Contact sensitivity to cyanoacrylate nail-adhesive with dermatitis at remote sites.
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A survey of occupational dermatoses, based on a questionnaire, clinical examination and patch testing, was carried out among present and former employees in a plant producing binders for glues and paints. The binders are chemically based on vinyl acetate and/or acrylates. Preservatives are needed and those based on methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) are the most commonly used. The questionnaire was answered by 83 out of 85 present employees (97.6%) and 12 out of 15 former employees (80.0%). 76 of the present (89.4%) and 11 of the former employees (73.3%), respectively, participated in the clinical examination and patch testing, which was conducted with a standard test series and chemicals from the work environment. Occupational dermatosis was diagnosed in 22 present workers (28.9%). Irritant and allergic contact dermatitis was demonstrated in 9 (11.8%) and 13 (17.1%) employees, respectively. Occupational contact allergy to acrylates and formaldehyde was detected in 3 workers and 1 worker, respectively. 12 individuals (9 present and 3 former production workers) had an occupational contact allergy to MCI/MI. 4 of the present workers had spilled Kathon LX on their skin resulting in chemical burns and allergic contact dermatitis. In total, the figure for occupational skin diseases among all present production workers was 40.4%.
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BACKGROUND: In recent years, itraconazole pulse therapy for onychomycosis has been developed [three 1-week pulses with itraconazole 400 (2 x 200) mg daily every month]. This has proved an effective and safe regimen which requires only 50% of the medication used for continuous dosing schedules. Parallel to the development of the new dosage schedule, additional studies were conducted to further document the safety and efficacy of itraconazole 200 mg once daily for 3 months to treat onychomycosis. OBJECTIVE: To compare the safety of itraconazole 200 mg once daily for 3 months, with or without itraconazole 200 mg once weekly for a further 3 months, with that of miconazole cream twice daily for 6 months, in the treatment of onychomycosis. Treatment efficacy was compared as a secondary objective. METHODS: In this multicenter, double-blind study, patients were randomized to receive itraconazole 200 mg once daily for 3 months followed by either itraconazole 200 mg once weekly for 3 months (ITR-ITR group, n = 599) or oral placebo once weekly for 3 months (ITR-PLAC group, n = 613), or to receive miconazole cream twice daily for 6 months (MIC-MIC group, n = 396). The primary variable was elevation of alanine amino-transferase (ALT) concentration above 50 U/I. RESULTS: Overall incidence of elevation of ALT concentration above 50 U/I, adverse events and rate of withdrawal because of adverse events were low and similar in the three treatment groups. Efficacy was significantly greater in the ITR groups than the MIC-MIC group. CONCLUSION: Itraconazole and miconazole were well tolerated and had no significant effect on liver function, but itraconazole was significantly more effective.
BACKGROUND: [corrected] Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. OBJECTIVE: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. PATIENTS AND METHODS: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. RESULTS: Direct microscopy was positive in 102 (59.3%) nail specimens. The culture test was positive in 90 cases (52.9%), showing a dermatophyte in 45, a yeast in 23 and a mould in 22 samples. The histological examination was positive in 94 (54.6%) samples. In 4 cases, it was the only investigation confirming the clinical diagnosis of nail mycosis. In most of the cases, the morphological aspect of the hyphae and/or spores suggested also to which group of pathogens (dermatophytes, yeasts or moulds) the mycetes observed in the histological sections could be ascribed. The concurrent presence of a dermatophyte and a mould was evidenced in a few specimens. The control histological examination at the end of the treatment showed negative results or residual non-vital hyphae and/or spores. CONCLUSIONS: Results of the present study indicate that the histological examination of nail clipping specimens is a relatively inexpensive, rapid and easily performed procedure. It is useful to confirm or refute the results of routine microscopy and culture tests. Moreover, nail histopathological observation may help in ascribing a pathogenic role of non-dermatophyte isolates and evaluating the effectiveness of antifungal treatment.
Psoriasis on the palms and soles is characterized by pustules, vesicles and hyperkeratotic plaques. Several studies have postulated that the pustules and vesicles are round or egg-shaped. This three-dimensional study reveals that neither pustules nor vesicles have a regular spherical morphology. The vesicles are located in the upper and middle layers of the epidermis and may exhibit dumb-bell- or banana-shaped lumina. The pustules consist of different compartments combining characteristics of a dyshidrotic vesicle with those of a microabscess of Munro.
Biochemical analysis of involved and uninvolved skin of a 16-year-old female with acrogeria showed that hyaluronic acid and collagen contents were decreased only in involved skin. Explant cultures from both involved and uninvolved skin synthesized mainly hyaluronic acid in similar amounts. Since the glycosaminoglycans and hydroxyproline excreted in the urine were not increased, we speculate that a localized rather than a systemic abnormality may be present in acrogeria. Decreased collagen and hyaluronic acid contents in the patient are discussed in relation to Werner's syndrome and type IV Ehlers-Danlos syndrome.
Although chlorhexidine is a widely used substance, allergic contact dermatitis from chlorhexidine has rarely been reported. Our objective was to study all cases of allergic contact dermatitis from chlorhexidine that were seen at St John's Institute of Dermatology from January 1983 to June 2002. The case records of all patients with positive patch-test reactions to chlorhexidine during the study period were retrieved. The clinical presentation, strength, and relevance of the positive patch-test results as well as possible sources of exposure were studied. There were five cases of allergic contact dermatitis from chlorhexidine during the study period; three of these patients had positive patch-test reactions to chlorhexidine that were of current relevance. The possible sources of exposure included Hibisol, Hibiscrub, a chlorhexidine spray, and peri- and postoperative antiseptic solutions. We concluded that allergic contact dermatitis from chlorhexidine is rare. However, when it occurs, it may cause a severe dermatitis reaction.
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