Occupational Chronic Contact Dermatitis Successfully Treated with Dupilumab: A Case Series

BACKGROUND

Occupational contact dermatitis may progress to a chronic course with an unfavorable prognosis. Dupilumab has been shown to be effective as a treatment for moderate-to-severe atopic dermatitis as well as other types of dermatitis.

OBJECTIVES

The aim of the study was to describe cases of chronic recalcitrant occupational contact dermatitis treated with dupilumab and with long-term follow-up.

METHODS

A retrospective review of 6 patients treated with dupilumab for chronic occupational contact dermatitis for periods of up to 30 months was performed.

RESULTS

All 6 patients had a positive and sustainable response, with dermatitis clearance and the ability to sustain work tasks.

CONCLUSIONS

We report a case series of atopic and nonatopic workers with occupational chronic contact dermatitis who failed to achieve remission under various systemic modalities but did so using dupilumab. We suggest considering dupilumab treatment for recalcitrant occupational contact dermatitis.

The Use of an Over-the-Counter Hand Cream With Sweet Almond Oil for the Treatment of Hand Dermatitis

Hand dermatitis is estimated to affect greater than 15% of the general population. Childhood eczema, frequent hand washing, and occupational exposure to chemicals are predisposing factors. Hand dermatitis treatment involves both prevention of outbreaks and treatment of active disease. Moisturizers are essential to protect the skin from the environment, enhance hydration, and repair the skin barrier. They have been shown in large studies to prevent occupational related breakouts. Natural oils are commonly used in moisturizers for their moisturizing and emollient properties. Sweet almond oil is an oil that contains high levels of fatty acids and has been used for centuries to treat skin diseases such as eczema and psoriasis. In this study, a moisturizer with 7% sweet almond oil and 2% colloidal oatmeal was found to be both safe and effective in treating patients with moderate to severe hand dermatitis. <p><em>J Drugs Dermatol. 2018;17(1):78-82.</em></p>.

Hard metal lung disease diagnosed on a transbronchial lung biopsy following recurrent contact dermatitis

A 63-year-old man employed in a hard metal manufacturing company for 40 years presented with a chronic dry cough and exertional dyspnea 20 years after the onset of recurrent exanthemas. A chest radiograph revealed bilateral reticular shadows in the upper lung field. Pathological specimens in which tungsten was detected were obtained via a transbronchial lung biopsy. Patch tests were positive for cobalt and other metals. The patient was diagnosed with hard metal lung disease (HMLD) concurrent with contact dermatitis and treated with corticosteroids. This case suggests that allergies to metal may play a role in the onset of HMLD.

Fiddler's neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player

Fiddler's neck refers to an irritant contact dermatitis on the submandibular neck of violin and viola players and an allergic contact dermatitis to nickel from the bracket attaching the violin to the chin rest on the violinist's supraclavicular neck. A 26-year-old woman developed submandibular and supraclavicular left neck lesions corresponding to the locations of the chin rest and bracket that was attached to her violin that held it against her neck when she played. Substitution of a composite chin rest, which did not contain nickel, and the short-term application of a low potency topical corticosteroid cream, resulted in complete resolution of the allergic contact dermatitis supraclavicular neck lesion. The irritant contact dermatitis submandibular neck lesion persisted. In conclusion, violin players are predisposed to developing irritant contact dermatitis or allergic contact dermatitis from the chin rest. We respectfully suggest that the submandibular neck lesions from contact with the chin rest be referred to as 'fiddler's neck - type 1,' whereas the supraclavicular neck lesions resulting from contact of the bracket holding the chin rest in place be called 'fiddler's neck - type 2.' A composite chin rest should be considered in patients with a preceding history of allergic contact dermatitis to nickel.

[Occupational allergic "march". Rapid evolution of contact dermatitis to ammonium persulfate into airborne contact dermatitis with rhinitis and asthma in a hairdresser]

BACKGROUND

Hairdressers are exposed to irritants and allergenic compounds that may cause contact dermatitis, rhinitis and asthma.

OBJECTIVES

In this paper we describe the case of a female, age 33 years, who developed contact dermatitis after 10 years of exposure to ammonium persulfate.

METHODS

After 7 months of progressively extensive and persistent skin lesions, respiratory symptoms appeared that were related to the occupational exposure (on-off test). SIDAPA and specific occupational patch test for hairdressers and occupational challenge with ammonium persulfate were performed. Clinical parameters of inflammation, ECP (eosinophil cationic protein) and exhaled nitric oxide (FeNO) were detected before and after the specific bronchial challenge.

