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Spain&#41;&#44; as well as the products provided by the patient and additional tests on a case-by-case basis depending on the clinical suspicion&#46; The allergens were applied on the back of the patient on healthy-appearing skin and covered for 48<span class="elsevierStyleHsp" style=""></span>h with AllergEAZE<span class="elsevierStyleSup">&#174;</span> Finn chambers &#40;Hamburg&#44; Germany&#41;&#46; Patch reactions were evaluated at 48 and 96<span class="elsevierStyleHsp" style=""></span>h&#44; and scored according to the criteria of the International Contact Dermatitis Research Group &#40;ICDRG&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive diagnosis was based on the results of epicutaneous testing and epidemiological and clinical parameters&#44; applying the hand eczema classification proposed by Agner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We compared the frequency of different forms of hand eczema in the paediatric and adult population&#46; We compared the age&#44; sex&#44; prevalence of allergy and prevalence of ACD in children with hand eczema and children with eczema in other locations&#46; We used the Fisher exact test to compare qualitative variables&#44; and the Wilcoxon sum-rank test to compare age between groups&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Between January 1996 and December 2015&#44; 5985 patients were referred to the skin allergy unit&#44; of who 389 &#40;6&#46;5&#37;&#41; were children aged 0&#8211;16 years&#59; 1153 patients &#40;19&#46;3&#37;&#41; had eczema localized exclusively in the hands&#44; and 42 of them &#40;3&#46;6&#37;&#41; were children&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the epidemiological characteristics of children with hand eczema and children with eczema in other locations&#46; Of the 42 children with hand eczema referred to our unit&#44; 25 &#40;59&#46;5&#37;&#41; were female and 17 &#40;40&#46;5&#37;&#41; male&#46; The sex distribution of children with hand eczema was similar to the sex distribution in children with eczema in other locations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;87&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The mean and standard deviation of the age of patients with hand eczema was 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9 years&#44; with ages ranging between 3 and 16 years&#46; There were no statistically significant differences in age between children with hand eczema and children with eczema in other locations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>66&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The final diagnosis made after performance of epicutaneous tests was atopic dermatitis in 15 patients &#40;35&#46;7&#37;&#41;&#44; ACD in 14 patients &#40;33&#46;3&#37;&#41;&#44; vesicular endogenous eczema in 6 patients &#40;14&#46;3&#37;&#41;&#44; hyperkeratotic endogenous eczema in 5 patients &#40;11&#46;9&#37;&#41; and irritant contact dermatitis in 2 patients &#40;4&#46;8&#37;&#41;&#46; The prevalence of ACD in children with hand eczema was lower compared to children with eczema in other locations &#40;39&#46;5&#37;&#41;&#44; although the difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>5&#41;&#46; Two patients that received a diagnosis of ACD also met the criteria for atopic dermatitis&#44; which had not been diagnosed&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the distribution of the paediatric and adult patients included in the analysis by type of hand eczema&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The results of patch testing were positive in a total of 16 children &#40;38&#46;1&#37;&#41;&#46; The prevalence of contact allergy was lower compared to the other children referred to our unit &#40;51&#46;6&#37;&#41;&#44; a difference that was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>09&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The allergens detected most frequently where thimerosal &#40;9 cases&#41;&#44; nickel &#40;5 cases&#41;&#44; mercury &#40;5 cases&#41; and cobalt &#40;4 cases&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows a complete list of the identified allergens and their relevance&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The areas of the hand involved most frequently &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; were the fingertips &#40;12 cases&#44; 28&#46;6&#37;&#41;&#44; palms &#40;9 cases&#44; 21&#46;4&#37;&#41;&#44; dorsum &#40;5 cases&#44; 11&#46;9&#37;&#41; and sides &#40;4 cases&#44; 9&#46;5&#37;&#41;&#46; In 12 cases &#40;28&#46;6&#37;&#41; involvement was diffuse&#44; without a primary site&#46; In patients with ACD&#44; the most frequent type of involvement was diffuse &#40;10 cases&#44; 71&#46;4&#37;&#41;&#44; followed by involvement of fingertips &#40;2 cases&#44; 14&#46;3&#37;&#41;&#44; dorsum &#40;1case&#44; 7&#46;1&#37;&#41; and palm &#40;1 case&#44; 7&#46;1&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The sensitization mechanism in patients with ACD was iatrogenic in 8 cases&#44; cosmetic in 2 cases&#44; use of gloves in 2 cases&#44; use of toys &#40;playdough&#41; in 1 case&#44; and use of costume jewellery in 1 case&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The prevalence of hand eczema in the paediatric population referred for epicutaneous testing was 10&#37;&#46; This figure is slightly lower compared to the prevalence reported in other studies conducted in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> which was probably due to our selection of patients with exclusive involvement of the hands&#46; In studies in adults that selected patients in who eczema was restricted to the hands&#44; the reported prevalence was similar to the one found in our study&#44; ranging between 7&#37; and 15&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;3&#8211;6&#44;8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean age of children with eczema was similar to the age of the rest of children referred for testing&#44; with a similar range and comprehending every age group under