O. P. Hornstein

Allergic and irritant reactions to rubber gloves in medical health services: Spectrum, diagnostic approach, and therapy

Delayed-type allergies account for most reactions to gloves. These have been found in 32 of 39 patients (82%) attending our department with occupationally induced contact dermatitis to gloves. Accelerators, mainly of the thiuram group, antioxidants, vulcanizers, organic pigments, and, presumably, glove powder ingredients are known responsible allergens. In contrast, immediate-type allergies to rubber gloves were less frequent (13 of 39 patients [33%] with occupationally induced glove allergies). They usually present as contact urticaria. Responsible allergens are latex, glove powder, and accelerators. On the basis of the numerous glove-related allergens, a comprehensive schedule of diagnostic tests is proposed. In addition, we introduce a new classification of hypoallergenic gloves according to their basic materials and ingredients and thus provide a guideline for individual therapy.

Perifollicular fibromatosis cutis with polyps of the colon—a cutaneo-intestinal syndrome sui generis

SummaryIn the present study, a peculiar fibromatosis cutis in two siblings has been reported the dermatosis being characterized by innumerable perifollicular fibromas on face, neck and trunk as well as multiple fibromata pendulantia. Since the father allegedly had skin lesions resembling those of his two affected children, an inherited condition is assumed for the disease manifesting itself rather late in age. In the female patient, several adenomatous colon polyps one being transformed into carcinoma were found.Since the association of distinct epithelial and mesenchymal tumours of the skin and the cranial bones with multiple colon polyps is typical for Gardners syndrome, we have discussed in detail the possibility of an unknown variant of it. On the other hand, most features of Gardners syndrome (cutaneous and subcutaneous epidermoid cysts, desmoid tumours, generalized osteomas, a marked multitude of colon polyps, early manifestation of skin and bone changes) were absent in both cases whereas, to our knowledge, in Gardners syndrome perifollicular fibromas have never been seen. Since perifollicular fibromas are organoid tumours of the mesenchymal hair sheath being clearly defined both clinically and histologically, they must not be confused with the equally well characterized cutaneous tumours of Gardners syndrome. We are prone to assume that the (irregular?) association of multiple perifollicular fibromas and colon polyps represents a distinct nosological entity neither identical with Gardners syndrome nor with any other known dermo-intestinal syndrome. Thus, perifollicular fibromatosis should alert the dermatologist to consider periodic thorough examination for intestinal polyps the more as they may change into malignant growth.ZusammenfassungPerifolliculäre Fibrome sind organoide, in einer solitären und einer multiplen Variante vorkommende Tumoren der mesenchymalen Haarscheide, die bisher nur sehr selten beschrieben worden sind. Wir untersuchten zwei Geschwister mit einer ungewöhnlichen Fibromatosis cutis, die durch eine excessive Zahl von perifolliculären Fibromen an Stirn, Wangen, Hals und Stamm, sowie durch multiple Fibromata pendulantia an Hals, Axillen und Leistenbeugen gekennzeichnet war. Da auch beim Vater ähnliche Hautveränderungen wie bei seinen beiden Kindern bestanden haben sollen, ist in unseren Fällen eine erbliche Ursache der Erkrankung mit relativ später Manifestation anzunehmen. Bei der einen Patientin fanden sich außerdem mehrere adenomatöse Colonpolypen, einer davon carcinomatös entartet.Da die Assoziation bestimmter epithelialer und mesenchymaler Tumoren der Haut mit Osteomen und multiplen Colonpolypen für das Gardner-Syndrom pathognomonisch ist, haben wir die Möglichkeit einer ungewöhnlichen, bisher nicht beschriebenen Variante dieses Syndroms eingehend diskutiert. Seine wesentlichen Merkmale (cutane und subcutane epidermoidale Cysten, Desmoid-Tumoren, generalisierte Osteome, ausgeprägte Multiplizität der Colonpolypen, frühe Manifestation der cutanen und ossären Veränderungen) waren jedoch bei unseren Fällen nicht vorhanden, während andererseits perifolliculäre Fibrome beim Gardner-Syndrom bisher unseres Wissens nicht beschrieben worden sind. Da perifolliculäre Fibrome einen klinisch und histologisch gut differenzierbaren organoiden Tumor der mesenchymalen Follikelscheide darstellen, dürfen sie nicht mit den ebenfalls klar definierten cutanen Geschwülsten des Gardner-Syndroms vermischt werden. Es ist vielmehr anzunehmen, daß die hier beschriebene (unregelmäßige?) Assoziation von multiplen perifolliculären Fibromen der Haut mit Colonpolypen eine besondere nosologische Entität darstellt, die weder dem Gardner-Syndrom noch einem anderen bekannten dermo-intestinalen Syndrom gleichzusetzen ist. Patienten mit multiplen perifolliculären Fibromen sollten also sorgfältig bezüglich intestinaler Polypen untersucht werden, zumal mit der Möglichkeit der malignen Entartung solcher Polypen gerechnet werden muß.

