Loffler, Harald; Effendy, Isaak
Dept. of Dermatology,
Phillipp-University of Marburg, Germany
Objective: The ear swelling
technique is the standard method for evaluating allergic skin reaction in
mice. However, in experimental irritant contact dermatitis, the epidermal
barrier disruption, which represents a predominant effect of irritants,
cannot be assayed by this method. An appropriate method to evaluate the
barrier disruption is the measurement of transepidermal water loss (TEWL)
but this was so far only possible on the trunk of nude or shaved mice. We
therefore developed a new technique to measure the TEWL of mice ears
(murine auricular TEWL: MATEWL).
Material and Methods: We
lengthened the cylinder of an evaporimeter probe, so that we could place a
whole ear of a mice in the cylinder. We measured the TEWL of a whole ear
before and after application of an irritant (sodium lauryl sulphate, SLS)
and an contact allergen (2,4-dinitro-flurobenzene, DNFB). We compared the
results with the measurement of ear swelling.
Results: The ear
thickness was remarkably higher (three to five times higher) in DNFB than
in SLS treated ears. The increase of MATEWL, however, was three times
higher in SLS than in DNFB treated ears.
Conclusion: We conclude
that for the evaluation of irritant induced epidermal barrier disruption
in mice, MATEWL measurement provides a novel approach that is superior to
the ear swelling method.
Case of Allergic Contact Dermatitis to a
Ibrahim Al-Aradi, M.D.
March 9 - 9:00 am
INTERESTING CASE OF ALLERGIC CONTACT DERMATITIS TO A PROSTHETIC
Dr. Ibrahim Al-Radi and Dr. Melanie Pratt
find possible sources of contact allergy and irritancy in this patient
with a prosthetic limb.
Method: We present a case of an 87 year old
gentleman with a congenital birth defect of the right leg which
necessitated an amputation in February, 1999. The patient had three
successive prosthesis over 10 months to which he developed an eczematous
dermatitis and secondary infection. Treatment included betamethasone
valerate cream, bactroban, uremol HC, myclo cream, halog unq. and oral
He was patch tested November, 1999 to:
1. NACDG Standard Series
2. Plastic and Glue
3. Steroid Series
4. Own topical
Results at 96 hrs:
1+ = imidazolidinyl urea
2+ = diazolidinyl urea
+ paratertiarybutyl phenol formaldehyde resin
3+ = uremol HC
1 + = fragrance
1 + = balsam of Peru
Dec/99 - The patient was patch tested to own components of
all prosthesis past, present and future. (12 things)
1+"Quick Sil" = (silicone material)
(impregnated with nylon and fiberglass)
3+ fitting putty made of
silicone used to shape stump
1+ duraplex (a plastic
Conclusions: The patent had a combination of allergic and
irritant contact dermatitis plus infection to account for his stump
problems. The relevance and sources of these positive allergens are
discussed and alternatives are suggested.
Hypersensitivity in Patients with Anogenital
March 9 - 9:10 am
DELAYED TYPE HYPERSENSITIVITY
IN PATIENTS WITH ANOGENITAL COMPLAINTS
Bauer Andrea, MD, Elsner
Department of Dermatology, Friedrich-Schiller-University Jena
Allergic contact dermatitis is common in the anogenital area. The results
of patch testing performed in 1008 patients, evaluated for allergic
anogenital contact dermatitis from 21 dermatological departments of the
Information Network of Departments of Dermatology (IVDK), from 1992 to
1997 were analysed.
The final diagnosis of allergic contact
dermatitis was made in 351 patients (34.8%). The allergen spectrum of
patients with anogenital complaints resembles that of all patients
(n=54.000) tested from 1992 to 1997. However, it is remarkable that
dibucaine HCI ranks fourth among contact allergens in the study
population. Positive reactions to chloromethylisothazolinone (CMI/Ml) and
to benzocaine --were observed more frequently among patients with
anogenital complaints compared to the total IVDK population (3.7% vs. 2.5%
and 2.7% vs 1.5 %). In general active agents of topical medicaments and
popular remedies, preservatives, and ointment bases appeared to cause
allergic reactions most frequently.
As a consequence of our
analysis, we recommend for patch testing in patients with anogenital
eczema to use the standard series, dibucaine HCI, propolis, bufexamac, and
further ingredients of topical preparations according to the patient's
Practices: ACDS Members
Jane Moore, M.D.
March 9 - 9:20
PATCH TESTING PRACTICES: ACDS MEMBERS
Jane Moore, MD, and
Erin Warshaw, MD, University of Minnesota, VAMC, Minneapolis,
The objective of this study was to evaluate patch testing
practices of American Contact Dermatitis Society (ACDS) members. An
independent, voluntary, nonproprietary questionnaire was sent to all 322
ACDS members. Returned questionnaires (46%) were computer scanned and
analyzed. The majority of respondents were male (61 %) and had practiced
for 11 -20 years (35%) in a Northeast U.S. (22%) private practice (36%).
Most patch tested 6-10 patients monthly (30%). Twenty-two percent of
responders used TRUE Test, most commonly because it was less
time-consuming (37%). Most (35%) applied an average of 26-50 patches and
96% applied personal items. The most prevalent patch test reading schedule
was 48, 96 hours (51 %) although 14% performed only one reading at either
48 or 72 hours. The most common "standard" trays utilized were European
standard (26%) and TRUE Test (27%). Sixty-five percent of respondents
photopatch tested. Seventy percent evaluated patients for latex allergy,
and 39% performed latex prick testing. Cosmetic allergy was the most
common (39%) subspecialty interest. Sixty percent stated they were not
satisfied with reimbursements. This study was supported by the Minneapolis
Veterans Affairs Medical Center.
Allergy in Israeli Contact Dermatitis Patients
March 9 - 9:30 am
GOLD ALLERGY IN ISRAELI CONTACT
Liran Horev1, Francis Afflo1, Abraham
Zlotogorski1, Shabtay Dikstein2 and Arieh Ingham1.
of Dermatology, Hadassah University Hospital, Jerusalem, Israel.
2 School of Pharmacy, Unit of Cell Pharmacology,
Hebrew University, Jerusalem, Isreal.
Background: Gold allergy is
a controversial subject. Given the high frequency of usage of gold in
jewelry and in dentistry and in implants there are surprisingly fewer than
expected reports of gold allergy. The relevance of positive patch tests
reactions to gold, is also not always clear.
The purpose of this study was to elucidate the frequency of positive
reactions to gold in patch tests among Israeli contact dermatitis patients
and its clinical relevance.
Method: Gold sodium
thiosulfate 0.5% in pet. Was included in our standard patch test series
and applied on the backs of 150 consecutive contact dermatitis patients.
The tests were evaluated in accordance with the ICDRG guidelines at day 2
and 4. A questionnaire on gold exposure and gold sensitivity was answered
by all the 150 tested patients.
Results: A positive
reactions to gold was found in 12 patients (8.0%) of the tested patients.
None of the patients received gold therapy. 56 out of 150 patients (37.3%)
responded that their ears were pierced. Of these 8 (14.3%) had positive
reaction to gold. 69 of 150 patients (46%) had had direct skin contact
with gold but only 13 (18.8%) had had skin symptoms on contact with gold .
10 of 150 (6.7%) thought they were hypersensitive to gold. Only 13 (18.8%)
had dental gold , 8 (5.3%) had oral
Conclusion: In routine patch tests of Israeli
Contact dermatitis patients the frequency of positive reactions to gold is
relatively high. The relevance is low except for ear piercing.
Dental Metal Allergy in
Subjects with Oral, Cutaneous, and Genital Lichenoid
Leigh Ann Scalf, B.S.
