Presence and absence of non-native fish species in the Wet Tropics region, Australia

Distributional records of non-native fish species were identified in the Wet Tropics region, Far North Queensland, Australia, through a compilation of published records and expert knowledge. A total of 1106 records were identified comprising 346 presence and four uncertain records for at least 13 species, and 756 absence records. All current presence records consist of six species from the families Cichlidae and Poeciliidae with established self-sustaining populations in the region, probably affecting the highly diverse native fish fauna.

Trophic ecology of northern Australia's terapontids: ontogenetic dietary shifts and feeding classification

The diets of 21 terapontid species from freshwater environments in northern Australia were investigated to determine the similarity and dissimilarity among species and the extent of any ontogenetic shifts. Distinct ontogenetic dietary shifts occurred in all species for which sufficient data were available, with many species passing through several discrete trophic categories during their life histories. Diets of all juvenile terapontids were similar, mainly comprising aquatic insects and zooplankton. Larger size classes of terapontids diverged into a broad spectrum of feeding groups comprising carnivorous dietary modes (including piscivory and lepidophagy), omnivory (including frugivory and consumption of allochthonous prey), herbivory and detritivory. The results indicate that the terapontids represent Australia's most trophically diverse freshwater fish family.

Fragrance contact dermatitis: a worldwide multicenter investigation (Part II)

The purpose of this study was to determine the frequency of responses to selected fragrance materials in patients who were fragrance sensitive. 178 patients were evaluated in 8 centers worldwide with a fragrance mix (FM) and 20 other fragrance materials. Reaction to the fragrance mixture (FM) occurred in 78.7% of the subjects. Substances reacting at a rate of 2% or higher included jasmine absolute, geranium oil bourbon, l-citronellol, spearmint oil, 1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethylcyclopenta-gamma-2-benzopyran, omega-6-hexadecenlactone, dimethyltetrahydrobenzaldehyde (isomer mixture), and alpha-amylcinnamaldehyde. These chemicals should be furthur evaluated to corroborate their allergenicity. We are constantly looking for new fragrance allergens to extend the diagnostic capability of the fragrance mix (FM).

Conversion of psoriasis patients from the conventional formulation of cyclosporin A to a new microemulsion formulation: a randomized, open, multicentre assessment of safety and tolerability

OBJECTIVE

To assess the safety, tolerability and efficacy of a new cyclosporin A (CyA) microemulsion formulation, Sandimmun Neoral (Neoral), in patients with severe psoriasis that was stable on CyA administered as Sandimmun (SIM).

METHODS

In this 24-week, open, randomized, prospective, multicentre trial, 28 patients continued on the same dosage of SIM, while 30 converted to Neoral at 2.5 mg/kg/day or a dosage equivalent to their pre-conversion SIM dosage. During the study, dosages could be adjusted to maintain efficacy, because of adverse events or after disease stabilization. The maximum permitted dosage for either formulation was 5.0 mg/kg/day. Primary efficacy criteria were change in Psoriasis Area and Severity Index (PASI) from baseline and time to relapse.

RESULTS

The dosage was increased to maintain efficacy in 22 patients (Neoral 13; SIM 9) and 20 dose reductions for safety were required (Neoral 14, SIM 6). In both groups, PASI scores remained stable throughout and relapses were primarily a result of dosage reduction after disease stabilization. No significant difference was found between groups in the proportion of patients remaining relapse-free. Adverse events were recorded in 20 patients receiving Neoral and 14 receiving SIM. Most drug-related events were of mild or moderate severity and reflected the known CyA side-effect profile. Dose titration guidelines ensured that mean blood pressure and serum creatinine concentrations remained stable in both groups.

CONCLUSIONS

If the guidelines for CyA use are followed and the Neoral dosage does not exceed 5 mg/kg/day, conversion of stable patients with severe psoriasis from SIM to Neoral should present no clinically relevant safety or tolerability problems and efficacy of treatment is maintained.

