Exposure of nickel in used and unused gold-plated earrings: a study using scanning electron microscopy and X-ray microanalysis

Nickel is the most common contact sensitizer in the female population. The aim of the present study was to examine closely the surface of both used and unused gold-plated earrings by scanning electron microscopy, and to ascertain the distribution of nickel on the surface of these earrings qualitatively and quantitatively by X-ray microanalysis. The claps of 4 sets of used earrings causing nickel dermatitis and of the 3 sets of unused earrings were examined. In backscattered electron images obtained by scanning electron microscopy, a large number of scratches and pits were found on the surface of the used earrings. Cross-sections of the surfaces confirmed that the gold plating was defective in some areas, exposing the nickel. Nickel was readily detected and quantitatively determined in the scratches and pits by X-ray microanalysis. We also found that, even in unused earrings, numerous scratch marks and pits Acre present, again exposing the nickel. Clearly, even in unused earrings, nickel exposed at the surface sensitizes the skin and causes contact dermatitis     

Evaluation of efficacy of a skin lipid mixture in patients with irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis: a multicenter study

Disturbances of skin barrier function occur in several skin diseases, e.g., atopic dermatitis (AD), irritant/allergic contact dermatitis (ICD, ACD). Skin barrier damage triggers the production of cytokines that stimulate lipogenesis which may also cause inflammatory processes. The aim of this study was to evaluate the efficacy of a topical skin lipid mixture in the treatment of ICD, ACD and AD. 580 consecutive patients suffering from ICD, ACD or AD were treated with a skin lipid mixture containing ceramide-3 and patented nanoparticles. Patients received the lipid mixture alone or in combination with topical corticosteroids until clearance or for 8 weeks. Both treatment groups statistically improved all parameters considered at week 4 and 8 as compared to baseline. Between the 2 treatment groups, there was a statistically significant difference in favour of combined therapy for (ICD, ACD, AD, respectively): erythema, pruritus and overall disease severity; erythema and pruritus; erythema, pruritus, fissuring and overall disease severity. No statistically significant difference was found for (ICD, ACD, AD, respectively): dryness, scaling and fissuring; scaling, fissuring and overall disease severity; dryness and scaling. Between the 2 ACD treatment groups, there was a statistically significant difference in favour of the skin lipid mixture for dryness. In conclusion, the study shows that balanced lipid mixtures are effective in improving barrier properties and the clinical condition of the skin in contact dermatitis.     

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.     

Complement profiles in human skin lymph during the course of irritant contact dermatitis

Using microsurgery a superficial peripheral lymph vessel draining the skin of the upper and medial part of the foot was cannulated on the lower leg of two healthy human volunteers. An irritant contact dermatitis was induced 2 days later by the application of 10% sodium lauryl sulphate to the drained skin area. After a further 3 days the spontaneously regressing skin reaction was treated with clobetasol propionate. Lymph was continuously collected in two aliquots per day for 7 days. The levels of total protein, of albumin and globulins, and of complement components of the classical, the alternative and the lytic pathway as well as the C4A and C4B gene products and the regulatory proteins FB, C1INH, C4BP, FH and FI were determined by ELISA and radial immunodiffusion techniques. Postoperatively, the levels of complement proteins and globulins in the lymph were 5–10 times lower than those in normal human serum, but increased during the course of the skin reaction, while the irritant contact dermatitis did not induce a change in their plasma concentration. In comparison to the baseline, the mean values for C1q, C1r, C2, C5, C6, C7, C8, C9, FB, C1INH, C4BP, FH and FI exhibited a 3–5-fold increase, C3, total C4, albumin and the alphal-globulin fraction a 6–9-fold increase, and C1s, C4A, C4B, FB and alpha2-, beta- and gamma-globulins a 10–20-fold increase. The increase in the levels of complement proteins, in contrast to IL-6 and TNF, did not occur in the early phase of the skin reaction, but correlated with the lymph flow, the output of cells and the levels of several other cytokines. These results suggest that complement proteins do not play a role in the initial pathomechanism of irritant contact dermatitis, but are locally involved in the inflammatory process and interact with inflammatory cells, cytokines and further soluble mediators transported to the regional lymph nodes.In this report, the nomenclature for complement follows Bull World Health Organ (1968) 39: 935–938, and that of the alternative pathway of complement follows Bull World Health Organ (1981) 59: 489–491. This work was supported by a grant from the Swiss National Fund (23-7774.89).     

