Allergic contact dermatitis by shampoo components: a descriptive analysis of 20 cases | Anais Brasileiros de Dermatologia (Portuguese)

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They are composed of several ingredients, usually ranging from 10 to 30, with different functions, such as surfactants for cleanning, preservatives to stabilize the product, and fragrances to make them cosmetically pleasant to the consumer.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a>Adverse reactions to their use may occur. Although studies demonstrate that the sensitizing power of allergens present in rinse products is low (through ephemeral contact with the skin), allergic contact dermatitis (ACD) due to components of shampoos has been well described in the literature.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> It is possible that sensitization occurs earlier by contact with other products containing the same allergens. In addition, factors such as frequency of use and presence of atopy may influence the onset of ACD.Pruritus and hair loss are the most described symptoms. Eczematous lesions are usually observed on the scalp, face, ears, and cervical region.<a class="elsevierStyleCrossRefs" href="#bib0005">1,5</a> In these cases, the patch test is the main tool for the identification of the causal agent and, subsequently, treatment.This study aimed to evaluate the main allergens that cause ACD by shampoos and the epidemiological characteristics of the population affected by this condition in a specialized dermatological service of a quaternary hospital.A total of 654 patch tests were carried out between January 2014 and August 2019. Among them, those with a final diagnosis of ACD by shampoo were chosen for analysis. All selected cases were tested with the Brazilian standard (FDA Allergenic, Brazil), capillary (IPI ASAC, Brazil), and Latin American (Chemothecnique, Sweden) tests.ACD by shampoo was diagnosed in 20 patients (3% of those who underwent the patch test). Of these, 19 (95%) were female and one male. The mean age was 52.2 years. The higher frequency of female patients is consistent with the greater use of cosmetics by this group.The mean time of illness was 46 months, reflecting probable difficulties in establishing the diagnosis, thus lengthening the time of illness since the causative agents were not withdrawn.The most affected regions in patients were: scalp in 12 cases (60%), face and upper limbs in ten (50%) each, cervical in seven (35%), back in four (20%), ears in three (15%), chest and armpits in two (10%) each, and abdomen and shoulders in one (5%) each; these data are compatible with the literature. This variety of possible clinical presentations contributes to diagnostic difficulties, particularly when there are no evident lesions on the scalp, as occurred in eight out of 20 patients (40%), which can be explained by the anatomical characteristics of this region (great thickness and greater number of pilosebaceous units), which hinder the penetration of allergens and the detection of eczema.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> In some patients, the lesions affected the areas that come into contact with the shampoo when it is rinsed: the forehead, eyelids, auricular region, lateral cervical, and back (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The relevant positive results of the patch tests are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The responsible allergens were preservatives (Kathon CG, formaldehyde, captan, methyldibromo glutaronitrile and dyazolinidyl urea), fragrances (FM1, FM2, and balsam of Peru), and surfactants (cocamidopropyl betaine, lauryl polyglucoside, and decyl glucoside). These results are in agreement with the literature.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is noteworthy that among the eleven ACD-causing allergens presented, only four are included in the Brazilian standard test (Kathon CG, formaldehyde, fragrance-mix 1, and balsam of Peru), while the others were present in the complementary tests used. In all cases, the diagnosis was confirmed by a test with current relevance, verified by reading the labels of the shampoos used (proving the exposure to the detected allergens), and the complete improvement after removal of these agents during clinical follow-up.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>As most shampoos have similar compositions, it is common for the dermatitis to persist even after patients change the product and brand on their own. Thus, it is essential to perform a patch test whenever there is clinical suspicion, which should be performed with the standard and the complementary series, thus allowing individualized guidance for each patient regarding which products should be used.Financial supportNone declared.Authors’ contributionsRosana Lazzarini: Approval of the final version of the manuscript; conception and planning of the study; effective participation in research orientation.Lilian Lemos Costa: Obtaining, analyzing, and interpreting the data; critical review of the literature.Nathalie Mie Suzuki: Elaboration and writing of the manuscript; critical review of the manuscript.Mariana de Figueiredo Silva Hafner: Conception and planning of the study; elaboration and writing of the manuscript; critical review of the manuscript.Conflicts of interestNone declared." 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An Bras Dermatol. 2020;95. https://doi.org/10.1016/j.abd.2019.12.009." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "Study conducted at the Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 487 "Ancho" => 905 "Tamanyo" => 97939 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient with chronic eczema (intense lichenification on the forehead) due to allergic contact dermatitis from methyl isothiazolinone present in the shampoos used." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1268 "Ancho" => 905 "Tamanyo" => 200328 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient with allergic contact dermatitis to components of the shampoos involving the pre-auricular, retroauricular, and lateral cervical regions (areas that come into contact with the shampoo when it is rinsed)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1062 "Ancho" => 905 "Tamanyo" => 116754 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient with hyperchromia and abrasions on the back caused by pruritus from allergic contact dermatitis to cocamidopropyl betaine in shampoos (demonstrated by patch test)." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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">Relevant allergens \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 positive tests \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">% \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 ; 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entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cocamidopropyl betaine \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><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">11.0 \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">Captan<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \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><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">11.0 \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">Lauryl polyglucoside \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><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">8.5 \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">Decyl glucoside \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><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">8.5 \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 ; 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entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FM2<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \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><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">4.0 \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">Diazolinidyl urea \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><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">2.0 \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 ; 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Zirwas" 1 => "J. Moennich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatitis" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "106" "paginaFinal" => "110" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Common Allergens Identified Based on Patch Test Results in Patients with Suspected Contact Dermatitis of the Scalp" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.M. Aleid" 1 => "R. Fertig" 2 => "A. Maddy" 3 => "A. Tosti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000453530" "Revista" => array:6 [ "tituloSerie" => "Skin Appendage Disord" "fecha" => "2017" "volumen" => "3" "paginaInicial" => "7" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28611994" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact Dermatitis to Cosmetics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.J. Zirwas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Rev Allergy Immunol" "fecha" => "2019" "volumen" => "56" "paginaInicial" => "119" "paginaFinal" => "128" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin Sensitization Induction Potential From Daily Exposure to Fragrances in Personal Care Products" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.A. Drechsel" 1 => "K.M. Towle" 2 => "E.S. Fung" 3 => "R.M. Novick" 4 => "D.J. Paustenbach" 5 => "A.D. Monnot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatitis" "fecha" => "2018" "volumen" => "29" "paginaInicial" => "324" "paginaFinal" => "331" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic eyelid dermatitis secondary to cocamidopropyl betaine allergy in a patient using baby shampoo eyelid scrubs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. Welling" 1 => "T.F. Mauger" 2 => "L.R. Schoenfield" 3 => "A.J. Hendershot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA Ophthalmol" "fecha" => "2014" "volumen" => "132" "paginaInicial" => "357" "paginaFinal" => "359" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000005/v2_202011080908/S0365059620301732/v2_202011080908/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/03650596/0000009500000005/v2_202011080908/S0365059620301732/v2_202011080908/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301732?idApp=UINPBA00008Z"]

