F. Bardazzi

Long-term results of topical immunotherapy in children with alopecia totalis or alopecia universalis

BACKGROUND Topical immunotherapy has been used in the treatment of children with alopecia areata with encouraging results. OBJECTIVE Our purpose was to determine the long-term results in 33 children with severe alopecia areata treated with topical immunotherapy. METHODS From 1983 to 1989 we treated 33 children with topical immunotherapy with squaric acid dibutylester. RESULTS Complete hair regrowth was observed in 10 children (30.3%). During the follow-up period (mean, 5.9 years; range, 4 to 12 years), 7 of these 10 patients had severe relapses that were not responsive to further treatment. Only three clinically benefited from topical immunotherapy. Two maintained complete hair regrowth after treatment was stopped. CONCLUSION Our results indicate that only a small proportion of children with severe alopecia areata will obtain a persistent benefit from topical immunotherapy.

Prevalence and sources of sensitization to emulsifiers: a clinical study

737 patients with suspected cosmetic‐ or medicament‐related contact dermatitis were patch with 6 emulsifier agents: triethanolamine, cetyl stearyl alcohol, sorbitan sesquioleate, polyoxyethylene sorbitan monopalmitate. polyoxyethylene sorbitan monooleate, and Amerchol L 101. 39 patients (5.3%) gave I or more positive patch texts to emulsifiers. A total of 54 positive reactions were found, 23 of which were clinically relevant, triethanolamine being the most frequent sensitizer. Patients with emulsifier sensitivity generally give a high prevalence of positive patch tests to other common ingredients of topical preparations, such as preservatives or active ingredients. Cosmetics and topical medicaments were detected as the source of sensitization in an equal number of patients. Patch tests with patients’own causative preparations were frequently negative. To avoid overlooking emulsifier sensitivity, it is advisable to test these compounds in patients with contact dermatitis that is possibly due to topical preparations, regardless of whether they have other clinically relevant positive reactions or whether patch tests with their own products are negative.

Telogen Effluvium due to Recombinant Interferon α-2b

Five of 10 patients receiving long-term recombinant interferon α-2b therapy complained of considerable hair loss. The pull test and the trichogram showed a telogen count consistent with a telogen effl

Graham Little-Piccardi-Lasseur syndrome following HBV vaccination.

A 48-year-old man, who was at risk for HBV infection as he worked as a nurse in an emergency department, received HBV vaccine Recombivax (Merck-Sharp & Dohme, MSD). The ¢rst dose of vaccine (1 ml) was given to the patient in July 1995 and the second (1ml) 4 weeks later. At the end of September 1995 the patient noted an eruption of numerous, polygonal, red and itchy papules localized on the trunk, limbs and wrists. No mucosal involvement was present. All routine laboratory tests results were normal, HBsAg and HBeAg results were negative while HBsAb and HBcAb were positive. The patient therefore consulted his general practitioner who diagnosed this condition as drug eruption and for which he prescribed antihistamines per os for 1 month. The condition healed in 6 weeks leaving a hyperpigmentation. Six months after the ¢rst dose the patient received the third vaccine dose (1 ml); 5 months later spinous, acuminate, follicular papules a¡ecting the scalp occurred. In November 1996 he consulted us. The dermatological examination revealed hyperpigmented polygonal, £at papules localized on the wrists and ankles and brown spots on the lateral surface of the trunk, probably the result of previous episodes of LRP. On the scalp some cicatricial alopecic areas as well as di¡use alopecia with ¢ne and coarse hair were present. The diagnosis of GLPLS was therefore formulated and con¢rmed on histological examination. The patient was treated with systemic and topical corticosteroids for 4 months, leading to healing of the hyperkeratotic papules, the alopecia still persisting.