[Harm Reduction--its history and practice]

In September 1997, Médecins sans Frontières-Holland (MSF-H) began a project to provide training and support for HIV/AIDS prevention among injecting drug users in the Russian Federation. The training course is based on the use of the Rapid Assessment Methodology developed by the World Health Organization (WHO) Programme on Substance Abuse (WHO, 1997) and the European Peer Support Manual (Trautmann and Barendregt, 1994) developed by the Trimbos Institute for the European Commission (both of which have been translated into Russian and, where necessary, adapted for use in Russia), as well as significant articles and books. The training programme also receives advice from the reports to UNAIDS Task Force on HIV Prevention among injecting drug users in Eastern Europe and the Newly Independent States. MSF-H is a permanent member of this Task Force.

Processes and outcomes of training on rapid assessment and response methods on injecting drug use and related HIV infection in the Russian Federation

In September 1997, Médecins Sans Frontières-Holland (MSF-H) began a project to provide training and support for HIV/AIDS prevention among injecting drug users (IDUs) in the Russian Federation, focusing on the use of the World Health Organization Rapid Assessment and Response Guide on Injecting Drug Use, and the European Peer Support Manual. As part of the training, participants are asked to carry out a rapid situation assessment (RSA) in their city or region as a major step towards designing and implementing an effective program to prevent HIV transmission among IDUs. This paper focuses on the first four training cycles of the programme (from January 1998 to January 1999), in which 89 health professionals and others from 32 Russian cities took part. A total of 28 rapid situation assessments were completed or almost completed by participants during these four cycles. The paper provides an overview of the methods used and major problems faced by participants undertaking these assessments, as well as summarising the 14 harm reduction programmes which resulted.

Pulmonary toxicity in a patient with psoriasis receiving methotrexate therapy

We report a 34-year-old woman with psoriasis who developed shortness of breath during methotrexate therapy. Methotrexate had been started 4 months earlier and the patient had ingested a cumulative dose of 232 mg. Pulmonary function tests showed a reduction in transfer factor to 76% of predicted. Methotrexate was stopped and her symptoms rapidly resolved. Pulmonary function tests deteriorated further despite stopping methotrexate but with no recurrence of symptoms with a transfer factor of 66% of predicted 2 months later. At 5 months after stopping methotrexate the patient remained well and pulmonary function had improved with a transfer factor of 79% of predicted. Pulmonary toxicity is a rare but important adverse effect of methotrexate therapy in patients with psoriasis.

HIV infection associated with drug injecting in the newly independent states, eastern Europe: the social and economic context of epidemics

AIMS

We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred.

METHODS

Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies.

FINDINGS

Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition.

CONCLUSIONS

An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.

[A decrease in harm: a new concept for Russian public health]

The main principles of the concept of the "decrease of harm", realized in many countries of the world, are presented and the expediency of using this concept in Russia is substantiated. The beginning of the realization of the Project "Decrease of Harm: the Russian Federation", aimed at training specialists capable of carrying out prophylactic work among users of intravenous drugs (UID), is demonstrated. The principles of the selection of the groups of trainees are shown: the groups are made up of physicians working at AIDS centres, specialists in narcology and representatives of non-governmental organizations. The course of training provides the basic information on the strategy of the prophylaxis of HIV infection among UID, including evaluation and study, outreach, change of syringes and needles, replacement therapy, the program of the treatment of drug addiction. At the present moment 46 specialists from 18 regions of Russia are taking the course of training.

A study of new fragrance mixtures

OBJECTIVE

To determine the frequency of responses to four mixtures of fragrance materials in routine clinic patients undergoing patch testing for suspect allergic contact dermatitis. The validity of using fragrance mixtures alone, or in combination, was evaluated in terms of predicting allergy to fragrance judged on the basis of finding a response to at least one of the fragrance mixtures.

METHODS

A total of 752 subjects were patch tested in five centers worldwide with (1) fragrance mix 8% (FM), (2) balsam of Peru 25%, (3) a mixture of seven of the eight FM 8% ingredients and other fragrance ingredients including jasmine absolute (jasmine/FM mix), and (4) a mixture of five selected natural fragrance ingredients (NM).

