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The chemokine CCL2 is a potential biomarker for progression of inflammatory skin disease. In a new article of the Journal of Investigative Dermatology, Shibuya et al. (2021) use murine experimental models to show that CCL2‒CCR2‒dependent IL-1β secretion by local skin cells and skin-infiltrating neutrophils are key drivers of skin irritation.

When topical drugs (skin ointments or creams) are used to treat skin diseases on a long-term basis, allergic contact dermatitis (skin inflammation) may develop in response to certain compounds in the cream. Hydrocortisone, however, is an often-prescribed agent that is identical to a hormone produced by the adrenal glands (cortisol, a corticosteroid). To evaluate whether patients with allergic reactions to hydrocortisone are also allergic to that drug (and related agents) given systemically, six patients were studied. The patients had developed allergic contact dermatitis from topical corticosteroids (four used hydrocortisone, two used hydrocortisone-17-butyrate). They were then tested (provoked) with oral hydrocortisone (a systemic drug). One patient received, in addition, a drug similar to ACTH (adrenocorticotropic hormone, which stimulates the production of cortisol by the adrenal glands). A placebo (inactive) drug was administered the day before the ACTH-like drug was given. Results showed that the four patients who were sensitive to topical hydrocortisone developed skin reactions in response to the systemic provocation, while the two who were not allergic to hydrocortisone developed no such reactions. The patients whose adrenal glands were stimulated also developed a skin reaction; the placebo drug was not associated with a reaction. The results show that patients with sensitivity to topical hydrocortisone can develop skin reactions to the drug when it is given systemically, and when their production of cortisol is stimulated. These findings may have clinical importance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pemphigus is a group of conditions marked by the eruption of large vesicles on the skin. Familial benign chronic pemphigus, also called Hailey-Hailey disease, is inherited as an autosomal dominant trait. The disease has periodic remissions and exacerbations, and may be provoked by heat, ultraviolet exposure, sweating, or infection of the skin. Treatment with antifungal and antibacterial agents, both topical and systemic, has been shown to be useful. To determine if patients with Hailey-Hailey disease have an increased risk of developing allergies to topical treatments, 15 patients from 10 families were given a series of skin tests for allergy to a variety of compounds, including those commonly used in the formulation of topical creams and ointments. A total of nine patients had some sort of allergic reaction. Of those nine, seven had reactions to compounds specifically used in the topical medicines. There were no control subjects included in this study, but the high percentage of patients testing positive suggests that they are at high risk for developing contact allergies. The medical literature describes few such cases, which may be due to the fact that in many cases the treatment was of little value and was discontinued. The authors recommend that patients with familial benign chronic pemphigus be routinely given standard patch tests for contact hypersensitivity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cellular inflammation is a characteristic of many skin diseases: inflammatory skin disorders include psoriasis, atopic eczema, contact dermatitis, seborrheic dermatitis and sunburn. The inflammation in these diseases can successfully be [...]

Several compounds that occur naturally in the normal human body are used for medical purposes. Such compounds include growth factors, cytokines and hormones that are identical to their counterparts in [...]

Contact allergies are complex diseases and an important challenge for public health. The purpose of this review is to discuss new developments in the field, including epidemiology and molecular mechanisms of contact allergy.

Baker's asthma and rhinitis are among the most common occupational diseases. Inhaled cereal flours, such as wheat, especially cause this disease.

Background Evaluations of rhinitis reactions in inhalation challenges (ICs) are sparse compared with research on nasal challenges. This study evaluates the outcome of IC tests in assessing occupational rhinitis (OR). It presents the largest rhinologic IC data in the literature, analyzing the exposure method of various agents causing OR and their relation to asthma.Methods Challenge tests performed on 829 individuals with suspected cases of OR were reviewed. Results from both exposures with occupational agents (n = 1229) and placebo (n = 838) were evaluated.Results A total of 10% of the occupational ICs (n = 123) were positive, suggesting OR, and 13% (n = 161) showed asthmatic reaction in the same challenge. In control challenges 2% showed rhinitis and 6% showed asthma symptoms. The most common agents tested were molds (160 tests), flours, and animal fodders (115 tests) and formaldehyde (122 tests). Obeche wood dust and latex produced positive nasal reactions the most frequently, followed by acid anhydrides.Conclusion Although IC is a resource-intensive methodology, the evaluation of nasal symptoms and signs together with bronchial reactions saves time and expense compared with the organization of multiple individual challenges. We encourage the simultaneous evaluation of both nasal and bronchial reactions in IC tests.

