Delayed-type allergenicity of triforine (Saprol®)

The delayed-type allergenicity of triforine (Saprol®), 1,4-bis (2,2,2-trichloro-l-formamidoethyl) piperazine, was studied. In a mass examination of chrysanthemum growers among whom triforine was commonly used, the highest rate of positive patch test reaction was seen to triforine (17%) among the 7 pesticides and chrysanthemum extracts tested. A higher prevalence rate of work-related skin symptoms was seen in subjects with a positive patch test reaction to triforine (44%) than in those with negative reactions to all allergens tested (15%) ( p < 0.05). 12 subjects (67%) with positive patch test reactions to triforine were also positive to dichlorvos (DDVP®), with a high × coefficient (0.65). The grading of guinea pig maximization test to triforine was grade IV (66%), defined as "strong", Cross-sensitization between triforine and dichlorvos was also shown. The present results confirm that triforine is capable of including delayed-type allergy among chrysanthemum growers and of showing cross-reactivity with dichlorvos.     

P56Occupational protein contact dermatitis from shiitake mushrooms

Case report:  A 54‐year‐old woman, with no family or personal history of atopy, developed skin symptoms and cough after she had been cultivating shiitake mushrooms for 12 months. The patient reported dermatitis on the backs of her hands, fingers and on her wrists, after 1 or 2 days of being in contact with shiitake mushrooms. The skin lesions and cough disappeared entirely during the holidays. Result: Prick tests to common inhalant allergens, molds and flours were negative, with the exception of D. farinae (3 mm). The prick‐to‐prick test was positive for shiitake gill (3 mm), shiitake stalk (3 mm) and dry shiitake (8 mm ps). The histamine wheal was 5–7 mm. Control prick tests with shiitake on 5 nonexposed subjects were negative. An open test was performed with shiitake on the flexor side of the upper arm. Within 20 minutes a positive reaction appeared comprising two wheals and flare reactions. Patch test with shiitake gave a strong toxic reaction in 2 days, which continued to diminish on days 3 and 4. Conclusion: Contact urticaria is the clinical skin symptom of immediate allergy, but repeated exposure may lead to protein contact dermatitis. However, our patient has not had urticaria symptoms from shiitake, although the prick‐to‐prick and open tests were positive. To our knowledge, this is the first report of protein contact dermatitis from shiitake in a patient with a positive immediate skin reaction and negative patch test result.     

Airborne contact dermatitis from Ambrosia deltoidea (triangle-leaf bursage)

3 cases of contact dermatitis due to exposure to airborne allergens from Ambrosia deltoidea (triangle-leaf bursage) are presented. Although airborne plant dermatitis was suggested in each case by a history of aggravation of the rash by outdoor exposure and typical skin lesions, patch testing with an oleoresinous extract of A. deltoidea leaves identified the source of the sensitizer, not previously reported. As A. deltoidea is a ragweed that probably contains sesquiterpene lactones nearly identical to those of ragweeds widely prevalent in most of North America, the patients presented indicate the need for commercially available, standardized, plant extracts for patch testing in this country. The finding of positive patch tests with filters from an air sampler placed in 1 patient's domestic environment suggests a new avenue of investigation in airborne contact dermatitis.     

(23) Nickel dermatitis—a follow-up study

Nickel dermatitis has become the most frequent allergic contact dermatitis in the region of Erfurt (Germany).
Between 1982 and 1986 the incidence in our patch test clinic increased from 13·7% (18·3% female, 5·7% male) to 21·5% (27·4% female, 80% male). Eighty per cent of the female patients were under 30 years of age and 42% under 20 years of age. Primary nickel sensitization was due to fancy jewellery and wrist watches in 62% and dressing buckles in 14%. Nickel sensitivity was occupationally acquired in 25%; half of the workers were galvanizers.
Three years after initial patch testing all cases of 2 + and 3 + reactions to nickel sulphate in 5% petrolatum remained positive. Twenty out of 32 patients were free of skin lesions. Eight still had mild eczema of the hands. Twenty-three have changed their job because of the nickel allergy and are now working as secretary, referee, textile shop assistant, telephone operator, woodworker and textile manufacturer.
A positive patch test to nickel can become negative but this is rare. Normally rehabilitation is possible by avoidance of numerous and intensive contacts and is easier than in chromate dermatitis. Polysensitization renders or prevents healing and occupational rehabilitation.     

