Pierre Piletta

High sensitization rate to emulsifiers in patients with chronic leg ulcers

Emulsifiers are common constituents of most topical preparations. To study the sensitization rate in a population with frequent use of these agents, we selected 47 patients with chronic or recurrent (> 1 year) inflammatory skin disease (leg ulcers, contact dermatitis, atopic dermatitis, psoriasis) for patch testing with the following emulsifiers: Tween 40 (polyoxyethylene sorbitan monopalmitate), Tween 80 (polyoxyethylene sorbitan monooleate), Span 60 (sorbitan monostearate), Span 80 (sorbitan monooelate), Ariacel 83 (sorbitan sesquioleate), Atlas G 2162 (polyoxyethylene oxypropylene stearate), Atlas G 1441 (polyoxyethylene sorbitol lanolin derivative), triethanolamine, Lanette O (cetylstearyl alcohol), Lanette N. 12 patients had at least 1 positive reaction (25.5%) at 3 or 4 days. Among them, 10 had leg ulcers (43.4% of the leg ulcer group), and 2 had contact dermatitis (13.3% of the contact dermatitis group). No positive reaction was observed in the other patients. When the patients were tested with their own topical preparations or wound dressings, 6 of them, all with leg ulcers, had positive reactions. These results show a surprisingly high prevalence of sensitization to emulsifiers in patients with chronic leg ulcers, in contrast to patients with other inflammatory skin diseases.

Frey syndrome treatment with botulinum toxin

The goal of this work is to present our results of the intradermic infiltration with botulinum toxin in patients with Frey syndrome. Sixteen hemifaces in 15 patients were studied. Gustatory stimulation was evoked by sucking on a slice of lemon while measurements were done on both hemifaces, with the normal side being used as a control. Skin temperature and color (erythema) were measured with a digital surface thermometer and a skin chromameter, respectively. Sweat quantity and surface were measured by using the previously described blotting paper and iodine-sublimated paper histogram methods, respectively. Testing was repeated 2 weeks after skin infiltration with botulinum toxin (dilution of 50 U/mL). The interinjection distances were 1 cm, and 0.1 mL (5 U) was infiltrated at each injection site. Frey syndrome complaints disappeared in all patients. Small residual amounts of sweat were measurable. The difference in sweat quantity before and after botulinum toxin infiltration was significant in every patient (P < 0.001). Skin temperature and color measurement gave inconclusive results. In conclusion, Frey syndrome treatment with botulinum toxin is an efficient and well-tolerated technique. Further work should address the optimal injection parameters.

Extensive annular verrucous late secondary syphilis.

We report an illustrative case of an apparently healthy 38‐year‐old man with a past history of alopecia universalis who developed extensive, slightly pruritic, infiltrated annular verrucous lesions of the scalp, perioral, lumbar, perianal and genital areas over a 6‐month period. The combination of an unusual clinical presentation, positive syphilis serology and rapid response to penicillin therapy was consistent with a diagnosis of extensive annular and verrucous late secondary syphilis. We present this case to illustrate a rare and potentially misleading clinical feature of late secondary syphilis, a disease considered to be of the past but still present in todays practice.

Medical, psychological and socio-economic implications of chronic hand eczema: a cross-sectional study.

Hand eczema (HE) is a common skin disease with major medical psychological and socio‐economic implications. Onset and prognosis of HE are determined by individual as well as environmental factors. So far, most epidemiological data on HE have been reported from Scandinavian and recently German studies.

Isothiazolinones: Sensitizers Not to Miss in Children

Isothiazolinone is known to be a sensitizer and a frequent cause of contact dermatitis in adults. Cases of contact dermatitis have also recently been reported in children. Derivatives of isothiazolinone, such as methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI), are commonly used in the care products of babies and children. This allergen should not be missed.

“ET” Material Allergic Contact Dermatitis

A 31-year-old physicist presented to our clinic with an 8-week history of erythematous and itchy plaques on his wedding ring finger and on his belly, behind his belt buckle. He was in good health with a history of atopic dermatitis and allergic rhinitis. Patch tests were performed with the European standard series (Hermal; Reinbek, Germany) and preservatives series. The readings were done on days 2 and 4. On days 2 and 4, the reading was positive (+++) to nickel(II) sulfate. The test confirmed contact dermatitis to nickel. The patient changed his belts, and improvement was noted on his aforementioned abdominal skin. This was not the case for his finger. Later it was discovered that his ring was made out of a type of meteorite iron called Gibeon, which was bought from a specialized boutique in Paris, France. Dimethylglyoxime test (Chemotechnique Diagnostics, Vellinge, Sweden) was done to identify the presence of nickel in his ring, and the result was positive. The dermatitis resolved once he stopped wearing his ring and avoided contact with objects containing nickel. Nickel is widely used for many purposes and is found in the alloy of different metals found in nature. It is known to be very sensitizing (especially with cheap jewelry and coins). Its principal sources are ores and iron-nickel meteorites. In this case, the ring was made of a meteorite material. It is composed of nickel-iron alloy and contains copper and phosphorus. This meteorite was found in Namibia in 1836 and was named Gibeon in reference to the village nearest to where it was found. It is classified in the iron meteorite class and is used for different purposes such as making tools, weapons, and jewelry.2 The unique and seamless ring made by this meteorite makes it attractive for certain consumers. It is also known to be stable and beautiful, and the fact that it is brought from the ‘‘cosmos’’ makes it distinguished and desired. Many people ignore the composition of meteorite and are unaware of its harmful effects on the skin. However, it is important to remember that allergens are found in the environment and even what is called ‘‘natural’’ should be investigated, if needed.

contact Dermatitis to Propylene Glycol in Topical Zovirax Cream

Much attention has been focused on contact allergy to antiviral drugs used in topical products. However, the vehicles and preservatives used in the prescription may also cause contact dermatitis. This report investigates a case of allergy to propylene glycol in topical Zovirax cream.

Chronic hand eczema: A prospective analysis of the Swiss CARPE registry focusing on factors associated with clinical and quality of life improvement

Hand eczema (HE) is common and may follow a chronic disease course. So far, prospective studies investigating the risk factors for disease progression as a prerequisite for targeted prevention are scarce.