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PubMed1992

[Toxic contact dermatitis].

Two types of irritant contact dermatitis are described: the acute and the cumulative toxic contact dermatitis. The acute contact dermatitis causes many different lesions on the skin. The most frequent irritants are acids and alkaline solutions. Chemical burns by hydrofluoric acid are the most dangerous of all injuries caused by acids and need special treatment. Cumulative toxic dermatitis is often observed on the back of the hands and forearms after exposure of several weeks or months. Repeated skin contact by harmless products can also cause cumulative toxic dermatitis. Xerodermatitis is the most frequent type of cumulative toxic dermatitis. Phototoxic reactions of the skin are not caused by immunologic factors, and they are only observed at sun-exposed areas. Drugs can cause frequently phototoxic reactions. The lesions on the UV-A-exposed skin are mainly erythema and blisters.

Acids↗
PubMedDate not supplied

[Transfer factor as specific immunomodulator in the treatment of moderate-severe atopic dermatitis].

BACKGROUND: Atopic dermatitis is a skin inflammatory disease which has been associated to high levels of IgE, eosinophiles and change of T lymphocytes. The transfer factor is an immunomodulator active substance and decreases the number of inflammatory cells and the severity of the symptoms of atopic dermatitis. OBJECTIVE: To determine the efficacy of the transfer factor as treatment of moderate and severe atopic dermatitis. MATERIAL AND METHODS: Articles related to treatment with transfer factor in the atopic dermatitis were looked up in Medline and EMBASE, and the ones referring to controlled studies in patients with moderate and severe atopic dermatitis in accord to SCORAD. RESULTS: We found seven articles with 121 patients and 88 controls demonstrating significant decrease in the symptoms of the SCORAD index, decreased IgE, and eosinophils in patients treated with transfer factor. CONCLUSIONS: The transfer factor is a choice treatment for moderate and severe atopic dermatitis.

Dermatitis, Atopic↗
PubMed1991

Nocturnal growth hormone release in children with short stature and atopic dermatitis.

This study was designed to test the hypothesis that children with atopic dermatitis and short stature fail to release growth hormone after falling asleep. Peak serum growth hormone response to arginine was compared with peak growth hormone concentration during sleep in 6 children with atopic dermatitis and short stature (greater than 3 SD below the mean) aged 7 to 12 years, and 5 control children aged 9 to 12 years without atopic dermatitis or asthma but with unexplained short stature (greater than 3 SD below the mean). All 5 control children achieved normal levels of growth hormone after falling asleep, whereas 3 of the 6 children with dermatitis did not. All patients with dermatitis were capable of releasing growth hormone after arginine stimulation. The results suggest that in some prepubertal children with atopic dermatitis and short stature there may be an impairment of growth hormone release during stage 4 sleep.

Arginine↗
PubMed2006

Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities.

Seborrheic dermatitis is a subacute or chronic disease of the skin, affecting the seborrhea afflicted areas and presenting with erythema and desquamation. The inflammatory reaction towards the fungi Malassezia spp. is considered to have a basic etiologic connection with this disease. Taking into consideration the pathogenesis, treatment of the dermatitis should be directed towards eradication of Malassezia spp., reduction of the skin lipids, and suppression of the inflammatory response. A wide variety of agents presented in different forms--ointments, shampoos and drugs--can offer quick, safe and effective treatment alternatives. The purpose of the present study was to monitor the therapeutic effects of the anti-fungal drug fluconazole in patients with seborrheic dermatitis. We compared two study groups of patients: Group I--27 patients with seborrheic dermatitis stage I, II and III, treated with fluconazole, 50 mg/day for two weeks. As topical therapy we applied clobetasol propionate 0.05% ointment. After the completion of the therapeutic course, 85% of the patients in this group were clinically cured and their symptoms faded away. Fifteen percent of the subjects in this group--mainly stage III seborrheic dermatitis patients, showed partial but significant clinical improvement. The specific fungal test for Malassezia spp. on Dixon agar was negative in 93% of the cases in this group. Group II--eleven patients with similar clinical indexes were treated with fluconazole 50 mg/day only, for the same time period. The therapeutic results in this group were also satisfactory--31.5% of the patients were cured and 68.5% showed clinical improvement. In 74% of the patients the specific test for Malassezia spp. was negative after treatment. Fluconazole treatment in patients with seborrheic dermatitis proves to be successful, effective and safe.

