Enantiospecificity in allergic contact dermatitis. A review and new results in Frullania-sensitive patients

Allergic contact dermatitis is essentially enantiospecific: sensitization to one enantiomer generally does not imply elicitation to the mirror-image allergens. Examples from patients allergic to Frullania, and from the literature (usnic acids, 4-methoxydalbergiones, gamma-methyl-alpha-methylene-gamma-butyrolactones, frullanolides) are discussed.

An outbreak of contact dermatitis in farm workers

Fourteen of twenty-six migrant workers developed contact dermatitis at a single tomato-strawberry farm in Tennessee. Investigation identified one of eleven pesticides used by the farmer, 2,4-dichloro-6-(o-chloroanilino)-s-triazine anilazine; Dyrene), as the cause of the dermatitis in six of seven workers who were available for patch testing. As a result of this investigation, the label on Dyrene has been revised to warn users of possible sensitization.

The action spectrum for benzanthrone photosensitization of mouse macrophages

An in vitro method for determination of the phototoxic action spectrum of benzanthrone was established using a cover slip-test tube culture system with mouse peritoneal macrophages. The action spectrum peaked between 380 and 400 nm with abrupt fall-off to either side. These findings correlate closely with both the absorption spectrum of benzanthrone and the clinical action spectrum of phototoxicity in humans.

The phototoxic and allergenic potential of EDS liquids

Liquid fuels derived by direct coal liquefaction may be similar in boiling range and chemical composition to coal tar products. In the past, phototoxicity, an occupational skin disorder, has been associated with coal distillation. Consequently, the phototoxic properties of 5 materials representing the full boiling range of liquids derived from the EDS process were characterized utilizing a guinea pig model. Results with low boiling, coal derived liquids (less than 200 degrees C) were not different from unirradiated controls; however, liquids boiling above 200 degrees C induced phototoxic effects. These results suggest that high boiling EDS liquids may possess phototoxic potential. Differences in the phototoxic activities of liquids of similar boiling range may be related to chemical composition. A study of the allergenic potential of the EDS liquids described above was conducted utilizing the guinea pig maximization test. None of the test materials produced positive responses, suggesting that EDS liquids are low in allergenic potential.

Allergic contact dermatitis from povidone-iodine

A patient developed an erythematous papular, vesicular rash after application of povidone-iodine 10% solution used as a surgical antiseptic. Patch testing revealed positive responses to povidone iodine 10 and 5% in water; 25 controls were negative. Patch testing with iodine, 0.5% in ethanol gave negative results.

Skin contact with gold and gold alloys

3 types of reaction to gold merit discussion. First, there is the effect known as black dermographism, in which stroking with certain metals immediately produces well-defined black lines on the skin. Some gold alloys are amongst such metals. The evidence indicates that the effect is the result of impregnation of the skin with black metallic particles generated by mechanical abrasion of the metal by contaminants of the skin. There is no positive and unequivocal evidence of the ability of metals to mark uncontaminated skin so rapidly that it is possible to write upon it. Secondly there are the 2 related phenomena of the wear of gold jewelry, and the susceptibility to certain individuals to blackening of the skin where it is in contact with such jewelry. The occurrence of smudge, as it is often called, is not very common, but is brought to the attention of most jewelers from time to time. In extreme cases it may make it embarrassing for the person concerned to wear metallic jewelry. It would appear as if gold smudge also results mainly from mechanical abrasion of jewelry, though this may be aided and/or supplemented in some instances by corrosion of gold or gold alloy induced by certain components of the sweat. Finally, there is the question of true allergic responses to contact of the skin with gold and its alloys. Judging from the very few cases which have been recorded, such responses are extremely rare. Some recent observations on the reactions of metallic gold with amino acids and of reaction to contact of the skin with gold on the part of rheumatoid arthritis patients undergoing gold therapy, are, however, relevant in this connection.

Contact dermatitis to yellow iron oxide

After epicutaneous patch testing, a 43-year-old non-atopic white female with eyelid dermatitis was found to be allergic to yellow iron oxide used as a dye in her mascara. Yellow iron oxide, also known as limonite or yellow ochre, is a common cosmetic dye which has not previously been described as a source of contact dermatitis. Formulation of mascara as well as classification of naturally occurring iron oxides are discussed.

Contact sensitivity to chlorhexidine?

In a joint study, 2061 patients (1346 women and 715 men) were patch tested with chlorhexidine gluconate 1% in water, included in a standard test series. 48 patients (2.3%) showed a positive reaction. These were relatively more common in men (3.2%) than in women (1.9%). Positive reactions were most common in patients with leg eczema (6.8%) or leg ulcer (10.9%). Of the 48 patients who were patch test positive, 14 (2 with leg ulcer) were retested with chlorhexidine gluconate 0.01 and 1%. Only one with a leg ulcer was positive. These findings indicate that false positive reactions, known as "the excited skin syndrome", may arise from testing eczema patients in a standard series. The sensitizing potential of chlorhexidine may be very low, but the potential in patients with an eczema or ulcer of the leg has to be further evaluated.

