Luis Conde-Salazar Gómez

Parabenos: ¿mito o realidad?

Conservar los productos en buen estado ha sido una preocupación de la humanidad desde el principio de los tiempos. En las últimas décadas se han conseguido avances hasta hace poco impensables, aunque el conservante ideal, aquél con un buen espectro antimicrobiano, estable, eficaz en un amplio margen de pH, no tóxico, no irritante y sin capacidad sensibilizante, todavía no ha sido encontrado. Los parahidroxibenzoatos (parabenos o parabenes), como el resto de los conservantes, son un grupo de compuestos capaces de prolongar la vida de los productos, y su uso durante más de 70 años avala su eficacia y seguridad. Su efecto antimicrobiano fue descrito por primera vez en 1924 por Sabalitschka1. Desde entonces, son unos de los conservantes más utilizados en productos cosméticos, farmacológicos y de alimentación. La sensibilización a los parabenos se comenzó a describir en los años cuarenta2,3. A partir de entonces se han descrito otros nuevos casos, lo que ha llevado a la inclusión de estos alérgenos en las baterías estándar de las pruebas epicutáneas. De todos modos, existen múltiples contradicciones a la hora de interpretar la prueba del parche con parabenos, lo que hace más difícil otorgar una relevancia a estos alérgenos, en un contexto clínico que, de por sí, ya suele ser bastante confuso. Parafraseando el título de un famoso artículo del campo de la dermatología de contacto4, hemos querido sintetizar y confrontar las conclusiones a las que han llegado los investigadores que se han ocupado de la sensibilización a los parabenos. Con esta revisión pretendemos aportar algo de claridad al tema o, al menos, exponer las principales dudas que se plantean.

Occupational airborne allergic contact dermatitis to olanzapine.

To the Editor: Occupational allergic contact dermatitis (ACD) due to drugs is long known, and there are several cases reported in the literature. In this setting, drug exposure occurs usually by epidermal application or inhalation (nebulization or dust exposure), leading to a high risk of sensitization. Professionals at major risk are those working for chemical or pharmaceutical companies, who participate in the drug manufacturing. The potential exposure can occur during the drug synthesis, packaging, or loading of the final product. Also at risk are technicians or cleaning employees and professionals who deal with the drugs in the therapeutic field. Sensitization may occur to precursors, intermediate components, and final products and also to other agents used during the synthesis process, such as accelerators, enzymes, catalysts, fillers, and stabilizers, because all of these substances can act as allergens. The diagnosis of these skin conditions is occasionally difficult because it requires collaboration with the pharmaceutical company to provide the necessary information regarding the drug manufacturing process and the diluted chemical compounds for patch testing. We present a pharmacist who developed an airborne ACD because of a drug in the occupational setting. It was a 43-year-old man, with pre-existing history of atopy and chronic hand eczema for 20 years, who attended to our department complaining of 1-year history of sporadic episodes of periorbital edema along with severe itching (Fig. 1). He worked as a pharmacist, preparing drugs for an important pharmaceutical company, namely, olanzapine, raloxifene, and tadalafil. He stated that his skin lesions subsided spontaneously in 3 days of leaving his work place, without requiring treatment. In addition, he associated the episodes when preparing olanzapine. A total of 15 employees worked preparing the same drugs, and no one else presented skin complaints. The patient was patch tested with the Spanish Contact Dermatitis Society baseline series (True Test\, Mekos Laboratories, HillerLd, Denmark, and Chemotechnique Diagnostics\, Vellinge, Sweden), and with olanzapine, raloxifene, and tadalafil in petrolatum at 1% and 5%. Allergens were applied using Curatest\ (Lohmann and Rauscher, Rengsdorf, Germany) Readings at day 2 and day 4 showed positive reactions to olanzapine at both concentrations, more intense at 5% dilution (Fig. 2). Patch tests in 10 healthy controls with olanzapine at 1% were all negative. Occupational ACD to olanzapine was diagnosed, and changing work place resulted in symptomatic improvement. Exposure to drugs in the occupational setting can originate skin reactions with different clinical patterns, such as irritant or ACD, airborne, dermatitis, photo-induced reactions, contact urticaria, or other dermatologic conditions. It can also trigger respiratory symptoms. There are several reports in the literature of occupational contact allergy to drugs but few to antipsychotic agents. Olanzapine, a thienobenzodiazepine, is an atypical antipsychotic agent that is Food and Drug AdministrationYapproved for the treatment of schizophrenia and other psychotic disorders and bipolar syndrome. Off-label uses include its uses for anxiety, eating disorders, and depression. Safety data sheets include potential of contact allergy, but so far, there are only 3 cases of occupational sensitization to olanzapine reported in the literature. All of those patients presented with episodes of facial and hand lesions when preparing olanzapine, and the misuse of the personal protective equipment was considered determinant to the sensitization. In our case, the patient had similar lesions and reported to use an individual, nonshared sealed air-fed mask and latex gloves during all steps of the drug manufacture and taking them off, but not always, in a different building facility. The point of drug exposure was possibly when dumping and mixing olanzapine with the other drug components because it remained in the environment because of a poor ventilation system. Potential exposure at other different stages of the drug fabrication could not be LETTERS