Administration, Topical↗
PubMed2006

Anti-thyroid autoantibody-associated interface dermatitis in individuals with undifferentiated connective tissue disease--an unrecognized subset of autoimmune disease?

OBJECTIVE: Skin conditions in individuals with undifferentiated connective tissue disease (UCTD) are poorly classified and characterized, and autoantibodies in serum can be heterogeneous and not always specific. We have identified a new subset of individuals with UCTD, interface dermatitis, and increased anti-thyroid antibodies. METHODS: We retrospectively reviewed 892 cases of individuals with UCTD. Serologic markers for CTD and autoantibodies against microsomes and/or thyroglobulin were analyzed. Skin lesions and medication history were documented, and persistent or recurrent skin lesions were biopsied. RESULTS: Anti-thyroid antibodies for thyroglobulin and/or microsomes (ATAb) were positive in 526 (59%). The ATAb(+) and ATAb(-) groups had similar antinuclear antibody (ANA) positivity (32% vs 28%, respectively), average age (59 vs 58 yrs), and female-male ratio (8:1 vs 6:1). ATAb positivity was significantly associated with a dermatitis manifested as erythematous macules/patches or papules on legs, upper arms, back, and shoulders in 9% (47/526) of ATAb(+) individuals versus 2% (7/366) in ATAb(-) individuals (p < 0.0001). Seventeen individuals with dermatitis, 15 ATAb(+) and 2 ATAb(-), had biopsies. Twelve biopsies (80%) from ATAb(+) individuals and one ATAb(-) individual showed a cell-poor lymphocytic interface dermatitis with vaculopathy of basal layer keratinocytes, dermal mucin deposition, and perivascular mononuclear inflammatory cell infiltrates in the upper dermis that spared eccrine glands. The interface dermatitis was not significantly associated with hypo- or hyperthyroidism, or medications. CONCLUSION: We describe an ATAb-associated interface dermatitis in roughly 9% of ATAb(+) patients with UCTD, which may represent a new subset of autoimmune disease. ATAb may be a useful marker for some individuals with UCTD.

Adolescent↗
PubMed1989

[Comparative histology and immunohistochemistry of tests of immediate allergic reaction and type I contact dermatitis].

Contrary to type IV contact dermatitis, histochemical studies of immunological mechanisms in type I contact dermatitis are rare. To analyse the immunohistochemical kinetics of immediate type I reactions we followed up prick-test reactions to individual specific allergens in 5 atopics with respiratory allergy (group I) and in 4 patients with proven type I contact dermatitis (group II). Punch biopsies (diameter 6 mm) were taken 20 minutes, 6, 24 and 72 h after prick testing. Histological investigations were performed on paraffin-embedded tissue; immunohistochemical studies were done one frozen tissue with a panel of monoclonal antibodies applying the alkaline-phosphatase-anti-alkaline-phosphatase-complex method. In type I contact dermatitis a moderate lympho-monocytic dermal infiltrate appeared, which increased until 72 hrs after testing. In contrast, the immediate allergic reactions of group I revealed only mild lympho-monocytic infiltration in all proven sequential biopsies. No quantitative differences concerning the immunohistochemical pattern of OKM-1, OKM-5, Leu-2a and Leu-3a were observed between the two groups. Group II showed an increase in HLA DR, OKT6, anti-IgE- and anti-IL-2-receptor immunoreactivity whereas group I exhibited only moderate or no immunoreactivity. A dendritic anti-IgE-staining pattern, most probably on Langerhans cells, was only observed in the epidermis of group II patients. A pathogenetic concept of IgE-mediated type I contact dermatitis is presented and possible relationships with atopic dermatitis are discussed.