特比萘芬成功治愈误诊为曲霉感染的皮肤利什曼病一例

患儿女,5岁,内蒙古人。左面颊皮疹10个月。起病前数周局部曾被犬抓伤,初起为无症状小红丘疹,渐扩大。皮屑镜检见分支分隔菌丝,皮屑培养示阿姆斯特丹散囊菌（曲霉有性期）,初诊为皮肤曲霉感染。给予伊曲康唑200 mg/d治疗2个月,疗效欠佳。组织病理检查及瑞氏-吉姆萨染色,见真皮及皮下组织细胞内外大量利-杜小体,PAS染色未见真菌成分,组织真菌培养阴性,确诊为皮肤利什曼病。给予特比萘芬125 mg/d治疗2个月后皮疹痊愈。     

两种表皮移植方法治疗白癜风的比较

为比较加温负压发疱和生物发疱两种方法治疗白癜风的疗效,作者治疗５９例病人共９３处皮损,其中加温负压发疱法治疗３７处皮损,成功率８１％,生物发疱法治疗５６处皮损,成功率９１％,由于前者获到的皮片小、所需皮片多,术后有补丁样外观,完全恢复时间较长,仅适合于小面积皮损患者,而后者皮片可根据皮损的大小、形态任意取栽,术后无明显补丁样外观,完全恢复时间亦较短,且所需设备较简单,操作更为方便。     

Prevalence of natural rubber latex allergy (Type I and Type IV) in laboratory workers in The Netherlands

The objective of the study was to study the prevalence of Type IV and Type I allergy to natural rubber latex (NRL) in a population at risk in the Netherlands. Laboratory workers regularly using gloves were invited to complete a questionnaire and to be tested. We performed patch tests with standard contact allergens, rubber additives, glove powder and pieces of 4 gloves; prick tests with inhalant allergens, glove extracts, glove powder and fruit extracts; and RASTs. Glove-related hand dermatitis was reported in 36.9% of the individuals interviewed. A positive patch test result for rubber additives was seen in only 6.6%. Glove-related urticaria, rhinoconjunctivitis and/or asthma were reported in 24.6% of all cases. Confirmation of an IgE-mediated reaction was achieved in 8.3% by prick test with glove extracts and 5.0% by RAST No reaction to glove powder was noticed in patch testing or in prick testing. A high prevalence rate of glove-related symptoms and NRL Type I allergy was found in laboratory workers exposed to rubber gloves. Surprisingly, there was no co-existence of Type I and Type IV allergy in this population.     

Allergy and toxicodermia from shiitake mushrooms

Skin and respiratory symptoms developed within 2 months of exposure in a patient involved in the commercial production of shiitake mushrooms. A diagnosis of contact urticaria and allergic contact dermatitis from shiitake mushrooms was confirmed by prick and patch tests. The respiratory symptoms, their timing, the presence of precipitating IgG antibodies to shiitake spores and increased amounts of inflammatory cells and T lymphocytes in bronchoalveolar lavage indicated allergic alveolitis (mushroom worker's disease). A generalized exanthem developed in a second patient after eating raw shiitake mushrooms. Reactions to prick and patch tests with shiitake mushrooms were negative. The skin eruption in this patient corresponded to the previously reported shiitake-induced toxicodermia.     

Occupational protein contact dermatitis from shiitake mushroom and demonstration of shiitake-specific immunoglobulin E

Shiitake are popular edible mushrooms all over the world, and eating raw shiitake may lead to relatively common 'shiitake dermatitis' or toxicodermia. Workers involved in shiitake cultivation and marketing have distinct occupational respiratory and skin diseases unrelated to 'shiitake dermatitis'. There are no previous reports of protein contact dermatitis (PCD) from shiitake, and there is only 1 report of shiitake-specific immunoglobulin (Ig) E. We report 2 shiitake growers who developed work-related eczematous eruption on their hands. Both of the patients had small prick test reactions to fresh shiitake, and specific IgE to shiitake was detected in their sera by immunospot. One of the patients had a large prick test reaction to dry shiitake and also a positive wheal reaction to fresh shiitake in an open application test. Neither of the patients had noticed any symptoms of contact urticaria at work. Both of the patients had immediate IgE-mediated allergy to shiitake, and the diagnosis of occupational PCD was made. There are no commercial in vitro tests for shiitake-specific IgE. Tests for immediate allergy are important when shiitake contact dermatitis is investigated.     

