[Picture of the month. Contact dermatitis of the hand].
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Dermatitis, Allergic Contact↗
Biomedical subjects
T Agner
Publications and source records attributed to T Agner.
Hand eczema in twins: a questionnaire investigation.
Hand eczema in a population-based twin cohort of 6666 persons aged 20-44 years was investigated by means of a questionnaire regarding skin symptoms on the hands and self- or physician-diagnosed hand eczema. Genetic influence was observed by significant differences between identical and fraternal twins regarding casewise concordance rate and correlations in liability under the threshold model. The casewise concordance rates were almost twice as high in identical compared with fraternal twins in both sexes. By extension of the threshold model a joint analysis could be performed, resulting in a heritability estimate of 0.65. Tendencies towards stronger genetic influence for men and for younger individuals were present, but neither was statistically significant. No particular symptom pattern expressed especially strong or weak genetic influence. Hereditary factors for hand eczema were observed despite a presumably substantial individual-specific environmental variation. The hypothesis that hereditary risk factors may play a significant part in the development of hand eczema in the general population, when no extreme environmental exposure exists, seems justifiable. The relevance of known individual risk factors such as atopic dermatitis or contact allergy in relation to heredity remains to be analysed. The possible importance of age and temporal change also needs further consideration.
Adult↗
[Smoking intervention among hospital staff at the H:S Bispebjerg Hospital. Toward a non-smoking hospital--short-term results].
As part of aiming towards a non-smoking hospital environment, staff at a Copenhagen university hospital were offered participation in a differentiated smoking cessation programme. This consisted of lectures, group therapy, follow-up visits and individually tailored nicotine replacement therapy free-of-charge for six weeks. Three hundred and seventy-four employees started the programme, with 353 continuing for the full six weeks. They were moderately nicotine dependent with a Fagerström score of 5 (0-10). Almost all smoked daily and smoked at work, with 87% having a CO measurement above 5 at the first visit. At six weeks follow-up 209 (59%) were still not smoking and a further seven (2%) had reduced their tobacco consumption substantially. The remainder had started smoking again. Only 10% had a CO measurement > 5 at the end of the study. In conclusion, a combination of theoretical education, individual follow-up visits and nicotine replacement therapy is useful and worthwhile in the effort to support hospital staff in smoking cessation.
Adolescent↗
Effect of long-term use of moisturizer on skin hydration, barrier function and susceptibility to irritants.
Moisturizers are often used in the prevention and treatment of irritant contact dermatitis. The present study was to determine whether long-term daily use of a moisturizer on normal skin would affect skin barrier function, hydration state, or susceptibility to sodium lauryl sulphate. Healthy volunteers used a moisturizer on one forearm 3 times daily for 4 weeks. The other forearm served as a control. Afterwards both forearms were challenged with a patch-test of sodium lauryl sulphate. Skin barrier function was evaluated by measuring trans-epidermal water loss and skin hydration by measuring electrical capacitance. Electrical capacitance was significantly increased on the treated arm during the treatment period. After challenge with sodium lauryl sulphate, transepidermal water loss was significantly higher on the arm treated with moisturizer than on the control arm. The results suggest that long-term treatment with moisturizers on normal skin may increase skin susceptibility to irritants.
Adult↗
Comparison between 2 test models in evaluating the effect of a moisturizer on irritated human skin.
The purpose of the present study was to compare 2 experimental models of moisturizer efficacy on the recovery of irritated skin on the hands and the volar forearms. 12 healthy volunteers had their hands immersed in sodium lauryl sulfate (SLS) 10 min 2x daily for 2 days, and at the same time the volunteers had patch tests with SLS (0.125%, 0.25% and 0.5%) applied on their forearms for 24 h. After irritation of the skin, the volunteers had a moisturizer applied on one arm/hand 3x daily for the following 9 days. The other arm/hand served as untreated control. Evaluation was done on days (D) 1, 3, 5, 8 and 12 by transepidermal water loss, electrical capacitance, laser Doppler flowmetry and DermaSpectrometry. Both models were found useful, and the moisturizer was found to accelerate regeneration of the skin barrier function in both the hands (D8, p<0.05) and the volar forearms (0.5% SLS, D5 and D8, p<0.01). When the forearm model is used in the present set-up, a relatively high concentration of SLS (>0.25%) should be used and evaluation measurements are best performed on D5-D8. The forearm model proved reliable and easy to handle and we suggest that this model is used in future studies on moisturizer evaluation.
Adult↗
Contact allergy to cosmetics: testing with patients' own products.
