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Allergic contact dermatitis to Plectranthus amboinicus masquerading as chronic leg ulcer.

This report discusses a case of a 69-year-old woman who developed chronic non-healing leg ulcers after long-term topical use of Plectranthus amboinicus. The ulcer was proven to be allergic contact dermatitis to P. amboinicus by a patch test. The ulcer healed after discontinuation of P. amboinicus. To the best of our knowledge, this is the first reported case of allergic contact dermatitis to P. amboinicus masquerading as chronic leg ulcer.

Administration, Topical↗

Great cases from the University of Pennsylvania.

New skin diseases are reported yearly. Some well-known conditions may develop unusual manifestations. Other cutaneous findings are simply rare. While patients with such diseases represent only a small fraction of our practice they are an important subset of our experience. Many of these diseases are treatable, pinpoint the discovery of internal disease, or simply allow for a diagnosis and prognosis to be given to a concerned patient who had previously escaped classification. Such cases expand our knowledge and provide excitement to our day. Several patients from whom I have learned the most in the last few years are detailed for your enjoyment.

Alopecia↗

Livedoid vasculopathy: long-term follow-up results following hyperbaric oxygen therapy.

BACKGROUND: Livedoid vasculopathy, also known as atrophie blanche, is a recurrent painful vasculopathy appearing mostly on the lower limbs. Treatment is challenging and relapses are frequent. OBJECTIVES: To analyse the long-term effect and safety of hyperbaric oxygen (HBO) therapy in treating livedoid vasculopathy. METHODS: Twelve patients with active livedoid vasculopathy were included in this study. All patients underwent HBO therapy five times a week. Each week photographs were taken and the total dose of analgesics was recorded. Side-effects were documented and assessed. Recurrence was defined as the presence of skin ulceration. RESULTS: Of the eight patients who completed the treatment, resumption of ambulation and reduction of analgesics were achieved at an average of 4.9 HBO therapy sessions. Leg ulcers in all eight patients healed completely at a mean of 3.4 weeks (range 2-5 weeks). Six patients suffered relapses of ulceration and responded to additional HBO therapy. No significant side-effects were found. CONCLUSIONS: HBO is a relatively safe, fast and effective method to treat patients with livedoid vasculopathy.

Adolescent↗

Linear scleroderma with severe leg deformity.

Linear scleroderma is an unusual form of localised scleroderma, mainly affecting the legs and occurring primarily in children. Sometimes the linear lesions may extend to involve the underlying muscles and bones, with severe disturbances in growth and possibly flexion deformities of the legs. In this study, two cases suffering from linear scleroderma of the legs are presented.

Adolescent↗

Pretibial myxoedema presenting as a scar infiltrate.

A 41-year-old man developed pretibial myxoedema localized to scars following treatment for hyperthyroidism. Pre-existing scars on both lower legs, present for more than 20 years, were infiltrated with firm and nonpitting nodules and plaques over his shins. The clinical presentation of this patient highlights pretibial myxoedema as a cause of scar infiltration. The pathogenesis of pretibial myxoedema is reviewed.

Adult↗

Contact dermatitis in patients with leg ulcers.

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.

Dermatitis, Allergic Contact↗

Allergy to various components of topical preparations in stasis dermatitis and leg ulcer.

Patients suffering from stasis dermatitis and leg ulcers (192) were found to give an allergic reaction in epicutaneous tests to one or more components of topical preparations in 69.2% of cases. The most common reactions were obtained with neomycin 34.0% and its component framycetin 31.2%, wool alcohols 22.9%, balsam of Peru 21.4%, chlorquinaldon 16.7%, bacitracin 13.1%, chinoform 10.9%, dequalin 9.9%, formaldehyde 4.2% and parabens 3.6%. The incidence of allergic reactions reflects local use of preparations containing various allergens as well as their capacity to produce alllergy. Allergy may in some cases interfere with effective topical therapy. Debrisan dextran polymer beads were found to be suitable for treatment of ulcers of multiallergic patients without risk of contact allergy.

Administration, Topical↗

Allergic contact dermatitis from eosin.

Before 1960, eosin sensitivity was not rare and lipstick cheilitis was very common. We report 4 patients seen in 1988 and 1989 who were sensitized to eosin from topical bacteriostatic preparations. All 4 patients had positive patch tests to eosin. The allergen is probably an impurity rather than eosin itself.

Adult↗

Chlorhexidine gluconate and acetate in patch testing.

Patch testing to chlorhexidine is usually performed with chlorhexidine gluconate aq. We report the results of 297 patients, almost all with leg ulcers, concomitantly tested with chlorhexidine acetate 1% aq. and chlorhexidine gluconate 1% aq. 39 patients had positive reactions to one of these compounds or to both. 36 positive reactions to the acetate were found, in contrast to 18 reactions to the gluconate. The reactions were considered relevant in 22 of 39 patients, since these patients had developed an eczema in an area where a chlorhexidine compound was used, and discontinuing the chlorhexidine compound resulted in improvement of the condition. In 10 of these 22 patients, the diagnosis would have been missed if the gluconate only had been used for testing, while the acetate failed to diagnose 2 patients. In 109 patients without leg ulcers, inconclusive patch test readings (i.e., irritant reactions or weak positive reactions) were found in 17% with chlorhexidine acetate 1% aq., compared to 5% with chlorhexidine gluconate 1% aq., indicating a high degree of irritant potential of the acetate 1% aq. We consider that some positive reactions are lost if chlorhexidine gluconate 1% aq. only is used for patch testing, but that chlorhexidine acetate 1% aq., on the other hand, is an unacceptably strong irritant. We therefore suggest that further testing with chlorhexidine acetate 1 and 0.5% aq. should be performed, in parallel with chlorhexidine gluconate 1% aq., in order to establish appropriate test concentrations. We find that up to 13% of the leg ulcer patients in this study may be sensitized to chlorhexidine, and we recommend that the indications for the drug in leg ulcer patients should be reconsidered.

Chlorhexidine↗

[Scurvy presenting with ecchymotic purpura and hemorrhagic ulcers of the lower limbs].

INTRODUCTION: The risk of vitamin C deficiency is underestimated in industrialized countries and is only disclosed in rare cases of severe scurvy. CASE REPORT: We report three cases of scurvy presenting with ecchymotic purpura and hemorrhagic ulcerations of the lower limbs. Vitamin C supplementation led to rapid improvement of the skin lesions. DISCUSSION: Clinical diagnosis of low-grade deficiency can be difficult. Biological diagnosis requires special care in sample taking and transport.

Aged↗