Florence Pasche-Koo

High sensitization rate to emulsifiers in patients with chronic leg ulcers

Emulsifiers are common constituents of most topical preparations. To study the sensitization rate in a population with frequent use of these agents, we selected 47 patients with chronic or recurrent (> 1 year) inflammatory skin disease (leg ulcers, contact dermatitis, atopic dermatitis, psoriasis) for patch testing with the following emulsifiers: Tween 40 (polyoxyethylene sorbitan monopalmitate), Tween 80 (polyoxyethylene sorbitan monooleate), Span 60 (sorbitan monostearate), Span 80 (sorbitan monooelate), Ariacel 83 (sorbitan sesquioleate), Atlas G 2162 (polyoxyethylene oxypropylene stearate), Atlas G 1441 (polyoxyethylene sorbitol lanolin derivative), triethanolamine, Lanette O (cetylstearyl alcohol), Lanette N. 12 patients had at least 1 positive reaction (25.5%) at 3 or 4 days. Among them, 10 had leg ulcers (43.4% of the leg ulcer group), and 2 had contact dermatitis (13.3% of the contact dermatitis group). No positive reaction was observed in the other patients. When the patients were tested with their own topical preparations or wound dressings, 6 of them, all with leg ulcers, had positive reactions. These results show a surprisingly high prevalence of sensitization to emulsifiers in patients with chronic leg ulcers, in contrast to patients with other inflammatory skin diseases.

Immediate local reaction to tetanus toxoid booster

T toxoid (TT) is known to induce protective immunity and, in sensitized patients, local and systemic responses. The most common adverse event after tetanus booster (50-85% of recipients) is a local reaction characterized by pain and tenderness at the injection site, followed by edema and erythema less frequently (20-30%), and rarely (2%,) by marked swelling (1). In a retrospective study of 740 patient charts with a history of adverse reaction to TT, Jacobs et al. (2) found 13% anaphylactoid reactions, but positive immediate skin tests were exceedingly rare (< 1%). Here, we report an immediate local reaction to a TT booster in a woman with a positive immediate skin test and serum anti-TT IgE.

Detection of formaldehyde in moistened baby toilet tissues

Formaldehyde is a ubiquitous and potent sensitizer. Formaldehyde‐sensitive patients may have long‐lasting hand eczema (1). Contact dermatitis from formaldehyde is often chronic, probably because it is so difficult to avoid exposure to formaldehyde‐containing products. An investigation in Denmark showed that 1/3 of all cosmetic products contained formaldehyde or formaldehyde‐releasing preservatives (2). Formaldehyde can also be found in many houshold products. In recent years, the use of moistened baby toilet tissues has greatly increased.

contact Dermatitis to Propylene Glycol in Topical Zovirax Cream

Much attention has been focused on contact allergy to antiviral drugs used in topical products. However, the vehicles and preservatives used in the prescription may also cause contact dermatitis. This report investigates a case of allergy to propylene glycol in topical Zovirax cream.