Leonardo Bianchi

Clinical and epidemiological features of textile contact dermatitis: an Italian multicentre study.

The prevalence of occupational and non‐occupational textile dermatitis seems to be increasing, probably because of changed textile manufacturing techniques.

Evaluation of milk enzymes and electrolytes, plasma metabolites, and oxidative status in twin cows milked in an automatic milking system or twice daily in a conventional milking parlor.

The aim of this paper was to evaluate the effects of automatic milking (AM) on milk enzymes and minerals related to mammary epithelial integrity in comparison with twice-daily conventional milking (CM). One cow from each of 6 pairs of twins was assigned to be milked with AM or with CM throughout first lactation. Milk production was recorded and milk samples were collected at 4, 11, 18, 25, 32, and 39 wk of lactation (WOL) to determine fat and protein content, somatic cell count, pH, plasminogen (pl) and plasmin (Pl) activities, Na, K, and Cl. Body condition score was monitored; blood samples were collected to determine energy-related metabolites in the first third of lactation (14 WOL), and plasma oxidative status throughout lactation. Overall mean and standard deviation of milking frequency (MF) in AM were 2.69 and 0.88, respectively. Milk production, fat and protein contents, and somatic cell count did not differ between milking systems. The pl and pl+Pl activities were lesser in AM than in CM. Milk pH was greater in AM than in CM. Milk Na, K, Na/K ratio, and Cl did not differ across the whole lactation. Milk pH had a positive correlation with milk Pl activity (r = 0.41), Na (r = 0.37), and Cl (r = 0.40) concentration, and negative correlation with the log(10) of pl/Pl ratio (r = -0.47). The milk Na/K ratio had a positive correlation (r = 0.55) with milk Pl activity. Milking system (MS) did not seem to affect mammary epithelial permeability. The differences in enzymatic (proteolytic) activity due to the MS, probably related to daily MF, lead one to suppose that the quality of the protein fraction for the cheese-making process was preserved better with AM than with CM, even if differences in pH might negatively interfere. No difference was detected in BCS, and in plasma concentration of triglycerides and nonesterified fatty acids, whereas plasma cholesterol concentration during the first 10 WOL was lesser in AM than CM. Oxidative status, measured by plasma reactive oxygen metabolites and thiol groups, did not differ between MS throughout the whole lactation. These results suggest that early lactation of AM primiparous cows may give rise to crucial situations: for milk production, when a low MF may impair further mammary cell proliferation; for milk quality, if an irregular MF, with prolonged milking intervals, leads to an increased milk pH with increased conversion of pl to Pl.

Occupational airborne allergic contact dermatitis from potassium metabisulfite

Sulfites are heterogeneous compounds that are widely used in occupational and non-occupational fields as preservatives and antioxidants in foods, beverages, drugs, and cosmetics, as fixatives in the photographic industry, and as acidifying agents in tanning of leather (1–5). They mainly cause immunoglobulin E-mediated disorders (6), but contact dermatitis from sodium metabisulfite is reported (7).

The role of acrylic acid impurity as a sensitizing component in electrocardiogram electrodes

Allergic contact dermatitis caused by (meth)acrylates is well known, both in occupational and in non‐occupational settings. Contact hypersensitivity to electrocardiogram (ECG) electrodes containing (meth)acrylates is rarely reported.