RESULTS

Of 752 subjects, 100 (13%) had positive patch tests to at least one of the four fragrance mixtures. The age of the patients was 45.2 +/- 18.3 years (mean +/- SD). Ninety-six percent were Caucasian. Facial eruptions and hand involvement were the most common topographic sites. Of subjects exhibiting a positive response, 67% reacted to FM, 63% to the jasmine/FM mix, 47% to the NM, and 38% to balsam of Peru. Testing with FM and NM identified 84% of the perfume-allergic patients. FM 8% tested simultaneously with the jasmine/FM mix identified 86% of the perfume-allergic patients. Testing simultaneously with three test materials combining either the NM or the jasmine/FM mix with balsam of Peru and FM identified 95% of the perfume-sensitive patients.

CONCLUSIONS

The simultaneous testing of NM or jasmine/FM mix, in addition to the conventional use of FM 8% and balsam of Peru, increases the sensitivity of testing for fragrance allergy from 81% to 95%.

Injecting equipment provision in Australia: the state of play

Injecting equipment provision measures in Australia can be judged reasonably successful as HIV prevention measures. In the capital cities of all Australian States and Territories, access to needles and syringes is easy, at least during the day in at least some areas. In conjunction with peer education and other activities, needle and syringe supply appears to have led to a change in norms away from the sharing of needles and other injecting equipment among at least older heroin injectors in large population centers. However, in many other areas, and in many subpopulations-particularly further marginalized groups such as Aboriginal and Vietnamese-Australian injectors-messages about HIV/AIDS risk are either not penetrating or are being ignored, and needle and other equipment sharing still appears to be common. The strategy of providing access to needles and syringes as a separate activity from peer education among injecting drug users (IDUs) needs to be reconsidered in the light of the widespread epidemic of hepatitis C among Australian IDUs. The level of supply of all injecting equipment also needs to be increased to assist all IDUs in learning and carrying out an aseptic injecting technique given the lack of an effective disinfection technique to prevent the spread of hepatitis C, and the problems surrounding both the promotion of disinfection and the promotion of noninjecting routes of administration.

The safety of topical anaesthetic and analgesic agents in a gel when used to provide pain relief at split skin donor sites

Post operative pain from split skin donor sites is a recognised problem. This study was carried out to assess the safety of a 'depot' preparation of bupivacaine and ketoprofen when applied to denuded dermis of a split donor site. Two groups of six patients each received either bupivacaine gel (2.5 mg/ml) or ketoprofen gel (1.6 mg/ml). One patient from each group was excluded as protocol was not followed. The mean surface area for bupivacaine was 106 cm2 (range 64-160) and the mean for ketoprofen was 130 cm2 (range 64-180). Blood samples were obtained before application and at 10, 20, 30, 60, 120, 240 and 480 min after application. Serum levels were assayed using Gas Liquid Chromatography and High Pressure Liquid Chromatography. Bupivacaine levels peaked at 120 min, mean level obtained was 0.07 microgram/ml (range 0.03-0.1). Ketoprofen levels also peaked at 120 min and the mean level obtained was 0.20 microgram/ml (range 0.12-0.27). The reported toxic serum level for bupivacaine was 4 micrograms/ml and for ketoprofen is 1128 micrograms/ml. In conclusion, these preparations, when applied to denuded dermis of a split skin donor site, are unlikely to result in toxic levels.

Pyoderma gangrenosum of the breast treated with low-dose cyclosporin A

Pyoderma gangrenosum (PG) is a painful chronic ulcerative skin disorder often occurring in association with systemic disease. It typically affects the lower limbs, but may also involve other sites, or sometimes develop after trauma of surgical procedures. We report the case of a woman with rheumatoid arthritis who developed disfiguring and severe PG of the right breast, a rare site, following biopsy for a benign breast lesion, and who was subsequently successfully treated with low-dose cyclosporin A.

Contact hypersensitivity in patients with orofacial granulomatosis

BACKGROUND

Orofacial granulomatosis is a clinical entity presenting with chronic swelling of the oral or facial tissues in association with histological evidence of noncaseating granulomatous inflammation. Its cause remains unclear, but a possible role of contact sensitivity to dietary components has been proposed.

