G. Angelini

Contact sensitization to 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one (MCI/MI). A European multicentre study.

The frequency of positive reactions to 5‐chloro‐2‐methyl‐4‐isothiazolin‐3‐one (MCI/MI) were studied at 22 European cntact dermatitis clinics over a period of 1 year. A total of 4713 patients participated. All the patients were patch tested with nickel sulphate, formaldehyde, paraben‐mix, and MCI/MI 19.4% of the patients had positive patch tests to nickel, making this the most common allergen, 3% of the patients reacted to 100 ppm MCI/MI, while 2.6% reacted to formaldchyde and 1.1% to parabens. There was great variation in the frequency of MCI/MI sensitivity among the 22 centres. MCI/MI contact allergy was most common among women and in patients with facial dermatitis, while it was rarely seen in patients with dermatitis on the lower legs. There were no fluctuations in the number of positive patch tests to MCI/MI on a monthly basis when the results from all centres were combined. 117 of the 141 MCI/MI sensitized patients included in the study were retested 88% had positive patch tests when retested. 101 of the MCI/MI‐sensitive patients participated in a double ‐blind, placebo‐controlled product use test. This test showed that 31% of the MCI/MI‐sensitive patients had a positive reaction to a MCI/MI‐preserved product. Only a few patients reacted to a control product. It is concluded that the preservative MCI/MI is an important new contact allergen.

Allergic contact dermatitis to some medicaments.

Over the years, changes have had to be made in the list of topical drags most frequently responsible for allergic contact dermatitis. The 4 most common sensitizers in Italy in the past have been penicillin. Sulfonamide, promethazine and neomycin. Now the list is headed by neomycin, benzoeaine and ethylenediamine. Antihislumines and parabens are less frequently observed as sensilizers. The increasing topical use of new drujis and additives, as well as older sensitizers, produces reactions 10 other substances, such as non‐steroidal anti‐inflammatory agents, some antimycotic drugs, propylene glycol and benzoyl peroxide.

Allergic contact dermatitis in a group of patients with perianal eczema

Results With a tool-grinding machine making endcutters of a tungsten carbide alloy containing about 10 % of cobalt and oil emulsion B, the maximum cobalt content was as high as 217 flg Co/g after 14 days. After one days use, the emulsion already contained about 40 flg Co/ g. The maximum contents of the other metals were 0.13 flg Cr/g and 0.61 flg Ni/g, respectively. Another working piece (a steel alloy with 1 % of chromium) was used in two different machines, a miller and a surface grinder with oil emulsions A and B. respectively. Maximum contents of chromium and nickel were 0.100.15 flg/g for centrifugated samples. Uncentrifugated samples were more irregular, up to 0.87 flg Cr/g and 0.72 flg Ni/g. In the surface grinder, the cobalt content of the emulsion raised to 1.4 flg/g after 28 days, but in the miller, 0.10 flg/g was not reached in 22 days.

Shoe contact dermatitis

The incidence of contact allergy was studied in a series of 165 patients with eczematous dermatitis of the feet correlated clinically with shoe contact. Positive reactions to one or more substances were recorded in 108 patients (65.4%). Among the relevant sensitizers were chromium, paraphenylenediamine, paratertiary butylphenolformaldehyde resin and nickel, while the other allergens were benzocaine, neomycin, balsam of Peru, ethylenediamine and parabens. Allergic contact dermatitis of the feel can he prevented by recognition of the allergens responsible, control of hyperhidrosis and avoidance of topical allergens.

A multicentre study of contact sensitization in children

The results of 7 months of patch testing with a standard series of 26 allergens, in 323 children with eczerematous conditions or itching palmoplantar psoriasis under the age Of 14 years are reported. 114 (35.3%) of the children had 1 or more positive reactions to this standard series. 28 children (8,7%) were poly sensitive. On the basis of personal history, additional series of allergens and/or specific allergens were also tested, 61.7% (90/146) of positive reactions were considered relevant to the current dermatitis. Metals, medicaments, preservatives or fragrances, and shoe components were the major sources of contact sensitization. It is suggested that patch testing he done more frequently in evaluating dermatitis in children.

Cell-mediated immunity in alopecia areata.

SummaryA study of cell-mediated immunity was carried out in a total of 69 subjects with alopecia areata (AA) of the scalp in various phases of its evolution. The blastic responses to mitogens PHA, Con A, and PWM proved significantly reduced, quite independently of the phase of the disease. The total E-rosettes test demonstrated a significant reduction in T-lymphocytes in patients with active AA. On the other hand, no significant differences could be demonstrated between the patients and the controls by means of active E rosette test. The mean values for Tγ and for theophylline-sensitive T-lymphocytes were reduced in patients with active AA. The significance of the results is discussed.ZusammenfassungZellvermittelte Immunität wurde bei insgesamt 69 Personen mit Alopecia areata (AA) der Kopfhaut in verschiedenen Entwicklungsphasen studiert. Die Blastenantwort auf die Mitogene PHA, Con A and PWM war, unabhängig von der Entwicklungsphase der Krankheit, signifikant reduziert. Der Test der totalen E-Rosetten zeigt eine signifikante Verminderung der T-Lymphocyten bei Patienten mit AA in progredienter Phase. Im Falle der aktiven E-rosetten gab es dagegen keine signifikanten Unterschiede zwischen Patienten und Kontrollpersonen. Die Durchschnittszahl der theophyllinsensiblen und Tγ-Lymphocyten war bei Patienten mit AA in der progredienten Phase vermindert. Die Bedeutung der Ergebnisse wird diskutiert.

