J. L. Díaz‐Pérez

Contact dermatitis from propolis

adhesive tape which was used when the patient was patch tested with the routine series and with the new cutting fluids after the summer (3). It is impossible to assess whether the sensitization to diphenylthiourea is due to the application of the compound in the routine series or to the adhesive tape. The patient was probably sensitized to diphenylthiourea through the patch testing procedure, as she did not use any adhesive tape in the interval between the tests. The results of re-testing 379 hand eczema patients with II substances first applied 6-21 months previously have been reported ( 4). 19% of the tests had become positive, but no testing was performed with dilutions. Therefore, some of the positive reactions may represent a higher sensitivity in previouslysensitized individuals. Diaminodiphenylmethane was one of the compounds giving a statistically significant change. The concentration used in this investigation was 2%, while the concentration of diaminodiphenylmethane in the present routine series is 0.5% (w/w). The crucial importance of the test concentration has been demonstrated (5). More subjects were sensitized by 8% para-phenylenediamine than by 2% when the same vehicle was used. Tetramethylthiuram disulphide ( 1%) sensitization by patch testing has been reported to be the most common ( 6). The present patient was sensitized to tetramethylthiuram monosulphide ( 1.5% w I w) and did not react to tetramethylthiuram disulphide at the same concentration. The reported case with patch test sensitization to 3, probably 4 substances in a routine test series is an example of possible adverse reaction to patch testing. The 4 compounds were chemically unrelated, so cross-reactivity is excluded. Patch test sensitization may be more common than expected, but sensitization to 3 compounds, shown by simultaneous flare-up reactions, is probably very rare. It is surprising that the patient with this disposition to patch test sensitization was not sensitized to substances in her environment, although she had a hand dermatitis.

Bexarotene activates the p53/p73 pathway in human cutaneous T‐cell lymphoma

Background  Bexarotene is the first synthetic retinoid X receptor‐selective retinoid (rexinoid) approved for the treatment of cutaneous T‐cell lymphoma (CTCL). However, little is known about the signalling pathways by which it exerts its anticarcinogenic effect.

A Customized Pigmentation SNP Array Identifies a Novel SNP Associated with Melanoma Predisposition in the SLC45A2 Gene

As the incidence of Malignant Melanoma (MM) reflects an interaction between skin colour and UV exposure, variations in genes implicated in pigmentation and tanning response to UV may be associated with susceptibility to MM. In this study, 363 SNPs in 65 gene regions belonging to the pigmentation pathway have been successfully genotyped using a SNP array. Five hundred and ninety MM cases and 507 controls were analyzed in a discovery phase I. Ten candidate SNPs based on a p-value threshold of 0.01 were identified. Two of them, rs35414 (SLC45A2) and rs2069398 (SILV/CKD2), were statistically significant after conservative Bonferroni correction. The best six SNPs were further tested in an independent Spanish series (624 MM cases and 789 controls). A novel SNP located on the SLC45A2 gene (rs35414) was found to be significantly associated with melanoma in both phase I and phase II (P<0.0001). None of the other five SNPs were replicated in this second phase of the study. However, three SNPs in TYR, SILV/CDK2 and ADAMTS20 genes (rs17793678, rs2069398 and rs1510521 respectively) had an overall p-value<0.05 when considering the whole DNA collection (1214 MM cases and 1296 controls). Both the SLC45A2 and the SILV/CDK2 variants behave as protective alleles, while the TYR and ADAMTS20 variants seem to function as risk alleles. Cumulative effects were detected when these four variants were considered together. Furthermore, individuals carrying two or more mutations in MC1R, a well-known low penetrance melanoma-predisposing gene, had a decreased MM risk if concurrently bearing the SLC45A2 protective variant. To our knowledge, this is the largest study on Spanish sporadic MM cases to date.

Allergic contact dermatitis from Kathon 893

ing in an additional medicament series. We have not tried to validate the relationship between ketoconazole cream and sodium sulfite sensitivity by use testing. From our data, it can be concluded that the majority of patients sensitized to sodium sulfite have no known previous contact with ketoconazole cream or sodium-sulfite-containing topical preparations. The clinical relevance of the positive reactions to sodium sulfite remains to be established. Contact Dermatitis 1992: 27: 345

Allergic contact dermatitis from a cream containing Centella asiatica extract

A 42-year-old housewife, with no atopic history, developed severe dermatitis of the legs, without previous sun exposure, after the application of a vasotonic cream (BlasteostimuJina®). She was patch tested, using Finn Chambers® and TRUE Test® and reading at 2 and 4 days, with the GEIDC standard series, the Blasteostimulina® cream and its ingredients. We found strongly positive reactions to neomycin (another component of the cream), colophony, fragrance-mix and carba-mix in the GEIDC standard series, as well as a positive reaction to Blasteostimulina® cream. On testing with the fragrance series (Chemotechnique), we found positive reactions to cinnamic aldehyde, geraniol, hydroxycitronellal, jasmine synthetic, Bulgarian rose oil, ylang-ylang oil, Bourbon geranium oil, neroli essence, lemon grass essence and cananga oil (all2% pet.). In the rubber series (Chern-

Disseminated Bacillus Calmette-Guerin Infection in an HIV-Infected Child: A Case with Cutaneous Lesions

Abstract: A boy bom to a mother with unknown HIV infection was immunized with BCG In his first month of life. Seven months later axillary adenopathy developed. At the age of 10 months, 2 months after HIV Infection had been diagnosed, papular skin lesions appeared all over his body. Mycobacterium bovis, BCG strain, was cultured from a lymph node and blood. Ziehl‐Neelsen stain of a skin biopsy specimen showed histiocytes loaded with numerous acid‐fast bacilli. The patient died 10 days later, before the infection was confirmed. This is the first reported case of disseminated BCG infection in an HIV‐infected child presenting with cutaneous lesions.