OBJECTIVES

This study was performed to document the prevalence of contact sensitivity to food additives in patients with orofacial granulomatosis and assess the role of elimination diets in management.

METHODS

Successive patients with a clinical diagnosis of orofacial granulomatosis were patch tested to the European Standard series and an Oral Battery containing common food additives. In addition, testing for immediate contact reactions to components of the Oral Battery was performed. In selected cases, appropriate elimination diets were implemented.

RESULTS

Forty-eight patients were investigated. Ten showed positive reactions to components of the Oral Battery on standard patch testing and, of these, seven showed improvement on an elimination diet.

CONCLUSIONS

Orofacial granulomatosis is a heterogenous clinical entity. Patch testing permits identification of a subgroup of patients likely to benefit from dietary manipulation and allows more appropriate targeting of such treatment.

Congenital triangular alopecia

We report a child with bilateral congenital triangular alopecia. Shaving the scalp and inserting intravenous cannulas into scalp vessels during the neonatal period was misconstrued by the parents as the cause of hair loss, and resulted in medicolegal implications.

Corticosteroid contact allergy: an EECDRG multicentre study

This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet., betamethasone-17-valerate 1% pet., clobetasol-17-propionate 1% pet., hydrocortisone-17-butyrate 1% eth., and tixocortol-21-pivalate 1% pet.; 189 (2.6%) gave a positive patchtest reaction (+, ++, + + +) to at least 1 of the corticosteroids. The data regarding the corticosteroid-sensitive patients, as well as the patchtest results, were recorded on a standardized form.

Fragrance contact dermatitis: a worldwide multicenter investigation (Part I)

OBJECTIVE

The aim of this study was to determine the prevalence of responses to selected fragrance materials in patients with suspect fragrance allergy and to evaluate risk factors and associations with such responses. The validity of using specific fragrance ingredients versus a mixture of fragrances was evaluated in terms of predicting allergy to different fragrance ingredients.

METHODS

One hundred sixty-seven subjects were evaluated in seven centers worldwide with a fragrance mix, the eight ingredients in the fragrance mixture, six other well-known fragrance allergens, balsam of Peru, and 15 lesser studied fragrance materials.

RESULTS

The age of the patients was 44.9 +/- 17.5 years (mean +/- SD). More than 85% were women. A relatively high proportion gave a past history of atopic disease. Facial eruptions (40%) and hand involvement (26.7%) were the most common topographic sites. All but 4 of the 35 fragrance materials produced a positive response in > 1%. A reaction to fragrance mix occurred in 47.3%. Seven of the 34 ingredients tested produced an allergic response in more than 10% of those tested. Men were more likely than women to exhibit a positive response to five fragrance ingredients. White persons were more likely to react to perfume mix (52.8% versus 25.3%) and certain ingredients in the mix than Asian persons. Allergy to benzyl salicylate was more common in Japan than in Europe or the United States.

CONCLUSION

The age at which patients with perfume allergy present for evaluation is similar to that of other contactants. Atopic individuals may be overrepresented in this group of patients. Face involvement is likely. White persons are more likely to react to fragrance mix, whereas in Asian patients benzyl salicylate was a more frequent allergen. Fragrance mix corrected with 85.6% of positive responses to fragrance ingredients. The addition of ylang ylang oil, narcissus oil, and sandalwood oil to fragrance mix would be expected to pick up 94.2% with positive responses to fragrance materials; adding balsam of Peru increases this to 96%.

Day 4 is better than day 3 for a single patch test reading

Readings were performed on day (D) 2, D3 and D4 after application of patch tests in 88 patients. 90 patch test reactions in 49 patients were interpreted as allergic and of past or present relevance. A single D2 reading detected 58 of the allergic reactions with 32 false-negatives and 23 false-positives. A single D3 reading detected 77 allergic reactions, with 13 false-negatives and 17 false-positives. A single D4 reading detected 85 allergic reactions, with 5 false-negatives and 9 false-positives. Therefore, if only a single reading is feasible, it is better performed on D4 than on D3.

