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Allergic contact dermatitis of the mouse ear.

Allergic contact dermatitis to picryl chloride on the mouse ear was registered by measuring the increasing wet weight during the inflammatory reaction. This quantitative technique permitted the use of small experimental groups of regular laboratory mice. Full sensitization to picryl chloride is achieved as early as 3 days after a single painting with the hapten. The allergic reaction peaks at 24 h after challenge. Sensitization and challenge are not inhibited, whether by antihistamine, histamine liberator, or antiserotonin. The hypersensitivity state lasts at least 4 months.

Animals↗

[Investigation of the cause of contact dermatitis due to heavy metal in a metal spray process in a film-condenser factory].

To investigate causes of contact dermatitis in the metal spray process in a film-condenser factory, we developed a questionnaire survey for workers exposed to metal dust, analyzed the metal dust, and conducted patch tests with the metal dust and its constituents. In the questionnaire survey, we identified 12 workers (12/26, 46.2%) who had had dermatitis. The main symptoms were itching, itchy red skin and itchy papules. Analysis of the metal dust showed that there was no copper oxide, but nickel, not contained in the materials of the metal spray, was detected. One worker with dermatitis had a positive reaction to 2.5% nickel sulphate. Some of the workers showed primary irritant reactions to 5% copper sulphate. As a result, we considered that these cases of dermatitis involved irritant contact dermatitis due to copper and/or allergic contact dermatitis due to nickel. To prevent dermatitis, we recommended improvement in ventilation, reducing the room temperature to reduce sweating, and to educate workers on the importance of frequent hand washing. Thereafter, the incidence of dermatitis decreased, and there were no cases requiring medication.

Adult↗

Large increase of Langerhans cells in human skin lymph derived from irritant contact dermatitis.

In order to monitor the kinetics of Langerhans cells in the afferent lymph during contact dermatitis, a superficial peripheral lymph vessel draining the skin of the upper and medial part of the foot was cannulated by means of microsurgery on the lower leg of four healthy volunteers. After 2 days an irritant contact dermatitis was induced by application of 10% sodium lauryl sulphate to the area of skin drained by the cannulated lymph vessel. Three days later the spontaneously regressing skin reaction was treated with clobetasol propionate in two of the subjects. Lymph was collected twice daily for 8 days. Langerhans cells were identified by immunofluorescence microscopy of cytocentrifuge slide preparations from the lymph, using a monoclonal anti-CD1a antibody. In the late phase of the contact dermatitis the output, i.e. both the absolute number and the percentage of Langerhans cells in the lymph dramatically increased. At the end of the experiment, when there were no remaining clinical signs of contact dermatitis, the Langerhans cell output still markedly exceeded the initial values. These results are the first direct evidence in humans that migration of Langerhans cells from the skin to the regional lymph nodes is a major feature of irritant contact dermatitis.

Adult↗

Allergic contact dermatitis to topical minoxidil solution: etiology and treatment.

After more than a decade of use, topical minoxidil solution has proven to be a safe and effective treatment for androgenetic alopecia. However, some patients present with complaints of pruritus and scaling of the scalp. The most common causes of these symptoms include irritant contact dermatitis, allergic contact dermatitis, or an exacerbation of seborrheic dermatitis. Patients suffering from allergic contact dermatitis may benefit from patch testing to determine the causative allergen. Among the patients we patch tested, propylene glycol was found to be the contactant in a majority of cases, not the minoxidil itself. Many of these patients may be candidates for treatment with alternative formulations using other solvents, such as butylene glycol, polysorbate, or glycerol. Although predictive, patch testing results do not ensure that the compounded preparations will be tolerated. Unfortunately, patients found to be allergic to minoxidil are no longer candidates for topical treatment of their alopecia with any preparations of minoxidil.

Administration, Topical↗

Contact dermatitis to biperiden and photocontact dermatitis to phenothiazines in a pharmacist.

A case of contact dermatitis to biperiden, an anti-Parkinson agent, and photocontact dermatitis to phenothiazines in a pharmacist was reported. The patient developed eczematous lesions on exposed area after she had worked at a psychiatric hospital for 6 months. She showed positive patch test reaction to biperiden. In addition, she reacted positively to photopatch testing with ultraviolet A and phenothiazines such as chlorpromazine and perphenazine. To our knowledge, contact dermatitis to biperiden has not been previously reported in the English literature.

Biperiden↗

Occupational protein contact dermatitis to cornstarch in a paper adhesive.

