C. L. Meneghini

Allergic contact dermatitis to some medicaments.

Over the years, changes have had to be made in the list of topical drags most frequently responsible for allergic contact dermatitis. The 4 most common sensitizers in Italy in the past have been penicillin. Sulfonamide, promethazine and neomycin. Now the list is headed by neomycin, benzoeaine and ethylenediamine. Antihislumines and parabens are less frequently observed as sensilizers. The increasing topical use of new drujis and additives, as well as older sensitizers, produces reactions 10 other substances, such as non‐steroidal anti‐inflammatory agents, some antimycotic drugs, propylene glycol and benzoyl peroxide.

Secondary polymorphic eruptions in allergic contact dermatitis.

10 cases of secondary dissemination of allergic contact dermatitis in the form of erythema multiforme-like or purpura and vasculitis-like lesions are reported. The responsible contact allergens were various constituents of topical applications, such as pyrrolnitrin, sulfonamide, promethazine, balsam of Peru and vioform + ethylenediamine. The clinical patterns and histopathological features of the lesions are described and the possible pathogenetic mechanisms are discussed.

Allergic contact dermatitis in a group of patients with perianal eczema

Results With a tool-grinding machine making endcutters of a tungsten carbide alloy containing about 10 % of cobalt and oil emulsion B, the maximum cobalt content was as high as 217 flg Co/g after 14 days. After one days use, the emulsion already contained about 40 flg Co/ g. The maximum contents of the other metals were 0.13 flg Cr/g and 0.61 flg Ni/g, respectively. Another working piece (a steel alloy with 1 % of chromium) was used in two different machines, a miller and a surface grinder with oil emulsions A and B. respectively. Maximum contents of chromium and nickel were 0.100.15 flg/g for centrifugated samples. Uncentrifugated samples were more irregular, up to 0.87 flg Cr/g and 0.72 flg Ni/g. In the surface grinder, the cobalt content of the emulsion raised to 1.4 flg/g after 28 days, but in the miller, 0.10 flg/g was not reached in 22 days.

Shoe contact dermatitis

The incidence of contact allergy was studied in a series of 165 patients with eczematous dermatitis of the feet correlated clinically with shoe contact. Positive reactions to one or more substances were recorded in 108 patients (65.4%). Among the relevant sensitizers were chromium, paraphenylenediamine, paratertiary butylphenolformaldehyde resin and nickel, while the other allergens were benzocaine, neomycin, balsam of Peru, ethylenediamine and parabens. Allergic contact dermatitis of the feel can he prevented by recognition of the allergens responsible, control of hyperhidrosis and avoidance of topical allergens.

Secretan's syndrome: an artefact oedema of the hand

Henri Secret an, a Swiss insurance and accident physician, was the first to describe persistent hard oedema of the dorsum of the hands in workers involved in compensation claims after injury (1). All the patients described by Secret an sustained minor injuries, the results from which persisted beyond the normal time required for resolution after simple contusions. Since this first report, similar cases have been described by other authors in the non-dermatological literature (2-4). Herewith we report a similar case observed over a period of 18 months.

Frequency of sensitisation to the preservative Kathon® CG

The incidences of sensitisation to Kathon® CG are reported for patients routinely tested from 1984 to 1986 in Bari. London. Louvain, Nijmegen, Oulu and San Francisco, For these 3 years, the overall frequency of sensitisation varied for women from 3.3% in Oulu to 0.6% in London and San Francisco and for men from 1.4% in Oulu to 0% in San Francisco. Women were predominantly sensitised, probably by cosmetics, toiletries and domestic cleaners. Occupational sensitisation was much less frequent.

Contact dermatitis to scabicides

Post-scabies eczematous dermatitis is quite common and is probably due to prolonged use of the available topical preparations. In the last 5 years we have treated 73 patients with widespread eczematous dermatitis following scabies. They all had a history of treatment with topical scabicides over periods of not less than 10 days. The preparations, freely available over the counter in Italy, are based on benzyl benzoate (5-10%), crotamiton or mesulphen. The patients in question used preparations of either benzyl benzoate or, in a majority of cases, mesulphen. All 73 patients were patch tested with the European standard series, with mesulphen (Bayropharm, Milan, Italy) 5% pet., and with benzyl benzoate (Sigma Chemical Company, Saint Louis, U.S.A) 5% pet. The patch-testing and result reading techniques were those described by Fregert et al. (1). The results were positive with mesulphen in 4 patients (2 males and 2 females) and with benzyl benzoate in 1 female patient (Table 1). Mesulphen or 2,7-dimethylthianthrene (empirical formula C14H12S2) (Fig. 1) is a wellknown scabicide and antimycotic. Several cases of allergy to mesulphen 8% in Tineafax®, a topical antifungal, have already been reported (2-5). Of preparations obtainable in Italy, Mitigal liquid® and Mitigal ointment® contain mesulphen at 100% and 64% respectively. In addition to its sensitizing effect, mesulphen is known as an irritant. In controls, skin tests with mesulphen 100% in pet. produced positive

Oral tests in contact allergy to para‐amino compounds

A group of 34 inpatients with contact allergy to para‐amino compounds (sulfanilamide, paraphenylenediamine, benzocaine) underwent a series of peroral tests using structurally related substances, sulphonvl ureas (carbutamide, tolbutamide and chlorpropamide), diaminodi‐phenyl‐sulfone. saccharin and salicyl azosulfapyridine. Sulphonyl ureas given orally can produce a widespread dermatitis in subjects with contact sensitivity to sulfanilamide. but not in those sensitized to paraphenylenediamine and benzocaine.

Contact dermatitis from pyrrolnitrin (an antimycotic agent)

Two cases are described of acute contact dermatitis from an antifungal cream, containing pyrrolnitrin, employed for the treatment of tinea cruris. Positive reactions to pyrrolnitrin and to a chemically related substance, 1‐chloro‐2,4 dinitrobenzene, were put into evidence.

Perinatal gangrene of the buttock: An iatrogenic or spontaneous condition?

Three cases of neonatal gangrene of the buttock are reported. They were characterized by: localization to the skin and muscles of one buttock; sudden onset, minutes after birth; sciatic palsy in two of three and absence of known causes, except for an umbilical injection at birth in two of three. This procedure seems responsible in the first two; the etiology of the apparently spontaneous third case is discussed.