Airborne irritant contact dermatitis from metal dust adhering to semisynthetic working suits

2 workers at an aircraft factory were employed in a plasma sparying unit. Soon after they were equipped with new semisynthetic working suits, they started to complain of pruritic eruptions after heavy exposure to metal dust. They noted that the dust was not as easily blown off the clothes by pressurized air as previously. Clinical findings consisted of discrete macular and papular lesions, partly follicular, on the ventral and medial thighs. Atopy score, IgE level and a standard series of prick tests ruled out atopic disposition. Patch tests revealed no reactions. A diagnosis of occupational airborne irritant contact dermatitis from metal dust was therefore made. To elucidate the role of the working suit, extensive physical investigations of the physical properties of the textile were performed. Microscopic pictures at low magnification showed more dust particles on the semisynthetic working suit, compared to the former pure cotton suit. This impression could not be confirmed by particle count because of too uneven particle distribution at higher magnification. Hairiness of the 2 textiles was low and ruled out irritation by the semisynthetic textile itself. No difference in electrostatic properties between the 2 working suits could be established either. Both textiles showed high static electrical propensity. When use of the semisynthetic overall was discontinued, the patients reported no recurrence. The 2 reported cases show that the physical properties of the textiles of working suits can be of interest and should be considered in the management of dust-induced irritant contact dermatitis. Extended physical examinations of textile failed to explain the clinical observation; further investigations might establish physical characteristics of textiles for such adhesion qualities.     

Small fibre function in patients with meralgia paresthetica

Introduction: Patients with meralgia paresthetica (MP) usually experience not only paraesthesias and decreased tactile sensation, but also painful dysesthesias in the distribution of the lateral femoral cutaneous nerve (LFCN). We aimed at assessing whether there is any functional impairment of small fibres of the LFCN in patients with MP. Methods: We carried out a clinical, psychophysical and neurophysiological study in 14 patients with MP and 14 healthy control subjects. We assessed pain in the last 2 months, thermal thresholds and small fibres conduction by using a visual analogue scale (VAS-pain), quantitative sensory testing (QST) and contact heat-evoked potentials (CHEPs), respectively. Data were grouped for control subjects, non-affected side and affected side of patients with MP. Results: Patients marked a VAS-pain of 4.3 ± 1.5. In the affected side, thresholds for warm and heat pain sensations were elevated and the amplitude of CHEPs was reduced in comparison to the non-affected side and controls (Bonferroni’s test; p < 0.001 for all comparisons). The amplitude of CHEPs correlated inversely with duration of the symptoms (r = −0.57, p = 0.002), as well as with heat pain thresholds (r = −0.18, p = 0.01). No significant correlations were found between CHEPs and VAS-pain (p > 0.05 for all correlations). Conclusion: Besides the involvement of large myelinated fibres, partial loss of function in small fibres may also account for the painful symptoms of patients with MP, especially in those with longer disease duration.     

Opium poisoning following self‐medication of radiation‐induced dermatitis with topical use of opium latex traditional extract; a teaching case

Despite Radiation‐induced dermatitis is a self‐limiting complication, it can be complicated if inappropriate self‐medications have been used such as opium latex traditional extract.     

Serum thymus and activation‐regulated chemokine as disease activity and response biomarker in alopecia areata

Serum thymus and activation‐regulated chemokine/CCL17 (sTARC) is known as a good indicator for atopic dermatitis severity. Herein, we investigate whether sTARC correlates with severity and therapeutic response for alopecia areata (AA) in our 121 patients. The sTARC mean of AA totalis and universalis was significantly higher than mild AA. Next, we compared sTARC of diffuse AA (n = 14) and severity‐controlled patchy AA (n = 32) and found that sTARC in diffuse AA (564.2 ± 400.0 pg/mL) was significantly higher than that of the patchy type (344.0 ± 239.8 pg/mL), suggesting a potential role of TARC in active progression of diffuse AA. Ten patients with diffuse AA were treated with i.v. corticosteroid pulse therapy. Then, we tested whether sTARC can predict prognosis after the pulse therapy and found that baseline sTARC in the poor responders (1025.5 ± 484.8 pg/mL) was significantly higher than that in the good responders (complete remission at 24 months after the pulse therapy, 347.8 ± 135.7 pg/mL), indicating sTARC as a response biomarker in the corticosteroid pulse therapy for diffuse AA. Finally, to investigate TARC production in the affected hair follicles, we performed immunohistochemical double staining of TARC and CD68 using scalp skin specimens of diffuse AA with high titers of sTARC. The results showed their co‐localization in the infiltrating cells around the AA hair follicles, suggesting that TARC is mainly produced from CD68⁺ histiocytes. In conclusion, sTARC is a disease activity and response biomarker in AA, providing new insight beyond the T‐helper 1/2 paradigm to solve the immunological pathogenesis of AA.     

Effect of topical heparin and levomenol on atopic dermatitis: a randomized four‐arm,placebo‐controlled,double‐blind clinical study

Background The aim of the controlled double‐blind trial was to demonstrate the superiority of a topical combination product over its single constituents. Patients and Methods A total of 278 patients with atopic dermatitis were randomized into four groups: 79 patients were treated with a topical combination of levomenol and heparin (A), 80 patients with levomenol alone (B), 78 patients with heparin alone (C) and 41 patients with the cream base with no active substances (D). The medication was applied twice daily for 8 weeks. Efficacy criteria included the severity of pruritus (visual analogue scale, VAS) and the SCORing Atopic Dermatitis (SCORAD) index as well as the overall assessment of efficacy and tolerance by both physician and patient. Results The improvement of pruritus and SCORAD values in Group A was significantly higher compared with Groups B–D (ancova , P < 7 × 10^?8). The improvement of pruritus in Group A approximately corresponded to the cumulative effect of the two single active substances, with mean improvements of itching of ?41.3, ?13.3, ?21.3 and +0.6 mm VAS in Groups A–D, respectively (95% CI 7.1–13.5, 2.9–9.2 and 10.4–18.3 mm for the comparisons A vs. B, A vs. C and A vs. D). Conclusion The combination of levomenol and heparin proved to be significantly more efficacious in the treatment of pruritus and inflamed skin than the preparations of the single components.     

Cyanoacrylate dermatitis

An outbreak of irritant dermatitis from a cyanoacrylate glue among a group of electronic assembly workers is described. It was caused by vaporization of monomer under conditions of low relative humidity. No further outbreak occurred when the humidity of the working environment was raised above 55%.