Nickel Transfer by Fingers | Actas Dermo-Sifiliográficas

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Isnardo, J. Vidal, D. Panyella, J. Vilaplana" "autores" => array:4 [ 0 => array:3 [ "nombre" => "D." "apellidos" => "Isnardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Vidal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "Panyella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "J." "apellidos" => "Vilaplana" "email" => array:1 [ 0 => "Vilaplana.juan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Research Center, Antonio Puig, S.A., Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Rovira i Virgili, Tarragona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Transferencia de níquel mediante los dedos" ] ] "textoCompleto" => "IntroductionDuring the last 30 years in our skin allergy department, we have had the opportunity to examine female patients with a history of intolerance to specific cosmetic products and who were shown to have hypersensitivity to nickel in patch tests. However, searching for nickel in the products used by the patient has yielded positive results only exceptionally.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>A clear history of intolerance to metals is recorded in each case,<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> and this finding is consistent with past relevance for nickel. Hypothetically, transfer of metal ions to the face via the fingers after contact with nickel-releasing metal objects (eg, coins,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> keys, and mobile phones<a class="elsevierStyleCrossRef" href="#bib0025">5</a>) would account for the symptoms of itching, stinging, and, in persons who are highly sensitized to nickel, the occasional finding of erythema.The objectives of the present study were as follows: first, to confirm the transfer of nickel from coins to the fingers; and, second, to verify whether nickel can be transferred from the fingers to the face.Material and MethodsA tape stripping method was developed to study the presence of nickel on the skin surface.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Tape stripping involves the use of common adhesive tape not only to verify release of nickel from coins, but also to show that the nickel present on the patient's fingers<a class="elsevierStyleCrossRef" href="#bib0035">7</a> can be transferred to the cheeks after a specific period of time. A roll of transparent adhesive tape (Niceday) measuring 19mm×33m was used to perform tape stripping, first on €1 and €2 coins and then directly on the fingers and cheeks.The tape was cut into strips measuring approximately 5cm, which were then applied to the coins up to 10 times. The process was repeated until approximately of 1g adhesive tape was collected in a clean, sterile plastic container (Deltalab Barcelona). A blank control was created by cutting strips of tape, which were collected in another container until approximately the same weight of tape was obtained. All the samples of adhesive tape were collected in clean, sterile plastic containers until analysis.Verification of Nickel Transfer From the Coins to the FingersThe study was performed on 10 volunteers (aged 30 to 45 years) divided into 2 groups of 5. Three were supermarket cashiers, 2 were hairdressers, and 5 were clerical workers. None of the volunteers had a clinical history of sensitization to nickel or wore prostheses or body piercings. The volunteers stopped wearing jewelry<a class="elsevierStyleCrossRef" href="#bib0040">8</a> 2 days before the test in order to avoid possible contamination of the areas studied.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>The first group had no contact with the coins. The second group rubbed the coins between their fingers for a period of 1hour. During this time, they did not wash their hands and tried not to touch any surfaces suspected of containing nickel.Strips of Niceday tape (approximately 5cm) were cut and applied 10 times to the fingers of each of the 10 volunteers. The process was repeated until 1g of adhesive tape was obtained from each volunteer. A blank control was created by cutting strips of tape, which were collected in another container until 1g of tape was obtained. All the samples of adhesive tape were collected in clean, sterile plastic containers for analysis.Verification of Nickel Transfer From the Fingers to the CheekThe same 10 volunteers who participated in the previous test rubbed the coins between their fingers for 30minutes and then rubbed their cheeks with the same fingers every 5minutes. Strips of transparent adhesive tape (Niceday) measuring approximately 5cm were applied the fingers of each of the volunteers 10 times. The process was repeated until 1g of adhesive tape was obtained from each volunteer. The same process was applied to collect 1g of adhesive tape from the cheeks.In order to verify the initial absence of nickel on the fingers and cheeks, a blank control of the fingers and cheeks was created following the methodology described above.Quantitative Analysis of NickelSamples were prepared and treated in a laboratory that was suitably prepared for determination of metals in order to avoid potential contamination. Inductively coupled plasma mass spectrometry (Agilent 7500ce) was used under standard conditions with helium. Calibration was with rhodium, which was added online as an internal standard (flow injection analysis system).Statistical AnalysisData were analyzed using Minitab version 16.0. A descriptive analysis of the quantitative variables was performed based on measures of central tendency and dispersion. The comparative analysis was performed using the t test with a 95% confidence interval. Statistical significance was set at P<.05.ResultsThe first test to verify release of nickel using tape stripping showed that the values obtained for the tape that had no contact with the coins were significantly lower (0.127ppm) than those of the samples used in coin stripping (53.61ppm) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Verification of Nickel Transfer From the Coins to the FingersThe results for verification of transfer of nickel from coins to fingers were quantifiable and differed between the groups, both when the volunteers were in contact with the coins (mean, 33.15ppm) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and when they were not (mean, 0.41ppm) (P=.02) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Verification of Nickel Transfer From the Fingers to the CheeksThe results (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) show the absence of nickel (0.6ppm on the fingers and 0.4ppm on the cheeks) before contact with coins (T0) and the presence of nickel on the fingers (mean, 8.2ppm) and cheeks (mean, 2.2ppm) after contact with coins (T30min). A statistically significant increase was observed after 30minutes, both for the fingers (P=.033) and for the cheeks (P=.035) (P<.05).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionOur findings show that contact with nickel on the fingers can lead to concentrations that are sufficiently high to cause allergic contact dermatitis via allergen transport in patients with nickel hypersensitivity. We can therefore confirm that tape stripping is a suitable method for monitoring release of nickel and that very low initial levels of nickel on the adhesive tape make it a useful material in this process.We also confirmed transfer of nickel by contact from coins to fingers and that the nickel concentrations found are similar to those reported by other authors.