Lichenoid reactions to gold from dental restorations and exposure to gold through intracoronary implant of a gold-plated stent.
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Dental Restoration, Permanent↗
Biomedical subjects
C Svedman
Publications and source records attributed to C Svedman.
Contact allergy to gold in patients with gold-plated intracoronary stents.
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Allergens↗
Contact allergy to gold in patients with gold-plated intracoronary stents.
An increasingly common and effective method for the treatment of atherosclerotic disease in the coronary arteries is percutaneous transluminal coronary angioplasty (PTCA) and stenting. The stents are made of different metals. An increased rate of restenosis when using gold-plated stents has been shown. Contact allergy to gold is common in many countries. Recently, a study has shown an increased rate of contact allergy to nickel among patients with restenosis and a nickel-containing stent. The aims of our study were to investigate whether there was an increased rate of contact allergy to gold among patients with gold-plated stents and if this increased the risk of restenosis. 22 patients who had received a gold-plated stent were patch tested. An age- and sex-matched population of 88 patients, previously patch tested because of a suspected contact dermatitis, served as controls. In the stent group, 10/22 (45.5%) had a contact allergy to gold, in the control group 18/88 (20.5%); the difference is statistically significant (P = 0.04). There was no significant difference regarding frequency of restenosis. Our study indicates that there is a risk of sensitizing the patient when implanting a gold-plated stent. Further studies are needed to confirm these results and to evaluate whether there is an increased risk of restenosis.
Adult↗
Ulcus vulvae acutum, a rare diagnosis to keep in mind.
Genital ulceration is today often thought to be caused by herpes simplex. In this case report, a rare differential diagnosis, ulcus vulvae acutum is described, probably caused by Epstein-Barr virus (EB-virus).
Adolescent↗
Deodorants: an experimental provocation study with hydroxycitronellal.
Axillary dermatitis is a common problem, particularly in individuals with contact allergy to fragrances. Many individuals suspect their deodorant to be the causal product of their fragrance allergy. It has been shown that deodorants containing cinnamic aldehyde (cinnamal) can elicit axillary dermatitis in patients sensitized to this substance. The aim of the present investigation was to evaluate the importance of hydroxycitronellal used in deodorants for the development of axillary dermatitis, when applied by individuals with and without contact allergy to this fragrance chemical. Patch tests with deodorants and ethanolic solutions containing hydroxycitronellal, as well as repeated open application tests (ROAT) with roll-on deodorants with and without hydroxycitronellal at different concentrations, were performed in 14 dermatitis patients, 7 with and 7 without contact allergy to hydroxycitronellal. A positive ROAT was noted only in the patients hypersensitive to hydroxycitronellal (P < 0.001) and only in the axilla to which the deodorants containing hydroxycitronellal had been applied (P < 0.001). Deodorants containing hydroxycitronellal in the concentration range of 0.032-0.32% used twice daily on healthy skin in individuals hypersensitive to hydroxycitronellal can elicit axillary dermatitis in a few weeks.
Adolescent↗
Hydroxyisohexyl 3-cyclohexene carboxaldehyde- known as Lyral: quantitative aspects and risk assessment of an important fragrance allergen.
Hydroxyisohexyl 3-cyclohexene carboxaldehyde, also known as Lyral, is a fragrance ingredient identified as the cause of contact allergic reactions in 2-3% of eczema patients undergoing patch testing. Lyral has been included in the standard patch test series in many clinics due to its importance as an allergen. It has been used without restrictions in cosmetic products, until now. In the present study, the dose-response relationship of Lyral contact allergy was studied with doses relevant for normal exposure in cosmetic products. 18 eczema patients, who previously had given a positive patch test to Lyral 5% petrolatum, were included along with 7 control subjects. All cases were tested with a serial dilution of Lyral in ethanol 6% to 6 p.p.m and subjected to a 2-week, repeated open application test with a low dose of Lyral in ethanol. In the case of no reaction, this was followed by another 2 weeks of testing with a higher dose. The test was performed at the volar aspect of the forearm. In 16 of 18 cases (89%), a positive use test developed, 11 reacting to the low and 5 to the high concentration. None reacted to the vehicle control of ethanol applied to the contralateral arm. All controls were negative to both the test solutions of Lyral and the ethanol control. The difference between the test and the control group was statistically significant (Fisher's test, P < 0.001). It is concluded that Lyral at the current usage levels is inducing sensitization in the community. The same levels were shown to elicit allergic contact dermatitis in almost all sensitized individuals. A significant reduction in usage concentrations is recommended to prevent contact allergic reactions.