Adolescent↗
PubMed1989

[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↗
PubMed1989

Immunology of contact dermatitis.

Allergic contact dermatitis is a classical type IV delayed hypersensitivity immune response. This cell-mediated response is also known as hapten-type delayed hypersensitivity. Allergic contact dermatitis may be viewed as hyperreactivity of the skin immune system. In the present view of allergic contact dermatitis, individuals are born in a state of tolerance to environmental haptenic allergens. During life, sensitization to any hapten(s) may occur. Subsequent elicitation of a sensitized individual then leads to dermatitis, often accompanied by severe pruritus. Human epidermal Langerhans cells play a central role during the sensitization stage. These antigen presenting dendritic cells, loaded with environmental haptens, continuously leave the epidermis through the lymph vessels and, upon arrival in the paracortical T-cell areas of the skin draining lymph nodes, they differentiate into interdigitating cells. There is now in-vitro evidence for such a maturation of human Langerhans cells into interdigitating cells. Any given individual may be sensitized to any particular hapten by this route. Allergic contact dermatitis is probably a skin-specific disease because of the capacity of Langerhans/interdigitating cells to induce relatively naive T-cells to become memory T-cells. Factors determining the ultimate outcome in this continuous hapten presenting process, i.e. whether or not the original state of tolerance will persist, are still enigmatic. During elicitation, when the allergenic hapten is applied epicutaneously to a sensitized individual, a focal accumulation of immune response associated cells producing a wide variety of cytokines and inflammatory mediators ultimately results in the clinical condition of allergic contact dermatitis. Langerhans cells do not seem to play a major role during this stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Patch test of mercury compounds and disinfectant solutions and the clinical picture of mercury contact dermatitis].

The results of patch tests with mercury compounds and disinfectant solutions as well as the clinical picture of mercury contact dermatitis are presented and discussed. During the period from Nov. 1983 to Dec. 1986, 686 patients were tested with mercury compounds. During the 13 year period from 1974-1986, 118 patients were tested with disinfectant solutions and 59 patients with mercury contact dermatitis were seen. Among the disinfectant solutions tested, the highest incidence of positive reaction, 11.5%, was obtained with thimersal. Cross sensitization has been shown between mercurochrome and ammoniated mercury, but no statistical correlation existed that demonstrated cross sensitization between mercury and thimerosal until our study. Therefore, the allergen in mercurochrome contact dermatitis is mercury. No statistical correlation could be established between the occurrence of atopic dermatitis and the patch test reactions to mercury compounds. The contactants were mercurochrome, thimerosal, and broken thermometers in 49 out of 59 cases of mercury contact dermatitis. Consequently, the number of occurrence of mercury dermatitis can be reduced by the elimination of the use of these two disinfectant solutions and the substitution of electric thermometers for mercury thermometers.

Adolescent↗
PubMed1987

Classification of diaper dermatitis: an overview.

Several types of diaper dermatitis are discussed: generic diaper dermatitis is most common and involves a simple erythema and mild scaling of the gluteal crease, buttocks, thighs, and lower abdomen. Candidal diaper dermatitis involves clinically significant infection with Candida albicans and presents as a sharply marginated area of erythema with significant involvement of the anterior thighs, genital creases, abdomen, and genitalia. Noduloulcerative diaper dermatitis may develop in a small percentage of patients who have chronic diaper dermatitis, as large, raised erosions with rolled margins. The lesions are most noticeable on the prominent body parts-genitalia, abdomen, thighs, and buttocks. Infantile seborrheic dermatitis involves a distinctive pattern of inflammation that usually begins beneath the diaper as a sharply marginated area of erythema with satellite lesions. Within 1-2 weeks, lesions develop on the scalp, cheeks, arms, legs, and intertriginous parts of the body. Impetigo is common in the diaper area, particularly in the first 6 months of life and during the warmer summer season. The lesions are usually bullous and represent infection by Staphylococcus aureus. Folliculitis appears as small, perifollicular erythematous papules and pustules, usually on the buttocks, thigh and lower abdomen. It is common in the warm summer months and is usually caused by bacteria such as S. aureus. Intertrigo categorizes disease that does not fit into the above categories. Often the patient presents with simple erythema of the folds without pustules or induration. This probably represents irritation and low-grade infection. It is important for the clinician to be aware that many other diseases can have manifestations in the diaper area.(ABSTRACT TRUNCATED AT 250 WORDS)