study&#46; Similarly&#44; we did not find differences in the distribution of eczema by sex between the two groups&#46; This was consistent with other studies that showed that hand eczema manifests in children as well as adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Overall&#44; endogenous eczema accounted for 62&#37; of cases&#46; However&#44; only half of patients with endogenous hand eczema met the criteria for diagnosis of atopic dermatitis&#46; This finding was consistent with or clinical experience&#44; as we often have patients with hand eczema that cannot be explained by an external cause and who do not meet the criteria for atopic dermatitis&#46; Other studies have found a higher incidence of atopic dermatitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#8211;9</span></a> which may be due to those studies not including specific classifications of vesicular and hyperkeratotic endogenous eczema&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The second most frequent diagnosis was ACD&#44; which was given to 1 out of 3 children with hand eczema&#46; The fact that some patients with ACD also met the criteria for atopic dermatitis highlights the importance of ruling out a superimposed allergy in patients with hand eczema and atopic dermatitis&#44; as recommended in European clinical practice guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The main difference in comparison to adult patients was the low prevalence of irritant contact dermatitis in children&#44; which is one of the most frequent causes of hand eczema in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> This may be due to the fact that most cases of hand eczema due to irritant contact result from a regular use of irritants in the home or workplace&#44; something that is uncommon among children&#46; Frequent handwashing or prolonged contact with liquids is also much more prevalent in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> Another difference was the low prevalence of atopic hand eczema in the adult population compared to other endogenous forms of hand eczema&#46; This is consistent with the findings of other studies in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The allergens involved in cases of ACD in the hands were similar to those found in other studies in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;9</span></a> As reported in other publications on skin allergy&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a> metals were the type of allergen identified most frequently in our study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Thimerosal was the most frequently identified allergen&#46; However&#44; fewer than half of the reactions to thimerosal seemed relevant to the hand eczema&#46; The reason is that thimerosal is a preservative that is no longer in use&#46; In our study&#44; all cases related to hypersensitivity reactions to thimerosal and mercury involved the use of mercury-based antiseptic solutions that are no longer distributed&#46; At present&#44; allergies to mercury or thimerosal that play a significant role in hand eczema are extremely rare&#44; despite them being the allergens identified most frequently through patch testing in children and adults&#46; This is the reason why the GEIDAC has decided to remove thimerosal from the allergens included in the standard patch test series&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Nickel and cobalt are very frequent allergens in the paediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;12&#44;14&#44;15</span></a> As is the case with thimerosal&#44; the relevance of sensitization to these substances is frequently dubious&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The new regulation of the European Commission substantially limiting the amount of nickel and other potentially allergenic metals that can be present in costume jewellery was enacted in 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Therefore&#44; it is expected that the incidence of cases involving a relevant sensitivity to nickel will decline in upcoming years&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Rosin and abitol are adhesives used in various products&#44; such as footwear&#44; gloves&#44; or dressings&#44; and in our study they were only detected in cases involving the use of dressings for medical care&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> Sensitization to rosin is also a marker of fragrance allergy&#44; so allergy to fragrances should be ruled out in patients with a positive patch test result for rosin&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Diaminodiphenylmethane is used as a curing agent in epoxy resins and in the manufacturing of lycra fibres&#46; In our study&#44; hypersensitivity to this substance was associated with the use of plastic gloves&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Following metals and adhesives&#44; preservatives were the third most frequent type of allergen found in children with ACD with hand involvement&#46; The most relevant preservatives are methylchloroisothiazolinone and methylisothiazolinone &#40;MCI&#47;MI&#41;&#46; At present&#44; they are the allergens most frequently involved in allergic reactions to cosmetics in adults<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20&#8211;22</span></a> and some studies have also reported a high prevalence of sensitization in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a> The reason is that MCI&#47;MI are ubiquitous substances&#44; found in every type of skin care product for children &#40;wet wipes&#44; moisturizing lotions&#44; fragrances&#41; or even craft materials&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a> and call for a high level of diagnostic suspicion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; the area of the hand that was involved most frequently was the fingertips&#44; unlike other studies conducted in adults where the fingertips were involved less frequently than the palm or the fingers&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;9&#44;26</span></a> It is worth highlighting that most cases