Contact dermatitis from Tetrapanax papyriferum trichomes.
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Biomedical subjects
Publications and source records attributed to B Santucci.
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Patch test data of 1000 consecutive patients sensitive to at least 1 substance of our standard series showed that transition metals gave associated reactions amongst themselves more frequently than they did with the remaining substances. The responses to transition metals were largely variable and seemed dependent not only upon the associated exposure to different metals or the concomitant responses of the T cell clones, as reported by others, but also upon the chemical properties of the metals and the consequent interactions inside the skin. Concomitant reactions to nickel sulfate and palladium chloride were the most frequently found associated positivities and occurred in a minority of nickel-sulfate-sensitive subjects. In 43 out of 45 of these subjects, patch tests to mixed solutions containing nickel sulfate, plus sulfates of magnesium, zinc, and manganese at higher doses, were not able to reduce the nickel sulfate reactions. This behaviour contrasted with that found in the majority of subjects sensitive only to nickel sulfate. These findings seem to demonstrate that, whilst in subjects with positive reactions to nickel sulfate alone antigen formation involves biomolecules containing ions, in those with concomitant reactions to palladium chloride, other structures are involved.
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70 nickel-sensitive subjects who previously gave positive patch test response to 10 microliters of nickel sulfate 0.1 M, were patch tested to 10 microliters of mixed aqueous solutions containing nickel sulfate 0.1 M+magnesium sulfate 0.3 M, nickel sulfate 0.1 M+zinc sulfate, 0.3 and 0.5 M, respectively, nickel sulfate 0.1 M+ manganese sulphate 0.3 and 0.5 M, respectively nickel sulphate 0.1 M+ cadmium sulfate 0.1 and 0.3 M, respectively, nickel sulfate 0.1 M+iron sulfate (III) 0.1 and 0.3 M, respectively, and to 10 microliters of aq. cadmium sulfate 0.1 M, aq. cadmium sulfate 0.3 M, aq. iron sulfate 0.1 M, aq. iron sulfate 0.3 M. The results showed that, whilst sulfates of divalent metals with similar size and redox properties (Mg, Zn and Mn) were able to reduce or to suppress, in a dose-dependent way, the majority (75%) of nickel reactions, those with large radius and different oxidation state(Fe III), generally gave an increase in the reactions. In about 15% of the tested subjects, an increase in all the positive reactions to the mixed solutions was found. The findings seem to demonstrate that in only a majority but not all of nickel sulfate allergic reactions, is Ni(II) able to substitute for divalent ions with similar properties at the ion sites of some proteins. This tendency reproduces the results of experimental systems, in which nickel toxicity and cancerogenity are considered responsible. In contrast, in about 15% of the tested subjects, there was a general enhancement of the reactions. In these cases, either the occurrence of a "hyper-irritable" skin caused by the adopted test system or, more likely, the formation of Ni complexes with different geometries, is hypothesized.
To verify if the counter-ion Cl- permits the same interactions between nickel and divalent metals with physicochemical similarities as the counter-ion SO4- does, 50 sensitive subjects to nickel sulfate 5% pet. who previously gave positive patch test reactions either to 8 mu 1 of aq. nickel sulfate 0.1 M or to 8 mu 1 of aq. nickel chloride 0.1 M, or to both, were patch retested simultaneously to 8 mu 1 of, respectively, aq. nickel sulfate 0.1 M and aq. nickel chloride 0.1 M, and to 8 mu 1 of aq. mixed solutions containing, respectively, nickel chloride 0.1 M+magnesium chloride 0.3 M, nickel chloride 0.1 M+zinc chloride 0.3 M, nickel chloride 0.1 M+zinc chloride 0.5 M, nickel chloride 0.1 M+manganese chloride 0.3 M, and nickel chloride 0.1 M+manganese chloride O.5 M. Whilst 4 subjects gave a positive patch test response to only nickel sulphate, 8 gave a positive response to nickel chloride alone and the remaining 38 gave a concomitant positive response to both. In all subjects who gave positive responses to nickel chloride, the chlorides of divalent metals were not able to inhibit or reduce the positive reaction. 25 healthy subjects patch tested to both single salts and mixed solutions, and all gave negative responses. 9 of the 50 subjects, 4 who previously gave positive reactions to only nickel chloride 0.1 M, and 5 with concomitant reactions of equal intensity to both nickel chloride and nickel sulfate 0.1 M, were patch retested simultaneously to 8 mu 1 of, respectively, aq. nickel sulfate 0.1 M, aq. nickel chloride 0.1 M and aq. mixed solutions containing nickel sulfate (0.1 M) mixed with sulfates (0.3 M) and nickel chloride (0.1 M) mixed with chlorides of Mg, Zn, Mn (0.3 M). Whilst the mixed sulfate solutions were able to reduce nickel sulfate, 0.1 M patch test positive reactions, those containing chlorides, at all concentrations tested, did not inhibit the nickel chloride reactions in any of the subjects. The results of the tests to chlorides, compared to those reached on testing to sulfates of the same metals, lead us to hypothesize that the anion probably affects the uptake and local tissue distribution of the metal, modulating in this way, together with the individual cutaneous ligands, its effects.
