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PubMedDate not supplied

Treatment of nickel dermatitis. (The influence of tetraethylthiuramdisulfide (Antabuse) on nickel metabolism).

Nickel is the most common cause of allergic contact dermatitis in females. The dermatitis can be maintained both by direct contact and by ingestion of nickel. In 9 out of 17 patients suffering from dermatitis, a diet with a low nickel content has improved their condition. Eleven patients with chronic nickel hand dermatitis were given a daily dosage of 200 to 400 mg of tetraethylthiuramdisulfide (Antabuse). Antabuse is metabolized to the nickel chelating substance sodium diethyldithiocarbamate. In eight patients, the dermatitis cleared. Measurements of serum and urine nickel were performed in six patients. One week after the start of the Antabuse treatment, the urine nickel rose from 1 to 3.6 micrograms per 24 hours to 8.3 to 76.0 micrograms per 24 hours. The serum nickel rose from 0.26 to 0.80 micrograms per 1 to 2.0 to 7.7 micrograms per 1. In four patients the serum nickel exhibited a declining tendency during the treatment period. The results suggest that Antabuse is able to reduce the nickel deposits in man.

Dermatitis, Contact↗

PubMed1980

IgA-containing circulating immune complexes in dermatitis herpetiformis, Henoch-Schönlein purpura, systemic lupus erythematosus and other diseases.

The sera of patients with dermatitis herpetiformis, Henoch-Schönlein purpura and systemic lupus erythematosus were examined for IgA-containing immune complexes using a newly described radioimmunoassay. The IgG Raji cell radioimmunoassay and the 125I-C1q binding assay were also used to detect IgG- and IgM- containing soluble immune complexes. IgA-containing immune complexes were found in the sera of twelve of forty-nine (24%) patients with dermatitis herpetiformis, four of six (67%) patients with Henoch-Schönlein purpura, and seven of ten (70%) patients with systemic lupus erythematosus. IgG- or IgM- containing immune complexes were also found in six of forty-seven patients with dermatitis herpetiformis, in one of six patients with Henoch-Schönlein purpura, and in nine of ten patients with systemic lupus erythematosus, by either the 125I-Clq binding assay or the IgG Raji cell assay. The finding of soluble IgA immune complexes in a high percentage of patients with systemic lupus erythematosus and Henoch-Schönlein purpura suggests that they may play an important role in the pathogenesis of these diseases. In contrast, their low prevalence in patients with dermatitis herpetiformis suggests that IgA-containing immune complexes may not play a major role in the pathogenesis of dermatitis herpetiformis.

Antigen-Antibody Complex↗

PubMed1995

The antipruritic effect of 5% doxepin cream in patients with eczematous dermatitis. Doxepin Study Group.

BACKGROUND AND DESIGN: Eczematous dermatitis is commonly characterized by intense pruritus. Current treatment modalities for this condition, regardless of its cause, are primarily directed at blunting the cutaneous inflammatory response and thereby providing relief of pruritus. To expand on our previous findings in atopic dermatitis, the present multicenter double-blind trial was conducted to evaluate the safety and antipruritic efficacy of 5% doxepin hydrochloride cream in patients with lichen simplex chronicus (n = 136), nummular eczema (n = 87), or contact dermatitis (n = 86). A total of 309 patients with moderate to severe pruritus were randomly assigned to apply either doxepin cream (n = 154) or vehicle cream (n = 155) to eczematous areas four times per day for a period of 7 days. Efficacy was assessed using a pruritus severity rating scale, a Physician's Global Evaluation for pruritus relief, and a Visual Analogue Scale for pruritus relief. RESULTS: Twenty-four hours after initiation of treatment, and continuing throughout the remainder of the study, patients treated with doxepin cream experienced significantly greater pruritus relief than did vehicle-treated patients as determined by all efficacy parameters (P < .002). Sixty percent of doxepin-treated patients experienced pruritus relief within 24 hours. The response rate increased to 84% by conclusion of the study. As judged by significant changes (P < or = .05) occurring in at least one assessment of efficacy, doxepin cream provided pruritus relief in all forms of eczematous dermatitis that were examined. The study medication was well tolerated. The two most common adverse effects, stinging at the site of application and drowsiness, were usually transient and mild to moderate in severity. CONCLUSION: Topical application of doxepin provides significant antipruritic activity with a favorable safety profile, suggesting a role for doxepin cream in the symptomatic treatment of pruritus associated with eczematous dermatitis.