Adult↗
The fragrance hand immersion study - an experimental model simulating real-life exposure for allergic contact dermatitis on the hands.
Recently, we showed that 10 x 2% of consecutively patch-tested hand eczema patients had a positive patch test to a selection of fragrances containing fragrances relevant to hand exposure. In this study, we used repeated skin exposure to a patch test-positive fragrance allergen in patients previously diagnosed with hand eczema to explore whether immersion of fingers in a solution with or without the patch-test-positive fragrance allergen would cause or exacerbate hand eczema on the exposed finger. The study was double blinded and randomized. All participants had a positive patch test to either hydroxycitronellal or Lyral (hydroxyisohexyl 3-cyclohexene carboxaldehyde). Each participant immersed a finger from each hand, once a day, in a solution containing the fragrance allergen or placebo. During the first 2 weeks, the concentration of fragrance allergen in the solution was low (approximately 10 p.p.m.), whilst during the following 2 weeks, the concentration was relatively high (approximately 250 p.p.m.), imitating real-life exposure to a household product like dishwashing liquid diluted in water and the undiluted product, respectively. Evaluation was made using a clinical scale and laser Doppler flow meter. 3 of 15 hand eczema patients developed eczema on the finger immersed in the fragrance-containing solution, 3 of 15 on the placebo finger and 3 of 15 on both fingers. Using this experimental exposure model simulating real-life exposure, we found no association between immersion of a finger in a solution containing fragrance and development of clinically visible eczema on the finger in 15 participants previously diagnosed with hand eczema and with a positive patch test to the fragrance in question.
Adult↗
Citral a fragrance allergen and irritant.
Citral is a well known contact allergen and a contact irritant. Routine patch testing in the past may have been restricted because of possible irritant (IR) patch test responses. 586 consecutive patients, with hand eczema, were patch tested with a selection of fragrances including citral 2% petrolatum and the European standard series. 28 of the patients showed a positive patch test reaction (+ to +++) to citral and 82 at least 1 IR patch test reaction and no positive patch test reaction to citral. A statistically significant association between a positive patch test reaction to citral and positive patch test reactions to other fragrances compared with IR reactions (n = 82) was established. The difference regarding fragrance history found between those with IR and positive reactions to citral was not significant. Citral could be an allergen and/or irritant, worthy of further more extensive studies.
Acyclic Monoterpenes↗
[Increased occurrence of gonorrhea in Copenhagen].
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Denmark↗
Skin mini-erosion technique for monitoring metabolites in interstitial fluid: its feasibility demonstrated by OGTT results in diabetic and non-diabetic subjects.
The aim of this study was to evaluate a new interstitial fluid (IF) sampling technique and its application in diabetology. IF and venous whole blood were sampled serially during an oral glucose tolerance test (OGTT) on days 1 and 3 after formation of a mini-erosion in eight non-diabetic controls and eight Type 2 diabetic subjects. Glucose, lactate, glycerol, 3-hydroxybutyrate and insulin were assayed in IF and plasma. With solitary exceptions, the IF sample volumes were in excess of those required for measurement of all five substances. However, mean IF sampling rates differed significantly both between the non-diabetic and diabetic groups and between days 1 and 3 (p < 0.001 in all cases). In both groups, the OGTT curves of glucose, glycerol and 3-hydroxybutyrate were similar to the respective curves for plasma, whereas for lactate concentrations they were markedly greater in IF than in plasma (40% and 93% in the control group and 57% and 100% greater in the diabetic group on days 1 and 3, respectively). The reverse was true of insulin concentrations in the non-diabetic group, which were 57% and 74% lower in IF than in plasma on days 1 and 3, respectively. In the non-diabetic group, the baseline (pre-OGTT) insulin level in IF increased from 49 +/- 22% (SD) of that in plasma on day 1 to 74 +/- 19% of that in plasma on day 3 (p=0.005). Sampling site re-epithelialization was rapid. In conclusion, the feasibility of transdermal sampling of IF via a skin mini-erosion has been demonstrated in both diabetic and non-diabetic subjects.
