Contact allergy to permanent colorants used for tattooing a nipple after breast reconstruction.
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Biomedical subjects
Publications and source records attributed to A Goossens.
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Between 1978 and 2001, 22 patients were diagnosed with occupation-related allergic contact dermatitis from isocyanates and/or polyurethanes in our clinic. 13 had a positive reaction to the isocyanates, of whom 10 also reacted to diaminodiphenylmethane (MDA), which is used in the production or processing of isocyanates and polyurethanes; 9 reacted only to MDA. The object of the present study was to identify the trades and industries responsible for the development of contact allergy to these resins. Such patients must be patch tested with the isocyanates contacted at work, and account must be taken of positive reactions to MDA as a marker for isocyanate sensitivity.
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The aim of this study was to determine the frequency of responses to selected fragrance materials in consecutive patients patch tested in 6 dermatological centres in Europe. 1855 patients were evaluated with the 8% fragrance mix (FM) and 14 other frequently used well-defined fragrance chemicals (series I). Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Reactions to FM occurred in 11.3% of the subjects. The 6 substances with the highest reactivity following FM were Lyral (2.7%), citral (1.1%), farnesol P (0.5%), citronellol (0.4%), hexyl cinnamic aldehyde (0.3%), and coumarin (0.3%). 41 (2.2%) of the patients reacted only to materials of series I and not to FM. 6.6% of 1855 patients gave a history of adverse reactions to fragrances which was classified as certain. This group reacted to FM only in 41.1%, to series I and FM in 12.0% and to series I only in 7.2%. 74.3% of the 39 patients reacting to both FM and 1 of the materials of series I had any type of positive fragrance history, which was significantly higher in comparison to those with isolated reactions to series I (53.6% of 41), p = 0.04. The study identified further sensitizers relevant for patch testing of patients with contact dermatitis, of which Lyral is the most important single chemical.
Phosphorylation of the alpha-subunit of eukaryotic initiation factor 2 (eIF2alpha) is a conserved mechanism regulating protein synthesis in response to various stresses. A screening for negative factors in yeast salt stress tolerance has led to the identification of Gcn2p, the single yeast eIF2alpha kinase that is activated by amino acid starvation in the general amino acid control response. Mutation of other components of this regulatory circuit such as GCN1 and GCN3 also resulted in improved NaCl tolerance. The gcn2 phenotype was not accompanied by changes in sodium or potassium homeostasis. NaCl induced a Gcn2p-dependent phosphorylation of eIF2alpha and translational activation of Gcn4p, the transcription factor that mediates the general amino acid control response. Mutations that activate Gcn4p function, such as gcd7-201, cpc2, and deletion of the translational regulatory region of the GCN4 gene, also cause salt sensitivity. It can be postulated that sodium activation of the Gcn2p pathway has toxic effects on growth under NaCl stress and that this novel mechanism of sodium toxicity may be of general significance in eukaryotes.
The elicitation response in allergic contact dermatitis is dose dependent, but the time-concentration relationship for elicitation has not previously been described. In this study 27 isoeugenol-sensitive patients participated in serial dilution patch tests with isoeugenol and a double-blinded Repeated Open Application Test (ROAT) using two concentrations of isoeugenol, 0.2 and 0.05%. Seven controls without isoeugenol allergy were also included. The participants applied 3.72 +/- 1.57 (mean +/- SD) mg/cm(2) of coded isoeugenol solutions twice a day to a 3 x 3 cm(2) area on the volar aspect of the right and left arm, respectively. For each test site the applications continued until a reaction appeared or for a maximum of 28 days. The minimal criteria for a positive reaction regarded as allergic contact dermatitis was persistent erythema at the ROAT test site. All controls were negative and 16/24 (66.7%) of the included isoeugenol-sensitive subjects showed a positive ROAT to the 0.2% solution within the study period (Fisher's test, p = 0.0024). Ten of the positive patients also reacted to the 0.05% solution. The median number of days until a positive reaction to the 0.2% solution was 7 days and was 15 days for the 0.05% solution. There was a highly significant correlation between the patients' patch test threshold and the number of days until a positive ROAT. In conclusion, the time until an isoeugenol allergic individual reacts in a ROAT depends on the individual sensitivity as well as the exposure concentrations; for low concentrations of the allergen or low degree of sensitivity, the allergic contact dermatitis may develop after several weeks of exposure. Therefore, a negative ROAT after 7 days may be a false negative.
