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1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The initial suspicion was protein contact dermatitis &#40;PCD&#41; to shellfish&#46; The additional tests performed to confirm the diagnosis were as follows&#58;</p><p id="par0020" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Skin biopsy&#44;</span> which revealed spongiotic dermatitis with a perivascular lymphocytic infiltrate in the papillary dermis and eosinophils&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Rub test</span> with the patient&#8217;s own products &#40;prawn&#44; king prawn&#44; and shrimp&#41;&#44; which led to pruritus and erythema after 10&#8239;minutes on the areas of the skin with eczematous lesions and no reaction on healthy skin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Prick test</span> &#40;prick-by-prick test&#41; with the patient&#8217;s own products &#40;prawn&#44; king prawn&#44; shrimp&#44; and latex&#41;&#58; the reading at 20&#8239;minutes revealed positive results &#40;&#62;&#8239;3&#8239;mm&#41;&#44; as follows&#58; prawn&#44; &#43;&#43;&#59; king prawn&#44; &#43;&#43;&#43;&#59; shrimp&#44; &#43;&#43; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Patch tests from the standard series of the Spanish Skin Allergy and Contact Dermatitis Research Group</span> and the patient&#8217;s own products &#40;prawn shell&#44; prawn meat&#44; king prawn shell&#44; king prawn meat&#44; shrimp shell&#44; shrimp meat&#41;&#46; A reading at 72&#8239;hours revealed a doubtful reaction &#40;&#43;&#47;&#8722;&#44; edge effect to prawn meat&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The reading at 168&#8239;hours revealed no positive results&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Exogenous dermatitis is classed as irritant contact dermatitis and allergic contact dermatitis &#40;ACD&#41;&#46; ACD is mediated by a delayed hypersensitivity mechanism &#40;type <span class="elsevierStyleSmallCaps">iv</span>&#41;&#46; Other clinical pictures are triggered by immediate hypersensitivity mechanisms &#40;type <span class="elsevierStyleSmallCaps">i</span>&#41;&#44; such as allergic contact urticaria manifesting as wheals and&#47;or urticaria or conditions triggered by a combination of both mechanisms&#44; such as PCD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case of PCD&#44; the allergens are high-molecular-weight proteins that are associated mainly with food &#40;animal proteins&#44; vegetable proteins&#44; flours&#44; cereals&#44; and enzymes&#41;&#46; Therefore&#44; this type of dermatitis is more common in professionals working in this field &#40;e&#46;g&#46;&#44; cooks&#44; butchers&#44; bakers&#41;&#44; without forgetting homemakers and people who cook at home&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Onset of symptoms is minutes after exposure and is characterized by erythema&#44; intense pruritus&#44; and&#47;or vesicular lesions on previous dermatitis lesions &#40;i&#46;e&#46;&#44; on damaged skin&#44; not healthy skin&#41;&#46; PCD does not manifest as wheals&#44; thus enabling it to be distinguished from chronic idiopathic urticaria&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The absence of symptoms after exposure in healthy skin can be explained by the fact that the allergens in PCD are high-molecular-weight proteins that do not come into contact with Langerhans cell receptors&#46; In contrast&#44; in ACD or chronic idiopathic urticaria&#44; the allergens are low-molecular-weight haptens&#44; which can cross the epidermal barrier easily&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore&#44; PCD leads to a positive result in the rub test on affected skin and a negative result on healthy skin&#44; unlike ACD and chronic idiopathic urticaria&#44; where the result is positive in both&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patch tests are essential for distinguishing between these conditions and are negative in most cases of PCD&#46; This makes it possible to establish a differential diagnosis with ACD&#46; On the other hand&#44; prick testing&#44; which reproduces an IgE-mediated reaction&#44; is positive in most cases of PCD and negative in ACD&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment is based on 2 fundamental pillars&#58; avoidance of the allergen involved in the reaction and treatment of the skin lesions&#44; which depends on the degree of involvement and severity&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the present case&#44; the acute onset of symptoms&#44; mainly pruritis after contact with shellfish&#44; and the negative rub test result enabled us to reasonably rule out contact urticaria to shellfish&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This observation&#44; together with the negative patch test results&#44; made it possible to confirm the diagnosis of PCD to raw shellfish&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The patient was recommended to avoid contact with shellfish and prescribed a topical corticosteroid&#46; The lesions resolved after a few months&#44; and the patient has not experienced new flare-ups after 8 months of follow-up&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This condition should be suspected in patients with hand eczema who handle food&#46; Since patch test results are mostly negative&#44; it is necessary to perform immediate-type tests&#44; with prick-by-prick being the most sensitive approach in these cases&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Hand Lesions After Contact With Shellfish: Beyond Patch Testing
Lesiones en manos tras contacto con marisco, más allá de las pruebas epicutáneas
A. Calleja Algarra
Corresponding author
albacallejaalgarra@gmail.com

Corresponding author.