Erythema multiforme due to contact with weeds: a recurrence after patch testing

Erythema multiforme (EM) as a complication of patch testing (PT) is rare. A 52-year-old woman with a 13-year history of episodes of EM, after contact with weeds during home gardening, had had no recent history of herpes simplex, other infection, drug ingestion or vaccination. On examination, EM lesions were distributed on the exposed skin. 5 weeks after complete resolution, PT and photopatch testing (PPT) were done with fresh plants she brought in. She was PT with a standard series and the Hermal-Trolab plants, woods, tars, balsams and flavors series. Intradermal testing, with a 3 + reaction to mixed weed pollens, was done 3 weeks later. Specific IgE to weed pollens class 1 (CAP-Pharmacia) was detected. Eczematous PT reactions were obtained with fresh leaves: common chickweed (Stellaria media Caryophyllaceae), dandelion (Taraxacum officinale Compositae), field-milk thistle (Sonchus arvensis Compositae) and white clover (Trifolium repens Leguminosae). Photoaggravation was seen to common chickweed and dandelion. Positive PT was also seen with alantolactone. By the 4-day reading, a typical EM had commenced, coming up to quite the same extent as seen on admission. There was no photosensitivity (UV skin tester, K. Waldmann). In the essential oil obtained from common chickweed, thin layer chromatography (TLC) revealed the well-known contact allergens borneol, menthol, linalool, 1,8-cineole, and other terpenes such as epoxy-dehydro-caryophyllene, monoterpene alcohol-ester and caryophyllene. Up to now, no data on essential oil in Stellaria media (common chickweed) have been reported. It can be concluded that EM developed due to contact with weeds, and recurred after patch testing. Neither blistering nor eczematous lesions have been seen on her skin, making this case very unusual. As far as the world literature is concerned, this is only the 4th report of EM developing in association with patch testing.     

Stevensjohnson Syndrome Caused by a Health Drink (Eberu®) Containing Ophiopogonis Tuber

Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with bullous and eroded lesions of skin and mucous membranes. We report a case of Stevenjohnson syndrome following consumption of a health drink containing ophiopogonis tuber. A 66-year-old female took an O.T.C. health drink for fever. The next morning, she noted erythema and swelling of her face, neck, and chest. She started to develop bullous and eroded lesions on the skin of her entire body and the mucous membranes of her oral cavity, conjunctiva, and cornea, and she became feverish. She had high degrees of corneal erosion and liver dysfunction. Skin biopsy showed diffuse necrosis of the epidermis. After admission to the hospital, steroid pulse therapy (1000 mg/day of methylprednisolone sodium succinate) was continued for 5 days. The health drink induced a positive drug lymphocyte stimulation test (DLST) and patch test. A challenge test was done with a one hundredth dose, and it was positive. We did patch tests with all components of the drink and found that Mai-Meu-Dong-Tang (ophiopogonis) alone was positive at 72 hours. There is no previous report of Stevens-Johnson syndrome caused by a health drink or Mai-Meu-Dong-Tang. Even though it is a health drink, we should be aware of the possibility of a severe reaction.     

