Dermatoses among housekeeping personnel

BACKGROUND

Housekeepers are exposed to irritants and allergens in their work and are at significant risk for developing occupationally induced contact dermatitis.

OBJECTIVE

We studied housekeepers at the Hershey Medical Center to determine the cause and frequency of contact dermatitis and contact urticaria in these workers.

METHODS

All housekeepers were examined. Those with hand dermatitis had an extensive history, patch testing, and latex RAST testing.

RESULTS

Eight of 130 had hand dermatitis. None had a relevant positive patch test or positive RAST test.

CONCLUSIONS

Of our housekeepers, 6.2% had occupationally induced irritant contact dermatitis. None had allergic contact dermatitis or contact urticaria to latex.

Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite

BACKGROUND

Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America.

OBJECTIVE

We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis.

METHODS

A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed.

RESULTS

Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion.

CONCLUSION

Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.

Epidemiology of hand dermatitis in dental personnel

BACKGROUND

Dental personnel are prone to frequent bouts of hand dermatitis. This has been attributed to hand washing, occupational exposure to a multitude of possible sensitizers, and frequent latex glove use. There has been some conflict in the literature as to the true frequency of allergic contact dermatitis in dental personnel.

OBJECTIVE

The purpose of this investigation was to quantify the frequency of allergic contact dermatitis and contact urticaria in a large group of Air Force dental personnel.

METHODS

Four hundred forty-nine dental personnel were surveyed for hand dermatitis. Positive responders were interviewed and examined. Patients with histories most consistent with allergic contact dermatitis were patch tested to a standard and a dental tray.

RESULTS

Of the 449 personnel completing our survey, 169 had a positive history of hand dermatitis. One hundred twenty of these were interviewed and examined, of which 27 patients gave a history most consistent with allergic contact dermatitis and were subjected to patch testing. Only 3 patients had relevant positive reactions to the allergens on the standard or dental trays. All others (93) were diagnosed with irritant contact dermatitis. None had contact urticaria to latex.

CONCLUSION

The frequency of hand dermatitis in our dental personnel is consistent with that in other published studies (37.6%). The majority of hand dermatitis occurring in this group is due to irritant contact dermatitis; the frequency of allergic contact dermatitis is very low (0.67%). None had contact urticaria.

Designing a biological monitoring program to assess community exposure to chromium: conclusions of an expert panel

The possible benefits of biological monitoring of large groups of people potentially exposed to environmental contaminants has become an area of much interest in recent years. Because chromite-ore processing residue has been found in some soils in northern New Jersey, urinary chromium monitoring of people in the community was evaluated as a potentially useful tool. In an attempt to identify those who could be exposed and to quantify the magnitude of exposure to the chromium in these soils, the New Jersey Department of Health (NJDOH) initiated a public health screening project. In 1992, the NJDOH proposed to evaluate over 4000 people who lived or worked near these sites. Volunteers were administered a questionnaire and were given a limited physical examination, and a single spot urine sample was collected. Because of the difficulties in using urinary chromium to assess low-level exposure and the potential implications of any regulatory decisions that could be based on the results of this project, a panel of experts was convened to evaluate the protocol. The panel consisted of five scientists and physicians with expertise in toxicology, dermatology, epidemiology, biological monitoring, and analytical chemistry. Like a World Health Organization group, the panel concluded that although urine biomonitoring can be useful in evaluating high levels of exposure to chromium, it is not reliable for assessing low-level exposure similar to that which may have occurred in northern New Jersey. The panel also noted that when urinary biomonitoring is to be used to assess the public's possible exposure, a large number of precautions must be taken to ensure the accuracy and usefulness of the results. The single most important recommendation was to collect a second, and perhaps a third, spot urine (or 24-h urine) sample before concluding that a person may be routinely overexposed. These suggestions are applicable to designing a biomonitoring program for nearly any environmental contaminant to which a community may be exposed. A review of scientific literature associated with biological monitoring of chromium is provided.

A clinical and pathologic study of histiocytosis X in adults

BACKGROUND

Histiocytosis X is a neoplastic disorder of Langerhans cells that usually occurs in children. Because histiocytosis X rarely occurs in adults, the diagnosis can frequently be missed by both clinicians and pathologists.

OBJECTIVE

The purpose of this investigation was to characterize the clinical and pathologic findings of histiocytosis X in adults.

METHODS

A retrospective study of four adults with histiocytosis X was undertaken. Paraffin-embedded biopsy specimens were stained with a panel of antibodies including S-100, vimentin, Ham-56, leukocyte common antigen, proliferating cell nuclear antigen (PCNA), UCHL-1, CD43, and Ki-1.