Contact allergy to components in topical ophthalmologic preparations

Contact allergy to various components of topical ophthalmological preparations was tested in 27 patients suffering from prolonged or chronic conjunctivitis, keratoconjunctivitis or blepharoconjunctivitis. Our results reveal relevant allergy towards ophthalmological preparations in 44.4% of patients tested. Allergic reactions to topical antibiotics, especially to neomycin (18.5%) and bacitracin (7.4%) was encountered as well as allergy to preservatives such as benzalconium chloride (3.7%). It is essential to bear in mind that contact allergy to components of topical preparations may cause complications and prolongation of symptoms during treatment, and therefore the importance of performing patch tests in prolonged cases of conjunctivitis or keratoconjunctivitis is stressed.

Impaired immune function in patients with xeroderma pigmentosum

The development of contact allergy in sun-exposed skin is markedly impaired in patients with xeroderma pigmentosum as compared to the responses in healthy control subjects. The degree of this immunological impairment is directly related to the severity of the cutaneous disease. These findings raise the possibility that sunlight-induced alterations of immune function may be involved in the marked susceptibility of these patients to the development of nonmelanoma skin cancer.

When is a chrysanthemum dermatitis not a chrysanthemum dermatitis? The case for describing florists' chrysanthemums as Dendranthema cultivars

In order to provide a new reference point in the dermatological literature from which the naming of florists' chrysanthemums may be regularised and standardised, the case is presented for the use of the generic name Dendranthema together with a cultivar name in place of a specific epithet. A review of cultivar specificity in chrysanthemum dermatitis is also presented.

Mechanism of anthralin inflammation. I. Dissociation of response to clobetasol and indomethacin

The effect of topical clobetasol propionate and a 1% topical indomethacin gel which could inhibit UV erythema was measured on anthralin inflammation by change in skin-fold thickness and erythema. The time course of the inflammatory oedema and erythema were different, as was their response to the drugs studied. The oedema of anthralin inflammation was completely inhibited by clobetasol propionate but the erythemal response showed a small and non-significant reduction. Indomethacin had no effect on anthralin oedema but produced a small but significant reduction in erythema in the first 24 h after anthralin application. These results suggest that either anthralin inflammation is not due to production of prostenoids, or that if it is, it occurs by other than the classical enzymic pathway.

[Allergic contact dermatitis caused by garlic, Primula, Frullania and Compositae]

As a complementary study to a previous work (14) in which we examined 43 cases of contact dermatitis to plants, we have taken a closer look at the provocative cases which made up 76% of that study - Allium (garlic) (11 cases), Primula (8), Frullania (8) and Compositae (6). The clinical methodology, preparation of extracts and execution of the skin tests were identical to those described in the previous study (14). Patients with sensitivity to Frullania and Compositae were submitted to standard skin tests as shown in table II. These patients were also tested with a 0.1% preparation of Helenin in vaseline. The eleven cases of sensitization to Allium sativum L (garlic) corresponded to women whose primary or secondary profession was that of a housewife. In each case, the reaction was in the form of pulpitis, typically affecting the thumbs, left middle and index fingers and right thumb, which are those that have the greatest contact with the garlic bulb. Primula obconica Hance was responsible for the sensitization of 7 women and 1 man. In two of the patients, the positive test result was unrelated to the clinical picture for which the patients sought medical attention. In one of the two cases, the patient had had prolonged, previous contact with Primula but without reaction. In the other case, the origin of the reaction could not be established. The contact dermatitis produced by Primula are located principally in the face and hands.(ABSTRACT TRUNCATED AT 250 WORDS)

Photosensitivity due to drugs

Photosensitivity reactions induced by drugs may be phototoxic or photoallergic in nature. Acute phototoxic reactions are by far the more common, and are generally characterised by erythema and oedema followed by hyperpigmentation and desquamation. Chronic repeated injury of this type may result in fragility, blistering and milia formation or even actinic keratoses and skin cancers. The photochemical mechanisms involved differ with the chemical photosensitiser involved. They include photoaddition of the chemical to biological targets such as DNA, the formation of toxic products due to absorption of the action spectrum by the photosensitising molecule, or the activation of toxic oxygen species or free radicals. Subsequent activation of the complement pathways may participate in the photoresponse to certain agents. Photoallergic reactions are uncommon. They represent an acquired altered reactivity dependent on a circulating antibody or a cell-mediated hypersensitivity process. Clinically, they are characterised by an immediate wheal and flare or a delayed papular to eczematous process. Some of the same drugs which cause phototoxic responses occasionally produce photoallergic reactions.

[Airborne contact dermatitis]

Two elderly individuals suffering from acute recurrent dermatitis of light-exposed skin between spring and autumn were shown to be allergic to feverfew (Tanacetum parthenium) of the Compositae family. Patch tests revealed not only strong reactions to the plant and its constituent parthenolide but also a number of cross-reactions to related species. The source of this contact allergy was dried airborne plant particles that attached themselves to the skin during long periods outdoors. Differentiation between patterns of airborne contact dermatitis and persistent light reaction is possible by several distinct observations, i.e., in patients with airborne contact dermatitis: a) Patch tests with Compositae plant extracts and constituents will be positive. b) There will be no skin lesions in winter. c) Skin regions that are usually not impaired during light exposure will also be involved: the upper eyelids, the retroauricular region, the shady area beneath the chin.

Acute allergic contact dermatitis from diazolidinyl urea (Germall II) in a hair gel

Diazolidinyl urea (Germall II) is a preservative recently used in cosmetics. It is effective against most contaminating microorganisms, especially Pseudomonas. We report the first case of an acute allergic contact dermatitis from diazolidinyl urea that was contained in a hair gel.