E. Serra‐Baldrich

Metal-induced generalized pruriginous dermatitis and endovascular surgery

Metal contact allergy is a common problem in the general population. Diagnostic and therapeutic medical‐surgical procedures in which metals can be responsible for eczema are diverse. Endovascular aortic surgery is still an experimental but less invasive technique. A generalized eczematous dermatitis elicited by metal of an endovascular prosthesis is presented. An abdominal aortic aneurysm was diagnosed in a 79‐year‐old woman. Endoluminal repair with a straight Vanguard® endograft was successful. 3 weeks later, she suffered a severe episode of erythema and eczema on the legs. Since then, she complained of continuous pruritus with eczema and excoriated papules. The dermatitis and also the patch test pathology showed eczema. Patch testing was positive to nickel sulfate and cobalt chloride. An endograft semi‐quantitative metal analysis was performed with plasma‐induction joint mass‐spectrometry. The self‐expanding metal stent was mainly composed of nickel (∼55%) and titanium (21%) with reinforcing thread of platinum. Antimony was detected only in the polyester textile. These results are consistent with Nitinol® composition. The need for preoperative patch testing for metals is controversial. Enquiry about metal allergy is recommended before endoluminal surgical procedures. In the near future, the design of endografts must take into account the possibility of this sort of reaction.

Resultados y evaluación del fotoparche en España: hacia una nueva batería estándar de fotoalergenos

Resumen Introduccion Mientras que la estandarizacion de la exploracion con pruebas de fotoalergia o fotoparche (FTP) sigue su curso en Europa, hemos realizado un estudio epidemiologico sobre la situacion actual de la fotoalergia en nuestro pais. Material y metodos Hemos recogido los resultados del FTP en 7 centros hospitalarios de Madrid, Cataluna, Galicia y Comunidad Valenciana, durante los anos 2004 y 2005. La exploracion ha incluido, al menos, la bateria estandar del Grupo Espanol de Fotobiologia (GEF), con 16 (foto)alergenos, que se han irradiado con 10 julios/ cm 2 . Hemos valorado el numero total de pacientes explorados, su sexo, la relevancia presente, pasada o desconocida de los fotoparches positivos, las reacciones cruzadas y los alergenos responsables de la fotosensibilizacion. Resultados El 39,3 % de los 224 pacientes explorados mediante FTP presentaron uno o mas fotoparches positivos. Ciento tres (71 %) se consideraron relevantes respecto a la historia clinica, 14 (9,6 %) fueron reacciones cruzadas y 28 (19,3 %) se consideraron de relevancia desconocida. Los alergenos mas prevalentes fueron los antiinflamatorios no esteroideos, particularmente el ketoprofeno (43 pacientes), seguido a distancia de la bencidamina (7 pacientes) y el etofenamato (5 pacientes). La mezcla de 4 filtros solares de la bateria estandar del GEF solo detecto 10/16 pacientes con fotoalergia a filtros solares. Los fotoparches de relevancia desconocida fueron sobre todo por antisepticos (fenticlor) y antihistaminicos topicos. Conclusiones Proponemos modificar la bateria estandar de fotoalergenos del GEF, que deberia contemplar la mayoria de los antiinflamatorios no esteroideos y filtros solares que hay en el mercado espanol. El ketoprofeno sigue siendo el fotoalergeno mas frecuente en nuestro pais. Su importancia deriva tambien de las sensibilizaciones cruzadas que puede presentar. Los filtros solares deben explorarse por separado, y no en forma de una mezcla.

Recent unexplained patch test reactions to palladium

zema of hands, wrists and around her mouth. An oral provocation test with 200 mg of thiamine caused a relapse. Thiamine intracutaneously caused a weal and flare in normal subjects, while 100 controls did not react to 50% thiamine on patch testing (3). A pharmaceutical worker developed eczema of exposed sites while working with thiamine hydrochloride. The patch test was positive and 9 other workers were also positive. None of these reacted to the vitamin orally ( 4). There is only 1 report of contact allergy to an intermediate (ethoxymethylmalodinitril) in the production of vitamin B 1 (5). Patient no. 1 was exposed only to the end product. He filled and packed containers with dusty thiamine hydrochloride. The process worker (case no. 2) worked in the department where thiothiamine was converted to thiamine chloride in a closed process. He was in charge mainly of the final step of crystallization and centrifugation. In this latter process, hot propanol was evaporated, presumably containing thiamine. Local ventilation was not entirely effective and contact with thiamine was thus possible. After centrifugation, damp thiamine had to be scraped from the inside of the container, while keeping the SHORT COMMUNICATIONS