Secretan's syndrome: an artefact oedema of the hand

Henri Secret an, a Swiss insurance and accident physician, was the first to describe persistent hard oedema of the dorsum of the hands in workers involved in compensation claims after injury (1). All the patients described by Secret an sustained minor injuries, the results from which persisted beyond the normal time required for resolution after simple contusions. Since this first report, similar cases have been described by other authors in the non-dermatological literature (2-4). Herewith we report a similar case observed over a period of 18 months.

Gelatinase expression at positive patch test reactions

Matrix metalloproteases (MMPs) are proteolytic enzymes involved in tissue remodelling and extracellular matrix (ECM) turnover. They are secreted in a latent form and activated at the cellular surface by a membrane type‐1 MMP (MT1‐MMP) and a tissue inhibitor of MMP‐2 (TIMP‐2) that is also responsible for striking a balance between the proteolytic enzymes and TIMP‐2. In allergic contact dermatitis (ACD) patients, MMP‐2 and MMP‐9, two members of the MMPs family, were increased during the challenge phase, in involved but not uninvolved skin. In contrast, TIMP‐2 was more evident in uninvolved than involved skin, while no differences were observed with regard to MT1‐MMP staining. Comparing the serum of ACD patients with that of healthy subjects, these differences were not observed. These data suggest that MMP‐2 and MMP‐9 could play a role in the mechanisms inducing alterations of the epidermal architecture, and in the pathogenesis of the lesions.

An evaluation of the allergic contact dermatitis potential of colloidal grain suspensions

BACKGROUND Colloidal grain suspensions have been used for decades as adjuncts in the treatment of atopic dermatitis, especially in the US. In Italy, many young children have been exposed to colloidal grains. Recently, it was suggested that these bath therapies may induce allergic contact dermatitis in some young atopic children. OBJECTIVE To evaluate the allergic skin reactions to topical oat and rice colloidal grain suspensions of normal and atopic children with and without previous exposure to colloidal grain suspensions. METHODS A double-blind, randomized patch study. Two concentrations of oat and rice colloidal grains (0.007% and 0.7%) were applied occlusively to the backs of 65 children living in Italy, ages 6 months to 2 years (43 were atopic and 22 were normal). RESULTS There were neither immediate urticarial nor allergic reactions in any of the 65 study subjects, atopic or nonatopic; 5 of 43 (12%) atopic subjects developed irritant reactions to the test materials. Radioallergosorbent tests (RAST) tests were performed on 55 subjects. The negative RAST test results found in the nonatopic group correlated well with nonatopic status, but positive RAST tests were found in only 8 of 35 (23%) atopic dermatitis subjects. None of the sera from positive RAST scores corresponded to subjects with irritant patch reactions. CONCLUSIONS The data indicate that topical colloidal grains can be used as an adjunct in the management of mild atopic dermatitis in children under 2 years of age. There was no evidence of sensitization to topical colloidal grains in the group studied.

Preliminary data on Pemphigus vulgaris treatment by a proteomics-defined peptide: a case report

BackgroundAlthough described by Hippocrates in 400 B.C., pemphigus disease still needs a safe therapeutical approach, given that the currently used therapies (i.e. corticosteroids and immunosuppressive drugs) often provoke collateral effects. Here we present preliminary data on the possible use of a proteomics derived desmoglein peptide which appears promising in halting disease progression without adverse effects.MethodsThe low-similarity Dsg349–60REWVKFAKPCRE peptide was topically applied for 1 wk onto a lesion in a patient with a late-stage Pemphigus vulgaris (PV) complicated by diabetes and cataract disease. The peptide was applied as an adjuvant in combination with the standard corticosteroid-based immunosuppressive treatment.ResultsAfter 1 wk, the treated PV eroded lesion appeared dimensionally reduced and with an increased rate of re-epithelization when compared to adjacent non-treated lesions. Short-term benefits were: decrease of anti-Dsg antibody titer and reduction of the corticosteroid dosage. Long-term benefits: after two years following the unique 1-wk topical treatment, the decrease of anti-Dsg antibody titer persists. The patient is still at the low cortisone dosage. Adverse effects: no adverse effect could be monitored.ConclusionWith the limits inherent to any preliminary study, this case report indicates that topical treatment with Dsg349–60REWVKFAKPCRE peptide may represent a feasible first step in the search for a simple, effective and safe treatment of PV.