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Furthermore, we confirmed transfer of nickel from the coins to the cheeks via the fingers and showed that the differences were statistically significant. Patients 4 and 7 had increased levels of nickel on their fingers and cheeks, respectively, compared with baseline, possibly owing to contact with metal objects outside the present study that were not reported when the history was taken at inclusion. Although our study is considerably limited by its small sample size, the results are statistically significant and leave no doubt about nickel transfer and, therefore, the potentially harmful effects for susceptible individuals.In conclusion, we show that rapid tape stripping is an easy and efficient method of demonstrating transfer of nickel via contact with coins that can be extended to other objects likely to contain nickel. This transfer could explain how dermatitis-like symptoms can be triggered on the face of very sensitive patients<a class="elsevierStyleCrossRef" href="#bib0050">10</a> through contact with fingers exposed to nickel-releasing objects, even if these symptoms (stinging, itching) are often subjective.Ethical DisclosuresProtection of Persons and AnimalsThe authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association.Confidentiality of DataThe authors declare that no private patient data are disclosed in this article.Right to privacy and informed consentThe authors declare that no private patient data are disclosed in this article.Conflicts of InterestThe authors declare that they have no conflicts of interest." 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Samples were collected from the fingers and cheeks of volunteers using the stripping method with standard adhesive tape, and nickel levels were quantified using mass spectrometry. Fingers and cheeks of individuals who had handled coins were both positive for nickel, with levels ranging from 14.67 to 58.64 ppm and 1.28 to 8.52 ppm, respectively. The levels in a control group were considerably and significantly lower. Transfer of nickel from a person's fingers to their face after handling a nickel-containing object could explain the presence of facial dermatitis in patients with nickel hypersensitivity." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Ante los casos de pacientes con historia de dermatitis facial y con dermatitis de contacto por hipersensibilidad al níquel se propuso investigar fuentes alternativas de exposición, por ejemplo monedas, que fuesen transferidas por los dedos hasta la región facial. Se utilizó cinta adhesiva común para realizar un stripping sobre los dedos y los pómulos de los voluntarios, y se llevó a cabo un análisis a través de técnicas de espectrometría atómica. Los resultados de níquel obtenidos fueron positivos tanto en los dedos, 14,67ppm a 58,64ppm, como en los pómulos, desde 1,28ppm a 8,52ppm, con niveles en controles muy inferiores y significativamente distintos a dichos valores. La transferencia de níquel desde el objeto que lo contiene hasta la cara del individuo mediante sus dedos podría justificar la clínica presentada por estos pacientes." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Isnardo D, Vidal J, Panyella D, Vilaplana J. Transferencia de níquel mediante los dedos. Actas Dermosifiliogr. 2015;106:e23–e26." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Stripping Performed on Coins</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel, ppm \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blank control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.127 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Coins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840240.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results for Nickel in Samples Obtained After Tape Stripping Performed on Coins." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tape Stripping Performed on Exposed Volunteers</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel, ppm \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blank control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.161 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840238.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results for Nickel Found in Samples From Patients Exposed to Coins." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "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="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tape Stripping Performed on Nonexposed Volunteers</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel, ppm \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Blank control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.511 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.124 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.265 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.870 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.306 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840239.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results for Nickel Found in Samples From Patients Not Exposed to Coins." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: Ni, nickel; T0, nickel content before exposure; T30min, nickel content after 30 minutes’ exposure." "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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T0, ppm Ni \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T30min, ppm Ni \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.207 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.541 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.171 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.117 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.963 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.44 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.514 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.535 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.193 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.152 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.298 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.96 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.237 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.266 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.245 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.691 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cheeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.136 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840241.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results for Transfer of Nickel From Fingers and Cheeks After 30 Minutes’ Exposure." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic contact dermatitis from nickel in an eye pencil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Zemba" 1 => "C. Romaguera" 2 => "J. Vilaplana" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "1992" "volumen" => "27" "paginaInicial" => "116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395616" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Kornik" 1 => "K.A. Zug" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nickel. Dermatitis" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "3" "paginaFinal" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nickel hypersensitivity: A clinical review and call to action" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.E. Schram" 1 => "E.M. Warshaw" 2 => "A. Laumann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.04307.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2010" "volumen" => "49" "paginaInicial" => "115" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20465634" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coin exposure may cause allergic nickel dermatitis: A review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.P. Thyssen" 1 => "D.J. Gawkrodger" 2 => "I.R. White" 3 => "A. Julander" 4 => "T. Menné" 5 => "C. 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Estadísticas

