Audra Blaziene

Formaldehyde may be found in cosmetic products even when unlabelled

Abstract Concomitant contact allergy to formaldehyde and formaldehyde-releasers remains common among patients with allergic contact dermatitis. Concentration of free formaldehyde in cosmetic products within allowed limits have been shown to induce dermatitis from shortterm use on normal skin. The aim of this study was to investigate the formaldehyde content of cosmetic products made in Lithuania. 42 samples were analysed with the chromotropic acid (CA) method for semi-quantitative formaldehyde determination. These included 24 leave-on (e.g., creams, lotions) and 18 rinse-off (e.g., shampoos, soaps) products. Formaldehyde releasers were declared on the labels of 10 products. No formaldehyde releaser was declared on the label of the only face cream investigated, but levels of free formaldehyde with the CA method was >40 mg/ml and when analysed with a high-performance liquid chromatographic method – 532 ppm. According to the EU Cosmetic directive, if the concentration of formaldehyde is above 0.05% a cosmetic product must be labelled “contains formaldehyde“. It could be difficult for patients allergic to formaldehyde to avoid contact with products containing it as its presence cannot be determined from the ingredient labelling with certainty. The CA method is a simple and reliable method for detecting formaldehyde presence in cosmetic products.

Chronic urticaria and thyroid autoimmunity markers

The association of chronic urticaria and autoimmune thyroid disease has been well recognized. Some authors observed relationship between thyroid autoimmunity and chronic autoimmune urticaria.ObjectiveThe primary objective was to evaluate thyroid autoimmunity and thyroid function in chronic urticaria. Secondary objective was to correlate results of antibodies to thyroid peroxidase and markers of autoimmune urticaria (autologous serum skin test and CD63 expression).Materials and methods128 patients with chronic urticaria were evaluated for antibodies to thyroid peroxidase, autologous serum skin test and donor basophil CD63 expression induced by patients sera. Thyroid-stimulating hormone was performed in all patients with elevated antibodies to thyroid peroxidase and 48 patients with normal level of antibodies.ResultsAntibodies to thyroid peroxidase were elevated in 25.0% patients. Thyroid function was abnormal in 28.1% patients with elevated antibodies to thyroid peroxidase and 8.3% patients with normal antibodies level. We did not find the relationship between thyroid antibodies and markers of autoimmune urticaria (autologous serum skin test and CD63 expression).ConclusionsChronic urticaria was frequently associated with thyroid autoimmunity. We did not observe significant relationship between chronic autoimmune urticaria and thyroid autoimmunity and we suggest these are tangential, parallel autoimmune events.

Rare cause of periorbital and eyelids lesions: Discoid lupus erythematosus misdiagnosed as allergy

Figure 1. Clinical presentation of eyelid and periorbital eruptions before treatment. clinically presented with eyelid-only involvement. A 67-year-old woman presented with erythema and light swelling of her upper eyelids and periorbital area without itching (Fig 1). Symptoms appeared 4 month previously. The patient had no history of allergy. The patient was evaluated by several dermatologists and treated for presumed allergic contact dermatitis and fixed drug eruption to occasionally taken nonsteroidal anti-inflammatory drugs. The patient was empirically treated with various topical medicaments (eg, corticosteroids and pimecrolimus for approximately 2 months) and oral antihistamines, without effect. She discontinued her nonsteroidal antiinflammatory drugs for 3 months and her antihypertensive drugs were changed, but no improvement was observed. At presentation, slight edema and violaceous erythema of the right and left eyelids and periorbital area were present without eczematous changes. The notable absence of pruritus was contrary to the diagnosis of allergic contact dermatitis and the violaceous pigmentary hue without duskiness, symmetry, and nonintermittency was contrary to fixed drug eruption. The allergy workup performed included skin prick tests, the results of which were positive for Betulaceae tree pollen mixture ( 2) and a 4-cereal pollen mixture ( 2; Stallergenes, Antony, Haute-de-Seine, France). These findings were irrelevant because her skin problems were not related to the pollination season. Epicutaneous patch testing with European baseline and Cosmetics series (Chemotechnique, Vellinge, Sweden) with readings at 48 hours, 96 hours, and 7 days showed at least 1 reaction (according to the reading criteria of the International Contact Dermatitis Research Group) to shellac. Because the patient used no nail or eye cosmetics containing shellac, this was deemed clinically irrelevant. Therefore, skin biopsy examination of an upper eyelid lesionwas performed. Histopathologic analysis with hematoxylin and eosin staining showed changes consistent with DLE: epidermal atrophy, vacuolar changes, and focal necrosis of basal keratinocytes (68 magnification). Higher magnification (158 ) showed massive periadnexal and perivascular lymphocytic infiltration in the dermis. Focal infiltration showed a lichenoid pattern in the basal layer of the epidermis and the epithelium of the hair follicle.1,2 Antinuclear antibody results were negative, but immunoblot results for extractable nuclear antibodies for Sjögren syndrome antibody A were strongly positive and the erythrocyte sedimentation rate was increased (48e63 mm/h). Results of baseline liver and renal function tests, whole blood cell count, and urine analysis were within normal limits. The Schirmer tear test result was normal and suggested against Sjögren disease.

Serum induced CD63 and CD203c activation tests in chronic urticaria

BackgroundApproximately half of patients with chronic urticaria (CU) have functional autoantibodies against FceRIα or against IgE that induce histamine release from basophils and cutaneous mast cells. In addition to intracutaneous autologous serum skin test (ASST), more recently upregulation of CD63 and CD203c molecules on basophils has been proposed to detect the presence of autoantibodies in sera of CU patients.ObjectiveOur aim was to assess the effect of serum from CU patients on basophil CD63 and CD203c expression and to correlate serum-induced basophil activation with ASST.MethodsSera were obtained from 128 patients with CU and 30 healthy controls. Patients or controls serum was incubated with atopic donor whole blood and activated basophils were identified by flow cytometry on basis of presence of CD63 or CD203c on high-expressing IgE positive cells. ASST was performed in all CU patients and 10 healthy controls.ResultsASST was positive in 33.6% CU patients. Serum from 36.7% patients induced upregulation of CD63 while serum from 45.3% patients upregulated the CD203c molecule. There was a positive correlation between ASST and upregulation of CD63, but no correlation was observed between ASST and serum-induced CD203c. The sensitivity and specificity of the ASST in vitro assays were 55.8% and 72.9% for CD63; 55.8% and 60.0% for CD203 respectively.ConclusionsSerum from CU patients upregulated both CD63 and CD203c molecules on blood basophils. A positive correlation between CD63 assay and ASST indicates the potential usefulness of this test for the diagnosis of the autoimmune form of CU.