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Contact dermatitis caused by cetrimide in antiseptics.

Cetrimide and chlorhexidine are widely used antiseptics. Irritant contact dermatitis from cetrimide has been reported, but only rarely and without pathologic study. We report the clinical and pathologic findings from a series of 18 cases of contact dermatitis caused by antiseptic solutions containing 3% cetrimide and 0.3% chlorhexidine. The patients consisted of 10 males and 8 females, aged from 2 to 62 years. Most patients developed pruritic, burning or painful rashes over the flexors and genitalia after 1 to 4 weeks of daily use of undiluted antiseptics for an underlying pruritic dermatosis. The lesions varied from slight scaling with minimal erythema to fiery or dusky red patches with a glazed surface. The rashes resolved in 2 to 4 weeks after discontinuing the antiseptics. Concentric annular lesions were noted in some patients. Patch testing revealed negative reaction to chlorhexidine 0.5% aq. but irritant reaction to cetrimide 0.5, 1 or 2% aq. and Savlon at 1:3 or 1:6 dilution. Light microscopy showed compact orthokeratosis and confluent parakeratosis without spongiosis. Our study suggests that the dermatitis was an irritant reaction to cetrimide after improper self-application of the antiseptic liquids for underlying pruritic rashes or personal hygiene. Recognition of the characteristic xerosis- or chemical-burn-like features primarily involving the flexors or genital area is essential to the diagnosis.

Administration, Topical↗

Epidermal cytokines in experimental contact dermatitis.

Topical exposure to a variety of xenobiotics may result in irritant as well as allergic contact dermatitis both in rodents and in humans. Despite their induction by different mechanisms, they cannot be differentiated by macroscopic appearance and, by histological examination they are both generally characterized by a perivascular mononuclear cell infiltrate and capillary hyperpermeability. Recently, cytokines, a family of inducible glycoproteins that play a pivotal role in immune and inflammatory reactions, have been identified as useful tools for differentiation of irritant and allergic contact dermatitis. In this article the role of cytokines in the development and differentiation of irritant and allergic contact dermatitis is discussed.

Animals↗

[Nickel contact dermatitis. A ring signal in actual pathology].

Contact dermatitis produced by nickel is extremely common in women by earrings or other items of jewelry which contain nickel. Areas of involvement are under rings, bracelets, watches, spectacle frames, coins in pockets, jeans studs and other sites of direct contact with the metal. The frequency of nickel dermatitis is increasing in the male population and this may be due of body-piercing or professional contact in the field of metallic constructions. The treatment is difficult because of the presence of nickel in so many substances, things or even food. The management of contact dermatitis include the reduction or elimination of the allergen, the use of topical or systemic steroids, oral desensitisation and use of nickel in selected cases.

Dermatitis, Allergic Contact↗

Differential hypermelanosis induced by allergic contact dermatitis.

In moderately colored guinea-pig skin, UVB, PUVA (psoralen plus UVA), and allergic contact dermatitis were shown to induce visibly well-defined hyperpigmentation that resembled the pigmentary changes observed in Mongoloid human skin. To clarify mechanisms of allergen-induced hyperpigmentation, we compared the effects of allergic contact dermatitis on pigmentation by using 6 different allergens: dinitrochlorobenzene (DNCB), 1-phenylazo-2-naphthol (PAN), benzyl salicylate (BS), jasmine oil (JO), hydroxycitronella (HC), and ylang ylang oil (YYO). The PAN-, JO-, HC-, and YYO-induced allergic reactions caused a definite visible hyperpigmentation that began to appear within 14 days, reaching maximum intensity about 40 days after the induction of the allergic reaction. These hyperpigmentations were accompanied by a significant increase in the population of dopa-positive melanocytes on day 24 following allergic reactions. In contrast, BS- and DNCB-induced allergic reactions did not give rise to visibly distinct hyperpigmentation in spite of the intensive allergic reactions following their challenge application. In a nonsensitized group, primary irritant reactions were induced by the application of 100% JO, but no distinctive hyperpigmentation was found 40 days after the last application. Quantitative analysis of the number of melanophages in the dermis showed that there was a marked increase in the number of melanophages in PAN, YYO, and HC allergy-induced hyperpigmented areas, with PAN showing a significant increase compared with those in non-treated areas of the same animals, whereas JO was associated with no such increase in hyperpigmented area, despite the stimulated pigmentation. In the case of the lack of induced hyperpigmentation, as seen in BS and DNCB allergy and JO irritation, there was also no substantial increase in the number of melanophages. Our findings indicate that allergic contact dermatitis is a unique melanogenic stimulant different from UV irradiation.

Allergens↗

Allergic contact dermatitis from latex rubber.

