Anna Conserva

Allergic and Photoallergic Contact Dermatitis from Ketoprofen: Evaluation of Cross-Reactivities by a Combination of Photopatch Testing and Computerized Conformational Analysis

Allergic contact dermatitis (ACD) and photo-ACD are cell-mediated delayed hypersensitivity reactions of the skin caused by a wide range of substances. Topical ketoprofen (KP), a nonsteroidal anti-inflammatory drug (NSAID), can induce ACD and photo-ACD. Patients with ACD and/or photo-ACD to KP frequently show concomitant sensitization to other substances. The aim of this study was to identify the substances most frequently associated with sensitization to KP, and to evaluate, by means of computerized conformational analysis, whether this association could be due to cross-allergy. 15 subjects with ACD and photo-ACD to KP were tested with the SIDAPA (Società Italiana di Dermatologia Allergologica Professionale ed Ambientale) patch test standard series, including fragrance mix and its components (eugenol, isoeugenol, oak moss, geraniol, hydroxycitronellal, amylcinnamaldehyde, cinnamyl alcohol and cinnamaldehyde) and with the SIDAPA photopatch test series. Allergic reactions to cinnamyl alcohol were noted in all patients, whereas some patients also showed positive reactions to fenticlor, octocrylene and benzophenone-10. Computerized conformational analysis demonstrated that the structure of cinnamyl alcohol is similar to that of KP, whereas the structures of benzophenone-10, octocrylene and fenticlor are completely different. These results suggest that in patients with contact allergy to KP, concomitant positive reactions to cinnamyl alcohol are due to cross-sensitization, whereas simultaneous allergic reactions to fenticlor, octocrylene and benzophenone-10 should be regarded as co-sensitizations.

Cutaneous manifestations of Mycobacterium gordonae infection described for the first time in Italy: a case report

IntroductionMycobacterium gordonae is one of the least pathogenic of the mycobacteria. This pathogen may produce caseating or non-caseating granulomas, and skin lesions showing acute or chronic inflammation with scattered histiocytes and giant cells have been seen. The mortality rate is less than 0.1%. Mycobacterium gordonae may be a marker of severe immunosuppression in patients infected with human immunodeficiency virus.Case presentationWe report a case of Mycobacterium gordonae infection in an 86-year-old woman and discuss the problems inherent to the identification and treatment of this emerging pathogen. Mycobacterium gordonae strain we isolated was resistant to trimethoprim-sulfamethoxazole but sensitive to ciprofloxacin, and long term administration (six months) induced complete healing of the cutaneous abscesses.ConclusionAdvanced laboratory diagnostic techniques have improved the isolation and identification of nontuberculous mycobacteria. The diagnosis requires a high index of clinical suspicion, as detection by conventional methods is difficult. To our knowledge, this patient is the first documented case of cutaneous infection from this pathogen in Italy.

Allergic Contact Dermatitis with a Fertilizer Containing Hydrogen Cyanamide (Dormex

Cyanamide is a chemical substance used in the treatment of chronic alcoholism as well in agriculture as a fertilizer. We report the case of a 28-year-old healthy non-atopic man that developed a severe skin eruption after the accidental penetration of a small amount of Dormex® (a plant growth regulator containing cyanamide) through the patients gloves. Patch tests revealed positive reactions to Dormex® 1% pet. and cyanamide at a dilution of 0.1% pet. and 1% pet. We discuss the causes of sensitization in a patients that regularly used protective measures during anti-parasites treatments.

Occupational contact dermatitis to a limonene-based solvent in a histopathology technician

Recently, D‐limonene‐based solvents are used as a safe alternative to xylene for histological and cytological application to dissolve paraffin. We report the case of a histopathology technician with a recalcitrant hand contact dermatitis strictly related to the use of a limonene‐based solvent agent. Patch tests with SIDAPA (Italian Society of Allergological, Professional and Environmental Dermatology) standard series, limonene‐based solvent used by the patient and D‐ and L‐limonene (both oxidized and nonoxidized form) and with Giemsa and methylene blue stains were performed. Patch testing gave positive results to oxidized D‐ and L‐limonene. The patient retired from work and promptly improved and healed the hand eczema. Subsequently, the potential occurrence of limonene oxidation products in the incriminated preparation was investigated using gas chromatography–mass spectrometry. While patch test showed positive reaction to oxidized limonene, chemical analysis failed to detect oxidized limonene in the preparations used by the patient. Considering the strict relation between the use of the preparations and the appearance of symptoms, we can assume that oxidized limonene may be produced during the handling of limonene‐based products, especially in the presence of oxidants stains, frequently used in histological laboratories.

Allergic Contact Dermatitis to Condoms: Description of a Clinical Case and Analytical Review of Current Literature

We describe the case of a 42‐years‐old non‐atopic man who developed a severe eczematous reaction in the genital area some hours after the use of a condom (Settebello‐Hatù® Durex) containing a retarding cream. Patch test revealed a strong allergic reaction to the retarding cream and to benzocaine and paraben mix contained in the cream itself. Condoms with retarding cream should be avoided in man sensitized to local anestethetics.