RESULTS

The patch test was positive to ammonium persulfate (++), and bronchial challenge for ammonium persulfate showed a significant late response (FEV1 decrease--33%). Both FeNO and ECP showed a significant increase after 24 hours. Dermatitis, urticaria and angioedema occurred on the uncovered skin due to airborne contact. Topic steroids and anti-histaminic drugs resolved the clinical symptoms.

CONCLUSIONS

Bronchial challenge is, in fact, considered to be the gold standard for the diagnosis of occupational asthma, although new inflammatory parameters can contribute to the diagnosis and can be useful for monitoring after a specific inhalation test with occupational agents. The described case summarizes the evolution from contact dermatitis to inhalation allergy, suggesting the occurrence of an allergic "march" for occupational allergy.

[Preparations based on zincum sulphate--new horizons in treatment of occupational allergic dermatoses]

Oxidative stress accompanies relapses of occupational aIlergic dermatoses. That was a reason to study influence of antioxidant zincum sulphate on their course. Adding zincum sulphate to occupational allergic dermatoses treatment helped to relieve oxidative stress, improve treatment outcomes, prolong duration of relapse-free periods, reduce the relapses number. That are the reasons to recommend zincum sulphate as a component of complex treatment of occupational allergic dermatoses.

Sea urchin granuloma secondary to Strongylocentrotus purpuratus and Strongylocentrotus franciscanus

Sea urchin injuries have been associated with a variety of cutaneous lesions, ranging from acute, transient reactions, to more chronic inflammatory conditions that result in the formation of granulomas. Although diverse species of sea urchins have been reported to produce chronic cutaneous granulomas, the two most prevalent organisms found on the US West Coast, purple and red sea urchins (Strongylocentrotus purpuratus and Strongylocentrotus franciscanus), have not yet been reported to induce persistent granulomatosis in humans. We describe one case of a 35-year-old marine biologist with chronic cutaneous lesions produced after repeated exposures. The lesions were similar to the ones produced by other urchin species, consisting of small, firm, erythematous nodules on his palms, dorsum of the hands, elbows, and knees. Increased awareness of this condition, including its association with the two prevalent organisms on the West Coast, should lead to a more rapid diagnosis for those affected. This article reviews the types of injuries, clinical cutaneoous lesions, histopathological features, and pathogenesis of the chronic inflammatory process induced by sea urchins.

Dermatitis caused by dimethyl cyanocarbonimidodithioate

Dimethyl cyanocarbonimidodithioate (CAS No. 10191-60-3) a raw material for cimetidine synthesis, is labelled as an irritant on its storage tank. There is no information available regarding the toxic effects of human exposure. We report a case of severe dermatitis clinically resembling erythema multiforme following an accidental exposure to dimethyl cyanocarbonimidodithioate in an occupational setting. A clerk sifted a handful of dimethyl cyanocarbonimidodithioate from an unlabelled bucket through his bare hands during an inspection prior to customs clearance. Five hours later, while he was washing his hands, pruritus, erythema and vesicles developed over the exposed area. The skin condition worsened within two weeks, extending to his whole body with generalized erythema and vesicles of various sizes. Some vesicles became confluent with ruptured bullae, resembling a second degree burn over 40% of the body. Elevation of the serum IgE (705 mu/mL, normal less than 300 mu/mL) and lymphocyte activation with an increased 3H-thymidine uptake by the patient's mononuclear cells suggested that this episode resulted from a cell-mediated allergic skin reaction. The skin lesions improved progressively after systemic steroid therapy for about two weeks. Dimethyl cyanocarbonimidodithioate is used as a raw material for cimetidine synthesis by some pharmaceutical manufacturers. Our experience suggests that a severe reaction similar to that caused by another H2-blocker, ranitidine and its intermediate may be caused by dimethyl cyanocarbonimidodithioate in occupational exposures. Systemic steroid administration is beneficial in treatment.

