Screening for contact allergy to artificial nails

27 patients (26 women and 1 man), all in contact with artificial nails, were tested for acrylic compounds, known to be present in nail cosmetics. The patch test results obtained in these patients demonstrated that 2-hydroxyethyl methacrylate and ethyl cyanoacrylate were the only 2 allergens needed to diagnose contact allergy to acrylic-containing nail cosmetics, except for 1 patient who reacted only to her nail preparation used and in which we were unable to identify the allergen. This concerns clearly a limited number of patients. The purpose was, however, to detect the most valuable allergen(s) to be used in a dermatologist's practice, in which not all possible allergens can be tested, in order to diagnose such cases.

Contact and photocontact allergy to ketoprofen. The Belgian experience

Topical ketoprofen (KP) is widely used because of its anti-inflammatory effect. However, photocontact dermatitis is a side-effect. Between May 2001 and June 2002, the Belgian Contact & Environmental Dermatitis Group conducted a prospective, open patch and photopatch test study in 20 patients suspected of KP dermatitis. Severe skin symptoms requiring systemic corticotherapy occurred in 47%. 5 patients were hospitalized. 1 patient showed prolonged photosensitivity. All patients were tested with KP and the other constituents of KP gel. Attribution to KP was demonstrated in all cases. Patch and photopatch tests with KP 2% in petrolatum showed contact photoallergy in 17 patients, contact allergy in 1 patient and photoaggravated contact allergy in 2 patients. 5 patients also reacted to the fragrance components lavender (Lavandula augustifolia) oil and/or neroli (Citrus aurantium dulcis) oil 5% in alcohol. However, in 4 of these, irritant reactions to the ethanolic dilutions could not be ruled out. Additional tests with 3 non-steroidal anti-inflammatory drugs without benzophenone structure ibuprofen, naproxen and diclofenac identified only 1 contact allergic reaction to diclofenac. Cross-reactivity to the substituted benzophenones, oxybenzone and sulisobenzone occurred only to the first in less than 30% of the patients. A high frequency (69%) of contact allergy to fragrance mix was found. Dermatologists should be aware of the severity of photoallergic reactions to KP and the risk of cross-sensitization.

Cutaneous manifestations of internal diseases

Collaboration between specialists is necessary for good practice of medicine. The dermatological examination, mainly based on visual characteristics, can greatly help other specialisms when confronted with a seemingly futile skin anomaly. We discuss the various cutaneous features of some metabolic and infectious diseases, the pitfalls in diagnosing lupus erythematosus without knowledge of skin disease and the relationship of dermatological diseases as cutaneous vasculitis, pyoderma gangrenosum, Sweet's syndrome, pemphigus and more to internal disease.

Pesticides and mortality from hormone-dependent cancers

Endocrine-disrupting chemicals are considered to be a possible cause of hormone-dependent cancers. In areas of high exposure to pesticides, people are concerned about the long lasting toxicity of pesticides, some of which are possibly hormonally active. We collected for each Belgian municipality (n = 589) the latest mortality statistics from breast and prostate cancer (period 1985-1994) and the latest data on crops and pesticides (1998). In addition, data on possible confounders such as population density, degree of urbanization, industrial activity and the presence of an incinerator were collected as well. The data were analysed with spatial statistics that takes into account the spatial nature of the data. There is a large variation in crops and pesticide exposure among the municipalities, the highest exposure being seen in the fruit production area. Apart from use of defoliants and potato cultivation, no consistent correlation was detected between crops, pesticides and mortality from breast and prostate cancer. Our data cannot support the hypothesis of a relationship between total and class-related pesticide use and breast and prostate cancer mortality. However, the increased mortality due to breast cancer and to a lesser extent due to prostate cancer in traditional potato-growing areas needs attention and more research.

Beneficial effects of a skin tolerance-tested moisturizing cream on the barrier function in experimentally-elicited irritant and allergic contact dermatitis

In experimentally-induced irritant (ICD) and allergic (ACD) contact dermatitis, an oil-in-water (o/w) cream was applied to investigate its effects on a disturbed barrier function compared to untreated physiological barrier repair. Transepidermal water loss (TEWL) measurements were performed. Before the start of the experiments, the skin tolerance of the cream was examined, revealing the non-irritating characteristics of the ingredients and the absence of any contact allergic patch test reaction. In the ICD study, sodium lauryl sulfate (SLS) patches were applied to the forearms of young female volunteers. Consequently, it was observed that repeated cream application (14 days, 2x/day) significantly improved the TEWL of SLS-damaged skin, leading to a complete recovery on day 15. In the ACD study, disruption of skin barrier function was obtained by a nickel-mediated contact allergy patch (CAP) test. The cream was then applied 2x/day for 4 consecutive days. Assessment of TEWL clearly showed that recovery of the disrupted skin significantly improved after cream application in comparison to untreated barrier repair.

Renal function, cytogenetic measurements, and sexual development in adolescents in relation to environmental pollutants: a feasibility study of biomarkers

BACKGROUND

Human exposure to chemicals is normally monitored by measurement of environmental pollutants in external media. We investigated whether biomarkers in adolescents can show exposure to, and health effects of, common environmental pollutants.

METHODS

We recruited 200 17-year-old adolescents (120 girls) from a rural control area and from two suburbs polluted by a lead smelter and two waste incinerators. We measured biomarkers of exposure and of effect in blood and urine samples, and obtained questionnaire data. School doctors measured testicular volume and staged sexual maturation.

