Prevalence of and factors influencing sensitization to corticosteroids in a Danish patch test population

Background. Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability. Aim. To estimate the prevalence of tixocortol‐21‐pivalate, budesonide and hydrocortisone‐17‐butyrate allergy in a Danish patch test population and characterize individuals with corticosteroid allergy. Materials/methods. Three thousand five hundred and ninety‐four patients were patch tested with tixocortol‐21‐pivalate, budesonide, and hydrocortisone‐17‐butyrate. Characterization was performed according to the MOAHLFA index and duration of disease. Results. Two per cent had a steroid allergy: 0.8% had a tixocortol‐21‐pivalate allergy, 1% a budesonide allergy, and 1% a hydrocortisone‐17‐butyrate allergy. Tixocortol‐21‐pivalate and budesonide allergy were associated with atopic dermatitis in crude analyses, but only tixocortol‐21‐pivalate allergy and atopic dermatitis remained associated in adjusted analyses. Leg dermatitis was uniquely associated with tixocortol‐21‐pivalate allergy. Hydrocortisone‐17‐butyrate allergy was associated with duration of disease in both crude and adjusted analyses. Discussion/conclusion. Chronic dermatoses (atopic dermatitis and leg dermatitis) were identified as risk factors for group A corticosteroid allergy, probably because of more pronounced exposure to group A steroids resulting from ease of access that is exploited by patients with a chronic dermatosis. The duration of disease rather than the dermatosis itself seemed to be important for group B and D2 corticosteroid allergy.     

Contact and photocontact allergy to octocrylene: a review

Octocrylene is an ultraviolet (UV)B and UVAII absorber that was introduced some 15 years ago, and is now widely used in sunscreen agents and skin care cosmetics. Since 2003, several studies, notably from France, Belgium, Spain, and Italy, have reported an increasing number of patients with photocontact allergy to octocrylene. This reaction is seen mainly in adult patients who have previously used topical products containing the non‐steroidal anti‐inflammatory drug ketoprofen. Photosensitization to ketoprofen leads, in many cases, to photocontact allergy to octocrylene; the mechanism of this reaction is unknown. Contact allergy to octocrylene also occurs, but is far less frequent, and is seen, in most cases, in children, resulting from the use of octocrylene‐containing sunscreen products. In this article, (photo)contact allergy to octocrylene is fully reviewed.     

Contact allergy to common ingredients in hair dyes

Background. It is widely accepted that there is a molecular weight (MW) cut‐off of 500, such that single chemicals with MWs higher than 500 cannot be skin sensitizers. If true, this could serve as a useful principle for designing non‐sensitizing chemicals. Objectives. To assess whether the 500 MW cut‐off is a myth or a reality. Methods. A database of 699 chemicals tested for skin sensitization in guinea pigs or mice was analysed to establish the number of tested chemicals with MW > 500, and to establish whether any of these were sensitizers. Results. Only 13 (2%) of the 699 chemicals in the database have MW > 500. Of the 13 tested compounds with MW > 500 in the database, five are sensitizers and eight are non‐sensitizers. Conclusions. The 500 MW cut‐off for skin sensitization is a myth, probably derived from the widespread misconception that ability to efficiently penetrate the stratum corneum is a key determinant of sensitization potency. The scarcity of sensitizers with MW > 500 simply reflects the general scarcity of chemicals with MW > 500.     

Contact sensitization to methylisothiazolinone in Finland--a multicentre study

Background. Antimicrobials constitute the second most common cause of contact allergy to cosmetics. Methylisothiazolinone (MI), previously always used together with methylchloroisothiazolinone (MCI), has recently been approved in the EU for use on its own in cosmetics and also various industrial products. MCI has been classified as an extreme–strong and MI as a strong–moderate sensitizer. Objectives. To study the frequency of positive patch test reactions to MI, and its relevance and relation to MCI/MI sensitivity, in Finland. Methods. Over a period of 3 years (2006–2008), MI 0.1% (1000 ppm) and 0.03% (300 ppm) were patch tested in 10 821 patients at eight Finnish dermatological clinics. During 2008, patients with positive reactions to MI were asked to take part in a repeated open application test (ROAT). Results. Of the patients tested, 1.4% and 0.6% showed positive patch test reactions to 0.1% and 0.03% MI, respectively. Sixty‐six per cent of those who were MI‐positive were also positive to 100 ppm MCI/MI. Thirty‐three agreed to undergo the use test, and 10 of these gave positive results (30%). Conclusions. Our data show that MI used alone also potentially induces contact allergy. Careful monitoring is needed to determine whether or not this antimicrobial is safe to use in cosmetics.     

