职业性皮肤病

三氯乙烯药疹样皮炎患者继发感染菌谱及药敏分析,三氯乙烯药疹样皮炎患者肝损害的B超影像学研究,三氯乙烯中毒引起皮疹的临床观察,广东中山地区职业性皮肤病1668例临床分析.     

职业性皮肤病

20 0 30 2 6 5　三氯乙烯药疹样皮炎患者的染色体检查 /梁丽燕 (广东省职业病防治院 )…∥中国职业医学 .- 2 0 0 2 ,2 9(3) .- 2 0～ 2 22 0 0 30 2 6 6　三氯乙烯药疹样皮炎代谢酶基因多态性的病例对照研究 /李来玉 (广东省职业病防治院 )…∥中国职业医学 .- 2 0 0 2 ,2 9(3) .- 4～ 82 0 0 30 2 6 7　职业性三氯乙烯药疹样皮炎的预防措施研究 /李来玉 (广东省职业病防治院 )…∥中国职业医学 .- 2 0 0 2 ,2 9(3) .- 452 0 0 30 2 6 8　避免职业性三氯乙烯致药疹样皮炎误诊应注意的问题 /华明 (广东中毒急救中心 )…∥中国职业医学 .- 2 …     

三氯乙烯药疹样皮炎1例

目的：报告1例三氯乙烯药疹样皮炎并探讨三氯乙烯药疹样皮炎在诊断、鉴别诊断及治疗方面的注意事项。方法：回顾分析2007年12月在我科住院的1例三氯乙烯药疹样皮炎患者的病史、临床表现、实验室检查及治疗情况并复习相关文献。结果：根据患者三氯乙烯职业接触史，有发热、淋巴结肿大、多形红斑样皮损、肝损、尿三氯乙酸明显升高，职业性三氯乙烯药疹样皮炎诊断明确；患者出现皮疹2天后有咳嗽咳痰、肺部湿哕音、胸片及痰培养异常，可确诊早期合并肺部感染。结论：多形红斑患者要注意职业接触史的询问，以免漏诊。     

职业性三氯乙烯药疹样皮炎

职业性三氯乙烯药疹样皮炎因其低发病率、高致死率以及严重的皮肤及肝功能损害,已经成为我国危重职业病之一。我国卫生部于2006年发布了《职业性三氯乙烯药疹样皮炎诊断标准》,将其定义为以急性皮肤炎症反应为表现的、全身性变应性疾病。本文根据近年对该病的研究进展进行综述。     

职业性皮肤病

20042905　职业性三氯乙烯药疹样皮炎患者血清肝纤维化指标的研究/杨爱初(广东省职业病防治院)…//中国职业医学.-2004,31(2).-35～37对28名三氯乙烯药疹样皮炎及16例对照组进行放射免疫法检测透明质酸(HA)、层粘连蛋白(LN)、III型前胶原(PCIII)、IV型胶原(C-IV)、甘胆酸(CG)的水平。结果肝损害指标HA、PCIII,C-IV,CG在三氯乙烯药疹样皮炎患者明显增高(P<0.05),与一些肝功能等肝损害指标有良好的相关性。因此,HA,PCIII,C-IV,CG检测可作为三氯乙烯药疹样皮炎患者肝损害程度的评价指标。患者皮肤病变的严重程度与肝损害后肝…     

职业性皮肤病

三氯生亚急性经口毒性的研究；乡镇煤矿工人生产环境与其皮肤病的相关性调查；N-羟基邻苯二甲酰亚胺致药疹样皮炎五例；职业性急性三氯乙烯中毒误诊为剥脱性皮炎型药疹一例；1例1-氯二甲基萘致药疹样皮炎和肝脏损害报告；     

职业性皮肤病

亚急性砷中毒三例;燃煤污染型砷中毒皮肤病变调查;人类白细胞抗原DRB1基因多态性与三氯乙烯药疹样皮炎易感性的关系;三氯乙烯药疹样皮炎患血清IgG、lgA和IgM水平的观察;三氯乙烯（TCE）药疹样皮炎患外周血变化的观察……[第一段]     