March 9 - 9:40
DENTAL METAL ALLERGY IN SUBJECTS WITH ORAL, CUTANEOUS, AND
GENITAL LICHENOID REACTIONS.
Joseph F. Fowler, Jr., M.D.,
Leigh Ann Scalf, B.S., Kelli W. Morgan, M.D., Stephen W. Looney, Ph.D;
Division of Dermatology and Department of Family and Community Medicine,
University of Louisville, Kentucky Background: The subject of lichen
planus (LP) and dental metal allergy has long been debated. An
overwhelming majority of the existing literature focuses on mercury and
gold salts in relation to oral lichen planus. Objective: Our objective was
to expand current knowledge regarding LP and lichenoid lesions (at) and
dental metal allergy (1) by investigating more dental metals, and (2) by
investigating cutaneous and genital disease in addition to oral disease.
Methods: Fifty-one patients with known LP or LL were patch tested to a
series of dental metals. Results: Thirty-eight of 51 patients (74.51%) had
at least one positive reaction. Twenty-five of 51 patients (49.0%) showed
sensitivity to at least one mercurial allergen. Prevalence data for
patients patch tested by the North American Contact Dermatitis Group
(NACDG) from 1994-1996 was available for: chromate, cobalt, nickel, and
thimerosal. The prevalence of positive reactions was higher in our group
than in the NACDG group for all four of these allergens and statistical
significance was achieved for chromate (p = 0.007) and thimerosal (p =
0.004). Conclusion: Sensitization to dental metals is more common among LP
and LL patients than in routinely tested patients, and may be an etiologic
or triggering factor in oral, cutaneous and genital LP and LL.
Tamara N. Salam, M.D.
March 9 - 9:50
BALSAM-RELATED SYSTEMIC CONTACT DERMATITIS
N. Salam, MD; Joseph F. Fowler, Jr., MD
University of Louisville,
Division of Dermatology, Louisville, KY
Background. Positive patch
tests to balsam of Peru (BOP) or fragrance mix (FM) may suggest the
possibility of systemic contact dermatitis from balsam-related foods and
Objective: A retrospective study to determine if avoidance
of balsam-related foods results in an improvement of dermatitis in these
Methods. A review of the records of all patients seen
from July 1st to December 31st, 1998 with positive patch tests to BOP, FM,
cinnamic aldehyde, and/or balsam of tolu was performed 9 to 14 months
after their evaluation in a tertiary dermatology center. All patients were
contacted via telephone to assess the status of their dermatitis and if
they were able to note any specific balsam-related food
Results: 75 patients were identified, and 71 could be
contacted. Fourteen were only allergic to BOP and/or FM on testing; 31
were positive to BOP/FM and other allergens with presumed relevance to
BOP/FM; 26 were positive to BOP/FM and others with other allergens felt to
be responsible for the dermatitis and were not placed on a BOP diet.
Excluding this last group, 21 of 45 (47%) had complete or significant
improvement that they related to dietary modification. 10 did not modify
their diet with 8 reporting no improvement. 8 improved with fragrance or
other allergen avoidance only, and 6 modified their diet unsuccessfully.
Most commonly implicated foods include tomatoes, citrus, and
Conclusion: Almost half of subjects with positive patch
tests to BOP and/or FM, who followed a BOP reduction diet, reported
complete/significant improvement of their dermatitis.
Allergic Contact Dermatitis (ACD) to Black Iron
March 9 - 10:00 am
EYELID ALLERGIC CONTACT
DERMATITIS (ACD) TO BLACK IRON OXIDE
University of Minnesota, Minneapolis, MN; Warshaw, Erin, VA Medical
Center; Ahmed, Debra, Mayo Medical Center, Rochester, MN
cosmetics contain a variety of pigments, fragrances, resins, preservatives
and vehicles. Mascara is one of the most commonly used eye cosmetics and
can cause irritant and allergic eyelid dermatitis.
We present a
case of eyelid ACD to black iron oxide. A 44-year-old woman presented with
a 10-month history of periorbital and eyelid dermatitis while using eye
cosmetics from a specific manufacturer. In spite of transient response to
prednisone and topical steroids, the eruption persisted. Epicutaneous
patch testing to T.R.U.E. Test, cosmetic, preservative, vehicle and
steroid series, and personal products yielded a marked reaction to her
black mascara. Subsequent patch testing to the mascara components provided
by the manufacturer revealed a severe reaction only to 5% black iron
oxide. This black iron oxide was further tested on 10 normal controls with
There is one previous report of ACD to iron oxide,
also presenting as eyelid dermatitis and found in eye cosmetics. In
summary, iron oxide should be considered an uncommon yet potentially
important allergen related to cosmetic eyelid ACD.
Claus Zachariae, M.D.
March 9 - 10:10
CUCUMBER CONTACT DERMATITIS
Claus Zachariae, Department
of Dermatology, Gentofte Hospital, University of Copenhagen, Niels
Andersen's Vej 65, DK-2900 Hellerup, Denmark.
causes allergic reactions. So far only oral contact urticaria, stornatitis
and food allergy have been described. Cucumber has not been reported to
cause delayed hypersensitivity reactions. We will here present a case of
possible allergic contact dermatitis to cucumber in a greenhouse
Cucumber (cucurnis sativus) belongs to a family of
cucurbitaceae vegetables also including watermelon and melon. As well as
causing irritant reactions they can all cause type I allergies especially
amongst catering workers. Irritant hairs on the surface of the plants
enhance the penetration of the antigen in to the skin.
42-year-old male greenhouse worker was referred to our department as he
had developed a severe eczematous reaction localized to the forearms, the
lower extremities and to a lesser degree the back. The first symptoms came
approximately 5 month after he had started working as a greenhouse farmer.
His job consisted of planting and pruning cucumber plants as well as
plucking cucumbers. His eczema was clearly work related as it started
clearing during the weekends. Patch test showed a ++ reaction at 3 and 7
days towards Formaldehyde, a ++ reaction at 2,3 and 7 days towards
dibrorndicyanobutane and a ++ reaction at 2,3 and 7 days towards cucumber
leaf as well as a + reaction at day 7 towards cucumber stem.
Pesticide Allergens in a Photopatch Testing Series
March 9 - 10:20 am - 10:45 am
PLANT AND PESTICIDE
ALLERGENS IN A PHOTOPATCH TESTING SERIES
Beck, Samuel MD;
Cohen, David E. MD, MPH; Soter, Nicholas A. MD.
The Ronald 0. Perelman
Department of Dermatology, New York University School of Medicine, New
Sunscreens, fragrances and biocides have classically been
described as allergens responsible for photo-allergic dermatitis. Reports
of newer photoallergens not included in standard allergen series have been
The purpose of this study is to evaluate the change in
the etiology of photo-allergic dermatitis over a thirteen year period,
from 1986-1999. The impact of including plant and pesticide allergens on
the overall epidemiology of photo-allergic dermatitis is
The results of photo-patch testing between December 1993
and December 1999 were compared to those tested between June 1986 and
Between 1993 and 1999, 33 patents were photo-patch
tested with the WU Skin and Cancer Unit's standard photo-allergen series,
which included plant and pesticide allergens. Thirteen patients had
positive tests, accounting for 37 positive photo-patch test reactions.
Fifteen (41%) positive tests were to sunscreens, 5 (13.5%) to fragrances,
8 (22%) to therapeutic agents, 6 (16%) to plants, and 3 (8%) to
pesticides. Between 1986 and 1993, 138 patients were photo-patch tested.
