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PubMed2003

Microbiological aspects of diaper dermatitis.

BACKGROUND: The microbiological basis of diaper dermatitis is not clearly elucidated, although a better knowledge of microbial colonisation can be of importance with regard to an adequate treatment. OBJECTIVE: To investigate the relevance of candida sp. and Staphylococcus aureus colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease. METHODS: Growth of candida sp. and S. aureus in the perianal, inguinal and oral regions was determined by positive/negative and semi-quantitative analysis in an open, multi-centre (n = 3) study. Forty-eight children with healthy skin and 28 with diaper dermatitis were analysed. The severity of diaper dermatitis was assessed using a total symptoms score. RESULTS: Colonisation by candida sp. was significantly more frequent in children with diaper dermatitis as compared to those with healthy skin (perianal 75 vs. 19%; inguinal 50 vs. 10%; oral 68 vs. 25%, p < 0.0003), whereas colonisation by S. aureus at the 3 swab locations was not different (p > 0.34). There was a highly significant, positive correlation between severity of disease and extent of candida sp. colonisation at all swab locations. CONCLUSIONS: Limited microbial colonisation in diaper dermatitis is of questionable relevance, but extensive colonisation seems to aggravate the symptoms; therefore, we suggest that semi-quantitative evaluation should be preferred to the positive/negative assessment for a differential diagnosis.

Anal Canal↗
PubMed1987

Common conditions and factors associated with diaper dermatitis.

In 1983, a questionnaire study was carried out to ascertain the types and principal causes of diaper dermatitis. Questionnaires were sent to 3,942 nursery personnel, and 1,773 responses were received. Diaper dermatitis was classified into six types according to distribution of skin lesions: type I was rash on the whole area in contact with the diaper; type II, eruptions on pubis, external genitalia, and intergluteal folds; type III, peridiaper rashes; type IV, psoriasis-like dermatitis; type V, perianal noduli; and type VI, partial eruptions of infantile dermatitis. According to questionnaire responses, type II dermatitis was seen most frequently (73.6%), followed by type I and type III (17.3%), type V (4.5%), type IV (1.7%), and type VI (1.5%). Erythema blastomyceticum infantile (EBI) must be differentiated from diaper dermatitis. EBI is due to Candida infection. Topical steroids are assumed to be a promoting factor of EBI.

Clothing↗
PubMed1983

The role of suppressor cells in the induction of murine photoallergic contact dermatitis and in its suppression by prior UVB irradiation.

Induction in mice of marked photoallergic contact dermatitis (PCD) to 3,3',4',5-tetrachlorosalicylanilide (TCSA) with UVA (320 to 400 nm) radiation requires pretreatment with cyclophosphamide (CY). Attempts to induce photoallergic contact dermatitis without CY result in only a small degree of sensitivity, accompanied by significant net splenic suppressor cell activity. These suppressor cells are antigen specific, inhibit the induction but not the elicitation of photoallergic contact dermatitis to TCSA, and are T lymphocytes. Exposure of mice to UVB (280 to 320 nm) radiation at a site distant from that of sensitization, before CY administration and sensitization, inhibits the development of photoallergic contact dermatitis. This is analogous to the suppression of allergic contact dermatitis (ACD) observed in mice after exposure to UVB radiation; such suppression is accompanied by the formation of antigen-specific splenic suppressor cells. However, in contrast to the findings with allergic contact dermatitis, splenic suppressor cells are not detected in mice that are treated with UVB radiation before CY administration and sensitization to TCSA. This is presumably because CY prevents their formation. This provides evidence that UVB-irradiated mice have a second form of anergy that is not mediated by suppressor cells.

Animals↗
PubMed1998

Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children.

OBJECTIVES: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I (HTLV-I). DESIGN: A case series of patients with ID were compared with patients with atopic dermatitis (AD), which is an important disease in the differential diagnosis of ID. SETTING: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. MAIN OUTCOME MEASURES: Clinical and laboratory features of patients with AD were compared with those of patients with ID. PATIENTS: Consecutive patients older than 1 1/2 years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. RESULTS: The mean ages of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both diseases were predominantly chronic dermatitis with propensity for skin colonization with Staphylococcus aureus and beta-hemolytic streptococci; however, the distribution of sites of skin involvement differed. Infection with HTLV-I was the most distinguishing feature among patients with ID, with seropositive results in 100%; only 5 (14%) of the 35 patients with AD had results seropositive for HTLV-I. Infective dermatitis was further characterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with palpable nodes. Anemia, lymphocytosis, and low albumin and elevated serum globulin levels were more prevalent among patients with ID. Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD. However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range. T-cell subsets among patients with ID revealed T-cell activation with a high percentage of HLA-DR antigen positivity, elevated CD4 (2.4 x 10(9)/L) and CD8 (1.4 x 10(9)/L) cell counts, with an increased CD4/CD8 ratio of 1:73. CONCLUSION: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.

