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Pustular psoriasis is a rare but serious form of psoriasis. Clinically it may be difficult to differentiate from a pustular drug reaction. We report a case of a generalized pustular eruption triggered by exposure to amoxycillin in a patient with chronic psoriasis. Patch testing to 1% and 5% amoxycillin preparation confirmed a delayed hypersensitivity reaction.
Most rosin (colophony) used today is chemically modified. Will contact allergy to modified rosin be overlooked when testing is performed with only unmodified rosin in the standard series? 2 components from modified rosins, maleopimaric acid (MPA) and glyceryl I-monoabietate (GMA), earlier identified as contact allergens, were added to the patch test standard series. Some commonly-used modified rosin products were also tested. Positive reactions were observed to the modified components MPA and GMA. Of the patients with positive reactions to MPA and GMA, several did not react to unmodified rosin in the standard series. No reaction was observed to the modified rosin products without a concomitant reaction to unmodified rosin. The positive reactions observed to the modified rosins may be due to residual unmodified material in the product, but a possible contribution from allergenic modified rosin components cannot be disregarded. When a patient's history indicates a rosin allergy, but a negative response to unmodified rosin in the standard series is observed, additional testing with GMA and MPA or, second best, with glycerol-esterified rosin and maleic-anhydride-modified rosin is recommended. Some modified rosin products, which could be used for additional testing, are suggested.
In contradistinction from certain strains of mice, contact allergy in man is hypothesized to be either lifelong or at least to last for years. We examined follow-up studies on contact allergy, as evaluated by patch testing, attempting to quantify its natural history. The allergens include colophonium, gold sodium thiosulfate, nickel, and cobalt. At present, due to technical limitations, we cannot state in quantitative terms whether contact allergy in man is lifelong and whether its clinical manifestations change. Thus, we list some criteria for future studies which may help resolve the above question.
INTRODUCTION: Many chemical products are known to induce depigmentation. This phenomenon was never reported with methacrylates which are components of acrylic resine. CASE REPORT: A female patient with artificial nails developed contact dermatitis. Localized depigmentation at the site of positive patch tests to methacrylates derivatives was observed. DISCUSSION: The chemical substance could have a direct influence either by its toxic effect or by the induced inflammatory reaction.
Pigmented contact dermatitis has been found to be caused by fragrances, cosmetics, washing powders, azo dyes in textiles, and rubber products in selected groups of patients. The aim of this study was to run screening patch tests in an unselected group of patients with pigmented contact dermatitis (n=29) encountered in our center over a 2-year period. The test series included the European standard, cosmetics, fragrance, Scandinavian photo, and personal products. 21 patients had a positive reaction in at least 1 of the series (total, 29 reactions): 16 - standard, 3 - cosmetics, 1 fragrance, 9 photo, and 1 - personal products; 16 (55%) had relevant results. We conclude that the highest yield for screening for pigmented contact dermatitis is achieved with the standard and photo series.
Classification of a chemical or chemical product as a primary skin irritant using laboratory animal tests has been defined rigorously and codified in Consumer Products Safety Commission (CPSC) regulations. However, no regulatory agency, including the CPSC, has defined a primary skin irritant threshold for human repeat insult patch tests (RIPTs) that are typically conducted on products, such as cosmetics, anticipated to come into direct contact with humans. Further more, the protocols for animal and human tests are significantly different, as are the schemes for grading responses. Consequently, comparing the results of one type of test with those from the other type has proved to be difficult. In this short communication, we propose a procedure to harmonize the results from these two types of skin irritation tests and suggest that a score of "5" in animal tests, considering 24-h results on unabraded skin, is equivalent to a score of "3" in human RIPTs.
Acute generalized exanthematous pustulosis is a potentially severe disease caused by drugs in about 90% of cases. To the best of our knowledge, acute generalized exanthematous pustulosis following use of bleomycin has not been previously reported. Here we report a case of acute generalized exanthematous pustulosis induced by bleomycin, which was confirmed by patch testing.