of ACD manifested in several areas of the hand&#44; without a clear demarcation of lesions&#46; Boonstra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> found similar results&#44; with a much higher incidence of ACD in cases that could not be clearly classified based on the primary site of involvement&#46; This can be explained by the allergen &#40;cosmetics&#44; dressings&#44; antiseptics&#44; &#8230;&#41; being in contact with different anatomical parts of the hand at the same time&#44; resulting in the absence of a clear primary site&#46; Thus&#44; ACD is a more likely diagnosis when the lesions are found in multiple areas of the hand as opposed to a single isolated location &#40;palm&#44; dorsum&#44; fingertips&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; hand eczema is a prevalent problem in children&#46; Overall&#44; endogenous eczema is the most frequent type&#44; although only half of patients meet the criteria for atopic dermatitis&#46; It is not rare for cases of ACD to manifest as hand eczema&#46; There are classical allergens &#40;thimerosal&#44; mercury&#44; nickel&#44; &#8230;&#41; whose presence is decreasing and whose relevance in allergy is now doubtful&#46; On the other hand&#44; there are emergent allergens &#40;fragrances&#44; isothiazolinones&#41; whose presence is increasing and which call for a high level of suspicion in the diagnosis of allergy&#46; Every child with hand eczema of a suspected allergic aetiology should be referred for performance of epicutaneous patch testing&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            2 => "Dermatitis"
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            0 => "Eccema de mano"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hand eczema is a frequent disease in adults&#46; Diagnosing the cause of hand eczema is difficult due to different classifications&#46; There is lack of evidence on hand eczema and its causes in children&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 389 children between 0 and 16 years were identified between 1996 and 2016&#44; from whom 42 &#40;10&#46;8&#37;&#41; with exclusively hand eczema were selected&#46; In all cases a standard battery of epicutaneous patch tests was performed&#44; as well as additional batteries depending on the clinical suspicion&#46; The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The 42 children with hand eczema included 25 &#40;59&#46;5&#37;&#41; girls&#44; and 17 &#40;40&#46;5&#37;&#41; boys&#44; with a mean age of 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9 years&#44; and did not differ from that of children with eczema in other locations&#46; The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases&#44; Allergic Contact Dermatitis in 14 patients&#44; Endogenous Vesiculous Eczema in 6 cases&#44; Endogenous Hyperkeratotic Eczema in 5 cases&#44; and Irritant Contact Dermatitis in 2 cases&#46; The most frequent allergens detected were thiomersal &#40;9 cases&#41;&#44; nickel &#40;5 cases&#41;&#44; mercury &#40;5 cases&#41;&#44; and cobalt &#40;4 cases&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hand eczema is a common condition in children&#46; The most common cause is atopic dermatitis&#44; although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon&#46; Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El eccema de manos es una forma frecuente de eccema en adultos&#46; Su diagn&#243;stico en ocasiones es complejo debido a la existencia de diferentes clasificaciones diagn&#243;sticas&#46; Existen pocos trabajos que estudien el eccema de manos y su clasificaci&#243;n en ni&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha identificado a 389 ni&#241;os entre 0 y 16 a&#241;os remitidos a la Unidad de Alergia Cut&#225;nea de nuestro servicio para estudio con pruebas epicut&#225;neas en el periodo 1996-2016&#46; De entre todos los casos se han seleccionado 42 casos con dermatitis localizada exclusivamente en la mano &#40;10&#44;8&#37; de todos los ni&#241;os remitidos&#41;&#46; En todos los casos se realizaron pruebas epicut&#225;neas parchando la bater&#237;a est&#225;ndar&#44; as&#237; como bater&#237;as adicionales en funci&#243;n de la sospecha cl&#237;nica&#46; Se recogieron datos epidemiol&#243;gicos &#40;edad&#44; sexo&#44; antecedentes de dermatitis at&#243;pica&#8230;&#41;&#44; as&#237; como cl&#237;nicos &#40;localizaci&#243;n de las lesiones&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 42 ni&#241;os remitidos con dermatitis de la mano&#44; 25 &#40;59&#44;5&#37;&#41; eran ni&#241;as y 17 &#40;40&#44;5&#37;&#41; ni&#241;os&#46; La edad media de los pacientes con dermatitis de la mano fue de 10&#44;6 &#177; 3&#44;9 a&#241;os&#46; El diagn&#243;stico definitivo tras la realizaci&#243;n de pruebas epicut&#225;neas fue dermatitis at&#243;pica en 15 casos&#44; dermatitis al&#233;rgica de contacto en 14 pacientes&#44; eccema end&#243;geno vesiculoso en 6 casos&#44; eccema end&#243;geno hiperquerat&#243;sico en 5 casos y dermatitis irritativa de contacto en 2 casos&#46; Los al&#233;rgenos detectados m&#225;s frecuentes fueron tiomersal &#40;9 casos&#41;&#44; ni&#237;quel &#40;5 casos&#41;&#44; mercurio &#40;5 casos&#41; y cobalto &#40;4 casos&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El eccema de manos es una entidad frecuente en ni&#241;os&#46; La causa m&#225;s frecuente es la dermatitis ato&#237;pica&#44; aunque no son infrecuentes los casos de dermatitis al&#233;rgica de contacto que se manifiestan como eccema de manos&#46; Todo ni&#241;o con eccema de manos en el que se sospeche una causa al&#233;rgica debe ser remitido para realizaci&#243;n de pruebas epicut&#225;neas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ortiz-Salvador JM&#44; Subiabre-Ferrer D&#44; Rabasco AG&#44; Esteve-Mart&#237;nez A&#44; Zaragoza-Ninet V&#44; de Miquel VA&#46; Eccema de manos en ni&#241;os&#46; Estudio cl&#237;nico-epidemiol&#243;gico de la poblaci&#243;n remitida a un hospital terciario&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;88&#58;309&#8211;314&#46;</p>"
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            "imagen" => "gr1.jpeg"