Fifty-three patients tested positive accounting for 77 positive
photo-patch test reactions. Forty-four (57%) positive tests were to
sunscreens, 14 (18%) to fragrances, 10 (13%) to therapeutic agents and 9
(120/6) to other agents.
The results indicate that plant and
pesticide allergens account for a substantial proportion of positive
photo-patch tests and should be included in a standard photo-patch test
allergen series. It appears that such an inclusion may increase the
sensitivity of photo-patch testing in those suspected of having
photo-allergic contact dermatitis. The inclusion of plants and pesticides
increases the positive yield of photo-patch testing.
Use of Topical
Tacrolimus in Chronic Actinic Dermatitis
Stacy L. Jacobs,
March 9 - 10:20 am - 10:45 am
USE OF TOPICAL TACROLIMUS
IN CHRONIC ACTINIC DERMATITIS
Stacy L. Jacobs and David E. Cohen,
M.D., MPH , Department of Dermatology New York University Medical Center,
New York, NY
A case of chronic actinic dermatitis in a 70 year old
is reported. He had a a two-year history of generalized pruritic eruption
on his head, neck, trunk and extremities. Treatment with systemic
corticosteroids resulted in transient improvement while treatment with
plaquenil and topical and intralesional steroids provided no relief. Use
of topical tacrolimus resulted in a marked decrease in erythematous
lichenified hyperpigmented plaques on sun-exposed areas. Phototests showed
a reduced minimal erythema dose response to UVA, a normal minimal erythema
dose to UVB, and no response to visible light. Photopatch tests were
negative with negative corresponding non-irradiated patch test
Allergy to Corticosteroids in Patients Who Have
Used Inhaled or
Michelle L. Bennett, MD
March 9 -
10:20 am - 10:45 am
CONTACT ALLERGY TO CORTICOSTEROIDS IN PATIENTS
WHO HAVE USED INHALED OR INTRANASAL CORTICOSTEROIDS
L. Bennett, M.D. and Elizabeth F. Sherertz, M.D. Wake Forest
University/Baptist Medical Center Winston-Salem, NC, USA
purpose of this investigation is to determine if skin allergy to
corticosteroids is a common occurrence in patients with allergic rhinitis
or asthma who use inhaled or intranasal corticosteroids. Several case
reports describe this phenomenon, but no controlled epicutaneous patch
test study has been performed to determine the prevalence of
Evaluation of thirty subjects with asthma
or allergic rhinitis will include pertinent history and physical
examination as well as patch testing using all available inhaled and
intranasal corticosteroid preparations as well as four common screening
steroids, the vehicle propylene glycol and the preservative benzalkonium
We will report our findings, including the percentage of
subjects with positive patch test results, providing information as to the
prevalence of corticosteroid allergy in this patient population. A
literature review will also be performed, and prior case reports as well
as studies using intradermal testing will be summarized.
descriptive pilot study, we expect to demonstrate that contact allergy to
corticosteroids in intranasal and inhaled preparations is an uncommon
Contact Dermatitis from
Preimpregnated Epoxy Products
Lasse Kanerva, MD
March 9 - 10:20 am - 10:45
OCCUPATIONAL ALLERGIC CONTACT DERMATITIS FROM PREIMPREGNATED
EPOXY PRODUCTS (PREPREGS)
Kanerva L, Estlander T, Jolanki R,
Henriks-Eckerman M-L, Tarvainen K. Finnish Institute of Occupational
Health, Helsinki, Finland
Objective: To describe a patient with
occupational allergic contact dermatitis from preimpregnated epoxy
Case Report and Methods: The patient was a
30-year-old laminator in an aircraft plant. He assembled aircraft parts
and was occupationally exposed to preimpregnated carbon fiber and
fiberglass sheets (prepregs) and epoxy tapes. Standard epoxy (DGEBA-ER)
provoked a -+ patch test reaction. In the next patch test session
triglycidyl-paminophenol (TGPAP; 1%-0.25%, 2+; 0.05%, 1+) and
tetraglycidyl-4,4'-methylenedianiline (TGMDA; 1%, 3+; 0.5%-0.05% 2+)
provoked allergic patch test reactions, whereas
o-diglycidylhexahydrophthalate was negative (1%- 0.05% pet). Six prepreg
products used by the patient were extracted by ultrasound sonification for
5 min, 10% w/v and tested in dilution series in acetone. They all provoked
allergic patch test reactions. The products were also analyzed for their
TGPAP, TGMDA and DGEBA content with gas and liquid chromatographic
methods, showing up to 10% of TGPAP, 19% of TGMDA and 5% of DGEBA-ER in
Conclusion: The patient had been occupationally
sensitized to TGPAP and TGMDA from prepregs and tapes. He was not able to
continue in his previous job but continued as an inspector at his
work-place. Even in this new task he had several relapses of dermatitis on
his face because he worked close to work-sites where epoxies were used.
This face dermatitis indicated airborne allergic contact dermatitis from
epoxies. TGPAP and TGMDA need to be used when patch testing patients
exposed to prepregs.
Chromium, Lead and Arsenic in Eye
March 9 - 10:20 am - 10:45 am
NICKEL, COBALT, CHROMIUM,
LEAD AND ARSENIC IN EYE-SHADOWS
Kanerva L (1), Jolanki R (1),
Hakala E (2), Sainio E-L (3) (1) Section of Dermatology, Finnish Institute
of Occupational Health, 00250 Helsinki (2) Oulu Regional Institute of
Occupational Health, 90220 Oulu (3) Consumer Agency and Ombudsman, Product
Safety, 00530 Helsinki, Finland
Background and Objectives: The
regulations relating to cosmetic products give no limit values for toxic
elements such as metals or arsenic (As) occurring as impurities in
cosmetic products. It has been proposed that the levels of nickel (Ni) or
cobalt (Co) should not exceed 5 ppm and should preferably be below 1 ppm.
The levels of As and lead (Pb) should not exceed 5 and 20 ppm,
respectively, and the level of water-soluble chromium (Cr) should
preferably be less than 2 ppm.
Material and Methods: Pb, Co, Ni, Cr
and As in eye-shadows in 88 colors of 25 brands and 49 products were
analyzed by electrothermal atomic absorption spectroscopy using Zeeman
background correction, matrix modification and pyrolytic tubes with wall
or platform atornization.
Results: 66 out of 88 (75%) of the colors
contained more than 5 ppm of at least one of the elements, and all 49
products contained more than one 1 ppm. of at least one of the elements.
In one color the amount of all elements was less than I ppm The highest
levels of Co and Ni were 41 and 49 ppm, respectively. These levels were
high enough to cause allergic symptoms in those previously sensitized.
Furthermore, long-term exposure to such levels may probably sensitize. The
concentrations of As were extremely low, 2.3 ppm at most. The level of Pb
was less than 20 ppm in all products. Accordingly, the concentrations of
As and Pb seemed to be safe. 9 colors had concentrations of water-soluble
chromium exceeding 2 ppm, and a very high level, 318 ppm, was encountered
in one case.
Conclusion: The results indicate that eye-shadows have
no significant systemic toxicological effects. The group at greatest risk
are those already sensitized to the allergenic elements. Such consumers
will have difficulties in choosing suitable products, since these elements
in the form of impurities are not declared in the list of ingredients.
Manufacturers should demand certification that the raw materials they buy
contain no toxic elements.
Mario Cezar Pires, MD
March 9 - 10:20 am -
Authors: Pires MC; Oliveira NRA;
Lopes LF; Andretta N; Landman G.