Adolescent↗
PubMed1980

Impaired monocyte-mediated cytotoxicity in atopic dermatitis.

Twenty-three adult patients with atopic dermatitis of different severity and extent all without present cutaneous infection were investigated for antibody-dependent cytotoxicity mediated by purified monocytes. Compared to a healthy control group the monocyte cytotoxicity was significantly decreased for patients with more widespread dermatitis. Eight patients with acute contact dermatitis and 13 patients with extrinsic asthma or allergic rhinitis showed normal cytotoxicity. Decreased monocyte cytotoxicity in atopic dermatitis was not related to the serum IgE level. In vitro cultivation of defective monocytes from atopics did not increase cytotoxicity, nor did normal monocytes preincubated with patient serum show abnormal function. In atopic dermatitis the total number of Fc receptor bearing monocytes was normal. However, the affinity of this receptor was lower than in normals. Serial studies are needed to establish whether reduced monocyte function is a basic pathophysiologic defect in atopic dematitis.

Adolescent↗
PubMed2004

An 8-year experience in airborne contact dermatitis.

OBJECTIVE: A large number of case reports concerning occupational airborne contact dermatitis have been published in the last few years. Our purpose was to establish the prevalence of airborne contact dermatitis in a routinely patch-tested population and to obtain further epidemiologic data. METHODS: In a single-center study, the data of 5,092 routinely patch-tested patients were collected using a standardized questionnaire and a documentation form. The study period extended from October 1994 to March 2002. RESULTS: The clinical diagnosis was airborne contact dermatitis in 15 cases (0.29%). Patch testing revealed positive and relevant results in nine patients (0.18%). Plant or wood extracts were the sensitizers in all cases but two, and perfume and epoxy resin were the sensitizers in one case each. The diagnosis of an irritant airborne contact dermatitis was established in six patients. A relationship with occupation was found in seven cases (0.14%) when 'housewife' was included as an occupational category and in five cases (0.1%) when this was excluded. CONCLUSION: Airborne contact dermatitis is a rare diagnosis in an unselected patch-test population. An occupational relationship was less common than has been implied in case reports in recent years.

Adolescent↗
PubMed2001

A skin moisturizing cream containing Quaternium-18-Bentonite effectively improves chronic hand dermatitis.

BACKGROUND: Irritant and allergic hand dermatitis is difficult to control in individuals who are unable to avoid causative exposures. Effectiveness of "protective" creams has been poor. OBJECTIVE: To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a newly developed moisturizing cream containing Quaternium-18-Bentonite. METHODS: Adult male and female subjects with chronic hand dermatitis felt to be either allergic, irritant, or combined in nature, after a 2-week observation period, were given the study cream for routine application. At 2, 4, and 8 weeks, the investigator and the subject evaluated the skin parameters, including redness, scaling, fissuring, blistering, and pruritus, on a numerical scale. A global evaluation was also performed. Photographs were taken at each visit. Use of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed. RESULTS: Thirty-seven subjects were enrolled in the study and 33 completed it. The physician's and the subject's initial global evaluations averaged 6.0 and 5.8, respectively (0-10 scale). The final scores were 2.9 and 2.8, respectively, an improvement of 50% (p < 0.001). Topical corticosteroid usage was reduced in 29 of 33 subjects. Fifteen of 35 had a final score of 0-2, indicating complete or almost complete clearing. Only 10, including 2 of the dropouts, failed to show improvement. No adverse effects were noted. COMMENT: This moisturizing cream significantly improved chronic hand dermatitis in a majority of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

Bentonite↗
PubMed1995

Epidermal expression of 65 and 72 kd heat shock proteins in psoriasis and AIDS-associated psoriasiform dermatitis.