Topical FK506: suppression of allergic and irritant contact dermatitis in the guinea pig

Topical FK506 has recently been shown to have an anti-inflammatory effect in vivo in humans. In this study its effects in contact dermatitis were studied in the guinea pig model. Topical FK506 suppressed both irritant and allergic patch-test reactions. The most prominent suppressive effect was seen when skin sites were pretreated with FK506. Topical FK506 did not impair the induction of contact allergy as assessed by challenges, although it suppressed local lymph node cell accumulation during contact allergy induction. Topical FK506 may hold promise as a treatment for skin disorders that respond to oral FK506 or cyclosporin A.Presented in part orally at the 54th Annual Meeting of the Society for Investigative Dermatology, Washington, D.C., 28 April 1993 (Lauerma et al. (1993) J Invest Dermatol 100: 491A)     

A high rate of cross-sensitivity between Parthenium hysterophorus and Xanthium strumarium in Indian patients with contact dermatitis

Parthenium hysterophorus is well known to produce contact dermatitis in India. Xanthium strumarium is another weed also belonging to the Compositae family present in India since much earlier times, but not recognised among the plants causing contact dermatitis. We have found a very high rate of cross-sensitivity between the two plants in patients presenting air-borne contact dermatitis. Of the 28 patients with air-borne contact dermatitis. 22 revealed positive patch tests with aqueous extracts of both plants, one patient showed a negative patch test with Parthenium hysterophorus and a positive test with Xanthium strumarium , while five patients were negative with both plants. In a control group of 15 patients with contact dermatitis due to other agents, only one patient showed a positive patch test with Xanthium strumarium , while the patch test with Parthenium hysterophorus was negative. Patch tests performed with serial 10-fold dilutions of standard extracts of both plants to determine the degree (titre) of contact hypersensitivity (TCH) revealed variable litres in different patients. Some patients had a much higher titre with Parthenium hysterophorus while others had a higher titre with Xanthium strumarium. The antigen in Xanthium strumarium , like that of Parthenium hysterophorus , could be extracted with water, acetone, ethanol, chloroform, benzene, ether and carbon tetrachloride. Infra-red spectrophotometry of extracts in ether revealed similar spectra in the two plants. The antigens in the two plants seem lo be very similar.     

sICAM-1, sE-selectin and sVCAM-1 are constitutively present in human skin lymph and increased in allergic contact dermatitis

The expression of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin is important for the regulation of the leucocyte traffic into and in inflammatory dermatoses. ICAM-1, VCAM-1 and E-selectin were initially identified as cell-surface proteins, but recent evidence suggests that they also exist in a soluble form. The collection of human afferent lymph exclusively deriving from a selected skin area allows insight into local pathomechanisms as well as signal transmission in skin disorders. In the present study we measured the concentrations of the soluble adhesion molecules (sAM) sICAM-1, sVCAM-1 and sE-selectin in human skin lymph derived from normal untreated skin, irritant contact dermatitis (CD) and the induction and elicitation phases of allergic CD. The strong elicitation reactions of allergic CD produced an increase in sAM output to about three times the baseline values but in the weaker irritant CD we observed no increase at all. In the induction phase of allergic CD the concentrations during the first 9 days of the experiment remained unchanged, as in the lymph derived from normal untreated skin, but were slightly increased thereafter. To our knowledge, no in vivo data exist on the local involvement of sAM in irritant and allergic CD in humans. Our results provide evidence of increased concentrations of sAM mainly in strong allergic CD. Received: 12 June 1996     

昆明地区女性200例慢性湿疹和接触性皮炎斑贴试验结果分析

目的探讨昆明地区女性慢性湿疹和接触性皮炎的变应原分布特点及其相关性。方法对100例慢性湿疹和100例接触性皮炎患者进行斑贴试验。结果斑贴试验显示,慢性湿疹组病人的斑贴试验阳性率为44％,接触性皮炎组病人的斑贴试验阳性率为68％,P〈0．0l,显示两者之间有显著性差异;湿疹组阳性病例中一种变应原的阳性率为63．57％,两种及以上变应原阳性率为36．43％;接触性皮炎组阳性比例中1种变应原阳性率为82．53％,两种及以上变应原阳性率为17．47％,均有统计学差异（P〈0．05）。结论 斑贴试验有助于明确慢性湿疹和接触性皮炎患者的接触变应原,其主要变应原不尽相同。     

Detection of selenium in generalized and localized argyria: report of four cases with X-ray microanalysis.

Electron microscopic and X-ray microanalytic studies were performed on four cases of argyria; one generalized and three localized. Deposition of electron dense granules was predominantly found on elastic fibers and around basal laminas of secretory portions of eccrine glands, although the amount of deposition was much less in the case of generalized argyria. In all four cases, X-ray microanalysis revealed that the depositions consisted mainly of silver, selenium, and sulfur. The importance of selenium in the detoxification of heavy metals was discussed.     

Immunophenotyping of the cellular infiltrate in the early elicitation phase of contact dermatitis in the skin of presensitized atopic individuals

