Biomedical subjects
Publications and source records attributed to C D Calnan.
One of the basic principles in the investigation of suspected contact dermatitis is always to test with the patient's "own" product or chemical, the one to which he or she was actually exposed. An equally basic second principle is not to rely solely on a positive test reaction. The author discusses a case of contact dermatitis involving only certain batches of a particular branded product.
Musk ambrette, a contact and photocontact allergen, is a synthetic fragrance present in aftershave lotions and many toiletries. Thirty-four patients with contact and photocontact allergy to musk ambrette were studied. All had a facial eczema. Four distinctive clinical pictures were seen. These were plaques of eczema, jawline (mandibular) dermatitis, acute contact dermatitis and chronic actinic dermatitis. Twenty-six patients were light sensitive by history and 10 were diagnosed by clinical criteria as having chronic actinic dermatitis. Patch and photopatch testing to musk ambrette showed that seven patients had pure photocontact dermatitis to musk ambrette. Eight patients had contact dermatitis to musk ambrette but this was exacerbated by irradiation. Cross reaction with moskene occurred. Scrupulous avoidance of musk ambrette has resulted in clinical resolution in most patients.
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Localized persistent pigmented macules and plaques due to a chronic form of pigmented purpuric dermatitis are described in forty-two patients. The designation 'lichen aureus' for this eruption can be justified because of the striking yellowish or bronze-like colour assumed by many of the lesions. The lower legs were the commonest sites but other body regions can be affected also. Histologically lichen aureus differs from other pigmented purpuric dermatoses in the density of the lichenoid tissue reaction and the marked accumulation of pigment-containing macrophages. Recently developed endothelial cell markers have been studied in selected cases.
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An outbreak of irritant dermatitis from a cyanoacrylate glue among a group of electronic assembly workers is described. It was caused by vaporization of monomer under conditions of low relative humidity. No further outbreak occurred when the humidity of the working environment was raised above 55%.
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Proven allergic contact dermatitis from carbon paper is an exceptional rarity; the reported causes are dyes and plasticisers. But carbon paper is gradually being replaced by pressure-sensitive or carbonless copy paper, particularly for business forms. The method depends on mechanical pressure or chemical transfer. For the latter, colour formers are held in microcapsules, which rupture under pressure, and released when they produce the colour. Some office workers have claimed that the handling of used carbonless papers are responsible for symptoms affecting the skin, eyes, and upper respiratory tract, as well as systemic symptoms including headaches, drowsiness and fatigue. Patch tests are negative. If the symptoms are attributable to carbonless paper it is suggested that the colour former solvents are most likely to be responsible.
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