Sara Weltfriend

Positive patch test reactions to allergens of the dental series and the relation to the clinical presentations.

The clinical manifestations of contact allergic dermatitis to dental materials are not uniform. This study was performed to detect the frequent allergens in the dental series associated with contact dermatitis and to define the causal relationship between the different allergens and the relevant clinical presentations. Between the years 2000 and 2004, 134 patients, aged 20–80 years, were patch tested. 121 patients were included in the study. The most frequent oral manifestations were cheilitis and perioral dermatitis (25.6%), burning mouth (15.7%), lichenoid reaction (14.0%), and orofacial granulomatosis (10.7%). 18 (14.9%) patients were dental personnel, all of whom suffered from hand dermatitis. The common allergens detected included goldsodiumthiosulphate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%), cobalt chloride (5.0%), and 2‐hydroxyethyl methacrylate (5.8%). Positive reactions to metals were frequent in all the different clinical variants, and no specific association between a specific clinical presentation and a particular allergen was found. Allergy to mercury was not a significant factor contributing to the pathogenesis of oral lichenoid reactions. However, a strong association with contact allergy to mercury in dental fillings was found in 2 patients with orofacial granulomatosis.

Differential irritant skin responses to topical retinoic acid and sodium lauryl sulphate: alone and in crossover design

Topically applied all‐trans retinoic acid (RA) is often associated with skin irritation. A detailed quantification of RA‐induced functional changes in stratum corneum is. however, still limited. U sing noti‐invasive bioengineering techniques of measurements of transepidermal water loss (TEWL), stratum corneum hydration and cutaneous blood flow (CBF). we quantified the irritant effects of 0·05% and 0·1% RA in ethanol on normal skin compared with 1% sodium lauryl sulphate (SLS) in water as a model irritant in a 24‐h occlusive patch‐test assay. Additionally, in order to document data possibly related to the mechanism of action, skin responses to both compounds applied in tandem was also investigated over 18 days

Effects of all-trans retinoic acid and sodium lauryl sulphate on the permeability of human skin in vitro

Recent in vivo investigations have shown that pretreatment with topical all‐trans retinoic acid (RA) may diminish the skin response to sodium lauryl sulphate (SLS). This study evaluated the permeation of SLS through human skin after pretreatment with RA, and vice versa, by in vitro methods. The permeability coefficient of SLS (3.24 ± 0.21 × 103 cm/h) and the 24‐h cumulative amount of SLS (3.41 ± 0.6% of dose applied) permeating RA‐pretreated skin did not differ significantly from those across untreated skin (control) (P > 0.05). In contrast, the permeability coefficient of RA (0.23 ± 0.05 × 103 cm/h) and its 24‐h cumulative amount (0.37 ± 0.05% of dose applied) penetrating SLS‐pretreated skin were significantly greater than those permeating untreated skin (P<0.05). Thus, an increase in RA penetration was induced by SLS pretreatment; however, pretreating the skin with RA did not inhibit the percutaneous permeation of SLS. Based on previous in vivo findings where RA reduced skin reactions to SLS,8 one would speculate that RA pretreatment may decrease SLS penetration. However, these penetration data do not necessarily uphold this presumption. Perhaps, other interactions between the substances and the skin, e.g. at cellular levels, may be responsible for the differing skin responses.

Preservatives sensitivity in Israel: a 10-year overview (1995–2004)

This study presents a 10‐year survey of 2285 patients tested to common preservatives in northern Israel. The demographic and clinical data were analysed using a revised MOAHLFA index. Patch testing was based on the International Contact Dermatitis Research Group (ICDRG) guidelines. 411 (18%) patients were found to have positive reactions to 1 or more preservatives. The most frequent allergens tested positively were thimerosal, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), and formaldehyde. The reactions to MCI/MI remained stable around 1.7% throughout the years 1995–1998, with a significant increase to 3.7%–4% (P= 0.029) during 1999–2004. The reactions to formaldehyde remained low around 0.3% until 1999; however, a considerable increase throughout the years 2000–2004 was noted, with rates of 1.5%–1.9% (P= 0.028). The sensitivity rates for parabens, quaternium‐15, imidazolidinylurea, and diazolidinylurea were low and unchanged, mostly under 0.5%. As for methyldibromoglutaronitrile (MDBGN), sensitivity rates around 2% were detected for the years 1996 and throughout 2000–2004. Overall, this extensive survey showed a concerning increase in the sensitivity rates for MCI/MI, formaldehyde, and MDBGN.

Cement-Induced Chromate Occupational Allergic Contact Dermatitis.