E-Case Report

Nickel Transfer by Fingers

Transferencia de níquel mediante los dedos

D. Isnardoa, J. Vidala, D. Panyellaa, J. Vilaplanab,

Autor para correspondencia

Vilaplana.juan@gmail.com

Corresponding author.

a Research Center, Antonio Puig, S.A., Barcelona, Spain

b Universidad Rovira i Virgili, Tarragona, Spain

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        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Research Center&#44; Antonio Puig&#44; S&#46;A&#46;&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Rovira i Virgili&#44; Tarragona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
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    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Transferencia de n&#237;quel mediante los dedos"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">During the last 30 years in our skin allergy department&#44; we have had the opportunity to examine female patients with a history of intolerance to specific cosmetic products and who were shown to have hypersensitivity to nickel in patch tests&#46; However&#44; searching for nickel in the products used by the patient has yielded positive results only exceptionally&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A clear history of intolerance to metals is recorded in each case&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and this finding is consistent with past relevance for nickel&#46; Hypothetically&#44; transfer of metal ions to the face via the fingers after contact with nickel-releasing metal objects &#40;eg&#44; coins&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> keys&#44; and mobile phones<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#41; would account for the symptoms of itching&#44; stinging&#44; and&#44; in persons who are highly sensitized to nickel&#44; the occasional finding of erythema&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objectives of the present study were as follows&#58; first&#44; to confirm the transfer of nickel from coins to the fingers&#59; and&#44; second&#44; to verify whether nickel can be transferred from the fingers to the face&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A tape stripping method was developed to study the presence of nickel on the skin surface&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Tape stripping involves the use of common adhesive tape not only to verify release of nickel from coins&#44; but also to show that the nickel present on the patient&#39;s fingers<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> can be transferred to the cheeks after a specific period of time&#46; A roll of transparent adhesive tape &#40;Niceday&#41; measuring 19<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>33<span class="elsevierStyleHsp" style=""></span>m was used to perform tape stripping&#44; first on &#8364;1 and &#8364;2 coins and then directly on the fingers and cheeks&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The tape was cut into strips measuring approximately 5<span class="elsevierStyleHsp" style=""></span>cm&#44; which were then applied to the coins up to 10 times&#46; The process was repeated until approximately of 1<span class="elsevierStyleHsp" style=""></span>g adhesive tape was collected in a clean&#44; sterile plastic container &#40;Deltalab Barcelona&#41;&#46; A blank control was created by cutting strips of tape&#44; which were collected in another container until approximately the same weight of tape was obtained&#46; All the samples of adhesive tape were collected in clean&#44; sterile plastic containers until analysis&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Verification of Nickel Transfer From the Coins to the Fingers</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was performed on 10 volunteers &#40;aged 30 to 45 years&#41; divided into 2 groups of 5&#46; Three were supermarket cashiers&#44; 2 were hairdressers&#44; and 5 were clerical workers&#46; None of the volunteers had a clinical history of sensitization to nickel or wore prostheses or body piercings&#46; The volunteers stopped wearing jewelry<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> 2 days before the test in order to avoid possible contamination of the areas studied&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The first group had no contact with the coins&#46; The second group rubbed the coins between their fingers for a period of 1<span class="elsevierStyleHsp" style=""></span>hour&#46; During this time&#44; they did not wash their hands and tried not to touch any surfaces suspected of containing nickel&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Strips of Niceday tape &#40;approximately 5<span class="elsevierStyleHsp" style=""></span>cm&#41; were cut and applied 10 times to the fingers of each of the 10 volunteers&#46; The process was repeated until 1<span class="elsevierStyleHsp" style=""></span>g of adhesive tape was obtained from each volunteer&#46; A blank control was created by cutting strips of tape&#44; which were collected in another container until 1<span class="elsevierStyleHsp" style=""></span>g of tape was obtained&#46; All the samples of adhesive tape were collected in clean&#44; sterile plastic