Administration, Cutaneous↗

PubMed1993

[Immune mechanisms of atopic dermatitis].

The syndrome of atopy consists of three major clinical entities, i.e., allergic rhinoconjunctivitis, allergic asthma and atopic dermatitis, and is usually associated with elevated serum IgE levels. Whereas the pathogenetic role of IgE is clearly established in the case of allergic rhinoconjunctivitis and allergic asthma, the occurrence of atopic dermatitis cannot be easily explained by hyperimmunoglobulinemia E. Atopic dermatitis clinically presents as eczematization of certain predisposed (mostly flexural) areas of the skin. The clinical and histopathological picture, as well as the emergence kinetics of atopic eczema, roughly follow the criteria of delayed type (type IV) immune reactions. It is at present unclear whether the type I-like and the type IV-like allergic reactions of atopy are events occurring independently of each other or, alternatively, are pathogenetically linked to each other. Recent data suggest that in contrast to allergic contact dermatitis where Th 1-like T cells producing interleukin (IL)-2 and interferon (IFN)-gamma are the cells eliciting the lesions, the cellular infiltrate of atopic dermatitis lesions is dominated by Th2 cells capable of producing IL-4 and IL-5. Consequently, two clinical findings of atopic disorders are explicable by the observed Th2 cytokine secretion pattern i.e. i) the hypereosinophilia by the hyperproduction of IL-5 and ii) the hyperimmunoglobulinemia E, for which the presence of IL-4 is a "conditio sine qua non".(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗

PubMed1994

Differential expression of ICAM-1, E-selectin and VCAM-1 by endothelial cells in psoriasis and contact dermatitis.

Adhesion receptors on endothelial cells are considered to be important for cellular influx in tissue. In this regard, skin constitutes a specialised environment for migration of leukocytes during inflammation. Using immuno-enzymatic staining techniques, we compared the in situ expression of ICAM-1, E-selectin, and VCAM-1 on endothelial cells and inflammatory infiltrates in both lesional and non-lesional biopsied skin from two immuno-inflammatory diseases, viz. psoriasis and contact dermatitis. The results were compared with those in skin specimens obtained from normal healthy individuals free from any history of skin disease. Our results show that ICAM-1 and ELAM-1 are upregulated in psoriatic non-lesional and lesional skin. On the other hand, in non-lesional biopsy from contact dermatitis patients, all three AR molecules are sparsely present, similar to the situation in normal skin although they are overtly expressed in the lesional sites. Moreover, VCAM-1 was found to be significantly increased on endothelial cells in the lesional sites of contact dermatitis as compared with biopsied psoriatic specimens. Interestingly VCAM-1 was also found to be present on some T-cells and Langerhans cells in contact dermatitis alone. The present data suggest that in different inflammatory dermatitis, varying adhesion receptor-ligand interactions involving endothelial cells and leukocytes are involved, which may be due to the differing cytokine profiles of perivascularly located T-cells.

Cell Adhesion Molecules↗

PubMed1994

Circulating ICAM-1 levels in children with atopic dermatitis.

Circulating intercellular adhesion molecule-1 (ICAM-1) levels were measured in 48 patients with atopic dermatitis (mild in 29, moderate in 13, and severe in 6) and in 32 controls. Circulating ICAM-1 levels gradually increased with the severity of atopic dermatitis (216 +/- 68 in control, 323 +/- 66 in mild, 376 +/- 92 in moderate, and 555 +/- 93 ng/mL in severe atopic dermatitis, respectively). A significant correlation was observed between serum ICAM-1 and eosinophilic cationic protein levels in patients with atopic dermatitis (r = .71, P < .01). Although a significant positive correlation was observed between serum eosinophilic cationic protein levels and peripheral eosinophil counts (r = .63, P < .01), only a weak correlation was observed between serum ICAM-1 levels and peripheral eosinophil counts (r = .35, P < .05). Changes in serum ICAM-1 levels in ten patients treated with ketotifen for 3 months were also demonstrated. A close correlation was observed between serum ICAM-1 levels and the disease severity (r = .76, P < .01). From these results, we speculate that serum ICAM-1 level may reflect the extent of inflamed tissue in atopic dermatitis.

Blood Proteins↗

PubMedDate not supplied

Use of a specific oral hyposensitization therapy to Dermatophagoides pteronyssinus in children with atopic dermatitis.