Institution: Complexo Hospitalar
Padre Bento de Guarulhos
The term "Actinic
Reticuloid" was joined by Hawk and Magnus in 1979. This is a
photodermatosis related to UVA, UVB and visible light. It is more common
in men and atopic patients. Frequently the patients show a chronic contact
dermatitis due allergens such as: nickel, cobalt, potassium dichromate and
others. Nowadays, the actinic reticuloid is classified in the group of the
actinic chronic dermatitis.
We present a case of a male, 59 years
old, machine technique who showed erythematous and scaling lesions in the
arm, neck and face. The patient told a history of chronic contact
dermatitis that worsens with the sun. Nowadays he is retired but the
The patch test was positive to 9 allergens.
Then we suspected the excited skin syndrome and we repeated the test with
these substances separated and all were positive again.
was treated with azathioprin 150 mg by day and improved after 16
Formulations of Sensitive Skin Products
March 9 - 10:20 am - 10:45 am
SENSIBLE FORMULATIONS OF
SENSITIVE SKIN PRODUCTS
Rachel Quinby, M.D. Andrew Scheman,
Northwestern University Medical Center Chicago, IL
presentation reviews the existing literature on ingredients known to
aggravate sensitive skin. The focus is then shifted to a rational approach
for designing products which will be optimally tolerated by individuals
with sensitive skin and to a list of preferred ingredients serving various
functions in such products.
Potassium Hydroxide and Trichloroacetic Acid
Irritation on In Vitro Percutaneous
Marylou C. Thelmo, MD, MPH
March 9 - 10:20 am -
EFFECT OF POTASSIUM HYDROXIDE AND
INDUCED SKIN IRRITATION ON IN
VITRO PERCUTANEOUS PENETRATION OF
Marylou C. Thelmo, M.D., M.P.H., Hanafi Tanojo,
Leanne L. Zhang, and Howard I. Maibach, M.D.
Dermatology, University of California,
San Francisco, CA
Objective: To study the change in the in vitro
percutaneous penetration of estradiol on excised skin pre-treated with two
Methods: Pretreatment of fresh human skin with various
concentrations of potassium hydroxide (KOH) for 2 hours and of
trichloroacetic acid (TCA) for 24 hours. Penetration of [14C]-estradiol
through the pre-treated skin was monitored using in vitro diffusion cells.
Untreated skin was used as control.
Results: There was a
significant decrease in skin permeability to estradiol on KOH pre-treated
skins compared to control. Comparisons between 0.05%, 0.1%, and 0.2% KOH
were significant. Skin permeability of estradiol decreased significantly
after 7.5% TCA pre-treatment compared to control, 20%, and 30%
Conclusion: KOH and TCA damage the skin barrier property thus
blocking the permeation of lipophilic compounds. The damage is
dose-dependent. However, there may be more than one mechanism
Acknowledgement: This work was supported by a research
fellowship (MCT) from the American Contact Dermatitis Society.
J.M. Femandez-Vozmediano, MD
March 9 -
10:20 am - 10:45 am
RELIABILITY OF T.R.U.E.
Fernandez Vozmediano JM, Armario Hita JC
Service. University Hospital of Puerto Real. University of
INTRODUCTION. There are numerous studies which compare
the reliability of TRUE test (TT) with Finn Chamber (FC). We present a
comparative study carried out on our population.
METHOD. Epicutaneous tests were carried out on 168 patients simultaneously
with TT and FC, the readings were made after 48 and 96
RESULTS. The patients had an average age of 33.41± , they
were 60% female. 68% presented eczema on the hands, 35% were housewives.
The most frequent allergens were nickel sulphate (46%), cobalt dichloride
(14%) and potassium dichromate (9%). The total concordance was of 68%. For
the total of the tests, sensitivity of TT compared to FC was of 69% and
specificity was of 99%. For some allergens, relative sensitivity was even
CONCLUSIONS. The proportion of false negatives of TT
compared to FC is very high, this fact leads to a lower number of
diagnosis. Protocoled epicutaneous tests carried out with FC present
higher sensitivity as a screening ACD test compared to TT.
By Three Commercial Adhesive Tapes:
March 9 - 10:20 am - 10:45 am
BY THREE COMMERCIAL ADHESIVE TAPES: A DIFFERENCE
S. J. Bash
A. L. Chew, A. Anigbogu, F. Dreher & H.I. Maibach Department of
Dermatology, University of California, San Francisco
Tape stripping of the stratum corneurn (SC) has been performed to measure
stratum corneum, barrier function, drug reservoir and percutaneous
Objective: Quantification of SC tape stripping and
water kinetic parameters utilizing three types of adhesive
Methods: SC was tape stripped and the mass of SC removed by
each tape quantified utilizing a protein assay. Transepidermal water loss
was measured, barrier disruption and SC water kinetics calculated. Three
common acrylate adhesive tapes were utilized and a comparison made between
Results: Each tape successfully stripped the SC, but the
rayon tape did not induce barrier disruption. Neither tape type nor site
significantly influenced the mass of SC removed. Water kinetics did not
differ significantly. Individual variation in barrier disruption to water
following tape stripping was demonstrated.
Conclusions: The tapes
removed a similar amount of SC. but have a different propensity to cause
barrier disruption. Some individuals do not demonstrate increased TEWL
despite an equivalent mass of SC being removed compared to those who do
show a response.
Birmingham and Occupational Dermatology in the U.S. Public Health
James S. Taylor, M.D.
March 9 - 10:50
DONALD J BIRMINGHAM AND OCCUPATIONAL DERMATOLOGY IN THE US
PUBLIC HEALTH SERVICE
James S. Taylor MD(1), Boris D.
Lushniak MD(2), Earl J. Rudner MD(3), and Marcus M. Key MD(4): Cleveland
Clinic, Cleveland OH(l); National Institute for Occupational Safety and
Health, Cincinnati, OH(2); Henry Ford Hospital, Detroit MI(3); and
University of Texas, Houston TX(4).
Donald J Birmingham MD
(1911-1998), ACDS honorary member, was a major contributor to occupational
dermatology in the United States. He served in the US Public Health
Service (USPHS) for 23 years and directed its occupational dermatology
activities from 1951-1964. Later he was chair of the departments of
Occupational and Environmental Health and Dermatology at Wayne State
University. During his career Birmingham made seminal contributions to our
present understanding of occupational skin disease through his clinical
reports, as well as through his research, educational and public policy
In the USPHS he continued a program begun in 1928 by Dr Louis
Schwartz at the National Institutes of Health. Field and laboratory
investigations included studies in the munitions, aircraft, machine tool,
pesticide, agricultural, food processing, mining, petroleum and plastics
industries. This work included major descriptions of cashew nut shell oil,
chromium, printing ink, and epoxy, polyester and formaldehyde resin
contact dermatitis, as well as dermatitis among TNT and tetryl workers,
oil acne, chloracne, arsenical dermatoses and phototoxicity from pink rot
celery. He was the major contributor to the 3rd edition of Schwartz,
Tulipan and Birmingham's Occupational Skin Diseases in 1957, and directed
a number of seminars including a month long didactic and field work course
in May 1967. He was a member of the AMA Committee which wrote the first
edition of the Guides to the Evaluation of Permanent Impairment and was
chair of the committee on the skin. Honors included the USPHS Meritorius
Service Medal and election as vice-president of the American Academy of
Dermatology. He never fully retired and continued to serve as a consultant
to industry and government. Donald Birmingham's career was characterized
by scholarship, mentorship, and major achievement with quiet reserve,
humor, modesty, honesty, and devotion to his family.
Skin Disease Prevention Project in the
Peter Elsner, M.D.
