Siegfried Borelli

Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort–spice syndrome

Protein contact dermatitis to meat is well known in butchers; spices are another source of potential contact allergy and usually are not recognized. We present a first case of contact‐dermatitis to spice mix in a 39‐year‐old‐butcher. The patient underwent skin prick testing (SPT) with standard allergens (ALK) and different meat and spice extracts (Stallergènes), scratch‐patch testing with spice mix containing glutamate, paprika and other spices. Specific serum‐IgE was measured with CAP‐FEIA. SPT only showed an immediate‐type sensitization to mugwort (+ +), as well as different spices (paprika +, curry +, cumin +) and camomile (+ + +). Scratch‐patch tests were negative for different meat, but strongly positive for spice mix (+ + +) after 30 min (wheal and flare) and (+ +) after 48 h (infiltration and vesiculation). Two healthy controls were tested negative for spice mix used from that patient (scratch‐patch). Specific IgE was slightly elevated for paprika 0.47 kU/L (CAP class 1), anise 0.43 kU/L, curry 0.36 kU/L and mugwort 3.83 kU/L. Sx1 atopy‐multiscreen was 3.8 kU/L due to a sensitization to mugwort alone. The tests performed demonstrate an IgE‐mediated contact allergy to spices but also a delayed type allergy to spice mix as a manifestation of the mugwort–spice syndrome in this individual. When testing for occupational dermatitis in butchers, protein contact allergy to spices must also be taken into consideration.

Molecular diagnostics of parapox virus infections.

Background: The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non‐specific necrotic ulcer. The histology may also be non‐specific, especially with older lesions. Negative‐staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time‐consuming viral culture are also rarely used in Europe.

Hydroxychloroquine‐induced hyperpigmentation

Dear Editors, Antimalarial medications are widely used in medicine. Chloroquine became a popular drug for prevention and treatment of malaria during World War II. Its derivative, hydroxychloroquine, was developed in the 1950s. Today the latter is broadly used for the treatment of autoimmune diseases such as systemic lupus erythematosus and chronic polyarthritis as well as photodermatoses. The most common and usually mild side effects are gastrointestinal symptoms, headaches, EEG changes, visual defects, photosensitivity, urticaria and rashes [1]. Hyperpigmentation after intake of chloroquine for more than four months is a well-known side effect [2]. Its occurrence due to hydroxychloroquine is very rare though, and only a few reports exist. A 49-year-old Hispanic woman, Fitzpatrick skin type IV, 155 cm tall and weighing 52 kg was diagnosed in February 2010 with a rheumatoid factor positive, anti-CCP antibody negative rheumatoid arthritis. On low-dose prednisolone (10 mg per day tapering to zero) and NSAID (diclofenac 75 mg twice a day) the polysynovitis resolved within three months. Due to a second flare in May 2010, immunomodulatory therapy with hydroxychloroquine (400 mg once a day, 8.6 mg per kilogram ideal body weight) was initiated. The ophthalmological evaluation was normal. Seventeen months later the patient was referred to the dermatology outpatient clinic with a four-month history of an asymptomatic, progressive, distinct gray-brown macular pigmentation (Figure 1). Her face, neck, shoulders, upper back, arms and hands were affected, but her oral mucosa and nails were spared. There was neither a history of preceding inflammation nor of use of other drugs likely to cause hyperpigmentation. Skin biopsy revealed melanophages and deposition of a partially extracellular granular brown pigment in the upper corium, which was positive on Masson-Fontana staining, as well as sporadic perivascular lymphocytes and increased basal layer pigmentation (Figure 2). Iron staining showed no hemosiderin deposits. Medical history, clinical examination, histopathological findings and absence of alternative explanations all suggest hydroxychloroquine as cause of the hyperpigmentation. Ten months after she stopped hydroxychloroquine, partial regression of the hyperpigmentation could be noticed. Acquired skin pigmentation can be generalized or localized and have many causes. Differential diagnostic consideClinical Letter rations include melasma, Addison disease, hemochromatosis, hyperthyroidism, nicotinic acid and vitamin B12 deficiency as well as erythema dyschromicum perstans. Heavy metal intake causes slate-gray (mercury, silver), blue-gray (bismuth, gold) or bronze (arsenic) pigmentation. Gray discoloration in sun-exposed areas may appear after topical usage of silver sulfadiazine. Excessive consumption of beta-carotene can cause yellow skin tones. Drug-induced hyperpigmentation is a well-known side effect from some psychotropic drugs,

Was brennt Ihren Patienten unter den Nägeln

ZusammenfassungNägel dienen dem Schutz und der Stabilität der Finger- und Zehenkuppen sowie der taktilen Sensibilität und fungieren an den Fingern als Greifwerkzeuge. Gleichzeitig stellen kranke Nägel eine kosmetische Einschränkung dar. Nagelerkrankungen verdienen daher ausreichende Beachtung und eine intensive Behandlung.

Short- and long-term effects of two emollients on itching and skin restoration in xerotic eczema

Pruritus is associated with various skin diseases, dry skin, and with it an impaired skin barrier function. The study objective was to investigate short‐term and long‐term effects of two emollients on symptoms and skin barrier functions in xerotic eczema. Randomized, double‐blind, study enrolling females/males, with bilateral itching. Two emollients, containing lactic acid and refined almond oil with/without polidocanol were administered on left versus right body sides. Itching severity, skin moisture, lipid content, and pH were assessed on Day 1, within 30–120 min after first administration, and on Days 7 and 14, and compared with baseline assessments. Severity of itching decreased 30 min after first administration of both emollients compared with baseline (p < .0001) and reached a maximum reduction of 63% (p < .0001) and 69% (p < .0001) on Day 14. Skin moisture and lipid content increased after first application, and further ameliorated within 14 days of treatment (p < .0001). Both emollients were tolerated well, and only a few adverse events were reported. This study confirmed the clinical efficacy of the two study emollients to substantially reduce itching already after first administration, and restore skin barrier integrity and thus should be considered as therapeutic approach for xerotic eczema.

