Keiji Sugiura

Results of patch testing with lavender oil in Japan

We report the annual results of patch testing with lavender oil for a 9‐year period from 1990 to 1998 in Japan. Using Finn Chambers and Scanpor tape, we performed 2‐day closed patch testing with lavender oil 20% pet. on the upper back of each patient suspected of having cosmetic contact dermatitis. We compared the frequency of positive patch tests to lavender oil each year with those to other fragrances. We diagnosed contact allergy when patch test reactions were + or <+ at 1 day after removal. The positivity rate of lavender oil was 3.7% (0–13.9%) during the 9‐year period from 1990 to 1998. The positivity rate of lavender oil increased suddenly in 1997. Recently, in Japan, there has been a trend for aromatherapy using lavender oil. With this trend, placing dried lavender flowers in pillows, drawers, cabinets, or rooms has become a new fashion. We asked patients who showed a positive reaction to lavender oil about their use of dried lavender flowers. We confirmed the use of dried lavender flowers in 5 cases out of 11 positive cases in 1997 and 8 out of 15 positive cases in 1998. We concluded that the increase in patch test positivity rates to lavender oil in 1997 and 1998 was due to the above fashion, rather than due to fragrances in cosmetic products.

Experimental study on phototoxicity and the photosensitization potential of ketoprofen, suprofen, tiaprofenic acid and benzophenone and the photocross‐reactivity in guinea pigs

Background: Ketoprofen, suprofen and tiaprofenic acid are arylpropionic anti‐inflammatories. Their chemical structures share the same elements as the benzoyl radical and the tiophene ring. We experienced nine cases of ketoprofen photoallergy, seven cases of suprofen photoallergy and three cases of tiaprofenic photoallergy.

A case of contact urticaria syndrome due todi(2‐ethylhexyl) phthalate (DOP) in work clothes

We previously reported a case of contact urticaria syndrome (CUS) due to di(2‐ethylhexyl) phthalate (DOP) in a polyvinyl chloride (PVC) grip on cotton gloves. The patient reported in this previous paper was careful not to have any contact with PVC products in his daily life or in his working environment. He discontinued the use of protective gloves with a PVC grip that was the cause of CUS. When working, he used cotton gloves without a PVC grip. We prescribed antihistamines which slightly improved his condition. However, when he wore work clothes while on duty, CUS relapsed. This condition was severe and made him feel anxious. When we advised him to wear a cotton shirt under his work clothes, the contact urticaria did not develop. We suspected that some component of the work clothes was the cause of his symptoms. A prick test with the extract solution of his work clothes showed a wheal and flare at the 15 min reading. The common component of the grip and the work clothes was found by analysis to be DOP.

Contact urticaria due to polyethylene gloves

We report a rare case of contact urticaria due to polyethylene gloves. The patient, a 46‐year‐old cook, had had had chronic urticaria since 1985, and first visited our hospital in June 2000. We began by prescribing antihistamine and antiallergenic drugs for him, but his condition did not improve. From a detailed interview, we established that when he put on polyethylene gloves at work, his condition worsened. We suspected some component of his gloves to be the cause of his symptoms. Prick and scratch tests with a solution extracted from his gloves showed a wheal‐and‐flare reaction at 15u2003min. We advised him to wear a cotton shirt under his clothes in daily life, and to put on cotton gloves under his polyethylene gloves while at work. Subsequently, the size and the number of wheals were markedly smaller and the subjects symptoms were reduced.