BACKGROUND: Protein contact dermatitis is better known in food-service and health-care workers than in industrial workers. Cornstarch has seldom been a problem, although it can cause contact urticaria to glove powder. OBJECTIVE: To present the case of a paper-bag maker who developed severe occupational (protein) contact dermatitis within two-three hours after returning to work. She lacked any evidence of urticaria and demonstrated largely negative patch-test results. METHODS: Following a history of occupational exposure to a cornstarch-based adhesive, the patient was patch-tested to materials with which she had worked, which she contacted, and with which she had attempted treatment. Following patch testing, she was prick-tested to cornstarch, the principal ingredient in the adhesive. RESULTS: Patch testing was negative except for a very mild reaction to the adhesive. Prick testing to cornstarch was more severe than the histamine control. The test site became eczematous and remained so for more than ten weeks. Avoidance of cornstarch and the adhesive was followed by clearing. CONCLUSION: Workup for prominent occupational contact dermatitis without urticaria may sometimes require testing for type 1 allergy.

Adhesives↗

Prognosis and work absence due to occupational contact dermatitis.

The consequences of a diagnosis of occupational contact dermatitis (OCD) were investigated using cases available from the voluntary surveillance scheme, EPIDERM. Cases of OCD reported from November 1994 to September 1995 were identified and sampled to give at least 100 cases of allergic, irritant and mixed OCD reported by consultant dermatologists (344 cases) and occupational physicians (377 cases). A questionnaire was sent to the reporting physician to elicit further information. 512 completed questionnaires were returned, of which 510 were eligible for analysis. Among cases reported by dermatologists (n = 286) and occupational physicians (n = 224), 7% (6.3%) had been unemployed and 16.8% (20.1%) had taken sick leave. 3 factors independently predicted time off work in a logistic regression analysis: age OR = 1.25 (95% CI, 1.05-1.49), allergic dermatitis OR = 1.77 (95% CI, 1.13-2.79) and medicolegal assessment OR = 4.42 (95% CI, 2.20-8.89). Overall, 15.7% did not improve clinically between the first and last visit. Those who did not improve had been exposed to the agent for longer (mean 7.6 years) than those who did (5.3 years) (p = 0.09). In patients <or= 45 years, those reported to be atopic failed to improve (25.4%) more often than those not atopic (13.4%) (p = 0.04). The substantial numbers (21%) with time off work and with persistent dermatitis suggest that OCD continues to have a significant impact on workers and their employers.

Absenteeism↗

Path test reactions to the Chinese Standard Screening Allergens in 1,135 patients investigated for allergic contact dermatitis.

BACKGROUND: The patch test has become the standard method of investigating patients with allergic contact dermatitis. Many countries have developed standard screening allergens to make patch testing more efficient. A series of the Chinese Standard Screening Allergens were studied and modified. OBJECTIVE: This study investigated the frequency of contact allergies in suspected allergic contact dermatitis and tested the practicality of the Chinese Standard Screening Patch Test Allergens. METHODS: A total of 1,135 patients suspected of having allergic contact dermatitis were patch tested. Three hundred twelve (27.5%) were men, and their age ranged from 2 to 75 years old (mean age, 34.3 years), 823 (72.5%) were women, and their age ranged from 2 to 76 years old (mean age, 33.0 years). Nanjing Medical University supplied the Chinese Standard Screening Allergens and Finn-Chamber. All patients were patch tested according to the Chinese Standard Screening Patch Test Allergens with Finn-Chamber the protocol as established by the International Contact Dermatitis Research Group (ICDRG). RESULTS: From the 1,135 patients suspected to have allergic contact dermatitis, 650 (57.3%) had at least one positive reaction. Nineteen (95%) of the Chinese Standard Screening Patch Test Allergens had positive reactions higher than 1%. Of 485 patients with negative reaction to the Standard Allergens, 106 patients were tested with other suspected contactants according to history. Thirty-nine (36.8%) had positive reactions to the contactants they provided. The total positive rate therefore increased by 3.4%. CONCLUSIONS: Our study results indicate that the Chinese Standard Screening Patch Test Allergens are suitable for use in routine clinic in China.

Adolescent↗

Non-steroidal and steroidal anti-inflammatory drugs vary in their modulation of dendritic cell function in the elicitation phase of allergic contact dermatitis.