[Contact dermatitis in Dakar]

Because of the widespread repartition of allergens, allergic contact dermatitis is the most common inflammatory skin disease. It's the best model of dilated hypersensibility mediated by T lymphocytes cells. Atopic dermatitis and irritative dermatitis are to be distinguished to contact dermatitis. The aetiological diagnosis is the most important step of management of patients with that disease because it's the best way to avoid recurrences. The identification of cause is based on aetiological interrogatory and epicutaneous tests with 23 allergens completed with personnel products and specialised tests. Contact dermatitis can be classified according to results of aetiological management. In occupational contact dermatitis, contact dermatitis due to drugs, to metals, cosmetics, clothes and accessory and proteins. Management of patients with contact dermatitis is based on individual eviction, protection, cosmetovigilance, declaration of occupational dermatosis and allergovigilance.

Intervention implementation research: an exploratory study of reduction strategies for occupational contact dermatitis in the printing industry

BACKGROUND

Occupational dermatitis is a problem in the printing industry but can be avoided through adequate protective measures. Research into intervention implementation is fundamental to the success of a formal intervention effectiveness trial.

OBJECTIVES

The preliminary testing of four risk reduction strategies for occupationally caused dermatitis, which represent a range of approaches and cost implications.

PATIENTS/METHODS

The strategies, the provision of (i) skin checks plus treatment advice; provision of (ii) gloves of the correct type/size plus use of an after-work cream; provision of (iii) information highlighting the problem of occupational dermatitis and (iv) development of a best practice skin care policy, were evaluated over 3 months in two non-randomly selected companies. A post-intervention evaluation into the effectiveness and efficacy of the intervention was also carried out.

RESULTS AND CONCLUSIONS

All interventions were found to be acceptable to some extent. No single intervention appeared to be completely effective. The most practical intervention appeared to be the regular use of gloves of the correct type and size. This preliminary intervention study has demonstrated an improvement in the skin condition of workers examined and points towards the need for further testing of risk reduction strategies for the prevention of dermatitis in the printing industry on a much larger scale.

Anaphylaxis and allergic contact urticaria from occupational airborne exposure to HBTU

We describe a case of anaphylaxis and allergic contact urticaria from occupational airborne exposure to HBTU (o-(benzotriazol-1-yl)-N,N,N',N'-tetramethyluronium hexafluorophosphate), which is a chemical used widely for solid and solution-phase peptide synthesis. Previously, the use of this chemical has been associated with occupational asthma, allergic contact urticaria and allergic contact dermatitis in individual cases, but not with anaphylaxis. Our diagnoses were based on the clinical symptoms, positive skin prick test (SPT) and positive skin provocation test to HBTU. The positive SPT indicates that the anaphylaxis reaction was IgE-mediated. We recommend that in the handling of HBTU, appropriate safety measures should be compulsory, and if work-related symptoms develop, the possibility of anaphylaxis should be considered in advising on appropriate work tasks.

Dermatitis artefacta in soldiers

BACKGROUND

Dermatitis artifacta is not an uncommon disease in military settings. Soldiers may intentionally produce skin lesions to achieve sick leave from military duties. The aim of this work was to describe a series of soldiers with dermatitis artifacta.

METHODS

A prospective study was conducted among soldiers of the Israel Defense Force.

RESULTS

Fourteen soldiers from the Israel Defense Force were included in the study. There were 13 men and one woman. The ages of the patients ranged between 19 and 26 years. For all patients, dermatitis artifacta was characterized by the acute appearance of a pruritic rash located on readily accessible areas of the limbs and abdomen. The rash was associated with systemic symptoms for 12 (85.7%) of 14 patients. None of the patients admitted to intentionally inflicting the skin lesions. The rash consisted of erythematous patches with numerous papules and pustules arranged in a linear pattern. All patients were treated with topical corticosteroids, four patients were treated with antibiotics, and three patients were treated with systemic corticosteroids. For all patients, the eruption resolved completely within 1 to 3 weeks.

CONCLUSIONS

In the context of soldiers standing to gain sick leave by assuming the sick role, dermatitis artifacta can be reliably diagnosed by noting the characteristic location and morphological features of the skin lesions.

A systematic review of contact dermatitis treatment and prevention

BACKGROUND

Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention.

METHODS

Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence.

RESULTS

In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications.

CONCLUSIONS

A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

Incidence Rates, Costs, Severity, and Work-Related Factors of Occupational Dermatitis

Objectives To extend and update past research on occupational dermatitis by examining recent workers' compensation claims data.

DESIGN

Retrospective analysis of workers' compensation claims from Oregon (1990-1997).

SETTING

All dermatitis-related workers' compensation claims were merged with US census data to estimate rates of dermatitis by age, sex, occupation, and industry. Associated claim costs and disability times were also calculated from these data.

