Hideo Nakayama

Fragrance contact dermatitis: a worldwide multicenter investigation (Part II)

The purpose of this study was to determine the frequency of responses to selected fragrance materials in patients who were fragrance sensitive. 178 patients were evaluated in 8 centers worldwide with a fragrance mix (FM) and 20 other fragrance materials. Reaction to the fragrance mixture (FM) occurred in 78.7% of the subjects. Substances reacting at a rate of 2% or higher included jasmine absolute, geranium oil bourbon, l‐citronellol, spearmint oil, 1,3,4,6,7,8‐hexahydro‐4,6,6,7,8,8‐hexamethylcyclopenta‐γ‐2‐benzopyran, omega‐6‐hexadecenlactone, dimethyltetrahydrobenzaldehyde (isomer mixture), and α‐amylcinnamaldehyde. These chemicals should be furthur evaluated to corroborate their allergenicity. We are constantly looking for new fragrance allergens to extend the diagnostic capability of the fragrance mix (FM).

Rôle of ear piercing in metal allergic contact dermatitis

To evaluate the effect of ear piercing on sensitization to gold and other metals, diagnostic patch testing with metals was performed. 377 patients 18 (65 men and 312 women. ranging in age from 15 to 78 years: mean 34.2 S.D±15.1 years) were patch tested; 107 had pierced earlobes. Metals were applied on the hack for 2 days, and the results read with the ICDRG scoring system 3 days after application. Reactions of + to +++ were regarded as positive. There were significantly more patients reacting to gold chloride (P < 0.001), mercuric chloride (P < 0.001). and nickel sulfate (P < 0.05) in patients with pierced ears than in those without. Statistical issues included: (iii) a significant number of patients without referred because of earring dermatitis; (ii) those with pierced ears represented a different age group from those without; (iii) a significant number of patients without eczema in the non‐pierced ear group. However, our data suggests that ear piercing is a risk factor not only for nickel but also for gold sensitization. Gold was the second most frequent metal allergen after nickel in the pierced group.

Churg-Strauss Syndrome: Report of a Case without Preexisting Asthma

A 38‐year‐old male with no history of asthma, who initially presented with episcleritis and subsequently developed symptoms of systemic vasculitis with marked blood eosinophilia, was diagnosed as having Churg‐Strauss syndrome (CSS). Both the patients skin lesions and pulmonary infiltrates revealed histologically proven vasculitis with predominantly eosinophilic infiltration.

Cytosine Arabinoside-Induced Vasculitis

Dermatologic side effects of cytosine arabinoside (ara-C) are rare and most commonly occur after high-dose (more than 100 to 200 mg/m2 per day) therapy has been administered for several days. Although vascular reactions after combination chemotherapeutic regimens with ara-C have been anecdotally described, they have not been previously reported after single-agent chemotherapy with ara-C. Herein we describe two patients with acute nonlymphoblastic leukemia in whom cutaneous small vessel necrotizing vasculitis developed after high-dose single-agent chemotherapy with ara-C. Cutaneous lesions developed 3 to 5 days after initiation of therapy and resolved spontaneously within a week after the chemotherapeutic regimen was completed. No evidence of systemic vasculitis was present in either patient. Prior experimental data have demonstrated a direct toxic effect of ara-C on endothelial cells, and this outcome may represent the underlying mechanism of vascular injury.

In vitro study of the cross-sensitivity of hair dye using hapten-specific lymphocytes

Paraphenylenediamine (pPDA), which is used frequently in hair dyes, has a high sensitization potential and is also well‐known to cross‐react with chemicals of similar structure. pPDA‐specific lymphocytes from sensitized inbred guinea pigs were prepared and the cross‐reaction of pPDA was examined using cultured epidermal cells as the target. The cytolytic effect was observed to be highest with pPDA, followed by paraaminophenol, orthophenylenediamine, and metaphenylenediamine. Resorcinol and the control produced no cytolytic reaction. These results showed a good correlation between in vitro and in vivo tests. The recognizing ability of hapten‐specific lymphocytes is suggested to vary according to the position of the functional group and its type.

