Sibylle Schliemann

Dry skin, barrier function, and irritant contact dermatitis in the elderly

Dry skin is characterized by a decreased lipid content and a delayed reconstitution of the epidermal barrier after skin irritation. These are problems of high relevance in the aged population, especially in the development of irritant contact dermatitis. Asteatotic and perineal irritant dermatitis are the most important subtypes of irritant contact dermatitis in the elderly. This contribution presents a compressed survey on these subtypes and elucidates their relation to an impaired barrier function. Typical irritants affecting aged individuals are explained and compared with irritants that seem to be more significant in younger people. Results of biophysical investigations, such as measurement of transepidermal water loss, are discussed regarding their age-dependence. Transepidermal water loss decreases with age, which was formerly interpreted as an indication of a decreased sensitivity. Today, we know that reconstitution of the epidermal barrier after irritation is delayed once it has been impaired. Reasons are decreased activities of enzymes involved in lipid synthesis and processing, a changed cytokine profile, a reduced acidification of aged skin, and alterations in the function of epidermal stem cells. Owing to these new insights, a reevaluation of the sensitivity of aged skin has to be initiated, especially with regard to occupational dermatology.

The use of ITS DNA sequence analysis and MALDI-TOF mass spectrometry in diagnosing an infection with Fusarium proliferatum

Abstract:  Although mycoses are among the most common diseases worldwide, infections with Fusarium spp. occur only rarely. Mostly patients suffering from underlying immune deficiency are infected with this mould, resulting in a considerably decreasing prognosis. In immunocompromised patients, cutaneous manifestations are more often associated with Fusarium sp. than with Candida sp. or Aspergillus sp. We describe one patient with acute lymphoblastic leukaemia, who was first treated with chemotherapy after GMALL protocol 07/03. After relapse, the patient was successfully transplanted in second remission with a human leukocyte antigen (HLA)‐matched unrelated peripheral blood stem cell graft. Ten months later, the patient died from respiratory insufficiency and recurrence of leukaemia. Previously, Aspergillus antigen was detected in blood. In the latter course, disseminated papules appeared. One of these was examined histologically and mycologically. Conventional cultural diagnostics led to the diagnosis of a fusariosis, further supported by internal transcribed spacer (ITS) sequencing and matrix assisted laser desorption/ionisation–time‐of‐flight mass spectrometry (MALDI‐TOF) mass spectrometry, both determining the isolated strain as Fusarium proliferatum, which is a very infrequent pathogen within this genus. Our investigations underline the potential of MALDI‐TOF MS based identification of Fusarium species as an innovative, time and cost efficient alternative to ITS sequencing.

Guideline on the management of hand eczema ICD-10 Code: L20. L23. L24. L25. L30.

© Dt. Dermatologische Gesellschaft u. a. • Journal compilation

Quantitative patch and repeated open application testing in hydroxyisohexyl 3‐cyclohexene carboxaldehyde sensitive‐patients

Objective: To identify the concentration of the fragrance compound hydroxyisohexyl 3‐cyclohexene carboxaldehyde (INCI) (HICC) that is sufficiently low not to cause an allergic reaction in patients with proven sensitization.

Preventing irritant contact dermatitis with protective creams: influence of the application dose

Skin protection creams (PC)s are used in the occupational setting to help prevent irritant hand dermatitis. The actual amounts of PC applied and the resulting dose per unit area on hands at work are lower than recommended.

Protective creams fail to prevent solvent-induced cumulative skin irritation - results of a randomized double-blind study.

Occupational skin contact with lipophilic substances is a risk factor for the development of irritant hand dermatitis. Skin protection creams form part of the personal protective equipment, and some are claimed to protect against lipophilic irritants. However, their benefit against solvents is under debate.

How much skin protection cream is actually applied in the workplace? Determination of dose per skin surface area in nurses.

Background. Skin protection creams (PCs) are used in the occupational setting to prevent irritant hand dermatitis. However, so far, the actual amounts of PC applied and the resulting dose per area unit on hands at work have not been a matter of systematic investigation. The quantities used in experimental studies investigating the efficacy of PCs range between 4 and 25 mg/cm2.

Contact dermatitis as a systemic disease

Systemic contact dermatitis (SCD) is a condition occurring in previously sensitized individuals after systemic re-exposure to the same or cross-reacting substance. Systemic route of administration means uptake of an allergen via percutaneous, transmucosal, oral, intravenous, intramuscular, and inhalational routes, as well as through implants. The intimate mechanisms behind SCD are not yet fully understood, but it is thought to be a T-cell mediated delayed type hypersensitivity reaction. The most common allergens recognized to date are nickel, aminoglycoside antibiotics, corticosteroids, balsam of Peru, and plants from the Anacardiacae and Compositae families. The most typical presentation of SCD, known as baboon syndrome, includes diffuse erythema of the buttocks, the upper inner surface of the thighs, and the axillary folds. Cases with the classical baboon pattern of distribution elicited by systemically introduced drugs without previous sensitization are encompassed by the acronym SDRIFE (Symmetric Drug-related Intertriginous and Flexural Exanthema). Interestingly, corticosteroids, although widely applied for anaphylaxis and other allergic conditions, can produce sensitization, and they are commonly mentioned as triggers of SCD.

Development of a standardized testing procedure for assessing the irritation potential of occupational skin cleansers

Frequent skin cleaning fulfils the definition of occupational ‘wet work’. Standardized methods are required to assess the irritation potential of workplace cleansers.

Occupational contact urticaria caused by food – a systematic clinical review

Food industry workers are at increased risk for occupational contact urticaria (CU). There are many foodstuffs that have been reported to cause occupational CU, including seafood, meat, vegetables, and fruits. The aim of this review is to summarize all reported occupational cases of CU in the food industry. This is a systematic review based on a MEDLINE search of articles in English and German and a manual search, between 1990 and 2014, to summarize the case reports and case series of occupational CU in the food industry. Many different foodstuffs have been implicated in CU. Occupational CU has been reported in many different occupations, mostly in individuals dealing with seafood, meat, vegetables, and fruits, such as chefs, cooks, bakers, butchers, slaughterhouse workers, and fish‐factory workers. Foodstuffs that commonly induce occupational protein contact dermatitis include fish, seafood, meats, vegetables, and fruits. Food handlers may acquire CU resulting from occupational exposures. The prognosis varies widely. The diagnosis of immunological CU is based on the clinical history and on a positive prick test with the suspected substance and/or measurement of specific IgE.