Estatísticas

Research Letter

Allergic contact dermatitis by shampoo components: a descriptive analysis of 20 cases

Rosana Lazzarinia, Lilian Lemos Costab, Nathalie Mie Suzukia, Mariana de Figueiredo Silva Hafnera,

Autor para correspondência

mariana@hafner.med.br

Corresponding author.

a Allergy Unit, Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

b Dermatology Clinic, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil

Lido

6913

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Shampoos are the most used cosmetics for hair and scalp care&#46; They are composed of several ingredients&#44; usually ranging from 10 to 30&#44; with different functions&#44; such as surfactants for cleanning&#44; preservatives to stabilize the product&#44; and fragrances to make them cosmetically pleasant to the consumer&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Adverse reactions to their use may occur&#46; Although studies demonstrate that the sensitizing power of allergens present in rinse products is low &#40;through ephemeral contact with the skin&#41;&#44; allergic contact dermatitis &#40;ACD&#41; due to components of shampoos has been well described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is possible that sensitization occurs earlier by contact with other products containing the same allergens&#46; In addition&#44; factors such as frequency of use and presence of atopy may influence the onset of ACD&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pruritus and hair loss are the most described symptoms&#46; Eczematous lesions are usually observed on the scalp&#44; face&#44; ears&#44; and cervical region&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> In these cases&#44; the patch test is the main tool for the identification of the causal agent and&#44; subsequently&#44; treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aimed to evaluate the main allergens that cause ACD by shampoos and the epidemiological characteristics of the population affected by this condition in a specialized dermatological service of a quaternary hospital&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 654 patch tests were carried out between January 2014 and August 2019&#46; Among them&#44; those with a final diagnosis of ACD by shampoo were chosen for analysis&#46; All selected cases were tested with the Brazilian standard &#40;FDA Allergenic&#44; Brazil&#41;&#44; capillary &#40;IPI ASAC&#44; Brazil&#41;&#44; and Latin American &#40;Chemothecnique&#44; Sweden&#41; tests&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">ACD by shampoo was diagnosed in 20 patients &#40;3&#37; of those who underwent the patch test&#41;&#46; Of these&#44; 19 &#40;95&#37;&#41; were female and one male&#46; The mean age was 52&#46;2 years&#46; The higher frequency of female patients is consistent with the greater use of cosmetics by this group&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean time of illness was 46 months&#44; reflecting probable difficulties in establishing the diagnosis&#44; thus lengthening the time of illness since the causative agents were not withdrawn&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The most affected regions in patients were&#58; scalp in 12 cases &#40;60&#37;&#41;&#44; face and upper limbs in ten &#40;50&#37;&#41; each&#44; cervical in seven &#40;35&#37;&#41;&#44; back in four &#40;20&#37;&#41;&#44; ears in three &#40;15&#37;&#41;&#44; chest and armpits in two &#40;10&#37;&#41; each&#44; and abdomen and shoulders in one &#40;5&#37;&#41; each&#59; these data are compatible with the literature&#46; This variety of possible clinical presentations contributes to diagnostic difficulties&#44; particularly when there are no evident lesions on the scalp&#44; as occurred in eight out of 20 patients &#40;40&#37;&#41;&#44; which can be explained by the anatomical characteristics of this region &#40;great thickness and greater number of pilosebaceous units&#41;&#44; which hinder the penetration of allergens and the detection of eczema&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> In some patients&#44; the lesions affected the areas that come into contact with the shampoo when it is rinsed&#58; the forehead&#44; eyelids&#44; auricular region&#44; lateral cervical&#44; and back &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The relevant positive results of the patch tests are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The responsible allergens were preservatives &#40;Kathon CG&#44; formaldehyde&#44; captan&#44; methyldibromo glutaronitrile and dyazolinidyl urea&#41;&#44; fragrances &#40;FM1&#44; FM2&#44; and balsam of Peru&#41;&#44; and surfactants &#40;cocamidopropyl betaine&#44; lauryl polyglucoside&#44; and decyl glucoside&#41;&#46; These results are in agreement with the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is noteworthy that among the eleven ACD-causing allergens presented&#44; only four are included in the Brazilian standard test &#40;Kathon CG&#44; formaldehyde&#44; fragrance-mix 1&#44; and balsam of Peru&#41;&#44; while the others were present in the complementary tests used&#46; In all cases&#44; the diagnosis was confirmed by a test with current relevance&#44; verified by reading the labels