Stefano Francalanci

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.

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.

Occupational contact dermatitis in 2 dental technicians.

2 dental technicians, both with chronic hand eczema, reported worsening from the use of 2 products containing methyl methacrylate, employed in manufacturing acryline prostheses. Patch tests in both patients gave positive reactions in methyl methacrylate, ethylene glycol dimethacrylate and products employed in manufacturing acrylic prostheses (2% and 5% pet.). On the basis of results subsequently obtained from patch tests carried out with pieces of glove interposed between the skin and the allergens (methyl methacrylate and products employed), we advised our patients still to use latex gloves during work. Follow‐up after 1 year showed complete regression of the dermatitis in I case and considerable improvement in the other.

Photopatch tests: an Italian multicentre study from 2004 to 2006

Background:  Evaluation of possible photoallergic contact dermatitis in at‐risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used.

Effectiveness of disperse dyes mix in detection of contact allergy to textile dyes: an Italian multicentre study

S. FRANCALANCI 1, G. ANGELINI2, N. BALAT02, E. BERARDESCA2, F. CusAN02, G. GADDONI2, P. Lrsr2, A. Lom, D. SCHENA2 AND A. SERTOLI 1 1U. 0. Autonoma Universitaria di Allergologia Dermatologica Professionale e Ambientale, Istituto de Clinica Dermatologica, Universita di Firenze, Via Alfani 37, 50121 Firenze, Italy 2GIRDCA Multicentre Study Group (Bari, Napoli, Pavia, Benevento, Faenza, Perugia, Milano, Verona)

Skin tests with fresh foods.

Benzoyl peroxide is a potent oxidizing agent widely used both as a topical medicament and as a curing agent in resin synthesis. Although allergic contact dermatitis due to benzoyl peroxide in orthopedic prostheses has not previously been fully documented, the patch test results indicate that this curing agent was the sensitizer of our patient. Jager & Balda (11) reported a 62-year-old patient with a total hip prosthesis who developed recurrent sterile fistulae and loosening of the prosthesis. Patch tests showed a positive reaction to benzoyl peroxide and contact allergy to benzoyl peroxide was suspected as the cause of the implant reaction. The positive patch test to quinolines resulted from the repeated application of topical medicaments containing chlorquinaldol as an active ingredient. Allergic contact dermatitis from topical medicaments is enhanced by trophic skin changes accompanying injured skin. The sensitive skin of leg ulcers is a· typical example. The skin at the site of amputations mimics this sensitivity and is likewise easily damaged.

Patch test triggering recurrence of distant dermatitis: the flare-up phenomenon.

A 37-year-old woman presented with a pruritic, vesiculobullous eruption on her neck in the region of an ebony pendant. Acute allergic contact dermatitis was suspected and treated with oral prednisone and hydroxyzine ([Figure 1][1]A and Figure 1B). Two months later, we performed a patch test on her

Multiple physical urticarias

Physical urticarias are a group of mucocutaneous disorders characterised by the appearance of whealing and/or angioedema and induced by physical stimuli. A 24-year-old Caucasian male affected by ultraviolet A-induced solar urticaria, specific food-dependent exercise-induced anaphylaxis, symptomatic dermographism and allergic rhinoconjunctivitis is described.

Allergic and photoallergic conditions from unusual chlorpromazine exposure: report of three cases

‘‘Chronic Actinic Dermatitis’’ is an umbrella designation used to refer to a group of linked disorders, namely persistent light reaction (PLR) and photosensitivity dermatitis. They are chronic eczematous dermatoses characterized by an extreme photosensitivity (UVB, UVA, visible light), which tends to persist without apparent continuing chemical exposure and sometimes evolve into a pseudolymphoma, that is, actinic reticuloid. Chlorpromazine and other related tranquilizers are commonly used to treat psychotic disorders. These drugs may be responsible for contact sensitization and photosensitization, in the form of both phototoxicity and photoallergy, through the production of stable-free radicals or chemical modification of biological macromolecules. Herein, we describe three cases of chlorpromazinerelated allergic conditions, ranging from allergic contact dermatitis and PLR even to actinic reticuloid. We assume in these cases a way of hapten exposure that should be noticed for its peculiarity.

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.