RESUMEN
BACKGROUND: Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is a synthetic fragrance ingredient. Case reports of allergy to HICC appeared in the 1980s, and HICC has recently been included in the European baseline series. Human elicitation dose-response studies performed with different allergens have shown a significant relationship between the patch-test threshold and the repeated open application test (ROAT) threshold, which mimics some real-life exposure situations. Fragrance ingredients are special as significant amounts of allergen may evaporate from the skin. OBJECTIVES: The study aimed to investigate the relationship between elicitation threshold doses at the patch test and the ROAT, using HICC as the allergen. The expected evaporation rate was calculated. MATERIALS AND METHODS: Seventeen HICC-allergic persons were tested with a dilution series of HICC in a patch test and a ROAT (duration up to 21 days). Seventeen persons with no HICC allergy were included as control group for the ROAT. Results The response frequency to the ROAT (in microg HICC cm(-2) per application) was significantly higher than the response frequency to the patch test at one of the tested doses. Furthermore the response rate to the accumulated ROAT dose was significantly lower at half of the doses compared with the patch test. The evaporation rate of HICC was calculated to be 72% over a 24-h period. CONCLUSIONS: The ROAT threshold in dose per area per application is lower than the patch test threshold; furthermore the accumulated ROAT threshold is higher than the patch test threshold, which can probably be explained by the evaporation of HICC from the skin in the open test.
Asunto(s)
Aldehídos/efectos adversos , Alérgenos/efectos adversos , Ciclohexanos/efectos adversos , Ciclohexenos/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Pruebas del Parche/métodos , Perfumes/efectos adversos , Adulto , Alérgenos/administración & dosificación , Dermatitis Alérgica por Contacto/etiología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Perfumes/química , Adulto JovenRESUMEN
BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.
Asunto(s)
Eccema/diagnóstico , Dermatosis de la Mano/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Eccema/psicología , Femenino , Estudios de Seguimiento , Dermatosis de la Mano/psicología , Humanos , Masculino , Persona de Mediana Edad , Fotograbar , Pronóstico , Estudios Prospectivos , Análisis de Regresión , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Fragrances are the first or second most common cause of contact allergy in dermatitis patients. OBJECTIVE: The aim of this study was to identify risk products for fragrance contact allergy. METHODS: The design was a case-control study with a case group of 78 fragrance-mix-positive eczema patients and two control groups, one consisting of 1,279 subjects selected as a random sample of the general population and the other consisting of 806 fragrance-mix-negative eczema patients. The identification of risk products was based on the patients' histories of rash to scented products. Analysis of the associations between first-time rash caused by different specified product categories and fragrance mix sensitivity was performed using logistic regression. RESULTS: It was found that first-time rash caused by deodorant sprays and/or perfumes were related to fragrance contact allergy in a comparison with both control groups. The risk (odds ratio) of being diagnosed as fragrance allergic was 2.3 to 2.9 greater in cases of a history of first-time rash to deodorant sprays and 3.3 to 3.4 greater in cases of a history of rash to perfumes than if no such history were present. First-time rash to cleansing agents, deodorant sticks, or hand lotions was also statistically significant but only in comparison with one of the control groups. CONCLUSION: Safety evaluation of fragrance materials used in perfumes and deodorant sprays should be performed with special attention.
Asunto(s)
Dermatitis Alérgica por Contacto/etiología , Perfumes/efectos adversos , Adulto , Anciano , Estudios de Casos y Controles , Cosméticos/efectos adversos , Dinamarca/epidemiología , Desodorantes/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/epidemiología , Eccema/epidemiología , Femenino , Productos Domésticos/efectos adversos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pruebas del Parche , Medición de RiesgoRESUMEN
BACKGROUND: Treatment of plantar or moccasin-type tinea pedis with conventional oral antifungal agents produces poor response rates. Itraconazole is a synthetic, broad-spectrum, orally active antifungal agent with pronounced antimycotic activity. OBJECTIVE: To confirm the efficacy and safety of short-term treatment with itraconazole for plantar or moccasin-type tinea pedis. METHODS: The study was a double-blind, randomized, placebo-controlled, multicenter trial. Seventy-two patients with tinea pedis (plantar or moccasin-type) were treated with itraconazole (200 mg twice daily) or placebo for 1 week with an 8-week treatment-free follow-up period. RESULTS: Thirty-six patients were randomized to each treatment group. The overall success rate (mycological cure and clinical response) at the end-point of follow-up was significantly higher in the itraconazole group than in the placebo group (53 vs. 3%; p <0. 001). Mycological cure (56 vs. 8%; p <0.001) and clinical response rates (75 vs. 11%; p <0.001) were significantly higher after itraconazole treatment compared with placebo treatment. During treatment, adverse events were recorded in 7 patients in the itraconazole group and 2 patients in the placebo group. Adverse events were noted in 3 patients in the placebo group during follow-up. No serious adverse events were reported in either group. CONCLUSIONS: Short-term treatment with itraconazole was significantly more effective than placebo in tinea pedis. The safety and tolerability profile or itraconazole was comparable with placebo.
