Begoña García-Bravo

Estudio epidemiológico de la dermatitis alérgica de contacto en España (2001)

Resumen Introduccion El estudio mediante pruebas de contacto estandar es fundamental para diagnosticar y tratar cualquier paciente en el que se sospeche una dermatitis de contacto. El primer estudio estadistico con pruebas epicutaneas estandar del Grupo Espanol de Investigacion de Dermatitis de Contacto (GEIDC) data de 1977. Veinticinco anos mas tarde, se realiza este estudio que tiene como objetivo valorar la prevalencia y la relevancia de las positividades a los alergenos de la serie estandar del GEIDC. Metodos Todos los pacientes fueron estudiados mediante la serie estandar del GEIDC (29 alergenos) en 13 centros dermatologicos. Se valoraron los siguientes parametros: sexo, edad, localizacion, diagnostico, causa del eccema, positividades y relevancia total, presente y pasada. Resultados El 55,11 % de los 3.832 pacientes estudiados (2.300 mujeres y 1.532 varones) tuvieron alguna positividad en la serie estandar. Los diagnosticos mas frecuentes fueron la dermatitis de contacto alergica en el 31,02 % e irritativa en el 15,88 %. El origen mas comun de la dermatitis fue profesional en el 16,66 % de los casos, y la metalurgia y la construccion fueron las ocupaciones mas prevalentes. Mas de la mitad de los pacientes sufrian eccema en manos (54,34%). El alergeno mas prevalente fue el niquel (26,64%) seguido de cobalto (9,89 %) y cromo (8,66 %). Conclusiones Comparando los datos de este estudio con el realizado por el GEIDC en 1977 comprobamos como ha aumentado la alergia a niquel mientras ha disminuido la debida a cromo y cobalto. Alergenos no incluidos anos atras como tiomersal, mezcla de perfumes y Kathon CG muestran actualmente una alta prevalencia. Es siempre fundamental establecer la relevancia de las pruebas positivas, que es alta en este estudio para las gomas y para el niquel.

Patch testing with oxidized R-(+)-limonene and its hydroperoxide fraction.

R‐(+)‐Limonene is an ubiquitous allergen in our environment. It is one of the most widely used fragrance materials not only in fine fragrances but also most often incorporated in domestic and occupational products. Although the non‐oxidized R‐(+)‐limonene itself is not allergenic, it easily forms allergenic products due to autoxidation during handling and storage. 2273 patients at 4 dermatological clinics in Europe were patch tested between 1997 and 1999 in 2 steps. First, the oxidation mixture of R‐(+)‐limonene and 1 selected allergen fraction of the mixture, the limonene hydroperoxides, were tested in 2 different vehicles in consecutive patients. A diverging frequency of positive patch test reactions was observed in the 4 clinics. 3·8% of the consecutive patients tested reacted to oxidized R‐(+)‐limonene in 2 clinics, 6·5% in the 3rd, whereas 0·3% in the 4th clinic. In 2 of the centres, different but significant concomitant positive response rates to other allergens were observed; e.g. to fragrance materials and to colophonium. However, in the total test population, 57% of the limonene‐allergic subjects did not react to any of the fragrance allergy markers used in the standard series. In the 2nd step, patients showing positive reactions were retested, also including additional separate allergens of the limonene oxidation mixture (carvone and limonene oxide). 60% of the limonene‐allergic patients showed positive results at retesting. The limonene hydroperoxide fraction was proved to be the most important allergen of the oxidation mixture, showing positive reactions in around 60% of the limonene‐allergic patients at both test sessions. Testing limonene oxide and carvone separately resulted in very few positive reactions. 3% oxidized R‐(+)‐limonene in non‐stabilized petrolatum is most suitable when using only 1 test preparation for diagnosis of contact allergy to oxidized limonene. Our data give clinical support to the European classification of R‐(+)‐limonene, containing oxidation products, as a skin sensitizer.

Hypersensitivity to ketoconazole preparations: study of 4 cases

Diffey et a!. (8) were the first to describe photosensitivity to tiaprofenic acid; further reports confirmed its photosensitizing properties (9, 11). Recently, Neumann et a!. (7) photopatch tested 45 patients to tiaprofenic acid and, in 23 of them (51%), phototoxic reactions were found. Oral photoprovocation tests have demonstrated that tiaprofenic acid can also exhibit photosensitizing properties after systemic administration (12). In our patient, there was a history of topical use of tiaprofenic acid with ion to therapy and no history of systemic use of the drug; moreover, there was no history of topical and/or systemic use offlurbiprofen. It is interesting that the patient had a relapse of lesions after oral intake of ketoprofen tablets, but that patch and photopatch testing with ketoprofen 2, 5 and 10% pet. gave negative results. In the light of these results, we consider that: (i) true cross-reactivity probably does not exist between tiaprofenic acid and ketoprofen, but that there is probably a group pharmacological reactivity; (ii) in photodiagnostic procedures, we must evaluate the role that different energies may have on the reactions of these compounds; (iii) our patient is a true case of allergic photocontact dermatitis from tiaprofenic acid, with propionic acid group reactivity.

Baboon syndrome in childhood: easy to avoid, easy to diagnose, but the problem continues.

Abstract:  Baboon syndrome was first described as a particular type of systemic contact dermatitis, characterized by an exanthem with involvement of the buttocks and flexures. In children, it is an important entity to take into account for the differential diagnosis of viral exanthem. A large number of allergens have been implicated, although inhalation of mercury vapor is a common trigger. We present the findings in 14 patients younger than 14 years with baboon syndrome. We also look at the frequency in children and the most common causes and triggers in our area.

Patch testing in children with hand eczema. A 5‐year multicentre study in Spain

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children.

Riga‐Fede Disease Associated with Postanoxic Encephalopathy and Trisomy 21: A Proposed Classification

Abstract: We present a new instance of Riga‐Fede disease in a 2‐year‐old boy with Down syndrome and postanoxic encephalopathy. We propose a classification of the disease, as either “precocious,” associated with natal or neonatal teeth or “late‐onset,” associated with neurologic disease.

Contact sensitization to limonene and linalool hydroperoxides in Spain: a GEIDAC(*) prospective study.

Limonene and linalool are common fragrance terpenes widely used in cosmetic, household and hygiene products. Their primary oxidation products formed after air exposure, the hydroperoxides, have been recognized as important contact haptens.

Patch testing with formaldehyde and formaldehyde-releasers: multicentre study in Spain (2005–2009)

Background. Formaldehyde and formaldehyde‐releasers are common causes of allergic contact dermatitis.

Generalized pustulosis and severe tubulointerstitial nephropathy as manifestations of carbamazepine hypersensitivity syndrome.

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Two cases of contact dermatitis caused by calcipotriol cream

Two patients with psoriasis were treated with calcipotriol cream, and both developed contact dermatitis. Patch test results were positive to calcipotriol and negative to the ingredients of the vehicle in both cases. The first case may be explained by a compound allergy or by a false-negative reaction to calcipotriol due to the very low concentration used for patch tests. The second patient was clearly positive to calcipotriol despite low concentration. This is the first case reported thus far with sensitivity to calcipotriol at a concentration < 2 mc/mL, as recommended in other studies.