Fragrances Contact hypersensitivity to ylang‐ylang oil

rural population) since 1985 and 989 (68% women) in Vienna (mostly urban population) in the past year, who all suffered from contact dermatitis. We used commercial solutions of 100 ppm Kathon CG in water according to the criteria of the ICDRG. Using the Kathon from Dr. Brinkmann Parm., FRG, only 4 women in Graz ( > 0.1%) and 2 men and 5 women in Vienna (0.7%) reacted to Kathon CG, most of them only weakly; most of them revealed multiple sensitivities. A clinical relevance could be presumed in only I patient (0.0!6% of all patients). In contrast, 19 out of 265 patients (7.2%) that tested in parallel both the Kathon Hermal products reacted positively, and only I also to the Brinkmann product. Clinical relevance, however, was still not evident in most of them. Since neither the incidence of exposure in industry nor in topical ointments and cosmetics differs in our country as compared to other European countries, several factors have to be considered for these discrepancies: patient selection, testing procedures, quality of the test substance, test observation and interpretation. We believe that problems in the standardization of the test substance and in the interpretation of the data play a key role for the controversial and in some countries (up to 6.1 %) horrifying numbers of Kathon CO-positive patients.

How to Treat Metal Hypersensitive Alopecia Areata and Atopic Alopecia

Metal allergy was found with severe types of alopecia areata (AA) at the rate of 69.9% and the elimination of metal allergens from dental metals, cooking instruments lead to satisfactory hair regrowth and prevention of severe relapse of AA for the period of in average four years and four months at the rate of 75.5%. The cooperation of dentists for analysis of dental metals, removing allergic alloys and replacing to ceramics were needed. Another causation of AA was type I and IV allergy to house dust mite (HDM). This type has been called atopic alopecia historically. There is enough evidence that HDM is the main causation of atopic dermatitis (AD). Severe and intractable AD could be cured by the mite fauna investigation by methylene blue agar (MBA) method, followed by environmental improvement to decrease mites to less than 50/m2 everywhere in the home. The same solution was applied to treat severe atopic alopecia cases, which were cured at the rate of 58.3%, and the longest record of confirmed period of cure was five years. When six years or more elapsed after the onset of AA, any kind of treatment was not successful, because biopsy of the scalp revealed the disappearance of hair follicles, which was replaced by dermal fibrosis. Therefore, the treatment of AA should start quickly, investigating allergy to metals and HDM.

Herb lotions to regrow hair in patients with intractable alopecia areata

The history of herbal medicine in China goes back more than 1,000 years. Many kinds of mixtures of herbs that are effective to diseases or symptoms have been transmitted from the middle ages to today under names such as Traditional Chinese Medicine (TCM) in China and Kampo in Japan. For the treatment of severe and intractable alopecia areata, such as alopecia universalis, totalis, diffusa etc., herb lotions are known to be effective in hair regrowth. Laiso®, Fukisin® in Japan and 101® in China are such effective examples. As to treat such cases, systemic usage of corticosteroid hormones are surely effective, however, considering their side effects, long term usage should be refrained. There are also these who should refrain such as small children, and patients with peptic ulcers, chronic infections and osteoporosis. AL-8 and AL-4 were the prescriptions removing herbs which are not allowed in Japanese Pharmacological regulations from 101, and salvia miltiorrhiza radix (SMR) is the most effective herb for hair growth, also the causation to produce contact sensitization. Therefore, the mechanism of hair growth of these herb lotions in which the rate of effectiveness was in average 64.8% on 54 severe intractable cases of alopecia areata, was very similar to DNCB and SADBE. The most recommended way of developing herb lotion with high ability of hairgrowth is to use SMR but its concentration should not exceed 2%, and when sensitization occurs, the lotion should be changed to Laiso® or Fukisin®, which do not contain SMR. Relapse of severe alopecia areata after or during hairgrowth is quite common, therefore, to maintain the cured conditions, the allergens to break immune priviledge (IP), such as metal allergy and / or atopic mite allergy should be investigated. When these allergens were removed, the cured conditions were maintained on an average of 4 years. It should also be noted that such allergen control (in other terms allergen avoidance or allergen elimination) should be performed, along with antisymptomatic treatments consisted of herb lotion application and temporary systemic usage of corticosteroid hormones. Correspondence to: Hideo Nakayama, Meguro Chen Dermatology Clinic Shinyo-CK Building 6F 3-3-5, Kami-Ohsaki, Shinagawa-ku, Tokyo 141-0021, Japan, Tel: +81-3-3786-1678; E-mail: nakayamadermatology@eos.ocn.ne.jp