Irritant contact dermatitis secondary to fiberglass: an unusual presentation

37‐year‐old white man presented with a 4‐day history of an intensely pruritic eruption on both forearms. The symptoms began immediately after crawling over fiberglass insulation in his attic. The patient had been wearing long pants and a short‐sleeved shirt, exposing his forearms to the insulation. By the third day, pustules had begun to form on both arms. Physical examination revealed multiple erythematous pustules on both forearms Scrapings from a pustule dissolved in 10% potassium hydroxide revealed numerous rectangular refractile crystals which were easily visualized under polarized light ( Fig. 2 ). A Gram stain of a pustule revealed numerous neutrophils and Gram‐positive cocci in clusters. The patient was diagnosed with fiberglass dermatitis with secondary infection and was treated with a 14‐day course of cephalexin, 250 mg per os four times a day.

Figure 2 Open in figure viewer PowerPoint Refractile crystal under polarized light     

T cell lymphomatoid contact dermatitis: a challenging case and review of the literature

Lymphomatoid contact dermatitis is a pseudolymphoma with clinical and histological features of allergic contact dermatitis and cutaneous T cell lymphoma. Incorrect diagnosis may lead to unnecessary testing, unnecessary treatment, or patient harm. The objective of this study is to present a case to demonstrate the diagnostic challenge and overlap between allergic contact dermatitis and cutaneous T cell lymphoma in a patient with lymphomatoid contact dermatitis caused by methylchoroisothiazolinone/methylisothiazolinone and paraben mix, and to review the existing literature in order to summarize the demographics, clinical features, allergens and treatments reported for lymphomatoid contact dermatitis. A search of major scientific databases was conducted for English‐language articles reporting cases of lymphomatoid contact dermatitis or additional synonymous search headings. Nineteen articles with a total of 23 patients were analysed. Lymphomatoid contact dermatitis was more common in men, with an average age of 58.5 years. Fourteen unique allergens were identified and confirmed by patch testing. However, no single test or study was diagnostic of lymphomatoid contact dermatitis. Allergen avoidance was the most useful management tool, but selected patients required topical or systemic immunosuppression. In conclusion, without specific diagnostic features, evaluation for lymphomatoid contact dermatitis should include a thorough history and examination, patch testing, and biopsy with immunohistochemistry and clonality studies.     

Hand dermatitis as an unsuspected presentation of textile dye contact sensitivity

The aim of this study was to evaluate disperse dye sensitization in patients with hand dermatitis. From January 1996 to December 2000, we identified 130 patients with hand dermatitis reacting to one of the 7 dyes included in our standard series. In 82 subjects the dermatitis was localized to the hands alone, whereas 48 patients had lesions both on the hands and on other skin sites. Disperse Blue dyes, and Disperse Orange 3 were the most common sensitizers. Among the 13 subjects allergic to disperse dyes alone, we found 3 cases of occupational allergic contact dermatitis, 1 child with atopic dermatitis worsening after the use of synthetic fibre garments, 4 subjects affected by clothing dermatitis, and 5 individuals occupationally exposed to irritants with a dermatitis involving the hands alone. In the latter, the hands may represent a 'locus minoris resistentiae', and both induction and elicitation of contact sensitization could be caused by impaired barrier function at a skin site repeatedly exposed to sensitizing garments.     

Atypical diaper dermatitis: contact allergy to mercapto compounds

We present a case of allergic contact dermatitis in an 18-month-old boy caused by type-IV allergy to mercapto mix and mercaptobenzothiazole as components of the elastic border of diapers. Allergic contact dermatitis should be included in the differential diagnosis of diaper dermatitis, especially in difficult-to-treat cases or atypical clinical presentation.     

Atypical neurothekeoma: a new case and review of the literature

Background:  Neurothekeoma is a rare neoplasm ascribed into the broad category of benign peripheral nerve sheath tumors. The atypical cellular variant of this neoplasm, showing a peculiar histological pattern, has been very rarely reported in literature.
Methods:  The clinical, histopathological and immunohistochemical profile of a new case of atypical cellular neurothekeoma in a 32-year-old woman is reported.
Results:  The described neoplasm showed the histological features of atypical variant of cellular neurothekeoma with high-rate mitotic activity and deep penetration into subcutaneous fat.
Conclusions:  Because only few cases of atypical neurothekeoma have been reported in literature, clinical and morphological available data on this neoplasm are very few, and its prognosis remains uncertain; anyway, dermatologists should be aware of histological features of this neoplasm for which a complete surgical excision is recommended.     

Allergic contact dermatitis to copolymers in cosmetics--case report and review of the literature

Copolymers or heteropolymers are large molecules with high molecular weights (>1000 D). They have been underestimated for a long time as to their sensitizing capacities. Allergic contact dermatitis to 6 copolymers in cosmetics and 1 in a medical dressing has been described; however, the nature of the hapten is still unknown. We report a case of allergic contact dermatitis to polyvinylpyrrolidone (PVP)/hexadecene copolymer in a purple-colored lipstick and review the literature on allergic contact dermatitis to 7 copolymers: PVP/hexadecene, PVP/eicosene, PVP/1-triacontene, methoxy polyethyleneglycol (PEG)-22/dodecyl glycols, methoxy PEG-17/dodecyl glycols, phthalic anhydride/trimellitic anhydride/glycols, and polyvinyl methyl/maleic acid anhydride.     

Lipoedema: from clinical presentation to therapy. A review of the literature

Lipoedema is an infrequently recognized disorder in women. Lipoedema is characterized by bilateral enlargement of the legs due to abnormal depositions of subcutaneous fat associated with often mild oedema. There is substantial variability in disease severity. The diagnosis should be made as early as possible to prevent complications of the disorder, which is associated with increasing functional and cosmetic morbidity. This review describes clinical manifestations, pathogenesis, technical investigations, management and therapies of lipoedema, with the aim of optimizing management and care of patients with lipoedema.