3-Hydroxybutyric Acid↗
Skin mini-erosion sampling technique: feasibility study with regard to serial glucose measurement.
PURPOSE: To describe a dermally non-invasive serial sampling technique and to test its clinical feasibility with regard to glucose measurement. METHODS: A standardized skin mini-erosion devoid of the epidermal barrier, and covered by an artificial one, was formed by a suctioning technique. Interstitial fluid (IF) was extracted serially by brief application of negative pressure, and its glucose content compared with that in capillary or venous blood samples. RESULTS: The procedure caused no discomfort. The epidermis regenerated rapidly after experimentation. There were no complications. In non-diabetic subjects (n = 13) the mean of all IF values measured daily for 6 days was 6.2 +/- 0.1 mmol/l (+/-SE). The corresponding capillary blood glucose value was 5.6 +/- 0.1 mmol/l, and the venous glucose value was 5.4 +/- 0.1 mmol/l. The differences between IF glucose values and invasive control values remained within narrow limits throughout. The 2SD limits of agreement for the differences were 1.44 mmol/l (IF vs. capillary blood samples) and 1.76 mmol/l (IF vs venous samples) respectively. The OGTT curves suggested glucose kinetics to be similar in IF and in capillary blood. In diabetic subjects, the mean of IF values determined serially during one day was 15.3 +/- 1.0 mmol/l (range, 6.7-21.8 mmol/l), and the corresponding mean capillary value was 12.0 +/- 0.9 mmol/l (range, 3.3-17.2 mmol/l). The ICC for all paired photometric observations was 0.948. CONCLUSIONS: The results suggest the new sampling technique to be a feasible approach for clinical and experimental purposes. A functionally integrated sampling patch is entering the clinical testing stage.
Adult↗
Laser Doppler imaging of skin microcirculation.
Laser Doppler imaging (LDI), a new technique which allows measurement of skin blood perfusion at a distance from the skin surface, was assessed methodologically in healthy volunteers. Each skin LDI value was based on virtually real-time measurements obtained from a number of discrete measuring sites. In scans made along the circumference of the lower arm, valid figures for LDI (as distinct from no output at all) were obtained in 8/8 measurements at 0 degrees inclination, and in 16/16 measurements at 7 degrees, 14 degrees, 22 degrees, 30 degrees and 38 degrees, respectively. Beyond this inclination a numerical output was obtained in only 9/16 of measurements at an inclination of 48 degrees, in 7/16 at 69 degrees, and in no more than 1/16 at 90 degrees. Values obtained at angles of inclination greater than 38 degrees fell within the relatively narrow range of values obtained at lesser angles of inclination. The findings are of interest since measuring sites of clinical importance may not be flat. Variability of measurement (coefficient of variation in per cent) was studied in the lower leg by performing LDI and conventional laser Doppler flowmetry (LDF) concomitantly. The coefficient of variation for measurements in one subject at rest was 13% for LDI vs. 19% for LDF, the corresponding interindividual coefficient of variation values being 25% vs. 28%. In response to heating, finger pulp perfusion increased by 55% as measured by LDI (p = 0.0051) and by 44% (p = 0.0756) as measured by LDF. In summary, the findings contribute to the validation of LDI for skin perfusion measurement.
Adolescent↗
The veno-arteriolar reflex in venous leg ulcer patients studied by laser Doppler imaging.