GIANT MOLLUSCUM CONTAGIOSUM PRESENTING AS A TUMOR IN AN HIV-INFECTED PATIENT

A 29-year-old ex-drug addict, Hiv-positive since 1987, consulted us in January 1992, presenting with tumoral disfiguring lesions on his face and scalp. He suffered from ganglionar tuberculosis in 1990, and at the same time also noticed a few small, dome-shaped papules, 2-6 mm in diameter, clinically typical for molluscum contagiosum on the face, arms, and the genital region. The lesions were treated with curettage and cryotherapy with partial success. In 1991, he developed candidiasis of the esophagus, and at the same time a nonHodgkins lymphoma (IV-D stage) was diagnosed. Chemotherapy (CHOP regimen) was started. Coinciding with the diagnosis of lymphoma and the beginning of the cytostatic treatment, confluent papular lesions developed on his face and scalp in the form of tumoral masses with severe, disfigurating dysmorphy of the patient (Figs. 1 and 2). At this time, we found the following immunologic parameters: leukocytes 4100/mm^ (26% lymphocytes), CD4 = 1% (lO/mm^), CD4/CD8 = 0.01. A biopsy confirmed the diagnosis. Histopathologic examination showed an acanthotic epidermis with an intense epidermal proliferation with giant craters full of eosinophilic and hyaline masses (Henderson-Patterson bodies), typical of molluscum contagiosum and corresponding to intracytoplasmic inclusion of viral particles (Fig. 3). Because of the extension of the giant molluscum contagiosum, we thought of possible surgical treatment but rejected this because of technical difficulties and the high risk of HIV transmission from exposure of the skin to contaminated blood products. We treated the lesions with aggressive cryotherapy using liquid nitrogen (2 cycles of 90 s with Cry-AcTM, Brymill Corporation, USA), on 1 or 2 days per week, with a partial decrease in number and size of the lesions. At present, new lesions have not appeared.

A positive patch test in a pyrazinamide drug eruption

A high level of nickel in the drinking water may add ,to the elements dietary intake (average: 150 Jig/day (lj), and cumulatively worsen the prognosis in nickel <j.ermatitis. The consumption of bottled water is on the increase: an equivalent of 3 litres per individual in the UK was recorded for 1988 (2). The mean nickel content of 6 litres tap water samples in the Greater Manchester area was 2.6 Jig/! (range: 0.3-23.8 Jig/1), whilst in 10 bottled waters it was 0. 7 Jig/! (range: 0.3-2.3 Jig/!, analytical limit: ± 0.3 Jig/! -graphite furnace A.A. spectroscopy). Similarly low Ni2+ levels in most bottled waters were reported from Belgium ( < 2 Jig/! in 13 samples, and 4 and 20 Jig/! in 2 others) (3). Mineral water has perhaps been less exposed to anthropogenic metal contamination. The mean alu-_ minium level in the samples we investigated was 2 Jig/! (range 1-6 Jig/!, analytical limit: ±I Jig/1),· whereas in our routine analysis, tap water usually contained at least 10 Jig/!. There is an increasing ·awareness of the importance of trace-metal contaminants. However, there are no standardized labelling requirements for these products, in particular listing their trace metal content.

Solar urticaria and cold urticaria in the same patient

long duration, which none the less responded rapidly to treatment. The patient was a 70-year-old farmer. His father had died at the age of 78 years of haemoptysis of unknown cause. Our patient presented in August 1992, with a pseudotumoral. asymptomatic plaque on his left upper arm. This lesion had grown steadily since it had first appeared when he was i years old. Examination revealed a 12 x 14cm, verrucose. hypertrophic lesion on the left arm (Fig. la), which was exuding small amounts of translucent, yellowish fluid. The margins of the lesion were well-defined, irregular in outline, and reddishviolet in colour. The lesion was surrounded by satellite papules, Diascopic examination revealed pale-yellow nodules. The remainder of the physical examination was normal. Investigations revealed an increased erythrocyte sedimentation rate, iron deficiency anaemia, and hypoproteinaemia. A chest X-ray and renal echographic studies were normal. Cultures of sputum and urine for mycobacteria were negative, and Ziehl-Neelsen staining of a biopsy specimen and exudate from the lesion did not reveal any mycobacteria. The Mendel-Mantoux reaction was 25 mm at 48 h. Histological examination revealed alternating zones of epithelial hyperplasia and hypoplasia. Samples taken from the margin of the lesion showed pseudoepitheliomatous hyperplasia. The dermis contained granulomas composed of epithelioid cells and Langhans giant cells surrounded by lymphocytes. There were foci of caseous necrosis, some of which were surrounded by fibrosis. Cultures of the exudate and biopsy tissue in Lowenstein medium grew Mycobacterium tuberculosis.

Contact dermatitis in a tracheostomized patient due to a rubber disc

Case Report A total laryngectomy was performed in a 45-year-old non-atopic man because of laryngeal squamous cell carcinoma. A rubber disc was put over the tracheostomy to support the cannula that runs from the trachea to the outside. 8 months after surgery, a pruriginous fissured eczema appeared on the skin around the tracheostomy. We found the following patch tests to be positive, as defined by the ICDRG (Table 1). A latex prick test was negative.