Cocamidopropyl betaine is a surfactant coming into wide use in shampoos and other cleansing products. Recent reports have implicated it as a potential allergen, although it is less irritating than other surfactants such as sodium lauryl sulfate. Twelve positive patch test results were seen over a period of fifteen months of testing in selected patients. Of these, seven results were thought to be relevant. All seven patients with relevant reactions and four of the five with uncertain relevance had dermatitis of the head and neck area. It is concluded that although cocamidopropyl betaine is not a common allergen, it may be at least partially responsible for some cases of allergic dermatitis of the head and neck.
Biocidal preservative agents are important in preventing the growth of pathogenic and nonpathogenic organisms in a variety of personal care, household and industrial products. Nearly all effective, commonly used preservative materials possess skin sensitization potential. In a series of 13 prophetic human repeat insult patch tests involving a total of 1450 subjects, no skin sensitization was induced at concentrations of 10 ppm, 6 ppm or 5 ppm (1121 subjects) or at 15 ppm (200 subjects) of a new isothiazolinone preservative mixture (Kathon CG). Delayed contact hypersensitivity was induced in 1 of 84 subjects at 12.5 ppm and in 2 of 45 subjects at 20 ppm. These results add further support to the previously reported conclusion that use of this new biocide at the very low concentrations required for effective preservation of rinse-off products involves an extremely low risk of clinical dermatoses.
Alterations in the proliferative capacity of human epidermis following topical exposure to structurally unrelated chemical irritants were investigated, with the aim of improving our understanding of the cellular changes that take place during the development of irritant contact dermatitis (ICD). Healthy volunteers were patch tested for 48 h with the following six irritants and their appropriate vehicle and occlusion controls: 5% sodium lauryl sulphate (SLS), 0.5% benzalkonium chloride, 80% nonanoic acid (NAA), 0.02% dithranol, 0.8% croton oil, and 100% propylene glycol (PG). After the degree of inflammation induced was visually graded, biopsy samples were removed and the dividing keratinocytes were identified immunocytochemically by using the monoclonal antibody Ki-67, with quantification being performed on the basis of the number of positive cells/100 basal keratinocytes. Statistically significant increases in the density of proliferating cells occurred in the reactions to SLS, NAA, and PG, whereas, in contrast, dithranol caused a marked decrease in the number of dividing keratinocytes. Overall, the density of proliferating keratinocytes did not show a linear relationship with the visually assessed intensity of inflammation, indicating that the changes observed were related to the chemical nature of the individual irritants and their specific biochemical interactions with the keratinocytes, rather than being the consequence of a generalized inflammatory response. Differential release of epidermal cytokines and mediators by the six irritants may account for these varying states of keratinocyte proliferation. Application of the Spearman rank coefficient of correlation revealed that the changes in mitotic activity of keratinocytes were unrelated either to the total density of leukocytes infiltrating the epidermis and dermis, or to the individual densities of the major phenotypic classes of inflammatory cells present. This makes it unlikely that the localized release of cytokines by infiltrating leukocytes is, by itself, the primary factor in the alteration in epidermal cell kinetics seen in ICD. Our results provide a further demonstration of the diverse actions of different chemical irritants on human skin and emphasize the need to regard ICD as a heterogeneous disorder.
Contact hypersensitivity to nickel is the most common form of allergic contact dermatitis. To gain insight into the induction of this frequent disease, T cell reactivity towards nickel was investigated in "nonallergic" individuals defined as those with no skin manifestations and a negative patch test towards NiSO4. Surprisingly, we found that nickel induced proliferation of peripheral blood mononuclear cells (PBMC) from 16 of 18 adult individuals tested. This activation was specific, and no stimulation of PBMC was observed using control stimulants at equimolar concentrations. Furthermore, the NiSO4-induced activation required the presence of professional antigen-presenting cells. To describe the functional capacity of the nickel-inducible T cells, cytokine release was investigated in both nickel-allergic and nonallergic individuals. The T cells from both groups released interferon-gamma but no interleukin-4 upon stimulation with nickel, suggesting that the functional capacities of these cell populations were similar in nickel-allergic and nonallergic individuals. Thus, at this level, no qualitative differences could be demonstrated between T cells obtained from nickel-allergic and nonallergic individuals.
