Cheilitis caused by contact allergy to cocamidopropyl betaine in '2-in-1 toothpaste and mouthwash'

A 10-year-old girl presented with a 2-year history of severe cheilitis. Despite cessation of any lip-licking behaviour her symptoms continued to worsen, with only minimum relief from therapeutic measures. Patch testing proved strongly positive to cocamidopropyl betaine, which was noted to be present in the patient's '2-in-1 toothpaste and mouthwash'. Her cheilitis settled after avoidance of this product. Cocamidopropyl betaine, a surfactant, is a common allergen in hairdressers; however, this case highlights the importance of excluding a contact allergy to this product in patients with intractable cheilitis.     

Contact allergy to ophthalmic dipivalyl epinephrine hydrochloride: demonstration by patch testing

A patient presented with a 3-month history of conjunctivitis and periocular eczema. He had a 3-year history of glaucoma and was being treated with 3 different locally applied eyedrops (Timoptic (timolol maleate) ophthalmic solution 0.25%, Pilocar (pilocarpine) ophthalmic solution 1%. and Propine (dipivalyl epinephrine hydrochloride) ophthalmic solution 0.1%). Patch testing with all 3 undiluted eyedrop solutions revealed a reaction only to Propine eyedrops. Patch testing to the individual components of Propine eyedrops revealed an allergic reaction to 0.5%, dipivalyl epinephrine hydrochloride that was apparent on the 2nd patch test reading. After discontinuing the Propine eyedrops, the conjunctivitis as well as the periocular dermatitis resolved, proving that the positive patch tests were relevant to both. It was reported that re-exposure to dipivalyl epinephrine hydrochloride by intra-ocular challenge was necessary to diagnose this allergy. This is the first demonstration of dipivalyl epinephrine hydrochloride allergy by patch testing. Since the 1st patch test reading (2 days) was weak. 2nd patch test (4 days) readings may be important in diagnosing this allergy by patch testing.     

外用茶油对变应性接触性皮炎发生的影响

目的 观察茶油对小鼠变应性接触性皮炎发生的影响。方法 建立二硝基氟苯致小鼠变应性接触性皮炎模型,外用药物进行治疗,观察发生皮炎的小鼠耳片的组织学变化（HE染色）,RT-PCR检测组织中炎症细胞因子IL-2、IFN-γ mRNA的表达水平。结果 成功建立二硝基氟苯致小鼠变应性接触性皮炎的动物模型,且皮肤中IL-2、IFN-γ mRNA的表达显著增高。哈西奈德溶液组和茶油组的耳片组织肿胀明显减轻,炎症反应轻微,炎性细胞浸润数目少,组织病理变化轻。在茶油和哈西奈德溶液的干预下,炎性组织IL-2、IFN-γ的mRNA表达均不同程度下降。结论 茶油减轻二硝基氟苯致小鼠变应性接触性皮炎的病理损害,下调了炎症因子的表达。     

Evaluation of patch testing in patients with chronic vulvar symptoms

The Dermogynaecology Clinic was established at the Mercy Hospital for Women in 1989. Since its inception, 700 patients have been investigated and 15% were clinically diagnosed as having contact dermatitis. Primary irritant dermatitis was regarded as the common cause but to investigate the place of contact allergy 50 patients were patch tested to a standard battery, medicaments, preservatives, corticosteroids and miscellaneous allergens. Twenty-one patients (42%) had a total of 44 positive tests. The most common positive reactions were to nickel (22%), cobalt (6%), fragrances (12%). caine mix (6%) and ethylenediamine (8%). Medicaments and fragrances were regarded as important allergens. Corticosteroid and imidazole allergy was not a problem in this series of patients.