            "Alto" => 741
            "Ancho" => 1000
            "Tamanyo" => 83119
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Girl aged 8 years with hand eczema&#46; Epicutaneous tests were positive for Kathon &#40;methylchloromethylisothiazolinone&#41; and formaldehyde&#44; which were considered relevant to the eczema&#46; The allergens were present in craft materials that the patient used regularly&#46; Note the involvement of multiple anatomical subunits&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Definition&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atopic hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hand eczema in a patient with atopic dermatitis diagnosed according to the modified Hanikin and Rajka criteria&#46; Absence of exposure with irritants or of relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Allergic contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sensitization to one or more allergens and relevant exposure to this allergen on the hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Irritant contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Documented prolonged or regular exposure to a known irritant and absence of relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperkeratotic endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic eczema with fissures&#44; hyperkeratosis or pulpitis and no vesicles in a patient that does not meet the criteria for atopic dermatitis&#46; Absence of exposure to an irritant or relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vesicular endogenous hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recurrent eczema with vesicular eruptions in patient that does not meet the criteria for atopic dermatitis&#46; Absence of exposure to an irritant or relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1760350.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Classification of hand eczema&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Children with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&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">Children with eczema in other locations<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&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"><span class="elsevierStyleItalic">P</span>&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;40&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACD diagnosis&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive for &#62; 1 allergen&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;38&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">179 &#40;51&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1760352.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics of paediatric patients with hand eczema and paediatric patients with eczema in other locations&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Children with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&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">Adults with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1111&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atopic hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Allergic contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">505 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Irritant contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">203 &#40;18&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperkeratotic endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;11&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vesicular endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">230 &#40;20&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1760353.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Final diagnosis in paediatric and adult patients with hand eczema following epicutaneous testing&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
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        "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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Allergen&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">Total&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&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">Relevant&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thimerosal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;44&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cobalt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palladium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rosin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kathon CG<span class="elsevierStyleSup">&#174;</span> &#40;methylisothiazolinone<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>methylchloroisothiazolinone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cyanoacrylate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Citronella&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Formaldehyde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combination of fragrances&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Piroxicam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diaminodiphenylmethane&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Allergens identified most frequently in our case series and percentage of cases in which the allergen was relevant to the eczema&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sides of fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Regions of the hand involved most frequently in patients with hand eczema&#46; The table also shows the distribution based on the presence or absence of ACD&#46;</p>"
        ]
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
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Original Article
Hand eczema in children. Clinical and epidemiological study of the population referred to a tertiary hospital
Eccema de manos en niños. Estudio clínico-epidemiológico de la población remitida a un hospital terciario
José María Ortiz Salvador
Corresponding author
josema.ortiz.salvador@gmail.com

Corresponding author.