Cold burn from contact with a propane and butane gas blend inside a spray canister used as a hooter

A 45-year-old non-atopic man was admitted to our clinic for a severe erythemato-edemato-vesicular and bullous reaction with a ‘poured’ aspect localized on the right arm, associatedwithhigh fever.Laboratory tests showed a neutrophilic leukocytosis, while venous and arterial echocolor doppler of both arms excluded a thromboembolic process. A systemic antibiotic therapy induced a progressive clinical improvement. After 10 days of hospitalization, the skin lesions worsened, becoming necrotic (Fig. 1). Laboratory tests showed leukocytosis and piastrinosis; computed tomography scan of the affected arm did not show any anomaly. After a careful review of the history, the patient mentioned that the skin complaint had started after accidental contact with the contents of a spray canister used as a hooter during a Sunday football match. As the spray canister was defective, it exuded a cold liquid that had run down his upper arm while he held it up. The contents of the canister were confirmed by the supplier to be a blend of propane and butane gas. Diagnosis of a cold burn because of contact with LPG was made, and the patient underwent hyperbaric oxygen therapy sessions.

Allergic contact dermatitis to regenerated oxidized cellulose contained in a matrix employed for wound therapy

We describe a case of a 40‐year‐old non‐atopic woman with recurrent leg ulcers because of the factor V Leiden mutation who developed a severe eczematous lesions of the skin surrounding an ulcer of the right leg after the use of a protease‐modulating matrix (Promogran®, Johnson and Johnson, Gargrave, Skipton, UK). The patient was patch tested with the SIDAPA (Italian Society of Allergological, Occupational and Environmental Dermatology) standard series, a piece of the device as is, of the bovine collagen (Zyderm®, Collagen Corporation, Palo Alto, CA, USA) as is, a piece of the gauze containing only regenerated oxidized cellulose (Tabotamp®, Johnson and Johnson, Gargrave, North Yorkshire, UK) and of a fold towels in pure cellulose (Foscart, Bassano del Grappa, Italy). Patch tests gave a positive reactions to nickel sulphate and Promogran® as is. We showed that the sensitizing agent was regenerated oxidized cellulose, a substance the treatment of ulcers and as is in and in combination with collagen in surgery for intraoperative hemostasis. The case reported suggests that regenerated oxidized cellulose can cause allergic contact dermatitis.

Contact dermatitis with clostridiopeptidase A contained in Noruxol® ointment

Clostridiopeptidase A, also called collagenase 1, is a proteolytic enzyme capable of digesting collagen. Preparations containing clostridiopeptidase A are used topically for the debridement of dermal ulcers, burns and other necrotic lesions to facilitate the formation of granulation tissue and subsequent epithelization. We observed 4 patients with a periulcerative eczema after repeated applications of Noruxol® ointment (Smith & Nephew Ltd, L Hull, UK). Patch testing with Noruxol® ointment as is and its excipients (soft paraffin and white petrolatum), as well as scaled dilutions of the main ingredient of this topical preparation, clostridiopeptidase A (Firma, Florence, Italy), showed doubtful reactions to Noruxol® ointment in 3 patients and a positive reactions only in 1 patient. All patients showed positive reactions to clostridiopeptidase A 1% in pet. This study shows the sensitizing capacity of clostridiopeptidase A that should be tested in all patients with suspect sensitization to Noruxol® ointment.

Risk factors for sensitization to AnisakiS simplex: a multivariate statistical evaluation.

Anisakis simplex is a nematode belonging to the Anisakidae family. The ingestion of third stage larvae in uncooked or undercooked seafood may cause human diseases known as anisakiasis and anisakidosis. A total of 400 (159 atopic and 241 non-atopic) subjects living in an area of southern Italy (Bari district) were consecutively evaluated to identify the association of some factors (sex, age, atopy, consumption of uncooked seafood and sensitization to dust mites) with the risk of Anisakis simplex sensitization. Patients were investigated on history of atopy and allergic diseases and were skin prick tested with commercial allergen extracts of Anisakis simplex, Acarus siro, Lepidoglyphus destructor, Tyrophagus putrescentiae, Glycyphagus domesticus, Euroglyphus maynei, Dermatophagoides pteronyssinus and Dermatophagoides faunae. Our results suggest that atopic subjects have a lower risk of Anisakis allergy than non-atopic subjects and show the association of Anisakis simplex sensitization with the consumption of uncooked seafood (anchovies and squid), increasing age and sensitization to Glycyphagus domesticus.

Long-term toxic effects of radiations: sarcomatoid carcinoma and multiple basal cell carcinoma of the limbs in chronic radiodermatitis.

A 73-year-old woman was referred to our attention for the presence of severe chronic lymphoedema and neoplastic lesions of the limbs. When she was 19 years old, the patient had undergone X-ray epilation of the limbs to remove unwanted body hair. The neoplastic lesions, observed 2 years before our observation, were excised, and histological examination revealed multiple basal cell carcinomas and a spindle squamous cell carcinoma on the left thigh. The case we observed offers some interesting points of consideration as it shows that in nonexposed areas cutaneous carcinomas can appear many years after irradiation and that the same treatment consequently requires careful follow-up for life. Another point of interest is the particular hystological aspect of neoplastic lesions in the site of radiodermatitis that requires in-depth immunohistochemical investigation for an exact diagnosis. Patients with previous treatment with ionizing radiation also in nonexposed areas need lifelong follow-up to identify cutaneous tumors at an early treatable stage.