Litte is known about the composition of the cellular infiltrate in the early elicitation phase of contact allergy in atopic individuals. Therefore, we rechallenged ten presensitized disease-free atopic volunteers with their known contact allergen and performed biopsies at time 0 and after 6 and 24 h. Ten patients with acute exacerbated atopic dermatitis in the early stage were chosen as a control group. Skin biopsy specimens were processed for immunohistochemistry (APAAP) and evaluated by computer-assisted morphometry. CD4⁺ and CD45R0⁺ cells were found to be significantly increased after 6 (t₆) and 24 h (t₂₄), and this was accompanied by an enhanced TCR / receptor expression at t₆-CD45O⁺ cells showed a marked influx into the epidermis at t₂₄. CD8⁺ cells infiltrated the basal layer of the epidermis, thus changing the CD4/CD8 ratio from 4.61 at t₀ to 2.21 at t₆. CD1a⁺ epidermal dendritic cells increased significantly from 811 ± 240/mm² at t₀, to 1210 ± 333/mm² at t₂₄ (P<0.01). At t₆ and t₂₄, a socalled epitope CD1a⁺ shedding was observed into the intercellular spaces of keratinocytes as well as an elongation and enlargement of the dendrites of CD1a⁺ cells. In the upper dermis, the number of CD1a⁺ cells increased from 1098 ± 485/mm² at t₀ to 2388 ± 740/mm² at t₂₄ (P<0.01). In 7/10 volunteers, IgE⁺ dendritic cells increased significantly in number at t₆ (P<0.02). The activation markers HLA-DR and CD25 were expressed most distinctly at t₂₄. Interestingly, expression of ICAM-1 on keratinocytes occurred only in four of the ten atopic volunteers. In general, the early elicitation phase of allergic contact dermatitis in atopy is characterized mostly by the same events as seen in non-atopies; however, the lower expression of ICAM-1 on keratinocytes and the increase in IgE-bearing dendritic cells seem to be characteristic for atopic individuals with contact allergy in the early phase after rechallenge with a contact allergen.     

A postal survey of patients with nickel and chromate dermatitis

A postal survey was made of 75 patients with nickel and chromate dermatitis who had been discharged from the clinic; 69% of patients replied to the questionnaire and in 81% of these the dermatitis was still active. In many patients (48%) this was causing significant disability long after initial presentation to the clinic (average of 56.5 months). All patients had patch tests performed and the relevance of this is discussed with reference to nickel dermatitis.     

特应性皮炎患者皮损超微结构及免疫病理研究

目的:研究特应性皮炎(AD)患者皮损超微病理及免疫病理的表现,探讨AD的发病机制。方法:取21例患者外周血,测定血清IgE、IgA、IgG、IgM,并取典型皮损分别做超微组织病理和免疫病理检查。结果:16例AD患者血清IgE值>150IU/L,5例≤150IU/L,血清IgG、IgM值明显升高,而IgA值明显降低。电镜检查表皮可见激活的淋巴细胞,少数中性粒细胞侵入表皮,早期真皮可见胶原间质水肿,后期间质纤维呈波浪性增生,无论在表皮或真皮均可见到活化型的免疫应答细胞。结论:AD发病与免疫有关。治疗AD的靶细胞是肥大细胞。IgG1蛋白沉积可能与AD慢性感染有关。     

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review

Background/objectives

Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature.

Methods

The study sample included 343 children and adolescents (197 female, 146 male; 1‐18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files.

Results

Ninety‐eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively).

Conclusion

Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.     

Illness perception and quality of life in patients with contact dermatitis

Background. People's subjective perceptions of illness are important determinants of their ways of coping with health threats and the ensuing physical and mental outcomes, including quality of life (QoL), which has been consistently reported to be impaired by contact dermatitis. Objectives. To investigate the relationships of subjective illness perceptions and dermatological QoL in atopic, contact and occupational dermatitis patients and a comparison group of patients with other dermatological diseases. Patients and methods. Three hundred and three patients of four diagnostic groups filled in the Brief Illness Perception Questionnaire and the Skindex-16 (+ occupational impact items) Dermatological QoL questionnaire before clinical examination and patch testing. Results. Perceptions of serious consequences, greater symptom burden and more uncertainty and worry were associated with lower QoL (r(s) > 0.50). Overall, patients reported low personal control over their condition and low understanding of the disease (3.5 and 4.8, respectively, on a 0-10 scale). QoL was most impaired among occupational dermatitis patients (mean = 46) and least impaired among patients who were later diagnosed as suffering from conditions other than contact dermatitis (mean = 62). Conclusions. Identifying critical components of illness perceptions in patients with atopic, contact and occupational dermatitis may enable the design of consultations and interventions to fit patients' perceptions, which could affect their QoL.     

Role of foods in irregular aggravation of skin lesions in children with atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that especially affects children and adolescents. Many environmental factors have been recognized as relevant in aggravating skin lesions of the disease. However, it remains to be determined whether foods play a role in worsening of skin lesions in children with atopic dermatitis. In the present study, we investigated whether foods play a role in irregular aggravation of skin lesions in children with the disease. The study population consisted of 69 patients aged 3-15 years with atopic dermatitis. They were hospitalized and open challenge tests were performed with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. We determined challenge-positive foods by evaluating the comparable before/after challenge photographs. One to three (average, 1.9) challenge-positive foods were confirmed in 52 (75%) of the 69 patients examined. Predominant offending foods were chocolate, cheese and yogurt. Specific immunoglobulin E values to offending foods were mostly negative. We asked patients to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a remarkable improvement in the disease. These results suggest that foods play an important role in irregular aggravation of skin lesions in children with atopic dermatitis.