Afectación ungueal de origen ocupacional

espanolDesde el siglo V a.C. Hipocrates ya describia las afectaciones ungueales, las cuales luego se relacionaban con enfermedades sistemicas o adquiridas. Los medicos de medicina del trabajo se deben preparar para detectar las afectaciones por factores externos. Sin embargo son pocos los casos publicados sobre patologia ungueal de origen ocupacional. Nuestra revision consiste en brindar conocimientos basicos sobre esta asignatura. Desde su definicion, funcion y la descripcion de su anatomia. La patologia ungueal la clasificaremos segun: a) anomalias de: la forma, de la adhesion, de la coloracion, superficie, infeccion; b) segun el mecanismo de accion que se producen o c) segun el tipo de ocupacion. Al adquirir estos conocimientos podremos establecer posteriores pautas de prevencion eficaces. EnglishFrom the V century B.C. Hippocrates described the damages in the nails, which then were related to systemic diseases or acquired. As physicians we must prepare work to detect the effects caused by external factors. However, few published cases of occupational origin nail pathology. Our review is to provide basic knowledge on this subject. From its definition, function and description of the anatomy. The nail pathology classify as: a) anomalies: the way of accession, coloration, surface, infection, b) according to the mechanism of action that occur oc) by type of occupation. By acquiring this knowledge we can establish effective prevention guidelines later.

Occupational sensitization to acrylates with paresthesias.

To the Editor: A 23-year-old woman, dental assistant for 5 years, was referred to our center for evaluation of a 3-month history of eczematous lesions on the dorsum and fingertips of both hands (Fig. 1). Also, the patient complained of itching and tingling sensation in the same location. There was a personal history of allergic rhinitis. On physical examination, we observed decreased thermoalgesic sensitivity in fingertips. In her workplace, the patient managed daily adhesives and composite resins and always wore vinyl gloves when dealing with these substances. Patch testing was performed with the Spanish Contact Dermatitis Society baseline series (True Test and Chemotechnique Diagnostics AB) and dental series (Table 1) (Chemotechnique Diagnostics AB). The patches were removed on day 2. Readings at days 2, 3, and 6 showed positive reaction to thiuram mix and several acrylates. Curiously, the patient presented a wide extension of the positive reactions on the acrylates patches, as well objective thermalgesic sensitivity reduction in the same location (Fig. 2A). Upon performing patch testing, there was only residual dermatitis on both hands. Three weeks later, we retested the acrylates separately to verify which ones actually the patient was sensitized and obtained positivity to ethyleneglycol dimethacrylate and 2-hydroxyethyl methacrylate (Fig. 2B). To date, and 6 months after the initial evaluation, the patient was given a disability by the Labour Department and had no relapse of her dermatitis, despite that the decreased sensitivity in fingertips persists. The decrease in sensitivity due to acrylic monomers has been documented in the occupational setting in orthopedic surgeons and in dentists. Fisher described the first case of prolonged and severe paresthesia in a client after a procedure of sculptured nails, and subsequently, other authors reported more cases, but to our knowledge, our case represents the first report of decreased sensitivity in the positive acrylic patch test. This altered sensitivity is the result of a peripheral neuropathy, the exact pathophysiological mechanism of which is not yet established, and is independent of allergic contact sensitization. When present, it may persist for several weeks after the resolution of the dermatitis. Donaghy et al studied histological sections of nerve biopsy of a dental technician with paresthesias and motor impairment of long evolution and found a chronic axonopathy with severe loss of large-diameter fibers and unmyelinated axons. Animal models in mice demonstrated that acrylates have a neurotoxic effect when applied locally, and recent studies support the theory that they interfere with the fast axonal transport. In summary, to our knowledge, this is the first report of decreased sensitivity on positive acrylate patches. The decrease in sensitivity after exposure to acrylates is not very common but can be persistent and debilitating, so dermatologists and neurologists should be aware of its existence.

