Contact allergy in atopic dermatitis: A prospective study on prevalence, incriminated allergens and clinical insights

BACKGROUND

The relationship between atopic dermatitis (AD) and allergic contact dermatitis (ACD) is a matter of debate.

OBJECTIVES

The purpose of our study is to assess the frequency of ACD in patients with AD, the incriminated allergens and the potential risk factors.

METHODS

This is a prospective study, including cases of AD diagnosed based on Hanifin and Rajka's criteria. All patients were patch tested to the European baseline series and corticosteroid series.

RESULTS

Ninety-three patients were included. Fifty-six patients (60.2%) had positive patch test results of which 71.4% were relevant. The most frequent allergens were: textile dye mix (24.7%), nickel (20.4%), cobalt (12.9%), isothiazolinone (8.6%), quanterium 15 (4.3%) and balsam of Peru (4.3%). Chromium, fragrance mix I, fragrance mix II and PTBP were positive in three cases (3.2%). Two cases of allergy to corticoids were identified. Facial involvement and duration of AD were significantly associated with contact sensitization (p = 0.04 and p = 0.005, respectively). Avoidance of relevant allergens resulted in a statistically significant decrease in SCORAD (p < 0.001).

CONCLUSIONS

ACD remains an important co-morbidity of AD. We observed a high frequency of ACD to textile dyes, isothiazolinones and fragrances. Avoidance of relevant allergens has resulted in an improvement of patients' skin symptoms.

Acquired Ichthyosis Revealing Lymphocytic Colitis

A 69-year-old patient with no personal or family history of ichthyosis consulted our dermatology department for diffused cutaneous xerosis with intense pruritus evolving for 3 weeks. Physical examination revealed diffused ichthyosis of large polygonal fine scales on the skin without erythema (Figure 1). The lesions spared the face. Examination of the mucous membranes, hair, and nails revealed no abnormalities. There was no fever or adenomegaly. A skin biopsy revealed an orthokeratotic hyperkeratosis with thinning of granular layer (Figure 2). The initial diagnosis of acquired ichthyosis was maintained. The patient also reported a change in bowel habits since 2 weeks with watery, non-bloody diarrhea and mild steatorrhea. His laboratory investigations presented low serum vitamin B12 level, mild anemia, hypoalbuminemia, and fecal leukocytes; however, antinuclear antibodies, perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), rheumatoid factor, and complement components C3 and C4 were normal. A colonoscopy performed was also normal without any abnormalities. Colon biopsies revealed histologic aspects of lymphocytic colitis with more than 20% increase in lymphocytes in the surface epithelium of colorectal mucosa. Laboratory investigations excluded neoplasia, hemopathies, or autoimmune-associated diseases. The patient was treated with salazopyrin with a remarkable lessening of diarrhea and cutaneous manifestations within 4 weeks (Figure 3).

A Mass on the Sole Revealing a Giant-Cell Tumor of the Tendon Sheath

A 61-year-old woman presented with a 3-year history of painless soft-tissue mass on the right sole. The patient reported gradual growth, with a rapid increase in size over the past few months, leading to difficulty in walking. She had no history of past trauma. Examination revealed a 4-cm ovoid mass located over the ball of the foot. It was firm in consistency, with well-defined margins, a smooth surface, and an overlying normal skin (Figure 1). An ultrasound image revealed an eccentric, hypoechoic, nonvascular subcutaneous lobular mass. A magnetic resonance imaging (MRI) of the foot revealed a well-defined mass arising from the flexor tendon sheath of the right foot. The lesion was heterogeneously hyperin-tense on T1- and T2-weighted images with an avid contrast enhancement. All of the surrounding soft tissues indicated normal signal intensity patterns. There was no associated bony destruction. Histopathologic examination after complete excision of the mass established a well-circumscribed lesion composed of osteoclast-like giant cells and mononuclear cells in a hyalinized stroma, consistent with a giant cell tumor of the tendon sheath (GCT-TS) (Figure 2). There was no recurrence during a 6-month follow-up period (Figure 3).

Les virus SARS-COV-2 et HHV-8 repérés ensemble

Introduction

Environ un dixième de tous les cancers sont causés par des virus ou associés à une infection virale [1]. Les événements mondiaux récents notamment cette pandémie dévastatrice du coronavirus-2019 (COVID-19) ont conduit à une rencontre fréquente entre l’Homme et les virus.

Observation

Une patiente âgée de 74 ans aux antécédents de polyarthrite rhumatoïde, consultait suite à l’apparition de plaques indolores au niveau du membre inférieur droit évoluant depuis 1 mois. La patiente rapportait que ces lésions sont apparues deux semaines après l’infection par le SARS-COV-2. À l’examen, elle présentait des lésions papulo-nodulaires érythémato-violines. La biopsie cutanée était en faveur d’une maladie de Kaposi, avec un immunomarquage positif pour HHV-8 dans les cellules tumorales. La sérologie VIH était négative. Le scanner thoraco-abdomino-pelvien et la fibroscopie digestive n’ont pas montré d’anomalies. L’évolution était marquée par une nette diminution spontanée des lésions deux mois après la guérison de la maladie COVID-19.

