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Occupational allergic contact dermatitis from 2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) and Kathon LX in a starch modification factory.

2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) is used in the production of cationic starch (CS) for the paper industry. It has been shown to be a sensitizer in guinea pigs, but cases of human sensitization are few. 4 workers were previously sensitized to the substance in a Finnish plant. This report describes 3 process men from another plant examined because of recurring dermatitis. 18 workers were involved in production, and had free access to all work sites. 3 process men, whose work involved drying the CS, had dermatitis, although they had only occasional contact with the cationizing chemical. 2 were already verified to be allergic to EPTMAC and had had variable dermatitis for 8-12 years. One had had dermatitis on his face for 1 year. Patch testing with a dilution series (1%, 0.5%, 0.2%, 0.1% pet.) confirmed their allergy to the cationizing chemical containing EPTMAC, but tests with CS were negative. In addition, 2 had contact allergy to Cl+ Me-isothiazolinone from contact with Kathon LX used as a slimicide in the process. In long-standing (years) recurrent dermatitis, re-examination of patients with verified exposure history and skin test is necessary. In line with our previous study, sampling the process materials, maintenance work and contamination of work sites and gloves caused sensitization. The results also confirm that EPTMAC is a strong human contact sensitizer. 0.2%-0.5% pure EPTMAC in pet. seems to be the optimal patch test concentration.

Adult↗

Contact sensitivity to chromate: comparison at a London contact dermatitis clinic over a 10-year period.

It has been argued that for chromate sensitivity to be reduced, then ferrous sulfate should be added to cement. This has not yet been done in the UK. To explore this further, we have looked at the comparative sensitization rates of patients attending the St. John's Institute of Dermatology Contact Dermatitis Clinic between the years 1982-3 and 1992-3. Patch-test-positive rates for females were not significantly different between the 2 populations studied (1982-3, 1.59% and 1992-3, 1.99% p NS). Similarly, there was no significantly different rate between the males (1982-3, 3.99% and 1992-3, 4.25% p NS) in the same time period. There was no difference in the distribution of eczema in chromate-positive subjects, nor of cobalt co-sensitization, a crude indicator of sensitization via cement. This work demonstrates no appreciable difference in the frequency of chromate sensitivity between the early 1980s and 1990s in London. Adding ferrous sulfate to cement may help to lower the frequency in the future.

Adult↗

How irritant is water? An overview.

Water is a skin irritant which deserves attention because of its ubiquity. During the Vietnam war, soldiers suffered from painful swollen feet, so-called tropical immersion foot. In occupational dermatology, the importance of water as a skin irritant is especially appreciated. The irritancy of water has been demonstrated by occlusion experiments; occlusion with either closed chambers or water-soaked patches has been shown to produce clinical and histopathological inflammation. Functional damage, as revealed by increased transepidermal water loss, has also been shown. Repeated water exposure without occlusion caused an increase in blood flow on irritated skin; however, clinical evaluation did not show a difference in dryness or scaling. Several mechanisms such as osmolarity, pH, hardness and temperature might account for the irritancy of water. Extraction or dilution of natural moisturizing factors in the stratum corneum is another possible explanation. Occlusion per se also changes the physiology of skin and may trigger the activation of potentially active substances. However, much remains to be done to clarify the risk factors and mechanisms of water-induced irritation.

Dermatitis, Irritant↗

Self-reported skin exposure--validation of questions by observation.

The aim of this study was to validate questions regarding skin exposure using observation. The study group consisted of 40 individuals in 5 different occupations: nurse in an intensive care unit, car mechanic, hairdresser, kitchen worker, and office worker. The participants completed a questionnaire before the start of a working day. The questionnaire covered total skin exposure times to water, foodstuffs, chemicals, and occlusive gloves and also covered the frequency of hand-washing during a working day. Observers subsequently used a hand-held computer to register the time and the frequency of each exposure. A strong correlation between self-reports and observations was found for questions regarding exposure times to water, foodstuffs, and occlusive gloves and also a moderate correlation for questions regarding frequency of hand-washing. The present observation method was insufficient for estimating total exposure times to chemicals as the true exposure time is influenced by, e.g. the use of contaminated protective gloves and the efficacy with which the chemicals were removed. The inter-observer reliability showed a very strong correlation. We consider the questions regarding skin exposure to water, foodstuffs, protective gloves, and hand-washing to be useful for future studies. The observation method seems to be reliable, useful, and easy to apply.

Adult↗

Generalized eruptive porokeratosis of Mibelli with associated psoriasis.

A case of eruptive porokeratosis of Mibelli with diverse morphologic features, including circinate macular, circinate plaque and verrucous varieties is presented. No matter how variable the clinical presentation may be, the histologic hallmark of porokeratosis, the cornoid lamellae, is always present. The cornoid lamellae vary in height in relation to how prominent the thready ridge of the clinical lesion appears. Our patient also had psoriasis which initially masked the porokeratotic lesions both clinically and histologically. Awareness of the various clinical expressions of porokeratosis of Mibelli would 1) make unnecessary the segregation of certain forms of porokeratosis into separate entities, and 2) help in the recognition of less classical forms of porokeratosis.