BACKGROUND: Psoriasiform dermatitis is common in patients with AIDS. The expression of heat shock proteins by keratinocytes has been postulated to be a significant factor in the physiopathology of psoriasis and might be subject to modulation in HIV-infected patients. OBJECTIVE: We sought to evaluate the epidermal expression of 65 and 72 kd heat shock proteins (HSPs) in lesions of AIDS-associated psoriasiform dermatitis (AIDS-PD) and compare it with that in psoriasis vulgaris and seborrheic dermatitis in patients not infected with HIV. METHODS: Sections from paraffin-embedded blocks of biopsy specimens of AIDS-PD (eight cases), psoriasis vulgaris (eight cases), seborrheic dermatitis (four cases), and normal skin (four cases) in non-HIV-infected patients were immunohistochemically stained by the avidin-biotin-peroxidase method and two monoclonal antibodies directed against the major 65 kd HSP antigen (HSP65) and against 70/72 kd HSP. The intensity, distribution, and cellular pattern of the epidermal stain were graded and assessed blindly. RESULTS: The epidermal expression of HSP65 in biopsy specimens from AIDS-PD lesions was irregular, with less intensity and less tendency to perinuclear arrangement than in psoriasis or seborrheic dermatitis not associated with AIDS. The expression of HSP72 was also less intense and more uniform in AIDS-PD. CONCLUSION: The altered interplay of T cells and keratinocytes in a situation of immune derangement such as AIDS might account for the differences observed in the expression of HSP65 and HSP72 by keratinocytes in psoriasis and AIDS-PD.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Textile dye dermatitis.

The literature concerning textile dye dermatitis published during the last decade was reviewed. Sixty-one cases of dye-allergic contact dermatitis in which the presentation or course of the dermatitis was unusual or the dye allergen was one not previously reported have been described. The four new dye allergens discovered were Disperse Blue 106, Disperse Blue 85, Disperse Brown 1, and Basic Red 46. The incidence of dye dermatitis varied from 1% to 15.9% depending on the country, patient sample, and number of dyes in the patch test series. The 10 new dye allergens discovered in these studies were Disperse Blue 153, Disperse Orange 13, Basic Black 1, Basic Brown 1, the acid dyes Supramine Yellow and Supramine Red, the direct dye Diazol Orange, the basic dye Brilliant Green, Turquoise Reactive, and Neutrichrome Red. Disperse Blue 106 and Disperse Blue 124 were shown to be the strongest clothing dye sensitizers to date. Standard screening patch test series were found to be inadequate for the detection of textile dye sensitivity; therefore textile dye patch test series should be used. It is difficult to determine whether the incidence of dye dermatitis is increasing or decreasing because controlled epidemiologic studies are lacking, but data suggest that textile dye sensitivity is more common than previously believed.

Allergens↗
PubMed2002

Cutaneous field stimulation of sensory nerve fibers reduces itch without affecting contact dermatitis.

BACKGROUND: A new technique, cutaneous field stimulation (CFS), which activates electrically unmyelinated C-fibers, is used to treat localized itch. Its action is similar to that of capsaicin, the pungent agent in hot peppers, which enhances delayed allergic reactions. The aim of the study was to investigate how experimental contact dermatitis responds to CFS. METHODS: Twelve patients with contact dermatitis in response to nickel were treated by CFS for 1 h each for four consecutive days. A flexible plate containing electrodes was applied to a test area on the upper arm and was stimulated by a constant current (0.8 mA). On the fifth day, patients were provoked by epicutaneous application of nickel sulfate (allergic contact dermatitis) and benzalkonium chloride (irritant contact dermatitis), and by intradermal tuberculin (delayed immunologic reaction). Twelve other patients with IgE-mediated allergy were treated by CFS on the lower arm for 1 h and were then pricked with histamine and allergen extracts (wheal volume was measured) and were tested using benzoic acid (nonimmunologic contact urticaria; closed test). Ten of these patients were also treated by CFS for four days, and experiments were performed on the fifth day. RESULTS: Test reactions to nickel, benzalkonium, and tuberculin were found to be unaffected by CFS treatment. Although allergic prick test reactions were enhanced (by 28%) after a single CFS treatment, the associated itch was significantly reduced both after single and repeated CFS treatments (by 65% and 38%, respectively). CONCLUSIONS: Repeated use of CFS to reduce itch has no adverse effects on contact dermatitis.

Administration, Cutaneous↗
PubMed2001

Contact dermatitis in Korean dental technicians.