We report the prenatal diagnosis at 16 weeks' gestation of bilateral split-hand/split-foot malformation (SHSFM) with severe lobster claw deformity of hands and feet in a male fetus without associated malformations. A minor manifestation of SHSFM was present in the father with only mild bilateral foot involvement (syndactyly I-II; cleft II-III; left cutaneous syndactyly III-IV). Mutation analysis of the p63 gene on chromosome 3q27 showed a missense mutation 577A-->G (predicting amino acid substitution K193E) in the father. This mutation has not been reported so far in SHSFM but resembles the previously reported 580A-->G (predicting amino acid substitution K194E) in a family with SHSFM.
Among 13,833 patients suspected of contact dermatitis examined during the years 1978-1999, occupational contact allergy to (meth)acrylates was diagnosed in 31 patients. The 3 most common sensitizers were ethyleneglycol dimethacrylate (17 positive patch tests), 2-hydroxyethyl methacrylate (14) and triethyleneglycol dimethacrylate (6). The aim of this report was to assess the different occupations and industries responsible for occupational sensitization to (meth)acrylates. 14 of the 31 patients work in the dental sector, either as a dentist or as a student of dental technology, where (meth)acrylate-containing dental prostheses and dental composites are mainly responsible for allergy to (meth)acrylates. An increasing trend in dermatological problems related to the expansion of the use of (meth)acrylates is clearly reflected in the patient population of our dermatology department.
In experimentally-induced irritant (ICD) and allergic (ACD) contact dermatitis, an oil-in-water (o/w) cream was applied to investigate its effects on a disturbed barrier function compared to untreated physiological barrier repair. Transepidermal water loss (TEWL) measurements were performed. Before the start of the experiments, the skin tolerance of the cream was examined, revealing the non-irritating characteristics of the ingredients and the absence of any contact allergic patch test reaction. In the ICD study, sodium lauryl sulfate (SLS) patches were applied to the forearms of young female volunteers. Consequently, it was observed that repeated cream application (14 days, 2x/day) significantly improved the TEWL of SLS-damaged skin, leading to a complete recovery on day 15. In the ACD study, disruption of skin barrier function was obtained by a nickel-mediated contact allergy patch (CAP) test. The cream was then applied 2x/day for 4 consecutive days. Assessment of TEWL clearly showed that recovery of the disrupted skin significantly improved after cream application in comparison to untreated barrier repair.
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This review is an update of 2 previously published articles on airborne contact dermatoses. Because reports in the literature often omit the term 'airborne', 18 volumes of Contact Dermatitis (April 1991-June 2000), 8 volumes of the American Journal of Contact Dermatitis (1992 1999) and 4 volumes of La Lettre du Gerda (1996-1999) were screened, and the cases cited were classified as to history, lesion locations, sensitization sources, and other factors. Reports on airborne dermatitis are increasingly being published, sometimes in relation to specific occupational areas.