Effect of somatic cell count and lactation stage on sheep milk quality

Abstract In order to evaluate the effects of mammary health status and lactation phase on the qualitative parameters of ovine milk, 213 individual milk samples were repeatedly collected from 40 primiparous Sarda ewes on a monthly basis. Yield, physico-chemical characteristics, casein fractions quantitative distribution, somatic cell count (SCC), cheese making properties and plasmin-plasminogen activity were determined on each sample. Repeated individual milk SCC were used as a marker of udder health status, allowing the definition of three classes: “Healthy” (H), “Infected” (I) or “Doubtful” (D). Samples were grouped into 4 classes of days in milk (DIM). To evaluate the influence of mammary health status and phase of lactation, a mixed model was performed using the ewe as random effect. Milk physico-chemical parameters were influenced both by the udder health status and by lactation phase. In particular, the udder health status adversely affected ケs1 and ゲ1-casein fractions (P00.01) and curd firmness (P00.05). Samples reactive to rennet were 92.73%, 70.65% and 64.60% in “H”, “D” and “I,” respectively. Lactation phase influenced the overall milk composition and technological characteristics. Plasmin activity was higher in the “I” group than in the others (16.1 vs 11.8 and 11.2 U/ml; P00.01) and it significantly (P00.01) increased during lactation. In conclusion, both mastitis and mammary involution are proven to exert a detrimental effect on milk quality since they enhance its endogenous proteolytic activity.

The Epidermal Growth Factor Receptor Inhibitor-Related Skin Toxicity Index (EGFRISTI): a new tool for grading and managing skin adverse reactions to epidermal growth factor receptor inhibitors.

Background: Skin toxicity is frequent and debilitating in oncologic patients treated with epidermal growth factor receptor inhibitors (EGFRIs). Grading and management of skin adverse events (AEs) are poorly standardized. Materials and Methods: We developed a new score (EGFRISTI: Epidermal Growth Factor Receptor Inhibitor-Related Skin Toxicity Index) which is able to quantify and monitor all EGFRI-related dermatologic AEs over time. The utility of this tool was validated in 130 patients treated with 5 different EGFRIs including both monoclonal antibodies and tyrosine kinase inhibitors. Results: The mean baseline EGFRISTI score was 26.9 (range: 6.0-64.5). Mild toxicity was found in 55 patients (42.3%), moderate toxicity in 43 (33.1%), and severe toxicity in 32 patients (24.6%). After the first-line toxicity treatment, an EGFRISTI score reduction of >75% was obtained in 31 patients (34.1%) and one of 50% in 40 patients (43.9%), while an improvement of <50% was observed in the remaining 20 subjects (22.0%). Conclusions: The EGFRISTI is a simple and reliable tool to quantify and express the severity of all clinical signs and symptoms of EGFRI skin toxicity with a single numerical value, to choose the most suitable therapy, and to measure its efficacy.

Deflazacort hypersensitivity: a difficult-to-manage case of systemic allergic dermatitis and literature review

Management of corticosteroid (CS) hypersensitivity is not easy, and the choice of an alternative CS is difficult, owing to the high frequency of cross-reactions. Deflazacort has been reported to be a safe alternative in subjects with CS hypersensitivity (1), and reports of deflazacort hypersensitivity are rare (2–7). Here, we report a difficult-to-manage case of systemic allergic dermatitis caused by deflazacort.

Dermatitis caused by arthropods in domestic environment: an Italian multicentre study

Skin diseases caused by mites and insects living in domestic environments have been rarely systematically studied.

Bullous nonpigmenting multifocal fixed drug eruption due to pseudoephedrine in a combination drug: clinical and diagnostic observations.

