Niels Hjorth

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 baboon syndrome: systemically-induced allergic contact dermatitis*

The catchword “baboon syndrome” is used to denote a characteristic distribution pattern of systemic allergic contact dermatitis. Diffuse erythema of the buttocks, upper inner surface of the thighs, and axillae are characteristic features. We describe 3 cases provoked by ampicillin, nickel and mercury. The condition may be overlooked and suspected of being a textile dermatitis or seborrhoeie dermatitis of the elderly.

Treatment of lichen planus with acitretin: A double-blind, placebo-controlled study in 65 patients

Sixty-five patients with lichen planus were included in a multicenter trial of acitretin. At the end of an 8-week placebo-controlled, double-blind phase, a significantly higher number of patients treated with 30 mg/day acitretin (64%) showed remission or marked improvement compared with placebo (13%). Furthermore, during the subsequent 8-week open phase, 83% of previously placebo-treated patients responded favorably to acitretin therapy. Typical retinoid adverse reactions were present in all patients on active drug. Laboratory studies did not show any clinically significant changes. This study shows that acitretin is an effective and acceptable therapy for severe cases of lichen planus.

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.

Compositae sensitivity among patients with contact dermatitis: Value of Compositae oleoresins in a standard test series

Patch tests with 24 Compositae species were performed on 81 patients suspected of having a plant dermatitis, of whom 16 had positive reactions to various species.

Perioral contact urticaria from sorbic acid and benzoic acid in a salad dressing

Contact urticaria was observed in a kindergarten in 18 of 20 children following the intake and accidental perioral application of a mayonnaise salad cream. In healthy adult controls, stinging tests and closed 20 minute patch test with the salad dressing were positive in 9 out of 12 and 4 out of 10 cases respectively. Twenty minute patch tests with the different components of the salad dressing were positive only so sorbic acid (SA) and benzoic acid (BA). Urticaria was provoked by inunction of the salad dressing periorally in two healthy boys. Serial 20 minute closed patch testing with varying concentrations of SA in 91 patients and BA in 41 patients gave almost identical results: positive reactions in two thirds of the patients with the highest concentrations. The response was only partially blocked by anti‐histamine applied locally before testing. Non‐immunologic mechanisms are probably responsible for the transient reaction, and no restriction in the extensive use of SA or BA as preservatives in food should be considered.

Routine patch testing with paraben esters

Paraben esters are the most widely used preservatives in cosmetics and topical medicaments. Their sensitization potential is low, based on both experimental and human experience. A paraben mixture is included in the ICDRG standard series, and in patch test studies, approximately 1% of eczema patients react to it. The present study confirms this frequency in 8020 patients patch tested consecutively. Testing with the individual paraben esters was employed as confirmation, which makes it unlikely that the excited skin syndrome is a significant problem in this context. It remains undetermined whether the present paraben mixture is the optimal patch test material for diagnosing paraben sensitivity.

HAND DERMATITIS IN HOUSEWIVES

SUMMARY.— In a series of 4000 patients patch tested in 5 European clinics, 1000 were engaged in domestic work only; they included 281 women with contact dermatitis of the hands. There were no significant differences between the 2 groups as regards age, duration of dermatitis and patch test results.

Contact sensitivity to chlorhexidine

In a joint study, 2061 patterns (1346 women and 715 men) were patch tested with chlorhexidine gluconate 1% in Water. included in a standard lest series. 4H patients (2.3%) showed a positive reaction. These were relatively marc common in men (3.2%) than in women (1.9%), Positive reactions were most common in patients with leg eczema (6.8%) or leg ulcer (10.9%). Of the 48 patients who were patch test positive. 14 (2 with leg ulcer) were retested with chlorhexidine gluconate 0.01 and 1%. Only one with a leg ulcer was positive. These findings indicate that false positive reactions, known as “the incited skin syndrome”, may arise from testing eczema patients in a standard series The sensitizing potential of chlorhexidine may be very low, but the potential in patients with an eczema or ulcer of the leg has to be further evaluated.