Frequency, spectrum and occupational relevance of type IV allergies to rubber chemicals

3851 consecutive patients patch tested between January 1985 and March 1990 have been analysed for rubber allergies. The incidence of rubber allergy was 3.8% (n=145) In 80/145 patients (55%). the source of rubber sensitization was occupational, 67 of whom (84%) had acquired allergy from wearing rubber gloves a work. Most of them (36%) were employed in the health services. The most commonly positive rubber‐mix in this group was thiuram‐mix (72%) Followed by carba‐mix (25%.) 13/80 patients (16%) had occupational rubber allergy from industrial rubber products other than gloves. Patch tests revealed thiuram‐mix (62%) as the most commonly positive rubber‐mix but, in contrast to the group with glove‐induced rubber allergy, black‐rubber‐mix came second (38%) In 47/145 patients (32%) the source of rubber sensitization W8S non‐occupational; in 18/145 (13%) the origin remained unknown.

Expression of adhesion proteins involved in cell-cell and cell-matrix interactions in the skin of patients with progressive systemic sclerosis

BACKGROUND Lymphocytic infiltration and activation of connective tissue metabolism in the early phase of progressive systemic sclerosis (PSS, scleroderma) may be critically influenced by cellular adhesion molecules (CAMs), which mediate cell-cell and cell-extracellular matrix interactions. OBJECTIVE The tissue distribution might demonstrate a pathogenetic role of these adhesion molecules in early edematous and chronic fibrotic scleroderma. METHODS We investigated by immunohistochemical techniques the in situ expression and distribution of beta 1 and beta 2 integrins, selectins, and CAMs of the immunoglobulin superfamily in patients with scleroderma. RESULTS In the early disease stage a moderate percentage of perivascular CD3+/CD4+/TCR alpha/beta + lymphocytes showed expression of the alpha 3, alpha 5, and beta 1 chains and, to a lesser degree, of the alpha 1, alpha 2, alpha 4 and alpha 6 subunits. In contrast to chronic PSS, LFA-1 alpha, LFA-1 beta and ICAM-1 expression on mononuclear infiltrating cells was seen more frequently in acute scleroderma. Different percentages of fibroblasts expressed alpha 1-, alpha 3-, alpha 5- and beta 1-integrin chains. In acute PSS ICAM-1 was expressed especially by fibroblasts located around perivascular inflammatory infiltrates as well as by endothelial cells (ECs). A few ECs expressed alpha 2 beta 1 integrins. CONCLUSION Our observations suggest that CAMs are intimately involved in early pathogenetic events in scleroderma, mediating cellular interactions between lymphocytes, ECs, and fibroblasts, as well as homing and tissue targeting of mononuclear infiltrating cells.

Increased Susceptibility to Infections in the Papillon-Lefèvre Syndrome

This report deals with a case of Papillon-Lefevre syndrome associated with an increased susceptibility to infections and a diminished lymphocyte stimulation by PHA in a 3-year-old girl.