Asunto(s)
Antifúngicos/uso terapéutico , Itraconazol/uso terapéutico , Tiña del Pie/tratamiento farmacológico , Dolor Abdominal/inducido químicamente , Adulto , Antifúngicos/efectos adversos , Método Doble Ciego , Femenino , Humanos , Itraconazol/efectos adversos , Masculino , Pacientes Desistentes del Tratamiento , Placebos , Factores de Tiempo , Resultado del TratamientoRESUMEN
The aim of the present study was to investigate the relationship between patients' own recognition of skin problems using consumer products and the results of patch testing with markers of fragrance sensitization. Eight hundred and eighty-four consecutive eczema patients, 18-69 years of age, filled in a questionnaire prior to patch testing with the European standard series. The questionnaire contained questions about skin symptoms from the use of scented and unscented products as well as skin reactions from contact with spices, flowers and citrus fruits that could indicate fragrance sensitivity. A highly significant association was found between reporting a history of visible skin symptoms from using scented products and a positive patch test to the fragrance mix, whereas no such relationship could be established to the Peru balsam in univariate or multivariate analysis. Our results suggest that the role of Peru balsam in detecting relevant fragrance contact allergy is limited, while most fragrance mix-positive patients are aware that the use of scented products may cause skin problems.
Asunto(s)
Dermatitis Alérgica por Contacto/etiología , Eccema/epidemiología , Eccema/etiología , Pruebas del Parche , Perfumes/efectos adversos , Adolescente , Adulto , Distribución por Edad , Anciano , Alérgenos , Biomarcadores/análisis , Cosméticos/efectos adversos , Dinamarca/epidemiología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/epidemiología , Eccema/diagnóstico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Distribución por Sexo , Encuestas y CuestionariosAsunto(s)
Dermatitis Alérgica por Contacto , Dermatitis por Contacto , Dinamarca , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/terapia , Dermatitis por Contacto/diagnóstico , Dermatitis por Contacto/epidemiología , Dermatitis por Contacto/terapia , Humanos , Educación del Paciente como Asunto , Programas Médicos RegionalesRESUMEN
One hundred and sixty-eight individuals (psoriatic patients treated with calcipotriol with dermatitis due to calcipotriol, psoriatic patients treated with calcipotriol with no dermatitis, psoriatic patients never treated with calcipotriol, patients with eczema and healthy volunteers) were patch-tested (Finn chambers, back, 48 h) with dilutions of calcipotriol ointment (50, 10, 2, 0.4 micrograms/g) and an ointment vehicle. Test evaluation was based on clinical scoring and various non-invasive measuring methods. Doubtful (?+) and weak (1+) reactions were common, irrespective of patient group and history. Moderate (2+) reactions were uncommon and with no increased frequency among psoriatic patients with adverse dermatitis during calcipotriol treatment. The blood flow of test sites measured by laser Doppler flowmetry was, however, increased in psoriatics, who developed dermatitis during calcipotriol treatment as an isolated finding. Furthermore a 1-week repeated open application test (ROAT) was performed on all subjects. None of the persons having a strong reaction in the patch test showed any dermatitis in the ROAT test, indicating that they were not sensitized. Calcipotriol was found to be a mild irritant of the non-corrosive type, i.e. with no influence on the skin barrier. Reactions were dominated by redness (increased laser Doppler flow and chroma a*) and only oedema formation in advanced reactions. The calcipotriol dose-irritation curve was found to be scattered. Calcipotriol induced no increase of transepidermal water loss (TEWL) versus the ointment vehicle, but the ointment vehicle itself increased TEWL. The special ointment vehicle needed for calcipotriol for stability reasons may itself be irritant and cause some impairment of the skin water barrier, with increase in TEWL values. Future patch test studies for calcipotriol allergy should not be done with this vehicle. The non-irritant threshold concentration of calcipotriol in an appropriate test vehicle is still unknown.