The role of dendritic cells (DCs) in allergic contact dermatitis has been clearly demonstrated for the induction phase. However, the situation during the elicitation phase is very complex within a distinct inflammatory response. This study was performed to exploit DC migration in the elicitation phase in a mouse model of allergic contact dermatitis and to evaluate the effects of steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) on DC migration through skin in the elicitation phase of allergic contact dermatitis. Topically and systemically administered acetylsalicylic acid (ASA) did not reduce the inflammatory response. However, systemically administered ASA significantly reduced the DC migration to the draining lymph node. In contrast, topically administered indomethacin reduced the inflammatory response, but had only minor effects on DC migration, whereas diflorasone diacetate reduced both inflammatory reaction and DC migration. Thus, NSAIDs may differ in their inhibitory action in immunological inflammation.

Animals↗

Contact dermatitis due to topical treatment with garlic in Hong Kong.

Contact dermatitis due to garlic is usually due to handling of garlic for cooking. Among the Chinese, garlic is also used as a form of topical medicament. 8 patients developed contact dermatitis after rubbing the cut end of a fresh garlic bulb onto the skin to treat fungal and other infections at the groin, neck, lower limb, hand or face. The distribution and morphology of the lesions were different from the classical form as described in the literature. Repeated open application tests with fresh garlic were all positive and patch tests with garlic extract were all negative. 5 controls tested by repeated open application with fresh garlic juice were also positive and patch tests in 10 controls with garlic extract were also negative. The results confirmed that the contact dermatitis was due to irritation. The patients were treated successfully with topical fluorinated steroid. For prevention, the practice of direct application of fresh garlic onto the skin for treating infections should be discouraged.

Administration, Cutaneous↗

Allergic contact dermatitis from amcinonide.

Allergic contact dermatitis from topical corticosteroids has been regarded as rare. However, it should be considered in long-standing, resistant or worsening eczema in spite of topical steroid therapy. Cases of allergic dermatitis from amcinonide have been reported previously. We report an additional case.

Administration, Topical↗

A histological and immunohistochemical study on chronic irritant contact dermatitis.

BACKGROUND: Chronic irritant contact dermatitis (CICD) is characterized by erythema, scaling, hyperkeratosis, chapping and fissures. It may be the result of skin damage evoked by the cumulative effect of a variety of irritant stimuli. The diagnosis of CICD is made on basis of the patient's history and clinical features. No specific diagnostic tests are available. OBJECTIVE: The histopathologic and cell biological features of CICD have not been extensively studied. Here, we describe the histological and immunohistological changes in CICD. METHODS: Punch biopsies were taken from 11 patients with CICD for hematoxylin eosin and immunohistochemical stainings. Four skin biopsies of the palms of the hands of healthy volunteers served as controls. RESULTS: The histopathologic pattern was characterized by different grades of hyperkeratosis, parakeratosis, spongiosis, exocytosis, acanthosis, and mononuclear perivascular infiltrates. Mitotic activity, as measured by Ki-67-staining in the epidermis, was increased fourfold in involved skin as compared with normal skin. Involucrin, a structural protein of the cornified envelope, was expressed from the stratum granulosum throughout the stratum spinosum in all patients with CICD and was upregulated in comparison with normal skin. Epidermal fatty-acid binding protein (E-FABP), a terminal differentiation marker, was proportionally unaltered in the CICD as compared with the normal skin and was localized from the stratum granulosum to the upper layers of the stratum spinosum. Cytokeratin 16, a differentiation marker expressed in hyperproliferative epidermis, was markedly increased from the stratum granulosum throughout the stratum spinosum in 5 out of 11 patients with CICD. Skin-derived antiproteinase (SKALP)/elafin, a proteinase inhibitor expressed in inflamed epidermis, was only detected within the stratum granulosum in 3 out of 11 patients. CONCLUSION: We conclude that CICD is clinically characterized by features of a chronic dermatitis and, at the histological level, by inflammatory changes, epidermal hyperproliferation and altered differentiation.

Adolescent↗

Importance of irritant contact dermatitis in occupational skin disease.

