B. Dezfoulian

The dramatic increase in the rate of methylisothiazolinone contact allergy in Belgium: a multicentre study.

The rate of contact allergy and allergic contact dermatitis caused by methylisothiazolinone (MI) is dramatically increasing throughout Europe.

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.

Melanotan-associated melanoma

reactions: they should be treated conservatively if possible as the vast majority resolves spontaneously without intervention. However, treatment may be considered for chronic, recalcitrant abscesses, which may take up to a year to resolve. Choice of treatment depends on the severity of the lesion and the suspected underlying pathological process, either inflammatory or infective. There is inconclusive evidence regarding the efficacy of systemic medications for the treatment of persistent abscesses. Several authors note good response to 2–4 weeks of erythromycin. Hanley et al. compared 1 month of erythromycin 250 mg four times daily and isoniazid 6 mg kg daily. There was no clearly superior treatment. Systemic therapies may be acting as anti-inflammatory agents rather than antituberculous remedies. Torres-Rojas et al. used clarithromycin 7Æ5 mg kg daily for 3 weeks to treat an erythematous nodule at the injection site; the lesion improved in 15 days. However, there is no conclusive evidence that use of antibiotics is superior to expectant management. A placebo-controlled trial is required to determine their role in the management of persistent BCG lesions. Traditionally abscesses have been treated surgically by incision ⁄drainage or needle aspiration and pus cultured. However, surgical intervention in a young child is less appealing than conservative management. Our patients who presented months after vaccination with severe BCG reactions were treated successfully with potent topical corticosteroids. This topical approach facilitated reduction in swelling, inflammation and pain at the BCG reaction site without the need for surgical or systemic intervention. Conservative management without the need for a skin biopsy and systemic medication is appealing in these relatively acute inflammatory reactions in young children. None the less, if recalcitrant lesions start to spread or fail to respond to topical steroids then biopsy for tuberculosis culture and antituberculous drugs may be indicated.

Congenital psoriasis following the lines of Blaschko

Abstract: Congenital psoriasis without an underlying nevus following the lines of Blaschko is described In a 6‐year‐old girl. In addition to this special type of psoriasis, she suffered from atopic dermatitis. The lesions were aggravated by sun exposure and phototherapy treatments, as well as by upper airways infections, without any clear explanation of these trigger factors. We propose to call this form of psoriasis congenital blaschkoid psoriasis.

Epithelioid Cell Histiocytoma: A Report of Two Cases

Epithelioid cell histiocytoma is a rarely reported tumor derived from factor-XIIIa-positive dermal dendrocytes. Two additional cases are presented including their clinical, histologic and immunohistochemical features.

Scedosporium apiospermum septicemia following a wedge excision of an ingrown toenail.

day and progressively improved. The dose was tapered gradually. On the maintenance dose, however, the symptoms worsened. Topical tacrolimus twice daily and prednisone 1 mg/kg/day were started. After 1 year of follow-up, the patient was asymptomatic and there was no recurrence of the clinical features. Crohn’s disease is a chronic inflammatory disorder of unknown origin which may involve any segment of the gastrointestinal tract from mouth to anus, and may present extraintestinal manifestations, with cutaneous being the most frequent. These may be classified as nonspecific or specific lesions with a granulomatous noncaseating infiltrate on histologic examination. The latter can affect the skin of the involved bowel directly, or sites distant from the gastrointestinal tract, known as metastatic Crohn’s disease. Metastatic Crohn’s disease was described for the first time by Parks et al. Clinically, it presents as ulcers, papules, nodules, plaques, or crusts located most frequently on the extremities, flexures, and genitalia. It is necessary to exclude other granulomatous diseases, such as cellulitis, erysipelas, intertrigo, sexually transmitted diseases, hidradenitis suppurativa, lichenoid eruptions, erythema nodosum, primary and secondary lymphedema, hypoproteinemia, and renal, cardiac, and venous problems. Characteristic histologic findings include a noncaseating granulomatous infiltration of the dermis, similar to that of primary Crohn’s disease, often arranged in a perivascular distribution, and sometimes described as granulomatous perivasculitis. There is no specific treatment for genital involvement of Crohn’s disease. Topical and systemic steroid, azathioprine, sulfasalazine, tetracyclines, metronidazole, and dapsone have been used with success. A few cases in which circumcision was required have been reported. Although it has been reported that topical tacrolimus is effective and safe in the treatment of perianal or anal ulcerating Crohn’s disease, metastatic Crohn’s disease treated with topical tacrolimus has not been described. We present a case of Crohn’s disease involving the penis successfully treated with prednisone and topical tacrolimus.