The high risk of occupational contact dermatitis in dental personnel are well accepted throughout the world. There are few reports concerning occupational skin disease in dental personnel in Korea. The purposes of this study were to investigate the frequency, characteristics and causative factors of contact dermatitis in Korean dental technicians. Recording of personal history, physical examination and patch tests with the Korean standard series and dental screening series were performed in 49 dental technicians. Most of the subjects were exposed to a variety of compounds, including acrylics, metals, plaster, alginate, etc. 22 (44.9%) subjects had contact dermatitis, present or past, and the site involved was the hand in all 22. The most common clinical feature of hand dermatitis was itching (77.3%); scaling, fissuring and erythema were other common clinical features. Metals, including potassium dichromate (24.5%), nickel sulfate (18.4%), mercury ammonium chloride (16.3%), cobalt chloride (12.2%) and palladium chloride (10.2%), showed high positive rates in patch test results of 49 dental technicians. 7 positive reactions to the various acrylics were found in 3 subjects. In our study, the frequency and clinical features of the contact dermatitis showed a similarity to other reports, though the patch test results were somewhat different; a higher patch-positive reaction to metals and a relatively lower patch-positive reaction to acrylics than the patch test results reported in Europe.

Adult↗
PubMed2002

Patch test results in 542 patients with suspected contact dermatitis in Turkey.

In this retrospective study, patch test results of 542 patients (303 female and 239 male), referred to our clinic between June 1996 and July 1999, were evaluated. All patients were patch tested with 32 allergens of an extended European standard series, 140 patients were tested with supplemental series, and 246 patients with their own substances. 280 (51.7%) patients had 1 or more positive results but allergic contact dermatitis, according to clinical relevance, was diagnosed in only 190 (67.9%) of these. Nickel sulfate was the most frequent sensitizer (19.1%), followed by potassium dichromate (11.8%), palladium chloride (9.4%), cobalt chloride (8.5%), and thiuram mix (7.7%). Frequencies of contact allergy to fragrance mix (5.5%), balsam of Peru (Myroxylon Pereirae resin) (2%), quaternium-15 (0.6%), and Kathon CG (methylchloroisothiazolinone+methylisothiazolinone) (0.2%) were relatively low, while no positive reactions were obtained to paraben mix in any case. Current clinical relevance to the present dermatitis was most frequently seen with carba mix (96.2%), thiuram mix (95.2%) and potassium dichromate (78.1%), whereas this rate was low for nickel (37.5%). In 85.8% of patients with allergic contact dermatitis, the responsible allergen was detected by testing with the extended standard series alone (18.4% identified by testing with the additional 10 allergens), in 11.6% by testing with the patients' own substances, and in 2.6% by testing with the supplemental series. Occupational contact dermatitis was diagnosed in 77 of the patients with positive reactions (27.5%), most of these being construction workers and house painters who showed relevant sensitizations to potassium dichromate, cobalt chloride, thiuram mix and carba mix. There was no statistically significant difference in the total contact sensitization rate between atopics and non-atopics, but contact sensitivity to nickel sulfate and palladium chloride was significantly higher among atopics. MOAHL index in % was: 44.1/14.2/24.9/ 54.4/2.4. In conclusion, we believe that similar large series of patients would be helpful to delineate the exact profile of contact dermatitis in Turkey.

Adolescent↗
PubMed2001

Morphology of glass fibers in electronics workers with fiberglass dermatitis--a scanning electron microscopy study.

BACKGROUND: Fiberglass is used as a reinforcement filler material in printed circuit boards (PCBs) which are widely used in the electronics industry. In a recent survey, we demonstrated that fiberglass dermatitis is the most common occupational dermatosis among electronics industry workers in Taiwan. Little is known, however, about the morphologic structures of the glass fibers which induce dermatitis. The purpose of this study was to assess the morphology of fiber spicules and to determine the relationship of this structure to fiberglass dermatitis. METHODS: Fourteen female patients with a diagnosis of fiberglass dermatitis were selected for study. The diagnosis was confirmed in all patients by positive skin stripping for glass fibers and matching with glass fibers from dust collected in work areas and from samples collected by scraping the edge of PCBs. Samples of collected glass fibers were analyzed by scanning electron microscopy (SEM). RESULTS: SEM of the fiberglass samples revealed that fibers were approximately 10 microm in diameter. In samples from both the edge of PCBs and from dust collected in work areas, SEM revealed that most of the fibers were in bundles of various sizes and lengths. All fibers collected from patients' skin by tape stripping showed a singular spicule, most had a sharp free end, and the lengths were in the range 50-150 microm . CONCLUSIONS: Singular glass fibers with a sharp free end and a length of 50-150 microm are most likely to induce fiberglass dermatitis.

