral and topical promethazine as an antipruritic, and professional or domestic exposure to cement.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors suggest that a standard PPT panel should be defined for Brazil. This set of allergens used is a preliminary suggestion to establish a Brazilian panel for photoepicutaneous tests, since it is an effective and important tool in the diagnosis of photosensitive dermatitis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Maria Antonieta Rios Scherrer: Statistical analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Vanessa Barreto Rocha: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-01" "fechaAceptado" => "2020-03-05" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Scherrer MAR, Rocha VB. Photoepicutaneous tests: a series of 37 Brazilian patients. An Bras Dermatol. 2020;95:766–7.</p>" ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Clinic, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1160 "Ancho" => 1508 "Tamanyo" => 139533 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epicutaneous photo test: DAC to perfume mix and allergic contact photodermatitis (ACPD) to balsam of Peru and promethazine.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1159 "Ancho" => 1508 "Tamanyo" => 132919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive reactions on the irradiated side of the photo epicutaneous test.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hapten \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vehicle \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of photoallergic reactions \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PABA 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oxybenzone (benzophenone-3) 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Butyl methoxybenzoylmethane 10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sesquiterpene lactone mix 0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Musk xylene 1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Balsam of Peru 35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Promethazine 1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perfume mix 7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Irgasan 1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Potassium bichromate 0.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chlorpromazine hydrochloride 0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thiourea 0.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chlorhexidine 0.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Water \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paraphenylenediamine 1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Compositae</span> mix 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Butyl hydroxytoluene (BHT) 2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2433437.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Panel of photoepicutaneous tests and number of photoallergic reactions</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photopatch testing in chinese patients over 10 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Hu" 1 => "D. Wang" 2 => "Y. Shen" 3 => "H. Tang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DER.0000000000000170" "Revista" => array:6 [ "tituloSerie" => "Dermatitis" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "137" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27172309" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European photopatch test baseline series: a 3-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Subiabre-Ferrer" 1 => "A. Esteve-Martínez" 2 => "R. Blasco-Encinas" 3 => "C. Sierra-Talamantes" 4 => "A. Pérez-Ferriols" 5 => "V. Zaragoza-Ninet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cont Dermat" "fecha" => "2019" "volumen" => "80" "paginaInicial" => "5" "paginaFinal" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photopatch and UV-irradiated patch testing in photosensitive dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Rai" 1 => "M. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2229-5178.174319" "Revista" => array:6 [ "tituloSerie" => "Indian Dermatol Online J" "fecha" => "2016" "volumen" => "7" "paginaInicial" => "12" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26955581" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A European multicentre photopatch test study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Taskforce EMPTSE" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2012.10857.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2012" "volumen" => "166" "paginaInicial" => "1002" "paginaFinal" => "1009" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22283432" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fisher's contact dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Fowler" 1 => "M. Zirwas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "7th ed." "fecha" => "2019" "editorial" => "Contact Dermatitis Institute" "editorialLocalizacion" => "Phoenix" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000006/v2_202011230629/S0365059620302154/v2_202011230629/en/main.assets" "Apartado" => array:4 [ "identificador" => "82768" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000006/v2_202011230629/S0365059620302154/v2_202011230629/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620302154?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 9 | 22 |
| 2024 October | 120 | 60 | 180 |
| 2024 September | 130 | 89 | 219 |
| 2024 August | 159 | 105 | 264 |
| 2024 July | 163 | 105 | 268 |
| 2024 June | 107 | 67 | 174 |
| 2024 May | 80 | 59 | 139 |
| 2024 April | 87 | 95 | 182 |
| 2024 March | 66 | 57 | 123 |
| 2024 February | 86 | 71 | 157 |
| 2024 January | 62 | 40 | 102 |
| 2023 December | 53 | 68 | 121 |
| 2023 November | 60 | 67 | 127 |
| 2023 October | 56 | 68 | 124 |
| 2023 September | 61 | 64 | 125 |
| 2023 August | 54 | 44 | 98 |
| 2023 July | 49 | 28 | 77 |
| 2023 June | 53 | 39 | 92 |
| 2023 May | 37 | 16 | 53 |
| 2023 April | 39 | 11 | 50 |
| 2023 March | 59 | 43 | 102 |
| 2023 February | 33 | 27 | 60 |
| 2023 January | 49 | 32 | 81 |
| 2022 December | 58 | 25 | 83 |
| 2022 November | 65 | 48 | 113 |
| 2022 October | 91 | 57 | 148 |
| 2022 September | 46 | 54 | 100 |
| 2022 August | 52 | 45 | 97 |
| 2022 July | 40 | 43 | 83 |
| 2022 June | 52 | 60 | 112 |
| 2022 May | 31 | 51 | 82 |
| 2022 April | 35 | 50 | 85 |
| 2022 March | 41 | 58 | 99 |
| 2022 February | 35 | 32 | 67 |
| 2022 January | 46 | 63 | 109 |
| 2021 December | 35 | 49 | 84 |
| 2021 November | 34 | 58 | 92 |
| 2021 October | 49 | 75 | 124 |
| 2021 September | 35 | 44 | 79 |
| 2021 August | 39 | 48 | 87 |
| 2021 July | 33 | 38 | 71 |
| 2021 June | 40 | 43 | 83 |
| 2021 May | 80 | 60 | 140 |
| 2021 April | 245 | 262 | 507 |
| 2021 March | 96 | 84 | 180 |
| 2021 February | 30 | 19 | 49 |
| 2021 January | 33 | 26 | 59 |
| 2020 December | 33 | 15 | 48 |
| 2020 November | 24 | 7 | 31 |
| 2020 October | 7 | 6 | 13 |
| 2020 September | 10 | 9 | 19 |
| 2020 August | 5 | 7 | 12 |
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