Contact stomatitis due to N, N‐dimethyl‐para‐toluidine

In recent years, interest in allergic contact dermatitis (ACD) from dental materials has increased remarkably, due to the number of new compounds utilized in this field. Some of these are already known to cause contact allergies, but in many cases, we lack data about their sensitizing properties. Acrylic resins are among the most widely used compounds in dental practice for the construction of prostheses. These resins are produced by inducing polymerization of a mixture of methyl methacrylate monomer and polymethyl methacrylate powder with benzoyl peroxide and an accelerator. The most wide, ly used accelerator is the tertiary amine N,N-dimethyl-para-toluidine. In this process, polymerization is rarely complete, and the small amount of N,N-dimethyl-para-toluidine present in the final compound may be responsible for sensitization.

Idiopathic Atrophy of the Nails: Clinical and Pathological Study of 2 Cases

BACKGROUND Whether idiopathic atrophy of the nails (IAN) should be considered a separate entity or a clinical variant of nail lichen planus is still controversial. OBJECTIVE We report here the pathological study of 2 patients with IAN. METHODS Our patients had similar clinical features consisting of severe nail atrophy with and without pterygium. RESULTS The nail matrix architecture was markedly deformed with complete disappearance of the keratogenous zone that was replaced by a 3- to 10-cell-thick granular layer. CONCLUSION The hypothesis that IAN is an acute and self-limited variety of lichen planus is still the most presumable. Even though this hypothesis can not be definitely proven, it is nevertheless not excluded by the clinical and pathological findings of our cases.

Contact dermatitis due to chlorpheniramine maleate in eyedrops

allergisantes naturelles et synthetiques. Rev Franc Allergo/1978: 18: 31-33. 14. Campolmi P, Sertoli A, Fabri P, Panconesi E. Alan to lactone sensitivity in chrysanthemum contact dermatitis. Contact Dermatitis 1978: 4: 93-102. 15. Schlewer G, Stampf J L, Benezra C. Synthesis of and allergic contact dermatitis to bicyclo (2,2, I)heptyl-a-methylene-y-butyro-lactones and camphene. Can J Biochem 1978: 56: 153-157. 16. Schlewer G, Stampf J L, Benezra C. Synthesis of a-methylene-y-butyrolactones: a structure-acContact Dermatitis 1990: 22: 55

Alopecia areata. A pathological study of nonresponder patients.

Fourteen patients, four male and 10 female and ranging in age from 11 to 57 years, affected by longstanding alopecia areata that had not responded to sensitizing treatments, were submitted to scalp biopsy. Five patients had alopecia totalis and nine had alopecia universalis. The biopsy was performed on a scalp area that had been baid for ≥ 1 year. We distinguished four distinct pathological patterns, which we termed “established bald patch,” “early regrowth,” “telogen,” and “scarring,” in four, seven, one, and two patients, respectively. Our study shows that, from a pathological point of view, nonresponder patients constitute a heterogeneous population. The pathological study of the scalp helps predict therapeutic failure only in the small proportion of nonresponder patients that shows a scarring pathological pattern.

Cutaneous complications of artificial hair implantation: a pathological study.

Five patients who developed severe cutaneous complications after artificial hair implantation were subjected to a scalp biopsy. The pathology showed the presence of hyperplastic epidermal proliferations that produced infundibulum-like structures around the implanted fibers in the superficial dermis. A dense acute inflammatory infiltrate surrounded the artificial fibers in the superficial dermis. In the deep dermis a granulomatous infiltrate was present whereas in the hypodermis the inflammatory infiltrate was sparse and the fibers were embedded in fibroplasia. The pathology of a patient who did not present any skin inflammation after artificial hair implantation showed similar pathological features but the absence of acute inflammation suggesting that bacterial infections play a major role in the development of the cutaneous complications of hair implantation. Since definitive treatment of the infections is ineffective until the fibers are removed from the scalp, surgical treatment was required in 2 of our patients.

Scar reactivation and dry cough.

A 52-year-old woman has swelling and redness of seven old scars and a dry cough. What diagnostic test should be performed?