Biomedical subjects
Publications and source records attributed to A Schulze-Dirks.
A 64-year old female patient was treated for a therapy-resistant generalized granuloma annulare with fumaric acid esters (Fumaderm initial). One week following begin of therapy with an initial dose of 30 mg per day, the papules had regressed significantly. A 6-week therapy with a final dose of 90 mg Fumaderm initial per day led to a nearly complete healing of the illness.
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An animal model for the evaluation of skin protective creams against chemical irritants is described. The irritants were applied daily for 2 weeks to shaved back skin of young guinea pigs: sodium lauryl sulphate (5% aq.; 30 min), sodium hydroxide (0.5% aq.; 2 min), and toluene (20% eth.; 2 min). The barrier cream was applied 2 h prior to and immediately after exposure to the irritant. Control animals were treated with the irritant only. The irritant reaction was scored on a 4-point scale for erythema and quantified with regard to transepidermal water loss (TEWL) by evaporimetry and skin blood flow volume (BFV) by laser Doppler velocimetry. A total of 90 guinea pigs, consisting of individual panels of 5 to 10 animals, was tested. While one barrier cream (Stokoderm) significantly suppressed the irritation due to sodium lauryl sulphate and toluene, the other (Contra-Alkali) failed to do so and even aggravated the response, which was particularly evident with sodium hydroxide. This model may be useful in developing more effective barrier creams.
A popular "skin protector" consisting of an emulsion-like foam of lipophilic and hydrophilic substances (Marly skin) was evaluated in a previously described repetitive irritation guinea pig model. The product failed to inhibit the irritation due to sodium lauryl sulphate and toluene. In striking contrast to the recommended use, the irritant response of sodium hydroxide was aggravated, as demonstrated by significant differences for all test parameters (clinical score for erythema and scaling, transepidermal water loss, blood flow volume). The results show that protection against chemical irritants may be quite specific and that some formulations may actually be harmful.
At eight dermatological clinics, a total of 2146 patients were tested between May 1990 and December 1991 to determine the significance of the preservative benzalkonium chloride in inducing allergic contact dermatitis and to evaluate recommendations for patch testing. In 225 cases an allergic reaction was proven, with 258 irritant reactions in addition. Only 12 cases were clinically relevant. Therefore, benzalkonium chloride is considered a weak allergen. A doubtful (erythema) or an incipient positive (with occasional papules) reaction may be regarded as an irritant reaction. In isolated cases a "repeated open application test" (ROAT) should be applied to determine clinical relevance. Our recommendation for patch testing is 0.1% benzalkonium chloride in vaseline, and also in water for special cases.
The development of blood flow measurement by Doppler frequency shift has been a very significant advance in phlebological diagnosis. The difficulty with ultrasonographic Doppler diagnosis lies in the potential homogeneity of the sounds even when the blood flow varies in nature. Therefore, anatomic variation in blood vessels may lead to misinterpretation. As a new noninvasive method, Duplex ultrasonography reflects substantial progress in the diagnosis of venous diseases. This method combines Doppler ultrasonography and real-time sonography, allowing precise interpretation of the sounds in relation to the vessel being examined.
A case of erythema multiforme-like allergic contact dermatitis due to midysalb, an ointment containing mephenesine is described. Patch testing showed marked sensitization to mephenesine, with positive reactions to different dilutions down to 0.1%. It is unlikely that the weak reaction to a further component, ethylene glycol monosalicylic acid ester, is responsible for the allergy. There are several other reports in the literature, so that mephenesine must be classed as one of the few allergens that cause reactions reminiscent of erythema multiforme.
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The paper contains a report on 16 patients with positive patch test reactions to polidocanol (11 women, 3 men, 2 children). The majority of the patients suffered from chronic dermatitis and had further contact sensitizations to antibiotics and to vehicle constituents. The clinical relevance of positive reactions to polidocanol remained unclear in many cases. A positive reaction was reproduced in only two of six cases at a late follow-up examination. A repeated open application test in the antecubital space with two polidocanol preparations for topical application was strongly positive in one case and doubtful in another case. In view of the wide use of preparations containing polidocanol literature reports and our own observations lead us to recommend patch testing with polidocanol in the drug series is recommended for all patients with chronic dermatitis, particularly those with lower leg and perianal dermatitis.
Eleven cases of contact allergy to dexpanthenol are reported (5 females, 6 males; mean age 62.4 years). Five patients suffered from a leg ulcer and/or stasis dermatitis. In five patients the sensitization occurred after the application of dexpanthenol-containing ointments to the face. Only one patient did not show sensitization to other common allergens. Three patients were sensitive to wool wax alcohols, which are present in a commonly used product. Dexpanthenol seems to be a rare sensitizer, yet clinically most relevant for patients with stasis dermatitis and multiple allergies.
Among 671 consecutive patients who underwent the patch test with Kathon CG (100 ppm active ingredient), 23 (3.43%) showed a positive reaction (87% females). In 52.2% of these cases the clinical relevance of these reactions was considered to be proven. Most of the patients were suffering from contact dermatitis of the face or hands. Cosmetics were found to be the major cause of sensitization. In view of the widespread use of this preservative, testing with Kathon CG is recommended in all cases of contact dermatitis.
The investigation of patients with leg ulcers, treated with a concentrated benzoylperoxide solution, revealed a sensitization to the substance in nearly half of the probands. Therefore and because of the probable promotion of neoplastic epidermal proliferation, benzoylperoxide-containing solutions should be used for the treatment of leg ulcers in selected cases only.