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Pesticide patch test series for the assessment of allergic contact dermatitis among banana plantation workers in panama.

BACKGROUND: Irritant contact dermatitis and allergic contact dermatitis (ACD) are frequent among agricultural workers and require targeted interventions. Patch testing is necessary for differential diagnosis, but patch testing with pesticides is uncommon. OBJECTIVE: This study explores the frequency of ACD and sensitization to pesticides among highly exposed banana plantation workers. METHODS: Frequently and recently used pesticides on banana plantations in Divala, Panama, were documented. A pesticide patch test tray specific for this population was prepared. A structured interview was administered to 366 participants, followed by a complete skin examination. The pesticide patch test series, as well as a standard patch test series, was applied to 37 workers with dermatoses likely to be pesticide related and to 23 control workers without dermatoses. RESULTS: The pesticide patch tests identified 15 cases (41%) of ACD (20 positive reactions) among the 37 workers diagnosed with pesticide dermatosis. Three controls had allergic reactions to pesticides (4 positive reactions). The pesticides were carbaryl (5 cases), benomyl (4 cases), ethoprophos (3), chlorothalonil (2), imazalil (2), glyphosate (2), thiabendazole (2), chlorpyrifos (1), oxyfluorfen (1), propiconazole (1), and tridemorph (1). Ethoprophos and tridemorph had not been previously identified as sensitizers. Thus, the prevalence of ACD was 0.03 (15 of 366). On the basis of observed prevalences of positive patch-test reactions among the subgroups with and without dermatoses, we estimated that > or = 16% of the entire population may be sensitized to pesticides. CONCLUSION: Sensitization to pesticides among banana plantation workers is a frequent occupational health problem. Pesticide patch test trays should be used in assessing skin diseases in highly exposed workers.

Adolescent↗

Study of lymphocyte subpopulations in contact dermatitis by sensitization to chrome and/or nickel.

Contact dermatitis is a hyperergic reaction mediated predominantly by T lymphocytes in which the target tissue is the skin. In this way and taking as a starting point that contact dermatitis is a reaction typically mediated by T lymphocytes, our aim is to study the possible existence of an unbalance between the lymphocyte subpopulations OKT-4+ and OKT-8- (T mu and T gamma) in comparison to a normal population and if, on the other hand, any of these subpopulations are involved in the increase of lymphocytes that form E active rosettes. We can see that there are no significant variations with regard to the number and function of the lymphocyte populations in individuals with contact dermatitis when we compare them to a control group. On the other hand, we consider it very important to emphasize that we have failed to detect differences in the parameters of lymphocyte populations and subpopulations studied before and after contact with the causal antigen responsible for the cutaneous condition.

Chromium↗

Allergic contact dermatitis. When to suspect it and what to do.

Allergic contact dermatitis is a common problem that can affect persons of all ages and in any state of health. A high index of suspicion and careful follow-through with patch testing and investigative work are needed to establish the diagnosis. Recognition of sources of exposure to the allergen and of important cross-reacting substances is the key to prevention of recurrences.

Acetates↗

Histologic aspects of patch test reactions in allergic contact dermatitis.

Twenty subjects with allergic contact dermatitis were patch tested with the responsible allergen applied to four fixed points on the back. Skin biopsies of the four sites were obtained after 6, 12, 24 and 48 hours, fixed in neutral formalin and stained with hematoxylin-eosin, Giemsa and toluidine blue. Sections were examined and lymphomonocytes, mast cells, eosinophils and basophils counted. In all cases the infiltrate consisted mainly of lymphomonocytes (80-82%); mast cells (5%) and basophils (0.2%) do not present clear variations within the given time. Eosinophils showed a definite numerical increase in six cases out of 20.

Adult↗

Cell populations in experimental contact dermatitis.

Sequential biopsy specimens from contact dermatitis induced in the guinea pig by the application of dinitrochlorobenzene were studied by histologic, histochemical, and electron microscopical methods. At 12 hours, mononuclear cells and polymorphonuclear cells reached their peak numbers. Increasing numbers of basophils were observed, and at 24 and 48 hours, the basophils reached their maximal numbers. The basophils were observed not only in the dermis but also in the epidermis, and they may have had an active role in inflammation or repair. A close relationship was noted between the macrophage and all of the successive cell populations in the dermis.

Animals↗

Occupational contact dermatitis II: risk assessment and prognosis.