Dermatological presentation of disease associated with antineutrophil cytoplasmic antibodies: a report of two contrasting cases and a review of the literature

Antineutrophil cytoplasmic antibody (ANCA)-associated disease (AAD) constitutes a pathological disease spectrum of a necrotizing vasculitis of small- and medium-sized vessels, extravascular granuloma formation, and necrotizing and crescentic glomerulonephritis, and also a clinical disease continuum which ranges from renal-limited disease to a widespread systemic vasculitis, including Wegener's granulomatosis and microscopic polyangiitis. In the latter, circulating ANCA are an aid to diagnosis and also may play a pathogenic part. Two contrasting patients with AAD are described, both of whom presented primary with dermatological features. These included a cutaneous purpuric vasculitis, orogenital ulceration, infarction of the fingertip, and pyoderma gangrenosum-like ulceration. These cases will familiarize dermatologists with both the concept and dermatological features of AAD.

Long-lasting allergic patch test reactions to nickel sulfate: analysis by nickel quantification and immunocytochemistry

We previously showed the median duration of positive patch test reactions to nickel sulfate (5% pet.) was 9 days, and defined as long-lasting (LLAPTR) the 14.3% of reactions that persisted for 17 days or longer. The pathomechanisms of LLAPTR are unclear, but may involve either localized antigen persistence or abnormal downregulation of the cellular immune response. In this study, we compared (a) the nickel concentration and (b) the immunocytochemical nature of the local immune reaction, between biopsies from LLAPTR (n = 8) and normally resolving allergic patch test reactions (NRAPTR) (n = 8) to nickel sulfate. The concentration of nickel in LLAPTR (median 0.56 microgram/g, range 0.25-3.87 micrograms/g, mean 0.83 microgram/g, 95% CI 0.35-1.31) and NRAPTR (median 0.58 microgram/g, range 0.2-1.85 micrograms/g, mean 0.88 microgram/g, 95% CI 0.02-1.74) was similar. Activated T lymphocytes, expressing surface IL-2 receptor, HLA DR, DR alpha 1, DP, DQ, and CD2 > CD8 > CD4 antigens, were seen throughout the dermis and occasionally infiltrating the suprabasal layer of the epidermis in all biopsies. CD1 and HLA DR, DR alpha 1, DP, and DQ-expressing Langerhans cells were present throughout the epidermis and occasionally seen in the papillary dermis. HLA DR, DR alpha 1, DP, and DQ antigen expression were also seen on the surface of non-dendritic cells in the epidermis (probably either keratinocytes or T lymphocytes) and vascular endothelial cells in the papillary dermis. There were no significant qualitative or quantitative differences in the immunocytochemical nature of the localized immune reaction between LLAPTR and NRAPTR. These findings suggest that the pathomechanism of LLAPTR to nickel sulfate is unlikely to be explained simply on the basis of nickel concentration or the nature of the localized immune reaction at the patch test site.

Nickel-containing alloys and platings and their ability to cause dermatitis

A broad range of nickel-containing alloys and coatings used in jewellery, watches and clothes, were patch tested in 100 nickel-sensitive subjects and in 20 nickel-negative controls. Three non-plated stainless-steel alloys tested caused no patch-test reaction. Nickel interliners under gold, silver or chromium plating, as well as nickel-silver and some white-gold alloys, caused positive patch-test reactions. Ear ornaments, wristwatches and buttons were the objects most frequently causing dermatitis. Half the nickel-sensitive participants suspected that they had been sensitized before the age of 20. The results of the study have been used as the basis for developing clinically relevant analytical methods for nickel release. The methods are proposed as European Standards and will be used in the Nickel Directive, an EC regulation aiming at the prevention of nickel allergy.