March 9 - 11:00 am
OCCUPATIONAL SKIN DISEASE PREVENTION PROJECT IN THE FOOD PROCESSING
Bauer Andrea, MD, Kelterer Daniela, MD, *Stadeler Martina,
MD, *Schneider Wolfgang, MD, *Kleesz Peter, MD, Elsner Peter, MD
Department of Dermatology Friedrich-Schiller-University Jena, *Research
Center for Applied System Safety and Industrial Medicine Erfurt,
Statistical reports of occupational diseases show high
incidences of occupational skin diseases in employees in the food
processing industry. Since January 1999 23 employees were included in an
interdisciplinary skin disease prevention program. After the analysis of
the occupational exposure and the personal occupational disease history,
diagnosis and therapy were re-evaluated and supplemented if necessary.
Individual skin care and protection regimes will be demonstrated and
practised. Since January 1999 16 employees were examined in the
occupational clinic. 75% of the employees had an irritant contact
dermatitis. The preliminary results showed that most of the occupational
skin diseases are due to no, wrong or misplaced skin care and protection
habits. 7 (44%) employees were followed up till now. In 43% skin condition
improved and/or healed. Moreover in 43% the skin condition was stable
although they stayed at work. These first results are promising. More
employees will be included and the program will be expanded.
Buffering Solution as a Protectant for Workers
March 9 - 11:10 am
BUFFERING SOLUTION AS A PROTECTANT FOR WORKERS USING
Marilyn Larson, Rodney Wolford, FOF Communications,
Alkaline pH has been shown to impede barrier
recovery while acidification of the SC enhances ft. Thus, workers using
alkalies may benefit from buffering rinses.
OBJECTIVE: To assess
the efficacy of a pH 5.5 buffering rinse to improve the condition of skin
occupationally exposed to alkalies, compared with water washing,
moisturizers, and gloves.
METHOD: Pre/post treatment surveys 30
days apart of 30 concrete truck drivers. Workers reported daily on use of
the four treatments. Workers were grouped by treatment compliance
(high/low). Relative risk for skin improvement was estimated between
compliance groups (Chi-Square).
RESULTS: Workers using buffering
rinse were 7.8 times more likely than workers not using ft to report
improvement (Cl: 1.2, 50.8; p=.001 ). No differences were seen between
workers using and not using water washes (p=.276), moisturizers (p=.311),
or gloves (p=.122). No difference in reported frequency of symptoms was
seen between compliance groups for any treatment
CONCLUSION: Skin exposed to alkalies may benefit from pH
5.5 buffering rinses. This conclusion is consistent with a requirement for
acidic pH in restoration of normal barrier recovery.
Occupational Skin Diseases in
Finnish Dental Nurses
Paivikki Susitaival, M.D.
March 9 -
OCCUPATIONAL SKIN DISEASES IN FINNISH DENTAL
Alanko K, Susitalval P, Estlander T, Jolanki R, and Kanerva
Finnish Institute of Occupational Health, Helsinki,
Objectives: Causes of occupational skin diseases (OSD) were
studied in a population of dental nurses. Material and methods: A
telephone interview, using a modified Tuohilampi questionnaire, was done
to 799/923 female dental nurses. 327 nurses (41%) reporting work-related
hand or facial dermatitis were invited to a medical interview and 245
nurses participated. 26 nurses had been previously diagnosed as having
OSD. 119 met the criteria for suspected undiagnosed OSD and were selected
for further clinical examinations with skin prick and patch testing.
Results: Among the 105 nurses examined, 21 new cases of OSD were
diagnosed. Among the 47 OSD cases, there were 27 diagnoses of allergic
contact dermatitis (ACD), 14 of contact urticaria (CU), and 10 nurses with
irritant contact dermatitis alone. Causes of ACID included (meth)acrylates
(10), rubber chemicals (10), and Ampholyte 103G (7). The cause of CU was
natural rubber latex (NRL) in 13 cases. Among the 19 examined with
latex-related Immediate complaints only none were diagnosed with CU.
Conclusions: Components of protective gloves and dental (met)acrylates
were the most common causes of allergy. 84% of the interviewed nurses
handled dental restorative plastics daily. 90% of the nurses used
protective gloves regularly. One fourth of the interviewed population
complained about latex-glove related skin problems but very few cases of
latex-CU were diagnosed.
ACD to Glutaraldehyde
in Health Care Workers
Donald V. Belsito, M.D.
March 9 -
ACD TO GLUTARALDEHYDE IN HEALTH CARE
Matthew P. Shaffer, B.A. and Donald V. Belsito, M.D.,
Dermatology, University of Kansas Medical Center, Kansas City, KS
In a five-year study, 468 patients were patch tested to
glutaraldehyde (1% and 0.2% in pet [1994-1996], 1% and 0.5% in pet
[1996-1998] or 1% in pet [1998-1999]). In addition, all patients were
tested to the NACDG's Standard Tray, which included formaldehyde (1% aq).
A comparison of results was made between health-care workers (HCWs) and
those who were not. HCWs allergic to glutaraldehyde were subsequently
questioned about their dermatitis, disease course following diagnosis,
occupational changes, glove usage and safety training while using
HCWs were more likely to be allergic to
glutaraldehyde than nonhealth-care workers (NHCWs): 17.6% vs 1.9% (p <
0.001). Statistically significant differences between HCWs and NHCWs were
also seen in their reactivity to thimerosal (p 0.002), benzalkonium
chloride (p = 0.046), and methyl methacrylate (p 0.003). Using a
chi-square test with Yate's correction, a higher than expected
co-reactivity to formaldehyde was also noted among HCWs and NHCWs allergic
to glutaraldehyde (expected co-reactivity, 1.53; observed co-reactivity, 7
[p < 0.001]), which cannot fully be explained by concomitant
In our study, ACD to glutaraldehyde often caused
persistent occupational dermatitis, which forced 3/6 workers to leave
their jobs. In 3 workers who remained in health-care, 2 had persistent
dermatitis despite precautions. Three workers were unavailable to
follow-up, 2 of the 3 because of pending litigation. Although NIOSH has
published guidelines for safe handling of glutaraldehyde, sensitized
workers in our study were unaware of these guidelines. It is essential
that workers exposed to glutaraldehyde heighten occupational safety
standards and improve barrier protection. The potential
cross-sensitization to the more ubiquitous formaldehyde molecule
accentuates the need for adherence to prescribed safety
Methacrylates (2-HEMA, TREGDMA) Through Disposable Protective
Gloves Lasse Kanerva, M.D.
March 9 - 11:40 am
METHACRYLATES (2-HEMA, TREGDMA) THROUGH DISPOSABLE PROTECTIVE
Kanerva L, Makela EA, Vaananen V, Jolanki R, Estlander
T, Alanko, K
Finnish Institute of Occupational Health, FIN-00250,
Objective: Methacrylate (MA) allergy is an
increasing problem, especially for dental personnel. Gloves are important
in avoiding skin contact with MAs, but usually gloves are not certified
for chemical protection against MAs.
Methods: A 50% mixture of
2-HEMA and TREGDMA was used as a test chemical. The study was carried out
according to the European standard EN 374-3 with the open loop method,
using purified water as collection medium and detecting the chemical with
an HPLC/UV-detector. Ten different types of disposable gloves were
studied. Some analyses were made with 2 glove samples on top of each other
Results: The breakthrough times (BTT) of the MA
mixture through glove materials varied from 3.5 min to >8 h:
methylethyl MA gloves (3.5 min), PVC gloves (8.2-10 min), natural rubber
latex (NRL) gloves (9.4 -16 min), nitrile gloves (14 -72 min) and
polychlorophene/ copolymer gloves (62 min). The BTTs of double gloving
were 1.2 - 2 fold compared to the sum of the BTT of single gloves, e.g.
the BTT time of polyethene glove (PE) combined with NRL glove was >
Conclusions: Some disposable glove materials, e.g. nitrile
gloves, can be used as barriers to MAs. Double-gloving seems to be
beneficial in reducing skin exposure; adding a simple PE glove under
another glove improves the protection considerably. Manufacturers should
be required to type-test gloves before marketing them for special
purposes, e.g. dentistry.
