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A 47-year-old man has been presented with acute perianal dermatitis due to Cl+Me-isothiazolinone-containing moistened toilet tissue. The European standard series remained negative except for Cl+Me-isothiazolinone. Three months later, the patient developed a presternal plaque of seborrhoeic dermatitis. A cream containing 1% hydrocortisone in Canestene® cream, mixed with Beeler cream in equal proportion, has been prescribed. Two weeks later, he had an exacerbation of his dermatitis. Patch tests were found positive with the cream and clotrimazole, its active ingredient.

Cetrimide has been largely used as a disinfectant in hospitals for preoperative skin preparation and treatment of operative wounds and inoperable ulcerated tumors for many years. Two cases of allergic contact dermatitis to cetrimide are described. They were disinfected with cetrimide in the operating theatre. Allergic contact dermatitis to quaternary compounds are seldom described. Usually the commonest sensitizer is benzalkonium chloride used in ophthalmic solutions and as a disinfectant for leg ulcer treatment.

Nobecutan is widely used for application to operation wounds and also for protection of the skin from irritants. It contains a polymerisation product of ethoxyethylmethacrylate and the propellant used is propane or butane gas. Tetramethylthiuramsulphide (TMTD) is added as an antiseptic in a concentration of 0.025%. The manufacturer gives the information that people may react to nobecutan in cases of already established allergy to TMTD in a brochure. No warning is given that nobecutan in itself may be sensitising.

This article reports on contact urticaria due to the effect of chloramine. Chioramine is commonly used as a sterilizer, disinfectant, and chemical reagent. It has been described as an occupational hazard for pharmaceutical workers. This article cites a case study of 52-year-old female nurse who developed itchy erythematous plaques on the dorsa of both hands. Doctors suspected that this is due to her hospital duties involving contact with irritants such as soaps, detergents and antiseptic solutions. After having suffered for several months from recurrent attacks of edema of the eyelids tingling sensation in her mouth and occasionally in her fingers whenever she came in contact with chloramine powder. On patch testing it was found that patient reacted positively with chloramine solution.

Benzalkonium chloride is a quaternary ammonium compound widely used as an antiseptic in surgery, in the treatment of infected dermatoses and in ophthalmic preparations like, contact lens solutions and cosmetics, though it is known to be irritant in higher concentrations. Allergic reactions have been reported in users of ophthalmic medications in orthopaedic patients treated with plaster of paris and in children wearing a gold earring cleaned with a disinfectant. However, benzalkonium chloride is considered a rare sensitizer.

Background: There is a lack of prospective studies investigating contact sensitization in patients with chronic leg ulcers. Objectives: To determine the frequency of contact sensitization in patients with chronic leg ulcers using a special series of patch tests and to determine whether the number of sensitizations was correlated with the duration of the chronic leg ulcers. Patients/methods: Multicentre study carried out in patients with chronic leg ulcers; patch tests with the European baseline series and with an additional 34 individual allergens or mixes and 3 commercial products. Results: Of the 423 patients (301 women, 122 men, mean age 68.5 years) with chronic leg ulcers, 308 (73%) had at least one positive patch test with 3.65 positive patch tests per patient. The main allergens were Myroxylon pereirae (41%), fragrance mix I (26.5%), antiseptics (20%), and corticosteroids (8%). The number of positive tests per patient was not correlated with the cause of ulcer but was increased with the duration of the ulcer with a statistical difference between the group of the <1 year compared with the group >10 years duration. Conclusions: From this large prospective multicentre study, polysensitization is frequent in patients with chronic leg ulcers, increasing with the duration of the ulcer. We propose avoidance of topical antiseptics and ointments containing perfumes in patients with chronic leg ulcers and an updated patch test series for investigating these patients. [ABSTRACT FROM AUTHOR]

Delayed reactions to radio-contrast media (RCM) with positive skin tests are rare. We report the study of a series of 15 patients who presented delayed reactions to RCM, with an analysis of the clinical features and the results of standardized drug skin tests. Patch tests were performed with RCM and iodized antiseptics (lAs). If negative, prick tests were performed, followed by intradermal tests (IDTs), then intravenous administration under hospital surveillance. The main clinical features were maculopapular rashes or a macular rubella-like rashes. Patch tests were positive with RCM in 2 of 15 cases and with lAs in 4 of 15 cases. All the prick tests were negative. IDTs were positive at 24 h in 8 of 15 cases. 5 of 12 patients had a non-severe relapse of the rash upon receiving an RCM despite clearly negative skin tests with the readministered RCM. Visipaque® cross-reacted with Iopamiron®, lomeron®, Telebrix®, Omnipaque®, Xenetix® and Hexabrix®. Omnipaque® cross-reacted with Hexabrix® and Iopamiron®. IDTs with delayed readings are of better value than patch tests in such patients. The readministration of RCM with negative IDTs must be performed with progressive amounts under hospital surveillance. Cross-reactions between various classes of RCM are frequent. The responsible epitopes are unknown. Iodine itself could be involved. [ABSTRACT FROM AUTHOR]

Presents a response by Felix Wantke, Wolfgang Hemme, Manfred Götz and Reinhart Jarisch to a letter to the editor his article "Routine Patch Testing With Thimerosal: Why Should It Be Performed," published in the July 1996 issue of the journal "Contact Dermatitis."

In 15 months, we detected allergic patch test reactions to tioconazole in 14 patients, 9 of the 14 patients were allergic to additional imidazole derivatives used as antifungal agents. The positive patch test reactions to tioconazole may have been caused either by simultaneous sensitization or more probably by cross-reactivity between the various commercially used imidazole derivatives with a similar chemical structure. The abundant use of tioconazole in concentrated (up to 28%) topical formulations in Finland could be the major cause of the apparent increase in allergic reactions. [ABSTRACT FROM AUTHOR]

Recommended patch test concentrations are given for preservatives. biocides and antimicrobials based on detailed reviews of the literature and the combined experience of the European Environmental and contact Research Group. [ABSTRACT FROM AUTHOR]

Because of their reported antiviral and anti-inflammatory activities, cream formulations containing n-docosanol (docosanol) or stearic acid were tested for effects on chemically-induced burns in mice. In this model, injury was induced by painting the abdomens of mice with a chloroform solution of phenol. This was followed by the topical application of test substances 0.5, 3, and 6 h later. Progression of the wounds was assessed by a single evaluator after 8 h, using a numerical score of gross morphology. Docosanol- and stearic acid-containing creams substantially and reproducibly lessened the severity and progression of skin lesions compared to untreated sites with a 76% and 57% reduction in mean lesion scores, respectively. Untreated wounds appeared red and ulcerated; docosanol cream-treated wounds showed only slight erythema. [ABSTRACT FROM AUTHOR]

Two cases of contact allergy to a disinfectant containing dodecyl-di-aminoethyl glycine (ddg) or Desimex i are reported. Desimex i is widely used in Finland as an antiseptic for instruments in hospitals and in dental practice. Two dental nurses had contact for several months with Desimex i before the appearance of eczematous lesions on their hands. After the elimination of Desimex i, symptoms disappeared. Several tests conducted to establish the relationship between Desimex i and eczema showed that it was worthwhile to include ddg in test series for medical personnel with hand eczema.

This article reports on ulcerative stomatitis in a neonate due to a chlorine antiseptic. Contact stomatitis, either from irritation by or allergy to various antiseptics is well-known. These antiseptics are mainly used for the care and hygiene of the oral mucosa and are contained in products. They include formaldehyde, potassium chlorate, halide compounds and quaternary ammonium compounds. This article also reports a case of ulcerative stomatitis in a neonate caused by a chlorine antiseptic.