Candidiasis, Cutaneous↗
PubMed1977

Immune responses to environmental antigens that act on the skin: the role of lymphokines in contact dermatitis.

Immune responses to enviornmental agents affecting the skin may take various clinical forms, among which contact dermatitis is the most prominent representative of delayed-type hypersensitivity. Whereas in industrialized countries a relatively restricted amount of chemical agents is responsible for the majority of contact dermatitis cases, other factors from the environment such as natural flora, seasonal or nutritional factors may also play a role. Like other immune responses, contact dermatitis is strongly influenced by genetic factors and the existence of immune response genes, in part linked to the major histocompatibility complex, has been established in experimental animals. Whereas the formation of conjugates between skin-specific proteins and contactant allergens is held by some to represent an important feature in contact dermatitis, recent experiments suggest that the direct binding of contactants to monocyte and lymphocyte membranes represents the most efficient way in inducing sensitization of the T lymphocytes primarily responsible for contact hypersensitivity. At the effector level, complete inhibition of contact dermatitis and other delayed type hypersensitivity reactions by an antiserum prepared against guinea pig lymphokines (especially migration inhibition factor) offers strong evidence that lymphokines, as products of activated lymphocytes, also play a decisive role in vivo. The properties of antibodies raised against purified lymphokine fractions are reviewed. Localized contact dermatitis reactions, as well as accompanying phenomenons such as flar-up reactions and generalized maculopapular rashes, may, however, still involve other elements than T lymphocytes and lymphokines. The participation of other secondary cell types and of local antibody formation is briefly discussed.

Allergens↗
PubMed1988

Pustulosis palmoplantaris and chronic eczematous hand dermatitis. Treatment, epidermal Langerhans cells and association with thyroid disease.

Long-standing hand and foot dermatoses, e.g. pustulosis palmoplantaris (PPP) and chronic eczematous hand dermatitis, severely affect the patients' quality of life. The cause of PPP is unknown and the disease usually responds unsatisfactorily to treatment. The aims of the studies of PPP were to determine the prevalence of thyroid disease and to evaluate the relative merits of treatment with etretinate, psoralen photochemotherapy (PUVA), and a combination of the two. Furthermore, epidermal Langerhans cells (LC) were quantified in lesional skin before and after treatment. The prevalence of thyroid disease was significantly increased in a group of PPP patients compared to normal individuals and psoriasis patients. Both hypo and hyperthyroidism were found. In addition, circulating autoantibodies to thyroid antigens were more common in patients with PPP than in the control group. The thyroid status was further examined in a new and larger group of PPP patients, including a 4-year follow-up examination of those with thyroid antibodies or subclinical thyroid dysfunction. The increased prevalence of thyroid diseases was corroborated when this PPP group was compared to an age and sex-matched control population sample from the same city. Some patients also showed biochemical evidence of gastric autoimmunity. Ninetyfour percent of the PPP patients were smokers at the time of onset of the skin disease, compared to 33% of the subjects in a control group. Patients with treatment-resistant PPP were recruited for a randomised, double-blind and placebo-controlled trial. A combination of etretinate and PUVA was more effective than monotherapy with etretinate or PUVA. The latter were equally effective. Etretinate frequently provoked side effects. Follow-up examinations showed a high relapse rate. Epidermal LC were visualised with monoclonal antibodies to Leu 6 and HLA-DR antigens utilizing an immunoperoxidase technique. Their number was increased in lesional skin. The number of HLA-DR positive LC was decreased following etretinate, and normalised with etretinate + PUVA. Chronic eczematous hand dermatitis is a common clinical challenge. These studies aimed at an evaluation of PUVA and UVB phototherapy in patients with recalcitrant lesions and to enumerate epidermal LC before and after treatment. PUVA was a highly effective mode of treatment and cleared all treated hands. UVB was better than no treatment but the dermatitis did not clear in any patient. The number of epidermal LC was increased in lesional palmar skin in both allergic contact dermatitis, irritant contact dermatitis and hyperkeratotic dermatitis of the palms.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Atopic dermatitis. A genetic-epidemiologic study in a population-based twin sample.

