Niels K. Veien

Changes in the pattern of sensitization to common contact allergens in Denmark between 1985–86 and 1997–98, with a special view to the effect of preventive strategies

The objective of the present study is to describe any changes in the prevalence of sensitization to common contact allergens in patch‐tested patients over a 12‐year period. Attention is given to possible effects of preventive strategies introduced in Denmark regarding nickel and chromate sensitization during that period, and particular areas of concern are identified. Members of the Danish Contact Dermatitis Group collected patch‐test results from consecutive eczema patients as well as information about exposures and demographic variables over a 6‐month period in 1985–86. The investigation was repeated in 1997–98 in the same clinics, at the same time of year, using identical methods and patch‐test substances, including nickel sulphate 5%, potassium dichromate 0·5% and fragrance mix 8%. Nickel was the most common contact allergen in both study periods, followed by the fragrance mix. In children 0–18 years of age, the frequency of nickel allergy decreased from 24·8% in the first study period to 9·2% in the second study period (P < 0·0008). Fragrance mix allergy doubled in frequency from 4·1% in 1985–86 to 9·9% in 1997–98, an increase that affected all age groups. Contact allergy to potassium dichromate decreased significantly from 3·0% in the first period to 1·2% in the second period (P = 0·001). The decrease was seen in both sexes and was most pronounced among those of working age. No other significant changes were found in the frequency of sensitization to common allergens over the 12‐year observation period.

Patch test reactivity to nickel alloys

11 widely used nickel alloys were investigated with respect to corrosion stability and reactivity in nickel‐sensitive individuals. Alloys with a nickel release in synthetic sweat exceeding 1 μg/cm2/week gave a strong patch test reaction in nickel‐sensitive persons; those with a release below 0.5 μg/cm2/week showed weak reactivity with one exception. Nickel allergy is a health problem. It may be minimized by using nickel alloys with a corrosion level below 0.5 μg/cm2/week. Action should be taken by dermatologists, industry and authorities to solve this neglected problem.

Long-term, intermittent treatment of chronic hand eczema with mometasone furoate.

Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long‐term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, χ2‐test). Side‐effects were minimal. It is concluded that long‐term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.

Cutaneous sarcoidosis in Caucasians

One hundred eighty-eight Caucasian patients with cutaneous sarcoid lesions were studied prospectively. Twenty-five had erythema nodosum, while 163 had infiltrative cutaneous lesions. One hundred thirty-eight patients had systemic as well as cutaneous lesions, and fifty had cutaneous lesions only. All types of clinical lesions were seen among patients with cutaneous lesions only. The extent of cutaneous lesions did not correlate with the extent of systemic disease. Papular lesions were relatively uncommon and occurred as the only manifestation of the disease or were associated with hilar adenopathy and acute disease. Lupus pernio, scar infiltrates, and plaque lesions were the most common clinical lesions and were typically chronic and commonly associated with pulmonary mottling and/or fibrosis. Forty-eight of 127 had a histologically positive Kveim test. Among patients followed for more than 2 years, dinitrochlorobenzene (DNCB) sensitivity was higher among those with acute disease than among those with chronic disease. Seventy-nine patients with infiltrative cutaneous lesions were followed until the cutaneous lesions had healed. Those with lupus pernio were often left with unsightly telangiectatic scars, while the other types of lesions left either pale, slightly depressed scars or no scars at all.

