Aynur Akyol

Contact sensitivity to standard series allergens in 1038 patients with contact dermatitis in Turkey

We planned to determine the frequency of sensitivity to European standard patch test allergens in 1038 patients with contact dermatitis. From 1992 to 2004, 1038 patients with the diagnosis of contact dermatitis were patch tested with the European standard series. Seven hundred and five patients were female (67.9%) and 333 patients were male (32.1%). A total of 336 patients (32.3%) had one or more positive patch test reactions. The most common allergens were nickel (17.6%), cobalt chloride (5.3%), potassium dichromate (4.6%), neomycin (2.4%), fragrance mix (2.1%) and balsam of Peru (2.1%). Contact sensitivity to potassium dichromate and thiuram was significantly more frequent in male patients, whereas nickel and primin sensitivity was significantly more frequent in female patients. Higher sensitivity rates for potassium dichromate, neomycin, balsam of Peru, wool alcohol, fragrance mix and primin were noted in patients over 40 years of age. Sensitivity rates of the standard series allergens were all similar in atopic patients and in non‐atopic patients. Metals, neomycin and fragrances are the leading allergens in Turkey. Although fragrances are among the most important sensitizers, sensitivity rates to fragrances and also to preservatives are much lower than the rates in Europe and the US.

Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b

Human papilloma virus (HPV) infections of the oral mucosa presents with various clinical and histopathologic features in relation with the causative HPV type and chronicity and the extent of the infection. 1 The entity is known by several names based on histopathologic variations such as focal epithelial hyperplasia, oral florid papillomatosis, verrucous hyperplasia, oral florid verrucosis, and Ackermans tumor. 2–4 In recent years, the term multifocal papillomavirus epithelial hyperplasia (MPVEH) has been proposed to define the variant that usually occurs in childhood and is characterized by diffuse confluent papillomatous lesions in the oral mucosa. 1 Despite the lesions’ benign appearance, early diagnosis and therapy of MPVEH is essential because of its high capacity for progression and its tendency for malign degeneration. 5–7

Contact sensitivity to preservatives in Turkey

This study was designed to evaluate the frequency of contact sensitivity to 14 common preservatives among patients with contact dermatitis in Turkey. From 2000 to 2004, 308 patients with the diagnosis of contact dermatitis were patch tested in the Department of Dermatology, Ankara University School of Medicine. All patients were patch tested with European standard series. In addition to the four preservatives included in the standard series, patients were also tested with DMDM hydantoin, imidazolidinyl urea, bromonitropropane diol, diazolidinyl urea, thimerosal, propylene glycol, chlorocresol, chloroxylenol, methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) and benzalkonium chloride. Out of the 308 patients suspected of having contact dermatitis, 23 patients were found to have positive reactions to one or more preservatives. Preservatives that were the most frequent cause of positive reactions were thimerosal (1.6%), benzalkonium chloride (1.6%), formaldehyde (1.3%) and MDBGN/PE (0.9%). In our study, 65% of the positive reactions were caused by allergens not present in the standard series, such as thimerosal, benzalkonium chloride and MDBGN/PE. Although thimerosal caused a high rate of contact sensitivity, it may not be considered as an important allergen, because clinical relevance could not be found in any of the patients.

Diagnosis of Immediate Hypersensitivity to β-Lactam Antibiotics Can Be Made Safely with Current Approaches

Background: Diagnosing immediate hypersensitivity to β-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to β-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. Methods: Eighty patients (age range: 6–74 years) with a history of immediate reactions to β-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use β-lactam antibiotics in future whenever their use was indicated. Results: Overall, 29 patients (36.2%) were diagnosed as β-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. Conclusions: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to β-lactams. If these steps are negative, the patients usually tolerate β-lactams and only a few develop mild, non-life-threatening reactions in the long term.

Contact sensitivity to aluminum.

Sensitization to aluminum is extremely rare. Most of the cases have been detected following hyposensitization therapies or vaccinations with substances containing aluminum. Aluminum allergy is more common in pediatric patients and is rarely reported in adults. We present a patient in whom aluminum sensitivity was an accidental finding on patch testing, as the patient had a positive reaction at all the test sites.

Comparative evaluation of Type 1 latex hypersensitivity in patients with chronic urticaria, rubber factory workers and healthy control subjects.

Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex‐specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0·05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.

Photosensitive Rash in Association with Porphyrin Biosynthesis Possibly Induced by Docetaxel and Trastuzumab Therapy in a Patient with Metastatic Breast Carcinoma

Docetaxel (Taxotere), an anticancer agent, is known to cause various reactions, including hypersensitivity, oedema, skin toxicity with erythrodysesthesia syndrome, infusion site reactions, alopecia, nail onycholysis, nail pigmentation, photosensitivity, scleroderma and stomatitis. However, of all the reported effects, photosensitivity has only rarely been described in the literature. We experienced a case of cutaneous photosensitivity with aberrations in porphyrin biosynthesis that developed 1 month after the patient received combination chemotherapy consisting of docetaxel and trastuzumab. The eruption resolved with sun avoidance and discontinuation of docetaxel therapy. To our knowledge, this is the first case of a photosensitive reaction with enhanced levels of porphyrins during docetaxel therapy.

Congenital malalignment of the great toenails in a pair of monozygotic twins.

Congenital malalignment of the great toenails is the lateral deviation of the long axis of nail growth relative to the distal phalanx. The nails grow slowly, with thickening, curving, and transverse ridging. We describe a pair of 3-year-old monozygotic female twins with congenital malalignment of the great toenails complicated by ingrowing and paronychia. Although there are a few cases without any family history, congenital malalignment is believed to be inherited through an autosomal-dominant gene of variable expression. This report provides further evidence of the heritability of the disease.

Giant keratoacanthoma-type low-grade squamous cell carcinoma of the upper lip: Response to intralesional interferon alpha-2B

Giant aggressive keratoacanthoma (KA) is a rare destructive subset of KA that grows rapidly to a large size, and often recurs after surgical management. Here, we present a patient with a solitary giant KA of the upper lip and philtrum that was successfully treated by intralesional injections of interferon alpha-2b (IFN-a-2b). A 43-year-old male presented with a rapidly growing mass on the upper lip for 4 months. The patient had previously been treated in another center with the diagnosis of KA with intralesional triamcinolone acetonide and intralesional methotrexate without any significant clinical response. Thus, the neoplasm continued to enlarge and cover both the philtrum and nasal orifices. Dermatological examination revealed a 7 5 cm verrucoid, firm, painless mass on the upper lip and philtrum extending towards both nasal cavities (Figure 1). A KOH preparation of a skin scraping for fungi, a giemsa-stained touch smear for Leishmania tropica, smears for acid-fast mycobacteria and cultures were all negative. His physical examination and laboratory results were insignificant. A skin biopsy revealed giant solitary KA-type low-grade squamous cell carcinoma (SCC). Total surgical removal of the lesion was refused by the patient. IFNa-2b, 3 1 million international units (MIU)/week was initiated. At the end of the second week, a 50% clinical regression was achieved. Then dosage was increased to 3 3 MIU/week. The treatment was discontinued after 12 injections, with complete resolution of the neoplasm (Figure 2). The disease is in complete resolution without recurrence after 17 months of follow-up. Giant solitary KA is a variant of low-grade SCC (1,2). Although spontaneous regression is common in solitary KA, the giant variant may express aggressive, destructive behavior. Complete surgical excision remains the treatment of choice followed by intralesional methotrexate, 5-fluorouracil, bleomycin, IFNa, triamcinolone acetonide and radiotherapy. Radiotherapy, although efficient in the treatment of KAs, is today used with some caution owing to its carcinogenic potential. In the present case, we consider intralesional IFNa-2b as a therapeutic option due to the patient’s refusal of surgical excision. Successful treatment of KA with intralesional IFNa-2a was first reported in 1989 by Wickramasinghe et al. (3). Since then, few studies had evaluated the efficacy of IFNa in the treatment of KA. The total amount of IFNa needed

Evaluation of the patch test results with standard antigens in various types of eczema

318 patients with various types of eczema, suspected of having contact allergy, were patch tested with a standard series (Chemotechnique Diagnostics AB, Sweden). Patch tests were performed using Finn Chambers@ (Epitest) on Scanpor@ (Norgesplaster). Reactions were graded on a to +++ scale, according to the recommendations of the NADG. Sex, age, localization oflesions, and occupations of the 112 patients with positive reactions, were analyzed.