A total of 1,050 patients with histories and clinical pictures suggestive of photoallergic contact dermatitis were seen. All the patients underwent photopatch tests with haptens proposed by the Gruppo Italiano Ricerca Dermatiti da Contatto plus other substances suggested by each patient's history. Two hundred fifty-nine patients (24.6%) were positive to at least one test substance of the standard series or to substances added. Typical photoallergic reactions were seen in 198 subjects (259 minus 40 toxic photodermatitis to chlorpromazine and 21 to promethazine), which represents 18.8% of the total population. Topical drugs represent the most involved substances in photodermatitis. The incidence in our population was about equal for antimicrobial agents, additives to fragrances, and fragrances themselves. Other allergens found were salicylanilides, whereas sun-screening agents were the fifth group of haptens but with clear-cut relevance. This study is a first attempt to organize the data about results of photopatch tests applied to Italian patients.
Experimentally demonstrated interactions between Ni2+ and Mg2+ were examined in human beings. 110 subjects patch-test-positive to 10 microliters aq. NiSO4 0.1 M were subdivided into groups of 30, 50 and 30 people. Each subgroup was tested to 10 microliters NiSO4 0.1 M solution as a control and to mixed solutions containing NiSO4 0.1 M together with, respectively MgSO4 0.1 and 0.3, 0.3 and 0.5 and 0.5 and 1 M. On increasing the applied concentrations of MgSO4, the % of patients with reduced or suppressed nickel reactions, with 1 exception, proportionally increased. The exception concerned testing with 0.5 M, where a paradoxically exacerbating increase in nickel reactions was seen in a majority of nickel-sensitive subjects. MgCl2 aq. at 0.3, 0.5 and 1 M concentrations was not able to reduce the cutaneous patch test positive reactions to NiCl2 0.1 M in 25 sensitive patients. On increasing the applied concentrations of MgCl2, both the number and intensity of patch test reactions to NiCl2 proportionally increased. A supposed rôle of the sulfate and chloride counterions in the penetration of nickel was examined in 30 NiSO4 5% patch-test-positive patients, testing to 10 microliters of aq. NiSO4 0.1 M, NiCl2 0.1 M, NiSO4 0.1 M + MgCl2 0.3 M, NiCl2 0.1 M + MgSO4 0.3 M, Na2SO4 0.3 M, NaCl 0.3 M, NiSO4 0.1 M + Na2SO4 0.3 M, NiCl2 0.1 M + NaCl 0.3 M. The findings suggest that the addition of sulfate or chloride to nickel could determine the formation of different Ni complexes directed toward different targets, one Mg(2+)-dependent, the other Mg(2+)-independent.
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87 subjects sensitive to both nickel sulfate and palladium-chloride pet., were contemporaneously patch retested to nickel sulfate 5% pet., metallic palladium chloride 1% pet. and to palladium chloride 1% aq. Whilst all subjects reacted to nickel sulfate and palladium chloride pet., only 3 reacted to palladium chloride aq. No positive reactions were found to metallic palladium. The negative results to palladium chloride aq. are probably due to the formation of a new palladium ion (PdCl4)2-, achieved on adding an amount of hydrocloric acid to the aqueous solution of PdCl2. The findings seem to demonstrate that the allergic reaction to palladium depends on the arrangement of the metal electrons. The sensitization to palladium does not seem to be dependent on the element itself but on the complexes formed by the different compounds. The concomitant reactions to nickel and palladium ions could be dependent on the generation of similar complexes between the ions and the skin proteins.
8 nickel-sensitive subjects were given a gradually increasing daily oral intake of NiSO4 in water. The exposure lasted from between 91 and 178 days and the total intake ranged from between 113 and 278 mg of Ni++. While 6 subjects were continuously exposed over the entire period, the other 2 were exposed for 2 shorter periods with an interval between the 2 exposures of 84 and 63 days, respectively. Nickel exposure was well tolerated by all subjects, and there was no worsening of the cutaneous manifestations. Ni++ serum and urine concentrations were repeatedly assayed. A reduction of intestinal adsorption and an activation of the renal excretion were shown through an evaluation of the ratios of Ni++ serum concentration/Ni++ cumulative oral intake, Ni++ urinary amount/nickel cumulative oral intake and Ni++ serum amount/Ni++ urine amount. The course of Ni++ faecal amounts, calculated indirectly, increased rapidly in time and was consistent with the other courses. In many subjects, the decrease in serum concentrations was followed by a slight increase. It is likely that this phenomenon is due to the release of epidermally stored nickel. These data seem to indicate that in some sensitive subjects, prolonged oral exposure to NiSO4 in water reduces the intestinal adsorption of nickel and activates its renal excretion, also promoting the mobilization of accumulated element.