PARTICIPANTS

All individuals with accepted dermatitis claims (N = 611) were included in the analyses.

MAIN OUTCOME MEASURES

The overall claim rates of individuals by age, sex, industry, and occupation were estimated. Total costs and average disability time were computed. Monthly patterns of dermatitis claims were examined.

RESULTS

The average claim rate of occupational dermatitis was estimated to be 5.73 per 100 000 workers (95% confidence interval, 5.66-5.80). Statistically significant differences (P<.001) in claim rates by age, sex, industry, and occupation were found. More than 47% of all claimants had 1 year of job tenure or less. Employees in the farming, forestry, and fishing occupations and industries had significantly higher claim rates compared with employees in other occupations. The average cost per claim was $3552, and the average disability time was 23.9 days. Some temporal trends in claim rates were observed.

CONCLUSIONS

Occupational dermatitis remains a significant problem in workplace settings. In addition, certain types of occupations and industries seem to be particularly affected by occupational dermatitis. Interventions may be particularly valuable for workers with little job tenure.

Eczema herpeticum complicating Parthenium dermatitis

Parthenium dermatitis is one of the most common causes of airborne contact dermatitis in India. Eczema herpeticum has been reported in association with various eczematous conditions, including Parthenium dermatitis. We report a case of eczema herpeticum in association with Parthenium dermatitis. Because Parthenium dermatitis is a common condition in this region, one should be aware of this complication so that appropriate treatment is not delayed.

Tertiare Pravention von Berufsdermatosen. Tertiary prevention of occupational skin diseases

BACKGROUND

Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long-term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available.

PATIENTS AND METHODS

The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period.

RESULTS

In 91% of 296 cases contact dermatitis of the hands was diagnosed (75% primary irritant contact dermatitis (37% chronic irritant contact dermatitis, 38% irritated atopic hand eczema, 16% allergic contact dermatitis). Clinically relevant Type IV-delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42% of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83% of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66%). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60%) and most often experienced corticosteroid withdrawal (53%) and atrophy of the skin of the hands (23%).

CONCLUSION

The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.

Effectiveness of a Hand Care Regimen with Moisturizer in Manufacturing Facilities Where Workers Are Prone to Occupational Irritant Dermatitis

BACKGROUND

Limited information documents the prevention and treatment benefits of a hand care regimen using moisturizer in a controlled manner for employees in typical manufacturing situations.

OBJECTIVE

The objective was to assess the effectiveness of a comprehensive skin care program including skin conditioning lotion in multiple manufacturing environments where employees are at high risk for skin disease.

METHODS

A randomized trial test design with multiple measures, including skin bioengineering measurement techniques, visual grading, and self-assessment questionnaires, was used to broadly characterize skin condition.

RESULTS

Comparison of the change in the skin condition of workers using the full hand care regimen with moisturizer versus a control group using a regimen without moisturizer demonstrated significant (p < .05) improvements in multiple measures after 1 to 2 weeks. Corneometer readings consistently showed significant improvement for employees using moisturizer, regardless of their work location.

CONCLUSION

Improved skin condition resulted from the regular use of an effective skin conditioning hand moisturizer as part of a skin care regimen in work environments in which workers were prone to experiencing occupational irritant contact dermatitis.

Skin-conditioning products in occupational dermatology

Moisturizers are frequently used in the prevention of occupational contact dermatitis. This review discusses their chemistry and mode of action. Methods to prove their preventive efficacy are presented. In addition to pharmacological efficacy, subjective factors that influence application of the products and compliance come into play. In conclusion, moisturizers are only one element of skin-disease prevention at the workplace that should be viewed as a complex, inter-dependent system. The efficacy of the complete, integrated system of occupational skin care has to be proven.

[Contact dermatitis caused by spinach, hedge mustard and chives]

A 54-year-old female working as a vegetable farmer presented with painful pruritic skin lesions on both hands. Physical examination showed a hyperkeratotic fissured eczema. RAST, prick- and patch testing revealed type I and IV hypersensitivity to spinach, ruccola, and chives, so that a protein contact dermatitis was diagnosed.

Allergic contact dermatitis to epoxy resin in immersion oil for light microscopy

Allergic contact dermatitis caused by immersion oil used for microscopy is a recently recognized phenomenon. We report a case with characteristic findings of periorbital erythema and edema in a cytogenetics technician. Positive patch test responses to epoxy resin, epoxy acrylate, and the immersion oil were noted. This case represents yet another contact allergic reaction, possibly airborne, to epoxy resin present in immersion oil used for microscopy.