职业性三氯乙烯药疹样皮炎

三氯乙烯为无色、透明、易流动、不燃烧、易挥发、具有芳香味的有毒液体,是工业常用溶剂,被广泛用作金属表面处理剂、电镀、上漆前的清洁剂、金属脱脂剂和脂肪、油、石蜡的萃取剂。三氯乙烯还是医用麻醉剂,对神经系统有麻醉作用。在我国传统的三氯乙烯使用领域主要为电子、电镀清洗行业以及农药和制药中间体合成,近年来也开始用于新型制冷剂的合成。Schwartz等［１］于1947年首次描述三氯乙烯相关的皮炎：三氯乙烯是一种致敏剂,并且能够引起程度不同的急性泛发性湿疹样皮炎,开始表现为红斑,接着出现丘疹以及水疱,同时伴有渗出、结痂、脱屑,多数伴有内脏和黏膜损害。报告病例均类似于药疹,特别是重症药疹,国内文献多称之为三氯乙烯药疹样皮炎。由于多数情况下本病与三氯乙烯的职业暴露有关,本病也经常被称为职业性三氯乙烯药疹样皮炎（occupational medicamentosa-like dermatitis induced by trichloroethylene,OMDT）［2］。本病的本质是三氯乙烯吸入后发生的系统性接触性皮炎［3］……     

肿瘤坏死因子拮抗剂治疗重症三氯乙烯药疹样皮炎

【摘要】 目的 观察肿瘤坏死因子拮抗剂在重症三氯乙烯药疹样皮炎治疗中的作用。 方法 5例以皮疹、发热、浅表淋巴结肿大和肝、肾损害为主要表现的重症三氯乙烯药疹样皮炎患者,在判断无肿瘤、结核及重症感染后,3例采用肿瘤坏死因子拮抗剂25 mg皮下注射,每周2次,联合糖皮质激素治疗;2例单独使用肿瘤坏死因子拮抗剂治疗。 结果 肿瘤坏死因子拮抗剂联合糖皮质激素治疗的3例患者体温在1周内降至正常,住院期间未发生感染、急性肝功能衰竭等,出院时皮疹消退,口腔、外阴等黏膜恢复正常,肝肾功能正常,平均住院时间36 d。单独使用肿瘤坏死因子拮抗剂的2例患者均治愈,临床疗效与联合糖皮质激素治疗的患者无明显差别,治疗后28周测得血清肿瘤坏死因子α水平降至正常。 结论 在重症三氯乙烯药疹样皮炎的治疗过程中尽早、足量使用肿瘤坏死因子拮抗剂有益于快速控制病情。     

职业性皮肤病

20090160三氯乙烯药疹样皮炎临床皮肤病理研究;20090161东莞市2002～2007年三氯乙烯职业损害分析;     

Flagellate Dermatitis as a Bleomycin-Specific Adverse Effect of Cytostatic Therapy

In oncology, bleomycin is a frequently used drug for the treatment of several malignancies. In particular, it is part of chemotherapy protocols in testicular cancer. We report on two patients with testicular cancer who received bleomycin-including chemotherapy and developed flagellate dermatitis. This is a typical adverse effect of bleomycin therapy; however, its pathophysiology has not yet been clarified. We discuss possible pathophysiologic mechanisms for this reaction. In general, it has been postulated that histopathologic findings in flagellate dermatitis share similarities with those observed in fixed drug eruptions. In fact, published cases in the literature have shown a broad variety of histologic changes and the histopathologic investigation of our two patients was not indicative of fixed drug eruption-like changes. Histology of one patient showed a superficial and deep, perivascular and periadnexal infiltrate of lymphocytes and eosinophils with a prominent perisudoral distribution, whereas the other patient was remarkable only for the presence of a rather sparse, superficial, perivascular lymphocytic infiltrate with occasional eosinophils and a few melanophages. Epidermal changes, in particular necrotic keratinocytes, were not present in either patient. We provide an overview of all reported histologic changes in bleomycin-induced flagellate dermatitis, including our experience with two patients. Based on these data, we present a summary of the clinical and histologic features.     

Patch testing in cutaneous reactions caused by carbamazepine

The usefulness of patch testing in the diagnosis of carbamazepine-induced allergic skin eruptions was studied in 18 patients with previous histories of skin eruptions caused by carbamazepine. The etiological role of carbamazepine was ascertained by peroral or topical provocation in 15 (out of 18) patients. The clinical reactions caused by the drug were classified as maculopapular exanthema with general symptoms (7 patients), other type of exanthema (3). exfoliative dermatitis (erythroderma) (3), fixed drug eruption (3), erythema multiforme (1) and urticaria (1). Patch testing showed positive reactions to carbamazepine in 7 patients; in addition. 2 patients had doubtful reactions. Positive patch test reactions were seen only in patients with exfoliative dermatitis (all 3 patients) and maculopapular exanthema (4 out of 7). None of the patients with fixed drug eruption, erythema multiforme or urticaria, or the control subjects, had positive patch test reactions 10 carbamazepine. The present study suggests that patch testing is useful in the diagnosis of carbamazepine allergy in patients with maculopapular eruptions or erythrodermas.     