Effects of epidermal growth factor, fibroblast growth factor, minoxidil and hydrocortisone on growth kinetics in human hair bulb papilla cells and root sheath fibroblasts cultured in vitro

SummaryComparative studies on growth kinetics of cultivated human hair bulb papilla cells (PCs) and hair root sheath fibroblasts (RSFs) yielded evidence of some pecularities of PCs in both proliferative behavior and morphological growth pattern. As the dermal papilla, essentially supporting the nutrition of matrix epithelium, can be considered a target tissue for agents influencing maintenance of hair growth, we studied the effects of epidermal growth factor (EGF), fibroblasts growth factor (FGF), minoxidil (Mino), and hydrocortisone (HC) on the proliferation of PCs and RSFs, both gained from dissected hair follicles of scalp biopsy specimens of two male adults and separately cultured in vitro. EGF and FGF proved to increase proliferation of both PCs and RSFs most, yet at a different intensity for each cell group. HC slowed proliferation, and Mino failed to influence growth of PCs and RSFs.

Recent Studies of Cutaneous Nociception in Atopic and Non-Atopic Subjects

Itching reflects a distinct quality of cutaneous nociception elicited by chemical or other stimuli to neuronal receptors at the superficial layers of the skin and muco‐cutaneous orifices. Although recent experimental studies of the conduction and perception of itch have yielded deeper insight into the physiology of this sensory quality, little is known about the neuromechanisms involved in pruritus accompanying many inflammatory skin diseases, in particular, in atopic eczema.

Clinical relevance of sonometry-derived tumour thickness in malignant melanoma : a statistical analysis

High‐frequency sonography has been shown to be a useful tool in planning operative strategy in the surgery of malignant melanoma (MM). The purpose of the present study was to compare sonometric and histometric data of tumour thickness in primary cutaneous MM, applying statistical methods in order to evaluate the pre‐operative relevance of sonometry. The thickness of 259 melanomas was measured preoperatively by a 20‐MHz B scan, and postoperatively by histometry. Statistical analysis was performed using Pearsons correlation coefficient and absolute and relative differences. Although the correlation between sonometry and histometry was good (r=0·88), there was a mean difference of 0·39 mm (relative difference 28%). Overall, sonometry was in agreement with the corresponding histological classes in 75% of cases. However, tumours assessed by ultrasound as between 0·55 and 0·95 mm thick were incorrectly classified according to histology in 34%, and those between 1·30 and 1·70 mm were incorrectly classified in 50% of cases.

Comparative morphological and growth kinetics studies of human hair bulb papilla cells and root sheath fibroblasts in vitro.

SummaryDermal papillae isolated from anagen hair bulbs obtained from biopsy specimens from five subjects with normal hair pattern, and fibroblasts derived from the mesenchymal root sheaths (RSF) of the same hair follicles were separately grown in culture and the cellcycle distribution pattern on different days was analysed by applying DNA flow cytometry (FCM). Papilla cells (PC) exhibited distinctive morphological features by forming cell aggregates differing from RSF with respect to cell shape and growth pattern. They also proliferated remarkably more slowly than RSF. DNA-FCM analysis showed that both PC and RSF demonstrated synchronous fluctuations in the percentage of cells in G1/0, S and G2+M phases during the period of subculture.

Acetylcholine is an inducer of itching in patients with atopic eczema.

As previous experimental studies disproved histamine as the main mediator of eliciting pruritus in atopic eczema (AE), we examined the neurocutaneous sensations in 15 patients with AE and in 15 age‐ and sex‐matched non‐atopic controls after i.c. injection of acetylcholine (Ach, 0.5 M, 20 μl) or buffered saline. The sensory perceptions were rated by the participants of the study with regard to their quality and intensity using a visual analogue scale. Simultaneously, the vascular reactions to Ach were recorded by the examinators via laser Doppler fluxmetry as well as flare and wheal planimetry. In contrast to the approximately equal flare and wheal extensions in either group, the cutaneous sensations differed significantly. The patients complained of ‘pure’ itching that developed shortly after Ach injection, whereas the control subjects reported only burning pain. Moreover, the patients perceived their sensations significantly earlier and significantly longer than did the controls. The study provides evidence that Ach plays an important role in the pathogeny of pruritus in patients with AE. Further investigations of the neuronal mechanisms involved in this atopy‐related effect of Ach have to be performed.