Posture-induced microcirculatory changes in the lower leg were studied in venous leg ulcer patients and in control subjects by means of laser Doppler imaging (LDI), a technique which allows almost real-time mapping of the perfusion from a distance, each perfusion value constituting the mean of a number of measurements at separate sites. LDI values for intact skin with the subject supine were 0.39 (0.32, 0.47) V [geometric mean (gm -SD, gm +SD)] and 0.32 (0.15, 0.70) V in two age groups of controls and 0.91 (0.66, 1.24) V in patients (NS). Values were 2.04 (1.25, 3.35) V for skin at the ulcer margin, and 1.44 (0.72, 2.88) V in the ulcer proper. With the lower leg passively dependent, lower LDI values were obtained at all sites in all groups, the reduction in intact skin value being 62 +/- 11% (arithmetic mean +/- SD) (p < 0.01) in the younger controls, 43 +/- 24% (p < 0.01) in the older controls and 62 +/- 19% (p < 0.001) in the patient group, and the reduction in ulcer values being 45 +/- 27% (p < 0.05) for the margin and 52 +/- 23% (p < 0.001) for the ulcer proper. Thus, a high degree of postural vasoconstriction was present overall, even in the ulcer itself. Vasomotor tone in the skin of the lower leg was assessed by topical application of methyl nicotinate, a vasodilator. The skin perfusion value (supine position, no stimulus) was 71 +/- 31% (p < 0.01) of the drug-induced (assumed peak) hyperaemia value [0.60 (0.30, 1.10) V] in patients and 24 +/- 25% (p < 0.001) of the hyperaemia value (1.30 (0.64, 2.62) V] in the controls. It would appear that in ulcer patients the veno-arteriolar reflex, despite being comparable in magnitude to that in controls, may nonetheless be insufficient to reduce tone during dependency to a level similar to that in healthy controls.
Adult↗
Administration of antidiuretic peptide (DDAVP) by way of suction de-epithelialised skin.
Transdermal drug delivery seems a promising way of achieving complete, predictable absorption, but the epidermis is a barrier for most drugs. A new technique for transdermal drug delivery, in which a small patch of epidermis was removed, was tested in seven healthy volunteers by means of the antidiuretic peptide 1-deamino-8-D-arginine vasopressin (DDAVP). The epithelium of a small area of forearm skin (diameter 5 mm) was removed painlessly, and in a standard way, by a simple device operating at a present vacuum. DDAVP was given by way of improvised occlusive reservoirs. Plasma DDAVP concentration/time curves conformed closely with zero-order kinetics, which suggests that the bioavailability approached 100%, corresponding to that for direct intravenous infusion. Four volunteers were given DDAVP daily for 4 days by way of the de-epithelialised site; there were no signs that re-epithelialisation hindered permeation. All plasma DDAVP values substantially exceeded the lowest effective therapeutic concentration for patients with diabetes insipidus. The vacuum removal of the epithelium caused pronounced hyperaemia in the de-epithelialised dermis (assessed by laser doppler flow measurement); the hyperaemia persisted, unaffected by DDAVP, and may have contributed to the efficient permeation. The skin spot appeared normal at 6 weeks.
Administration, Cutaneous↗
Skin suction blister wound exposed to u.v. irradiation: a burn wound model for use in humans.
The effects of exposing blister wounds to u.v. irradiation were assessed in 14 male volunteers, on whose forearms blister wounds (diameter 5 mm, suction set at 200 mmHg below atmospheric for 2 h 15 min, blister roof cut at base), and irradiated blister wounds (as above, in addition u.v. irradiation given selectively for 30 min from a distance of 10 cm), were produced. In non-u.v.-irradiated wounds, flow cessation, assessed by video microscopy (n = 6), was observed in a small proportion of the papillary loop vessels. The oedema adjacent to the wound was poorly developed. Laser Doppler linear scans (n = 8) demonstrated a pronounced hyperaemia in the wound bed and also in the adjacent skin, the reaction subsiding over a few days. The exudation rate, determined by weighing the hydrocolloid dressings applied to the wound, was maximal on day 1 and then rapidly decreased. Epithelialization, assessed evaporimetrically as the time taken for reinstatement of the epidermal water barrier, was complete in 5.1 days. In the u.v.-irradiated wounds the blood flow had ceased in all the papillary loop vessels by day 1, and increased oedema, exudation and hyperaemia at the wound edges were observed. Epithelialization was not significantly retarded by the irradiation injury. After 6 months, slight discolouration of the skin was occasionally observed, but no cosmetically disturbing scars. This benign and standardized wound model in humans--based on a combination of a mechanical suction injury and a superficial radiation burn--may prove to be useful, for instance when studying the effects of burns treatment.