PICC置管术后透明敷料贴敷致接触性皮炎资料分析

目的：明确972例恶性肿瘤患者置入PICC置管术后因透明敷料所致接触性皮炎的发生率和危险因素。方法：对恶性肿瘤置入PICC导管后因透明敷料所致接触性皮炎患者的性别、年龄、体重指数、cTNM分期、药物过敏史、肿瘤类型、嗜酸性粒细胞和嗜碱性粒细胞水平等可能影响接触性皮炎发生的危险因素进行单因素和多因素分析。结果：972例置入PICC导管肿瘤患者中,有80例接触性皮炎（男21例,女59例）,发生率为8.23％;单因素分析显示,嗜酸性粒细胞水平、睡眠状态、体重指数、药物过敏史与接触性皮炎发生有关（P＜0.05）;多因素分析显示,失眠、肥胖、药物过敏史是接触性皮炎的独立危险因素（P＜0.001）。结论：PICC置管术后因透明敷料所致的相关接触性皮炎的发生率较高。失眠、肥胖、药物过敏史是PICC置管术后透明敷料所致接触性皮炎的独立危险因素。     

An Epidemiologic Study of Perianal Dermatitis Among Children in Egypt

Abstract: Perianal dermatitis is a common problem occurring among infants and children. Streptococci, particularly β-hemolytic group A organisms, play a major role in its causation. An epidemiologic association between perianal dermatitis caused by group A β chemolytic streptococci in some patients and pharyngeal colonization with the same organisms seems to exist. A similar relation is also true for other organisms, including non-group A β-hemolytic streptococci and Staphylococcus aureus. This was the main conclusion of a hospital-based study performed on 150 children with perianal dermatitis. All patients were subjected to a questionnaire, clinical examination, two perianal cswabs, and two throat swabs. The bacterlologic examination of the perianal swabs revealed the presence of β-hemolytic streptococci in 35.3% of the cases, half of which were of the group A β-hemolytic strain (17.3%) and half of which were nongroup A (18%). Throat swabs revealed the presence of β-hemolytic streptococci In 44% of cases, half of which were found to belong to group A (21.3%) and half to non group A (22.7%). Among patients with perianal dermatitis caused by group A β-hemolytic streptococci, 53.8% had associated pharyngeal colonization by the same organism. S. aureus was isolated from the perianal skin in five patients (3.4%); in four of whom the same organism also grew in cultures from throat swabs. A relatively good association between pharyngeal colonization by β-hemolytic streptococci and Staphylococci and the presence of perianal dermatitis caused by the same organisms was demonstrated using the Kappa test of agreement ( K = 0.4)     

Hypersensitivity syndrome due to trichloroethylene exposure: a severe generalized skin reaction resembling drug-induced hypersensitivity syndrome

The number of patients suffering from trichloroethylene (TCE)-related severe skin disorders with liver dysfunction has been increasing in developing countries in Asia, especially since the mid-1990s. In Japan, five cases of this disease have been reported, but none since the 1990s. However, two additional cases were recently observed in Tokyo. The published work and our investigation indicated that oxidative metabolites of TCE, which might include trichloroacetylated-protein adducts, could induce a generalized skin eruption. Furthermore, human leukocyte antigen (HLA)-B*1301 and HLA-B*44 were identified as markers of individual susceptibility to TCE-induced hypersensitivity syndrome (HS). Moreover, polymorphism of aldehyde dehydrogenase (ALDH), the major enzyme in TCE metabolism, appeared to be associated with TCE-induced HS. Interestingly, this disorder is quite similar to drug-induced hypersensitivity syndrome (DIHS), also referred to as drug rash with eosinophilia and systemic symptoms (DRESS), from the perspective of the onset of the reaction after exposure to TCE/drugs, clinical manifestations, blood examination and period of virus reactivation. This article reviews the similarity between TCE-related HS and DIHS/DRESS.     

