Riekeld J. Scheper

Angry back or the excited skin syndrome: A prospective study

Allergens eliciting weak positive reactions were retested to ascertain their reproducibility. Weak positive patch test reactions, concomitant to other weak or strong positive reactions, were retested after 3 weeks in 61 patients. 79 reactions were retested; 35 (44.3%) were negative. Allergens which are marginal irritants, e.g., formaldehyde, often gave weak positive reactions which were lost at retesting. In patients without dermatitis but with several strong positive reactions, lost reactions were frequently encountered, suggesting that strong reactions induced a state of hyperirritability. False positive reactions were often found in the proximity of strong reactions. We attempted to develop a nonspecific irritant (sodium lauryl sulfate) as a hyperirritability marker. A correlation between the score of this test and false positive reactions was not found. It is concluded that weak positive reactions should not be accepted as a proof of sensitization. The allergens eliciting these reactions should be retested at a later date.

Autologous full-thickness skin substitute for healing chronic wounds

Background  Chronic wounds represent a major problem to our society. Therefore, advanced wound‐healing strategies for the treatment of these wounds are expanding into the field of tissue engineering.

Penicillin Allergy and the Relevance of Epicutaneous Tests

Epicutaneous tests with penicillins are important in the evaluation of penicillin allergy in patients who have shown a delayed urticarial or maculo-papular rash after the administration of penicillin derivatives. Of 23 patients who showed positive epicutaneous tests only 5 also showed immediate-type reactivity upon subsequent intracutaneous tests with the major determinant of penicillin. Moreover, patients with positive epicutaneous tests were evidently immunologically reactive on penicillins, since lymphocytes from 14 out of 17 patients showed increased DNA synthesis induced by penicillin G and ampicillin in vitro. The performance of epicutaneous tests with various penicillin derivatives is recommended as a first step in establishing penicillin allergy, because it is a safe method and because an extra group of sensitized patients is detected.

Depression or Enhancement of Skin Reactivity by Inflammatory Processes in the Guinea Pig

An animal model for the excited skin syndrome was developed in the guinea pig. Hyperirritability of the skin could be induced by immunization with Freunds complete adjuvant (FCA). This hyperirritability was evident from the enhancement of both patch test reactions to an irritant (sodium lauryl sulfate) and open epicutaneous test reactions to a contact sensitizer (2,4-dinitrochlorobenzene). The skin tests were performed at sites other than those pretreated with FCA. Maximum enhancement was observed in a period 3-5 weeks after FCA immunization. A similar but less marked hyperirritability could be induced by eliciting a localized chronic croton oil dermatitis. The period of hyperirritability induced by FCA or croton oil was preceded by a short period (1-14 days) of depressed skin reactivity.

Booster-Dependent Alterations of the Subsets of T Lymphocytes and Eosinophils in the Bronchi of Immunized Guinea Pigs

We investigated whether guinea pigs sensitized to ovalbumin show changes in T cells in the bronchial wall and whether they correlate with eosinophil migration. Animals received two injections of 10 µg