The aim of the present study was to evaluate the efficacy of an oral specific hyposensitization therapy in children with atopic dermatitis and positive prick skin tests and/or RAST to Dermatophagoides pteronyssinus (D.pt.). A total of 60 patients, in three different clinical groups, were selected for a three years clinical trial. Group A: children with atopic dermatitis and allergic asthma and/or rhinitis; groups B and C: children with exclusively atopic dermatitis. Groups A and B received specific hyposensitization therapy. Group C was the control group. The clinical evaluation of the dermatological lesions, at the end of our study, didn't show any significant difference among the three groups. Moreover, the onset of respiratory symptoms between the two groups with exclusively atopic dermatitis was similar and not related to the positivity of prick skin tests and/or RAST to seasonal allergens. Our study suggests that specific hyposensitisation therapy with extracts of D.pt., although with no side effects, does not affect the natural history of atopic dermatitis.

Administration, Oral↗

PubMed1993

Contact dermatitis.

Contact dermatitis is a common inflammatory skin disorder caused by exposure to various antigens and irritants. It is associated with significant morbidity, and it is one of the most common reasons for worker's compensation claims for skin disease. Based on the mechanism by which contact allergy develops, several types are recognized, including allergic contact dermatitis, irritant contact dermatitis, contact photo-dermatitis and contact urticaria. The clinical presentation of contact dermatitis, regardless of the mechanism, ranges from localized vesicles and bullae on erythematous skin in acute stages to erythematous lichenified plaques in chronic stages. Diagnosis is suggested by the localization of the eruption and the history of exposure to an offending agent. Treatment includes removal of the offending agent in conjunction with use of anti-inflammatory steroid creams, antihistamines and, in severe cases, oral corticosteroids.

Adult↗

PubMed1993

[Follow-up of atopic dermatitis after early childhood].

A total of 106 patients, 57 women and 49 men, had had atopic dermatitis even in infancy and were monitored by means of questionnaires at a mean age of 23.5 years. Items of interest were the course of the dermatosis, influences on its course and the frequency of respiratory allergic manifestations. The persistence rate of atopic dermatitis was 60.4%. It was possible to identify ten different courses of atopic dermatitis. Only 11.3% of these patients had suffered from the eczema exclusively during infancy. In 27.4% of cases the patients were free of manifestations for an average of 9 years, after which they had a new attack of the illness. Almost one third of the patients showed a continuous type of development of their atopic dermatitis, which had persisted since infancy. The most common localizations were the antecubal fossa (48.4%), the fingers (45.3%) and the face (37.5%). The course of atopic dermatitis was influenced by the seasons in 71% of these patients, and 59.4% observed a connection between psychic stress and the exacerbation of skin conditions or a new attack of the dermatosis. As adults, 59.4% of all patients suffered from one or more respiratory allergic manifestation: 41.5% had pollinosis, 24.5% allergic rhinitis, and 25.5% bronchial asthma. Respiratory allergies disappeared in 24 cases (19.8%), bronchial asthma at a mean age of 13 years, and pollinosis at 15.3 years and perennial rhinitis at 16 years on average.

Adolescent↗

PubMed1993

Bronchial hyperresponsiveness in children with atopic dermatitis.

Using histamine provocation tests, bronchial responsiveness was measured in 43 children with atopic dermatitis, aged 7 to 15 years, who had attended pediatric dermatology clinics within the past 5 years. The children were divided into two groups, one group of 21 children in whom asthma had been previously diagnosed and in whom symptoms of asthma had occurred in the preceding year, and the other comprising 22 children who denied any such symptoms. Bronchial hyperresponsiveness (as defined by a 20% fall in forced expiratory volume in 1 second at a provoking dose of histamine of 7.8 mumol or less [PD20]) was demonstrated in all but 1 of the children with atopic dermatitis and asthma, in 18 of the 22 children with atopic dermatitis alone, but in only 3 of a control group of 18 children without atopic dermatitis or asthma. The asthmatic subjects (median PD20 = 0.22 mumol) had more severe bronchial hyperresponsiveness than the nonasthmatic subjects (median PD20 = 2.10 mumol). This study confirms the strong association between atopic dermatitis and bronchial hyperresponsiveness, even in the absence of overt asthmatic symptoms.

Adolescent↗

PubMed1993

Prevalence of respiratory symptoms in children with atopic dermatitis attending pediatric dermatology clinics.