Asunto(s)
Calcitriol/análogos & derivados , Fármacos Dermatológicos/efectos adversos , Erupciones por Medicamentos/diagnóstico , Pruebas del Parche , Psoriasis/tratamiento farmacológico , Adulto , Anciano , Calcitriol/efectos adversos , Calcitriol/uso terapéutico , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Dermatitis por Contacto/diagnóstico , Dermatitis por Contacto/etiología , Fármacos Dermatológicos/uso terapéutico , Método Doble Ciego , Erupciones por Medicamentos/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pomadas , Vehículos Farmacéuticos/efectos adversos , Psoriasis/complicaciones , Piel/irrigación sanguíneaRESUMEN
The amount of chromium found in human skin after in vitro application of cement suspensions on full-thickness human skin in diffusion cells was investigated. Cement suspensions made from ordinary Portland cement or Portland cement with the chromate reduced with added ferrous sulphate were used. The cement suspensions were either applied on the skin surface under occlusion for 48 h or applied repeatedly every 24 h for 96 h. No statistically significant difference in chromium content of skin layers between skin exposed to ordinary Portland cement, skin exposed to cement with added ferrous sulphate and unexposed skin was observed, despite a more permeable skin barrier at the alkaline pH of the cement suspensions, i.e., pH 12.5. Increased chromium levels in epidermis and dermis were seen when ordinary Portland cement was applied as a suspension with added sodium sulphate (20%) on the skin surface for 96 h. The content of water-soluble chromium in ordinary Portland cement may vary due to the alkali sulphate content of the cement.
Asunto(s)
Cementación , Cromo/farmacocinética , Materiales de Construcción/toxicidad , Dermatitis por Contacto/prevención & control , Dermatitis Profesional/prevención & control , Compuestos Ferrosos/farmacología , Piel/metabolismo , Técnicas de Cultivo , Dermatitis por Contacto/metabolismo , Dermatitis Profesional/metabolismo , Femenino , Humanos , Piel/efectos de los fármacosRESUMEN
A randomised double-blind placebo controlled trial was performed to assess the efficacy and safety of tromantadine ointment 1% in male patients with genital herpes. 45 patients with penile genital herpes of less than three days duration were randomised to local treatment with tromantadine ointment 1% or placebo (ointment base alone) five times daily up to 12 days. No difference in time of healing could be detected between the two groups (p = 1.0). Both the objective signs (vesicles, pustules, ulceration, and glandular swelling) and the subjective symptoms (itching, burning, pain and dysuria) all diminished simultaneously in the two groups.
Asunto(s)
Amantadina/análogos & derivados , Antivirales/uso terapéutico , Herpes Genital/tratamiento farmacológico , Enfermedades del Pene/tratamiento farmacológico , Administración Tópica , Adulto , Amantadina/administración & dosificación , Amantadina/efectos adversos , Amantadina/uso terapéutico , Antivirales/efectos adversos , Método Doble Ciego , Humanos , Masculino , Enfermedades del Pene/microbiologíaRESUMEN
We report a case of possible idiosyncratic reaction in a fifty-two-year-old man with centroblastic malignant lymphoma. Immediately after administration of 20 mg bleomycin intravenously for the first time, the patient developed stomatitis. When readministered a few weeks later the patient developed mucocutaneous manifestations such as stomatitis, symmetrical linear maculopapular exanthema on the neck, trunk, and both arms, and indurated nodules on the palms.
Asunto(s)
Bleomicina/efectos adversos , Erupciones por Medicamentos , Estomatitis/inducido químicamente , Bleomicina/administración & dosificación , Erupciones por Medicamentos/patología , Humanos , Linfoma/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
A noninvasive method allowing measurements of the propeptides of collagen type III (PIIINP) and type I (PICP) in ulcer washings was developed. The response to topical human growth hormone was examined. Fourteen patients with venous ulcers were treated sequentially with human growth hormone (0.1, 0.25, and 1 IU/cm2/day), each dose for 1 week, followed by 1 week washout. On alternate days, three and two times during treatment and washout periods, respectively, the ulcers were washed and incubated for 30 minutes with sterile water. No changes in healing rates in relation to growth hormone application were observed. In contrast, PIIINP increased significantly to 168% (154% to 184%) (mean, 95% confidence interval) and 195% (179% to 218%) 5 and 9 days, respectively, after start of treatment, (p < 0.01). Propeptides of collagen type I reached a significant increase, to 196% (172% to 232%), in the fourth week, (p < 0.01). The areas under the curves of PICP and PIIINP correlated significantly with the healing rates (r = 0.57, p = 0.04; and r = 0.64, p = 0.01, respectively). The authors conclude that propeptide measurements may be useful markers of healing in clinical studies.
