Letter to the Editor
Allergic Contact Dermatitis in Medical Professionals Due to Exposure to Ultrasound Gel
Dermatitis alérgica de contacto en profesionales médicos por exposición a gel ecográfico
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"saludo" => "<span class="elsevierStyleItalic">To the Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "116" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Javier Garcia-Miguel, Nuria Lamas-Doménech, Pere Barceló-Garcia" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Javier" "apellidos" => "Garcia-Miguel" "email" => array:1 [ 0 => "35778jgm@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nuria" "apellidos" => "Lamas-Doménech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Pere" "apellidos" => "Barceló-Garcia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitari Sagrat Cor-Quirón Salud, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Sagrat Cor-Quirón Salud, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto en profesionales médicos por exposición a gel ecográfico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1156 "Ancho" => 995 "Tamanyo" => 166428 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive patch tests 72<span class="elsevierStyleHsp" style=""></span>h after exposure to methylisothiazolinone (top) and ultrasound gel (bottom).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There are numerous publications describing the development of allergic contact dermatitis caused by the presence of isothiazolinone, a preservative used in household cleaning and personal care products, as well as in materials for industrial use, such as paint and varnish.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Isothiazolinones are found in those products as a mixture of methylchloroisothiazolinone and methylisothiazolinone in a proportion of 3:1 (a compound known commercially as Kathon CG). They are heterocyclic organic components with powerful antibacterial and antifungal activities. However, they interact with epidermal proteins, and can induce allergic sensitivity. In Europe, they are the second most common cause of allergic dermatitis secondary to preservatives, preceded only by formaldehyde releasers; they have even been considered responsible for an “authentic allergy epidemic” because of their widespread presence in the market.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Isothiazolinones are used as preservatives in ultrasound gels, and there are publications dealing with patients who have developed allergic contact dermatitis, in most cases after undergoing gynecological ultrasound or other procedures that involve the use of these gels.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> However, there are few reports in the literature describing allergic contact dermatitis caused by ultrasound gels in health care professionals who carry out ultrasound studies.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 28-year-old man, a rheumatologist with no history of allergies, who has worked for the last 10 years in a rheumatology department where he performed musculoskeletal ultrasound, without gloves, on a regular basis, using the ultrasound gel Mebaline<span class="elsevierStyleSup">®</span> (Esteer PHARMA GmbH, Reilingen, Germany). The patient reported the appearance of pruritic, eczematous lesions on the outer side of the pads of the 4th and 5th fingers and in the middle segment of the 3rd finger of his dominant hand (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Erythema with a few vesicles and scaling were observed and painful fissures appeared that developed into skin atrophy over a 2-month period. The lesions did not improve with the application of moisturizing cream or intermediate-potency topical corticosteroids.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The composition of the ultrasound gel used was glycerin, carbomer, sodium hydroxide, propylene glycol, methylisothiazolinone, iodopropynyl, butylcarbamate and sodium chloride. As dermatitis secondary to prolonged contact with the ultrasound gel was suspected (the lesions coincided with the areas of skin exposed to the gel during manipulation of the ultrasound transducer), patch tests were carried out for methylisothiazolinone and the ultrasound get, with positive results for both substances (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient began to use latex gloves to avoid contact with the allergen and a moisturizer for his skin, and 3–4 weeks later, there was a marked improvement. In addition, the ultrasound gel was replaced by a hypoallergenic product.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis generally appears as a subacute or chronic eczema, especially on the hands and face (in the case of cosmetic use), and can sometimes mimic chronic irritant dermatitis. Logistic regression analyses have identified painters, blacksmiths, operators of industrial machinery and individuals whose profession involves the use of cosmetics as being at risk, especially those over the age of 40 years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In the case we report here, the principal sensitizer was methylchloroisothiazolinone and the cause was prolonged exposure to this compound.