Previously we have found occasional patients with delayed hypersensitivity to latex (in rubber gloves) in the absence of allergy to any chemicals in the rubber chemical screen. There are many reports of contact urticaria to latex and isolated reports of delayed hypersensitivity to latex, usually in the presence of contact urticaria. To establish if latex ruber is a more common cause of delayed hypersensitivity than is currently recognized, we patch tested all patients attending our contact dermatitis clinic, over a 6-month period, with latex. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six exhibited contact urticaria to latex, five contact urticaria and allergic contact dermatitis, and five allergic contact dermatitis alone. Of the five with delayed hypersensitivity to latex in the absence of contact urticaria, only one was atopic and the sensitivity was thought to be relevant or possibly relevant in four. Of our patients, 1.2% exhibited positive patch-test reactions to latex. Patch testing with latex should be considered where contact dermatitis to a latex rubber-containing product is suspected, e.g. gloves and footwear.

Adolescent↗

Humoral immunity in different phases of contact dermatitis.

Although cell-mediated hypersensitivity seems to be the main immunological response of man in contact dermatitis, recent studies suggest the potential involvement of antibody-mediated and basophilic cutaneous hypersensitivity in the physiopathology of this affection. The aim of this work was to contribute data intended to clarify the possible involvement of factors traditionally assigned to humoral hypersensitivity in the pathology of contact dermatitis. For this purpose blood levels of the different immunoglobulins were determined in patients with contact dermatitis. Three phases were considered, namely, one in which the patients showed typical clinical signs (acute phase), another in which the lesions had subsided (intercrisis phase) and a third in which the signs had recurred (acute outbreak). All those patients who concomitantly suffered from or had any personal or family antecedents of type I hypersensitivity were excluded from the study. The results found were compared with those obtained for a control gorup consisting of healthy individuals with no atopic antecedents. No significant differences were found between the results obtained in the three phases. However, the IgE levels of the patients were significantly higher than those of the control group, whereas the differences in the IgE, IgA and IgM levels were insignificant.

Acute Disease↗

Mini-epidemic of contact dermatitis from ginkgo tree fruit (Ginkgo biloba L.).

3 cases of contact dermatitis from ginkgo fruit are reported. Swelling of the prepuce can be the only clinical sign of intolerance, as was observed in 1 case. Diagnosis of contact dermatitis to ginkgo fruit should be made in cities where female ginkgo trees grow, in Chinese, Japanese and South-East Asian subjects, who are aware of the ginkgo nut's culinary qualities within the fruit, as well as in children who play with the fallen fruits as "marbles".

Adult↗

Contact dermatitis in a woodworker.

Woods are capable of causing allergic or irritant contact dermatitis which typically occurs on the exposed areas of the arms, face, and neck. The allergens found in woods include quinones, stilbenes, phenols, and terpenes. We report an 84-year-old woodworker who developed allergic contact dermatitis from Bolivian rosewood and Cocobolo wood. The patient was patch-tested using the North American Contact Dermatitis Group Standard Tray; 2,6 dimethoxyl 1,4 benzoquinone; and wood that he had been exposed to on a regular basis. Positive patch test reactions occurred to methyldibromo glutaronitrile phenoxyethanol, sodium gold thiosulfate, Bolivian rosewood, and Cocobolo wood. Allergens found in Bolivian rosewood and Cocobolo wood caused this patient's chronic dermatitis, which cleared when he avoided these woods.

Aged↗

Reproducibility of patch tests. A multicenter study of synchronous left-versus right-sided patch tests by the German Contact Dermatitis Research Group.

BACKGROUND: The efficiency and reproducibility of patch tests remain controversial. OBJECTIVE: Our purpose was to determine the efficiency and reproducibility of patch tests and to identify factors influencing these features. METHODS: We double-tested 1285 patients concomitantly with 10 standard allergens by manually filled test chambers. Additional information was obtained from all patients with a standardized protocol. RESULTS: Patch test efficiency was good (> or = 0.94) with all 10 allergens. In contrast, nonreproducibility of patch tests was strongly allergen dependent, ranging from 0.2 for nickel sulfate to 0.6 for formaldehyde. The likelihood of nonreproducible allergic reactions increased when more than four positive reactions were seen at the same time, and with another positive reaction located in close proximity to an allergic reaction. Sex and age of patients, atopy, dermatitis at distant sites, sleeping habits, and the time of allergen exposure (24 or 48 hours) did not affect the rate of nonreproducible results. CONCLUSION: To increase patch test reproducibility, specific preparations of patch test allergens need to be improved. Furthermore, amplification effects by synchronous neighboring positive reactions should be excluded.

Allergens↗