In a 2-year period, 1527 patients with contact dermatitis were investigated in the patch-test clinic. In 531 patients, allergy to cosmetics was suspected from the history and they were tested with their own cosmetic products. 40 (7.5%) (of the 531 patients) had 1 or more positive reactions, 82 (15.4%) had doubtfully positive reaction(s) and 31 (5.8%) had irritant reaction(s). Skin-care products were tested most frequently and were also found to cause most positive, doubtfully positive and irritant reactions, 80% of the patients with positive reactions to their own products had no history of contact dermatitis prior to the presenting attack, and in 92.5% of the cases, the positive reaction was considered relevant or partly relevant. In patients with a positive reaction, ingredients that could be responsible were found in 60% of the cases by testing with the European standard series and a series of common cosmetic ingredients. Fragrance mix and formaldehyde were found to be the ingredients most often responsible and were significantly more frequent in patients with positive reactions to their own products, compared to a control group of eczema patients also seen in the patch-test clinic.
Adult↗
Formaldehyde allergy: A follow-up study.
BACKGROUND: Formaldehyde is a commonly used preservative in cosmetic products, cleaning agents and industrial products, and sensitization to formaldehyde frequently occurs. OBJECTIVE: The aim of the study was to evaluate the effect of extensive information and exposure assessment of formaldehyde on the prognosis of eczema. METHODS: The present study was designed as a clinical follow-up study of formaldehyde-sensitive patients. 105 patients diagnosed as formaldehyde allergic in the period January 1 1990 to December 31 1994 were thoroughly informed about their allergy, and exposure assessment was performed as a formaldehyde analysis on the patients' products. RESULTS: At follow-up 1 to 5 years later, 57 patients accepted the invitation to attend the outpatient clinic for an interview and a skin examination by a dermatologist, and were also at this time asked to bring products to which they were currently exposed for formaldehyde analysis. Evaluated by reported number of eczema eruptions and from objective skin examination patients had generally improved from their first visit to the department. At follow-up, 38 of 49 patients bringing products for analysis were still exposed to formaldehyde, as assessed by formaldehyde analysis on their products. There was a trend that severe eczema was found more often in patients still exposed to formaldehyde, but this finding was not statistically significant. Thirty-seven patients reported that they "paid attention to their allergy" when buying and using cosmetics or consumer products. CONCLUSION: Patients who paid attention to their allergy had statistically significantly fewer eruptions than those who did not.
Adult↗
Guidelines on sodium lauryl sulfate (SLS) exposure tests. A report from the Standardization Group of the European Society of Contact Dermatitis.
This report reviews the clinical and histopathological reactions caused by sodium lauryl sulfate (SLS), and the non-invasive methods that can characterize these reactions. Furthermore, SLS exposure techniques and factors that may influence the outcome of these exposures are discussed. Finally, guidelines are introduced for each exposure technique in order to have a uniform approach to SLS testing in man. Since different study aims warrant different testing conditions, we have proposed 2 categories, namely susceptibility testing and provocative testing, tailored to the aim with which the study is performed.
Dermatitis, Contact↗
Iodopropynyl butylcarbamate: a new contact allergen.
Iodopropynyl butylcarbamate (IPBC) has been used for years as a fungicide and bactericide for wood and paint preservation without any reports of cutaneous side-effects. During the last few years, it has entered cosmetic products and is temporarily permitted in the EU Cosmetics Directive in a use concentration of 0.1%. In the present study, we report our preliminary experience with patch testing consecutive contact dermatitis patients with IPBC. A patch test concentration of 0.1% seems appropriate for initial screening but deserves further evaluation. Among 311 consecutive patch test patients, 3 patients with a positive patch test to IPBC have been identified. Contact allergy is likely in at least 1 case, based on clinical history, exposure history, patch testing with dilution series, ROAT and chemical analysis.
Adult↗
Threshold for occluded formaldehyde patch test in formaldehyde-sensitive patients. Relationship to repeated open application test with a product containing formaldehyde releaser.