Contact allergy to tixocortol pivalate

I. Barker K A. Allergic contact to phenylephnne. Contact Dermatitis 1983: 9· 274-277. 2. Camarasa J G. Contact dermatitis to phenylephnne. Contact Dermatitis 1984: 10: 182. 3. Matlu.as C G, Maibach H I, Irvme A, Adler W. Allergic contact dermatitis to echothwphate Iodide and phenylephnne. Archzves of Ophthalmology 1979: 97· 286-288. 4. Roed-Petersen J. Contact sensitivity to metaoxednne. Contact Dermatitis 1976: 2: 235-236. 5. Kaneta Y, Ohhosh1 H, Takase M, Ueda H, Nabeta Y, Kurobe M, Uke1 C. The results of patch tests with topical ophthalmic medicaments (in Japanese). Skm Research 1983: 25: 617-621. 6. Yoshikawa K, Kawahara S. Contact allergy to atropme and other mydnatic agents. Contact Dermatitis 1985: 12: 56-57 7 Ducombs G, De Casamayor J, Venn Ph, Maleville J. Allergic contact dermatitis to phenylephnne. Contact Dermatitis 1986: 15: 107-108. 8. Tosti A, Bardazz1 I, Tosti G, Colombatl S. Contact dermatitis to phenylephnne. Contact Dermatitis 1987: 17· 110-1 I 1.

Results and Assessment of Photopatch Testing in Spain: Towards a New Standard Set of Photoallergens

INTRODUCTION While the standardization of exploration with photoallergy tests or photopatch testing runs its course in Europe, we have carried out an epidemiological study about the current situation of photoallergy in our country. MATERIAL AND METHODS We have gathered the results of photopatch testing in seven hospital centres of Madrid, Cataluña, Galicia and Comunidad Valenciana during the years 2004 and 2005. The exploration has included, at least, the standard set of the Spanish Photobiology Group (GEF), with 16 (photo) allergens, that have been irradiated with 10 joules/cm(2). We have assessed the total number of explored patients, their sex, present, past or unknown relevance of positive photopatch testing, cross reactions, and allergens responsible for photosensitization. RESULTS Of 224 patients explored by photopatch testing, 39.3 % show one or more positive tests. Seventy-one percent (103) were considered relevant with respect to clinical history, 14 cases (9.6 %) were cross reactions, and 28 (19.3 %) were considered of unknown relevance. The most prevalent allergens were nonsteroidal antiinflammatory drugs, specially ketoprophen (43 patients), followed by bencydamine (7 patients) and etofenamate (5 patients). The mixture of four sunscreens from the standard set of the GEF only detected 10 of 16 patients with photoallergy to sunscreens. Photopatch testing of unknown relevance was mainly due to antiseptics (fenticlor) and topical antihistamines. CONCLUSIONS We propose the modification of the standard set of photoallergens from the GEF, that should include the majority of nonsteroidal antiinflammatory drugs and sunscreens available in Spain. Ketoprophen continues to be the most frequent photoallergen in our country. It is also important for the cross sensitizations that may present. Sunscreens should be explored separately and not in form of a mixture.

Allergic contact dermatitis from 3-(aminomethyl)-pyridyl salicylate

2 patients with acute allergic contact dermatitis from 3‐(aminomethyl)‐pyridyl salicylate are described. Both patients were females with histories of urticaria and showed cross‐sensitization to substances of the para group. Clinical manifestations included eczema, angioedema and respiratory effects. In 1 patient, airborne elicitation was suspected. A lymphocyte transformation test confirmed the allergy, with an extremely high response index. 35 normal controls were negative.

Contact urticaria from sodium fluoride.

5. McDonagh A J G, Wright A L, Cork M J, Gawkrodger D J. Nickel sensitivity: the influence of ear piercing and ·atopy. Br J Dermato/1992: 126: 16-18. 6. Hemingway J D, Mo1okhia M M. The dissolution of metallic nickel in artificial sweat. Contact Dermatitis 1987: 16: 99-105. 7. Emmett E A, Risby T H, Jiang L, Ng S K, Feinman S. Allergic contact dermatitis to nickel: bioavailability from consumer products and provocation threshold. JAm A cad Dermato/1988: 19: 314--322. 8. Fischer T, Fregert S, Gruvberger B, Rystedt I. Nickel release from ear piercing kits and earrings. Contact Dermatitis 1984: 10: 39-41. SHORT COMMUNICATIONS

Photoallergic contact dermatitis caused by benzophenones in magazine inks.

A case study is presented of contact dermatitis caused by benzophenones found in magazine inks.

Allergic contact dermatitis from picric acid

Picric acid (2,4,6-trinitrophenol) is used as an antiseptic, in aqueous solution at I% or in ethanol at I% to 3%, to avoid infections in burns and wounds. Its skin absorption can be toxic, producing nausea, vomiting, abdominal pain, diarrhoea, oliguria, anemia, yellow hyperpigmentation of the skin, pruritus, confusion, convulsions and death (!). Because of that, its extensive application to large areas of wounded skin is not recommended. In industry, picric acid is used in explosives, matches, electric batteries, etching copper, dyeing textiles and leather, glazing pottery and as a reagent.

Contact dermatitis due to clarifying cream

A 45‐year‐old woman developed a severe eczematous reaction localized on the application site after using a clarifying cream. Patch testing showed positively to vitamin K1.