Discussion

La maladie de Kaposi (MK) est un processus tumoral angiogénique lié au virus HHV8. Il en existe plusieurs formes cliniques qui peuvent survenir dans diverses circonstances, notamment en rapport avec une immunodépression acquise. Chez notre patiente, une authentique maladie de Kaposi cutanée « méditerranéenne » semble avoir été révélée par l’infection COVID-19. À notre connaissance, cette association a été rapportée dans un seul cas dans la littérature [1]. Divers mécanismes peuvent avoir contribué à cette association. Des études in vitro et in vivo ont suggéré que des concentrations élevées de cytokines anti- et/ou pro-inflammatoires peuvent être liées au développement et à la gravité de la MK. D’autre part, le rôle significatif de l’IL-6 dans la pathogenèse du COVID-19 a été confirmé par diverses études [2]. D’autres suggèrent que les protéines codées par le SRAS-CoV-2 et certains médicaments anti-COVID-19 actuellement utilisés induisent une réactivation du HHV8, l’un des principaux virus oncogènes humains [3]. Ces événements peuvent initier l’oncogenèse virale chez les patients qui ont été exposés et traités contre la COVID-19 et particulièrement les patients immunodéprimés, comme le cas de notre patiente.

Conclusion

Notre observation souligne l’importance de reconnaître les séquelles cutanées engendrées par la maladie COVID-19 et le sarcome de Kaposi peut faire partie de ces manifestations.

Spindle cell lipoma: An uncommon variant of lipoma affecting the foot sole

We report a 36‐year‐old male with an atypical variant of lipoma occurring on an atypical site.

Atypical localization of demodicosis after COVID‐19 infection

Since its outbreak in December 2019, a consistent number of case reports have been published describing a complex spectrum of skin manifestations associated with COVID‐19. We report a first observation of demodicosis of the scalp after a severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) infection.

Since its outbreak in December 2019, a consistent number of case reports have been published describing a complex spectrum of skin manifestations associated with COVID‐19. We report a first observation of demodicosis of the scalp after a severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) infection.

Herpes zoster following COVID-19 vaccination: about 2 cases

The COVID-19 vaccine often well tolerated in healthy adults at the same time, different cutaneous reactions have been reported. Two cases presented of developed a first episode of Herpes zoster (HZ) following the first dose of vaccination against COVID-19. The pathogenetic mechanism suggested that SARS-CoV-2 infection can induce a decrease of blood absolute lymphocyte number, especially CD3+ CD8+ lymphocyte. The COVID-19 vaccine, by stimulation of inflammatory cytokines, may negatively affect the antigen expression and contribute to HZ reactivation. It is also possible that the vaccine induces some kind of immunomodulation that allows VZV to revert an infectious state.

A comparative case-control study of diagnostic criteria for atopic dermatitis and proposal of new diagnostic criteria from Tunisia

BACKGROUND

Atopic dermatitis (AD) is a heterogeneous disease. Thus, it is difficult to set up standard diagnostic criteria that cover the entire spectrum of AD patients. Our objectives were to study the epidemiologic characteristics of AD in Tunisia and to evaluate five diagnostic criteria (Hanifin and Rajka, Williams, Taieb and Boralevi, REACH and ISAAC questionnaire).

METHODS

This prospective case-control study was carried out in our Dermatology Department in Tunisia. The cases and controls were collected over a period of one year (January 3, 2017, to January 2, 2018).

RESULTS

We collected 101 patients with AD and 101 controls. Patients and controls were comparable by age and gender. The mean age of patients was 9 years and 9 months with sex ratio 1.02. Children accounted for more than half of the patients (61.39%). The sensitivity and specificity of the criteria were, respectively: 90.1% and 90.1% for the Hanifin and Rajka criteria, 53.47% and 96.04% for the Williams criteria, 62.50% and 92.3% for the Taieb and Boralevi criteria, 41.58% and 92.08% for ISAAC questionnaire, 49.5% and 91.09% for REACH questionnaire. A new version of AD diagnostic criteria has been proposed. By applying these new criteria retrospectively to our patients, the sensitivity rises to 90.1%.

CONCLUSION

The new version of AD criteria is a practical diagnostic tool compared to the Hanifin and Rajka criteria and seems to correct the problem of low sensitivity of the Williams criteria. Large validation studies are needed.

Lichen planus pigmentosus inversus: a series of 10 Tunisian patients

BACKGROUND

Lichen planus pigmentosus inversus (LPPI) is a rare variant of LP. Only 31 cases have been reported in the literature.

METHODS

Here we report a series of 10 patients with LPPI from North Africa.

RESULTS

Ten cases of LPPI, clinically suspected and histologically confirmed, were seen over 3 years (2013-2015). The mean age of patients was 62.4 years old. Eight patients were women and two were men. Main folds involved were the axillae and groin. All patients were treated by topical steroids without success.

CONCLUSIONS

Our series of LPPI seems that this disorder is underreported mainly among 3 dark-skinned persons as we have seen these ten cases within three years.