Allergic contact dermatitis from surgical paints.
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Biomedical subjects
Publications and source records attributed to F Granel.
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BACKGROUND: Resorcinol is a rare sensitizer. In Lorraine, where it is used in high concentrations in an anti-wart ointment, this molecule has induced many cases of allergy. The purpose of this study was to describe clinical features in patients sensitized to resorcinol, to determine the incidence of sensitization in Lorraine and ascertain the occurrence of cross reactions with other phenolic pro-haptens. PATIENTS AND METHODS: The files of all patients sensitized to resorcinol were studied from 1992 to 1999. Over a 20-month period, 983 consecutive patients underwent our standard patch tests where we included resorcinol (1 p. 100 in petrolatum). Co-sensitization with other pro-haptens was studied in all sensitized patients. RESULTS: Sensitization to resorcinol was observed in 0.5 p. 100 of the 983 consecutively tested patients. Contact sensitization was found in 24 patients, who all but one had previously used the anti-wart ointment containing resorcinol. All developed contact eczema on the site of application of the ointment, with generalized urticaria (4 cases), pompholyx (1 case), and generalized papulo-vesicular rash with pompholyx (6 cases). Positive patch tests were observed with resorcinol monobenzoate (15/19 cases), pyrocatechol (7/14 cases), pyrogallol (9/19 cases), salicylaldehyde (2/17 cases), and hydroquinone (6/17 cases). Negative patch tests were observed with phenysalicylate, hexylresorcinol, or fluoresceine. CONCLUSION: Resorcinol should not be applied in high concentrations as it can provoke generalized sensitization and co-sensitization with other pro-haptens.
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BACKGROUND: A woman was cured of a melanoma of the leg. She presented an ultra late recurrence 17 years later, then rapid and extensive recurrence immediately after venous stripping. CASE REPORT: In 1977, a 38-year-old woman was operated for a SSM melanoma of the calf. She was then given chemotherapy and BCGtherapy for 2 years. In 1994, she presented a nodular recurrence which was treated surgically. In March 1997, she underwent a stripping of the leg. One month later, a nodular recurrence was discovered along the stripping line. DISCUSSION: The ultra late recurrence (> 15 years) in this case is highly exceptional and, to our knowledge, this is the first case of a recurrence along a vascular course. We discuss metastatic dissemination of SSM melanoma and the role played by stripping in this case of recurrence.
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INTRODUCTION: Transthoracic endoscopic sympathectomy for palmar hyperhidrosis is a safe and effective method. However, no radical and definite treatment exists for plantar hyperhidrosis. We report our experience, immediate post-operative and mid-term results after transthoracic and lumbar endoscopic sympathectomy for palmar and plantar hyperhidrosis. PATIENTS AND METHODS: One hundred and seven of 117 patients cured between January 94 and December 98, answered a questionnaire regarding their past history, the early post-operative results, side effects and complications caused by the operation and mid-term results with particular emphasis on patient satisfaction. RESULTS: Seventy-eight thoracic and lumbar endoscopic sympathectomies and 125 thoracic endoscopic sympathectomies were performed. The patients were 30 men (median age 30 years) and 77 women (median age 26 years). Only women underwent lumbar endoscopic sympathectomy because of risk of retrograde ejaculation. No severe complications were noted. The success rate was 96 p. 100 for palmar hyperhidrosis and 98,5 p. 100 for plantar hyperhidrosis. No recurrences were noted in 97 p. 100 of the patients with median follow-up of 28 months. The main side effect was compensatory sweating which was the reason for dissatisfaction for 5 p. 100 of the patients. Cutaneous dryness and gustatory sweating were also described. However, 95 p. 100 of the patients were "satisfied" or "very satisfied". CONCLUSION: Our experience proved that lumbar endoscopic sympathectomy is as safe and effective for treatment of plantar hyperhidrosis, as thoracic endoscopic sympathectomy for palmar hyperhidrosis.
INCREASING INCIDENCE: The development of new interventional techniques in radiology, particularly angioplasty of the coronary arteries, has lead to a rise in the incidence of radioderimitis. Clinical presentations vary from skin rash to necrosis and chronic ulceration. Telangiectasic atrophy and poikilodermitis are also observed. CASE REPORTS IN THE LITERATURE: Twenty-three cases of radiodermitis after cardiac catheterism have been reported in the literature. Mean delay to onset after the first radiology examination varies from 15 days to 10 years. TO REDUCE THE RISK: The main risk factor is a long duration of scopy using the same incidence. Use of older non-digitalized radiology machines also increases the risk. Physicians performing endovascular procedures should be aware of the risk of radiodermitis after angioplasy and implement radioprotective measures. RETROSPECTIVE DIAGNOSIS: Patients who develop localized pigmentation disorders and/or telangiectasies should be questioned concerning prior, often forgotten, radiology examinations.
