Christen Mowad

The role of extracellular polysaccharide substance produced by Staphylococcus epidermidis in miliaria

BACKGROUND Previous studies have indicated that cutaneous bacteria, particularly coagulase-negative staphylococci, play a role in the pathogenesis of miliaria. An accumulation of periodic acid-Schiff (PAS)-positive material has been described as blocking the sweat duct in miliaria. Furthermore, a PAS-positive extracellular polysaccharide substance (EPS) has been identified as a product of some strains of Staphylococcus epidermidis. OBJECTIVE We evaluated the relative ability of various species of coagulase-negative staphylococci to induce miliaria with particular reference to the potential role of EPS. METHODS We inoculated various strains of coagulase-negative staphylococci on the volar forearms of subjects under an occlusive dressing coupled with thermal stimulation. Ability to induce miliaria as well as microbiologic, histologic, and immunostaining features were evaluated. RESULTS Miliaria was induced only with strains of S. epidermidis; other species including S. haemolyticus, S. hominis, S. cohnii, S. saprophyticus, and S. simulans were not capable of inducing miliaria. Moreover, only S. epidermidis strains capable of producing EPS were capable of inducing miliaria. CONCLUSION Our data indicate that EPS is the PAS-positive material that obstructs the delivery of sweat to the skin surface in miliaria and therefore demonstrate that the EPS produced by S. epidermidis plays a central role in the pathogenesis of miliaria. Furthermore, in a survey of staphylococcal flora isolated from 68 subjects, EPS-producing strains were found to be common.

Bleomycin-induced flagellate dermatitis: a clinical and histopathological review

We report a case of bleomycin‐induced flagellate dermatitis. Our patient developed pruritic linear lesions 4 days after her first dose of bleomycin. A closed patch test was performed, and was negative. However, on rechallenge, the linear eruption recurred in the previously involved sites, and in new sites, within 24 h. Flagellate dermatitis is a characteristic reaction to bleomycin use, but varying histological features and clinical presentations may be seen.

Contact dermatitis to foods and spices.

Cutaneous reactions to foods and spices occur in both the workplace and at home in those who grow, handle, prepare, or cook food. As spices are also used in cosmetics and perfumes other exposures are found. Several patterns have been described upon contact with food including irritant contact dermatitis, allergic contact dermatitis, contact urticaria, phototoxic contact dermatitis, and protein contact dermatitis. The purpose of this article is to review the approach to a patient suspected of having a cutaneous reaction to food or spices, as well as discuss these reactions and the allergens that cause them.

Chloroxylenol causing hand dermatitis in a plumber.

Chloroxylenol use has increased and is found in many over-the-counter preparations. Although not a common sensitizer, chloroxylenols role as a contact allergen and relevance, when positive patch tests are found, is often high. Pre-patch test assessment generally does not identify chloroxylenol as a causative agent. It is increasingly found in liquid soaps particularly in industry and specifically in the health care environment. Even as a wash-off product, this allergen can be a hidden cause of allergic contact dermatitis.

Routine testing for Primula obconica: Is it useful in the United States?

Allergic contact dermatitis to Primula obconica has long been established. It is considered a significant allergen in Europe and has been included in standard screening there. The allergen is much less common in the United States. The frequency of allergy to P obconica in the United States is difficult to assess because no series of routine testing to this allergen has been reported. The purpose of this study was to evaluate the frequency of primin allergy in routine testing in a referral patch test center. A series of 567 consecutive patch tests was performed that included primin as part of the standard screening. Only one patient had a positive reaction. Although it is frequently missed and often difficult to diagnose, the frequency of primin allergy in this series was too low to indicate including this allergen as part of routine testing.

Contact urticaria from xylene

Xylene is widely used in medical technology, but there are many concerns about its safety. A 52-year-old woman, employed as a histotechnician, presented with burning, swollen hands. Patch testing and a visit to her place of work confirmed exposure and sensitivity, in the form of contact urticaria, to xylene. The use of xylene-resistant gloves resulted in clearing of the dermatitis. Establishing the diagnosis of contact urticaria from xylene allowed the patient to be cured of her dermatitis and continue working.

Elephantiasis nostras of the lips: A case report

Elephantiasis nostras (EN) is a clinical entity that usually presents as a persistent swelling of the lower extremities. It has been related to recurrent lymphangitis of bacterial origin that causes a fibrosis and thickening of both epidermal and connective tissue. Although very rare, EN has been previously reported in the lips. This is the first case reported in the oral medicine literature that describes EN involving the lips. We describe the clinical features and a differential diagnosis of the lip lesions and a treatment protocol to which this patient has responded. A diagnosis of EN should be entertained in patients with chronically edematous, scaling lip lesions.