Biomedical subjects
Publications and source records attributed to C L Meneghini.
Nine cases of disease malingering with skin lesions attributed by the patients to occupational factors are reported. History and morphology of the lesions provided sufficient grounds for the diagnosis of occupational dermatitis arterfacta. Four out of nine patients admitted to having produced these artefacts.
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A series of 14 cases of sporotrichosis cutanea is reported. Epidemiological and clinical aspects of the disease are discussed in the light of recent data. In addition to cultures, the diagnostic methods to be considered include an indirect immunofluorescence test, which is positive at variable titre and for which use may be made of normal human antiserum or anti-immunoglobulin, mainly IgG and IgM, antisera. The mainstay of the treatment is preparations of iodine, with trimethoprim- sulpha-methoxazole as a possible alternative.
Triclocarban was subjected to a profiling of its dermatitis producing potential including irritancy (21-day cumulative irritancy potential and application to 213 normal controls), phototoxicity (method of Marzulli), predictive contact sensitization (modified Draize method), predictive phototesting and battery screening in 2200 dermatitis patients, in an effort to define its relative dermatitis potential. The allergic contact dermatitis potential of triclocarban following bar soap use appears minimal.
Results of an investigation of 134 subjects with atopic dermatitis and 29 controls are described. The investigation involved: 1) an allergological enquiry into each patient's medical history, with particular reference to consumption of eggs, milk and fish; 2) a total IgE assay; 3) RAST with egg, milk, cod; 4) a challenge test. Recording of medical histories revealed the existence of clinical sensitivity to egg, milk and cod in respectively 21, 17 and 7 of the 134 subjects with atopic dermatitis, but in none of the controls. In the atopic subjects, RAST demonstrated egg, milk and cod antibodies in 37, 28 and 14 cases respectively, while of the controls only 2 had antibodies--and then in minimal amounts. The maximum incidence of egg and milk antibodies was demonstrated in the initial 3 years of life. Clinical sensitization to cod manifests itself in the form of attacks (urticaria, angi-oedema, vomiting) showing significant correlation between clinical history, results of RAST and the response to challenge, while in the case of sensitivity to eggs and, even less evidently, to milk, the symptoms are more often referred to as "exacerbation of the dermatosis" and the results of RAST, of challenging and the clinical history tend to be contradictory.
Patch tests repeated one or more times over periods of up to 3 years in 208 subjects with allergic contact dermatitis produced evidence of persistent specific sensitivities in almost 50% of cases. In about 25% the reactivity disappeared and over 25% developed new sensitivities. No new sensitivities appeared in 253 patients with non-allergic contact dermatitis or with other types of dermatitis in whom the same patch tests were carried out. The history and follow-up of patients with new sensitivities brought into focus the presumed aetiopathogenetic role of further contacts, especially occupational or after topical applications. Patch tests themselves, provided the correct technique is employed especially as regards the concentration of allergens, do not seem to be responsible for new sensitizations to any significant extent.
Cell-mediated immunity to bacterial antigens was studied by intradermal testing, and to contact antigens (cosmetics, environmental chemicals and topical medicaments) by patch testing in 270 children with atopic dermatitis. The incidence of delayed-type immune cutaneous reactions in these patients was lower than in the controls. Contact allergy is a rare finding in the first 4 years of life but its incidence increases subsequently. In subjects with atopic dermatitis the incidence of sensitization by contact with allergens contained in topical medicaments proved to be lower than in subjects with eczema of other types. The data collected points to a reduced cell-mediated immune reactivity in a proportion of subjects with atopic dermatitis.
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Results of a study in 62 patients with urticaria and 30 controls, all under 12 years of age, are reported. The study involved history taking and assays of immunoglobulins A, G, M, D, E, of complement fractions C3c and C4 and estimation of C1 estease inactivator activity in the plasma. Acute urticaria is more frequent than chronic urticaria in children, expecially in subjects with atopic diathesis; papular urticaria (or strophulus infantum) is particularly frequent in children under 6 years of age and in the male. Assays of plasma immunoglobulins demonstrated selective deficiency of IgA in two and significant reduction of this immunoglobulin in a further three cases. The mean levels of IgE proved normal in chronic urticaria, raised in acute urticaria, and very high in papular urticaria. Complement assays demonstrated, in one case, a reduction of C3c below 60 mg/100 ml, persisting after the disappearance of urticaria.
The incidence of contact allergy to 63 substances, including active principles and excipients used in a variety of topical preparations, has been studied by patch testing in 306 patients being treated conservatively for stasis dermatitis with or without ulceration. Positive reactions to one or more test compounds were recorded in 177 patients. The main offenders among drugs were neomycin, sulphonamide and promethazine; among the excipients, they were parabens, lanolins and benzoyl peroxide. Frequent reactions were observed to certain substances of the 'para' group, benzocaine, diaminodiphenylmethane, aniline and paraphenylendiamine, with the first three acting mainly as indicators of cross-sensitization. The extension and spread of allergic dermatitis can also be produced by drugs administered systematically. Recognition of the allergens responsible for allergic contact dermatitis arising at the lower leg site is a necessary condition if chronicity and spread of the dermatitis are to be prevented. For the same reason it is important to restrict topical applications to non-allergic substances.
Two cases are described of acute contact dermatitis from an antifungal cream, containing pyrrolnitrin, employed for the treatment of tinea cruris. Positive reactions to pyrrolnitrin and to a chemically related substance, 1-chlor-2,4dinitrobenzene, were put into evidence.
A case of Phenergan-induced allergic photo-contact dermatitis in a boy aged 11 years is described. The condition produced a dermatological picture of senile-looking elastosis and citrine skin in exposed areas.
Cell-mediated immunity (CMI) was investigated in a series of patients with epithelial tumours of the skin and with Kaposi's sarcoma. In all 53 patients the peripheral blood lymphocyte count showed no substantial difference from the control values. The blasts count after phytohaemagglutinin stimulation in 30 patients ranged from 40-50% with no noticeable difference from the control values. Intradermal tests with the staphylococcal antigen, PPD-tuberculin and streptokinase-streptodornase carried out in 59 patients proved negative in a significant number of cases, mainly those of Kaposi's sarcoma. The non immune inflammatory response to chemical irritant (benzalkonium chloride) was more often negative (17 of 59 cases) than in controls (5 of 30 subjects). The DNCB sensitization test carried out in 28 patients was negative in 5 cases (2 cases of late basal-cell epithelioma, 2 cases of advanced squamous-cell carcinoma and 1 case of Kaposi's sarcoma). The findings do not thus indicate the presence of a gross CMI defect in the material studied, which would be borne out by all the tests employed. The sometimes discordant results of the various tests suggest the existence of partial CMI defects in certain tumours, but mainly in Kaposi's sarcoma. Such partial defects, encountered even in early neoplasms, coexist, in some cases, with failure of inflammatory response to chemical irritants.
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