We report a case of hypertrophic allergic contact dermatitis probably due to p-phenylenediamine (PPDA) in a 26-year-old female, which developed at the sites of application of a black hair dye to the skin. Histological examination revealed an eczematous process. The lesions subsided completely except for leukoderma that remained on the leg. Patch tests showed positive reactions to PPDA, p-aminophenol and Disperse Orange 3. PPDA, which was one of the components of the dye, was considered to be the primary sensitizer because it was the only substance able to reproduce at the patch test site both the hypertrophic pattern and the permanent leukoderma found in the patient's lesions. To explain the difference in reaction between PPDA and the other 2 para-group substances, we speculate that they are due to different quantities of reactive intermediates, oxidation products and free radicals, produced by these substances.
Nickel (Ni) dermatitis is thought to involve the formation of complexes between Ni ions and suitable proteins. 4 groups of 30 subjects who gave positive patch test responses to NiSO4 2.9% aq. were each retested to 1 of 4 different solutions containing equimolar (0.1 M) amounts of NiSO4 plus MgSO4, NiSO4 plus CuSO4, NiSO4 plus ZnSO4, and NiSO4 plus Li2SO4, respectively. The results, evaluated at 2 days by visual scoring only, demonstrated that the 4 metals exerted a different influence on the nickel reactions, perhaps interfering with one or more factors affecting the formation of Ni+ + complexes.
In an investigation of the role of keratinocytes in the pre-immunological phase of contact allergy, we have studied the effect of paraphenylenediamine (PPD) on cell proliferation, membrane lipid peroxidation and the expression of the intercellular adhesion molecule 1 (ICAM-1). Because PPD undergoes rapid autoxidation in the culture medium, the effect of PPD-modified medium on keratinocyte proliferation and ICAM-1 expression was also examined. PPD at low concentrations (up to 10 micrograms/ml) and with low exposure times (0.5 h) enhanced keratinocyte proliferation, but at high concentrations and with longer exposure times resulted in cell stasis and toxicity. These effects and the enhanced membrane lipid peroxidation that was also observed can be ascribed to the production of superoxide and hydrogen peroxide by the autoxidation of PPD in the medium. At non-cytotoxic concentrations, PPD induced ICAM-1 expression on the keratinocytes. PPD-modified medium was also cytotoxic to the keratinocytes and induced ICAM-1 expression in non-cytotoxic concentrations. It appeared that superoxide and hydrogen peroxide were not responsible for the cytotoxicity. These results are consistent with the view that oxidative stress may be an essential part of the pre-immunological phase in the induction of allergic contact dermatitis.
A multicenter study was performed in 9 Italian centers by members of the GIRDCA, to evaluate the frequency and source of contact sensitization in a group of 302 hairdressers with dermatitis. Occupational habits and use of preventive measures were specifically investigated both in these 302 hairdressers and in a further group of 240 hairdressers who answered a questionnaire. The results showed the presence of an occupationally relevant sensitization in 60.9% of the 302 hairdressers. This proportion included 52 hairdressers who had negative patch tests to the hairdressers' series but showed positive reactions to other allergens, such as nickel, rubber additives, preservatives and fragrances, which were judged relevant to their occupation. Among hair dyes, PPD caused 73 reactions (24.2%), PAP 32 reactions (10.6%), ONPPD 24 reactions (7.9%), and PTD 40 reactions (13.2%). A low incidence of sensitization was detected in our hairdressers to resorcinol and pyrogallol (1.3% for each substance). Among permanent wave allergens, positive reactions to GMTG were found in 11.3% of patients, while ATG gave a lower rate of positive reactions (5.0%). Allergic contact dermatitis due to APS was also relatively common (11.3%). 4 hairdressers in this study gave a positive reaction 30 min after a provocative test with latex gloves, patch testing to the rubber series being negative. Enquiry regarding preventive measures revealed that the majority of hairdressers use gloves when doing hair dyeing, but rarely use them for washing dyed hair or for doing permanent waving. The infrequent use of preventive measures by Italian hairdressers was confirmed by the results of the questionnaire, and possibly explains the high frequency of skin problems (12.5%) in the hairdressing population that was specifically interviewed.
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