Contact allergy to oil of turpentine: a 10-year retrospective view. Contact Dermatitis Research Group in Comecon Countries.
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Biomedical subjects
Publications and source records attributed to L Nebenführer.
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In a previous paper, we reported on nickel sensitivity in 2400 consecutive patients in 5 countries. 3 years later, we reassessed 104 of the 157 nickel-positive patients of this former study and found 13 now to be negative to nickel sulphate. Nearly all the others can no longer tolerate nickel contact. 68 patients were free from nickel dermatitis, 16 showed a very mild eczema or dyshidrosis, and 13 were suffering from chronic hand dermatitis. 42 of 104 patients had changed their occupation, 36 successfully, with clearance of skin lesions. Rehabilitation by avoidance of nickel-containing costume jewelry, wrist-watches and clothing buckles, and by change of occupation, is possible and necessary.
In 2400 consecutive patients at 8 clinics in 5 countries, nickel hypersensitivity was found in 176 cases (7.3%), 19 male (2.1%) and 157 female (10.5%). The incidence ranged from 15 to 38 cases in 300 patients of every department (5.0% Sofia to 12.7% Erfurt). 60.6% of the nickel positives were schoolgirls or younger than 25 years. The exposure time was 3 years, in 49% 1 year or shorter. Most cases (75%) are not occupationally acquired, but due to costume jewelry (31.8%), wrist watches (23.3%), metal clothing buckles (3.4%) including jeans buttons. Job dependent nickel dermatitis is often (36/51 cases) linked with wet work. Atopic dermatitis was found in 8.3% of female nickel allergy. Nickel positivity without a dermatitis history was seen in 9/176 cases (5%). Nickel allergy will become a sex-indifferent phenomenon in Europe, because of the changing customs of adornment.
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Epicutaneous tests were performed 1979 using a standard test series of 31 substances on 436 hospitalized patients. The positive results were analysed for relevance and latency. Occupational and environmental origin of sensitization was looked for in both sexes. The order of allergens causing contact dermatitis in women was: Dichromate, phenylbutazone, cobalt (as concomitant allergy?), balsam of Peru, p-phenylene diamine, chloramphenicol, phenyl-isopropyl-p-phenylene diamine, N-phenyl-cyclohexyl-p-phenylene diamine (as concomitant allergy?), mercury amidochlorate, formaldehyde, mercury bichloride (as concomitant allergy?). In men the order of frequency was: dichromate, phenyl-isopropyl-p-phenylene diamine, N-phenyl-cyclohexyl-p-phenylene diamine (as concomitant allergy?), cobalt (as concomitant allergy?), p-phenylene diamine, chloramphenicol, formaldehyde, phenylbutazone, balsam of Peru, mercury amidochlorate, mercury bichloride (as concomitant allergy?). The mode and degree of exposure are important factors influencing the composition of the spectrum of allergens. It is essential to distinguish between relevant and latent sensitization primarily in occupational exposure when decisions concerning the patient's future occupation must be made.
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Examples of cross-, concomitant- and pseudo-cross allergies are discussed based on the results obtained in a series of patch tests made with 31 chemical allergens. Special attention is paid to the relevance of positivity. Para-group allergy is analysed as an example of cross-allergy. Analysis of various combinations of allergy to p-phenylene diamine and phenylisopropyl-p-phenylene diamine suggests that in addition to the classical cross-allergy, concomitant sensitization may also occur. Concomitant allergy to three metals (chromium, cobalt and nickel) is discussed. Concomitant sensitization to chromium and cobalt has been found to occur most frequently. Associated positivity to various aromatic balsam-like substances (balsam of Peru, turpentine, colophony, wood tar) has been interpreted as pseudo-cross-allergy.
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Between 1991 and 1993, 32 cases of fingernail mycosis and 20 cases of toenail mycosis caused by dermatophytes were treated with terbinafine. For 8 weeks, 250 mg of terbinafine was given daily for fingernail infections, and for 12 weeks the same dose was given for toenail involvement; the short-term follow-up was 24 and 48 weeks respectively. A long-term follow-up was performed twice, initially at 24 and then at 48 months after the end of the treatment. For fingernail mycosis, the mycological cure rate was 100% at the end of month 24 and 91% at the end of month 48. Mycological cultures gave negative results in toenail infections in 90% after 24 months and in 86% after 48 months. After 24 months, 23 out of 26 patients (88%) with fingernail and 17 out of 20 patients (95%) with toenail mycosis were clinically cured. After 48 months, 20 out of 22 cases (91%) with fingernail and 10 out of 14 cases (71%) with toenail involvement showed a complete cure.