Adult↗
Hyperbaric oxygen treatment of healthy volunteers with u.v.-irradiated blister wounds.
Healthy male volunteers were wounded by skin blistering, excision of the blister roof and u.v.-irradiation of the dermal wound bed. The lesions, painlessly inflicted on one forearm, were occluded, and no systemic therapy was given (n = 7). Ten days later the procedure was repeated contralaterally, and this time hyperbaric oxygen (HBO) therapy was given (1 h at 283 kPa in a 'multi-place' chamber) beginning 1.5 h, 10.5 h and 21.5 h after injury. The maximum 'length' of the lesions - including the surrounding oedema zone - differed throughout the experiment when comparisons were made on a daily basis (P less than 0.005 on day 1). The values were lower after HBO treatment, the difference being maximal on day 1 when it was 41 per cent. The hyperaemia at the periphery of the lesions, assessed with a mechanical laser Doppler linear scanner, was less in the HBO-treated group on days 3, 4, and 5 (P less than 0.05 on day 3). Centrally within the wound the mean Doppler values were lower after HBO-treatment for the duration of the experiment, but the differences were not significant for comparisons made on a daily basis. The exudation rates decreased after HBO treatment (P less than 0.05 on days 2-6). The end-points of epithelialization (5.1 days (HBO group) vs. 5.7 days) did not differ significantly. Thus, HBO had beneficial effects on this superficial dermal lesion. Oedema and exudation decreased, as did the peripheral hyperaemia, but the rate of epithelialization was not accelerated.
Adult↗
Epithelialization and blood flow in suction blister wounds on healthy volunteers.
Epithelialization and blood flow in painlessly inflicted small suction blister wounds were studied in healthy volunteers (n = 26) using evaporimetry and laser Doppler flowmetry (LDF), respectively. As expected, the evaporation rate normalized faster in wounds covered by an occlusive film than in wounds covered with gauze. The evaporimetry technique was found to be a simple alternative to the biopsy-based methods that have previously been used in humans. Blood flow was increased after 25 min of suctioning, and the hyperemia increased further after equalization to atmospheric pressure. This wound hyperemia (day 1) was more pronounced than that observed during heating of adjacent skin, and more pronounced at a pressure of 400 mm Hg below atmospheric pressure than at 200 mm Hg below. The hyperemic response lasted for some days and was similar on arm and foot. A mechanical LDF linear scanner was used to create a flow profile across the wound into the adjacent skin. Six months after inflicting the lesions there was no visible scar. The findings suggest that this blister wound model may be useful for studying epithelialization and microcirculatory events after trauma and during early wound healing in humans.
Adolescent↗
Contact allergy to isoeugenol and its derivatives: problems with allergen substitution.
A total of 2261 (808 male, 1453 female) consecutive patients attending contact dermatitis clinics were patch tested to isoeugenol and its derivatives listed in the EU Inventory of Fragrance Ingredients. Positive reactions were found to isoeugenol in 40, transisoeugenol in 40, isoeugenyl acetate in 19, isoeugenyl benzoate in 4, isoeugenyl phenylacetate in 16, isoeugenyl methyl ether in 6 and benzyl isoeugenyl ether in 2 patients. There was a concomitant reaction to isoeugenol in 36/40 of those positive to transisoeugenol, 13/19 of those to isoeugenyl acetate, 3/4 of those to isoeugenyl benzoate and 15/16 of those to isoeugenyl phenylacetate but in none of those 6 positive to isoeugenyl methyl ether and in neither of those 2 positive to benzyl isoeugenyl ether. Concomitant contact allergy between isoeugenol and its derivatives may occur through chemical cross-reactivity or local skin metabolism of the derivatives. It is more commonly observed with the esters rather than the ethers. Isoeugenyl acetate has been proposed as an alternative to isoeugenol, but there is a high degree of concomitant reactivity with isoeugenol.
Allergens↗