BackgroundHexavalent chromium in cement is a common cause of occupational allergic contact dermatitis (OACD). MethodsAnalysis of patch test data during 1999 to 2013 was done. Patients with cement-induced chromate OACD filled the Dermatology Life Quality Index, graded 1 to 5. ResultsOf 4846 consecutive patients who were patch tested, 146 (3%) were chromate-sensitive. Of 46 (31.5%) who presented with chromate OACD, 27 (59%) had cement-induced chromate OACD. The proportion of chromate-sensitive patients with clinically relevant cement exposure increased from 7.7% in 2002 to 2004 to 28.7% in 2011 to 2013 (P = 0.04). The median age of presentation was younger than for other chromate-sensitive patients (32 vs 42 years). Hand eczema (88.9%) was the most frequent clinical presentation. Of the 27 with cement-induced chromate OACD, 21 (77.8%) had ongoing dermatitis at the time of the review. Although 14/27 (51.9%) changed their occupation to avoid exposure to cement, symptoms persisted in 9/14 (64.3%). Prolonged exposure to cement before development of symptoms was associated with chronicity. All the symptomatic patients experienced at least a moderate effect on their quality of life (grade 3 or higher on the Dermatology Life Quality Index). ConclusionsWe recommend the adoption of the European legislation in Israel, to reduce the prevalence of chromate OACD from cement.

Chromate Allergy in Northern Israel in Relation to Exposure to Cement and Detergents.

BackgroundThe prevalence of chromate allergy has declined worldwide in the last decades. ObjectivesThe aim of the study was to assess tendencies in chromate allergy in northern Israel and its possible causes. MethodsRetrospective analysis of patch test data during 1999-2013 and a review of the medical records of patients with chromate allergy were conducted. ResultsA total of 4846 consecutive patients were patch tested, of whom 146 (3%) were found to be chromate sensitive. The prevalence of chromate allergy decreased significantly from 4.7% in 1999–2001 to 2.8% in 2002–2004 (P = 0.02). Since then, no significant fluctuations have occurred. A gradual and consistent decline in chromate allergy was recorded among women from 4.8% in 1999–2001 to 2.3% in 2008–2010. Cement (18.4%) was the most frequent source of exposure and was mainly observed in men. The frequency of clinically relevant cement exposure increased significantly from 7.7% in 2002–2004 to 28.7% in 2011–2013 (P = 0.04), whereas the frequency of relevant detergent exposure decreased significantly from 25% in 1999-2001 to 5.7% in 2011–2013 (P = 0.04). Hand (68.5%) was the most frequently involved anatomical site. ConclusionsThe prevalence of chromate allergy in northern Israel is stable in the general population and gradually decreasing among women. These changes may be caused by reduced exposure to water-soluble hexavalent chromium in detergents but not in cement.

Nodular Melanoma Arising in a Large Segmental Speckled Lentiginous Nevus.

REFERENCES 1. Tieche M. Uber benigne Melanome (Cromatophorome) der Haut-“Blaue Naevi.” Virchows Arch Pathol Anat. 1906;186:212. 2. Park YM, Kang H, Cho BK. Plaque-type blue nevus combined with nevus spilus and smooth muscle hyperplasia. Int J Dermatol. 1999; 38:775. 3. Patrizi A, Medri M, Neri I, et al. Becker naevus associated with basal cell carcinoma, melanocytic naevus and smooth muscle hamartoma. J Eur Acad Dermatol Venereol. 2007;21:130. 4. Tzu J, Goldman C, Perry AE, et al. Combined blue nevus-smooth muscle hamartoma: a series of 12 cases. J Cutan Pathol. 2013; 40:879. 5. Happle R. Superimposed segmental manifestation of polygenic skin disorders. J Am Acad Dermatol. 2007:57:690–699. 6. Happle R. What is paradominat inheritance? J Med Genet. 2009:46:648.

Pyoderma Gangrenosum in a Patient with Systemic Sclerosis

To the Editor: Pyoderma gangrenosum (PG) is an ulcerative inflammatory noninfectious disease of the skin. Treatment is mainly empirical, consisting of a combination of local and systemic treatments, including corticosteroids and immunosuppressive drugs1. In many cases, PG is associated with an underlying disease, most commonly inflammatory bowel disease, occasionally in the stromal area. PG occurs in several hematological and malignant diseases. PG has also been described in several rheumatic diseases: rheumatoid arthritis, spondyloarthropathies, systemic lupus erythematosus, Behcet’s disease, and sarcoidosis2. Hod, et al 3 reported a huge PG-like lesion as a presenting sign of antiphospholipid antibody syndrome (APS). In the literature we are aware of … Address correspondence to Dr. J. Feld, Bnai Zion Medical Center – Rheumatology, 47 Golomb Street, Haifa 31048, Israel. E-mail: joyfeld{at}gmail.com