BACKGROUND: Irritant contact dermatitis (ICD), provoked by work materials or workflows, is believed to be a frequent cause of occupational skin disease (OSD). Data of incidence rates of ICD within different occupations are inadequate. OBJECTIVE: We conducted a population-based study to identify occupational groups at risk for irritant and allergic contact dermatitis (ACD). METHODS: The data are based on all workers' compensation claims reported to our register of OSDs in Northern Bavaria [Berufskrankheitenregister Haut-Nordbayern (BKH-N)], Germany. RESULTS: From 1990 to 1999, 5285 patients had their cases completely assessed and recorded by government-employed physicians. We calculated the incidence rates of ICD and ACD in various occupations, divided into 24 occupational groups, in co-operation with the German State Institute of Labor and Occupation; there were a known total number of employees in each of the occupations. In these groups 3097 (59%) patients with OSD were observed, with an overall annual incidence rate of 4.5 patients per 10,000 workers for ICD, compared with 4.1 patients per 10,000 workers for ACD. The highest ICD annual incidence rates were found in hairdressers (46.9 per 10,000 workers per year), bakers (23.5 per 10,000 workers per year), and pastry cooks (16.9 per 10,000 workers per year); at the same time ICD was the main diagnosis of OSD in pastry cooks (76%), cooks (69%), food processing industry workers and butchers (63%), mechanics (60%), and locksmiths and automobile mechanics (59%). The results of a questionnaire showed frequent skin contact with detergents (52%), disinfectants (24%), and acidic and alkaline chemicals (24%) in the workplace. CONCLUSION: Based on the incidence data of the BKH-N, this study identified occupational groups with a high risk of ICD. Different frequencies of ICD and ACD within a single group are demonstrated. The frequent usage of detergents is being addressed because of the introduction of German legislation of recent date (the Approved Code of Practice 531 on 'wet work').

Adult↗

Allergic contact dermatitis from isocyanates among sculptors.

Allergic contact dermatitis from isocyanates is rare. We present the cases of two sculptors who developed a dermatitis from polyurethane sculpting materials. The patients reacted to diphenylmethane diisocyanate and isophorone diisocyanate. One of the patients had positive patch-test reactions to 1,6-hexamethylene diisocyanate and toluene diisocyanate as well. The patients also exhibited a sensitivity to diaminodiphenylmethane, an amine that has been reported in other cases of isocyanate sensitivity.

Adult↗

Airborne occupational allergic contact dermatitis from champignon mushroom.

BACKGROUND: Allergic contact dermatitis from mushrooms has only seldom been reported. OBJECTIVES: We report on a mushroom picker who developed skin symptoms from occupational exposure to the mushroom champignon. METHODS: Conventional patch testing and prick testings were performed. RESULTS: Erythema and vesicular edemic dermatitis appeared around the eyes, on the cheeks, around the nose, and around the lips of a 31-year-old woman who had been involved in the commercial production of champignons for 5 years. Prick testing to champignon was negative, but patch testing with raw champignon provoked a 2+ allergic reaction and was negative in the controls. CONCLUSION: Our patient had been occupationally sensitized from exposure to champignon. The allergen is not known but may be a low-molecularweight chemical or a protein present in the champignon.

Adult↗

Protein contact dermatitis: myth or reality?

Protein contact dermatitis is a dermatosis which usually presents as a chronic eczema with episodic acute exacerbations a few minutes after contact with the offending allergen. Patch tests with the responsible allergen are usually negative, and the diagnosis can only be made by means of scratch or prick tests with the allergen. Sometimes, specific IgE antibodies can be detected in the blood. As there is considerable confusion about this entity, we have reviewed the cases reported in the literature.

Dermatitis, Contact↗

[Computers and contact dermatitis].

A computerized database with the complete composition of pharmaceutical products and some cosmetics helps the patient with an allergic contact dermatitis reaction to avoid his specific allergens. Together with a database with patient information (12000 cases) this product, file serves as the basis for an expert system that assists the dermatologist during his every day clinical practice. The use of the computer in the field of contact dermatitis has gained much interest in the course of the last decade. In fact, the computer can be a particularly helpful tool in: 1. The storage of large amounts of data that can help to identify the patient's allergen microenvironment: --literature: articles related to contact dermatitis problems; --product information such as, for example, the composition of pharmaceutical, cosmetics, and industrial materials; --the dermatologist: the filling in of a standardized anamnesis from also helps to assure that relevant clinical data is not overlooked. 2. The diagnosis of allergic contact dermatitis: on the basis of all these data stored, an expert system can be developed to provide targeted information to assist the physician with the anamnesis of a new patient. Depending on the profile of the patient, several factors that could be at the source of the contact dermatitis, such as the patient's profession, hobbies, and use of pharmaceutical products and cosmetics, can be considered, thus increasing the efficiency of the allergological examination considerably. 3. Research in contact dermatitis: --The data can be used for epidemiological analyses in behalf of the patients, the medical profession, the industry, and the authorities.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗

Effects of pressure on contact dermatitis.

In human volunteers, firm pressure was applied to deformable plastic chambers containing chemical irritants, glass fibers, and selected allergens to which the subjects were sensitive. Pressure variably intensified irritant dermatitis and strikingly enhanced fiberglass dermatitis. Pressure did not influence allergic contact dermatitis. Pressure is one of several mechanical factors that can aggravate nonallergic contact dermatitis.

Allergens↗