Asunto(s)
Exudados y Transudados/química , Hormona del Crecimiento/administración & dosificación , Úlcera de la Pierna/diagnóstico , Fragmentos de Péptidos/análisis , Procolágeno/análisis , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/análisis , Enfermedad Crónica , Femenino , Humanos , Úlcera de la Pierna/terapia , Masculino , Persona de Mediana Edad , Cicatrización de HeridasRESUMEN
Chromium permeation studies were performed on full thickness human skin in diffusion cells. All samples were analysed for the total chromium content by graphite furnace Zeeman-corrected atomic absorption spectrometry. Some samples were analysed by an ion chromatographic method permitting the simultaneous determination of Cr(VI) and Cr(III) as well. The amounts of chromium found in all skin layers were significantly higher when potassium dichromate was applied to the skin compared with chromium chloride or chromium nitrate. Chromium could only be detected in the recipient phase after application of the dichromate solution. Chromium skin levels increased with increasing concentrations of applied chromium salts up to 0.034 M Cr. The amount of chromium in recipient phase and skin layers increased with increasing pH when the applied solution contained potassium dichromate. This was ascribed to a decreased skin barrier function of the skin. The amount of chromium found in all skin layers after application of chromium chloride decreased with increasing pH due to lower solubility of the salt. The % of chromium found in the recipient phase as chromium(VI) increased with increasing total chromium concentration indicating a limited reduction ability of the skin in vitro.
Asunto(s)
Cloruros , Compuestos de Cromo , Cromo/farmacocinética , Piel/metabolismo , Cromo/análisis , Femenino , Humanos , Concentración de Iones de Hidrógeno , Técnicas In Vitro , Permeabilidad , Dicromato de Potasio/farmacocinética , Piel/química , Piel/efectos de los fármacos , SolucionesAsunto(s)
Cementos Cermet/efectos adversos , Cromo/efectos adversos , Materiales de Construcción/efectos adversos , Dermatitis Profesional/epidemiología , Dermatitis Profesional/etiología , Eccema/epidemiología , Eccema/etiología , Sesgo , Enfermedad Crónica , Estudios de Cohortes , Factores de Confusión Epidemiológicos , Dinamarca/epidemiología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Dermatitis Alérgica por Contacto/prevención & control , Dermatitis Irritante/diagnóstico , Dermatitis Irritante/epidemiología , Dermatitis Irritante/etiología , Dermatitis Irritante/prevención & control , Dermatitis Profesional/diagnóstico , Dermatitis Profesional/prevención & control , Eccema/diagnóstico , Eccema/prevención & control , Estudios de Seguimiento , Humanos , Incidencia , Pruebas del Parche , Prevalencia , PronósticoRESUMEN
Risk factors for cement eczema were studied among workers employed in the Danish construction industry. 2 cohorts exposed to cement containing different concentrations of water-soluble chromate were examined. A statistically significant decrease in the number of workers with allergic cement eczema was found in the cohort exposed to cement with the lower water-soluble chromate concentration. Allergic cement eczema was found to have a greater extent of involvement than irritant cement eczema. A 3rd cohort was followed to evaluate individual risk factors. The degree of exposure to wet cement seems to have a certain, though not statistically significant, effect on the risk of developing irritant cement eczema. Individual preventive measures, such as the use of gloves and creams, did not seem to reduce the development of irritant cement eczema.