Contact Allergy, An Unsuspected Source of
E. Andersen, M.D.
March 9 - 11:50 am
IMMERSION OIL CONTACT
ALLERGY, AN UNSUSPECTED SOURCE OF EPOXY ALLERGY
Andersen*, Ole.J. Clemmensen#, *Department of Dermatology and #Department
of Pathology, Odense University Hospital, Odense, Denmark.
four laboratory technicians working at the chromosome laboratory at the
department of pathology developed recurrent dermatitis on hands, face and
neck during the fall of 1998. The dermatitis was strictly work related
with aggravation on workdays, improvement in weekends and complete
clearing during longer holidays and vacation. A new immersion oil was
introduced in the laboratory in February 1998. The label did not contain
any warning or information about the components of the oil. Standard
battery patch testing revealed an unexpected positive reaction to epoxy
resin in 3 of the 4 laboratory technicians. Use-test and patch testing
with the oil was strongly positive and the dermatitis cleared completely
after removal of the oil. Subsequent information on the oil revealed that
it contained epoxy resin. In the literature publications appeared
describing an epidemic of occupational contact dermatitis from an
immersion oil for microscopy. According to a recent publication (Le Coz
and coworkers. Contact Dermatitis 1999; 40: 77-83) the newly formulated
immersion oil had been withdrawn from the market. Unfortunately, the
company marketing the oil had not taken the necessary steps to inform
laboratories using the oil about the epoxy problem.
Relationships in Elicitation of lsoeugenol
Klaus E Andersen, M.D.
March 9 - 2:00
TIME/DOSE RELATIONSHIPS IN ELICITATION OF ISOEUGENOL CONTACT
Klaus E. Andersen*, Department of Dermatology, Odense
University Hospital, Denmark.
*Presenting author on behalf of the
European perfume allergy group
J. Duus-Johansen, T. Menne, S. Rastogi;
Denmark; M. Bruze, Sweden; P. Frosch, Germany; A. Goossens, Belgium; I.
White, UK; J.-P. Lepoittevin, France
A total of 27 isoeugenol
sensitive patients and 7 controls underwent serial dilution patch testing
with isoeugenol in ethanol and subsequently Repeated Open Application Test
(ROAT) with isoeugenol in ethanol in 2 concentrations: 0.2% and 0.05%. The
ROAT was performed blindly and the participants applied the test solutions
to the right and left arm twice daily until a visible reaction appeared or
for a maximum of 28 days. The ROAT sites were evaluated and the amount of
isoeugenol solution used was measured once a week. 16/27 (59%) (Fisher
test, p=0.0085) showed a positive ROAT to isoeugenol 0.2% and 10/27 (37%)
(Fisher test, p=0.055) had positive ROAT to 0.05%. The controls were
negative. There was a significant linear dose response relationship
between the patch test reactivity and the number of days until the ROAT
became positive for both concentrations of isoeugenol. The total amount of
isoeugenol solution 0.2% used in the ROAT among those developing
dermatitis varied between 0.11 g and 1.54 g. Those with a negative ROAT
used a total of 1.76 g (25% and 75% fractiles: 1.24 g and
Dermatologists' Approach to Patch Testing
March 9 - 2:10 pm
U.S. DERMATOLOGISTS' APPROACH TO
Erin Warshaw MD, University of Minnesota and Veterans
Affairs Medical Center, Minneapolis, MN
One-third (3,215) of all
American Academy of Dermatology Fellows with U.S. addresses were
systematically sampled using a written questionnaire on patch testing
practices. Forty-three percent (1,372) of surveys were returned, computer
scanned (Teleform software), and tabulated (Microsoft Access software).
Eighty-three percent of responding dermatologists patch tested and most
(83%) patch tested five or fewer patients per month. The most common
reason given for not patch testing was poor reimbursement. While the
majority of dermatologists (52%) employed a 48-hour, 96-hour patch test
reading schedule, 26% only performed a single reading at 48 or 72 hours.
The majority of dermatologists (74%) used TRUE Test and most (44%) did so
because it was less time-consuming for staff. Many dermatologists (46%)
felt that they were patch testing more patients now than when TRUE Test
was not available. Only 11 % of dermatologists performed photopatch
testing although 24% said that allergic contact dermatitis was one of
their special interests and 80% had at least one specialty book on contact
dermatitis. This independent, non-proprietary study was supported by the
Minneapolis Veterans Affairs Medical Center.
Contact Dermatitis Group Patch Test
G. Marks, Jr., M.D.
March 9 - 2:20 pm
NORTH AMERICAN CONTACT
DERMATITIS GROUP PATCH
TEST RESULTS 1996-98
James G. Marks, Jr.
-M.D. The Milton S. Hershey Medical Center,
Hershey,PA, Donald V.
Belsito, M.D., Kansas University Medical
Center, Kansas City, KS,
Vincent A. DeLeo, M.D., St.
Lukes/Roosevelt Hospital Center, New York,
NY, et al
Objective: We report patch testing results from July 1,
1996 to June 30, 1998 on over 3,400 patients with suspected allergic
Method: The patients were evaluated and then
patch tested by 12 North American Contact Dermatitis Group (NACDG)
dermatologists with a screening series of 50 allergens using a
Results: The patients' age in the 1996-98
study ranged from 3 to 96 years. 70.8% had at least one positive allergic
patch test reaction. The most frequent primary diagnosis was allergic
contact dermatitis (48.5%) followed by irritant contact dermatitis (15%),
other dermatitis (13.4%), other dermatoses (9.8%), and atopic dermatitis
(6.6%). The new allergens tested in the 1996-98 series were sodium gold
thiosulfate, methyldibromo glutaronitrile/phenoxyethanol, and
Conclusions: Patch testing remains a worthwhile
diagnostic tool in evaluation of patients with suspected allergic contact
dermatitis. The screening series will evolve over time based on experience
with previously tested antigens and the introduction of new
Routine Testing for Primula Obconica Useful in the
Christen M. Mowad, M.D.
March 9 - 2:30 pm
ROUTINE TESTING FOR PRIMULA OBCONICA USEFUL IN THE UNITED
Christen M. Mowad MD
Geisinger Medical Center, Danville,
Background: Primula obconica is a known sensitizer.
However, reports of allergic contact dermatitis to this allergen are
higher in Europe than in the United States. The incidence of allergy to
Primula obconica in the United States is hard to access because no series
of routine testing to this allergen has been performed.
This study evaluated 567 consecutive patients for
sensitivity to this allergen as part of a standard screening. Patients
were tested to primin 0.01 % in petrolatum (Trolab). Patches were applied
in a standard fashion, applied to the upper back and left in place for 48
hours. All patients underwent two separate readings.
One positive reaction was identified. This patient also had an expanded
plant series tested and these were all negative.
Although not always apparent and therefore, difficult to diagnose, the
frequency of primin allergy in this series was too low to do routine
testing to this allergen. These findings do not support the use of routine
testing to Primula obconica in the United States.
the Pareto Principle, Lorenz Curves, and Gini Coefficients to Patch
Philip D. Shenefelt, M.D.
