Dan Slodownik

Irritant contact dermatitis: A review

Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. The diagnosis of irritant contact dermatitis is often clinical, and may only be possible after the exclusion of allergic contact dermatitis with patch testing. There is no readily available diagnostic test. There is an incomplete understanding of the factors which lead to the development of cumulative irritant contact dermatitis and persistent postoccupational dermatitis. We have used the experience from our tertiary referral occupational dermatology clinic to illustrate various aspects of irritant contact dermatitis, and to highlight the difficulty sometimes encountered in making this diagnosis. We believe that increased awareness of the often pivotal role of irritant contact dermatitis, as well as all the other factors contributing to occupational dermatitis, will lead to improvement in outcomes for patients.

Textile allergy – the Melbourne experience

Background. Textile allergy is a well‐established entity, but there are relatively few Australian reports in this area.

Occupational factors in skin diseases.

A significant proportion of our lives is spent at work, and thus environmental factors are of great importance. Work-related skin conditions have become one of the leading causes of occupational diseases impacting on individuals, society and the economy. We discuss important occupational skin diseases and also occupational aggravation of pre-existing skin conditions. Chemical, physical and mechanical causes are discussed as well. We believe that better understanding of these conditions would result in improved strategies for prevention and better risk management.

Occupational airborne contact dermatitis caused by pantoprazole.

Pantoprazole is a proton pump inhibitor, a member of the benzimidazole family. It is used for the treatment of erosion and ulceration of the oesophagus caused by gastro-oesophageal reflux disease, gastric hypersecretion, Helicobacter pylori gastrointestinal tract infection, and Zollinger–Ellison syndrome. We present a case of airborne contact dermatitis caused by this drug in the setting of the pharmaceutical industry.

Occupational airborne contact dermatitis to simvastatin, carvedilol, and zolpidem

Simvastatin is a 3-hydroxy-2 methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, commonly used as a lipid-lowering agent. Carvedilol is a nonselective beta-adrenergic blocking agent with alpha 1-adrenergic blocking activity and no intrinsic sympathomimetic activity. It is usually prescribed as an antihypertensive agent. Zolpidem is an imidazopyridine sedative–hypnotic structurally unrelated to the barbiturates and benzodiazepines, used for treatment of insomnia. We present a case of an airborne contact dermatitis to these three drugs in the setting of a pharmaceutical industry.

Prolonged paresthesia due to sculptured acrylic nails

Allergic reactions to acrylates in sculptured nails are common. However, there are few reports of paresthesia as a consequence of acrylic exposure, and such paresthesia does not necessarily accompany the evolution of the dermatitis.

Thimerosal--is it really irrelevant?

Recently, several investigators claimed that thimerosal is one of the most irrelevant allergens existing in screening for contact dermatitis. 508 patients who were suspected to have allergic contact dermatitis were patch tested at our clinic. They completed a questionnaire including medical, demographic and occupational details. We used the standard tray of chemotechnique diagnostics (Malmö, Sweden) and additional series, which were case relevant. The relevance of the allergic reaction to thimerosal was scored from 1 to 6. 19 patients (3.7%) had an allergic reaction to thimerosal. 6 (31.5%) had a definite relevance and 8 (42.1%) had a probable relevance. Only 3 patients (15.8%) had an irrelevant reaction. SPIN value (significance–prevalence index number) was 2281. We found a high proportion of mechanics (42.1%) among the patients who had positive reaction to thimerosal (P < 0.0001). Although previous reports found thimerosal highly irrelevant, our daily experience being supported by the above data indicates that positive reactions to thimerosal could be relevant for many patients.

The human skin/chick chorioallantoic membrane model accurately predicts the potency of cosmetic allergens

Abstract:  The current standard method for predicting contact allergenicity is the murine local lymph node assay (LLNA). Public objection to the use of animals in testing of cosmetics makes the development of a system that does not use sentient animals highly desirable. The chorioallantoic membrane (CAM) of the chick egg has been extensively used for the growth of normal and transformed mammalian tissues. The CAM is not innervated, and embryos are sacrificed before the development of pain perception. The aim of this study was to determine whether the sensitization phase of contact dermatitis to known cosmetic allergens can be quantified using CAM‐engrafted human skin and how these results compare with published EC3 data obtained with the LLNA. We studied six common molecules used in allergen testing and quantified migration of epidermal Langerhans cells (LC) as a measure of their allergic potency. All agents with known allergic potential induced statistically significant migration of LC. The data obtained correlated well with published data for these allergens generated using the LLNA test. The human‐skin CAM model therefore has great potential as an inexpensive, non‐radioactive, in vivo alternative to the LLNA, which does not require the use of sentient animals. In addition, this system has the advantage of testing the allergic response of human, rather than animal skin.

Controversies regarding the sensitive skin syndrome

Patients commonly complain about sensitive skin, yet this condition is not fully appreciated or understood by the medical community. While it is broadly associated with discomfort induced by environmental factors, there is no consensus about its definition and classification. By contrast, the cosmetic industry has been well aware of consumers’ perceived need for products suitable for sensitive skins and the resulting lucrative market for such products. Host factors identified as risk factors for the sensitive skin syndrome include young age, female gender and atopy. The variability in clinical manifestations and the lack of clarity regarding a definition of sensitive skin makes it hard to establish a single, reliable, diagnostic procedure. Bioengineering tools are a promising way to evaluate this condition; however, no particular method has been established as a gold standard. Similarly, there is no established treatment regime.

Does exercise cause asthma

BACKGROUND The Israel Defence Forces needed to define the correlation between physical activity and asthma. AIM To determine whether combat unit (CU) soldiers are more susceptible to exercise-induced asthma (EIA) than other military units. METHODS A follow-up study of recruits with normal clinical and pulmonary function tests over a period of 30 months after having been assigned to CU, maintenance units (MU) or clerical tasks (CT). The participants chosen had already been subjected to additional tests 6 weeks after induction to eliminate any cases of active asthma. RESULTS Out of 799 subjects, 125 developed asthma during the follow-up. Twenty-one per cent of those in the CU developed asthma against 15% in the MU and 5% in the CT. The relative risks for newly diagnosed asthma were 3.7 for CU/CT (P < 0.001), 2.7 for MU/CT (P < 0.001) and 1.4 for CU/MU (P < 0.05). EIA was observed as the only manifestation of asthma in 32% of the soldiers posted in CU compared to 13 and 11% in MU and CT, respectively. CONCLUSION The increased risk of EIA in CU compared to MU and CT may indicate that any one or all the factors associated with CU service conditions could contribute to this increased risk of uncovering the mild cases of asthma, especially EIA, that had been overlooked up to the time of induction into the army.