79例重症药疹病例临床回顾

分析我院皮肤科1993－1999年间住院重症药疹病例79例,其中大疱表皮坏死松解型药疹37例,重症多形红斑型药疹26例,剥脱性皮炎型药疹16例,死亡12例。解热镇痛药在致敏药物中占首位,其他依次为青霉素类,头孢菌素类,别嘌呤醇、卡马西平、磺胺药,中药,不明种类药物,痢特灵和鲁米那。死亡率以剥脱性皮炎型最高,大疱表皮坏死松解型次之,重症多形红斑型最低。死亡患者至少有3个以上脏器累及。因此认为患者年龄、药疹类型、从发病到正规足量皮质类固醇治疗的时间以及内脏累及的多少决定患者的预后;解热镇痛药、别嘌醇以及卡马西平等药物的应用应谨慎。     

Allergic contact dermatitis caused by sodium metabisulfite: a challenging allergen. A case series and literature review

Background. Sulfites, preservatives and antioxidants used in the cosmetic, pharmaceutical and food industry are contact allergens whose relevance seems to be difficult to establish. Objectives. To perform a retrospective study on patients patch tested with a sulfite. Materials and methods. Between 1990 and 2010, 2763 patients were patch tested with sodium metabisulfite. The reactions were considered to be relevant if there was a clear relationship between the dermatitis and sulfite exposure. Results. One hundred and twenty‐four (4.5%) of 2763 patients patch tested positively to sodium metabisulfite. The most frequent localizations of the lesions were the face (40.3%) and the hands (24.2%). Six patients also reported systemic symptoms. Thirteen cases (10.5%) were occupational, 10 of them presenting with hand eczema. Sodium metabisulfite was the single allergen found in 76 cases (61.3%). The reactions were considered to be relevant in 80 cases (64.5%), of which 11 were occupational. Conclusions. Allergic contact dermatitis caused by sulfites is frequent and often relevant. One should be aware of possible relevant sources of exposure, particularly in occupational settings such as hairdressing and the food industry, and in pharmaceutical and cosmetic products. Patch testing with sodium metabisulfite, which seems to be the best indicator for sulfite contact allergy, is also useful in cases of immediate reactions to sulfite‐containing products.     

Experience with a gluten free diet in the treatment of linear IgA disease

A study was undertaken to determine whether the skin eruption of linear IgA disease (LAD) was gluten dependent. Six patients with LAD were treated with a gluten free diet (GFD) for an average period of 33 months (range 19-48). Although one patient with LAD had an enteropathy which was clearly gluten sensitive, there was no convincing evidence that the rash of any of the patients responded to a GFD. Four of the six patients showed no significant alteration in their drug requirements. The remaining 2 patients showed a fall in minimum drug requirement but there was no increase after gluten challenge indicating that they were entering spontaneous remission. This contrasts to the situation in dermatitis herpetiformis, where both the rash and the enteropathy are gluten dependent. These data add further to the evidence that LAD and dermatitis herpetiformis are separate entities.     

Propolis-induced contact allergy

Six patients with contact dermatitis to propolis are reported (3 women, 3 men; mean age 57 years). All three men had eczema on their hands and had acquired their sensitization in the course of bee keeping. The women had been sensitized by propolis contained in ointments of various kinds. Upon patch testing all six patients reacted to propolis and four also to Peruvian balsam. While ten flavonoids were test-negative, a cinnamic acid ester (1.1-dimethylallyl-3',4'-dihydroxy cinnamic acid ester) isolated both from propolis and from poplar buds was positive in two out of three patients; this may be the major allergen.     

Cyclosporin A in the treatment of severe allergic contact dermatitis

Background Allergic contact dermatitis is sometimes difficult to treat because the patients are unable to effect prevention. Contact dermatitis can then become chronic and progressive, posing serious therapeutic problems. Patients and Method Fifteen patients with severe allergic contact dermatitis were treated with cyclosporin A (CyA). All patients were polysensitized and unable to avoid with haptens for socioeconomic reasons. The drug was given orally at a dose of 5 mg/kg/day for 4 weeks followed by 3 mg/kg/day for a further 2 months. In three patients the treatment was continued for a further period of 60 days at 2 mg/kg/day. Results All patients responded well to the therapy and no side effects were observed. The manifestations of acute inflammation improved rapidly, whereas the signs of chronic reaction took longer to regress. At the end of treatment some subjects remained without lesions for up 6 months while others relapsed with mild forms. The recurrent dermatitis responded to a further cycle of CyA. Patch test reactions were only slightly modified after 30 days of treatment. Conclusion Our results qualify CyA as a new drug for the treatment of allergic contact dermatitis. It cannot be regarded as the elective treatment but it can be extremely useful in chronic and severe cases.