, Daniela Subiabre Ferrer, Ana García Rabasco, Altea Esteve-Martínez, Violeta Zaragoza Ninet, Víctor Alegre de Miquel
Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Girl aged 8 years with hand eczema&#46; Epicutaneous tests were positive for Kathon &#40;methylchloromethylisothiazolinone&#41; and formaldehyde&#44; which were considered relevant to the eczema&#46; The allergens were present in craft materials that the patient used regularly&#46; Note the involvement of multiple anatomical subunits&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hand eczema is a frequent form of eczema&#46; It is characterized by erythema&#44; vesicles and pustules in acute forms and desquamation and fissures in chronic forms&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> The criteria for its diagnosis are vaguely defined&#44; and there are multiple clinical classifications of hand eczema&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is also disagreement regarding the role played by allergic contact dermatitis &#40;ACD&#41; and atopic dermatitis in paediatric hand eczema&#46; Some authors recommend performance of epicutaneous tests in all children presenting with hand eczema&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> while others believe that the underlying cause is atopic dermatitis and no further testing is required&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to establish the prevalence of hand eczema in the paediatric population referred to the skin allergy unit of our hospital&#44; and to identify the most frequent clinical forms of hand eczema and the allergens involved in exogenous allergic forms&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a single-centre&#44; retrospective observational study in which we reviewed the cases of all patients aged 0&#8211;16 years referred to the skin allergy unit of the Hospital General Universitario de Valencia for evaluation of hand eczema by means of patch testing between 1996 and 2016&#46; We excluded patients with hand eczema that had eczema in other locations&#46; All patients included in the study had been evaluated with the standard patch test series of the Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea &#40;Spanish Working Group on Contact Dermatitis and Skin Allergy &#91;GEIDAC&#93;&#41; provided by Marti Tor<span class="elsevierStyleSup">&#174;</span> &#40;Barcelona&#44; Spain&#41;&#44; as well as the products provided by the patient and additional tests on a case-by-case basis depending on the clinical suspicion&#46; The allergens were applied on the back of the patient on healthy-appearing skin and covered for 48<span class="elsevierStyleHsp" style=""></span>h with AllergEAZE<span class="elsevierStyleSup">&#174;</span> Finn chambers &#40;Hamburg&#44; Germany&#41;&#46; Patch reactions were evaluated at 48 and 96<span class="elsevierStyleHsp" style=""></span>h&#44; and scored according to the criteria of the International Contact Dermatitis Research Group &#40;ICDRG&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The definitive diagnosis was based on the results of epicutaneous testing and epidemiological and clinical parameters&#44; applying the hand eczema classification proposed by Agner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We compared the frequency of different forms of hand eczema in the paediatric and adult population&#46; We compared the age&#44; sex&#44; prevalence of allergy and prevalence of ACD in children with hand eczema and children with eczema in other locations&#46; We used the Fisher exact test to compare qualitative variables&#44; and the Wilcoxon sum-rank test to compare age between groups&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">Between January 1996 and December 2015&#44; 5985 patients were referred to the skin allergy unit&#44; of who 389 &#40;6&#46;5&#37;&#41; were children aged 0&#8211;16 years&#59; 1153 patients &#40;19&#46;3&#37;&#41; had eczema localized exclusively in the hands&#44; and 42 of them &#40;3&#46;6&#37;&#41; were children&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the epidemiological characteristics of children with hand eczema and children with eczema in other locations&#46; Of the 42 children with hand eczema referred to our unit&#44; 25 &#40;59&#46;5&#37;&#41; were female and 17 &#40;40&#46;5&#37;&#41; male&#46; The sex distribution of children with hand eczema was similar to the sex distribution in children with eczema in other locations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;87&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The mean and standard deviation of the age of patients with hand eczema was 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9 years&#44; with ages ranging between 3 and 16 years&#46; There were no statistically significant differences in age between children with hand eczema and children with eczema in other locations &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>66&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The final diagnosis made after performance of epicutaneous tests was atopic dermatitis in 15 patients &#40;35&#46;7&#37;&#41;&#44; ACD in 14 patients &#40;33&#46;3&#37;&#41;&#44; vesicular endogenous eczema in 6 patients &#40;14&#46;3&#37;&#41;&#44; hyperkeratotic endogenous eczema in 5 patients &#40;11&#46;9&#37;&#41; and irritant contact dermatitis in 2 patients &#40;4&#46;8&#37;&#41;&#46; The prevalence of ACD in children with hand eczema was lower compared to children with eczema in other locations &#40;39&#46;5&#37;&#41;&#44; although the difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>5&#41;&#46; Two patients that received a diagnosis of ACD also met the criteria for atopic dermatitis&#44; which had not been diagnosed&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the distribution of the paediatric and adult patients included in the analysis by type of hand eczema&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The results of patch testing were positive in a total of 16 children &#40;38&#46;1&#37;&#41;&#46; The prevalence of contact allergy was lower compared to the other children referred to our unit &#40;51&#46;6&#37;&#41;&#44; a difference that was not statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>09&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The allergens detected most frequently where thimerosal &#40;9 cases&#41;&#44; nickel &#40;5 cases&#41;&#44; mercury &#40;5 cases&#41; and cobalt &#40;4 cases&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows a complete list of the identified allergens and their relevance&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The areas of the hand involved most frequently &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41; were the fingertips &#40;12 cases&#44; 28&#46;6&#37;&#41;&#44; palms &#40;9 cases&#44; 21&#46;4&#37;&#41;&#44; dorsum &#40;5 cases&#44; 11&#46;9&#37;&#41; and sides &#40;4 cases&#44; 9&#46;5&#37;&#41;&#46; In 12 cases &#40;28&#46;6&#37;&#41; involvement was diffuse&#44; without a primary site&#46; In patients with ACD&#44; the most frequent type of involvement was diffuse &#40;10 cases&#44; 71&#46;4&#37;&#41;&#44; followed by involvement of fingertips &#40;2 cases&#44; 14&#46;3&#37;&#41;&#44; dorsum &#40;1case&#44; 7&#46;1&#37;&#41; and palm &#40;1 case&#44; 7&#46;1&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The sensitization mechanism in patients with ACD was iatrogenic in 8 cases&#44; cosmetic in 2 cases&#44; use of gloves in 2 cases&#44; use of toys &#40;playdough&#41; in 1 case&#44; and use of costume jewellery in 1 case&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The prevalence of hand eczema in the paediatric population referred for epicutaneous testing was 10&#37;&#46; This figure is slightly lower compared to the prevalence reported in other studies conducted in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> which was probably due to our selection of patients with exclusive involvement of the hands&#46; In studies in adults that selected patients in who eczema was restricted to the hands&#44; the reported prevalence was similar to the one found in our study&#44; ranging between 7&#37; and 15&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;3&#8211;6&#44;8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean age of children with eczema was similar to the age of the rest of children referred for testing&#44; with a similar range and comprehending every age group under study&#46; Similarly&#44; we did not find differences in the distribution of eczema by sex between the two groups&#46; This was consistent with other studies that showed that hand eczema manifests in children as well as adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;7&#44;9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Overall&#44; endogenous eczema accounted for 62&#37; of cases&#46; However&#44; only half of patients with endogenous hand eczema met the criteria for diagnosis of atopic dermatitis&#46; This finding was consistent with or clinical experience&#44; as we often have patients with hand eczema that cannot be explained by an external cause and who do not meet the criteria for atopic dermatitis&#46; Other studies have found a higher incidence of atopic dermatitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#8211;9</span></a> which may be due to those studies not including specific classifications of vesicular and hyperkeratotic endogenous eczema&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The second most frequent diagnosis was ACD&#44; which was given to 1 out of 3 children with hand eczema&#46; The fact that some patients with ACD also met the criteria for atopic dermatitis highlights the importance of ruling out a superimposed allergy in patients with hand eczema and atopic dermatitis&#44; as recommended in European clinical practice guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;10</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The main difference in comparison to adult patients was the low prevalence of irritant contact dermatitis in children&#44; which is one of the most frequent causes of hand eczema in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> This may be due to the fact that most cases of hand eczema due to irritant contact result from a regular use of irritants in the home or workplace&#44; something that is uncommon among children&#46; Frequent handwashing or prolonged contact with liquids is also much more prevalent in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> Another difference was the low prevalence of atopic hand eczema in the adult population compared to other endogenous forms of hand eczema&#46; This is consistent with the findings of other studies in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The allergens involved in cases of ACD in the hands were similar to those found in other studies in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;9</span></a> As reported in other publications on skin allergy&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a> metals were the type of allergen identified most frequently in our study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Thimerosal was the most frequently identified allergen&#46; However&#44; fewer than half of the reactions to thimerosal seemed relevant to the hand eczema&#46; The reason is that thimerosal is a preservative that is no longer in use&#46; In our study&#44; all cases related to hypersensitivity reactions to thimerosal and mercury involved the use of mercury-based antiseptic solutions that are no longer distributed&#46; At present&#44; allergies to mercury or thimerosal that play a significant role in hand eczema are extremely rare&#44; despite them being the allergens identified most frequently through patch testing in children and adults&#46; This is the reason why the GEIDAC has decided to remove thimerosal from the allergens included in the standard patch test series&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Nickel and cobalt are very frequent allergens in the paediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;12&#44;14&#44;15</span></a> As is the case with thimerosal&#44; the relevance of sensitization to these substances is frequently dubious&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The new regulation of the European Commission substantially limiting the amount of nickel and other potentially allergenic metals that can be present in costume jewellery was enacted in 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Therefore&#44; it is expected that the incidence of cases involving a relevant sensitivity to nickel will decline in upcoming years&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Rosin and abitol are adhesives used in various products&#44; such as footwear&#44; gloves&#44; or dressings&#44; and in our study they were only detected in cases involving the use of dressings for medical care&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> Sensitization to rosin is also a marker of fragrance allergy&#44; so allergy to fragrances should be ruled out in patients with a positive patch test result for rosin&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> Diaminodiphenylmethane is used as a curing agent in epoxy resins and in the manufacturing of lycra fibres&#46; In our study&#44; hypersensitivity to this substance was associated with the use of plastic gloves&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Following metals and adhesives&#44; preservatives were the third most frequent type of allergen found in children with ACD with hand involvement&#46; The most relevant preservatives are methylchloroisothiazolinone and methylisothiazolinone &#40;MCI&#47;MI&#41;&#46; At present&#44; they are the allergens most frequently involved in allergic reactions to cosmetics in adults<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20&#8211;22</span></a> and