Contact dermatitis treated with new topical products: a case study

Contact dermatitis, an inflammatory response of the skin to an irritant or an allergen, can affect hospital staff. Most clinicians are routinely exposed to irritants such as latex, detergents, and chemicals. Treatment with topical corticosteroids and avoidance of suspect irritants usually resolves the dermatitis. A case study is presented of a licensed practical nurse who developed persistent contact dermatitis. The dermatitis did not resolve with 15 months of traditional treatments. Only after 3 months of treatment with two investigational topical products, which are now available to the public, was the dermatitis resolved and complete healing achieved. This case study discusses the new products and traditional treatment products used and presents results of irritant specificity testing and a series of photographs documenting resolution and healing.

A skin moisturizing cream containing Quaternium-18-Bentonite effectively improves chronic hand dermatitis

BACKGROUND

Irritant and allergic hand dermatitis is difficult to control in individuals who are unable to avoid causative exposures. Effectiveness of "protective" creams has been poor.

OBJECTIVE

To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a newly developed moisturizing cream containing Quaternium-18-Bentonite.

METHODS

Adult male and female subjects with chronic hand dermatitis felt to be either allergic, irritant, or combined in nature, after a 2-week observation period, were given the study cream for routine application. At 2, 4, and 8 weeks, the investigator and the subject evaluated the skin parameters, including redness, scaling, fissuring, blistering, and pruritus, on a numerical scale. A global evaluation was also performed. Photographs were taken at each visit. Use of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed.

RESULTS

Thirty-seven subjects were enrolled in the study and 33 completed it. The physician's and the subject's initial global evaluations averaged 6.0 and 5.8, respectively (0-10 scale). The final scores were 2.9 and 2.8, respectively, an improvement of 50% (p < 0.001). Topical corticosteroid usage was reduced in 29 of 33 subjects. Fifteen of 35 had a final score of 0-2, indicating complete or almost complete clearing. Only 10, including 2 of the dropouts, failed to show improvement. No adverse effects were noted.

COMMENT

This moisturizing cream significantly improved chronic hand dermatitis in a majority of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

Efficacy of a skin-protective foam in the treatment of chronic hand dermatitis

BACKGROUND

Irritant and/or allergic hand dermatitis in individuals who are unable to avoid causative exposures is difficult to control. Usefulness of protective creams has been generally unsatisfactory.

OBJECTIVE

To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a protective foam containing dimethicone and glycerin.

METHODS

Adult male and female subjects with chronic hand dermatitis for at least 12 months, felt to be either allergic, irritant, or combined in nature were given the study foam for routine application after a 2-week observation period. At 2 and 6 weeks the skin was evaluated by the investigator and subject for parameters including redness, scaling, fissuring, blistering, and pruritus on a numerical scale. A global evaluation also was performed. Photographs were taken at each visit. Usage of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed.

RESULTS

Thirty-one subjects were enrolled in the study and 28 completed it. The physician and subject's initial global evaluations averaged 6.13 and 5.48, respectively (0-10 scale). The final scores were 3.68 and 4.75, respectively (P < .001 for physician rating; P = .259 for subject rating). Topical corticosteroid usage was reduced in 16 of 30 (53.6%) subjects. Twenty-one of 30 subjects (70.0%) had improved over the course of the study. No adverse effects were noted.

CONCLUSION

This protective foam greatly or moderately improved chronic hand dermatitis in a sizable number of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

Long-term, intermittent treatment of chronic hand eczema with mometasone furoate

Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long-term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, chi2-test). Side-effects were minimal. It is concluded that long-term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.

[Fluorescence with Wood's light. Current applications in dermatologic diagnosis, therapy follow-up and prevention]

The invisible long-wave ultraviolet radiation (340-450 nm, max.365 nm) produced by a Wood lamp can help to diagnose dermatoses with a characteristic fluorescence (tinea capitis, erythrasma, tinea versicolor, Pseudomonas infections, porphyrians, and pigmentary alterations). It is also used in the detection of medications that are taken systemically (tetracycline) or that are applied to the skin. Recently, a fluorescence technique with Wood light has been used as a preventive measure to monitor and quantify skin protection at the workplace and to teach workers in high-risk occupations the proper use of protective creams.