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Following the second series of intravenous human immunoglobulins (IVIg; 0.4 g/kg) prescribed to treat a sensorimotor polyneuritis, a 28-year-old woman developed pompholyx that recurred after each of the following monthly treatments with IVIg. During the administration of the 10th series, the patient developed a typical baboon syndrome. Immunohistochemical studies of a skin biopsy revealed an unexpected epidermal expression of P-selectin, usually expressed by endothelial cells. Patch, prick and intradermal tests performed with IVIg on the back, arms and buttocks gave negative results on immediate and delayed readings. IVIg were re-administered, with the informed consent of the patient, and induced a generalized maculopapular rash. This is the first reported case of baboon syndrome induced by IVIg. Although extensive skin testing was performed, all test sites remained negative. We wonder whether IVIg could reproduce immunological mechanisms involved in the 3 types of systemic contact dermatitis (pompholyx, baboon syndrome and maculopapular rash), including the epidermal expression of P-selectin.
BACKGROUND: Since 1997, new side effects like lipodystrophia have been described in HIV-1-infected patients treated with protease inhibitors. The evolution is not specified in the most reported cases. CASE REPORT: A 44-year-old man treated for HIV 1 infection developed a Buffalo hump 12 months after initiating a new treatment including indinavir-protease inhibitor (Crixivan). Ten months later, we observe neither other fat accumulation nor fat loss and significant metabolic disorders. DISCUSSION: Many publications emphasized the relationship that would exist between protease inhibitors therapy and the occurrence of lipodystrophia. Clinical features of this syndrome appear like an accumulation of fatty tissue anywhere on the trunk, or a fat loss on the limbs, the buttocks and the face. It is sometimes associated with metabolic disorders. The pathogenesis of these lipodystrophia is unclear. Larger studies have to be led to highlight the incidence of these lipodystrophia and their subsequent effects on the HIV-1 infection.
PURPOSE: This study was aimed at determining the prevalence of anti-beta 2glycoprotéine I antibodies (anti-beta 2-GPI antibodies) in young adult patients presenting with either livedo reticularis or ischemic stroke. METHODS: Forty patients referred between February 1996 and February 1997 underwent clinical examination and laboratory tests with search for anticardiolipin antibodies (ACL antibodies), lupus anticoagulant (LA) and anti-beta 2GPI antibodies. RESULTS: Twenty-one patients presented with ischemic stroke (one with ACL antibodies), 13 had livedo (six with ACL antibodies, two with LA) and six patients presented with Sneddon's syndrome (two with ACL antibodies, two with LA). Only one was positive for anti-beta 2-GPI antibodies. CONCLUSION: beta 2-GPI is a cofactor that increases anticardiolipin antibody adhesion to cardiolipin. Our results suggest that the prevalence of anti-beta 2GPI antibodies is not high in young patients with either livedo reticularis or ischemic stroke. However, due to the small number of patients included in the study, definite conclusions may not be drawn out. Anti-beta 2-GPI antibodies assay is not justified in routine evaluation of patients with either livedo reticularis or ischemic stroke.
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BACKGROUND: Fluoroscopic and cineradiographic procedures expose patients undergoing coronarography to high doses of ionizing irradiation. CASE REPORT: We report four cases of radiodermitis following cardiac catheterization. A 69-year-old man developed a radio-induced ulceration on the left scapular region in 1991 which required excision with skin graft. He had undergone 3 coronarographies and 2 angioplasties from 1989 to 1991. In 1992, a 59-year-old women developed a hard dorsal lesion with central ulceration and scar formation requiring excision and graft. From 1990 to 1992, she had undergone two coronary dilatations with angioplasty during one procedure. An atrophic necrotic wound situated under the right nipple developed in a 63 year old man. Excision with flap reconstruction was performed in 1993, two years after an unsuccessful angioplasty then two-vessel bypass. In a fourth case, a 52 year-old woman developed a telangiectasic ulceration on the right breast in 1990. The diagnosis of radio-induced dermitis was confirmed in 1996 and the patient was treated by excision. She had had three angioplasties in 1989. DISCUSSION: Four other cases of radio-induced dermatitis following cardiac catheterism have been reported in the literature since 1996. Six other cases were also recently reported in France. All of these patients had undergone coronarography with transluminal coronary angioplasty. Besides coronarography, irradiation exposure is greatest for guide and balloon insertion required for dilatation procedures. Angioplasty is particularly dangerous because the irradiation beam is focused on the stenosis while the entire coronary network is concerned for coronarography. In most cases of radio-induced dermatitis following cardiac catheterism, the diagnosis is usually evident from the clinical context and the localization of the coronary lesion. In many cases however, the long delay to onset may make diagnosis a difficult task. In addition, the radiation dose delivered to the skin during cardiac procedures is not measured.
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INTRODUCTION: Nail dyschromia in patients infected with human immunodeficiency virus (HIV) was first described in 1987 by Furth and Kazakis. It has since been reported in patients with the acquired immunodeficiency syndrome (AIDS), predominantly in patients treated with zidovudine. CASE REPORT: We describe the case of a 37 years old white woman, who developed AIDS in 1994, with nail longitudinal colored bands, oral and cutaneous pigmentation without taking zidovudine. DISCUSSION: There have been four reports of nail pigmentation in HIV-infected patients who had no received this antiviral agent. The singularity of our case is the onset in a white woman. A lot of causes must be evoked and biology must be done, with histopathologic study when it is possible.