William P. Jordan

Clinical effects of diaper types on the skin of normal infants and infants with atopic dermatitis.

Cloth diapers, cellulose core diapers (conventional disposable diapers), and cellulose core diapers containing absorbent gelling material were examined for their effects on diaper rash and skin microbiology of normal infants and infants with atopic dermatitis in a 26-week double-blind clinical trial. Infants with atopic dermatitis wearing the diapers containing absorbent gelling material had significantly lower diaper rash grades than infants with atopic dermatitis wearing cloth diapers at five of eight grading visits. Infants with atopic dermatitis wearing conventional cellulose core diapers had statistically less rash at one of eight visits. There was no statistically significant difference between diaper types at three of the eight visits. At no time did the cloth group have less diaper rash than the conventional cellulose or absorbent gelling material disposable diaper group. A statistical correlation between the severity of general atopic dermatitis outside the diaper area and the diaper rash condition under the diaper occurred only in the atopic dermatitis group wearing cloth diapers. Isolation of microorganisms from the intact, uninvolved skin surface both inside and outside the diaper showed no biologically significant changes in the presence or numbers of selected skin organisms. Repeated isolation, at multiple grading visits of Staphylococcus aureus from uncompromised skin inside the diaper area was infrequent but correlated with the diagnosis of atopic dermatitis when observed.

Threshold responses in formaldehyde-sensitive subjects

Patch tests with three low concentrations of formaldehyde were applied continuously in formaldehyde-sensitive subjects for 1 wk. The closed patch test method produced a response to 30 parts per million (ppm) in some subjects by 120 continuous hours of testing. Thirteen subjects then sprayed a 30-ppm formaldehyde solution in an axilla on a double-blind, controlled, 2-wk-use test. Their responses to 30 ppm aqueous formaldehyde indicate that levels below this concentration should be tolerated by sensitive subjects if repeatedly applied to normal skin. Popular formaldehyde-releasing preservatives can be above or below this threshold-eliciting response.

Cross-sensitization patterns in acrylate allergies.

Five subjects developed allergic contact dermatitis to one or more acrylate components used in a commercial adhesive tape. Patch testing to acrylic monomers was performed to examine their cross‐reaction patterns. Two subjects with broad cross‐reactions to acrylates did not react to methyl methacrylate or the alkyl methacrylate that corresponded to the acrylate which induced the sensitization. Methyl methacrylate may not be adequate as a screen for many acrylates used commercially.

Nickel feeding in nickel-sensitive patients with hand eczema

Ten women with vesicular hand eczema and delayed hypersensitivity to nickel were given 0.5 mg nickel supplements to their diets. The double-blind controlled supplements were given on Monday and Tuesday of each week for at least 1 month. The nickel supplement was lower than that used in previous studies, and only one subject had reproducible flaring of her vesicular dermatitis. We conclude that dietary restriction of nickel is not warranted based on nickel supplement studies, but nickels role in hand eczema could be clarified by depleting nickel from body stores with chelating agents.

Long-term modified Goeckerman regimen for psoriasis using an ultraviolet B light source in the home

An ultraviolet B (UVB) unit for the home was built for each of fifty-six people with extensive psoriasis. This light unit is constructed to deliver the most cost-effective radiation while remaining portable, height-adjustable, and free of the necessity to nail or screw the unit to the wall. Six 40-watt fluorescent sunlamps in an open configuration will deliver 150 to 170 mu watts/cm2 to one half of the body at a distance of 30.5 cm (1 minimal erythema dose [MED] = 1-2 min). Fifty-five patients completed a modified Goeckerman program starting at 1-minute exposures, with weekly increases of light by 1 minute until 6 or 8 weeks of treatment had elapsed. All patients were cleared of psoriasis (scalp not included). Fifty-one patients accomplished the clearance program totally in the home. Over 80% of them remain virtually clear as they have maintained a 6- to 8-minute tar-light program two to five times a week. Thirty-seven subjects have used this home UVB unit for over a year. Our results with the modified Goeckerman treatment of psoriasis in the home show that: (1) only six nonenclosed lamps are needed for the economical clearing and maintenance of many psoriatics, and (2) the initial clearing rate using forty-two to sixty suberythemal treatments is outstanding.

Allergic contact dermatitis to All‐trans‐retinoic acid; epicutaneous and leukocyte migration inhibition testing

Two male prison volunteers had severe cutaneous reactions to the initial patch testing of All‐trans‐retinoic acid containing products being evaluated for irritancy. Multiple patch testing procedures performed throughout one year, along with leukocyte migration inhibition studies, speak strongly for delayed hypersensitivity reactions in these subjects. The failure to document a previous exposure in subjects living in a controlled environment suggests that these responses were cross‐reactions to a prior sensitizer, perhaps unique to this environment.

Reproducibility of Patch Tests: A United States Multicenter Study

The reproducibility of patch tests using allergens dispersed in petrolatum or water and placed into Finn chambers (Epitest Ltd, Oy, Hyryla, Finland) was studied in a double-blind fashion. A total of 128 patients were tested concomitantly to three different lots of an allergen to which they previousl

Human Studies That Determine the Sensitizing Potential of Haptens: Experimental Allergic Contact Dermatitis

Human experimental sensitization studies have evolved over 40 years to reduce the chance of consumers’ experiencing allergic contact dermatitis from commercial products. This article reviews the changes in test methods over the years and discusses important variables in the test that can be overlooked. The most important variable, concentration of the test material, is the most important feature of experimental sensitization studies and is often ignored by suppliers of raw material to manufacturers.

Effect of coadministration of corticosteroids on the development of contact sensitization

BACKGROUND Transdermal administration of drugs can increase patient compliance and reduce side effects, but it can also cause contact sensitization. Corticosteroids frequently are used to suppress the local immune response; however, their use as a pretreatment for transdermal system application sites is not practical. OBJECTIVE Our purpose was to determine the feasibility of suppressing contact sensitization by delivering a corticosteroid with the transdermal delivery systems. METHODS Materials were applied continuously for 3 weeks to the same (protocol SS) or different (protocol AS) skin sites. Skin flux and appearance of sensitization were determined. RESULTS Coadministration of hydrocortisone reduced the incidence of sensitization by d-chlorpheniramine and benzoyl peroxide from 45% to 7.5% and from 20% to 2.3%, respectively, under protocol SS. Under protocol AS, sensitization by d-chlorpheniramine was reduced from 15% to 1%. Frequent exposure to the sensitizer plus corticosteroid induced tolerance to the sensitizer. CONCLUSION Sensitization by moderately immunogenic drugs after any length of exposure may be reduced to acceptable levels by the coadministration of hydrocortisone.

Postsorters' rubber fingerstall dermatitis

An outbreak of rubber fingerstall dermatitis in a Danish post office was found to be caused by minute amounts of isopropylphenyl‐para‐phenylenediamine (IPPD) in the fingerstalls. The presence of IPPD in the fingerstalls could not be explained by the manufacturer and had to be confirmed by gas chromatographic analysis.