Etain Cronin

Dermatitis of the hands in caterers

Hand eczema among 50 caterers was occupational in 47 and endogenous in 3 cases. Irritants were considered more important than sensitisers. There was a correlation between atopy and sensitisation to type‐1 but not type‐IV allergens The commonest type‐I sensitizers was fish and for type‐IV was garlic. Dilutions of garlic and of onion 50% in arachis oil were not irritant and seemed effective patch test materials. The prognosis was not good and the hand eczema continued even in some of those who changed their jobs.

Clinical patterns of hand eczema in women

The hand eczema of 263 women was studied as 4 clinical patterns: palms and fingers, dorsa and lingers, lingers only and the entire hands. The palmar pattern was the commonest. Sensitisers affected the patterns equally but irritants were of less significance in the palmar group than among the rest. Atopics did not appear to have a distinctive pattern. Among the occupational group, irritants were of much greater importance than allergens.

Antioxidants in cosmetics

Antioxidants are commonly added to cosmetics. Allergy to these substances will be missed unless specifically looked for. During a 2‐year period, patients with facial dermatitis have been routinely tested with butylhydroxyanisole and tertiary butylhydroquinone. 7 patients are reported who have been shown to have an allergic contact dermatitis to an antioxidant in their cosmetics or toiletries.

HAND DERMATITIS IN HOUSEWIVES

SUMMARY.— In a series of 4000 patients patch tested in 5 European clinics, 1000 were engaged in domestic work only; they included 281 women with contact dermatitis of the hands. There were no significant differences between the 2 groups as regards age, duration of dermatitis and patch test results.

Oil of turpentine — a disappearing allergen

Oil of turpentine has become an infrequent allergen because of its replacement by the petroleum product white spirit, its deliberate exclusion from industrial products, and because the balsam oils used nowadays do not contain the sensitiser Δ3‐carene. On the basis of the generally low incidence of sensitisation being currently recorded, the International Contact Dermatitis Group recommend that oil of turpentine be removed from standard patch test series.

CONTACT DEEMATITIS XVII

The serious effects that may occur were emphasized during the Second World War by reports from troops who were given courses of oral sulphonamides having been previously sensitized by their topical use. Twelve such cases were described by Park (1943) who found that the severity of the eruption varied with the sensitivity of the subject and the size of the dose oi sulphonamide given. In the same patient a large amount caused a severe reaction and a small dose a mild effect. In 60% of cases the allergy was to one sulphonamide only, whereas in 40% it could be elicited by several (Park, 1944). Sulphanilamide in powder or petroleum jelly was the most frequently used topical application and caused the majority of reactions (Grant Peterkin, 1945)i. A surprizing but apparently consistent feature of many of these patients was their negative response to patch testing with sulphonamides (Park, 1943; Grant Peterkin, 1945). Sulzberger et al. (1947) recorded that of all their patients only 31% gave a positive patch test but in those with severe reactions all were positive.

Lanolin of reduced sensitizing potential

Confirmation has been obtained that reducing the content of natural free alcohols in lanolin to below 3 % particularly in the absence of detergent residues, reduces the incidence of positive patch test reactions amongst selected lanolin‐sensitive skin patients by 99.3 %. Only one reaction out of 149 subjects was recorded.

Lanolin with reduced sensitizing potential A preliminary note

The allergens of lanolin appear to lie in the content of natural free fatty alcohols rather than in the total alcohols as hitherto supposed. The delectable incidence of allergy is increased by the simultaneous presence of detergent. Amongst selected lanolin‐sensitive skin patients, removal of both free fatty alcohols and detergent from lanolin reduces the incidence of detectable hypersensitivity by 96 %. Methods are described for determining free fatty alcohols and detergent in lanolin, and for removing them.

Lichen planus pemphigoides

Lichen planus pemphigoides is a rare disease in which blistering occurs in association with lesions of classical lichen planus. We describe a patient with lichen planus pemphigoides and discuss the evidence for there being one disease rather than the coincidence of bullous pemphigoid and lichen planus.

Photocontact urticaria from chlorpromazine.

Chlorpromazine is well recognised as a cause of delayed photosensitive eczema. A patient illustrated typical features of the phenomenon. Urticarial lesions were also elicited on photopatch testing.