Respiratory and skin hypersensitivity reactions caused by a peptide coupling reagent

TBTU (2-[1H-benzotriazol-1-yl]-1,1,3,3-tetramethyluronium tetrafluoroborate; CAS No: 125700-67-6) and HBTU (2-[1H-benzotriazol-1-yl]-1,1,3,3-tetramethyluronium hexafluorophosphate; CAS No: 94790-37-1) are increasingly used as coupling reagents for the stepwise synthesis of peptides. There have been isolated reports describing the development of rhinitis, urticaria and contact dermatitis1–4 caused by these uronium compounds. We evaluated six workers exposed to TBTU in a laboratory producing a wide variety of biologically active peptides. Three times a week, they weighed 30–50 g of TBTU powder into separate aliquots which were dissolved in dimethylformamide in closed vials and connected to an automated synthesiser. The survey included a detailed questionnaire and skin-prick tests with five common inhalant allergens, natural rubber latex, and freshly prepared dilutions of TBTU, HBTU and hydroxybenzotriazole (HOBt) (1 and 10 mg/ml) in sterile saline. The protocol of …

A new generation of hydrocolloid dressings in combination with topical corticosteroids in the treatment of psoriasis vulgaris

Abstract Aim A clinical, randomized, parallel, multicenter study was undertaken to compare the efficacy and the tolerability of two known steroid creams, betamethasone 17-valerate and clobetasol propionate, alone or left under a hydrocolloid dressing (Contreet° Derma Cover), in the treatment of chronic plaques of psoriasis. Methods A total of 70 patients with symmetrical localized psoriasis were divided randomly into two groups for the study. Each patient applied the corticosteroid preparation under Contreet° Derma Cover once a week on one plaque and the same topical corticosteroid alone b.i.d on the other plaque; the treatment lasted 3 weeks for betamethasone 17-valerate, and 2 weeks for clobetasol propionate. Results The healing rate reached 79% with the Contreet° combined treatment versus 15% ( P P Conclusion The use of the new generation of hydrocolloid dressings in combination with steroid preparations can be considered as another therapeutic option for the treatment of chronic localized psoriatic lesions. Furthermore, with this method the amount of the topical corticosteroid used can be reduced.

Urticaire de contact suite à l’application d’un fond de teint contenant de l’huile de sésame

Resume De multiples produits cosmetiques contenant de l’huile de sesame sont utilises pour les soins quotidiens. Le risque de reactivation secondaire d’un eczema voire d’un choc anaphylactique apres application topique de produits contenant des huiles vegetales est encore mal evalue. Une malade de 36 ans atopique, sensibilisee au sesame a presente une urticaire de contact a un fond de teint contenant de l’huile de sesame. Les prick-tests et les tests epicutanes, a lecture immediate, a l’aide de l’huile de sesame, les graines de sesame, le fond de teint et ses constituants, ont confirme cette sensibilisation. Nous discutons de l’innocuite de l’utilisation de produits d’origine vegetale a vocation alimentaire dans les produits cosmetiques chez les patients souffrant d’une dermatite atopique, surtout en phase inflammatoire, ainsi que chez les patients sensibilises specifiquement a ces allergenes.

Primary Systemic Amyloidosis - A report of 2 cases

We report 2 cases of primary systemic amyloidosis. A monoclonal gammopathy was confirmed at the postmortem examination of the first patient. An extensive search for evidence of chronic infection, inflammation, neoplasms and paraproteinemia was conclusively negative in the other patient. The recognition of cutaneous signs of primary systemic amyloidosis is crucial to insure a rapid management aimed at postponing the fatal issue of the disease.