A postal questionnaire, completed by parents, was used to study the prevalence of respiratory symptoms in 250 children with atopic dermatitis who had attended pediatric dermatology clinics in London within the past 5 years. A response rate of 84% was achieved. Each child had a control matched for age and sex, whose parents filled in an identical questionnaire. The prevalence of wheezing was 76% in the atopic dermatitis group and 12% in the control group. Of the children with atopic dermatitis who wheezed, 87% had been given a diagnosis of asthma by a doctor, compared with 40% of the control children who wheezed. Overall, 68% of the children with atopic dermatitis had been given a diagnosis of asthma by a doctor. This prevalence of respiratory symptoms and of diagnosed asthma is substantially higher than has been shown in previous studies. As the test population consisted of children who had been referred to a tertiary center for management of their skin disease, this higher prevalence may partially reflect the increased severity of atopic dermatitis in the study group, as well as the heightened awareness of the association between these two diseases by their parents and physicians.

Adolescent↗

PubMed1977

Juvenile dermatitis herpetiformis: an immunologically proven case.

Subepidermal blistering diseases of childhood have, in the past, been thought to represent cases of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood. While the small-blister variety closely resembles adult-type dermatitis herpetiformis, the large-blister, or bullous, variety has clinical and histologic resemblances to bullous pemphigoid. The patient presented in this report clearly fits previous descriptions of the large-blister type of juvenile dermatitis herpetiformis, bullous pemphigoid, or benign chronic bullous dermatosis of childhood both clinically and histologically, while his therapeutic response to dapsone and the presence of in vivo bound IgA at the basement membrane of normal and perilesional skin are highly characteristic of the adult type of dermatitis herpetiformis. Immunofluorescent studies of similar cases reported in the literature, however, have shown variable results, thus obscuring their classification. Though the proper place of all such cases in the nosology of blistering diseases is not yet clear, at least some of them closely resemble adult-type dermatitis herpetiformis by two important criteria--immunologic and therapeutic.

Child, Preschool↗

PubMed1996

[Pustular dermatitis in veterinarians following delivery in domestic animals; an occupational disease].

OBJECTIVE: To assess the prevalence of contact dermatitis after deliveries in cattle or sheep among veterinarians. DESIGN: Retrospective. SETTING: Provinces of Groningen, Friesland and Drenthe, The Netherlands. METHODS: By means of a short inquiry 31O veterinarians were asked whether and how often they had experienced pustular dermatitis after deliveries in cattle and sheep and what course the dermatitis had run. They were also asked about details of the deliveries (type of animal, condition of the foetus, course of the partus), about microbiological investigation, preventive measurements and therapy. RESULTS: The response to the questionnaires was 24.5%. One or more episodes of pustular dermatitis on an arm after a delivery in cattle or sheep was noticed by 6(2) (81.5%) of the 7(6) respondents. Sometimes it was associated with secondary symptoms like headache, fever and lymphadenitis. Listeria monocytogenes (7 times out of 13) and Salmonella dublin (4/13) were the agents cultured most often. CONCLUSION: Contact dermatitis after deliveries in cattle or sheep occurs frequently as an occupational disease of veterinarians.

Animals↗

PubMed1996

[Studies of allergen specific IgE antibodies with atopic dermatitis--evaluation of house dust 6 (house dust Japan) specific IgE antibody].

We examined the usefulness of allergen housedust-6 measurement in 44 patients (22 males and 22 females) with atopic dermatitis. The positivity for each of housedust HD-2 and HD-6 and that for each of D-1 and D-2 was well correlated in more than 90% of the patients (correlation coefficient > 0.85). The positivity for HD-2 and for HD-6 was also correlated in 93.2% of the patients. However, there was a discrepancy between D-1 or D-2 and HD-2 or HD-6 in only a few patients. The positivity for antibody against specific IgE was higher in atopic dermatitis-patients with allergic rhinitis, allergic conjunctivitis or bronchial asthma as compared with patients with only atopic dermatitis. Only one patient with severe atopic dermatitis had a negative result for specific IgE, suggesting the contribution of other circumferencial factors in the development of the disease. In conclusion, our study suggested that housedust-6 is useful in clinical evaluation of patients with atopic dermatitis.

Adolescent↗

PubMed1997

Evaluation of previously patch-tested patients referred to a contact dermatitis clinic.