containers for analysis&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Verification of Nickel Transfer From the Fingers to the Cheek</span><p id="par0055" class="elsevierStylePara elsevierViewall">The same 10 volunteers who participated in the previous test rubbed the coins between their fingers for 30<span class="elsevierStyleHsp" style=""></span>minutes and then rubbed their cheeks with the same fingers every 5<span class="elsevierStyleHsp" style=""></span>minutes&#46; Strips of transparent adhesive tape &#40;Niceday&#41; measuring approximately 5<span class="elsevierStyleHsp" style=""></span>cm were applied the fingers of each of the volunteers 10 times&#46; The process was repeated until 1<span class="elsevierStyleHsp" style=""></span>g of adhesive tape was obtained from each volunteer&#46; The same process was applied to collect 1<span class="elsevierStyleHsp" style=""></span>g of adhesive tape from the cheeks&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In order to verify the initial absence of nickel on the fingers and cheeks&#44; a blank control of the fingers and cheeks was created following the methodology described above&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Quantitative Analysis of Nickel</span><p id="par0065" class="elsevierStylePara elsevierViewall">Samples were prepared and treated in a laboratory that was suitably prepared for determination of metals in order to avoid potential contamination&#46; Inductively coupled plasma mass spectrometry &#40;Agilent 7500ce&#41; was used under standard conditions with helium&#46; Calibration was with rhodium&#44; which was added online as an internal standard &#40;flow injection analysis system&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Statistical Analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Data were analyzed using Minitab version 16&#46;0&#46; A descriptive analysis of the quantitative variables was performed based on measures of central tendency and dispersion&#46; The comparative analysis was performed using the <span class="elsevierStyleItalic">t</span> test with a 95&#37; confidence interval&#46; Statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The first test to verify release of nickel using tape stripping showed that the values obtained for the tape that had no contact with the coins were significantly lower &#40;0&#46;127<span class="elsevierStyleHsp" style=""></span>ppm&#41; than those of the samples used in coin stripping &#40;53&#46;61<span class="elsevierStyleHsp" style=""></span>ppm&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Verification of Nickel Transfer From the Coins to the Fingers</span><p id="par0085" class="elsevierStylePara elsevierViewall">The results for verification of transfer of nickel from coins to fingers were quantifiable and differed between the groups&#44; both when the volunteers were in contact with the coins &#40;mean&#44; 33&#46;15<span class="elsevierStyleHsp" style=""></span>ppm&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and when they were not &#40;mean&#44; 0&#46;41<span class="elsevierStyleHsp" style=""></span>ppm&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Verification of Nickel Transfer From the Fingers to the Cheeks</span><p id="par0095" class="elsevierStylePara elsevierViewall">The results &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; show the absence of nickel &#40;0&#46;6<span class="elsevierStyleHsp" style=""></span>ppm on the fingers and 0&#46;4<span class="elsevierStyleHsp" style=""></span>ppm on the cheeks&#41; before contact with coins &#40;T0&#41; and the presence of nickel on the fingers &#40;mean&#44; 8&#46;2<span class="elsevierStyleHsp" style=""></span>ppm&#41; and cheeks &#40;mean&#44; 2&#46;2<span class="elsevierStyleHsp" style=""></span>ppm&#41; after contact with coins &#40;T30<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; A statistically significant increase was observed after 30<span class="elsevierStyleHsp" style=""></span>minutes&#44; both for the fingers &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41; and for the cheeks &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Our findings show that contact with nickel on the fingers can lead to concentrations that are sufficiently high to cause allergic contact dermatitis via allergen transport in patients with nickel hypersensitivity&#46; We can therefore confirm that tape stripping is a suitable method for monitoring release of nickel and that very low initial levels of nickel on the adhesive tape make it a useful material in this process&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We also confirmed transfer of nickel by contact from coins to fingers and that the nickel concentrations found are similar to those reported by other authors&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Furthermore&#44; we confirmed transfer of nickel from the coins to the cheeks via the fingers and showed that the differences were statistically significant&#46; Patients 4 and 7 had increased levels of nickel on their fingers and cheeks&#44; respectively&#44; compared with baseline&#44; possibly owing to contact with metal objects outside the present study that were not reported when the history was taken at