Contact dermatitis is a common and important condition in the occupational setting. In a companion paper, I describe changes in the incidence of recorded occupational skin disease from 1972 to 1999. Despite substantial improvements in workplace hygiene, the incidence of occupational skin disease remains half of that recorded in 1972. In the companion paper, it is argued that a more sophisticated approach to prevention and management may be required to substantially reduce the burden of occupational skin disease further. In this paper, I address the present state of risk assessment (including components of hazard identification, measuring or estimating dermal exposure, percutaneous absorption, dose-response relationships, and risk characterization) and the poor prognosis of serious occupational contact dermatitis, with a view to potential improvements in practice and outcomes.

Dermatitis, Allergic Contact↗

[Occupationally-induced contact dermatitis and bronchial asthma in a unusual delayed reaction to hydroxychloroquine].

We report the case of a a 60 year-old worker in the pharmaceutical industry who suffered from recurring contact dermatitis. Initially the contact dermatitis was limited to the hands; later on it became generalized. The patient had been working on a drug filling line in a pharmaceutical plant for more than 20 years. Eight years after starting this job he had developed allergic hand dermatitis to 2,6-diaminopyridine (patch test positive); this healed upon cessation of exposure. Ten years later he again developed hand dermatitis which progressed to generalized dermatitis and conjunctivitis. Under systemic and local therapy with corticosteroids and cessation of work, it healed nearly completely. Four months after returning to work, the patient experienced a first episode of severe asthma and generalized dermatitis with conjunctivitis following exposure to hydroxychloroquine the day before. The asthma and dermatitis improved after systemic corticosteroid therapy and stopping work. His condition continued to fluctuate, when though the patient was transferred at work and now wore rubber gloves. Eight months later he again developed a generalized dermatitis. Patch testing revealed delayed-type sensitizations to hydroxychloroquine (tested in concentrations of 0. 1%, 0.5%, 1% and 2%). Equivalent tests in five healthy volunteers were negative. The patch test reactions were pustular, while a biopsy was interpreted as a multiform contact dermatitis reaction. Bronchial exposure with hydroxychloroquine dust produced a delayed bronchial obstruction over the next 20 hours, which progressed to fever and generalized erythema (hematogenous contact dermatitis). After removing exposure to 2,6-diaminopyridine and hydroxychloroquine, the patient went on to develop a contact dermatitis to latex (patch test positive). However, skin prick tests with latex and patch tests with rubber additiva were negative. Hydroxychloroquine is well known to cause drug reactions. To our knowledge, contact dermatitis to this substance has not yet been reported. It is noteworthy that the patch test reactions were pustular and of multiform morphology and that bronchial exposure to the allergen resulted in asthma and a generalized drug reaction. Pathogenetically the asthmatic reaction seems to be on a delayed-type mechanism as is also seen with ampicillin, cobalt and nickel induced asthma.

Asthma↗

Contact dermatitis to methyl methacrylate.

2 cases of contact dermatitis to methyl methacrylate monomer are presented. The patients are nurses who mixed bone cement at orthopedic operations. During the procedure, they used 2 pairs of gloves (latex). Butyl rubber gloves are recommended for methyl methacrylate monomer to avoid sensitization and/or cumulative irritant contact dermatitis on the hands.

Adult↗

Contact dermatitis from propolis.

Two patients with contact dermatitis due to the natural product propolis (bee glue) are reported. They presented perioral eczema and stomatitis which were recalcitrant until propolis was considered as the cause. Patch tests with propolis preparations were positive in both patients, and, furthermore, in the second patient the lesions relapsed after provocation tests. European standard patch test including balsam of Peru were negative. The complexity of propolis, its supposed anti-inflammatory effect due to flavonoids, and the sensitizing agents originating mainly from the poplar trees are discussed together with the cross-sensitization to balsam of Peru. Contact dermatitis due to propolis should be considered in unexplained eczemas, mainly perioral but also in other areas, as propolis preparations are available also as ointments and cosmetic creams.

Aged↗

Contact dermatitis: prognosis, risk factors, and rehabilitation.

This article reviews the prognosis for irritant and allergic contact dermatitis and occupational and nonoccupational contact dermatitis. Factors adversely affecting prognosis are discussed. Rehabilitation of the patient with disabling contact dermatitis is considered. The importance of the various risk factors for contact dermatitis are reviewed.

Dermatitis, Contact↗

Allergic contact dermatitis in children: strategies of prevention and risk management.