Experimental systemic contact dermatitis from nickel: a dose–response study

Systemic contact dermatitis is usually seen as flare‐up of previous dermatitis or de novo dermatitis similar to allergic contact dermatitis. Although systemic contact dermatitis from medicaments is a well‐established entity, the existence of clinically relevant systemic reactions to oral nickel exposure, in particular systemic reactions to nickel in the daily diet, remains controversial. Several studies have shown that oral exposure to nickel can induce systemic contact dermatitis in nickel‐sensitive individuals. In most of these studies, however, the exposure dose of nickel used has been considerably higher than the nickel content in the normal daily diet. The aim of the current investigation was to study dose–response dependency of oral exposure to nickel. In a double‐blind, placebo‐controlled oral exposure trial, 40 nickel‐sensitive persons and 20 healthy (non‐nickel‐sensitive) controls were given nickel sulfate hexahydrate in doses similar to and greater than the amount of nickel ingested in the normal Danish daily diet. The nickel content in urine and serum before and after oral exposure was measured to determine nickel uptake and excretion. The influence of the amount of nickel ingested on the clinical reactions to oral exposure and on nickel concentrations in serum and urine was evaluated. Among nickel‐sensitive individuals, a definite dose–response dependency was seen, following oral exposure to nickel. 7 of 10 nickel‐sensitive individuals had cutaneous reactions to oral exposure to 4.0 mg nickel, an amount approximately 10 times greater than the estimated normal daily dietary intake of nickel. 4 of 10 nickel‐sensitive individuals had cutaneous reactions to 1.0 mg nickel, a dose which is close to the estimated maximum amount of nickel contained in the daily diet. 4 of 10 nickel‐sensitive individuals reacted to 0.3 mg nickel or to the amount equivalent to that contained in a normal daily diet, and 1 of 10 reacted to a placebo. None of the 20 healthy controls had cutaneous reactions to 4.0 mg nickel or to a placebo. Prior to oral exposure, there was no measurable difference in the amount of nickel in the urine or serum of nickel‐sensitive persons and healthy controls. Following the oral challenge, the nickel content in the urine and serum of both nickel‐sensitive and healthy control individuals was directly related to the dose of nickel ingested.

Clinical patch test data evaluated by multivariate analysis

The aim of the present study was to evaluate the influence of individual explanatory factors, such is sex, age, atopy, test time and presence of diseased skin, on clinical patch lest results, by application of multivariate statistical analysis. The study population was 2l66 consecutive patients patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of ft months. Fur the 8 test allergens most often found positive (nickel, fragrance‐mix, cobalt, chromate. balsam of Peru, carba‐mix, colophony, and formaldehyde). one or more individual factors were of significance for the risk of being sensitized, except for chromate and formaldehyde it is concluded that patch test results can be compared only after stratification of the material or by multivariate analysis.

Hand eczema : causes, course, and prognosis II

Background:  Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described.

Antabuse treatment of nickel dermatitis. Chelation-a new principle in the treatment of nickel dermatitis

Eleven nickel‐hypersensitive patients with chronic, dyshidrotic hand eczema aggravated by oral challenge with 0.6–2.5 mg nickel were treated with 100 mg tetraethylthiuramdisulfide (Antabuse®) two to four times daily for 4–10 weeks.

Low nickel diet: An open, prospective trial

BACKGROUND Nickel-sensitive patients may experience persistent dermatitis even if they avoid cutaneous contact with nickel-plated items. OBJECTIVE The purpose of the study was to determine whether reduced nickel intake in food reduces the activity of dermatitis in selected nickel-sensitive persons. METHODS Ninety nickel-sensitive patients who had a flare of dermatitis after oral challenge with 2.5 mg of nickel but had no reaction to a placebo were instructed to adhere to a low-nickel diet. RESULTS Fifty-eight of the 90 patients benefited in the short term from the diet, whereas 15 others had possible benefit. Seventeen patients did not benefit in the short term. Fifty-five patients who adhered to the diet for at least 4 weeks, and whose dermatitis had cleared or improved at the end of this time, responded to a questionnaire follow-up 1 to 2 years later. Forty of these patients had long-term improvement of their dermatitis. Patients with strongly positive patch tests to nickel had less benefit from the diet than patients with moderately positive patch tests. CONCLUSION Reduction of the dietary intake of nickel may benefit some nickel-sensitive patients.

Systemic Contact Dermatitis

The term systemic contact dermatitis is used to describe a dermatosis seen in some persons with delayedtype hypersensitivity to a hapten administered systemically. Immunohistochemical studies of flare-up reactions seen after oral challenge indicate that the mechanism includes delayed-type hypersensi