inclusion&#46; Although our study is considerably limited by its small sample size&#44; the results are statistically significant and leave no doubt about nickel transfer and&#44; therefore&#44; the potentially harmful effects for susceptible individuals&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion&#44; we show that rapid tape stripping is an easy and efficient method of demonstrating transfer of nickel via contact with coins that can be extended to other objects likely to contain nickel&#46; This transfer could explain how dermatitis-like symptoms can be triggered on the face of very sensitive patients<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> through contact with fingers exposed to nickel-releasing objects&#44; even if these symptoms &#40;stinging&#44; itching&#41; are often subjective&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethical Disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protection of Persons and Animals</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed adhere to the ethical guidelines of the responsible committee on human experimentation and comply with the Declaration of Helsinki of the World Medical Association&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Confidentiality of Data</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Right to privacy and informed consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Material and Methods"
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              "identificador" => "sec0060"
              "titulo" => "Verification of Nickel Transfer From the Coins to the Fingers"
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              "identificador" => "sec0065"
              "titulo" => "Verification of Nickel Transfer From the Fingers to the Cheek"
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            2 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Quantitative Analysis of Nickel"
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              "titulo" => "Statistical Analysis"
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          "titulo" => "Results"
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              "titulo" => "Verification of Nickel Transfer From the Coins to the Fingers"
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            1 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Verification of Nickel Transfer From the Fingers to the Cheeks"
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          "identificador" => "sec0030"
          "titulo" => "Discussion"
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          "identificador" => "sec0035"
          "titulo" => "Ethical Disclosures"
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              "titulo" => "Protection of Persons and Animals"
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              "identificador" => "sec0045"
              "titulo" => "Confidentiality of Data"
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            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
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        9 => array:2 [
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          "titulo" => "Conflicts of Interest"
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    "fechaRecibido" => "2014-01-31"
    "fechaAceptado" => "2014-11-22"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec540942"
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            0 => "Cosmetics"
            1 => "Nickel"
            2 => "Dermatitis"
            3 => "Contact"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "Cosm&#233;ticos"
            1 => "N&#237;quel"
            2 => "Dermatitis"
            3 => "Contacto"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We investigated fingers as a potential source of nickel transfer to the face in patients with allergic contact dermatitis to nickel and a history of facial dermatitis&#46; Samples were collected from the fingers and cheeks of volunteers using the stripping method with standard adhesive tape&#44; and nickel levels were quantified using mass spectrometry&#46; Fingers and cheeks of individuals who had handled coins were both positive for nickel&#44; with levels ranging from 14&#46;67 to 58&#46;64&#160;ppm and 1&#46;28 to 8&#46;52&#160;ppm&#44; respectively&#46; The levels in a control group were considerably and significantly lower&#46; Transfer of nickel from a person&#39;s fingers to their face after handling a nickel-containing object could explain the presence of facial dermatitis in patients with nickel hypersensitivity&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ante los casos de pacientes con historia de dermatitis facial y con dermatitis de contacto por hipersensibilidad al n&#237;quel se propuso investigar fuentes alternativas de exposici&#243;n&#44; por ejemplo monedas&#44; que fuesen transferidas por los dedos hasta la regi&#243;n facial&#46; Se utiliz&#243; cinta adhesiva com&#250;n para realizar un <span class="elsevierStyleItalic">stripping</span> sobre los dedos y los p&#243;mulos de los voluntarios&#44; y se llev&#243; a cabo un an&#225;lisis a trav&#233;s de t&#233;cnicas de