Hydroxychloroquin‐induzierte Hyperpigmentierung

Medikamente gegen Malaria sind in der Medizin weit verbreitet. Während des Zweiten Weltkriegs war Chloroquin ein populäres Mittel zur Vorbeugung und Behandlung von Malaria. Sein Derivat Hydroxychloroquin wurde in den 50er Jahren entwickelt und kommt heute weitgehend in der Behandlung von Autoimmunerkrankungen, z.B. bei systemischem Lupus erythematodes und chronischer Polyarthritis, sowie bei Photodermatosen zum Einsatz. Zu den häufigsten, meist milden Nebenwirkungen zählen gastrointestinale Symptome, Kopfschmerzen, EEG-Veränderungen, Sehstörungen, Photosensibilität, Urtikaria und Hautausschlag [1]. Hyperpigmentierung nach mehr als viermonatiger Einnahme von Chloroquin ist eine bekannte Nebenwirkung [2]. Dennoch tritt sie unter Hydroxychloroquin sehr selten auf und ist nur wenig berichtet worden. Bei einer 49-jährigen südamerikanischen Patientin, Fitzpatrick-Hauttyp IV, 155 cm groß und 52 kg schwer, wurde im Februar 2010 eine rheumatoide Arthritis (Rheumafaktor positiv, Anti-CCP-Antikörper negativ) diagnostiziert. Unter niedrig dosiertem Prednisolon (10 mg täglich mit Ausschleichen auf Null) und NSAR (Diclofenac 75 mg zweimal täglich) ging die Polysynovitis innerhalb von drei Monaten zurück. Wegen eines zweiten Schubs im Mai 2010 wurde eine immunmodulatorische Therapie mit Hydroxychloroquin eingeleitet (einmal täglich 400 mg, 8,6 mg pro Kilogramm Idealgewicht). Die ophthalmologische Untersuchung war normal. Siebzehn Monate später wurde die Patientin an das Dermatologische Ambulatorium überwiesen wegen seit vier Monaten bestehender asymptomatischer, zunehmend ausgedehnter graubrauner fleckförmiger Pigmentierung (Abbildung 1). Betroffen waren Gesicht, Hals, Schultern, oberer Rücken, Arme und Hände, nicht jedoch Mundschleimhaut und Nägel. Anamnestisch war weder eine vorausgegangene Entzündung noch die Einnahme anderer Medikamente als mögliche Ursache der Hyperpigmentierung festzustellen. Die Untersuchung der Hautbiopsie zeigte Melanophagen und Ablagerung von teilweise extrazellulärem körnigem braunem Pigment im oberen Korium, das in der Masson-Fontana-Färbung positiv war, sowie sporadisch perivaskuläre Lymphozyten und verstärkte Pigmentierung der Basalschicht (Abbildung 2). In der Eisenfärbung waren keine Hämosiderinablagerungen zu erkennen. Insgesamt deuteten Anamnese, klinische Untersuchung, histopathologische Befunde und fehlende Alternativerklärungen darauf hin, dass Hydroxyychloroquin die Hyperpigmentierung verursacht hatte. Zehn Monate nach Absetzen von Hydroxychloroquin war eine partielle Rückbildung der Hyperpigmentierung zu beobachten. Clinical Letter

Veränderungen der Fingernägel

Hande und Nagel haben eine wesentliche Bedeutung in der sozialen Interaktion. Gesund aussehende Nagel sind wesentlicher Bestandteil des Korperbilds. Dementsprechend gross ist die Morbiditat bei Nagelveranderungen, sowohl in funktioneller als auch ‒ durch die kosmetische Entstellung ‒ in sozialer Hinsicht

Pathologies des ongles des doigts

Les pathologies ungueales peuvent avoir une morbidite non negligeable et du meme fait amputer la qualite de vie. En plus de l’examen clinique, des examens mycologiques (direct, culture, histologie), radiologiques et histologiques peuvent etre indiques.

Molekularbiologische Diagnostik von Parapockenerkrankungen

BACKGROUND: The diagnosis of parapox virus infections relies primarily on a history of contact with infected animals. The clinical presentation is usually a non-specific necrotic ulcer. The histology may also be non-specific, especially with older lesions. Negative-staining electron microscopy (EM) is a fast and reliable diagnostic tool, but is not widely available. Serological tests and the time-consuming viral culture are also rarely used in Europe. PATIENTS AND METHODS: The diagnostic procedure in two patients with ecthyma contagiosum and milkers nodule using polymerase chain reaction specific for orthopox, parapox and Orf virus is explained. Diagnostics included bacterial culture, viral culture, histology and EM. In addition to these, a polymerase chain reaction (PCR) was performed in both cases. RESULTS: The patient with ecthyma contagiosum was negative for ortho-, parapox-, and orf-virus on PCR, whereas the patient with milkers nodule had a PCR positive for parapoxvirus. CONCLUSIONS: PCR is a simple, fast, and standardized method of diagnosis that can distinguish between the subgroups of parapoxviruses. A diagnosis can be made even in cases of ambiguous history or unspecific clinical presentation. The method is limited by the necessity to sample native material or to use neutrally buffered formalin in case of PCR from paraffin material.