Successful treatment with infliximab of sibling cases with generalized pustular psoriasis caused by deficiency of interleukin‐36 receptor antagonist

within 5 months she developed verrucous papules and nodules on the nose, forearms and legs bilaterally. These were treated with terbinafine (250 mg id, 12 weeks) and subsequently voriconazole (400 mg id, 8 weeks) along with excision and cryotherapy. Six years later, despite no identifiable factor, she continues to develop lesions. Apart from this, we did not observe relapses or new lesions during a mean follow-up of 32 months. Cutaneous alternariosis represents 74.3% of overall alternaria cases, mostly by A. alternata, and is observed in Mediterranean countries in patients with predisposing factors (immunosuppression, local wound or systemic disease). Over 50% occur in transplanted patients as evidenced in our series. Rural surroundings are predominant as we observed, and local trauma facilitates the penetration of the pathogen, justifying why reported lesions are mainly solitary. In our experience, however, multiple lesions were more frequent. Moreover, we can speculate that the recurrent picture of our ‘healthy’ patient may be due to a specific host susceptibility to Alternaria infection. In transplanted patients, immunosuppressant reduction is obligatory to improve immune status and because of the interaction of antifungals (namely itraconazole) at tacrolimus’ common CYP3A4 pathway. Close track of tacrolinemia and renal function is mandatory. Itraconazole, voriconazole, posaconazole, amphotericine B and terbinafine can all be used. In our series, itraconazole was efficacious when combined with cryotherapy, surgical excision or both. Therefore, we suggest a 12-week course of itraconazole, 200mg bid, associated with physical intervention and follow-up for at least 24 months.

Immediate allergy, drug-induced eruption, by entecavir

© 2008 The Authors JEADV 2009, 23, 441–496 Journal compilation

Immunological cell situation in the skin of atopic model mice.

Backgroundu2002 We observed nishikinezumi, cinnamon‐coloured (NC)/Fujita (F) mice aged between 5 and 28 weeks. These NC mice have skin eruptions that resemble human atopic dermatitis (AD) under conventional circumstances.

Study of the Patch Test Reactions to Myocoptes musculinus (Kekuidani) of NC/F Mice (Atopic Model Mice)

Background: Atopic dermatitis is considered to be developed by the IgE-mediated immediate allergy and by the delayed hypersensitivity to causative allergens. We have previously reported that IgE-mediated type I allergy to mites contributed to the development of skin eruptions on atopic model mice (NC mice). Objective: This time, we studied the delayed hypersensitivity skin reaction to mites in NC/F mice. Methods: We conducted 48-hour closed patch testing with Myocoptes musculinus (kekuidani) that is a parasite in NC/F mice and BALB/C mice. Results: At both the 48- and 72-hour readings, 7 (87.5%) out of 8 NC/F mice tested showed positive reactions to M. musculinus. All BALB/C mice showed negative reactions to M. musculinus. All animals showed negative reactions to white petrolatum. Conclusion: Our previous data and results of this study give positive proof that both IgE-mediated immediate allergy and cell-mediated delayed hypersensitivity to a mite antigen contribute to the development of skin eruptions on NC/F mice resembling human atopic dermatitis.

Delayed‐type hypersensitivity reactions due to sodium lauryl sulphate in omeprazole

© 2008 The Authors JEADV 2009, 23, 570–620 Journal compilation

Punctate palmoplantar keratoderma type 1 with a novel AAGAB frameshift mutation: intrafamilial phenotype variation due to ageing

by local T-cell cytotoxic response, which is developed against the external materials used in the treatment. Another case reported by Kowing et al. is madarosis and facial alopecia secondary to botulinum A toxin injection for orofacial dystonia. They considered this side-effect as an idiosyncratic reaction. They also mentioned that madarosis may be due to oedema occurring at the site of percutaneous injection. Rubegni et al. reported one patient with Meige hereditary lymphoedema presenting with alopecia of the lateral third of eyebrows and conjunctival oedema. Alopecia of the lateral third of the eyebrows is a common sign of obstruction in lymphatic drainage of the periorbital region. Herein, the underlying pathology is a nerve sheath tumour which presumably impairs lymphatic drainage and therefore causes a mild periorbital oedema and milphosis. Physicians have to take into consideration that unilateral milphosis can be a possible sign of intracranial pathologies.