Over recent years, allergic contact dermatitis in children has repeatedly been reported as a significant clinical problem. It is generally accepted that allergic contact dermatitis is rare in the first years of life, and with increasing age (by the age of 10 years) reaches the incidence seen in adults. As in adults, metals are one of the most common sensitizers in children, along with rubber chemicals and fragrances. The influence of fashion trends and lifestyle such as piercing, decorative skin paintings, the hype of natural remedies and cosmetics (e.g. tea tree oil) or the use of cosmetical products with fragrances or herbal ingredients play an important role in developing allergic contact dermatitis. This review aims to give an overview on allergic contact dermatitis in childhood by focussing on strategies for prevention, potential risk factors and recommendations for parents as well as for physicians. By reporting typical cases of our outpatients clinic we point out several characteristics of allergic contact dermatitis. Prevention of allergic contact dermatitis in children is a current problem of interdisciplinary concern not only for dermatologists and paediatricians, but also for midwives. Frequently, children are already exposed at an early age to well-known allergens, and therefore, strategies of avoidance have to gain or regain importance and should start as early as possible.

Child↗

Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva.

Irritant and allergic contact dermatitis are commonly seen in patients complaining about itching, burning and irritation in the vulvar area. Irritation often precedes allergic sensitization. Clinically, irritant and allergic contact dermatitis can be difficult to distinguish. Diagnosis is made by history, clinical investigation and patch testing. Recommended patch test series are the standard series, a medicament series, the patient's own topical medicaments, popular remedies and other suspected products. A skin biopsy may be useful to establish the diagnosis of contact dermatitis, but it is usually not helpful for the differential diagnosis between irritant and allergic dermatitis.

Allergens↗

Occupational epoxy resin allergic contact dermatitis.

Sixteen cases of occupational contact dermatitis to epoxy resins were seen over a 5-year period. All were men. Six cases worked in the construction industry, two worked as painters, two as engineers, two as car windscreen repairers, and one each worked in a timber yard, a car yard, on a farm and as a cane-furniture salesman. Most presented with rashes on their faces (56%), hands (50%) or arms (37%). Two patients were allergic to the reactive diluent phenyl glycidyl ether, and one was allergic to the epoxy hardener isophorone diamine. The rest were allergic to the epoxy resin itself. Outcome in this series was poor because most continued to be exposed to epoxy resins in their workplace environment.

Adolescent↗

Occupational allergic contact dermatitis from mercury.

Occupational allergic contact dermatitis from metallic mercury is rare. Here we present the only 2 patients with relevant occupational mercury allergy detected at our clinic since 1974. The first patient was a dental nurse who became sensitized to metallic mercury from amalgam when handling uncured amalgam without protective gloves. The second patient had previously been sensitized to mercury from topical medicaments and developed work-related dermatitis when a mercury thermometer was broken at her place of work. Both patients had a positive patch test reaction to metallic mercury.

Adult↗

A comparative study of allergic and primary irritant contact dermatitis with dinitrochlorobenzene (DNCB) in dogs.

Attempts were made to induce allergic contact dermatitis in dogs, a species generally considered poorly responsive to experimental allergic contact dermatitis. Yound Beagles were sensitized to 2,4 dinitrochlorobenzene (DNCB) by multiple intradermal injections. Two weeks after sensitization, these dogs were challenged topically with 0.1% DNCB by a standard closed-patch technique. Sensitization evidenced by various degrees of reaction following challenge was established in all of 14 pups used, while 7 nonsensitized control pups did not react to challenge. Primary irritant contact dermatitis was induced in the skin of nonsensitized Beagle pups by 1%, 5%, and 10% solutions of DNCB. In allergic contact dermatitis the sites of challenge were grossly indurated, erythematous, and edematous. Histologically at these sites there was an infiltration of mononuclear cells which reached maximum intensity at 3 to 4 days. Accumulations of lymphoid cells were marked around sweat galnds and hair follicles. Penetration of leukocytes into these cutaneous adnexa was associated with degenerative processes in their cellular structures. Mononuclear cell infiltration into the epidermis was mild. Spongiosis was observed in the epidermis, but vesicle formation was rare. In primary irritant contact dermatitis gross lesions were characterized by severe erythema, edema, and gangreen of the skin. Microscopically, the main lesions were necrosis of the epidermal cells, separation of the epidermis from the dermis, dermal edema, and massive infiltration of the dermis with polymorphonuclear cells.

Administration, Topical↗