Skin sensitivity to denture base materials in the burning mouth syndrome

The significance of sensitizing compounds in the denture base for the etiology of the burning mouth syndrome (BMS) has been studied in 53 denture-wearing persons, seven males and 46 females. Epicutaneous patch tests were performed with standard concentrations of benzoyl peroxide, dibutylphthalate, dimethyl-p-toluidine, formaldehyde, hydroquinone, methylmethacrylate, p-phenylendiamine and with cadmium sulfate, potassium dichromate, cobalt chloride and nickel sulfate. Furthermore, patch testing was performed with filings from the denture mixed with the patient's own saliva. In cases with an inflamed oral mucosa, the presence of hyphae of Candida albicans was assessed by a smear technique. Positive skin reactions were observed in 15 persons to dimethyl-p-toluidine, hydroquinone, formaldehyde, methylmethacrylate, p-phenylendiamine, potassium dichromate, cobalt chloride and nickel sulfate, including three cases with reactions to filings from their dentures, and one patient who after subsequent testing showed skin sensitivity to balsam of Peru. In 12 cases an etiological connection could be traced between the oral symptoms and the denture base, indicating that contact sensitivity to base materials or to allergens and microbial antigens on the denture plate plays a greater role in the pathogenesis of BMS in edentulous persons than previously suggested.     

Sarcoidal-type allergic contact granuloma: a rare complication of ear piercing

As body piercing is increasingly en vogue, complications are on the rise as well. Biopsies of such lesions can impose special problems to the reviewing dermatopathologist. We present two patients who developed papulonodular lesions at the sites of ear piercings. Unexpectedly, the findings included prominent sarcoidal granuloma formation with confluent areas of fibrinoid necrosis. An infectious etiology was excluded. However, patch testing revealed contact allergy to palladium, platinum, and nickel. Interestingly, histopathologic examination of the patch test sites also demonstrated granuloma formation. These findings suggest that the lesions represent allergic contact granulomas. When confronted with this special type of tissue reaction in skin biopsies of piercing sites, the reviewing dermatopathologist should consider the possibility of an allergic reaction. Careful history and thorough diagnostic procedures, including biopsy of the patch test site can establish the diagnosis of contact allergic granuloma.     

Kontaktdermatitis auf Spinat,Rauke und Schnittlauch

A 54-year-old female working as a vegetable farmer presented with painful pruritic skin lesions on both hands. Physical examination showed a hyperkeratotic fissured eczema. RAST, prick- and patch testing revealed type I and IV hypersensitivity to spinach, ruccola, and chives, so that a protein contact dermatitis was diagnosed.     

Pigmented purpuric contact dermatitis from Disperse Blue 106 and 124 dyes

The diagnosis of purpura pigmentosa progressiva in a female patient had to be changed to purpuric contact dermatitis after patch testing with textile dyes. A modified patch test performed in the area in which most of her skin lesions were located revealed a petechial reaction to the azo dye Disperse Blue 124/106. For evaluation of purpura pigmentosa progressiva we suggest a patch test with potential allergens, and, especially for textile dyes, a patch test at the lesion site may be helpful.     

Symptoms and signs reported during patch testing.

BACKGROUND:In a pilot questionnaire study, there was a high frequency of subjective complaints and distant skin reactions during patch testing as reported at the day of test reading, particularly in female patients. OBJECTIVE: To document in a controlled study possible side-effects of a generalized nature occurring during the test procedure. METHODS: A questionnaire study on symptoms and signs reported at application and at reading of standard patch tests was conducted with 401 patients, with the patients serving as their own controls. RESULTS: An eczematous flare-up during patch testing was observed in 3.7% of the patients. There were plenty of different symptoms of malaise but, with one exception (itch on the back), the number of symptoms tended to be less on the day of reading than on the day of application of the tests. This held true also for itch occurring in the patients' dermatitis. There was no statistical correlation between symptoms and signs on the one hand and positive patch tests on the other. CONCLUSION: Distant skin reactions and impairment of general health occurring during patch testing are often reported at the time of test reading. However, with the exception of itch on the back, symptoms and signs are rather less common after the application of patch tests than before.     

Contact allergy to Compositae plants in patients with summer-exacerbated dermatitis

16 patients with summer-exacerbated dermatitis were examined by patch testing and photopatch testing with a battery of Compositae and standard allergens. IgE and RAST, and the thresholds to UVA and UVB, were determined. 6 female and 2 male patients showed allergic contact reactions to one or more Compositae extracts from flowers common in Sweden, also used in skin care products. The study points to the importance of including testing with Compositae allergens in patients with summer-exacerbated dermatitis. This group comprises patients with multiple contact reactions, photosensitivity and flares of atopic dermatitis.     