Atopic dermatitis is a multifactorial disease that seems both to rise in frequency and to be dependent on a genetic predisposition. In order to clarify these issues we encircled a representative twin series with atopic dermatitis from a total twin population of 592 like-sexed twin pairs. We found that the cumulative incidence rate (0-7 years) of atopic dermatitis in Denmark has increased significantly from 0.03 for the birth cohort 1960-1964 to 0.10 for the birth cohort 1970-1974, that monozygotic twin pairs are more often concordant for atopic dermatitis than dizygotic twin pairs, that monozygotic twins run a risk of 0.86 of having atopic dermatitis if the twin partner has the disease, whereas the disease risk of 0.21 run by dizygotic partners does not differ from the frequency seen in ordinary brothers and sisters. The results indicate that genetic factors play a decisive role in the development of atopic dermatitis and that widespread environmental factors are operating in genetically susceptible individuals.

Child↗
PubMed1978

Serum IgE in atopic dermatitis: relationship to severity of cutaneous involvement and course of disease as well as coexistence of atopic respiratory diseases.

Serum IgE concentrations were determined according to the radioimmunosorbent technique (RIST, Phadebas) on 116 adult patients with atopic dermatitis of varying severity and activity. Geometric mean IgE levels of patients with atopic dermatitis were significantly higher compared with the mean level of ninety-three non-atopic adult subjects without parasitic infestation. Severity of the atopic dermatitis was highly correlated to the levels of serum IgE. Severe chronic cases with ever-recurrent exacerbations show the most extreme values. In the moderate forms of atopic dermatitis, coexistent bronchial asthma causes a greater increase in the IgE values. Among the mild or abortive forms higher IgE levels were found in cases with allergic rhinitis than in the cases with 'pure' atopic dermatitis. Other findings in connection with IgE in atopic dermatitis are summarized. The pathogenetic significance of IgE in the cutaneous changes is briefly discussed.

Adolescent↗
PubMed1993

Saphenous vein graft donor site dermatitis. Case reports and literature review.

BACKGROUND: Coronary artery bypass grafting for atherosclerotic heart disease is commonly performed throughout the world. Complications of coronary artery bypass grafting include saphenous neuralgia due to injury to the saphenous nerve during harvest of the saphenous vein. Dermatologic complications of coronary revascularization are infrequently reported and include an eruption overlying the vein donor-site scar. OBSERVATIONS: We describe two cases of saphenous vein donor site dermatitis associated with sensory peripheral neuropathy in the distribution of the dermatitis. Histopathologic studies revealed a subacute spongiotic dermatitis. The course of the eruption was characterized by exacerbations and remissions with gradual resolution of both the dermatitis and neuropathy over a 1- to 2-year period. CONCLUSIONS: Our cases are unique because the dermatitis developed in the area of the neurologic changes. We propose that the dermatitis may be a trophic change secondary to saphenous neuralgia.

Aged↗
PubMed1996

Distribution and appearance of elastic fibers in the dermis of clinically normal dogs and dogs with solar dermatitis and other dermatoses.