Asunto(s)
Materiales de Construcción/efectos adversos , Dermatitis Profesional/inducido químicamente , Eccema/inducido químicamente , Compuestos de Potasio , Cromatos/efectos adversos , Cromatos/análisis , Estudios de Cohortes , Dinamarca/epidemiología , Dermatitis Profesional/epidemiología , Dermatitis Profesional/prevención & control , Eccema/epidemiología , Eccema/prevención & control , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/epidemiología , Dermatosis de la Mano/prevención & control , Humanos , Ropa de Protección , Factores de RiesgoRESUMEN
The cytokine expression on epidermal cells in the allergic patch test reaction (APR) and irritant patch test reaction (IPR) was studied using antibodies against rIL-6, rTNF alpha, rIL-1 alpha and rIL-1 beta in a histochemical biotin-avidin technique. Nickel sulphate was used for APR in 5 nickel allergic patients and sodium lauryl sulphate for IPR in 5 healthy individuals. The individuals served as their own control. Enhanced keratinocyte expression of IL-6 was observed in APR and IPR, whereas staining for TNF alpha remained unaltered compared with non-tested and petrolatum-tested skin. Staining for IL-1 alpha and IL-1 beta proved negative in all specimens. Double-staining experiments demonstrated that epidermal and dermal OKT-6 (CD1) positive Langerhans cells (LC) remained negative for all cytokines. These results demonstrate that enhancement of keratinocyte-bound IL-6 does not induce TNF alpha, IL-1 alpha/beta or IL-6 expression by LC during APR or IPR, and that enhanced keratinocyte expression of IL-6 fails to distinguish between these two reactions.
Asunto(s)
Dermatitis por Contacto/metabolismo , Interleucina-6/metabolismo , Irritantes , Queratinocitos/metabolismo , Pruebas del Parche , Factor de Necrosis Tumoral alfa/metabolismo , Adulto , Dermatitis por Contacto/diagnóstico , Dermatitis por Contacto/etiología , Dermatitis por Contacto/patología , Femenino , Humanos , Inmunohistoquímica , Interleucina-1/metabolismo , Células de Langerhans/metabolismo , Masculino , Persona de Mediana Edad , Níquel/efectos adversos , Piel/patologíaRESUMEN
Patch testing to chlorhexidine is usually performed with chlorhexidine gluconate aq. We report the results of 297 patients, almost all with leg ulcers, concomitantly tested with chlorhexidine acetate 1% aq. and chlorhexidine gluconate 1% aq. 39 patients had positive reactions to one of these compounds or to both. 36 positive reactions to the acetate were found, in contrast to 18 reactions to the gluconate. The reactions were considered relevant in 22 of 39 patients, since these patients had developed an eczema in an area where a chlorhexidine compound was used, and discontinuing the chlorhexidine compound resulted in improvement of the condition. In 10 of these 22 patients, the diagnosis would have been missed if the gluconate only had been used for testing, while the acetate failed to diagnose 2 patients. In 109 patients without leg ulcers, inconclusive patch test readings (i.e., irritant reactions or weak positive reactions) were found in 17% with chlorhexidine acetate 1% aq., compared to 5% with chlorhexidine gluconate 1% aq., indicating a high degree of irritant potential of the acetate 1% aq. We consider that some positive reactions are lost if chlorhexidine gluconate 1% aq. only is used for patch testing, but that chlorhexidine acetate 1% aq., on the other hand, is an unacceptably strong irritant. We therefore suggest that further testing with chlorhexidine acetate 1 and 0.5% aq. should be performed, in parallel with chlorhexidine gluconate 1% aq., in order to establish appropriate test concentrations. We find that up to 13% of the leg ulcer patients in this study may be sensitized to chlorhexidine, and we recommend that the indications for the drug in leg ulcer patients should be reconsidered.
Asunto(s)
Clorhexidina/análogos & derivados , Clorhexidina/efectos adversos , Dermatitis por Contacto/diagnóstico , Pruebas del Parche , Clorhexidina/administración & dosificación , Desinfectantes/administración & dosificación , Desinfectantes/efectos adversos , Eccema , Humanos , Irritantes , Dermatosis de la Pierna , Úlcera de la PiernaRESUMEN
Despite the critical role of the Langerhans cells in the induction of contact hypersensitivity reactions, non-Langerhans antigen-presenting cells in already sensitized individuals may play a role in the elicitation phase of a contact hypersensitivity reaction. Following epicutaneous challenge with antigens, the number of CD1+DR+ epidermal Langerhans cells increased in a time-dependent way and, concomitantly, CD1-OKM5+DR+ epidermal non-Langerhans cells appeared. In parallel with this, the capacity of epidermal cells to present both alloantigens and auto/nominal antigens increased, and 4 days after initiation of the contact hypersensitivity reactions 33-53% of the epidermal antigen-presenting capacity was due to CD1- non-Langerhans antigen-presenting cells. Thus, contact hypersensitivity skin reactions are accompanied by the appearance of non-Langerhans antigen-presenting cells capable of presenting both alloantigens and auto/nominal antigens.