Can expired TRUE Test® be used for patch testing?

Patch testing is a method for diagnosing allergic contact dermatitis, and the best way to differentiate it from irritant contact dermatitis (1). As part of the Spanish Contact Dermatitis Society baseline series, the thin-layer rapiduse epicutaneous test, known as TRUE Test® (TT), is widely used (2–4). With the aim of studying the diagnostic capacity of expired TRUE Test® panels, a prospective study on consecutive patients attending our occupational dermatology department during February 2013 was conducted. In all patients, three TRUE Tests® with different expiry dates (2011, 2012, and 2013) were applied. Also, according to the clinical history and occupation of each patient, patch testing with a specific series was performed. Patients signed an informed consent form before the study was performed. The patches were removed on D2, and readings were performed on D2 and D3. During the study period, a total of 11 patients were patch tested with three TRUE Tests® with different expiry dates: 2011, 2012, and 2013. In 9 of 11 patients, the same positive reactions, with identical intensities, were observed in the three TRUE Tests® (Fig. 1). In the remaining 2 patients, the same positive reactions were observed in the TRUE Tests® with expiry dates in 2012–2013, and negative results were obtained in the TRUE Test® in with an expiry date in 2011 (Table 1).

Recuperación del taller del Museo Olavide: Conceptos y criterios para el diseño

Since the inauguration in 1882, the Olavide Museum had a complex history. There are many aspects still unknown, like the exact number of figures. Moreover, there is no evidence that another artists, in addition to E. Zofio, were contracted for the museum. After many events, in the years 1966-67 the museum is closed. The figures and a lot of documentation about the museum and his founder, Dr. Jose Eugenio de Olavide, were kept in boxes, which remained in several places. Once these figures were localized, the next problem was to have a place to work in the restoration and exposition of them. Thanks to the collaboration of the Escuela Nacional de Medicina del Trabajo (National School of Occupational Medicine), and specially to his director, Dr. Jeronimo Maqueda, we have a place with the adequate conditions to do this work.

Dermatosis profesionales en cuidadores de ancianos

The increasing proportion of elderly citizens worldwide is leading to the development of a new professional group of people who are specialized in elderly personal care. They may have an increased risk of occupational skin damage due to the characteristics of their work that is often associated with regular exposure to skin irritants and constant wetwork. Skin disease studies within this group are rare. Aims: The aim of this study was to describe and analyse the characteristics and dermatologic diagnosis of the patients that work taking care of elderly people studied in our department. Methods: We studied retrospectively all 41 patients who work as elder care-taker who attended our department in a 11-year period. Results: We found an absolute female predominance. The most common location affected was the hands. Of the skin diseases clinically diagnosed, endogenous eczema showed the highest prevalence (39,6%) followed by irritant contact dermatitis (ICD) (27,1%), allergic contact dermatitis (ACD) (12,5%), asymptomatic (10,4%), allergy to natural rubber latex (NRL) (4,2%) and others. Conclusions: Elderly care-taker workers are emerging and they have a great social importance. They are at increased risk of occupational skin disease due to contact with several substances and wet work. In our study, endogenous eczema, represented by atopic dermatitis, is the most important diagnosis. It could be concluded that irritants, occlusion and wet work favoured the development of dermatitis in vulnerable patients that would be remained asymptomatic avoiding this work. New further studies are needed.