Domenico Bonamonte

Occupational sensitization to epoxy resin and reactive diluents in marble workers

10 out of 22 marble workers handling a bicomponent resin, based on epoxy resin and ortho‐cresyl glycidyl ether (CGE), developed Contact dermatitis and airborne contact dermatitis within 20 days to 2 months of exposure. All 22 subjects were patch tested with epoxy resin, bisphenol A, epichlorohydrin and a series of reactive diluents. The 10 symptomatic subjects were all positive to the reactive diluent CGE, and 4 of them also to epoxy resin. The other reactive diluents that gave positive reactions were phenyl glycidyl ether (7 cases), cyclohexanedimethanol glycidyl ether (2 cases), 1,6‐hexanediol diglycidyl ether (2 cases) and allyl glycidyl ether (1 case). The findings of our Study suggest that allergic potential is directly proportional to the electronic charge available, for all electron‐rich molecules (solvents, high and low polymers, reagents) that interact with the glycidyl ether group. Lesser, but still noticeable, effects are detected when activation of the glycidyl group is related to the possible formation of intramolecular hydrogen bonds. In practice, the occupational problem was partly solved by changing the type of glycidyl ether.

The role of 3-dimethylaminopropylamine and amidoamine in contact allergy to cocamidopropylbetaine

Since it has been found that all subjects with contact allergy to cocamidopropylbetaine (CAPB) have positive reactions to 3‐dimethylaminopropylamine (DMAPA), and reports have appeared in literature of the sensitizing action of amidoamine in products containing CAPB, we aimed to verify the possibility that pure amidoamine may have a sensitizing role in subjects with positive reactions to CAPB. To this end, in 10 patients with contact allergy to a commercial CAPB, we tested DMAPA 1% aq. and a pure amidoamine in concentrations ranging from 0·5% aq. to 0·1% aq. The study showed that all patients with positive reactions to DMAPA reacted to amidoamine at 0·5% and 0·25% aq., while 4 of the 10 also had positive reactions to amidoamine at 0·1% aq. We consider that simultaneous allergic reaction to DMAPA and amidoamine represents cross‐reactivity and hypothesize that DMAPA is in fact the true sensitizing substance, while amidoamine, which may in any case release DMAPA in vivo as a result of enzymatic hydrolysis, may favour the transepidermal penetration of the sensitizing agent. In addition, we advise that testing of CAPB be suspended, because, as suggested by chemico‐structural analyses and demonstrated in vivo, when thoroughly purified, it no longer has a sensitizing action.

Occupational contact allergy to cephalosporins

Patients, Methods and Results 18 nurses (4 male and 14 female), ages ranging between 24 and 52 years (mean 35.5 years), were studied. They all had contact dermatitis and reported frequent contact with various cephalosporins; their eczema had lasted between 8 months and 15 years (mean 5.2 years). Lesions were localized on the hands (18 cases), forearms (3 cases) and face (2 cases). 2 patients had a history of allergic rhinitis, 1 of allergic asthma and 1 of atopic dermatitis. All were patch tested with the European standard series, penicillin and the cephalosporins listed in Table 1. The patch tests were applied in double series on the back with Finn Chambers. 1 series was removed and read after 20 min and the other after 2 days, with further readings at D3 and D4. In 4 subjects with positive reactions to cephalosporins, intradermal (i.d.) tests were made with 0.01 ml of the same substances in water ( 1: I 0), and with 0.01 ml of the main penicillin antigenic determinant, penicilloyl polylysine (PPL) (Sigina Chemical, St. Louis, Missouri, USA) at a concentration of 6X 10 M. 30 control subjects were tested with the same cephalosporins at 20% pet., with negative results. Negative results were obtained to the 20-min patch tests, for both cephalosporins and penicillin. The results of the D2 patch tests are reported in Table 1. 7 patients

Allergic and Photoallergic Contact Dermatitis from Ketoprofen: Evaluation of Cross-Reactivities by a Combination of Photopatch Testing and Computerized Conformational Analysis

Allergic contact dermatitis (ACD) and photo-ACD are cell-mediated delayed hypersensitivity reactions of the skin caused by a wide range of substances. Topical ketoprofen (KP), a nonsteroidal anti-inflammatory drug (NSAID), can induce ACD and photo-ACD. Patients with ACD and/or photo-ACD to KP frequently show concomitant sensitization to other substances. The aim of this study was to identify the substances most frequently associated with sensitization to KP, and to evaluate, by means of computerized conformational analysis, whether this association could be due to cross-allergy. 15 subjects with ACD and photo-ACD to KP were tested with the SIDAPA (Società Italiana di Dermatologia Allergologica Professionale ed Ambientale) patch test standard series, including fragrance mix and its components (eugenol, isoeugenol, oak moss, geraniol, hydroxycitronellal, amylcinnamaldehyde, cinnamyl alcohol and cinnamaldehyde) and with the SIDAPA photopatch test series. Allergic reactions to cinnamyl alcohol were noted in all patients, whereas some patients also showed positive reactions to fenticlor, octocrylene and benzophenone-10. Computerized conformational analysis demonstrated that the structure of cinnamyl alcohol is similar to that of KP, whereas the structures of benzophenone-10, octocrylene and fenticlor are completely different. These results suggest that in patients with contact allergy to KP, concomitant positive reactions to cinnamyl alcohol are due to cross-sensitization, whereas simultaneous allergic reactions to fenticlor, octocrylene and benzophenone-10 should be regarded as co-sensitizations.

Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids

Little is known about the socio‐economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids.

