Javier Sánchez-Pérez

Current patch test results with the European baseline series and extensions to it from the 'European Surveillance System on Contact Allergy' network, 2007-2008

Background. The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences.

Occupational allergic contact dermatitis from eugenol, oil of cinnamon and oil of cloves in a physiotherapist.

Other such reactions reported are Stevens-Johnson syndrome (4) and a fixed drug eruption (5). The allergies to neomycin, nystatin and clioquinol were probably related to the use of these agents in topical treatments for intertrigo, though no records were available from the patient’s general practitioner to substantiate this. Our patient’s systemic reaction is difficult to characterize with certainty. The results of patch testing suggest a systemic Type IV reaction, but the flare within 24 h, with gastrointestinal upset and arthralgia, suggests an immune complex component (Type III hypersensitivity reaction).

Schnitzler's syndrome with monoclonal IgGκ gammopathy: good response to cyclosporin

Schnitzlers syndrome (SS) is a rare entity characterized by the association of chronic urticaria and monoclonal IgM gammopathy. Usually, intermittent fever, arthralgia and elevation of erythrocyte sedimentation rate also occur. We report a patient with the same symptoms, but with monoclonal IgG instead of IgM paraproteinaemia. Histological examination of the urticarial lesions showed signs of leucocytoclastic vasculitis. After 20 years of therapeutic failure, cyclosporin has achieved a total clearance of urticarial lesions in our patient. Two previous similar cases with clinical features of SS and monoclonal IgG immunoglobulin have been described. We suggest our case also represents a variant of SS with IgG gammopathy.

Epidemiología del eczema de contacto en España. Resultados de la Red Española de Vigilancia en Alergia de Contacto (REVAC) durante el año 2008

BACKGROUND The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units. OBJECTIVES The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. MATERIAL AND METHODS Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. RESULTS Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. CONCLUSIONS The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series.

Nickel allergy in Spain needs active intervention.

Juan Garcı́a-Gavı́n1 , José Carlos Armario-Hita2 , Virginia Fernández-Redondo1, José Manuel Fernández-Vozmediano3, Javier Sánchez-Pérez4, Juan Fco. Silvestre5, Wolfgang Uter6 and Ana M Giménez-Arnau7 1Faculty of Medicine, Department of Dermatology, University Hospital Complex, Santiago de Compostela, La Coruña 15706, Spain, 2Department of Dermatology, Hospital Punta de Europa (Algeciras), University of Cádiz, Cádiz 11207, Spain, 3Department of Dermatology, Hospital Universitario de Puerto Real, University of Cádiz, Cádiz 11510, Spain, 4Department of Dermatology, Hospital Universitario la Princesa, Madrid 28006, Spain, 5Department of Dermatology, Hospital General Universitario de Alicante, Alicante 03010, Spain, 6Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nüremberg, Erlangen 91054, Germany, and 7Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona 08003, Spain

Biological Treatments in Atopic Dermatitis

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases that affect both children and adults with a prevalence of 30% and 10%, respectively. Even though most of patients respond satisfactory to topical anti-inflammatory drugs, about 10% require one or more systemic treatments to achieve good control of their illness. The progressive and increasingly detailed knowledge in the immunopathogenesis of AD has allowed research on new therapeutic targets with very promising results in the field of biological therapy. In this article, we will review the different biological treatments with a focus on novel drugs. Their mechanism of action, current status and results from clinical trials and observational studies will be specified.

Maculopapular eruption with enlarged macrophages in eight patients receiving G-CSF or GM-CSF

In the last years, granulocyte and granulocyte‐macrophage colony‐stimulating factors (G‐CSF and GM‐CSF) are being increasingly used and several cutaneous eruptions have been reported in relation to these treatments. In 1991 Horn et al. described three patients with maculopapular eruption that paralleled the time of infusion of GM‐CSF. Two of the cases showed an increase in the number and size of macrophages in the biopsy specimen. Since then, several cases have been reported showing this histopathological alteration that has been considered characteristic of reaction to G‐CSF or GM‐CSF. Although maculopapular eruption with enlarged macrophages can appear after chemotherapy treatment, we have found that the presentation of this eruption after the beginning of cytokine treatment is suggestive of the involment of G‐CSF and GM‐CSF in the eruption. We described eight cases of patients treated with G‐CSF or GM‐CSF that developed maculopapular eruptions with enlarged macrophages.

Patch test results with fragrance markers of the baseline series – analysis of the European Surveillance System on Contact Allergies (ESSCA) network 2009–2012

Contact allergy to fragrances is common, and impairs quality of life, particularly in young women.

Late skin reaction to iodixanol (Visipaque®): clinical manifestations, patch test study, and histopathological evaluation

Late reactions to iodinated contrast media are frequent. Cutaneous manifestations are the commonest, in which maculopapular exanthema, a type of cutaneous presentation, is widespread. Controversy exists about the utility of the skin test in the management of these reactions. The aim of this study is to analyse the clinical characteristics, the histopathological findings, and the results of the patch test in patients who developed a late skin reaction (LSR) to the nonionic, dimeric, iodinated contrast media Visipaque®. We retrospectively reviewed the patients with LSR to Visipaque®, seen in the Dermatology Department between 1999 and 2005. A total of 12 patients participated in this study (7 men and 5 women), ages ranging from 39 to 76 years (mean 56). 11 of the patients had significant medical history. All the patients developed a maculopapular exanthema between 2 hr and 3 days after the radiological examination, involving the trunk and proximal limbs, although some of the patients showed involvement of distal areas. The skin biopsy, performed in 6 patients, showed nonspecific findings consistent with drug reaction. In 3 patients, patch tests to Visipaque® and iodixanol were positive. The most frequent manifestation of LSR to iodixanol is a maculopapular exanthema, involving the trunk and the limbs, although distal involvement can be seen. Histopathological findings are nonspecific and cannot be distinguished from other drug reaction. Patch tests have a limited value, and in cases where they were negative, reintroduction of the drug triggered a new LSR.

ESSCA results with the baseline series, 2009-2012: rubber allergens.

Allergic contact dermatitis caused by rubber allergens is common, and causes significant patient morbidity. Contemporary data are important to allow appropriate preventive measures and identification of contact allergy trends.