The efficacy of a moisturizer (Locobase) among cleaners and kitchen assistants during everyday exposure to water and detergents

Workers exposed to various irritants are widely advised to use moisturizers. To evaluate the efficacy of a moisturizer (Locobase), we studied 111 cleaners and kitchen workers during everyday exposure to water and detergents. All took part in a standardized interview. After randomization, 1/2 the workers (n = 56) used Locobase during a period of 2 weeks (period L), followed by a period without any emollient (period C), or vice versa (n = 55). Clinical assessment and measurements of the skin surface temperature, electrical capacitance and transepidermal water loss (TEWL) were performed on the fingers, hands and arms on entry to the study, after 2 weeks and 4 weeks, or at drop out. The final evaluation showed that 70 (63%) were able to complete the study; 23 (21%) completed period L, but withdrew from period C after a mean of 6 days because of progressive dryness of the skin and eczema; and 12 (11%) were excluded because they used topical corticosteroids or emollients. The remaining 6 (5%) participants were lost to follow-up. Clinically, we observed a significant increase in dryness (p < 0.001) during periods of no treatment (period C), and normalization of the skin texture during use of Locobase. Clinical observations were confirmed by statistically significant differences (p < 0.001) in the electrical capacitance (epidermal hydration), which decreased during period C and increased to pre-study values during period L. No significant differences were found in skin temperatures and TEWL rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Mycobacterium marinum cutaneous infections acquired from occupations and hobbies

BACKGROUND

Non-tuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included.

METHODS

The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x-ray, and treatments were recorded.

RESULTS

M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure.

CONCLUSIONS

Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term "M. marinum cutaneous infection" or "M. marinum granuloma" instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.

[UV cured acrylates--potent contact allergens in the occupational environment]

Allergic contact dermatitis is still an important disease in occupational medicine. Acrylic compounds are known to be potent contact sensitizers causing allergic eczema after occupational exposure. To illustrate the problem and the need for preventive arrangements the authors present an unusual clustering of allergic contact dermatitis in three technicians who produced hearing aids using ultraviolet cured akrylate compounds. All three technicians developed eczema on their fingers few months after introduction of the new acrylate compounds in the production. Skin patch testing with the products confirmed that sensitization.

Allergic contact dermatitis from 4-chloro-7-nitrobenzofurazan

A 30-year-old pharmacist suffered from acute allergic contact dermatitis due to 4-chloro-7-nitrobenzofurazan (NBD-Cl). Contact allergy towards this reagent and 2 of its reaction products was proven by patch tests. As NBD-Cl has not been reported as an allergen before, the characteristics of this chemical and its use as an analytical reagent are briefly surveyed. Similarities to dinitrochlorobenzene (DNCB) are pointed out.

Magnolia grandiflora dermatitis

A patient is described who had allergies to several sesquiterpene lactone-containing plants, but the reaction to Magnolia grandiflora was extremely severe. The condition was a chronic lichenified dermatitis that was unresponsive to treatment but cleared with protective measures. Primary allergy to Magnolia is rarely reported, even though some studies of cross-reactivity suggest that sensitivity is far from rare.

Iontophoretic treatment of herpetic whitlow

Herpetic whitlow can be a vector for spread of infection, especially among health care professionals. Until now, treatment has been inadequate. In two patients with documented herpetic infections of the finger, the antiviral drug idoxuridine was applied to the lesions by cathodal iontophoresis. Results were characterized by rapid relief of discomfort and swelling, rapid appearance and coalescence of vesicles, and rapid healing, with reduced pain and little or no paresthesia. No recurrences have been noted in the two patients after 42 and 38 months. The positive beneficial results indicate that aggressive iontophoretic treatment for herpetic whitlow is useful and justified.

Phaeohyphomycosis due to Phialophora richardsiae

Phaeohyphomycosis, an infection characterised by dematiaceous yeast-like cells, hyphae and pseudohyphae in tissue, is an uncommon condition, often affecting immunosuppressed patients. A sixty four year old boat-builder, receiving treatment with prednisone and azathioprine developed multiple cutaneous nodules on the extremities. Histology showed a mixed dermal inflammatory infiltrate with scattered spores and hyphae. Culture revealed two organisms, Phialophora richardsiae and Exophiala jeanselmei. Fluorocytosine was initially given but the organism was found to be resistant. Since side effects have been associated with long term ketoconazole therapy, a less toxic and more potent triazole compound, itraconazole, was used. After three months, the lesions had completely resolved without adverse clinical or biochemical changes.