Irritant-induced enhancement of induction and elicitation of sensitization for the treatment of seborrheic keratoses

A reconsideration of acute Beryllium disease

CONTEXT

Although chronic beryllium disease (CBD) is clearly an immune-mediated granulomatous reaction to beryllium, acute beryllium disease (ABD) is commonly considered an irritative chemical phenomenon related to high exposures. Given reported new cases of ABD and projected increased demand for beryllium, we aimed to reevaluate the patho physiologic associations between ABD and CBD using two cases identified from a survey of beryllium production facility workers.

CASE PRESENTATION

Within weeks after exposure to beryllium fluoride began, two workers had systemic illness characterized by dermal and respiratory symptoms and precipitous declines in pulmonary function. Symptoms and pulmonary function abnormalities improved with cessation of exposure and, in one worker, recurred with repeat exposure. Bronchoalveolar lavage fluid analyses and blood beryllium lymphocyte proliferation tests revealed lymphocytic alveolitis and cellular immune recognition of beryllium. None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described. In both cases, lung biopsy about 18 months after acute illness revealed noncaseating granulomas. Years after first exposure, the workers left employment because of CBD.

DISCUSSION

Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium. Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.

RELEVANCE TO PRACTICE

ABD may occur after exposures lower than the high concentrations commonly described. Prudence dictates limitation of further beryllium exposure in both ABD and CBD.

Use of a keratolytic agent with occlusion for topical treatment of hyperkeratotic seborrheic keratoses

BACKGROUND

Seborrheic keratoses are the most common benign tumors in adults. Despite their negative cosmetic appearance, no topical treatment is commonly recommended for these lesions.

OBJECTIVE

Our objective was to assess whether clinical benefit could be achieved by using a keratolytic topical agent and superficial scraping for this condition.

METHODS

A topical 50% urea-containing product under occlusion was applied daily to large and/or thick hyperkeratotic seborrheic keratoses on the truck and extremities. The patients were instructed to digitally scrape the surface of the lesions in an attempt to reduce the thickness of the lesions.

RESULTS

In a pilot nonrandomized open-label survey, patients expressed satisfaction with using this topical therapeutic technique.

CONCLUSIONS

Hyperkeratotic seborrheic keratoses can be satisfactorily managed with topical agents and scraping with reasonable patient satisfaction. Further studies with various keratolytic agents using other delivery systems are warranted.