Generalized pruritus in a patient sensitized to tobacco and cannabis

Respiratory problems or urticaria are well known in patients sensitized to tobacco. This occurs mainly as an occupational disease in tobacco workers, but also occasionally in those who smoke tobacco or dip snuff. Similar respiratory problems and anaphylactoid reactions have been observed in patients sensitized to cannabis. This may occur in those allergic to cannabis pollen when the plants bloom, in those with agricultural exposure and rarely in the end consumer. We describe a patient with generalized itching provoked by tobacco and cannabis smoking. Skin prick tests and specific IgE towards tobacco and cannabis were positive. Because of the close correlation of smoking tobacco or cannabis and the onset of symptoms, we put forward the diagnosis of a type I allergic reaction towards tobacco and cannabis.     

Autosomal recessive congenital ichthyosis due to homozygous variants in NIPAL4 with a dramatic response to ustekinumab

Autosomal recessive congenital ichthyosis is a genetically and phenotypically heterogenous group of scaling skin disorders. We describe a patient with ARCI caused by homozygous variants in NIPAL4, in whom the dermatologic phenotype and an associated arthropathy, markedly improved with ustekinumab.     

Melanin fate in the human epidermis: a reassessment of how best to detect and analyse histologically

Melanin is the predominant pigment responsible for skin colour and is synthesized by the melanocyte in the basal layer of the epidermis and then transferred to surrounding keratinocytes. Despite its optical properties, melanin is barely detectable in unstained sections of human epidermis. However, identification and localization of melanin is of importance for the study of skin pigmentation in health and disease. Current methods for the histologic quantification of melanin are suboptimal and are associated with significant risk of misinterpretation. The aim of this study was to reassess the existing literature and to develop a more effective histological method of melanin quantification in human skin. Moreover, we confirm that Warthin‐Starry (WS) stain provides a much more sensitive and more specific melanin detection method than the commonplace Fontana‐Masson (FM) stain. For example, WS staining sensitivity allowed the visualization of melanin even in very pale Caucasian skin that was missed by FM or Von Kossa (VK) stains. From our reassessment of the histology‐related literature, we conclude that so‐called melanin dust is most likely an artifact of discoloration due to non‐specific silver deposition in the stratum corneum. Unlike FM and VK, WS was not associated with this non‐specific stratum corneum darkening, misinterpreted previously as ‘degraded’ melanin. Finally, WS melanin particle counts were largely similar to previously reported manual counts by transmission electron microscopy, in contrast to both FM and VK. Together these findings allow us to propose a new histology/Image J‐informed method for the accurate and precise quantification of epidermal melanin in skin.     

Circulating melanoma cells as a potential biomarker to detect metastasis and evaluate prognosis

TNM staging is mainly used to evaluate the prognosis of melanoma patients. Serum biomarkers such as 5‐S‐cysteinyldopa (5‐S‐CD) have occasionally been used but most do not respond until the tumour burden becomes high. Recently, circulating melanoma cells (CMC) have been reported as a possible new biomarker to detect metastasis, monitor treatment response and predict prognosis. The object of this exploratory study was to evaluate the efficacy of CMC to detect metastasis and predict prognosis by cross‐sectional and prospective observational analyses, respectively. Altogether 15 patients with stages II–IV melanoma were enrolled and CMC were enumerated by CellSearch system with cut‐off values of two cells/7.5 mL. Serum 5‐S‐CD and lactate dehydrogenase (LDH) were also measured. The sensitivity of CMC and 5‐S‐CD for the detection of metastasis was 33 and 50%, respectively. The combination of CMC and 5‐S‐CD showed a sensitivity of 67%, the best performance among CMC, 5‐S‐CD, LDH and any combination of two of the markers. Additionally, a 30‐month prospective observation showed that CMC could segregate patients with poorer prognosis. The median survival time for the patients with <2 CMC and those with ≥2 CMC was 19.5 and 4.5 months, respectively. The limitation of this study is the small sample size. These preliminary results indicate CMC may complement the efficacy of 5‐S‐CD to detect metastasis and can be a prognostic marker. Although there is still room for improvement to maximise the sensitivity, the CellSearch system is reproducible, standardised and suitable for multi‐centre studies.     

Use of secukinumab in a pediatric patient leads to significant improvement in nail psoriasis and psoriatic arthritis

Many pediatric psoriasis patients suffer from nail involvement and psoriatic arthritis. In adults, biologic agents have demonstrated success in treating refractory nail psoriasis and arthritis, but studies are limited in children. In this report, we present a pediatric patient with severe, recalcitrant nail and joint psoriasis, successfully treated with secukinumab.