Björn M. Hausen

Erythema-multiforme-like eruption and depigmentation following allergic contact dermatitis from a paint-on henna tattoo, due to para-phenylenediamine contact hypersensitivity

Case Reports A 9-year-old girl received a paint-on tattoo on her right upper arm in August 2000, a week before her flight back home from Egypt. The day before departure, the tattoo had been repainted. 24 h later, she developed itching, papules and vesicles in the tattoo area. The lesions improved slowly after topical treatment with hydrocortisone butyrate, but depigmentation, developing in the area of the tattoo, persisted for 6 months. Her 11-year-old sister also received paint-on tattoos on her right upper arm, as well as on the back of her fingers, a week before the flight back home. The day before departure, the tattoo had been repainted. 24 h later, she developed itching, papules and vesicles in the tattoo areas. After resolution of the lesions on topical treatment with hydrocortisone butyrate, depigmentation developed, which still persists. Nearly 4 weeks after application of the tattoo, the older girl developed erythema-multiforme-like lesions on her hands and forearms. There were no allergic reactions in her case history, no atopic eczema, no history of hair dyes, and no history of infection for more than 6 weeks prior to the eruption. An 11-year-old boy in the same tourist party had received a tattoo (skull) on the upper arm which had been repainted after 9 days. 3 days later, the boy developed symptoms similar to those observed in the 2 girls. They resolved after topical treatment with mometasone furoate. Hypopigmentation was seen for 2 months. 2 siblings, a 13-year-old boy and his sister, 17 years old, also received such tattoos in Egypt on their right upper arms. 1 day after the tattoos had been repainted, itching, papules and vesicles developed and were cleared with topical corticosteroids. On the arm of the girl, hypopigmentation in the former tattoo area still persists. Patch testing was performed with hair-dye substances as well as textile colours and henna products, according to the guidelines of the German Contact Allergy Group. Lawsone, the known quinonoid constituent of henna (Lawsonia inermis L.), as well as natural henna products, were used to detect hypersensitivity to henna (Table 1). p-phenylenediamine was strongly positive in all patients. Cross-reactions to 3and 4-aminophenol, isopropyl-PPD, p-aminoazobenzene, 4-toluylenediamine and Disperse Orange 3 were also observed. Lawsone produced only 1 slight irritant reaction.

Contact allergy to Disperse Blue 106 and Disperse Blue 124 in German and Austrian patients, 1995 to 1999.

Between 1995 and 1999, 1986 patients were tested in the 31 participating centres of the Information Network of Departments of Dermatology (IVDK), all of them members of the German Contact Dermatitis Research Group, with a textile dyes series containing Disperse Blue (DB) 106 and 124, and since 1997 also with a mix of both. 86 patients (4.3%) reacted positively to DB 106 and/or DB 124; with good concordance between the 2 allergens (Cohen’s weighted kappa 0.72), and the single allergens and the mix (κ=0.75 in both cases), which had been tested in parallel in 969 and 975 patients, respectively. In contrast, concordance between DB 106/124 and p‐phenylenediamine and p‐aminoazobenzene, respectively, was poor. Some 70% of positive reactions to DB 106/124 had current clinical relevance. Furthermore, a significant increase in the proportion of DB 106/124‐positive patients among those tested was found from 1995 to 1999. Hence, DB 106/124 are important allergens deserving close monitoring. The use of a mix of DB 106 and DB 124 seems justified in view of the close chemical similarity of both compounds. If possible, the presence of the allergen(s) in individual textiles considered causative should be checked by thin layer or column chromatography.

Contact allergy to woods

Abstract Among the various natural resources, wood plays an important role for construction, furniture, boat-building, plywood, veneer, and other purposes. It also is absolutely necessary for the production of pulp and paper. In addition, half of the world demands wood for use as fuel. The principal areas from which the major timbers come are tropical and subtropical regions such as South Asia, West and Central Africa, and South America (Amazon basin). Wood for pulp and paper production is provided from the temperate zone and from the tropics of Brazil and Malaysia. Inhalation of wood particles, especially fine wood dust, as well as direct contact with solid wood, may cause a series of different changes in the human organism among which severe poisoning and wood dermatitis are the most striking. Another occupational hazard is adenocarcinoma of the nose and nasal cavities in workers heavily exposed for decades to fine wood dust. 1 This currently is the subject of much discussion in Europe. Carpenters, cabinet makers, joiners, and others who saw, sand, turn, and plane wood are at high risk to develop allergic contact dermatitis, allergic rhinitis, asthma, and, sometimes, extrinsic allergic aveolitis. Irritant dermatitis may arise from the sap or latex of species belonging to the plant families Anacardiaceae, Apocynaceae, Euphorbiaceae, and Moraceae. Among these, some timbers contain compounds with blistering properties due to histamine-liberating alkaloids like cryptopleurine in poison walnut and chloroxylonine in East Indian satinwood. Others contain strong sensitizers, such as (R)-3,4-dimethoxy-dalbergione in Machaerium scleroxylum Tul., which may elicit irritant reactions when applied to the skin in high concentrations. Contact urticaria is produced by species such as obeche ( Triplochiton scleroxylon K. Schum.), 2 limba ( Terminalia superba Engl. & Diels), 3 ramin ( Gonystylus bancanus Baill.), 3,4 teak ( Tectona grandis L.), 5 and larch ( Larix decidua Mill.), 4,6 but rarely is seen. Certain wood species of the families Rutaceae and Flindersiaceae are known for their phototoxic properties, 7 but most of them are not of great commercial value.

