Simonetta Giorgini

Anaphylactic shock from mustard after ingestion of pizza

A 27-year-old nurse came to us because of itching and the appearance of wheals on her forearms when she prepared injections containing analgesics (unspecified). In the past, from the age of 12 until her first pregnancy at age 23, she had taken analgesics containing phenazonic compounds regularly during her periods. At age 26 she took an unspecified analgesic for back pain and had an immediate reaction of diffuse itching. Approximately 1 year later a tablet of Nisidina® produced anaphylactic shock. Nisidina is a mixture of two antispastic drugs, adiphedrine and ethyl-N-diphenylaminoacetate, an antihistamine, diphenydramine, and the analgesic methamizole (4-methylamino-1.5dimethyl-2-phenyl-3-pyrazolone sodium methanesulfonate) which is sold in Italy under the name Novalgina®. Patch tests with 10 % aminophenazone gave negative immediate and delayed reactions. The prick test with aminophenazone (10 %) and an intradermal test with a 1 % concentration both provoked an immediate wheal reaction. A patch test with Nisidina (saturated solution) also provoked an immediate wheal reaction, but patch tests with the individual ingredients (10 % pet.) were all negative except for methamizole which gave an immediate wheal reaction. Prick tests with methamizole in concentrations of 1, 5, 25, and 50% all provoked immediate reactions. The structural formulas of methamizole and aminophenazone are: Methamizole (Novalgina)

Multicentre study of allergic contact cheilitis from toothpastes

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially‐targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop‐restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Allergic contact dermatitis from henna temporary tattoo

484 JEADV 2006, 20, 461–488

Iatrogenic calcinosis cutis following nadroparin injection

Accumulation of calcium in the skin is usually classified as a group of disorders referred to as calcinosis cutis. We report the case of a patient who developed iatrogenic calcinosis at the site of subcutaneous administration of low‐molecular‐weight heparins (LMWH) as nadroparin. This is usually used for the prevention of deep venous thrombosis, especially following renal transplantation. The role of calcium content in nadroparin is discussed.

Sensitization from contact with ethyl alcohol

Numerous forms of contact dermatitis, both occupational and non-occupational, are attributed to the irritant and dehydrating properties of ethyl alcohol. In very few cases has sensitization been demonstrated, despite the frequent use of this substance as a disinfectant (1-7). A 49-year-old woman with a family history of atopy and an allergic contact dermatitis from cosmetics and topical drugs, developed a dermatitis following contact with denatured alcohol and with 2 ammonia-based disinfectants (Citrosil and Bialcool). Citrosil (containing benzalkonium chloride, lemon grass oil, bergamot, thyme, ethyl alcohol, nonyl-phenol-oxyethylate, tartrazine yellow, Blue E 131 and distilled water) was thought to be responsible for a scaly, erythematous eruption in the axilla following contact with a Citrosil-disinfected thermometer, and for a similar lesion in the right elbow flexure following contact with cotton wool soaked in Citrosil. Bialcool (containing dodecyl chloride benzyl ammonium-N-diethyl alcohol, ethyl alcohol, acetone, ethyl acetate, fragrance, pine oil, diethylene glycol mono-ethyl ether and deionized water) caused a papular eruption in the elbow flexure after a blood sample was taken. The next day, similar lesions appeared on the side of the neck and sternum. Denatured alcohol (ethyl alcohol to which adulterating substances have been added to render it unfit to drink and thus be tax free) was considered responsible for red papular lesions on the flexor surface of the left wrist, 24 h after she had given her husband an intramuscular injection, during the course of which her wrist came into contact with cotton wool soaked in it. In contrast to cases reported in the literature, the patient made no mention of skin eruptions after drinking alcohol. Patch tests with 70° denatured ethyl alcohol (10%, 50% and 100%) gave positive results, while the same tests were negative in 6 control subjects. Further patch tests performed using denaturant (1 %,10% and 50%) were negative. (Denaturants are mixtures of several substances, the exact formulae of which are kept secret and vary from one country to another.) There are a number of denaturants used in Italy, the principal ones being composed of various hydrocarbons, oil of acetone, pyridic bases, dyes, etc. There have been 6 other cases reported in the literature (2-7) of occupational and non-occupational contact dermatitis in subjects with sensitization to ethyl alcohol. In all of them, an eruption developed or was aggravated after alcoholic beverages (wine, gin, sherry, etc.) had been consumed. Our patient, however, showed no such reaction despite the fact that she drank wine daily.

Prurigo-like eczema as an unsuspected presentation of textile dermatitis

Auteur(s) : Linda TOGNETTI linda.tognetti@alice.it, Simonetta GIORGINI, Torello LOTTI Dermatologic Clinic II Division of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Villa S.Chiara; Piazza indipendenza 11, 50129 Firenze, Italy The wide spectrum of clinical presentations of textile dermatitis includes unusual patterns and atypical localization [1]. These cases may be difficult to diagnose, especially when clinical features [...]

Allergic contact dermatitis from 2‐ethylhexyl acrylate contained in a wig‐fixing adhesive tape and its ‘incidental’ therapeutic effect on alopecia areata

(Meth)acrylates are a relatively uncommon cause of occupational and non-occupational allergic contact dermatitis (ACD) (1), being used mostly in artificial nails, bone cement, dentalmaterial, and adhesives. Among the many (meth)acrylates known to cause ACD, the most frequently involved are ethylene glycol dimethacrylate, 2-hydroxyethyl methacrylate, and 2-hydroxypropyl acrylate (1–4). We report here a case of ACD from acrylates with previously unreported contact modality and causative allergen.

First case of Mycobacterium haemophilum infection in an AIDS patient in Italy.

Mycobacterium haemophilum, a strongly acid‐ and alcohol‐fast bacillus belonging to the group of non‐tuberculous mycobacteria was first described in 1978 as the cause of cutaneous ulcerating lesions in a woman with Hodgkins disease. Infection due to M. haemophilum is rare but increasing in prevalence in immnunosuppressed subjects, particularly in patients with acquired immunodeficiency syndrome (AIDS) patients. The skin is the most common site of infection with erythematous or violaceous papules and/or nodules that are usually painless at first, but some elements develop into abscesses or ulcers that can become very painful. The incidence of M. haemophilum is unknown, but cases of infection have been reported in Australia, Canada, the United States, France, Israel, the United Kingdom and Taiwan; to date no cases have been reported in Italy, thus the case reported here is apparently the first one observed in our country.

Prevention of allergic contact dermatitis with alternative products

In ACD from footwear, sensitization to chromium salts used in tanning is one of the most frequent causes. The alternative is leather (alternative Leather, AL) produced with vegetable tannins. The absence of chromium in AL provided by its manufacturer was checked by colorimetry and atomic absorption spectrophotometry; a series of tests (2) established (i) humidity, organic and inorganic substances; (ii) good resistance to traction, but decreased elasticity and waterproofing; (iii) lack of colour fastness to damp without seeping through. 12 patients sensitized to potassium dichromate and with ACD from leather shoes, who had used footwear made withAL (on average 5 days per week for 3-12 months), volunteered (without treatment): (a) considerable (8/ 12) or slight (4112) improvement clinically; (b) judgement on esthetic value, fit and protection as good-average in over ! the cases. All patients intended to continue wearing AL footwear.

Evaporimetiy in the differentiation of allergic, irritant and doubtful patch test reactions.

Background/aims: The aim is to evaluate, using evaporimetry, the possibility of getting further information supporting clinical reading of allergic, irritant reactions and doubtful patch test reactions.