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Allergic dermatitis produced by ultrasound gels is rare, and has mainly been associated with substances like propylene glycol, methyldibromo glutaronitrile, parabens, imidazolidinyl urea and isothiazolinones. The series published to date mention cases in which patients have undergone ultrasound examinations, but the medical literature makes no reference to health care professionals.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Informative message</span>: any eczema located on the dominant hand in health care professionals who perform ultrasound examinations may be secondary to contact dermatitis caused by the ultrasound gel.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcia-Miguel J, Lamas-Doménech N, Barceló-Garcia P. Dermatitis alérgica de contacto en profesionales médicos por exposición a gel ecográfico. Reumatol Clin. 2016;12:115–116.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 751 "Ancho" => 995 "Tamanyo" => 96322 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Eczematous lesions with fissures in the skin on the outer side of the pads of the 3rd, 4th and 5th fingers of the dominant hand. Erythema with a few vesicles, scaling and painful fissures in the skin are observed.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1156 "Ancho" => 995 "Tamanyo" => 166428 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Positive patch tests 72<span class="elsevierStyleHsp" style=""></span>h after exposure to methylisothiazolinone (top) and ultrasound gel (bottom).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización en la dermatitis de contacto alérgica por metilcloroisotiazolinona/metilisotiazolinona y metilisotiazolinona" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. 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Johanssen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12286" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "295" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25141913" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Undisclosed methylisothiazolinone in an ultrasound gel causing occupational allergic contact dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.T. Madsen" 1 => "S. Broesby-Olsen" 2 => "K.E. Andersen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cod.12282" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "312" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25345795" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000002/v1_201604080059/S2173574316000228/v1_201604080059/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000002/v1_201604080059/S2173574316000228/v1_201604080059/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316000228?idApp=UINPBA00004M" ]
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| 2024 August | 328 | 141 | 469 |
| 2024 July | 251 | 41 | 292 |
| 2024 June | 210 | 44 | 254 |
| 2024 May | 227 | 44 | 271 |
| 2024 April | 271 | 13 | 284 |
| 2024 March | 404 | 37 | 441 |
| 2024 February | 534 | 27 | 561 |
| 2024 January | 354 | 36 | 390 |
| 2023 December | 398 | 29 | 427 |
| 2023 November | 309 | 37 | 346 |
| 2023 October | 304 | 28 | 332 |
| 2023 September | 212 | 32 | 244 |
| 2023 August | 254 | 19 | 273 |
| 2023 July | 242 | 22 | 264 |
| 2023 June | 202 | 25 | 227 |
| 2023 May | 175 | 37 | 212 |
| 2023 April | 183 | 7 | 190 |
| 2023 March | 248 | 28 | 276 |
| 2023 February | 198 | 33 | 231 |
| 2023 January | 153 | 25 | 178 |
| 2022 December | 137 | 29 | 166 |
| 2022 November | 268 | 35 | 303 |
| 2022 October | 222 | 39 | 261 |
| 2022 September | 249 | 36 | 285 |
| 2022 August | 252 | 49 | 301 |
| 2022 July | 155 | 51 | 206 |
| 2022 June | 172 | 39 | 211 |
| 2022 May | 221 | 43 | 264 |
| 2022 April | 197 | 50 | 247 |
| 2022 March | 211 | 63 | 274 |
| 2022 February | 181 | 36 | 217 |
| 2022 January | 179 | 58 | 237 |
| 2021 December | 132 | 45 | 177 |
| 2021 November | 136 | 51 | 187 |
| 2021 October | 132 | 73 | 205 |
| 2021 September | 150 | 53 | 203 |
| 2021 August | 170 | 43 | 213 |
| 2021 July | 185 | 35 | 220 |
| 2021 June | 171 | 28 | 199 |
| 2021 May | 204 | 45 | 249 |
| 2021 April | 440 | 98 | 538 |
| 2021 March | 272 | 35 | 307 |
| 2021 February | 141 | 25 | 166 |
| 2021 January | 118 | 22 | 140 |
| 2020 December | 68 | 18 | 86 |
| 2020 November | 115 | 23 | 138 |
| 2020 October | 81 | 14 | 95 |
| 2020 September | 67 | 32 | 99 |
| 2020 August | 41 | 14 | 55 |
| 2020 July | 45 | 12 | 57 |
| 2020 June | 37 | 20 | 57 |
| 2020 May | 49 | 13 | 62 |
| 2020 April | 27 | 14 | 41 |
| 2020 March | 15 | 6 | 21 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 9 | 2 | 11 |
| 2018 April | 69 | 8 | 77 |
| 2018 March | 77 | 6 | 83 |
| 2018 February | 61 | 7 | 68 |
| 2018 January | 52 | 5 | 57 |
| 2017 December | 52 | 7 | 59 |
| 2017 November | 45 | 5 | 50 |
| 2017 October | 33 | 8 | 41 |
| 2017 September | 32 | 11 | 43 |
| 2017 August | 64 | 6 | 70 |
| 2017 July | 30 | 14 | 44 |
| 2017 June | 51 | 16 | 67 |
| 2017 May | 56 | 15 | 71 |
| 2017 April | 35 | 10 | 45 |
| 2017 March | 45 | 9 | 54 |
| 2017 February | 54 | 16 | 70 |
| 2017 January | 31 | 9 | 40 |
| 2016 December | 69 | 16 | 85 |
| 2016 November | 93 | 16 | 109 |
| 2016 October | 108 | 13 | 121 |
| 2016 September | 87 | 10 | 97 |
| 2016 August | 54 | 10 | 64 |
| 2016 July | 42 | 7 | 49 |
| 2016 June | 1 | 0 | 1 |
| 2016 May | 3 | 0 | 3 |
| 2016 April | 2 | 15 | 17 |
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