Multiple dermatofibromas in a patient with HIV infection

We report the case of a 26-year-old man with haemophilia B and human immunodeficiency virus infection (HIV) who presented with a short history of multiple dermatofibromas. He also had troublesome psoriasis for which he was receiving acitretin with UVB therapy and had recently discontinued low-dose daily prednisolone for associated arthropathy. Multiple dermatofibromas are rare and have been reported previously in association with autoimmune disease, especially in individuals receiving immunosuppressive therapy. We believe this to be the first report of multiple dermatofibromas in an individual with advanced HIV infection and propose that it may be related to his viral-mediated immunodeficiency, possibly augmented by UVB and systemic corticosteroid therapy.

Patch testing with fragrances: results of a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes

The objective of this study was to determine the frequency of reactivity to a series of commonly used fragrances in dermatological patients. A total of 48 fragrances (FF) were chosen, based on the publication of Fenn in 1989 in which the top 25 constituents of 3 types (1. perfumes, 2. household products, 3. soaps) of 400 commercial products on the US market had been determined. In a pilot study on a total of 1069 patients in 11 centres, the appropriate test concentration and vehicle were examined. For most fragrances, 1% and 5% were chosen, and petrolatum proved to be the best vehicle in comparison to isopropyl myristate and diethyl phthalate. In the main study, a set of 5 to 10 fragrances at 2 concentrations was patch tested in each centre on a minimum of 100 consecutive patients seen in the patch test clinic. These patients were also patch tested to a standard series with the 8% fragrance mix (FM) and its 8 constituents. In patients with a positive reaction to any of the 48 FF, a careful history with regard to past or present reactions to perfumed products was taken. A total of 1323 patients were tested in 11 centres. The 8% FM was positive in 89 patients (8.3% of 1072 patients). Allergic reactions to the constituents were most frequent to oak moss (24), isoeugenol (20), eugenol (13), cinnamic aldehyde (10) and geraniol (8). Reactions read as allergic on day 3/4 were observed only 10X to 7 materials of the new series (Iso E Super (2), Lyral (3), Cyclacet (1), DMBCA (1), Vertofix (1), citronellol (1) and amyl salicylate (1)). The remaining 41 fragrances were negative. 28 irritant or doubtful reactions on day 3/4 were observed to a total of 19 FF materials (more than 1 reaction: 5% citronellol (2), 1% amyl salicylate (2), 1% isononyl acetate (3), 0.1% musk xylol (2), 1% citral (2), and 1% ionone beta (2)). Clinical relevance of positive reactions to any of the FF series was not proved in a single case. This included the 4 reactions in patients who were negative to the 8% FM. In conclusion, the top 25 fragrances commonly found in various products caused few reactions in dermatological patients and these few appeared to be clinically irrelevant, with the possible exception of Lyral. However, this data should be interpreted in the light of the relatively small number of patients tested (only 100 in most centres).

Testing with fragrance mix. Is the addition of sorbitan sesquioleate to the constituents useful?

In a multicentre study, the value of adding sorbitan sesquioleate (SSO) to the constituents of the 8% fragrance mix (FM) was investigated. In 7 centres, 709 consecutive patients were tested with 2 types of FM from different sources, its 8 constituents with 1% SSO, its 8 constituents without SSO, and 20% SSO. 5 patients (0.71%) reacted to the emulsifier SSO itself, read as definitely allergic on day 3/4. 53 patients reacted to either one of the mixes with an allergic type of reaction. When tested with the constituents without SSO, 41.5% showed an allergic reaction versus 54.7% with SSO. If both types of reactions were considered (allergic and irritant) 38.3% of 73 patients showed a positive "breakdown" result without SSO, versus 54.8% with SSO. The differences were statistically significant. Reactivity to FM constituents was changed in a specific pattern by addition of SSO--irritant reactions increased, particularly for cinnamic alcohol, eugenol, geraniol, oak moss and hydroxycitronellal, whereas others showed only a slight change. Allergic reactions were also increased by SSO, but the rank order of the top 3 sensitizers (isoeugenol, oak moss and eugenol) did not change. Cinnamic alcohol was the only constituent with decreased reactivity after addition of SSO. A positive history of fragrance sensitivity (HFS) was clearly associated with a positive allergic reaction to either the mix or 1 of its constituents (51% versus 28.6% with a negative HFS). Irritant reactions were linked to a negative HFS in a high proportion (64.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Contact allergy to gold sodium thiosulfate