Nonpigmenting fixed drug eruption (NPFDE) is a clinically recognizable entity first reported in 1987 as a variant of FDE characterized by large and well-circumscribed erythematous plaques, rarely bullous, appearing repeatedly in the same area and shortly after drug readministration without residual pigmentation. In NPFDE, the site of lesions does not remain heavily pigmented after resolution because of the absence of hydropic degeneration of the basal cell layer and of pigmentary incontinence. Among the reported causes of NPFDE, pseudoephedrine hydrochloride (Ph) is the drug most commonly associated and the bullous form was described only in 1 of the 3 patients reported by Shelley and Shelley. As in patients with classic FDE, a challenge test with the suspected drug is the gold standard in establishing the diagnosis. In fact, a patch test with the offending drug, especially when applied on the previous lesions, may help diagnosis of NPFDE, but its sensitivity and its diagnostic value are unknown. However, this diagnostic algorithm is not easy to perform when the culprit drug is in a combination tablet and when it is not available individually on the market, as in the case reported below. A 38-year-old woman affected by allergic rhinoconjunctivitis was referred to us in April 2015 for many round, large, and itchy scarlet-colored edematous multifocal plaques symmetrically localized on the upper and lower limbs, lower back, and buttocks (Figure 1, A), and on the right-hand palm (Figure 1, B), and the nape. In the latter, the plaque was centered by a serous blister (Figure 1, C ). All lesions developed 6 hours after the single administration of a combination tablet containing Ph (60 mg), triprolidine hydrochloride (Th) (2.5 mg), and paracetamol (P) (300 mg). Lesions spontaneously disappeared within 2 weeks with no residual pigmentation. The patient reported that the same drug was administered several times during the last 5 years and that 1 year before similar lesions had appeared 10 hours after the administration of the same drug (second tablet on day 2). Two months later, we carried out patch tests both on uninvolved skin (upper back) and on previously involved skin (buttock) with the combination tablet as is. This was diluted 25% and 50% w/v in petrolatum (pet) and in dimethyl sulfoxide (DMSO) (Table I). No positive reactions were observed. Although we warned the patient not to take Ph-, Th-, and P-based drugs, in July 2015, she self-administered a combination tablet containing Ph (60 mg) and Th (2.5 mg). Five hours after, all the plaques relapsed in all previous sites and with the same clinical features. The lesions spontaneously resolved in 10 days with no residual pigmentation. In view of this positive self-rechallenge and according to the patient, we subsequently performed an oral challenge test with P (day 1: 0.3 mg, and 3.0 mg 12 hours later; day 2: 30.0 mg, and 300.0 mg 12 hours later) to definitely exclude this antiinflammatory drug, with negative result. Only in September 2015 we were able to obtain separately Ph and Th to clarify the etiological role of these 2 compounds and to specify the culprit drug. The 2 chemicals were patch tested as reported in Table I. Strong positive reaction to Ph 10% in DMSO on previous buttock plaque was observed. Diagnosis of multifocal bullous NPFDE due to Ph was made. The reported case presents some atypical clinical features. To our knowledge, among the cases of NPFDE due to pseudoephedrine reported in the literature, ours is the second bullous form described. Moreover, compared with multifocal classic FDE, our patient was younger (third decade vs sixth decade of life), the latency time was shorter (5-10 hours vs 24 hours to some days), and clinical course was shorter (10-14 days vs 1-6 weeks). Our patient raises the problem of the methodology and diagnostic value of allergological tests in NPFDE caused by Ph in a combination tablet. Ph is marketed in Italy only in combination with 2 or more active ingredients. For this reason, we first patch tested the combination tablet with false negative result, likely due to Ph low concentration in a tablet that is not able to elicit a positive patch test response. Positive self-rechallenge with PhþTh in a combination tablet allowed us to confirm the clinical but not the precise etiological diagnosis of NPFDE; the latter was possible only when Ph was singularly patch tested. In conclusion, our findings support the diagnostic utility of the patch test in NPFDE when performed (i) with the culprit drug, (ii) on the previously affected area, and (iii) employing DMSO as a vehicle with the function of a penetration enhancer. Moreover, this diagnostic procedure performed by us is relevant because it is well known that serious generalized, bullous, mucosal, and cutaneous reactions may be elicited by the challenge test in cases of FDE.

Histopathologic features of erythematous papulopustular eruption to epidermal growth factor receptor inhibitors in cancer patients

Erythematous papulopustular eruption (EPPE) is the most frequent skin adverse event to epidermal growth factor receptor (EGFR) inhibitors but its histopathologic features have been poorly studied. As EPPE is a strong predictor of patients treatment response, the EPPE histopathologic features and their correlations with skin eruption severity and involved drug were investigated.