Fernando Toledo

Fragrance contact allergy: a 4-year retrospective study.

Background: Fragrance chemicals are the second most frequent cause of contact allergy. The mandatory labelling of 26 fragrance chemicals when present in cosmetics has facilitated management of patients allergic to fragrances.

Patch testing in children with hand eczema. A 5‐year multicentre study in Spain

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children.

A Summary of shoe allergic contact dermatitis caused by dimethyl fumarate in Spain

Juan Francisco Silvestre1, Fernando Toledo1, Pedro Mercader2 and Ana Marı́a Giménez-Arnau3, on behalf of the Spanish Research Group of Allergic Contact Dermatitis due to Dimethyl Fumarate in Spain 1Dermatology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain, 2Dermatology Department, Hospital General Universitario Morales Meseguer, 30008 Murcia, Spain, and 3Dermatology Department, Hospital del Mar, 08003 Barcelona, Spain.

Correlation between lesion site and concentration of dimethyl fumarate in different parts of shoes in patients with contact dermatitis caused by dimethyl fumarate in footwear.

Background. Dimethyl fumarate (DMF) has been identified as being responsible for an outbreak of shoe contact dermatitis in Europe. All reported cases to date have involved the dorsa of the toes and the dorsa of the feet, sometimes in association with other areas.

Delayed hypersensitivity to methylchloroisothiazolinone/methylisothiazolinone not detected by the baseline series of the Spanish group

A mixture of methylcholoroisothiazolinone and methylisothiazolinone (MCI/MI), in a 3:1 ratio (1), has been used for over 20 years as a preservative in various products for personal, household, and industrial use. In most baseline series, MCI/MI has been included for years at a concentration of 100 ppm aq. (2), which has been considered to be the optimum concentration required to detect the greatest number of cases of contact allergy to the preservative with the fewest number of false negative and irritant reactions. We describe a series of cases of allergy to MCI/MI that were only diagnosed with MCI/MI at a concentration of 200 ppm aq. and accounted for 24% of

Contact allergy to beryllium chloride: report of 12 cases

Background. Isolated cases of allergic contact dermatitis, gingivitis and stomatitis caused by beryllium have been previously reported. We have been able to study a series of 12 patients with patch test reactions to beryllium chloride.

Cauliflower ear in a teenager: a possible sign of child abuse.

Abstract:  “Cauliflower ear” is a perichondritis of the auricular pavilion, usually caused by infection or repeated trauma. In children, this entity is considered infrequent. We present the case of a 10‐year‐old girl living in a child care institution with “cauliflower ear” that was interpreted as a possible sign of child abuse.

Photodynamic therapy of vulvar intraepithelial neoplasia using methyl aminolevulinate

Sir, Vulvar intraepithelial neoplasia is a pre-cancerous lesion that defines the grade of dysplasia of the vulvar squamous epithelium. According to the classification of the International Society for the Study of Vulva Diseases (ISSVD) 2004, the lesions may be low grade (VIN1) or high grade (VIN2 and VIN3) (1). Currently, there is little consensus regarding the optimal treatment method. Instead of vulvectomy, the tendency is to use more conservative forms of treatment such as laser ablation or local excision. Laser ablation is one of the most generally indicated methods, especially in young women with multicentric disease, in view of its good cosmetic and functional results. Various topical medical treatments including imiquimod, 5FU, dinitrochlorobenzene, bleomycin or interferon-a have also been tried, but they are sometimes very painful and have only limited success (2). No therapy is entirely satisfactory in all cases and the treatment chosen depends on the patient’s age and the site and extent of the lesions, together with the biopsy results. There are studies that have demonstrated the efficacy of photodynamic therapy (PDT) to treat VIN with 5-aminolevulinic acid (ALA). We present a case of VIN type III in an HIV-positive patient successfully treated with PDT and methyl aminolevulinate (MAL). A 38-year-old woman was referred for evaluation of vulvar lesions resistant to laser treatment. Her medical history included: ex-parenteral drug use, smoking 25 packet/year, chronic hepatitis C, hepatitis B viral infection, HIV infection with undetectable viral load and CD4 > 700, and urinary stress incontinence. The patient was undergoing treatment with lamivudin, nevirapin and tenofovir. Ten months previously she had been diagnosed as having grade III vulvar intraepithelial neoplasia and was treated by laser vaporization by the gynaecology service. Six months later, biopsies were performed again and the findings were reported as VIN II with koilocytotic changes suggesting viral infection (pathology not available for review). Because of the persistence of the lesions the patient was referred to the dermatology service. On physical examination, desquamative, pruriginous, erythematous plaques were seen involving the right labia majora, the root of the clitoris and perianal zone (Figure 1). In view of the lack of response to treatment, it was decided to use PDT. Topical MAL was applied to cutaneous and mucosal lesions. The area was then covered with an occlusive adhesive dressing. After 3 h of occlusion, any excess cream was removed using a 0.9% saline solution and the fluorescence of the lesions were evaluated using an ultraviolet lamp. To reduce discomfort, a spinal anesthesia was performed prior to the illumination. The area was exposed with 37 J/cm of red light from a lightemitting diode (LED) source (Aktilite CL128) for 10 minutes. Three months after the first session an improvement was seen, although clinically the lesions persisted. Since the first session was well tolerated it was decided to repeat the treatment. After the second session, the lesions disappeared completely and no signs of dysplasia were found in the biopsies repeated

Progressive macular hypomelanosis, excellent response with narrow‐band ultraviolet B phototherapy

Progressive macular hypomelanosis (PMH) is an acquired disorder of skin pigmentation, which is mostly under‐diagnosed. It is characterized by nummular hypopigmented lesions appearing on the trunk in young persons. Several treatment options are available, although topical clindamycin and benzoyl peroxide have been used traditionally. However, good results have recently been achieved using narrow‐band ultraviolet B (NBUVB) phototherapy. We present the case of a 13‐year‐old girl with hypopigmented lesions on the trunk and limbs that had progressed over 1 year and that were diagnosed as PMH. The patient was initially treated with topical clindamycin and benzoyl peroxide. However, little improvement was seen and treatment was then started with NBUVB phototherapy. After 25 sessions, with a total cumulative dose of 18 J/cm2, the patient showed almost total repigmentation of the lesions. The treatment of PMH is often difficult, and very little is currently known about the treatment response in this disorder, as most reports have very small series of patients with a short disease progression time. NBUVB phototherapy has been shown to be effective, as seen in our patient, although in many cases, there is recurrence after the cessation of treatment.

Irritant contact dermatitis due to ammonium bifluoride in two infant twins.

Abstract:  Ammonium bifluoride is one of the most corrosive acids that may produce severe chemical burns when in contact with skin. This hazardous chemical is widely used in household products. We report two pediatric cases of irritant contact dermatitis after exposure to a rust remover, which contained ammonium bifluoride.