278 consecutive patients with suspected contact dermatitis were patch tested with the European standard series and gold sodium thiosulfate (0.5% pet.): 13 patients (4.6%) had a positive allergic response to gold sodium thiosulfate (GST). All of these patients were female, with a mean age of 37 years. The most frequent site of eczema in these patients was the head and neck (62%). A seborrhoeic distribution of eczema was common. 46% had involvement of the limbs, 15% had a perianal or perivulval rash. The mean duration of eczema in this group of patients was 15.8 months. 54% of patients allergic to gold were also allergic to nickel. Biopsy of positive patch test reactions to GST were consistent with allergic contact dermatitis.

Spread the word and reach a wider audience. Writing for publication

1. The advancement of nursing depends on sharing ideas through submitting articles for publication. 2. Nurses are often reluctant to write up their ideas for publication. 3. A review of the literature is essential in understanding the principles of writing for publication. 4. A system of peer review should be developed in the workplace to encourage and support nurses in the publication process.

The value of a baseline liver biopsy prior to methotrexate treatment

Two patients with severe disabling psoriasis were treated with methotrexate (MTX). As a short course of treatment was envisaged, a pretreatment liver biopsy was not performed. Although both patients developed similarly abnormal levels of hepatic enzymes after low cumulative doses of MTX (440 and 450 mg), subsequent liver biopsies revealed contrasting findings. In one patient the histological features were normal. However, in the second, there was hepatic fibrosis, and the absence of a pretreatment biopsy led to problems with interpretation of these histological findings. As a liver biopsy is by far the most reliable method of detecting liver disease, we suggest that it is still of value to include a baseline liver biopsy in the pretreatment assessment of patients even when only a short course of MTX is planned.

Allergic contact dermatitis from the synthetic fragrances Lyral and acetyl cedrene in separate underarm deodorant preparations

The case is reported of a 28-year-old man who developed allergic contact dermatitis from 2 synthetic fragrance ingredients, Lyral (3- and 4-(4-hydroxy-4-methylpentyl)-3-cyclohexene-1-aldehyde) and acetyl cedrene, in separate underarm deodorant preparations. The implications of the patient's negative patch test reactions to the European standard series (Trolab) and cosmetics and fragrance series (both Chemotechnique Diagnostics) are discussed. The importance is stressed of patch testing with the patient's own preparations when cosmetic dermatitis is suspected, and of identifying and reporting offending fragrance ingredients, with a view possibly to updating the European standard series and commercially available cosmetics and fragrance series.

An audit of dermatology in a paediatric accident and emergency department

Two studies were undertaken of patients with dermatological disorders who attended the Accident and Emergency (A&E) Department of the Royal Belfast Hospital for Sick Children during 1990-1991. The aims were to review diagnostic accuracy and assess the benefits of an open-access consultant dermatology clinic. A retrospective survey of 14,340 new attendances at the A&E department over a 7-month period found that 540 of these (4%) had a primary dermatological disorder. In 26% no diagnosis had been made although only 10% were referred for a specialist opinion. A 2-month prospective study of patients who attended the department and were referred to a consultant dermatology open-access clinic revealed overall diagnostic accuracy of 66% (+/- 2 SEM). Individual rates of diagnostic concordance between junior doctor and consultant were 59% for skin infections and 77% for papulosquamous disorders. The open-access clinic allowed prompt referral for correct diagnosis and initiation of appropriate management.

Leucopenia, thrombocytopenia and lymphadenopathy associated with sulphasalazine

We report a 19-year-old woman with psoriasis who developed a severe allergic reaction within 1 week of commencement of sulphasalazine; her skin becoming erythrodermic with associated lymphadenopathy, leucopenia and thrombocytopenia. Clinical signs and haematological abnormalities rapidly returned to normal on discontinuation of sulphasalazine. It is important to monitor carefully haematological indices in the early stages of treatment with this drug.