Allergic contact dermatitis from Mentha spicata (spearmint)

Case Report A 64-year-old non-atopic woman, with a history of contact dermatitis from shoes and leather items, presented with painful erythemato-edemato-vesico-bullous lesions on the right knee after repeated applications of compresses with an infusion made with fresh leaves of Mentha spicata, for pain in the knee due to gonarthrosis. The clinical signs and symptoms regressed after suspension of the compresses and treatment with topical antiseptics and oral antihistamines. Patch tests with the SIDAPA (Italian Society of Allergological, Occupational and Environmental Dermatology) standard series yielded positive reactions to potassium dichromate, para-phenylenediamine, Disperse Blue 124, Disperse Yellow 3, fragrance mix, and Myroxylon Pereirae resin. A patch test with an alcoholic extract of the leaves of Mentha spicata elicited an erythemato-vesicular reaction. Patch tests with a further series (Table 1) were positive to peppermint and spearmint oils, whereas menthol was negative. Photopatch tests were negative.

Nickel contact allergy and menstrual cycle

According to some reports in the literature, the hormonal fluctuations which occur during the menstrual cycle may affect the clinical expression of contact allergy to a greater or lesser degree. In clinical practice, too, patient history often shows exacerbation of the contact dermatitis during the days immediately preceding menstruation. On the contrary, the follicular phase of the cycle seems to have a temporary protective role in inhibiting the eliciting phase of allergic contact dermatitis. One possible explanation for this phenomenon is of immunological type: it has been demonstrated that oestradiol induces inhibition of delayed hypersensitivity type reactions, probably by acting indirectly on cells having a regulatory function in cell‐mediated immunity. To investigate any inhibitory effect of the ovulatory phase of the menstrual cycle on contact sensitization, 30 selected fertile women, allergic to nickel sulfate and with a regular menstrual cycle lasting between 25 and 32 days, were enrolled. Patch tests were performed with a series of 10 serial aqueous dilutions of nickel sulfate, from 5% to 0.0013%. The 30 women were tested at 2 different times, in the ovulatory phase (demonstrated by transvaginal ultrasound) and the progestinic phase; they were subdivided into 2 groups of 15 women: in one group, the tests were made first in the ovulatory phase, and in the other, first in the progestinic phase of the menstrual cycle. There was a minimum interval of 5 weeks between the 2 test phases. The study shows that during ovulation the patch tests elicited significantly less intense responses than in the progestinic phase. These data therefore suggest that the ovulatory phase of the cycle has a significant inhibitory role on delayed hypersensitivity type reactions. For this reason, negative responses to patch tests executed in this phase could likely be false‐negatives, and after careful evaluation of the phenomenon and of the clinical condition and patient history, it may be considered advisable to repeat the tests during the progestinic phase of the menstrual cycle.

Noneczematous Contact Dermatitis

Irritant or allergic contact dermatitis usually presents as an eczematous process, clinically characterized by erythematoedematovesicous lesions with intense itching in the acute phase. Such manifestations become erythematous-scaly as the condition progresses to the subacute phase and papular-hyperkeratotic in the chronic phase. Not infrequently, however, contact dermatitis presents with noneczematous features. The reasons underlying this clinical polymorphism lie in the different noxae and contact modalities, as well as in the individual susceptibility and the various targeted cutaneous structures. The most represented forms of non-eczematous contact dermatitis include the erythema multiforme-like, the purpuric, the lichenoid, and the pigmented kinds. These clinical entities must obviously be discerned from the corresponding “pure” dermatitis, which are not associated with contact with exogenous agents.

Spitz naevi and melanomas with similar dermoscopic patterns: can confocal microscopy differentiate?

Differentiating Spitz naevi from melanomas can be difficult both clinically and dermoscopically. Previous studies have reported the potential role of in vivo reflectance confocal microscopy (RCM) in increasing diagnostic accuracy.

Prevalence of specific anti-skin autoantibodies in a cohort of patients with inherited epidermolysis bullosa

BackgroundInherited epidermolysis bullosa (EB) is a group of skin diseases characterized by blistering of the skin and mucous membranes.There are four major types of EB (EB simplex, junctional EB, dystrophic EB and Kindler syndrome) caused by different gene mutations. Dystrophic EB is derived from mutations in the type VII collagen gene (COL7A1), encoding a protein which is the predominant component of the anchoring fibrils at the dermal-epidermal junction.For the first time in literature, we have evaluated the presence of anti-skin autoantibodies in a wider cohort of patients suffering from inherited EB and ascertained whether they may be a marker of disease activity.MethodsSera from patients with inherited EB, 17 with recessive dystrophic EB (RDEB), 10 with EB simplex (EBS) were analysed. As much as 20 patients with pemphigus vulgaris, 21 patients with bullous pemphigoid and 20 healthy subjects were used as controls.Anti-skin autoantibodies were tested in all samples with the Indirect Immunofluorescence (IIF) method and the currently available ELISA method in order to detect anti-type VII collagen, anti-BP180 and anti-BP230 autoantibodies.ResultsThe mean concentrations of anti-type VII collagen autoantibodies titres, anti-BP180 and anti-BP230 autoantibodies were statistically higher in RDEB patients than in EBS patients.The sensitivity and specificity of the anti-type VII collagen ELISA test were 88.2% and 96.7%. The Birmingham Epidermolysis Bullosa Severity score, which is used to evaluate the severity of the disease, correlated with anti-skin autoantibodies titres.ConclusionsThe precise pathogenic role of circulating anti-skin autoantibodies in RDEB is unclear. There is a higher prevalence of both anti-type VII collagen and other autoantibodies in patients with RDEB, but their presence can be interpreted as an epiphenomenon.