Our purpose was to investigate the eliciting threshold concentration of formaldehyde in formaldehyde-sensitive individuals in the occluded and non-occluded patch test, and to evaluate the relationship to repeated open application test (ROAT) with a product containing a formaldehyde releaser. 20 formaldehyde-sensitive patients and a control group of 20 healthy volunteers were included in the study. Occluded and non-occluded patch tests with formaldehyde solutions from 25 to 10,000 ppm, and ROAT for 1 week with a leave-on cosmetic product containing on average 300 ppm formaldehyde, were carried out simultaneously on each subject. In the occluded patch test, 1/2 of the 20 patients only reacted to 10,000 ppm formaldehyde, 9 reacted to 5,000 ppm, 3 reacted to 1,000 ppm, 2 reacted to 500 ppm and 1 reacted to 250 ppm. No definite positive reactions were observed in the non-occluded patch test or in the ROAT. No positive reactions were observed in the control group to any of the test procedures. We concluded that the threshold concentration for occluded patch test to formaldehyde in formaldehyde-sensitive patients was 250 ppm. The threshold in occluded patch test corresponded to the degree of sensitivity. Definite positive reactions in the ROAT were not seen, either indicating that they are unlikely to happen with the type of product used or that the exposure time was too short.
Adult↗
PCR for detection of Chlamydia trachomatis in endocervical, urethral, rectal, and pharyngeal swab samples obtained from patients attending an STD clinic.
OBJECTIVE: To investigate, by use of the Amplicor PCR in a routine setting, the recovery rate of Chlamydia trachomatis in ano-rectal and pharyngeal swab samples obtained from males and females attending an STD clinic in relation to sexual practices, symptoms, and signs. DESIGN: Data regarding sexual practices, and symptoms and signs related to the rectum and pharynx, were obtained from 196 females and 208 males, including 31 homosexuals and eight bisexuals. Swab samples were obtained from the urethra, rectum, and pharynx from all the patients. An additional endocervical swab sample was obtained from the females. METHODS: All samples were analysed by the Amplicor PCR (Roche). SETTING: Rudolph Bergh's Hospital, a clinic for sexually transmitted diseases situated in the centre of Copenhagen, Denmark. RESULTS: The overall prevalence of urogenital C trachomatis infection was 9.2% (37/404). The specificity of the Amplicor PCR was 100% for both ano-rectal and pharyngeal swab samples. In females three (13%) of the 23 infections were detected only by testing an ano-rectal or throat swab sample. In homosexual males two (67%) of three infections were detected only by the anorectal swab sample. Ano-rectal intercourse without use of condom was reported by 44% of females and by 52% of homosexual males. Fellatio without condom use was reported by 91% of females, and 80% of heterosexual males practised cunnilingus. Pharyngeal infection, however, occurred only in females, and the presence of pharyngeal symptoms or signs seemed predictive for pharyngeal C trachomatis infection, for which the time of incubation or colonisation exceeded 3 months. The presence of ano-rectal signs or symptoms was not predictive for an ano-rectal C trachomatis infection. CONCLUSION: The Amplicor PCR can be used on ano-rectal and pharyngeal swab samples. Ano-rectal swab samples should be obtained in females and homosexual males at high risk of being infected. Pharyngeal samples should be taken in females at high risk of being infected, especially when pharyngeal signs or symptoms are present.
Adolescent↗
Preventive and therapeutic effects of a moisturizer. An experimental study of human skin.
The effect of a moisturizer was tested on experimentally irritated human skin in two studies. In a prevention study, 12 volunteers had both hands immersed into a 0.375% sodium lauryl sulphate solution, 10 min twice daily for 2 days. Before each immersion one hand was treated with the moisturizer; the other hand served as control. In a therapeutic study, 12 volunteers had both hands immersed in the same way as mentioned above. After the last immersion one hand was treated for 5 days with the moisturizer; the other hand served as control. Skin barrier function was evaluated by transepidermal water loss (Evaporimeter), and blood flow was evaluated by laser Doppler flowmetry and skin hydration by electrical capacitance (Corneometer). A significant preventive effect was obtained on the treated hand, compared to the control hand, judged by all measured parameters. A significant therapeutic effect was observed on skin barrier function and on skin hydration on the treated hand, compared to the control hand, while no difference between the hands in blood flow was observed after the end of treatment. The moisturizer could prevent irritant skin reactions induced by a detergent, and it could also accelerate regeneration of the barrier function of irritated skin.
Administration, Topical↗
Effect of water on experimentally irritated human skin.
The effect of water on experimentally irritated skin was studied in 21 healthy volunteers to evaluate water as a primary irritant. Volunteers had one hand exposed to water 15 min twice daily for 2 weeks, while the other hand served as control. The transepidermal water loss and the electrical capacitance were measured reflecting skin barrier function and skin hydration, respectively. The blood flow and the erythema index were measured reflecting inflammation. Water did not significantly influence transepidermal water loss, but caused a significant increase in skin blood flow, as evaluated by laser Doppler flowmetry. It is concluded that exposure to water 30 min daily for 2 weeks does not influence the barrier of previously subclinically irritated skin. It does, however, elicit an increase in skin blood flow.
