Biomedical subjects
Publications and source records attributed to P J Frosch.
Six months after the occurrence of pyoderma gangrenosum, subcorneal pustular dermatosis developed in a 60-year-old woman. The patient's serum was found to contain an IgA-lambda paraprotein. Although similar cases have been reported, this case is unique in that a distinct episode of pyoderma gangrenosum was followed by subcorneal pustular dermatosis.
The frequency of positive reactions to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI) were studied at 22 European contact dermatitis clinics over a period of 1 year. A total of 4713 patients participated. All the patients were patch tested with nickel sulphate, formaldehyde, paraben-mix, and MCI/MI. 19.4% of the patients had positive patch tests to nickel, making this the most common allergen. 3% of the patients reacted to 100 ppm MCI/MI, while 2.6% reacted to formaldehyde and 1.1% to parabens. There was great variation in the frequency of MCI/MI sensitivity among the 22 centres. MCI/MI contact allergy was most common among women and in patients with facial dermatitis, while it was rarely seen in patients with dermatitis on the lower legs. There were no fluctuations in the number of positive patch tests to MCI/MI on a monthly basis when the results from all centres were combined. 117 of the 141 MCI/MI sensitized patients included in the study were retested. 88% had positive patch tests when retested. 101 of the MCI/MI-sensitive patients participated in a double-blind, placebo-controlled product use test. This test showed that 31% of the MCI/MI-sensitive patients had a positive reaction to a MCI/MI-preserved product. Only a few patients reacted to a control product. It is concluded that the preservative MCI/MI is an important new contact allergen.
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Preservatives have come under fire due to their possible detrimental properties and the high rate of contact allergies some of them cause. Therefore, the pharmaceutical industry is searching for alternatives that will be effective, safe and economical. The present paper introduces a selection of new or revived biocides (Kathon CG, benzisothiazolinone, Euxyl K 400, Biobans, Grotans, Bronopol, Germall II), and the range of application and the sensitization potency of each are discussed. Test concentrations for patch tests are recommended. Kathon CG is the most commonly used preservative among these biocides, although it has a high sensitization potency and is a frequently encountered contact allergen. To make discovery of a new allergen easier and to reduce the risk of side effects, manufacturers should be required to specify the ingredients of their products on the labels.
We report on a single case of a lichen planus like contact dermatitis caused by colour developers. We emphasize similarities to lichen planus with regard to clinical, histopathological and immunohistological aspects.
In this report on a young female patient with hyalinosis cutis et mucosae (Urbach-Wiethe disease, lipoid proteinosis), we present the clinical, immunological and ultrastructural features of this inherited disorder and discuss the differential diagnosis against other interstitial connective tissue depositions. Immunologically, the most important result was the increased amount of collagen type IV at the junction zones of epidermis, dermal vessels and appendages. This was in accordance with the ultrastructural deposition of hyalin material, mainly consisting of multiplied basal laminae at the respective junction zones. The pathogenesis (gene defect or defective gene regulation?) and therapy are discussed.
A total of 8149 patients were patch tested with the preservative Bronopol in 7 European contact clinics. The majority of patients (6507) were investigated in London. Reactivity was low, with a total of 10 irritant (0.12%) and 38 allergic reactions (0.47%). In only 17 cases (0.21%) was the patch test reaction to Bronopol considered to be of current or past clinical relevance. Concomitant sensitization to formaldehyde was present in about 1/3 of patients. Based on these figures, the present sensitization rate to Bronopol in Europe seems to be quite low, which may be related to its less frequent use as a preservative in cosmetics and medicaments in comparison to parabens or isothiazolinones.
Panel 2 of the standardized, ready-to-apply patch test, the TRUE Test, has been evaluated on 808 patients with suspected contact dermatitis. The patients were tested with 11 different allergens and the negative control, and compared with corresponding allergens in pet. (or aq.) in Finn Chambers fixed with Scanpor. The TRUE Test, Panel 2 and the control were applied symmetrically on the upper back. Left/right application of the respective test varied at random. Most tests were removed after 48 h and evaluated after 72 or 96 h, according to generally accepted recommendations. There were positive test reactions to all 11 allergens tested in the patient group. The concordance of positive reactions (1+, 2+, 3+) was 63% between TRUE Test, Panel 2 and the control method; 17% of positive reactions occurred only with TRUE Test, Panel 2 and 20% only with the compared method. Approximately 75% of all positive test reactions were explained by the patients' present or past history. Irritant/questionable reactions occurred in the same frequency for the 2 methods. Such reactions were recorded in less than 1% of all patches applied. No late reactions were recorded.