BACKGROUND: One of the frustrations for clinicians who use patch testing is the patient in whom screening patch tests does not yield a relevant result that improves patient outcome. Is it allergic contact dermatitis? Was an allergen missed? Is the screening allergen relevant after all? OBJECTIVE: The purpose of this study was to look at the subset of patients referred to a contact clinic who had previously undergone patch testing to seek answers to these questions for this population. METHOD: The charts of all 119 physician-referred patients seen in the contact clinic from February through August 1995 were reviewed. Information was gathered about the sites of dermatitis, previous patch testing results, current patch testing results (using the North American Contact Dermatitis Group series and supplemental allergens when indicated), and final diagnosis. RESULTS: Forty-three patients had previously undergone patch testing. Nineteen had been tested with the True Test and 24 with the screening series presumed to be Hermal. The sites of skin involvement were similar to the untested group (approximately 1/3 hands, 1/3 face/exposed sites, and 1/3 other). Eighteen pretested patients(42%) had been reported to have one or more positive patch tests, with the most frequently reported allergens, including neomycin (4), quaternium 15 (3), Balsam of Peru (3), fragrance (2), and formaldehyde (2). On repeat testing, 77% of the previous positives were again positive, and many were thought to be relevant. Nine of the 18 had additional allergens deemed relevant. Twenty-five pretested patients had been negative on initial patch testing. Eighteen of the 25 (72%) had positive allergens on repeat testing, and most were thought to be relevant. There were 17 reactions to screening allergens and 16 reactions to additional allergens or products. Variations noted with initial negative testing included use of systemic corticosteroids, patient self-removal of tests, and single 48-hour readings. Overall, 27 of 43 pretested patients (63%) were found to have relevant additional allergens with contact clinic evaluation. Screening allergens were underrecognized as being relevant by clinicians in practice. CONCLUSIONS: Patients suspected of having an allergic component to their dermatitis should be patch tested with the screening series of allergens. Interpretation of the relevance of the allergens and appropriate avoidance is a challenge. If screening allergen patch testing is negative or believed to be not relevant in a patient with persistent dermatitis, there may be a high yield on further patch test evaluation.

Dermatitis, Allergic Contact↗

PubMedDate not supplied

Epidemiologic study of contact dermatitis in hemodialysis patients.

Hemodialysis (H) implies the application of different topical substances (such as antiseptics, plaster and rubber chemicals, etc.) and the contact with potential allergenic materials (like gloves, catheters, needles, etc.). H patients may present contact dermatitis (allergic or irritant) as a consequence of this procedure. The frequency of this dermatitis is not known, as reports of isolated cases constitute the only source of information. The aim of this study was to evaluate the prevalence of contact dermatitis and positive patch tests (PT) in patients treated with chronic maintenance H. Eighty patients (40 females and 40 males) on chronic H were studied. We found a low frequency of eczematous lesions among our H patients (1.25%). PT were carried out with the GEIDC standard panel and a "dialysis" battery. Fourteen patients (17.5%) had positive PT, 3 of them having polysensitization. The most frequent sensitizing agents were p-phenylenediamine (3.75%), carba mix (3.75%) and Betadine solution (3.75%). Irritative patch test reactions were seen in 29 patients (36.2%), all of them due to Betadine solution (povidone-iodine). There was no relationship between the length of time of H, sex, age, history of contact dermatitis or cutaneous examination for dermatitis, and PT results. Regarding our results one might suggest that H is a low source of sensitization, but one has to take into account the state of anergy typical of uremic patients. Although the H procedure could be responsible for those sensitizations, it is also possible that they were acquired before H treatment.

Adult↗

PubMed1977

Staphylococcal infections in patients with atopic dermatitis.

Cutaneous staphylococcal infections appear to be relatively infrequent in atopic dermatitis even though patients have broken skin heavily colonized with staphylococcal organsism. We found superficial staphylococcal pustules on the skin of 22 patients with atopic dermatitis. Such lesions were more commonly found with severe exacerbations of atopic dermatitis. They appeared on unbroken skin independent of hair follicles and were associated with considerable pruritus. Such lesions were rapidly removed by excoriation and frequently were overlooked by patients and physicians. Most lesions appeared when polymorphonuclear leukocyte chemotaxis was depressed. Ineffective chemotaxis combined with high-colonization density and inadequate stratum corneum barrier during exacerbations of atopic dermatitis may lead to mild staphylococcal infections. These infections appear to have no systemic effects but possibly the considerable associated pruritus could worsen the atopic dermatitis. Occasional patients may require intermittent or continuous antibiotic therapy.

Adult↗

PubMed1997

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↗