of the shampoos used &#40;proving the exposure to the detected allergens&#41;&#44; and the complete improvement after removal of these agents during clinical follow-up&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">As most shampoos have similar compositions&#44; it is common for the dermatitis to persist even after patients change the product and brand on their own&#46; Thus&#44; it is essential to perform a patch test whenever there is clinical suspicion&#44; which should be performed with the standard and the complementary series&#44; thus allowing individualized guidance for each patient regarding which products should be used&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Rosana Lazzarini&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; effective participation in research orientation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Lilian Lemos Costa&#58; Obtaining&#44; analyzing&#44; and interpreting the data&#59; critical review of the literature&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nathalie Mie Suzuki&#58; Elaboration and writing of the manuscript&#59; critical review of the manuscript&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mariana de Figueiredo Silva Hafner&#58; Conception and planning of the study&#59; elaboration and writing of the manuscript&#59; critical review of the manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Kathon CG<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&nbsp;\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">26&#46;0&nbsp;\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">Formaldehyde&nbsp;\t\t\t\t\t\t\n
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                  \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">8&nbsp;\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">17&#46;0&nbsp;\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">Cocamidopropyl betaine&nbsp;\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
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                  \t\t\t\t">5&nbsp;\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">11&#46;0&nbsp;\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">Captan<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\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&nbsp;\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">11&#46;0&nbsp;\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">Lauryl polyglucoside&nbsp;\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&nbsp;\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">8&#46;5&nbsp;\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">Decyl glucoside&nbsp;\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&nbsp;\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">8&#46;5&nbsp;\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">Methyldibromo glutaronitrile&nbsp;\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&nbsp;\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&#46;0&nbsp;\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">FM1<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\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&nbsp;\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&#46;0&nbsp;\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">FM2<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\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&nbsp;\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&#46;0&nbsp;\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">Diazolinidyl urea&nbsp;\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&nbsp;\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&#46;0&nbsp;\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&nbsp;\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&nbsp;\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&#46;0&nbsp;\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">Total&nbsp;\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">47<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\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">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                            3 => "A&#46;J&#46; Hendershot"
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Informação do artigo

ISSN: 03650596
Idioma original: Inglês

DOI:10.1016/j.abd.2019.12.009

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2023 Junho	77	43	120
2023 Maio	79	20	99
2023 Abril	59	22	81
2023 Mar�o	83	44	127
2023 Fevereiro	73	36	109
2023 Janeiro	48	32	80
2022 Dezembro	67	21	88
2022 Novembro	102	48	150
2022 Outubro	84	50	134
2022 Setembro	77	67	144
2022 Agosto	58	36	94
2022 Julho	53	55	108
2022 Junho	57	54	111
2022 Maio	50	52	102
2022 Abril	57	51	108
2022 Mar�o	59	67	126
2022 Fevereiro	37	34	71
2022 Janeiro	46	67	113
2021 Dezembro	32	54	86
2021 Novembro	39	48	87
2021 Outubro	47	82	129
2021 Setembro	35	40	75
2021 Agosto	49	42	91
2021 Julho	38	38	76
2021 Junho	38	60	98
2021 Maio	44	76	120
2021 Abril	115	214	329
2021 Mar�o	89	62	151
2021 Fevereiro	28	17	45
2021 Janeiro	63	15	78
2020 Dezembro	44	17	61
2020 Novembro	49	10	59
2020 Outubro	38	14	52
2020 Setembro	35	10	45
2020 Agosto	10	10	20
2020 Julho	14	13	27

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