Foot Dermatoses↗

Recalcitrant pustular eruptions of the extremities.

Forty-seven biopsies of pustules from patients with recalcitrant pustular eruptions of the palms and soles were examined blind and the results were subsequently compared among three clinical sub-groups: acrodermatitis continua, pustular psoriasis and pustulosis palmaris et plantaris. With the exception of three cases, it was not possible to make a diagnosis of psoriasis on the basis of histology alone. Histological findings were otherwise uniform and typical: intra-epidermal, unilocular, well-delineated pustules. No significant differences were found among the three subgroups. In view of the uniform histology, the unknown etiology and the uncertain clinical classification, the authors prefer the clearly descriptive term pustulosis palmaris et plantaris.

Acrodermatitis↗

Onychomycosis (trichophyton mentagrophytes). A scanning electron microscopic observation.

Nails from four patients, infected with dermatophytes, were investigated with the scanning electron microscope (SEM) to gain insight into the spatial arrangements of the dermatophytes within the nail. Fungal hyphae could be detected in nails of all four patients. A toenail from one patient infected with Trichophyton mentagrophytes was more extensively studied and the results are presented in this paper. Light microscopic observations with bright field illumination and Nomarski interference contrast confirmed the dermatophytic infection. Fungal hyphae found with the SEM distally on the ventral part of the toenail showed typical T. mentagrophytes structures and the comparison with cultured material clearly demonstrated the correspondence in morphology and size. Besides the fine structural morphology of the invasion of fungal hyphae into the nail plate between the horny cells and/or directly into corneocytes, "tunnel"-like holes were observed in paraffin embedded sections after removal of the paraffin. Scanning electron microscopy, with its enormous focal depth, yielded far more information than light microscopic techniques about the three dimensional behavior of dermatophytes in the nail.

Foot Dermatoses↗

Self-reported occupational dermatological reactions among Danish dentists.

The aims of the study were to investigate the causes and prevalences of occupational dermatological reactions among Danish dentists. Questionnaires and telephone interviews with Danish dentists revealed that 37.8% reported skin reactions. In 27.2% of the cases the reactions were related to occupation, occurring with a point prevalence of 9.6%, and with a 1-yr period prevalence of 21.4%. The main causes were hand washing/soaps, latex gloves and (di)methacrylate-containing materials occurring at point prevalences of 7.1%, 1.3% and 1.7%, respectively. In addition, several other causes were reported, each occurring at relatively low frequency. Diagnosed allergic latex eczema was reported by 0.6%, but the frequency might be more than 2%, estimated on basis of reported symptoms. Allergic eczema caused by (di)methacrylate-containing materials was diagnosed among 0.7%, but estimated by the description of symptoms to be nearly 2%. The results urge for developing safer materials for dental use.

Composite Resins↗

PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles.

PUVA-bath therapy has proven to avoid many side effects associated with oral 8-methoxypsoralen (8-MOP) treatment. In order to investigate the effectiveness of topical PUVA-bath therapy (PUVA-soak therapy) on chronic palmoplantar dermatoses, 30 patients with plaque-type psoriasis, pustular psoriasis, endogenous eczema, dyshidrotic eczema and hyperkeratotic dermatitis of the palms and soles were treated over 8 weeks with PUVA-soak using 8-MOP. No additional treatment except skin moisturising cream such as unguentum emulsificans aquosum was used during the study period. The single UVA-doses applied ranged from 0.3 to 3.0 J/cm2 (mean single dose of 1.8 J/cm2), with a mean cumulative dose of 48.6 J/cm2 per patient. Altogether 26 of 30 patients responded well within 8 weeks of treatment with 63% of all patients showing a complete remission and 23% showing considerable improvement, as shown by flattening of plaques, decreased scaling and erythema, as well as decreased vesicle and pustule formation. The condition responding best to our therapy was palmoplantar psoriasis followed by atopic eczema. Hyperkeratotic dermatitis displayed the poorest responding rates in this study. Unwanted side effects such as erythema, pain, blistering or patchy hyperpigmentation were not observed in any of the patients. We conclude that PUVA-soak therapy can be highly efficient in the treatment of palmoplantar dermatoses, especially in the management of palmoplantar psoriasis.

Administration, Cutaneous↗

Treatment of severe recalcitrant dermatoses of the palms and soles with PUVA-bath versus PUVA-cream therapy.

PUVA-bath therapy developed into a first line topical PUVA therapy, and gel and cream preparations have been described as alternative modes of topical 8-MOP application. Because bath-PUVA can be difficult to manage, topical PUVA therapy using 8-MOP gel or cream preparations may become an important alternative when treating localised skin diseases. However, controlled comparisons of efficacy with this alternative topical PUVA therapy are lacking. We therefore compared the efficacy of PUVA-cream therapy with PUVA-bath therapy in 12 patients with recalcitrant dermatoses of the palms and soles using a left/right trial design. These patients responded well to both treatment modalities, meaning that both could be used successfully to treat recalcitrant dermatoses of the palms and soles.

Administration, Cutaneous↗