RESULTS

The predominant lesions were papules and pustules that usually involved the groin, axilla, and scalp. Histologically the infiltrate exhibited a periappendageal distribution. Strong positive staining for PCNA appeared to correlate with the clinical course.

CONCLUSION

Histiocytosis X in adults has a predilection for skin sites rich in appendages and histologically shows a periappendageal infiltrate. PCNA staining of the histiocytes may indicate progressive disease and serve as a useful prognostic marker.

American Academy of Dermatology Patch Testing Survey: use and effectiveness of this procedure

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.

Frequency of postoperative allergic contact dermatitis to topical antibiotics

BACKGROUND AND DESIGN

Topical antibiotics are one of the most common causes of allergic contact dermatitis and are frequently used in postoperative wound care. We prospectively followed up patients having cutaneous surgery to determine the frequency of allergic contact dermatitis to topical antibiotics used on postoperative wound care.

RESULTS

Nine (4.2%) of 215 patients who had undergone surgery who were using a topical antibiotic had an eruption develop postoperatively that was consistent with an allergic contact dermatitis from the topical antibiotic. Seven of the nine patients agreed to patch testing with the standard tray and selected topical antibiotics. Five patients had a positive patch test to neomycin sulfate and four had a positive patch test to bacitracin. The frequency of allergic contact dermatitis proved by patch testing to neomycin and bacitracin is five (5.3%) of 94 and four (2%) of 198, respectively, in the patients who used these antibiotics. All proved sensitivities to bacitracin occurred in patients using a topical antibiotic that also contained neomycin and were patch tested positive to the neomycin. No patients using only pure bacitracin had allergic contact dermatitis.

CONCLUSIONS

Allergic contact dermatitis to a topical antibiotic, especially neomycin, should be considered in any patient who has development of a dermatitis after cutaneous surgery. Because of the frequency of allergic contact dermatitis, neomycin-containing antibiotics should be avoided in postoperative wound care.

Methylchloroisothiazolinone-methylisothiazolinone reactions in patients screened for vehicle and preservative hypersensitivity

More than 1100 patients were tested with methylchloroisothiazolinone-methylisothiazolinone, 100 ppm, in aqueous and petrolatum-based patch test materials from 1985 to 1987 by members of the North American Contact Dermatitis Group. Thirteen reactions to the aqueous materials and 10 to the petrolatum-based materials were observed. Irritant reactions were infrequent, and about half the reactions were deemed relevant. From 1984 to 1985, patch tests with this substance at a concentration of 250 ppm in petrolatum were conducted. Thirteen persons were identified as allergic, but three others were sensitized by the patch test procedure. Sensitization as not observed in tests with aqueous or petrolatum-based substance at a concentration of 100 ppm, and this concentration appears to be the best compromise between safety and sensitive detection of allergy. Use tests are helpful but not infallible as a guide in establishing relevance with methylchloroisothiazolinone-methylisothiazolinone. Wash-off products are frequently well tolerated by patients with positive reactions to this substance.

Allergic contact dermatitis to nasturtium

In conclusion, oil of mustard, contained in many plants and recognized mainly as a skin irritant, is also capable of causing an allergic contact dermatitis. Nasturtium, which contains mustard oil, should be added to the list of plants capable of causing this dermatitis and must be suspected in any patient who handles plants and presents with hand dermatitis.

Dermatoses among floral shop workers

Concern about the increasing incidence of hand dermatitis in floral shop workers in the United States and its possible association to the plant Alstroemeria, a flower that has become popular since its introduction in 1981, prompted investigation of the prevalence and cause of hand dermatitis in a sample of floral workers. Fifty-seven floral workers were surveyed, and 15 (26%) reported hand dermatitis within the previous 12 months. Sixteen floral workers (eight with dermatitis) volunteered to be patch tested to the North American Contact Dermatitis Group Standard and Perfume Trays, a series of eight pesticides and 20 plant allergens. Of four of seven floral designers and arrangers who reported hand dermatitis, three reacted positively to patch tests to tuliposide A, the allergen in Alstroemeria. Patch test readings for all other plant extracts were negative. A positive reading for a test to one pesticide, difolatan (Captafol), was noted, the relevance of which is unknown.

Treatment of apocrine chromhidrosis with topical capsaicin

A 30-year-old white woman with facial apocrine chromhidrosis was treated successfully with topical capsaicin once or twice daily. Paired comparison of treated versus untreated sides and active drug-treated versus vehicle-treated sides showed suppression of the chromhidrosis only when capsaicin was used. After treatment was discontinued, the chromhidrosis returned within 2 days.