Adult↗
Effect of glove occlusion on human skin. (I). short-term experimental exposure.
UNLABELLED: Skin barrier function was studied after use of occlusive gloves on normal and compromised skin. 2 studies were performed (Study A and B), and the effects were evaluated by non-invasive methods. Participants in the studies were instructed to wear an occlusive glove on one hand, while the other hand served as control. The gloves used were hypoallergenic, non-latex. Study A: 20 volunteers wore a glove on normal skin 6 h/day for 3 days. Study B: 20 volunteers wore a glove on sodium lauryl sulfate(SLS)-compromised skin 6 h/day for 3 days. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation was evaluated by erythema index (DermaSpectrometer). RESULTS: Study A. Glove occlusion on normal skin 6 h/day for 3 days caused no significant influence on the water barrier function. Study B: Glove occlusion on SLS-compromised skin for the same period of time had a significantly negative effect on the water barrier function. It is concluded that occlusion may be an additional factor in the pathogenesis of cumulative irritant contact dermatitis.
Adult↗
Effect of glove occlusion on human skin (II). Long-term experimental exposure.
Gloves are indispensable in many occupations. Irritant skin reactions from gloves have, however, been reported. In the present study, the effect of long-term glove occlusion on normal skin (6 h/day for 14 days) was studied and, in addition, the effect of a cotton glove worn under the occlusive glove was also studied. 2 studies were performed (studies A and B). Study A: 19 volunteers wore an occlusive glove on normal skin 6 h/day for 14 days. They wore the glove on one hand only, while the other hand served as control. Study B: 18 volunteers wore occlusive gloves on both hands on normal skin. A cotton glove was worn under the occlusive glove on either the left or the right hand. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation by erythema index (Derma-Spectrometer). The gloves used were hypoallergenic non-latex gloves. Results. Study A: glove occlusive on normal skin 6 h/day for 14 days had a significant negative effect on skin barrier function, as measured by TEWL. Study B: the negative effect on skin barrier function from occlusive gloves was prevented by the use of a cotton glove. It is concluded that gloves may be a substantial factor in the pathogenesis of cumulative irritant contact dermatitis, and that recommendations as to their use are important.
Adult↗
Chromium allergy in consecutive patients in a country where ferrous sulfate has been added to cement since 1981.
Cement eczema used to be a common occupational disease in Denmark. Since 1981, ferrous sulfate has been added to all cement produced in Denmark to reduce the amount of soluble hexavalent chromate to below 2 mg/kg (2 ppm). The aim of the study was to analyse a material of consecutive chromate-sensitive patients in an urban tertiary referral centre with respect to primary cause of sensitization, in a geographical area where the risk of chromate exposure from cement had been reduced. In the 6-year period January 1989 to December 1994, a total of 4511 patients were patch tested with the European standard series, including chromate. 79 patients, 31 male and 48 female, were diagnosed as chromate sensitive. Relevant chromate exposure was established in 34 of these 79 patients. Leather was the most frequent source of chromate sensitization (19 out of 34) (47%). Chromate sensitization from cement was considered likely in 10 out of 34 subjects. Of these, 7 had been sensitized before 1981, 2 had been sensitized by non-occupational exposure to cement, and only 1 had been sensitized from occupational cement exposure in the 6-year period.
Adult↗
Patch test study with calcipotriol ointment in different patient groups, including psoriatic patients with and without adverse dermatitis.
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.
Adult↗
Temperature dependency of skin susceptibility to water and detergents.
Exposure to water and detergents is an important factor for development of irritant contact dermatitis. The aim of the present study was to investigate the effect of temperature on the damaging effects of water and detergents on the skin. Twenty healthy volunteers participated in the study. Ten participants had right and left forearms immersed into a detergent (soap) solution for 2 days twice daily for 10 min. Another 10 participants had both forearms immersed into sterile water. Right and left forearms were randomized to immersion into 20 degrees C and 40 degrees C solutions, respectively. Reactions were evaluated clinically, and by measurement of transepidermal water loss, electrical capacitance and erythema. Immersions into 40 degrees C sodium lauryl sulphate solution caused significantly increased transepidermal water loss as compared to immersion into 20 degrees C sodium lauryl sulphate solution. Electrical capacitance and erythema were not significantly influenced by temperature. Immersion into water caused no significant changes in any observed parameter. Water temperature influences the irritant capacity of a detergent. Change of temperature may be a simple but important means for prevention of irritant contact dermatitis.
Adult↗