The sensitizing capacity of helenin and of two of its main constituents, the sesquiterpene lactones alantolactone and isoalantolactone: a comparison of epicutaneous and intradermal sensitizing methods in different strains of guinea pig

The sensitizing capacities of helenin (an extract from a Compositae Inula helenium L.), alantolactone and isoalantolactone (two isomeric sesquiterpene lactones), were assessed by sensitizing guinea pigs of different strains: albino Himalayan spotted, Pirbright and Hartley. Both alantolactone and isoalantolactone are found to be sensitizers if injected intradermally. Only Pirbright guinea pigs showed a high sensitization rate by the open epicutaneous technique; with this method, alantolactone was the more potent sertsitizer.

Butenylbithiophene, α‐terthienyl and hydroxytremetone as contact allergens in cultivars of marigold (Tagetes sp.)

Ornamental cultivars of Tagetes sp., commonly named marigold, are one of the presently most popular pot, and garden plants. Sensitizing experiments in guinea pigs with short ether extract and isolated compound‐ repealed the presence of 3 constituents that must be considered as contact allergens. They were identified as 5‐(3‐buten‐1‐ynyl)‐2.2′‐bithiophene, α‐terthienyl and hydroxytremetone. In sensitized animals, butenylbithiophene showed moderate to strong Sensitizing potency while α terthienyl was less strong and hydroxytremetone weak. The results demonstrate, for the first time, that at least some of the thiophenes abundantly occurring in many species of the Composite family possess not only phototoxic activity but also sensitizing properties.

Squaric‐acid‐diethylester ‐ a strong sensitizer

A patient developed a circumscribed contact dermatitis after a single contact with squaric‐acid‐diethylester (SADE). Patch tests with low concentrations of SADE were positive. Based on these observations, experimental studies on the sensitizing capacity of SADE were performed on guinea‐pigs. The results disclosed that this compound is a strong sensitizer. Derivatives of SADE, such as the nearly insoluble squaric acid, squaric‐acid‐1, 2‐diarnide and dithio‐N, N′‐dicyclohexyte‐1,2‐diamide were not able to produce allergic skin reactions in the sensitized patient nor in guinea‐pigs. The chemistry and the range of uses of squaric acid and its derivatives are briefly mentioned. A hypothesis on the molecular mechanism of conjugation of SADE to human proteins and thereby on sensitization is discussed. A warning is given for taking precautionary measures before handling this substance.

A simple method of isolating parthenolide from Tanacetum and other sensitizing plants

2. Riva F, Pigatto P D, Altomare F G, Riboldi A. Sensitization to dental acrylic compounds. Contact Dermatitis 1984: 10: 245. 3. Dahlquist I, Fregert S. Allergic contact dermatitis from volatile epoxy hardeners and reactive diluents. Contact Dermatitis 1979: 5: 406-407. 4. Tosti A, Guerra L, Toni F. Occupational airborne contact dermatitis due to epoxy resin. Contact Dermatitis 1988: 19: 220-222. Contact Dermatitis 1991: 24: 153

Contact vitiligo following a strong patch test reaction to triglycidyl-p-aminophenol in an aircraft industry worker: case report and review of the literature

Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50‐year‐old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4‐butanediol diglycidyl ether (1,4‐BDDGE). The chemical triglycidyl‐p‐aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP‐patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo.

Hydrangenol, a strong contact sensitizer found in hydrangea (Hydrangea sp.; Hydrangeaceae)

cury in spectacle frames and skin-lightening creams. Contact Dermatitis 1987: 17: 306--309. 2. Van Ketel W G, Liem D H. Eyelid dermatitis from nickel contaminated cosmetics. Contact Dermatitis 1981: 7: 217. 3. Goh C L, Ng S K, Kwok S F. Allergic contact dermatitis from nickel in eyeshadow. Contact Dermatitis 1989: 20: 380-381. 4. Fisher A A. Cosmetic dermatitis of the eyelids. Cutis 1984: 34: 216--221. 5. Friedlaender M H. Ocular allergy. J Allergy Clin Immuno/1985: 76: 645-657. ·

Allergic contact dermatitis from common ivy confirmed with stored allergens

viously been reported as a cause of dental plate hypersensitivity. Patient no. 7 showed a positive reaction to palladium which is found in dental amalgam. No decision has yet been made to replace his dental fillings. Burning mouth syndrome, orofacial granulomatosis and lichen planus have all been shown in some studies to be associated with delayed hypersensitivity (1, 3), while we found none in these latter 2 categories. Palladium in dental amalgam has been shown to be relevant in 2 other intra-oral studies (4, 5). Our study also shows the importance of flavourings when assessing oral problems, which agrees with previous studies (1–6). It also highlights the potential of patch testing with the patient’s own toothpaste 50% pet. Regarding the 8 patients who were negative, our patch test series may lack some allergens of clinical importance. None of these patients were atopic. Other causes that might give rise to oral symptoms would be irritant or urticarial reactions to foods, food additives and flavourings.