Juan Francisco Silvestre

Shoe contact dermatitis from dimethyl fumarate: clinical manifestations, patch test results, chemical analysis, and source of exposure

Background: The methyl ester form of fumaric acid named dimethyl fumarate (DMF) is an effective mould‐growth inhibitor. Its irritating and sensitizing properties were demonstrated in animal models. Recently, DMF has been identified as responsible for furniture contact dermatitis in Europe.

Efficacy of omalizumab in chronic spontaneous urticaria refractory to conventional therapy: analysis of 110 patients in real-life practice

Objective: To collect data on the efficacy and safety of omalizumab in 110 patients from 9 Spanish hospitals suffering from chronic spontaneous urticaria (CSU) refractory to conventional treatment. Methods: A retrospective, descriptive analysis was performed, showing the data of 110 patients suffering from refractory CSU who received omalizumab as an off-label treatment in 9 Spanish hospitals from October 2009 to September 2012. Results: Ninety (81.8%) patients exhibited a complete or significant response, 12 (10.9%) had partial response, and 8 (7.2%) showed no response. Sixty-six (60%) patients were able to stop all concomitant medications, remaining asymptomatic treated with omalizumab alone. No serious adverse events were reported. Conclusions: Omalizumab shows excellent efficacy and safety profile in a large series of CSU patients in real-life practice. This drug will contribute to settle the debt with CSU patients contributing to restore their quality of life.

Fragrance contact allergy: a 4-year retrospective study.

Background: Fragrance chemicals are the second most frequent cause of contact allergy. The mandatory labelling of 26 fragrance chemicals when present in cosmetics has facilitated management of patients allergic to fragrances.

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.

Patch testing in children with hand eczema. A 5‐year multicentre study in Spain

Background. Hand eczema is common in children, but affected children are seldom patch tested. Relatively few studies have assessed patch testing in the paediatric population, and none has specifically evaluated its use in hand eczema in children.

Contact sensitization to limonene and linalool hydroperoxides in Spain: a GEIDAC(*) prospective study.

Limonene and linalool are common fragrance terpenes widely used in cosmetic, household and hygiene products. Their primary oxidation products formed after air exposure, the hydroperoxides, have been recognized as important contact haptens.

Patch testing with formaldehyde and formaldehyde-releasers: multicentre study in Spain (2005–2009)

Background. Formaldehyde and formaldehyde‐releasers are common causes of allergic contact dermatitis.

Progression of Meyerson's naevus to Sutton's naevus.

Melanocytic naevi can suffer two types of perilesional inflammation, a depigmentation and a dermatitis [1, 2]. The former seems to be a form of cell-mediated, auto-immune reaction directed towards the destruction of the naevus and related to vitiligo. The dermatitis reaction is thought to be immune mediated [3, 4]. Meyerson’s phenomenon has not only been described with melanocytic naevi but also with other entities such as dermatofibroma. Although both processes involve the immune system, the mechanisms are different [5, 6]. Some authors consider these two as the opposite ends of the same immunological processes [3, 4]. On the other hand, other authors support the idea that they are different processes [5, 6] because the clinical, histological and evolutional data of both entities are very different [5]. The clinical findings which suggest that they are separate processes are that the eczematous halo does not show depigmentation and is pruriginous [1, 6]. The histology favours the latter hypothesis: the eczematous halo does not show the regression changes which are characteristic of the halo naevus [5]. Finally, the evolution of these two entities is often quite different, since in previously reported cases the eczematous halo did not evolve towards depigmentation and regression of the naevus [3–5]. A 28-year-old man developed itchy areas around the melanocytic naevi on both legs, of 1 month’s duration. Three months previously, he had experienced a similar episode that resolved spontaneously. Fig. 1. One of the naevi on the leg showing an eczematous halo. Fig. 2. Biopsy of one of the Meyerson’s naevi. The dermo-epidermal melanocytic naevus shows signs of regression in the papillary dermis. There is a lymphohistiocytic infiltrate, with numerous eosinophils in the upper dermis. Haematoxylin-eosin. Original magnification !200.

Contact cheilitis from bisabolol and polyvinylpyrrolidone/hexadecene copolymer in lipstick

A 20-year-old woman, with no significant personal history, attended our surgery complaining of dry, desquamative cheilitis of both lips that had been present for 3 months. On suspicion of allergic contact cheilitis, the patient was told to stop using all her lipsticks, and her clinical symptoms disappeared in 8 days. A repeated open application test (ROAT) with her lipsticks was performed on her inner arm, and 3 days later, there was an eczematous reaction in the region where the lipstick Forever Metallic 40 pink mercury (Maybelline NY, L’Oreal, Paris, France) had been applied. She was patch tested with the standard series of the Spanish Contact Dermatitis Research Group (GEIDC), cosmetic series (Chemotechnique , Malmö, Sweden), the lipstick components provided by the manufacturer, and the end product. Patches were removed after 2 D and evaluated at 2 D and 4 D. There was a positive reaction to polyvinylpyrrolidone (PVP)/hexadecene copolymer (5% pet.), bisabolol (5% pet.), and the end product (Table 1). Patch tests performed on 10 controls with bisabolol (5% pet.), PVP/hexadecene copolymer (5% pet.), and the end product were negative. She was also tested with the plant series (Chemotechnique ), and this was negative at 2 D and 4 D. 3 months later, the patient presented once again with cheilitis of both lips after inadvertently using a lipstick containing bisabolol (Liposan; BDF Nivea, Hamburg, Germany).

Allergic contact dermatitis from apraclonidine in eyedrops

Case Report A 59-year-old man presented with right sided conjunctivitis and lichenified dry eczema on the right lower eyelid and cheek present for 2 years. Past medical history included high blood pressure on treatment with AmerideA (amiloride and hydrochlorothiazide) and glaucoma of the right eye on treatment with CusimololA 0.5% and IopimaxA 0.5% for 7 years. IopimaxA eyedrops (0.5% apraclonidine, 0.1% benzalkonium chloride, sodium acetate, sodium chloride, hydrochloric acid and purified water) were applied only to the right eye. CusimololA drops (0.5% timolol, benzalkonium chloride, monosodium phosphate, disodium phosphate, sodium chloride, and purified water) were applied to both eyes. Patch testing was performed with the GEIDC standard series, 0.1% benzalkonium chloride, 0.5% Iopimax’ and 0.5% Cusimolol’. Positive reactions were obtained to Iopimax 0.5%A (ππ) at D3 and D4. Patch testing with 0.25%, 0.5%, 1% and 10% aq. apraclonidine gave a positive reaction (ππ) only to 10% apraclonidine. 10% apraclonidine patch testing in 20 healthy volunteers was negative. 0.5% Iopimax’ was stopped and this led to resolution of the conjunctivitis and eczema of the right eye. The patient has kept on applying the 0.5% CusimololA without any side-effects for the last year.