FINDINGS

Internal exposure was mostly within current standards. Concentrations of lead and cadmium in blood, PCBs (polychlorinated biphenyls) and dioxin-like compounds in serum samples, and metabolites of VOCs (volatile organic compounds) in urine were higher in one or both suburbs than in the control area. Children who lived near the waste incinerators matured sexually at an older age than others, and testicular volume was smaller in boys from the suburbs than in controls. Biomarkers of glomerular or tubular renal dysfunction in individuals were positively correlated with blood lead. Biomarkers of DNA damage were positively correlated with urinary metabolites of PAHs (polycyclic aromatic hydrocarbons) and VOCs. Interpretation Biomarkers can be used to detect environmental exposure to pollutants and measure their biological effects before overt disease develops. Our findings suggest that current environmental standards are insufficient to avoid measurable biological effects.

Contact allergy to resorcinol monobenzoate

Resorcinol monobenzoate is an ultraviolet light absorber used in cellulose plastics and is known to cause allergic contact dermatitis reactions. It is the most important allergen in spectacle frames but can be a potential allergen in shoes as well. We report 7 cases of allergy to resorcinol monobenzoate with different clinical presentations. Our series further illustrates several possible cross-sensitizers.

Correlation between in vivo humoral and in vitro cellular immune responses following immunization with hepatitis B surface antigen (HBsAg) vaccines

To study the regulation of the human immune response to hepatitis B surface antigen (HBsAg) we have carefully monitored the in vivo humoral and in vitro cellular immune responses to HBsAg in 50 subjects receiving four doses of hepatitis B vaccine according to a 0, 1, 2, 12 month vaccination scheme. Twenty-three subjects were given a plasma-derived vaccine (Hevac B) and 27 received a recombinant HBsAg vaccine (yeast-derived; Engerix-B). The humoral and cellular immune responses were measured before vaccination (day 0); 6 days after the second dose (day 36); 6 days (day 66), 2 months (day 120) and 10 months (day 365) after the third dose and 1 month after the fourth dose (day 395). Based on the kinetics of the humoral immune responses, the vaccinees could be classified into fast, intermediate and slow/non-responders. Based on the magnitude of the immune response (anti-HBs titre) on day 395, the vaccinees could be divided into high (> or = 2000 U l-1) and low (< or = 2000 U l-1) responders. A close correlation between the kinetics and the magnitude of the humoral immune response was observed. The in vivo anti-HBs response was measured using commercially available immunoradiometric assays. The in vitro cellular immune response was measured using an HBsAg-specific lymphoproliferation assay. Because of interassay variability the results were considered as dichotomous variables (proliferation versus non-proliferation) for further data analysis. A statistically significant correlation was observed between the kinetics and magnitude of the humoral immune response on the one hand and the in vitro anti-HBs response on the other hand.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis B virus-specific cytotoxic T lymphocyte responses in patients with acute and chronic hepatitis B virus infection

An in vitro model was developed that allowed the analysis of hepatitis B virus-specific cytotoxic T lymphocyte responses in patients suffering from acute and chronic hepatitis B virus infections. Since virus-specific cytotoxic T lymphocytes recognize endogenously synthesized and processed antigen only when it is presented in the context of autologous HLA class I molecules and since hepatitis B virus does not infect human cells in vitro, a panel of recombinant vaccinia viruses was constructed to induce the expression of hepatitis B virus envelope and nucleocapsid proteins in cultured primary cells or cell lines derived from the patients to be studied. In order for a cytotoxic T lymphocyte response to be detectable with the currently available techniques, a sufficient number of activated cytotoxic T lymphocytes is required. To meet this requirement, lymphocytes freshly isolated from venous blood were stimulated in vitro with recombinant vaccinia-infected and formaldehyde-fixed autologous T lymphoblasts. The presence of hepatitis B virus-specific cytotoxic T lymphocytes, amplified and activated during this induction culture, was demonstrated in a microcytotoxicity assay using 51Cr-labeled, recombinant vaccinia-infected Epstein-Barr virus-immortalized, autologous B lymphocytes as target cells. Using this in vitro model, we were able to demonstrate the presence of hepatitis B virus envelope- and nucleocapsid-specific cytotoxic T lymphocytes in venous blood from one subject who had recently recovered from an acute hepatitis B virus infection and in three patients suffering from chronic hepatitis B virus infections. No hepatitis B virus-specific cytotoxic T lymphocytes activity was discernible in the venous blood from two vaccine recipients.(ABSTRACT TRUNCATED AT 250 WORDS)

Dermatitis plantaris sicca

In 22 children with dermatitis plantaris sicca no or insufficient arguments were found to relate the condition to atopy, contact allergy or mycologic infection. Successful therapeutic results with urea creams and salicylic acid ointments rather point to dehydration by external factors as an important cause.

Evolution of atopic dermatitis

A follow-up study was done in 50 patients with atopic dermatitis over a time lapse of approximately 20 years. 31 patients (62%) continued to have atopic dermatitis, although usually in a less severe form. Severe atopic dermatitis in childhood, association with asthma and hay fever, presence of atopy in the family seem to indicate that atopic dermatitis will continue in adult age. Hay fever and a familial history of atopy are statistically significant risk factors.

Ethylenediamine sensitivity from exposure to epoxy resin hardeners and Mycolog cream

Sensitivity to ethylenediamine and to epoxy resin hardeners was found in three patients with long standing contact dermatitis. In one patient, a young man, the sensitivity was elicited by occupational contact with epoxy resin hardeners and subsequently sustained by use of Mycolog cream. In two patients, both elderly women, the condition was only due to use of Mycolog cream. These case histories and test results indicate that use of Mycolog cream can result in occupational disease viz. contact dermatitis from epoxy hardeners.