, R. Aragón Miguel, F.J. Ortiz de Frutos, F. Tous Romero
Hospital 12 de Octubre, Madrid, Spain
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    "titulo" => "Hand Lesions After Contact With Shellfish&#58; Beyond Patch Testing"
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        "titulo" => "Lesiones en manos tras contacto con marisco&#44; m&#225;s all&#225; de las pruebas epicut&#225;neas"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patch test reading at 72&#8239;hours&#58; uncertain positive result &#40;&#43;&#47;&#8722;&#41; to shrimp meat&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 52-year-old woman with a history of pollen allergy and hand eczema&#46; She was referred to our department with redness&#44; itching&#44; and inflammation of the hands that had first appeared 24&#8239;hours earlier after contact with raw shellfish&#46; These episodes rarely appeared when her hand eczema was well controlled&#46; The patient denied having experienced wheals or labial edema after intake of raw shellfish&#46; She reported worsening of the condition after using latex gloves at work&#44; which forced her to stop using them&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed erythematous&#44; scaly plaques with marked lichenification on the dorsa of the hands and lateral aspects of the fingers&#46; Superficial fissures were also observed on the fingers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The initial suspicion was protein contact dermatitis &#40;PCD&#41; to shellfish&#46; The additional tests performed to confirm the diagnosis were as follows&#58;</p><p id="par0020" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Skin biopsy&#44;</span> which revealed spongiotic dermatitis with a perivascular lymphocytic infiltrate in the papillary dermis and eosinophils&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Rub test</span> with the patient&#8217;s own products &#40;prawn&#44; king prawn&#44; and shrimp&#41;&#44; which led to pruritus and erythema after 10&#8239;minutes on the areas of the skin with eczematous lesions and no reaction on healthy skin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Prick test</span> &#40;prick-by-prick test&#41; with the patient&#8217;s own products &#40;prawn&#44; king prawn&#44; shrimp&#44; and latex&#41;&#58; the reading at 20&#8239;minutes revealed positive results &#40;&#62;&#8239;3&#8239;mm&#41;&#44; as follows&#58; prawn&#44; &#43;&#43;&#59; king prawn&#44; &#43;&#43;&#43;&#59; shrimp&#44; &#43;&#43; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">- <span class="elsevierStyleItalic">Patch tests from the standard series of the Spanish Skin Allergy and Contact Dermatitis Research Group</span> and the patient&#8217;s own products &#40;prawn shell&#44; prawn meat&#44; king prawn shell&#44; king prawn meat&#44; shrimp shell&#44; shrimp meat&#41;&#46; A reading at 72&#8239;hours revealed a doubtful reaction &#40;&#43;&#47;&#8722;&#44; edge effect to prawn meat&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The reading at 168&#8239;hours revealed no positive results&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Exogenous dermatitis is classed as irritant contact dermatitis and allergic contact dermatitis &#40;ACD&#41;&#46; ACD is mediated by a delayed hypersensitivity mechanism &#40;type <span class="elsevierStyleSmallCaps">iv</span>&#41;&#46; Other clinical pictures are triggered by immediate hypersensitivity mechanisms &#40;type <span class="elsevierStyleSmallCaps">i</span>&#41;&#44; such as allergic contact urticaria manifesting as wheals and&#47;or urticaria or conditions triggered by a combination of both mechanisms&#44; such as PCD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the case of PCD&#44; the allergens are high-molecular-weight proteins that are associated mainly with food &#40;animal proteins&#44; vegetable proteins&#44; flours&#44; cereals&#44; and enzymes&#41;&#46; Therefore&#44; this type of dermatitis is more common in professionals working in this field &#40;e&#46;g&#46;&#44; cooks&#44; butchers&#44; bakers&#41;&#44; without forgetting homemakers and people who cook at home&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Onset of symptoms is minutes after exposure and is characterized by erythema&#44; intense pruritus&#44; and&#47;or vesicular lesions on previous dermatitis lesions &#40;i&#46;e&#46;&#44; on damaged skin&#44; not healthy skin&#41;&#46; PCD does not manifest as wheals&#44; thus enabling it to be distinguished from chronic idiopathic urticaria&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The absence of symptoms after exposure in healthy skin can be explained by the fact that the allergens in PCD are high-molecular-weight proteins that do not come into contact with Langerhans cell receptors&#46; In contrast&#44; in ACD or chronic idiopathic urticaria&#44; the allergens are low-molecular-weight haptens&#44; which can cross the epidermal barrier easily&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore&#44; PCD leads to a positive result in the rub test on affected skin and a negative result on healthy skin&#44; unlike ACD and chronic idiopathic urticaria&#44; where the result is positive in both&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patch tests are essential for distinguishing between these conditions and are negative in most cases of PCD&#46; This makes it possible to establish a differential diagnosis with ACD&#46; On the other hand&#44; prick testing&#44; which reproduces an IgE-mediated reaction&#44; is positive in most cases of PCD and negative in ACD&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Treatment is based on 2 fundamental pillars&#58; avoidance of the allergen involved in the reaction and treatment of the skin lesions&#44; which depends on the degree of involvement and severity&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the present case&#44; the acute onset of symptoms&#44; mainly pruritis after contact with shellfish&#44; and the negative rub test result enabled us to reasonably rule out contact urticaria to shellfish&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This observation&#44; together with the negative patch test results&#44; made it possible to confirm the diagnosis of PCD to raw shellfish&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The patient was recommended to avoid contact with shellfish and prescribed a topical corticosteroid&#46; The lesions resolved after a few months&#44; and the patient has not experienced new flare-ups after 8 months of follow-up&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This condition should be suspected in patients with hand eczema who handle food&#46; Since patch test results are mostly negative&#44; it is necessary to perform immediate-type tests&#44; with prick-by-prick being the most sensitive approach in these cases&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Calleja Algarra A&#44; Arag&#243;n Miguel R&#44; Ortiz de Frutos FJ&#44; Tous Romero F&#46; Lesiones en manos tras contacto con marisco&#44; m&#225;s all&#225; de las pruebas epicut&#225;neas&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;274&#8211;275&#46;</p>"
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ISSN: 15782190
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Idiomas
Actas Dermo-Sifiliográficas
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