Jytte Roed-Petersen

Occupational protein contact dermatitis in food handlers

The preparation of food in restaurant kitchens carries a high risk of occupational dermatoses. Analysis of 33 cases revealed four different etiological types. Simple irritant dermatitis was rare (2 cases), plain contact dermatitis was more common (6 cases). Fifteen patients had relevant patch tests and scratch tests; ten had positive scratch tests only to explain the cause of their dermatitis. The last type was termed protein contact dermatitis. The major type IV allergens incriminated were metals, onion and garlic. The major proteinaceous allergens indicated by history and test results were fish and shell‐fish. Open patch tests with the incriminated foods may cause erythema or oedema on normal skin after 20 minutes. Previously eczematous, now normal looking, skin often responds with a crop of dyshidrotic vesicles preceded by erythema and itching 30 minutes after the application of an open test. Examination for specific IgE is not always positive in such cases. Inhalant allergy was rare. The results indicate that food handlers are sensitized by the protein they touch, and then react to later contact with the proteins. Protein contact dermatitis is similarly common among veterinary surgeons, while the importance in other occupational groups remains to be studied.

The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial

The study compared the effect of a sustained silver‐release foam dressing (Contreet Foam) with a foam dressing (Allevyn Hydrocellular) without added silver in critically colonised venous leg ulcers with delayed healing. The study was a multicentre, open, randomised, controlled study lasting for 4 weeks. Ulcer area and healing were assessed weekly. Odour, maceration, absorption capacity and leakage were evaluated at dressing changes. All adverse events were recorded. One hundred and twenty‐nine patients were included (Contreet Foam: 65, Allevyn Hydrocellular: 64). The two groups were comparable in all respects. After 4 weeks, there was a significantly greater reduction in ulcer area in the Contreet Foam group (45%) than in the Allevyn Hydrocellular group (25%). After 1 and 4 weeks, odour was present in significantly less of the ulcers in the Contreet Foam group (17% and 19%, respectively) compared with the Allevyn Hydrocellular group (47% and 39%, respectively) and at the final visit there were significantly fewer leakages in the Contreet Foam group (19%) compared with the Allevyn Hydrocellular group (49%). Also, less maceration was observed after 1 and 4 weeks in the Contreet Foam group (34% and 37%, respectively) compared with the Allevyn Hydrocellular group (55% and 48%, respectively). The occurrence and cause of adverse events were equally distributed between the study groups. The present study provides evidence of the superior performance of the silver‐releasing dressing, Contreet Foam, compared with a traditional moist foam wound healing dressing in the treatment of critically colonised, chronic venous leg ulcers. The results of this randomised, controlled study suggest an important role of sustained silver‐releasing dressings in the treatment of critically colonised chronic wounds.

Airborne contact dermatitis from Compositae oleoresins simulating photodermatitis

American ragweed (Ambrosia) dermatitis has an airborne pattern and is caused by lipid soluble oleoresins of pollens, A similar weed dermatitis has been described in India and Australia. The weeds involved were all of the Compositae family and contain sesquiterpene lactones with one common antigenic determinant.

Contact dermatitis from antioxidants

In a search for contact sensitivity to antioxidants we patch tested consecutive patients referred with eczematous dermatitis.

Type I allergy from cows in veterinary surgeons

Occupational contact dermatitis caused by obstetric work and/or contact with cows is common among veterinary surgeons. We examined serum from nine veterinary surgeons of whom seven gave a history of itching and flare of eczema after obstetric work and/or contact with cows. By means of crossed radioimmunoelectrophoresis the occurrence of specific IgE against cow hair and dander was demonstrated. The IgE did not differ qualitatively or quantitatively from IgE in serum from patients with allergic asthma from cows. Four veterinary surgeons with flare‐up of eczema during obstetric aid to cows did not have assignable s‐igE against bovine amnion or allantoic fluids.

Erythema multiforme as an expression of contact dermatitis

Due to topical deterioration of the complaint during treatment, she suspended the therapy. Soon after reapplication of the cream given by us under a code number, a pronounced vesicular eczema appeared which spread extensively. The tests showed a strong positive reaction to the miconazole cream ( + + + ), to miconazole 2 % in yellow soft paraffin ( + + +) and to the antioxidant butyl hydroxy anisol 5 % in petrolatum ( + + ). The tests with Tefose 63 (as is) an emulsifying agent consisting of a mixture of monoand distearic esters of ethylene glycol and polyoxyethylene glycols; with Labrafil M 1944 CS (as is) an emulsifying agent consisting of polyethylenic oleic glycerides; and with powdered flavour perfume no. 4074 5 % in yellow soft paraffin, were negative. The tests with the standard series were also negative. A rather extensive literature can be found about the toxic side-effects of butyl hydroxy anisol, when taken orally (in food). Allergic skin reactions are rare, but positive tests have been published before (Meneghini et al.). Vandaele and Uyttendaele in 1972 mentioned a burning sensation after application of miconazole cream. Van Ketel has published a case of allergy to miconazole nitrate. We were not able to test the possibility of group sensitivity to the imidazole ring, as did Van Ketel with negative results. Our patient refused further allergic investigations. We assume that miconazole is a weak sensitizer, but we have to be aware of the possibility of contact dermatitis caused by this antimycotic drug. Fig. 1: Structural formula of miconazole nitrate (R 14889) 1-{ 2-(2, 4-dichlorophenyl)-2[(2, 4dichlorophenyl) methoxy] ethyl}-1H-imidazole mononitrate.

Rapid increase in skin problems among dental technician trainees working with acrylates

A panel of trainees at The Danish School of Dental Technicians was asked to fill in questionnaires 2 × a year, to elucidate whether the prevalence of skin problems on their hands increased during the study and to compare the results to the general population. At the beginning of the study, trainees had a prevalence of skin problems not statically significantly different from that in the general population. 8 months later, an increase of 23% in the prevalence was observed. Compared to the general population the stadardized prevalence ratio (SPR) increased to 4.78, and compared to dental technicians at work, and SPR of 0.71 was found after 1 year of study. Very few trainees experienced relief in symptoms during the 1st year of study (5%), whereas 33% developed worse symptoms. The results demonstrate that trainees shortly after beginning their education have the same very high magnitude of skin problems as dental technicians at work. Trainees were exposed to acrylates more extensively than dental technicians. It is far from acceptable that this educational experience involves such a great risk to individuals with no experience or knowledge of the hazards of their occupational environment. Preventive actions are called for, e.g., increased use of encapsulated systems, use of gloves with a well documented protective effect and mandatory courses on the hazardous effects of dental materials.

Postsorters' rubber fingerstall dermatitis

An outbreak of rubber fingerstall dermatitis in a Danish post office was found to be caused by minute amounts of isopropylphenyl‐para‐phenylenediamine (IPPD) in the fingerstalls. The presence of IPPD in the fingerstalls could not be explained by the manufacturer and had to be confirmed by gas chromatographic analysis.