Hyposensitization to poison ivy after working in a cashew nut shell oil processing factory

19 adults were patch tested to urushiol, the allergen in poison ivy/oak, to determine their sensitivity to this allergen after working in a cashew nut shell oil (CNSO) processing plant. The cashew nut tree and poison ivy/oak are in the same botanical family. Anacardiaceae, and they share similar chemicals which cause allergic contact dermatitis. 13 of the 19 workers had a preemployment history of poison ivy sensitivity, with 10 developing CNSO dermatitis. After working in this factory for several months, 9 of the 13 noticed a decreased sensitivity or no sensitivity to poison ivy/oak. When tested to urushiol extract, only 3 reacted positively, 2 minimally. These results imply that hyposensitization to poison ivy/oak occurred in these employees after development of hardening to cashew nut shell oil.

Milk tester's dermatitis

Hand dermatitis is a frequent problem among workers in milk testing laboratories. An epidemiologic study was conducted at the Pennsylvania Dairy Herd Improvement Association Milk Testing Laboratory, where more than 300,000 milk samples are examined monthly for protein, butterfat, and "somatic" cells. These samples are preserved with potassium dichromate for transport from the farm to the laboratory. A survey of the laboratory was conducted and workers were interviewed. Eight of 16 subjects reported a history of occupationally exacerbated hand dermatitis. Three of 16 subjects had positive patch test results to potassium dichromate. Two of 15 subjects who underwent patch testing to milk preserved with potassium dichromate had positive reactions. None reacted to milk alone, bronopol, or Kathon CG. Two workers are receiving workers' compensation because of severe allergic contact dermatitis of the hands to potassium dichromate. We conclude that milk testing laboratory workers are at substantial risk for acquiring allergic contact dermatitis from milk preserved with potassium dichromate.

Allergic contact dermatitis to Alstroemeria

Two female florists developed dermatitis of the fingertips. Patch testing revealed allergic contact dermatitis to the flower, Alstroemeria, used in floral arrangements. They had positive patch tests to portions of Alstroemeria, and to tuliposide A, the allergen in this plant. Vinyl gloves were not helpful since tuliposide A readily penetrates through these gloves. Nitrile gloves may be protective since they prevented positive patch test to tuliposide A.

Dermatologic problems of office workers

Occupational dermatoses among office personnel are infrequent. Nevertheless, the dermatologist should be aware of the various suspected causes of these dermatoses (poor ventilation, visual display terminals, paper, etc.), since some patients will attribute their cutaneous as well as extracutaneous symptoms to office work.

Acyclovir resistance in a patient with chronic mucocutaneous herpes simplex infection

Chronic cutaneous herpes simplex virus infection is described in a 68-year-old man who was immunocompromised because of chronic lymphocytic leukemia. The herpes infection was not amenable to therapy with acyclovir. Clinical isolates of herpes simplex virus were assessed for viral thymidine kinase activity, which was markedly decreased in two isolates. By the method of viral plaque autoradiography, these isolates were determined to be composed primarily of mutant thymidine kinase-negative herpes simplex virus mixed with occasional standard thymidine kinase-positive herpes simplex virus. Viral plaque autoradiography permitted the quantitation of proportions of thymidine kinase-negative and thymidine kinase-positive herpes simplex virus in the mixed virus populations. The chronic cutaneous infection persisted, unlike other reported infections by thymidine kinase-negative herpes simplex virus.

Changes in lymphocyte and Langerhans cell populations in allergic and irritant contact dermatitis

We observed in situ changes in lymphocyte subpopulations and Langerhans cells during allergic and irritant contact dermatitis using immunohistochemical staining methods with monoclonal antibodies to cell surface antigens. In both types of contact dermatitis, there was a perivascular infiltrate of T lymphocytes, with helper/inducer T cells predominating. B cells were absent, and natural killer cells were absent or sparse. During the course of allergic contact dermatitis, Langerhans cells showed a striking sequential change in location, with the cells first in the epidermis, then perivascularly in the dermis (days 1-14), and returning to the epidermis (days 14-21). In irritant contact dermatitis, the Langerhans cells were initially identified in the epidermis and then appeared diffusely in the dermis (days 1-2). The numbers in the dermis then decreased abruptly (day 4). They were again identified in normal numbers in the epidermis (day 21). The response of Langerhans cells appears to be different between allergic and irritant contact dermatitis.