some studies have also reported a high prevalence of sensitization in children&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">23&#44;24</span></a> The reason is that MCI&#47;MI are ubiquitous substances&#44; found in every type of skin care product for children &#40;wet wipes&#44; moisturizing lotions&#44; fragrances&#41; or even craft materials&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a> and call for a high level of diagnostic suspicion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">In our study&#44; the area of the hand that was involved most frequently was the fingertips&#44; unlike other studies conducted in adults where the fingertips were involved less frequently than the palm or the fingers&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;9&#44;26</span></a> It is worth highlighting that most cases of ACD manifested in several areas of the hand&#44; without a clear demarcation of lesions&#46; Boonstra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> found similar results&#44; with a much higher incidence of ACD in cases that could not be clearly classified based on the primary site of involvement&#46; This can be explained by the allergen &#40;cosmetics&#44; dressings&#44; antiseptics&#44; &#8230;&#41; being in contact with different anatomical parts of the hand at the same time&#44; resulting in the absence of a clear primary site&#46; Thus&#44; ACD is a more likely diagnosis when the lesions are found in multiple areas of the hand as opposed to a single isolated location &#40;palm&#44; dorsum&#44; fingertips&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; hand eczema is a prevalent problem in children&#46; Overall&#44; endogenous eczema is the most frequent type&#44; although only half of patients meet the criteria for atopic dermatitis&#46; It is not rare for cases of ACD to manifest as hand eczema&#46; There are classical allergens &#40;thimerosal&#44; mercury&#44; nickel&#44; &#8230;&#41; whose presence is decreasing and whose relevance in allergy is now doubtful&#46; On the other hand&#44; there are emergent allergens &#40;fragrances&#44; isothiazolinones&#41; whose presence is increasing and which call for a high level of suspicion in the diagnosis of allergy&#46; Every child with hand eczema of a suspected allergic aetiology should be referred for performance of epicutaneous patch testing&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Hand eczema"
            1 => "Patch-test"
            2 => "Dermatitis"
            3 => "Eczema"
            4 => "Cutaneous allergy"
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            0 => "Eccema de mano"
            1 => "Pruebas epicut&#225;neas"
            2 => "Dermatitis"
            3 => "Eccema"
            4 => "Alergia cut&#225;nea"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hand eczema is a frequent disease in adults&#46; Diagnosing the cause of hand eczema is difficult due to different classifications&#46; There is lack of evidence on hand eczema and its causes in children&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 389 children between 0 and 16 years were identified between 1996 and 2016&#44; from whom 42 &#40;10&#46;8&#37;&#41; with exclusively hand eczema were selected&#46; In all cases a standard battery of epicutaneous patch tests was performed&#44; as well as additional batteries depending on the clinical suspicion&#46; The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The 42 children with hand eczema included 25 &#40;59&#46;5&#37;&#41; girls&#44; and 17 &#40;40&#46;5&#37;&#41; boys&#44; with a mean age of 10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9 years&#44; and did not differ from that of children with eczema in other locations&#46; The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases&#44; Allergic Contact Dermatitis in 14 patients&#44; Endogenous Vesiculous Eczema in 6 cases&#44; Endogenous Hyperkeratotic Eczema in 5 cases&#44; and Irritant Contact Dermatitis in 2 cases&#46; The most frequent allergens detected were thiomersal &#40;9 cases&#41;&#44; nickel &#40;5 cases&#41;&#44; mercury &#40;5 cases&#41;&#44; and cobalt &#40;4 cases&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hand eczema is a common condition in children&#46; The most common cause is atopic dermatitis&#44; although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon&#46; Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing&#46;</p></span>"
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            "titulo" => "Introduction"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El eccema de manos es una forma frecuente de eccema en adultos&#46; Su diagn&#243;stico en ocasiones es complejo debido a la existencia de diferentes clasificaciones diagn&#243;sticas&#46; Existen pocos trabajos que estudien el eccema de manos y su clasificaci&#243;n en ni&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha identificado a 389 ni&#241;os entre 0 y 16 a&#241;os remitidos a la Unidad de Alergia Cut&#225;nea de nuestro servicio para estudio con pruebas epicut&#225;neas en el periodo 1996-2016&#46; De entre todos los casos se han seleccionado 42 casos con dermatitis localizada exclusivamente en la mano &#40;10&#44;8&#37; de todos los ni&#241;os remitidos&#41;&#46; En todos los casos se realizaron pruebas epicut&#225;neas parchando la bater&#237;a est&#225;ndar&#44; as&#237; como bater&#237;as adicionales en funci&#243;n de la sospecha cl&#237;nica&#46; Se recogieron datos epidemiol&#243;gicos &#40;edad&#44; sexo&#44; antecedentes de dermatitis at&#243;pica&#8230;&#41;&#44; as&#237; como cl&#237;nicos &#40;localizaci&#243;n de las lesiones&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 42 ni&#241;os remitidos con dermatitis de la mano&#44; 25 &#40;59&#44;5&#37;&#41; eran ni&#241;as y 17 &#40;40&#44;5&#37;&#41; ni&#241;os&#46; La edad media de los pacientes con dermatitis de la mano fue de 10&#44;6 &#177; 3&#44;9 a&#241;os&#46; El diagn&#243;stico definitivo tras la realizaci&#243;n de pruebas epicut&#225;neas fue dermatitis at&#243;pica en 15 casos&#44; dermatitis al&#233;rgica de contacto en 14 pacientes&#44; eccema end&#243;geno vesiculoso en 6 casos&#44; eccema end&#243;geno hiperquerat&#243;sico en 5 casos y dermatitis irritativa de contacto en 2 casos&#46; Los al&#233;rgenos detectados m&#225;s frecuentes fueron tiomersal &#40;9 casos&#41;&#44; ni&#237;quel &#40;5 casos&#41;&#44; mercurio &#40;5 casos&#41; y cobalto &#40;4 casos&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El eccema de manos es una entidad frecuente en ni&#241;os&#46; La causa m&#225;s frecuente es la dermatitis ato&#237;pica&#44; aunque no son infrecuentes los casos de dermatitis al&#233;rgica de contacto que se manifiestan como eccema de manos&#46; Todo ni&#241;o con eccema de manos en el que se sospeche una causa al&#233;rgica debe ser remitido para realizaci&#243;n de pruebas epicut&#225;neas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ortiz-Salvador