March 9 - 2:40
RELEVANCE OF THE PARETO PRINCIPLE, LORENZ CURVES, AND GINI
COEFFICIENTS TO PATCH TESTING
Philip D. Shenefelt, M.D.,
University of South Florida, Tampa, Florida, USA
contact allergens are much more frequent problems in a given population
than are others. Of the roughly 3000 known delayed contact sensitizers,
only a small proportion account for most of the cases of allergic contact
The purpose of this study is to describe and illustrate
concepts for examining the concentration of cases within categories and
their relevance to patch testing.
Three methods of describing
concentrations of cases within a category were borrowed from economics
theory and applied to the results of two recent reports of the frequency
of specific patch test positivity.
The Pareto Principle was found
to provide a rough rule of thumb concerning the concentration of specific
patch test antigen positive results in the study groups of patients. The
Lorenz curve was shown to provide a graphic illustration of this
concentration of cases of specific allergen positivity. The Gini
coefficient was found to provide a numerical indicator of the degree of
concentration of the results.
The Pareto Principle, Lorenz curves,
and Gini coefficient are useful descriptors for examining the
concentration of cases with respect to specific patch test
New Method to Facilitate Successful Antigen Avoidance: Database
Generated Guide of Skin Care Products Free of the Patients'
James A. Yiannias, M.D.
March 9 - 2:50 pm
NEW METHOD TO FACILITATE SUCCESSFUL ANTIGEN AVOIDANCE: DATABASE GENERATED
GUIDE OF SKIN CARE PRODUCTS FREE OF THE PATIENTS' ALLERGENS
A. Yiannias, M.D., Assistant Professor of Dermatology, Mayo Clinic
Rokea A. el-Azhary, M.D., Associate Professor of
Dermatology, Mayo Clinic Rochester
Commercial availability of patch
testing has allowed dermatologists the ability to more readily diagnose
contact allergy. However, antigen avoidance compliance is commonly
difficult in part because of the complexity of antigen names and the
consequent difficulty in finding appropriate skin care
Traditionally, following patch testing "negative" antigen
avoidance methods are utilized. This approach lists the sources of the
allergen and the general methods of avoidance. We have developed a
"positive" approach that utilizes a database of nationally available skin
care products. The physician or medical staff enters the name of the
identified antigen(s), and the database generates an extensive list of
commercially available soaps/shampoos, moisturizers, sunscreens, make-ups,
and other skin care products that are free of the designated
This interactive database will be demonstrated as an
evolving educational tool to facilitate the successful avoidance of
Patch-Test Substances May Mask Detection of Perfusion and Affect
Perfusion Assessments Made with the Laser Doppler Imaging Technique
Bolli Bjamason, M.D.
March 9 - 3:00 pm
OF PATCH-TEST SUBSTANCES MAY MASK
DETECTION OF PERFUSION AND AFFECT
ASSESSMENTS MADE WITH THE LASER DOPPLER IMAGING
Ellen Flosadottir2 and Torkel
1 Department of Dermatology, Karolinska
Hospital, Stockholm, 2 Faculty of Odontology, Karolinska Institute,
Stockholm, 3 National Institute for Working Life, Solna,
Objective: To investigate effect of pigmented patch-test
substances on assessment of perfusion made with the
Materials: Subjects allergic to balsam of Peru were retested
with variably pigmented balsam of Peru test substances applied with
transparent polyester patches and directly in a petrolatum vehicle with
transparent foils. Readings were performed with the LDIT prior to and
following detachment of the foils with an instrument set-up that we have
suggested for non-pigmented substances on white skin.
Results show that pigment remnants following detachment of tests may mask
detection of perfusion and affect perfusion
Conclusion: Pigment of patch-test substances may
affect perfusion assessments with the instrument set-up suggested for
Acknowledgments: The Swedish Foundation
for Health Care and Allergy Research, the Welander-Finsen
Edward M. Jackson, PhD
March 9 - 3:10
PEDICULICIDE CONTACT DERMATITIS
Edward M. Jackson,
Jackson Research Associates, Inc. Sumner,
INTRODUCTION Pediculicides have been limited to naturally
occurring pyrethrum and its chemically synthesized analogs, the
permethrins, in topical over-the-counter drugs. In June, 1999 malathion
was re-introduced as a topical prescription drug pediculicide.
1998 Florida began a malathion spraying program to control the
Mediterranean fruit fly. This program was similar to the California
infestation control program.
METHODS The contact dermatitis
potential of malathion presented by a complete review of the contact
dermatitis literature, the Center for Disease Control Florida spraying
surveillance program results as published in the MORIBIDITY AND MORTALITY
REPORT will be reviewed. The content of two Internet sites, one of which
presents uninformed opinion and the other scientifically and medically
based facts, will also be summarized.
should be informed on the safety of malathion to be able to answer patient
questions and prescribe safe and effective remedies.
Corticosteroid Patch Test Preparations
March 9 - 3:40 pm
STABILITY OF CORTICOSTEROID PATCH
Marlene Isaksson, Birgitta Gruvberger, Lena
Persson, Magnus Bruze
Department of Occupational and Environmental
Dermatology, Malmo University Hospital, Malmo, Sweden
chemically investigate the stability of 3 corticosteroid patch test
markers, tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate
(Hc-17-B) in petrolatum preparations and in ethanolic
Method: Petrolatum preparations and ethanolic solutions
containing each corticosteroid as well as mixtures of the 3
corticosteroids were made up and kept at room temperature, refrigerated
and deep frozen. To check the stability high performance liquid
chromatography analyses were carried out repeatedly for 1 year. A decrease
of -<20% of the value at time 0 was used as the threshold for
Results: All preparations with the corticosteroids in
petrolatum and tixocortol pivalate and budesonide in ethanol were stable
during the investigative period, irrespective of storage conditions.
Hc-17-B in ethanol was stable during the whole investigative period only
when kept deep frozen.
Conclusions: All investigated petrolatum
preparations were stable at least during 1 year, irrespective of storage
conditions. The chemical stability of Hc-17-B in ethanol was dependent of
concentration and storage conditions.
Contact Dermatitis from IPBC
Tove Agner, M.D., PhD
9 -3:50 pm
ALLERGIC CONTACT DERMATITIS FROM IPBC
T, Bryld LE and Menne T
Department of Dermatology, Gentofte University
Hospital, DK-2900 Hellerup, Denmark.
Background: Only few
occurrences of allergic contact dermatitis to IPBC
(3-iodo-2-propynyl-butylearbainate) have been recorded to date. While the
first cases reported were seen in men with an occupational or unknown
exposure (1), a cosmetics-associated case of allergic contact dermatitis
due to IPBC has recently been published (2).
review our experience with three and half years of consecutive testing
with IPBC in a hospital clinic. All patients referred to patch testing
were additionally tested with IPBC preservative in a concentration of 0. %
in pet. Where appropriate, an additional dilution series and a blinded
ROAT (repeated open application test) was performed.
From 1996 to 1/12000 a total of 3147 persons (2077 women and 1070 men)
referred to the clinic for contact dermatitis were patch tested with IPBC
as part. Besides the three male cases previously published (1), four more
persons with IPBC contact allergy were found. Two persons had a confirmed
exposure history to an IPBC-containing skin lotion, and two persons, who
had multiple allergies, had possible exposure to IPBC-containing cosmetics
products. The latter four persons were all diagnosed in 1999, and all were
women. The number of persons patch tested per year in 1996-99 was alike,
but no persons with IPBC allergy were found in 1997 or
Conclusion: IPBC, a biocide originally used for wood or
paint preservation, has in recent years been introduced as a preservative
in cosmetics. Our experience suggests that the introduction of IPBC into
everyday cosmetics may probably result in an increased number of cases
with cosmetically induced allergic contact allergy due to
1. Bryld LE, Agner T, Rastogi SC, Menne T
lodopropynly butylcarbamate: a new contact allergen. Contact Dermatitis
1997, 36: 156-158.
