Pachydermoperiostosis with new clinical and endocrinologic manifestations.
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Photocontact dermatitis is not a common condition, but neither is it rare. Both photo-irritant contact dermatitis (PICD) and photoallergic contact dermatitis (PACD) are seen by most dermatologists in general practice. PICD is diagnosed on clinical grounds and is usually caused by furocoumarins in plants like limes and celery. PACD is caused primarily by sunscreens but can also be the result of fragrances and antibacterial agents. PACD can only be diagnosed by photo-patch testing that most dermatologists, even those who patch test and give phototherapy in their office, do not perform. The procedure as outlined in this manuscript is relatively simple and can easily be accomplished in the dermatologist's office.
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Within DSM Chemicals BV, a producer of acrylonitrile, skin complaints are frequent. The majority of these are of an irritant nature, while a smaller portion is based on acquired allergies. Allergological examination revealed 5 employees with an allergy to acrylonitrile. 1 of these subjects also developed paraesthesiae in the skin sites affected, a finding not previously described for acrylonitrile. In the guinea pig maximization test (GPMT), acrylonitrile showed strong allergenic potential. For prevention and treatment of contact allergologic disorders, close cooperation between occupational health officer, dermatologist and toxicologist in chemical companies is recommended.
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Results of patch tests performed in 15,553 patients by 18 dermatological departments (members of the German Contact Dermatitis Research Group) and recorded by the Information Network of Departments of Dermatology (IVDK) were analysed by comparing recently defined reaction indices (RIs). The RIs studied were calculated from the numbers of allergic (a), questionable (q), and irritant (i) reactions (RI = (a-q-i/(a + q + i)), which were obtained using 13 European standard allergens. RIs were calculated for all patients and for separate subgroups defined by age, sex, history of atopic dermatitis, time of allergen exposure (1 versus 2 days), and time of patch test reading (2 or 3 days after allergen application). Higher RIs were consistently obtained when patch tests were applied for 1 day, as compared to 2 days. Readings at 3 days after allergen application resulted in higher RIs than readings after 2 days. In contrast, sex, age, and history of atopic dermatitis of patients were not found to have a consistent influence on the RIs. We suggest that reading after 3 days should be obligatory, and that allergen exposure for 1 day instead of 2 days might make patch test evaluation easier. These suggestions need to be substantiated by data on clinical relevance.
2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) is used in the production of cationic starch (CS) for the paper industry. It has been shown to be a sensitizer in guinea pigs, but cases of human sensitization are few. 4 workers were previously sensitized to the substance in a Finnish plant. This report describes 3 process men from another plant examined because of recurring dermatitis. 18 workers were involved in production, and had free access to all work sites. 3 process men, whose work involved drying the CS, had dermatitis, although they had only occasional contact with the cationizing chemical. 2 were already verified to be allergic to EPTMAC and had had variable dermatitis for 8-12 years. One had had dermatitis on his face for 1 year. Patch testing with a dilution series (1%, 0.5%, 0.2%, 0.1% pet.) confirmed their allergy to the cationizing chemical containing EPTMAC, but tests with CS were negative. In addition, 2 had contact allergy to Cl+ Me-isothiazolinone from contact with Kathon LX used as a slimicide in the process. In long-standing (years) recurrent dermatitis, re-examination of patients with verified exposure history and skin test is necessary. In line with our previous study, sampling the process materials, maintenance work and contamination of work sites and gloves caused sensitization. The results also confirm that EPTMAC is a strong human contact sensitizer. 0.2%-0.5% pure EPTMAC in pet. seems to be the optimal patch test concentration.
Exposure to formaldehyde is common from both consumer products and industry. The reliability of the patch test is essential for the diagnosis of formaldehyde allergy as it is difficult to suspect from the patient's history. The recommended formaldehyde patch test concentration has been reduced over the last decades from 4-5% to 2% and is currently 1%. The changes have not been based upon formal studies, but driven by an intention to reduce irritancy and false-positive results. The aim of the present study was prospectively to compare the outcome of simultaneous testing with formaldehyde 1% and 2% in consecutively patch-tested patients, with respect to frequency of positive patch test reactions, strength of patch test reactions to different formaldehyde test concentrations, irritancy and relevance. The study included 3734 consecutively patch tested patients. 121 gave a positive reaction to 1% and/or 2% formaldehyde in water. There was no statistically significant difference between 1 and 2% with respect to allergic reactions, but 2% gave significantly more irritant reactions. Doubtful, positive and follicular reactions at day (D) 2 frequently developed into true positive reactions at D 3 to 4. Reading at D 7 gave few additional positive cases compared to D 3/4. Problems related to relevance are discussed. Based on present knowledge, a 1% patch test concentration for formaldehyde is recommended.
A survey of occupational dermatoses, based on a questionnaire, clinical examination and patch testing, was carried out among present and former employees in a plant producing binders for glues and paints. The binders are chemically based on vinyl acetate and/or acrylates. Preservatives are needed and those based on methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) are the most commonly used. The questionnaire was answered by 83 out of 85 present employees (97.6%) and 12 out of 15 former employees (80.0%). 76 of the present (89.4%) and 11 of the former employees (73.3%), respectively, participated in the clinical examination and patch testing, which was conducted with a standard test series and chemicals from the work environment. Occupational dermatosis was diagnosed in 22 present workers (28.9%). Irritant and allergic contact dermatitis was demonstrated in 9 (11.8%) and 13 (17.1%) employees, respectively. Occupational contact allergy to acrylates and formaldehyde was detected in 3 workers and 1 worker, respectively. 12 individuals (9 present and 3 former production workers) had an occupational contact allergy to MCI/MI. 4 of the present workers had spilled Kathon LX on their skin resulting in chemical burns and allergic contact dermatitis. In total, the figure for occupational skin diseases among all present production workers was 40.4%.
An unusual cutaneous eruption of the feet and lower limbs induced by ultraviolet radiation in a 30-year-old caucasian man is presented. Previous reports in the literature and the present case indicate that sunlight and UV radiation may provoke fixed eruptions themselves without drug exposure.
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A 25-year-old man who survived carbon monoxide intoxication presented erythematous cutaneous lesions with blister formation in pressure areas. Histologic examination revealed subepidermal vesicles with extensive sweat gland necrosis. We discuss the clinicopathological findings of carbon monoxide poisoning. Similar cutaneous features have been observed in patients with various kinds of drug-induced coma.
A 58-year-old immunocompetent man presented with a 9-month history of several disseminated subcutaneous ulcerative nodules, fever and weight loss. Histopathological changes were not specific. X-ray of the chest disclosed a large right hilar density highly suggestive of a lung carcinoma. All these manifestations eventually proved to be caused by Mycobacterium tuberculosis, which grew from sputum and skin. We report this case because of its striking clinical features.
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