Stefano Caraffini

Erythema-multiforme-like contact dermatitis from budesonide

Case Reports Case no. 1 A 19-year-old non-atopic girl with acne, with allergic contact dermatitis of the face and hands from benzoyl peroxide, was treated with 0.1% budesonide ointment (Preferid® lipocrema) 2Xdaily. After 5 days, she showed a fresh outbreak oflesions and an erythema-multiformelike eruption on the hands, forearms and face. Patch and prick tests with the allergens listed in Table 1 showed delayed-type positive reactions to budesonide and triamicinolone acetonide. After suspension of the topical corticosteroid, the dermatitis quickly improved without further treatment.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Skin tests in the diagnosis of eruptions caused by betalactams

The aetiologic evaluation of adverse cutaneous reactions to penicillins is still not an easy problem to solve. Skin testing is usually earned out intradermally with benzylpenicilloyl polylysine (BPO‐PPL) and minor determinant mixture (MDM), but these are often unsuitable for the detection of sensitivity to betalactam antibiotics. 101 selected subjects, with different cutaneous reactions to betalactams and with a clinical history of positive challenge, were skin tested (patch lest, prick test, intradermal test) with a standard betalactam series (amoxycillin, sodium penicillin G, ampicillin, bacampicillin, aztreonam, ceftriazone, BPO‐PPL, MDM). 1 or more positive reactions to skin tests, mainly to intradermal tests, were observed in 47.5% of the subjects studied, especially in those with maculopapular eruptions, urticaria/angioedema and drug reactions caused by ampicillin and amoxycillin. Cross‐sensitivity was demonstrated in 22.8% of cases and was due almost solely to the semi synthetic penicillin. Finally, to increase the yield in detecting positive patients, it is necessary that ampicillin and amoxycillin be tested in addition to major and minor determinants.

Maculopapular and urticarial eruption from cetirizine

Discussion Rosemary is a plant commonly used as a spice, flavouring agent and naturally-occurring antioxidant (I). It has also been used for its medical properties. There have been reports of the inhibition of carcinogenesis by rosemary and its constituents ( 1, 2). Because of its anti-inflammatory properties, it has been used on local injuries. Contact dermatitis due to plants applied topically for Contact Dermatitis 1997: 37: 249

Drug reaction with eosinophilia and systemic symptoms syndrome caused by an everolimus-eluting stent

cant sunburn in infancy) and had Fitzpatrick phototype IV skin. Moreover, he did not show phenotypic abnormalities associated with familial BCC syndromes, such as palmar or plantar pits, jaw cysts, rib anomalies on x-ray, calcification of the falx cerebri, or other anomalies. Given this clinical picture, we asked the patient about his family medical history. He did not remember if his parents had exhibited any similar lesions. However, the patient had a 50-year-old daughter who demonstrated a pigmented and superficial BCC on her left shoulder, similar to those of her father, and did not have photo damaged skin or any history of risk factors. Although BCC is the most common skin cancer, patients are usually affected by one or a small number of concurrent or subsequent lesions over time. Ultraviolet radiation is the main risk factor for BCC, thus sunexposed locations are most frequently affected. According to a study of a series of BCCs reported by Robinson, the risk for developing a second BCC was 22% in the first year and 36% in the fifth year, whereas the risk for developing between five and 10 lesions over five years was 2%. Furthermore, risk for recurrence was statistically associated with having Fitzpatrick skin type I or II. Moreover, the occurrence of pigmented BCC is rare in Caucasian populations. Robinson reported that among 1039 BCCs, only 70 (6.7%) were pigmented. All of these data support our initial conclusion that we were witnessing an unusual case which was difficult to explain simply by the action of external risk factors. Happle uses the term multiple non-syndromic basal cell carcinoma to describe clinical pictures characterized by multiple BCCs that cannot be explained by the action of external risk factors or by classical BCC-associated syndromes. Moreover, it should be noted that our patient presented with multiple BCCs of a superficial type. This feature seems to be characteristic of this entity as it has been described in other cases. The genetic character of these clinical findings is supported by the existence of familial occurrence or mosaic manifestations. This suspicion, which is based on clinical observation, seems to be supported by a study reported by Naderi, who analyzed two members of a family with non-syndromic BCCs. He found a microdeletion of chromosome 22q11.1 within a region of ~ 14.5 Mb without changes on 9q22.3 (PTCH1) or 1p33~p34 (PTCH2). We do not know if all of the cases reported demonstrated these genetic changes; however, this study suggests that cases of BCC caused by genetic susceptibility without phenotypic syndrome associations do occur. In conclusion, we present an unusual case of multiple superficial and pigmented BCC not associated with any risk factors or with any phenotypic features that might explain this high incidence of tumors. It is possible that easier access to genetic screening tests in the future will reveal different alterations in chromosomes that might explain susceptibility to the development of these tumors. It might also become possible to distinguish more precisely among similar clinical pictures. At a practical level, knowledge of hereditary genetic potential could possibly strengthen the health education of a patient’s descendants (such as about their condition and sun exposure habits), but this would require close monitoring of the patient and his or her descendants.