6278 patients were patch tested with a sesquiterpene lactone mix (SL-mix) in 10 European clinics. 4011 patients were tested only with 0.1% SL-mix, 63 (approximately 1.5%) of whom were positive, with 26 (41%) of these cases being considered clinically relevant. There were no cases of active sensitization, though 5 cases of irritation were reported. 22 irritant reactions and 22 cases of active sensitization occurred when testing also with 1% and 0.33% concentrations of SL-mix. SL-mix 0.1% pet. is shown to be an important patch test and many relevant sensitizations will be missed without routine screening with such a mix. Most patients with SL-mix sensitivity presented with hand and/or face dermatitis, apparent photodermatitis or more generalised eczema.
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A 59-year-old female patient who developed fever, headache, arthralgia and painful, raised red cutaneous plaques located predominantly on the upper trunk is presented. On the basis of the clinical and histological findings acute febrile neutrophilic dermatosis (Sweet's syndrome) was diagnosed. In affected skin we applied immunohistochemical methods to examine the topographical organization of neutrophil-associated proteinase/proteinase inhibitor systems, i.e. the PMN-elastase/alpha 1-proteinase inhibitor and the cathepsin G/alpha 1-antichymotrypsin systems. Cathepsin G, PMN-elastase and alpha 1-antichymotrypsin were found in association with the polymorphonuclear infiltrating cells, whereas alpha 1-proteinase inhibitor was localized exclusively in the subepidermal oedema. In conclusion, our immunohistological findings support the view that free PMN-elastase is involved in the pathogenesis of cutaneous lesions in Sweet's syndrome.
The authors describe a case in which contact allergy to propylene glycol would have been missed if a concentration higher than 10 per cent in water had not been used for patch testing. They suggest raising the patch-test concentration to at least 20 per cent and using 50 or even 100 per cent in doubtful cases, although cautioning that further experience with larger numbers of patients is necessary.
In order to clarify the effect of retinoids on wound healing, diabetic rats were treated with oral acitretin or isotretinoin at 1 mg/kg for 5 days prior to the setting of deep punch biopsies, 6 mm in diameter, and for 14 days thereafter. Wound care was done with either a dry or a wet dressing. Wound surface area and transepidermal water loss were measured twice weekly at the time of the change of dressings. Statistically significant increases of both test parameters were noted after 1 week in retinoid-treated animals, but only with dry dressings. No excessive granulation tissue was observed at any time. The data suggest that under certain unfavorable circumstances, problems in wound healing may arise under retinoid treatment.
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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.
Three women with a photoallergic dermatitis precipitated by benzydamine are reported. In one patient the cause of the photosensitization was a cream containing benzydamine (Tantum cream), whereas in the other two the reaction occurred after oral administration (Tantum drops). In all three cases the photosensitization was confirmed by a photopatch test that was positive for the active ingredient benzydamine.
43 patients with suspected adverse reactions to ophthalmic medicaments were tested using three different methods: normal patch test on back skin (ENH), patch test on stripped back skin (HSA) and on scarified skin of the forearm (SKT). The ENH was positive in only 9 patients (20.0%) with one of the used preparations whereas on stripped skin positive reactions were observed in another 14 patients (32.6%). The SKT was solely positive in 10 patients (23.7%). Clinical relevance of these test results has been ascertained in most cases. However, reactions on stripped skin as well as on scarified skin may be false positive. The antibiotics neomycin and gentamicin were the major allergens (13.9% and 9.3%). Some ophthalmic medicaments produced rather severe irritant reactions on scarified skin, confirmed by a positive conjunctival exposure test. In order to detect weak sensitizations or cumulative irritant reactions in patients with long term use of eye medicaments, the application of a method with increased sensitivity such as the patch test on stripped skin or the scarification technique is recommended.