OBJECTIVE: To determine the distribution and amount of elastic fibers in the dermis of clinically normal dogs and dogs with dermatoses, particularly solar dermatitis. DESIGN: Skin specimens from 7 anatomic sites were obtained from 19 clinically normal dogs after euthanasia to evaluate the normal distribution of elastic fibers. Biopsy specimens also were obtained from 34 dogs with dermatoses, including 16 with solar dermatitis. Tissue sections were stained with H&E, Verhoeff-van Gieson, and periodic acid-Schiff. ANIMALS: 19 clinically normal dogs and 34 dogs with dermatoses. PROCEDURE: Numbers of elastic fibers were graded subjectively. Comparisons between clinically normal dogs and dogs with dermatoses were made. RESULTS: Normal elastic fibers were present in low numbers in the dermis of adult dogs, regardless of anatomic site or presence or severity of dermatitis. Condensed elastotic material was visualized in only 2 dogs with solar dermatitis. In both dogs, the elastotic material was Verhoeff-van Gieson and periodic acid-Schiff stain positive but was not visible with H&E stain. The most frequent histopathologic finding in the dermis of dogs with solar dermatitis was superficial dermal fibrosis. CONCLUSIONS: The dermis of clinically normal dogs does not contain abundant elastic fibers. Alterations of elastic fibers in dogs with solar dermatitis are rare. Superficial dermal fibrosis may be a better indicator of solar damage.

Animals↗
PubMed1995

[Risk indicators of reaginic allergy: relations between atopic dermatitis and serum specific IgE of various pneumallergens].

This study was conducted in 1,091 children and adolescents submitted to an allergy check-up for respiratory symptoms. All subjects had a research of IgE for Dermatophagoides pteronyssinus, cat and timothy grass pollen by CAP-System Pharmacia. Three hundred subjects had a personal history of atopic dermatitis. They were compared to the 791 others. No difference was found for age, sex, family history of allergic respiratory disease, breast feeding nor exposure to tobacco smoke. The IgE level was significantly enhanced among subjects with an history of atopic dermatitis, but this difference was due to a higher frequency of sensitisations. In subjects with at least one positive RAST (> 0.35 kIU/l) no significant difference was found (p = 0.41). The highest frequency of sensitisations in case of atopic dermatitis was exclusively related to the simultaneous sensitisation against all the three allergens. Such situation was more frequent when the atopic dermatitis was noted before the age of six months. On the other hand, the sensitisation severity, according to RASTs' classes, was independent of atopic dermatitis history. The author points out the necessity of strong primary preventive measures of pneumallergen environmental avoidance for all infants with atopic dermatitis.

Adolescent↗
PubMed1996

Soluble E-selectin in sera of patients with atopic dermatitis and psoriasis--correlation with disease activity.

E-selectin endothelial leucocyte adhesion molecule-1 is expressed on endothelial cells in distinct inflammatory skin diseases. E-selectin mediates the adhesion between activated endothelium and different inflammatory cells. To evaluate soluble E-selectin as a marker of disease activity in patients with atopic dermatitis and psoriasis, the concentration of soluble E-selectin, determined by ELISA, was studied in sera of patients before and after treatment and compared with normal non-atopic controls. The disease severity was established using clinical scoring systems. Levels of soluble E-selectin were significantly elevated in sera of patients with atopic dermatitis and psoriasis (as compared with controls). Clinical improvement, after treatment, in patients with atopic dermatitis, but not in psoriasis, was associated with a significant decrease in serum levels of soluble E-selectin. There was a significant correlation of soluble E-selectin and disease activity in patients with atopic dermatitis. These data indicate that soluble E-selectin is another parameter to evaluate the inflammatory response in atopic dermatitis and psoriasis. Determination of soluble E-selectin may be a useful measure of disease activity in atopic dermatitis.

Adolescent↗