The development of cutaneous lesions during follow-up of patients with primary neuritic leprosy

BACKGROUND: Primary neuritic leprosy (PNL) is a rare form of leprosy where the characteristic skin lesions are absent. Investigations of apparently normal skin from the areas of sensory change have revealed microscopic evidence of nerve involvement. Clinical studies have found that a proportion of patients develop visible skin lesions during follow-up. The aim of the study was to perform a clinical and histological analysis of PNL patients who developed visible skin lesions during treatment and follow-up, to gain insight into the pathogenesis of the disease. METHODS: Twenty-nine individuals in a series of 182 PNL patients developed visible skin lesions during follow-up. Analysis of the number, location, histology and time of onset of the new skin lesions in relation to the type and regularity of the treatment regimen were noted. A biopsy from the new skin lesion when available was compared with the nerve biopsy findings at the time of initial diagnosis. RESULTS: Thirty-eight per cent of patients developed a single patch and 28% developed two patches. Over three-quarters of these were on the lower limb (47%) or the upper limb (29%). Sixty-two per cent of patients developed the lesions within 2 years of the onset of symptoms. Patients on regular treatment developed patches earlier than those on irregular treatment or no treatment. A skin biopsy from the new patch revealed borderline tuberculoid leprosy histology in 47% of the patients. CONCLUSIONS: The findings suggest that leprosy primarily affects the nerve and that a neuritic phase precedes the development of visible cutaneous lesions.     

Dermatitis in bulb growers

A damaged skin forms a health hazard in flower-bulb growers as it enables higher permeation rates For pesticides than normal skin. Therefore, an investigation was performed into the skin condition of 103 bulb growers and 49 controls. Contact dermatitis of the hands was of the same order (11 and 10%) in both groups. However, minor signs of dermatitis were seen more often in bulb growers (30 versus 8%, p <0.05). Most growers had contact with narcissus sap during the investigation. This irritant sap, as well as many other skin contacts with irritants such as hyacinth dust and pesticides, seemed to be responsible for many skin complaints. Contact serialization was suspected in 19 growers and 3 controls. Patch tests showed that contact sensitization existed to pesticides in probably 10, and to flower-bulb extracts in 4 growers. Reactions to propachlor were not regarded as very reliable as the test concentration seemed to be marginally irritant. There were only a few allergic reactions to narcissus (3) and tulip (2) and none to hyacinth. This investigation showed that minor irritant contact dermatitis was frequent in bulb growers, and indicated that contact sensitization to pesticides and bulbs seemed to be a less frequent but important cause of dermatitis.     

Gramineae pollen as trigger factors of atopic eczema: evaluation of diagnostic measures using the atopy patch test

After contact with grass pollen, seasonal exacerbations of eczematous skin lesions have been described in a subgroup of patients with atopic eczema (AE). Epicutaneous patch testing with aeroallergens (atopy patch test, APT) has been used to investigate these patients. We performed comparative APT in 79 patients with AE and 20 control subjects (14 non-atopic volunteers and six patients with grass pollen allergic rhinoconjunctivitis). Subjects were tested with grass pollen allergen extract in petrolatum and with unprocessed native dry pollen of Dactylis glomerata . Results after 48 h were compared with the patient's history, corresponding skin prick test and specific IgE. Fifteen of the 79 AE patients showed clear-cut eczematous reactions to unprocessed D. glomerata pollen; 14 of these had an elevated serum IgE to D. glomerata and 13 had a positive skin prick test. Twenty patients had a positive APT reaction to grass pollen allergen extract, including 12 of the D. glomerata reactive subjects ( P  < 0.001). Positive patch test reactions to D. glomerata were seen in 66.7% of cases with and 10.5% of patients without a predictive history of exacerbations during the pollen season. For the standardized extract, these percentages were 75% vs. 16.4% ( P  < 0.001). No side-effects were observed. Control subjects showed no positive reactions. We conclude that grass pollen preparations may be used to investigate trigger factors for eczematous skin lesions in a subgroup of patients with AE.