JM&#44; Subiabre-Ferrer D&#44; Rabasco AG&#44; Esteve-Mart&#237;nez A&#44; Zaragoza-Ninet V&#44; de Miquel VA&#46; Eccema de manos en ni&#241;os&#46; Estudio cl&#237;nico-epidemiol&#243;gico de la poblaci&#243;n remitida a un hospital terciario&#46; An Pediatr &#40;Barc&#41;&#46; 2018&#59;88&#58;309&#8211;314&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Girl aged 8 years with hand eczema&#46; Epicutaneous tests were positive for Kathon &#40;methylchloromethylisothiazolinone&#41; and formaldehyde&#44; which were considered relevant to the eczema&#46; The allergens were present in craft materials that the patient used regularly&#46; Note the involvement of multiple anatomical subunits&#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  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Definition&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atopic hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hand eczema in a patient with atopic dermatitis diagnosed according to the modified Hanikin and Rajka criteria&#46; Absence of exposure with irritants or of relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Allergic contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sensitization to one or more allergens and relevant exposure to this allergen on the hands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Irritant contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Documented prolonged or regular exposure to a known irritant and absence of relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperkeratotic endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic eczema with fissures&#44; hyperkeratosis or pulpitis and no vesicles in a patient that does not meet the criteria for atopic dermatitis&#46; Absence of exposure to an irritant or relevant contact allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vesicular endogenous hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recurrent eczema with vesicular eruptions in patient that does not meet the criteria for atopic dermatitis&#46; Absence of exposure to an irritant or relevant contact allergy&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Classification of hand eczema&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Children with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&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">Children with eczema in other locations<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>347&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"><span class="elsevierStyleItalic">P</span>&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;40&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACD diagnosis&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137 &#40;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive for &#62; 1 allergen&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;38&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">179 &#40;51&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1760352.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics of paediatric patients with hand eczema and paediatric patients with eczema in other locations&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Children with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&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">Adults with hand eczema<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1111&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atopic hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Allergic contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">505 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Irritant contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">203 &#40;18&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyperkeratotic endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;11&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vesicular endogenous eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">230 &#40;20&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1760353.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Final diagnosis in paediatric and adult patients with hand eczema following epicutaneous testing&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "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  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Allergen&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">Total&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&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">Relevant&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thimerosal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;44&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nickel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">3 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cobalt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palladium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abitol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rosin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kathon CG<span class="elsevierStyleSup">&#174;</span> &#40;methylisothiazolinone<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>methylchloroisothiazolinone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mercapto mix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cyanoacrylate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Citronella&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Formaldehyde&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combination of fragrances&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Piroxicam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diaminodiphenylmethane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab1760351.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Allergens identified most frequently in our case series and percentage of cases in which the allergen was relevant to the eczema&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location&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">Total<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&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">ACD<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&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">No ACD<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dorsum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Palm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sides of fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fingertips&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffuse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" 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">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1760354.png"
              ]
            ]
          ]
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ISSN: 23412879
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