Triglycidyl isocyanurate (TGIC) is mainly used in polyester-based powder paints, but also in laminates, insulating varnishes, coatings and adhesives. Several cases of contact allergy to TGIC have been reported during the last 10 years. Contact allergy to TGIC has developed in a factory producing the chemical, in a factory producing powder paints containing TGIC, and in industries using powder coating. In this paper, we report a man who developed a work-related dermatitis when working on the painting of metal frames. He was exposed to polyester powder pigments containing TGIC. When patch tested, he was negative to TGIC (prepared in 1988) 3x and positive to polyester powder pigment. Only when a new test preparation of fresh TGIC powder was tested, was a positive reaction obtained. Chemical analyses showed that there was no TGIC in the test preparation from 1988, and that in the TGIC powder from 1988, there was only 30% of the expected amount of TGIC. The investigations, clinical and chemical, strongly indicate degradation of TGIC in the test preparation and powder. Both substances and the test preparations made from them may change over time. Therefore, if a false-negative reaction due to a test preparation is strongly suspected, we recommend a re-test of the patient with a new test preparation of fresh material. As a general rule, patch testing should be performed with fresh substances and test preparations made from them, unless their stability and durability are known.
Contact sensitivity to drugs administered systemically occurs mainly among healthcare workers, pharmaceutical operatives, and veterinary surgeons. Of the 14,689 patients suspected of contact allergy examined in our department from 1978 to 2001, occupational allergic contact dermatitis from drugs in healthcare workers was diagnosed in 33, the first in 1980. The most common sensitizers were antibiotics such as penicillins, cephalosporins, and aminoglycosides. They accounted altogether for 35 positive patch tests, followed by propacetamol hydrochloride, and ranitidine hydrochloride, which elicited 10 and 7 positive reactions, respectively. The aim of this report is to draw attention to the importance of occupational contact allergy to drugs in healthcare workers. By far the greatest number of the sensitized patients in this series were nurses, there being 26 nurses, 4 veterinarians, 2 pharmacists, and 1 medical doctor.
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The diagnosis of a contact allergy can be missed in the various stages of the allergological investigation: the clinical examination of the patients, the anamnesis, the skin testing as well as the determination of the relevance of a positive test. This is illustrated by means of examples from the literature.
OBJECTIVE: The purpose of this work was to define the MR imaging findings of fluid collections confined to the medial collateral ligament (MCL) bursa and to correlate these findings with anatomic features shown in cadaveric specimens. MATERIALS AND METHODS: The anatomic location of the MCL bursa was investigated by MR-anatomic correlation in seven cadaveric knees. The MR imaging studies and clinical charts of six patients with fluid collections confined to the MCL bursa were reviewed. RESULTS: On anatomic sections, the MCL bursa was located between the superficial and deep portions of the MCL. Separate femoral and tibial compartments were seen in most specimens. CONCLUSION: The anatomy of the MCL bursa is shown with MR imaging in cadaveric specimens and patients. Understanding the compartmentlike distribution of fluid in the MCL bursa at MR imaging allows accurate diagnosis and differentiation from other conditions.
BACKGROUND: Budesonide, a marker for corticosteroid allergy, is a 1:1 mixture of 2 diastereomers, the R and S, present in all commercial formulations. Budesonide is said to cross-react with group B substances through the R and S diastereomer and some group D substances only through the S diastereomer. OBJECTIVE: To investigate the cross-reactivity pattern between the R and S diastereomers and 4 potentially cross-reacting substances, 2 from group B and 2 from group D. METHODS: By patch testing 10 patients hypersensitive to budesonide with a serial dilution of budesonide, the R and S diastereomer, triamcinolone acetonide, amcinonide, prednicarbate, and hydrocortisone-17-butyrate. RESULTS: Nine of 10 patients reacted to budesonide and the S diastereomer. Seven of 9 to the R diastereomer. Each of the 9 patients with S diastereomer allergy reacted to the group B and/or group D substances. Five patients reacted to triamcinolone acetonide, not to 1.0% but only to 0.0010% and 0.00010%. CONCLUSION: The R and S diastereomers can induce positive patch test reactions in budesonide-hypersensitive individuals. The potential of budesonide to cross-react with substances from group B and D might be explained by the presence of the 2 diastereomers. When patch testing with triamcinolone acetonide, much lower concentrations than recommended should be used.