William F. Schorr

Prospective study of cosmetic reactions: 1977-1980

This prospective study (1977-1980) of cosmetic adverse reactions by eleven dermatologists identified 487 cases of cosmetic-induced dermatitis. Approximately half of the cases were covert in nature. Eighty percent were due to allergic contact dermatitis; the face, eye, and upper arm were the most involved sites. Skin care products, hair preparations (including colors), and facial makeup products were the most commonly involved product categories. Fragrances, preservatives, lanolin and lanolin derivatives, p -phenylenediamine, and propylene glycol were the most commonly identified causative agents. The data may not be representative of the country at large because of the special interests of the dermatologists involved.

Concomitant positive patch test results with standard screening tray in North America 1985–1989

Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross‐sensitization such as between para‐phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the “angry back syndrome”. This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.

Relapsing Polychondritis: Unusual Neurological Findings and Therapeutic Efficacy of Dapsone

Relapsing polychondritis is a rare disease of undetermined cause. The most frequently seen symptom is redness and swelling of the cartilaginous ear, followed by cartilage inflammation elsewhere in the body. Our five cases had neurologic symptoms that posed diagnostic difficulties. Because vasculitis is not uncommon in relapsing polychondritis, it was difficult to determine whether these neurologic symptoms were attributable to relapsing polychondritis or to other unrelated causes. In our cases, specific neurologic complaints were caused by a concomitant but unrelated disease, rather than by relapsing polychondritis. We add five additional documented cases to the medical literature and confirm the therapeutic efficacy of dapsone in the treatment of this unusual disease.

multivariate Analysis of the Effect of Selected Factors on the Elicitation of Patch Test Response to 28 Common Environmental Contactants in North America

Standardized patch tests were performed on 3,974 patients between August 1, 1985 and July 31, 1989. Significant determinants of positive responses based on previously reported bivariate analysis of response were entered into a logistic regression model; the contribution of each factor to response to each of 27 test substances with which the patients were tested was evaluated. For 14 test substances, age increased the odds of response; nickel was striking in that increasing age decreased the odds of a positive response. Specific contactants were found to be associated with gender and topographical location of the eczematous dermatitis leading to the application of the patch tests. Atopic dermatitis was associated with a lower odds of response toP-phenylenediamine, but in no instance was associated with increased odds of a positive response.

Tobramycin-neomycin cross-sensitivity

Fifty normal control volunteers were patch tested to 20% neomycin as well as tobramycin 1%, 10%, 20% and 30% in white petrolatum. Tobramycin is a new aminoglycoside antibiotic for prescription Ophthalmologic use in the United States.

Cutaneous manifestations and differential diagnosis of the deep mycoses.

Four major morphologic categories of cutaneous lesions representing deep mycoses are considered: the verrucous plaque, the chancriform syndrome, the mycetoma-type lesion, and the subcutaneous abscess with or without ulceration. Each should bring to mind a definite group of diagnostic possibilities. Representative diseases are illustrated, and fine points in differentiation are presented.

Urticaria: diagnostic work-up and management.

One aspect of management of urticaria noteworthy for its lack of value is extensive scratch testing. Some 10 to 20 percent of cases of hives are thought to be emotional in origin. Recognized causes include drugs (chiefly penicillin and aspirin), foods, insect stings, inhalants, cold, heat, sunlight, pressure and water. Recent studies suggest that candidal organisms and food yeasts may be important in 20 percent of cases of chronic urticaria. Rarely, urticaria is inherited.