Food protein-induced enterocolitis syndrome (FPIES) is thought to be a non-IgE mediated food allergy syndrome. Affected infants typically demonstrate gastrointestinal symptoms after hours after ingestion of the offending food. Traditional allergy testing is not useful for this disorder because tests for food specific IgE are routinely negative. A diagnostic oral food challenge (OFC) is the only method to confirm the diagnosis of FPIES. This prospective study was undertaken to determine whether the atopy patch test (APT) is able to predict the results of the OFC. Nineteen infants with suspected FPIES by clinical history underwent APT to the suspected foods. After APT was performed, subjects underwent OFC to determine whether FPIES was present. The results of APT and OFC were compared and used to calculate sensitivity and specificity of the APT. APT predicted the results of oral food challenges in 28/33 instances. There were 16 cases of FPIES confirmed by oral food challenges. In all 16 cases of FPIES, the APT was positive to the suspected food. However, the APT was positive in five instances where the oral food challenge was negative. All 12 patients with a negative APT had a negative oral food challenge to the suspected food. APT appears to be a promising diagnostic tool for the diagnosis of FPIES.
The mechanism of occupational asthma from diisocyanates (DI)(1-10)(Fig. 1) is not fully known; only about 10%-30% of such patients have specific IgE antibodies to DI (3, 11, 12). A T-cell mediated response has been considered to be involved in DI asthma (13) and we therefore wondered whether patch testing might be of any help in its diagnosis.
The allergenicity of two different types of rosins (gum rosin and tall oil rosin) was compared. The rosins were divided into their neutral and acid fractions. The neutral fraction of tall oil rosin failed to induce contact sensitivity in animals tested according to the Guinea pig maximization test method (GPMT). The neutral fraction of gum rosin as well as the two acid fractions gave significant responses. Relatively fewer dermatitis patients reacted to the neutral fraction compared with reactions to the unfractionated gum rosin when patch tested. Fewer reactions to tall oil rosin than to gum rosin (p less than 0.05) were observed. It is concluded that tall oil rosin is less allergenic than gum rosin, which may be due to the absence of allergens in its neutral fraction.
The study was a single-centre, double-blind randomized, placebo-controlled within-subject comparison of 42 healthy volunteers. Occlusive patch test for 48 h was performed with solutions of 1 alpha,25(OH)2D3 (calcitriol), two vitamin D analogues (calcipotriol and KH 1060 (lexacalcitol)), all-trans retinoic acid and sodium lauryl sulphate (SLS) as reference irritant. Solution vehicles and an empty chamber was also included. Test evaluation was performed at day 2, day 3 and again on day 7. Test evaluation was based both on clinical scoring and on various non-invasive measuring methods. 1 alpha,25(OH)2D3, calcipotriol and KH 1060 all showed mild irritation in the concentrations tested. The number and severity of test reactions was found to be dose dependent based both on clinical scoring and on non-invasive measurements. Irritation of the vitamin D analogues mainly affected the vasculature with vasodilation and increased cutaneous blood flow. All-trans retinoic acid showed irritant reactions with some similarity to the tested vitamin D analogues; however, the reactions were more prolonged. Transepidermal water loss (TEWL) was affected neither after application of vitamin D analogues nor after application of all-trans retinoic acid and it was thus concluded that these substances are non-corrosive. SLS showed the known irritant mechanism with corrosion and increase in TEWL as the primary event.
150 patients with light sensitivity of unknown aetiology were photo patch tested at the 2nd Department of Dermatology University of Vienna. 22 patients showed photoallergy. The identified photoallergens were mostly halogenated salicylanilides and other phenolic compounds. These substances are used as antimicrobials in soaps and cosmetics and as antimycotics in dermatological preparations. Four of the patients showed allergic contact photosensitivity to chlorpromazine. In two patients a new photoallergen has, perhaps, been discovered, namely a derivative of phthalic acid which is employed as fungicidal pesticide. The problems and consequences of photoallergy are discussed.
Three cases of contact allergy to Kathon CG, a preservative for cosmetics and toiletries containing, as active ingredients, 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one are presented. In two patients, Kathon CG was contained in a moisturizing cream, and the third was sensitized by a diagnostic patch test. Although it has been used extensively in cosmetics and toiletries for 9 years in Europe and 4 years in the USA, these appear to be the first case reports of non-occupational sensitization to Kathon CG.
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