2. Pazzaglia M, Tosti A. Allergic contact
dermatitis from 3-iodo-2-propynylbutylcarbamate in a cosmetic cream.
Contact Dermatitis 1999, 41: 290.
Swimming Pool Water: Chlorine-Sensitive
March 9 - 4:00 pm
BROMINATED SWIMMING POOL
WATER: CLORINE-SENSITIVE BEWARE!
D. Sasseville, MD, Royal
Victoria Hospital, Montreal, QC, CANADA
Objective: to report a case
of allergic contact dermatitis to 1-bromno-3-chloro-5,5-dimethylhydantoin
in a patient sensitized to sodium hypochlorite.
Case report: A
40-year-old woman had previous episodes of hand eczema after contact with
sodium hypochlorite bleach, and generalized dermatitis within days of
swimming in chlorinated pools. Due to her intolerance to chlorine, she was
advised to brominate her own pool with DiHalo ® tablets. After a week of
daily swims, she broke out in a pruritic eruption on her trunk, arms and
thighs, with relative sparing of the areas covered by her
Patch tests were done with the standard series, the
products used to sanitize the pool, some of their ingredients and various
chlorinated substances. At day 4, there were positive reactions to DiHalo®
1% aq., NaOCI 1% aq. and LiOCl 1% aq. Chloramine-T and DMDM Hydantoin gave
Conclusion: Allergic contact dermatitis or
urticaria to sodium hypochlorite occur rarely. In 1983, an epidemic of
dermatoses was seen in the U.K. among users of swimming pools disinfected
with DiHalo ®. All patients had negative patch tests, suggesting an
irritant mechanism. Sold as "bromine tablets", 1 bromo-3-cNoro-5,
5-dimethylhydantoin (DiHalo®, Halobrome®, Aquabrome®) releases both
bromine and chlorine. In 1995, 3 patients had positive patch tests to
Halobrome® while negative to chlorine compounds.
relies almost exclusively on chlorinated products. Alternative systems
such as ionizers, oxygen generators, UV devices and oxidative catalysts
have low or unproven efficacy. My patient was able to sanitize her pool
with polyhexamethylene biguanide (PHMB), a chlorine-free compound sold In
the U.S.A. as Bacquacil® or Softswim®.
Sasseville D, Geoffrion G, Lowry RN. Allergic contact dermatitis to
chlorinated swimming pool water. Contact Dermatitis
2. Rycroft RJG, Penny PT. Dermatoses associated with
brominated swimming pools. Br Med J 1983:287;462.
DA, Wilkinson SM, Bhaggoe R, et al. Spa pool dermatitis. Contact
and Eczematous Reaction to Benzophenone in
Susan Nedorost, M.D.
March 9 - 4:10
URTICARIAL AND ECZEMATOUS REACTION TO BENZOPHENONE IN FINISHED
Nedorost M.D.a, Richard Averitte Jr., M.D.a, Nihal
Ahmad PhD.a, James Arnold M.D. b, Kevin Cooper
M.D.a Depts. of Dermatologya and
Otolaryngologyb, University Hospitals of Cleveland and Case
Western Reserve University, Cleveland, OH
girl was referred by her otolaryngologist. Her mother reported a history
of a red rash beginning within hours of exposure to plastic sipper cup
lids, disposable diapers, and outdoor playground equipment. The rash would
last for several days. She previously had plastic myringostomy tubes with
constant ear drainage until these were removed and replaced with metal
tubes and then had no further difficulty. Examination revealed urticarial
and eczematous dermatitis around her mouth and on her right index finger
and thumb where she held her sipper cup.
Patch testing revealed a
1+ reaction to benzophenone-3. The patient's sipper cup lid was the most
recent and problematic exposure. The manufacturer denied the presence of
any UV absorber in the cup lid. However, high-pressure liquid
chromatography performed in our department revealed benzophenone in the
Benzophenone is used as a stabilizer in many plastic
and rubber products. Both contact urticaria and dermatitis have previously
been reported. When this child required tonsillectomy, only metal devices
were used for surgery and anesthesia and she experienced no
Acknowledgments: Sally Kline PhD. PolyBlend
Holidays-Severe Allergic Contact Dermatitis from Paint-on Tattoos in
Rosemary L. Nixon, M.D.
March 9 - 4:20
HAZARDOUS HOLIDAYS - SEVERE ALLERGIC CONTACT DERMATITIS FROM
PAINT-ON TATTOOS IN BALI
Rosemary L. Nixon and Matheen
Dermatology Unit Monash Medical Centre and Monash University
Department of Medicine, Melbourne Australia
Bali is a favoured
holiday destination for Australians. We report three holiday makers who
experienced more than they bargained for. They developed severe allergic
reactions to "paint-on tattoos" where the primary eruption at the tattoo
site was followed within days by a generalised eruption requiring
treatment with oral steroids.
Traditionally, henna has been used
for skin painting. However there have been an increasing number of reports
of tattoo reactions from Bali, India and Africa where paraphenylene
diamine (PPD) has been applied to the skin. In our cases it appeared that
PPD was mixed with a solvent, such as kerosene, to aid skin
PPD is an extremely strong sensitiser as evidenced in
vitro guinea pig sensitisation tests. Not only did our patients develop
this widespread rash, described variously as an id or autosensitization or
conditional hyperirritability response, they also developed severe
allergic reactions to PPD on patch testing, characterised by +++
blistering reaction. Even diluting the standard PPD to 10% made little
difference. All patients developed a large number of cross reactions
relating to hair dyes, black rubber and textile dyes.
development of such severe allergy to PPD could have enormous implications
in those who are occupationally exposed, such as hairdressers.
Leukoderma Due to Buspirone Patches
M. Shane Chapman,
March 9 - 4:30 pm
CHEMICAL LEUKODERMA DUE TO BUSPIRONE
M.Shane Chapman, MD, Kathryn A. Zug, MD and Jose Peraza, MD
Dartmouth-Hitchcock Medical Center Lebanon, New
Hydroquinones and certain phenolic compounds are well
known causes of contact or chemical leukoderma. Most reported cases of
contact leukoderma occur in occupational settings with contactants known
to cause this entity, however, a number of consumer products have also
been reported to cause contact leukoderma. Although transdermal patch
delivery systems are known to cause local irritation and allergic contact
dermatitis, none have been previously reported to cause leukoderma. We
describe a case of contact leukoderma due to buspirone patches.
Histologically these areas revealed an absence of melanocytes and minimal
inflammation. Patch test results and the mechanics of testing will be
discussed along with a review of contact leukoderma. Based on our review
of the literature, this is the first case of contact leukoderma caused by
a transdermal drug delivery system.
Addiction-Steroid Withdrawal Syndrome
Marvin J. Rapaport,
March 9 - 4:40 pm
STEROID ADDICTION - STEROID
Marvin J. Rapaport, M.D., Vicki Rapaport, M.D.
UCLA, Los Angeles, California 90095
A large series of patients with
the "red scrotum syndrome," vulvodynia, "status cosmeticus,"
photosensitive eczema, intractable eczema and perianal atrophoderma will
be presented. Some additional examples of facial problems will also be
All of these patients had been applying increasingly more
potent topical corticosteroids and some had used systemic corticosteroids
for many years. Patch testing and modes of therapy will be demonstrated
and described. Most of the patients cleared with the cessation of
corticosteroid usage. The relationship of all of the above syndromes was
that the patients were addicted to corticosteroid usage.
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