espectrometr&#237;a at&#243;mica&#46; Los resultados de n&#237;quel obtenidos fueron positivos tanto en los dedos&#44; 14&#44;67<span class="elsevierStyleHsp" style=""></span>ppm a 58&#44;64<span class="elsevierStyleHsp" style=""></span>ppm&#44; como en los p&#243;mulos&#44; desde 1&#44;28<span class="elsevierStyleHsp" style=""></span>ppm a 8&#44;52<span class="elsevierStyleHsp" style=""></span>ppm&#44; con niveles en controles muy inferiores y significativamente distintos a dichos valores&#46; La transferencia de n&#237;quel desde el objeto que lo contiene hasta la cara del individuo mediante sus dedos podr&#237;a justificar la cl&#237;nica presentada por estos pacientes&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Isnardo D&#44; Vidal J&#44; Panyella D&#44; Vilaplana J&#46; Transferencia de n&#237;quel mediante los dedos&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;e23&#8211;e26&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Stripping Performed on Coins</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel&#44; ppm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Blank control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Coins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;61&nbsp;\t\t\t\t\t\t\n
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                  <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="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tape Stripping Performed on Exposed Volunteers</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel&#44; ppm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Blank control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab840238.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Results for Nickel Found in Samples From Patients Exposed to Coins&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "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="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tape Stripping Performed on Nonexposed Volunteers</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nickel&#44; ppm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Blank control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;511&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;124&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;265&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results for Nickel Found in Samples From Patients Not Exposed to Coins&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Ni&#44; nickel&#59; T0&#44; nickel content before exposure&#59; T30<span class="elsevierStyleHsp" style=""></span>min&#44; nickel content after 30 minutes&#8217; exposure&#46;</p>"
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                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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Volunteer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T0&#44; ppm Ni&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">T30<span class="elsevierStyleHsp" style=""></span>min&#44; ppm Ni&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;963&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;535&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;298&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;266&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;691&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cheeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab840241.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Results for Transfer of Nickel From Fingers and Cheeks After 30 Minutes&#8217; Exposure&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Allergic contact dermatitis from nickel in an eye pencil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "C&#46; Romaguera"
                            2 => "J&#46; Vilaplana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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                        "fecha" => "1992"
                        "volumen" => "27"
                        "paginaInicial" => "116"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Kornik"
                            1 => "K&#46;A&#46; Zug"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nickel&#46; Dermatitis"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nickel hypersensitivity&#58; A clinical review and call to action"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;E&#46; Schram"
                            1 => "E&#46;M&#46; Warshaw"
                            2 => "A&#46; Laumann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2009.04307.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2010"
                        "volumen" => "49"
                        "paginaInicial" => "115"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20465634"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coin exposure may cause allergic nickel dermatitis&#58; A review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;P&#46; Thyssen"
                            1 => "D&#46;J&#46; Gawkrodger"
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Información del artículo

ISSN: 15782190
Idioma original: Inglés

DOI:10.1016/j.adengl.2015.04.011

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