Adult↗
PubMed2003

Return-to-work barriers for workers with contact dermatitis.

There is little information available regarding barriers to return-to-work (RTW) in workers with contact dermatitis. The purpose of this study was to survey occupational health and safety personnel to determine their perceptions regarding RTW barriers for workers with contact dermatitis. The study was conducted during an occupational health and safety research conference attended by stakeholders from labour, management, injured workers, government, safety associations, occupational health and safety practitioners and researchers. The attendees were presented with 3 pictures of varying degrees of work-related hand contact dermatitis and were asked to list the 3 key barriers or challenges in RTW for individuals with contact dermatitis. 21 individuals completed the survey. Issues identified in descending order of frequency were concern of ongoing dermatitis, ability to do the job safely, appearance, ability to accommodate, personal protective equipment, fear that the rash was contagious, workplace attitudes and pain. While some of these issues are potentially common to RTW situations in general, others are more specific to health problems which have a visible manifestation. Increased awareness of and attention to these possible barriers to RTW may lead to better RTW outcomes.

Attitude of Health Personnel↗
PubMed2004

Allergic contact dermatitis from allyl isothiocyanate in a Danish cohort of 259 selected patients.

Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology, Gentofte Hospital, Denmark, from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+ reaction. One of the patients with a positive reaction provided samples of margarine, salad cream, oil and mayonnaise. These were analysed with high-performance liquid chromatography, and a moderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking 'tulip fingers' or allergic contact dermatitis from garlic and onions. In conclusion, allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases, despite frequent exposure. The large number of ?+ reactions raises the question as to whether the recommended patch test concentration is too low.

Adult↗
PubMedDate not supplied

Changes in lymphocyte and Langerhans cell populations in allergic and irritant contact dermatitis.

We observed in situ changes in lymphocyte subpopulations and Langerhans cells during allergic and irritant contact dermatitis using immunohistochemical staining methods with monoclonal antibodies to cell surface antigens. In both types of contact dermatitis, there was a perivascular infiltrate of T lymphocytes, with helper/inducer T cells predominating. B cells were absent, and natural killer cells were absent or sparse. During the course of allergic contact dermatitis, Langerhans cells showed a striking sequential change in location, with the cells first in the epidermis, then perivascularly in the dermis (days 1-14), and returning to the epidermis (days 14-21). In irritant contact dermatitis, the Langerhans cells were initially identified in the epidermis and then appeared diffusely in the dermis (days 1-2). The numbers in the dermis then decreased abruptly (day 4). They were again identified in normal numbers in the epidermis (day 21). The response of Langerhans cells appears to be different between allergic and irritant contact dermatitis.

Antigens, Surface↗
PubMed1976

Occupational protein contact dermatitis in food handlers.

The preparation of food in restaurant kitchens carries a high risk of occupational dermatoses. Analysis of 33 cases revealed four different etiological types. Simple irritant dermatitis was rare (2 cases), plain contact dermatitis was more common (6 cases). Fifteen patients had relevant patch tests and scratch tests; ten had positive scratch tests only to explain the cause of their dermatitis. The last type was termed protein contact dermatitis. The major type IV allergens incriminated were metals, onion and garlic. The major proteinaceous allergens indicated by history and test results were fish and shell-fish. Open patch tests with the incriminated foods may cause erythema or oedema on normal skin after 20 minutes. Previously eczematous, now normal looking, skin often responds with a crop of dyshidrotic vesicles preceded by erythema and itching 30 minutes after the application of an open test. Examination for specific IgE is not always positive in such cases. Inhalant allergy was rare. The results indicate that food handlers are sensitized by the protein they touch, and then react to later contact with the proteins. Protein contact dermatitis is similarly common among veterinary surgeons, while the importance in other occupational groups remains to be studied.

Adolescent↗
PubMed1979

Captafol dermatitis in the timber industry.

Captafol is a common cause of dermatitis amongst workers in the timber industry. In a survey of 14 timber treatment plants 23% of 133 workers exposed to captafol gave a history suggestive of occupationally induced dermatitis. Although allergic dermatitis can occur, irritant dermatitis is far more common. Attention to plant and personal hygiene will reduce the prevalence of captafol dermatitis significantly. Recommendations on how to achieve this are made. "The ultimate end...is not knowledge, but action. To be half right on time may be more important than to obtain the whole truth too late."

Captan↗