Background:Dental products contain many allergens, and may cause problems both for patients undergoing dental treatment and for dental personnel because of occupational exposure. Individual patch test clinics may not study sufficient numbers of patients to collect reliable data on uncommon allergens. Objective:To collect information on dental allergens based on a multicenter study. Materials and Methods:The Finnish Contact Dermatitis Group tested more than 4,000 patients (for most allergens, 2,300 to 2,600 patients) with dental screening series. Conventional patch testing was performed. The total number and percentage of irritant (scored as irritant [IR] or doubtful [?]) and allergic (scored as +, ++, or +++) patch test reactions, respectively, were calculated, as well as the highest and lowest percentage of allergic patch test reactions recorded by the different patch test clinics. A reaction index (RI) was calculated, giving information on the irritancy of the patch test substances. Results:The most frequent allergic patch test reactions were caused by nickel (14.6%), ammoniated mercury (13%), mercury (10.3%), gold (7.7%), benzoic acid (4.3%), palladium (4.2%) and cobalt (4.1%). 2-hydroxyethyl methacrylate (2.8%) provoked most of the reactions caused by (meth)acrylates. Menthol, peppermint oil, ammonium tetrachloroplatinate, and amalgam alloying metals provoked no (neither allergic nor irritant) patch test reactions. Conclusion:Patch testing with allergens in the dental screening series, including (meth)acrylates and mercury, needs to be performed to detect contact allergy to dental products.

Immune mechanisms play a central role in various diseases such as eczema and psoriasis, and in the past treatment tended to involve corticosteroids and cytostatic drugs. Organ transplantation has stimulated the development of newer immunosuppressants, some of which have also been found to be efficacious in the inflammatory dermatoses.

BACKGROUND AND DESIGN: Palmoplantar pustulosis (PPP) is an inflammatory skin disease characterized by pustule formation, erythema, induration, and scaling of the affected skin of the palms and soles. Palmoplantar pustulosis is usually resistant to treatment. In a double-blind study (phase 1) of 4 weeks, 40 patients with PPP were randomized to receive oral cyclosporine, 2.5 mg/kg per day, or placebo. An open-label dose-finding phase 2 with cyclosporine doses of 1.25, 2.5, and 3.75 mg/kg per day was performed in the following 3 months. The patients were then followed for at least 2 months after termination of cyclosporine treatment. Response to treatment was judged by the number of fresh pustules. Patients displaying a reduction of 50% or greater in the number of pustules, compared with baseline, were defined as responders. RESULTS: Of the patients who completed phase 1, 17 of 19 patients in the cyclosporine group and four of 15 in the placebo group were classified as responders (P<.001). Cyclosporine, but not placebo, significantly reduced formation of new pustules (P=.001). In the subsequent open phase, a daily cyclosporine dose of 1.25 mg/kg appeared to be an effective treatment of PPP in approximately half of the treated patients. Many patients relapsed after initial success with cyclosporine. However, only one patient studied totally failed to respond to cyclosporine treatment. At the end of phase 3, most of the studied parameters had returned to pretreatment levels. The most common side effect was headache in the 2.5 mg/kg per day dosage group; no significant side effects were observed in the 1.25 mg/kg per day dosage group. CONCLUSIONS: Low-dose cyclosporine treatment (1.25 to 2.5 mg/kg per day) is effective in PPP.(Arch Dermatol. 1993;129:1273-1279)

Cryptococcosis is an opportunistic infection caused by a fungus, Cryptococcus neoformans. It is usually seen in immunocompromised patients with AIDS, leukaemia, lymphoma, sarcoidosis or immunosuppressive treatments. We describe a patient who was treated with systemic glucocorticosteroids for 4 years because of lung sarcoidosis. During the last year of treatment, a papular eruption developed which later became ulcerative. In a histopathological examination of a skin biopsy, there was granulomatous inflammation, and the disease was treated as sarcoidosis without success. After 1 year’s unsuccessful treatment, another skin biopsy and skin fungal culture revealed C. neoformans. Cryptococcal antigen was found in blood and cerebrospinal fluid, too. The patient was successfully treated first with an amphotericin-B-flucytosine combination and later with fluconazole.

TO THE EDITOR.— The number of cases published on contact allergy to topical corticosteroids has increased rapidly in the past few years.1 This could suggest that physicians are more aware of the possibility of contact allergy to corticosteroids and/or that the actual prevalence of this condition has increased. In a recent study, we observed an increase in incidence of allergic patch test reactions to hydrocortisone-17-butyrate in a 6-month study in 1989 and 1990 compared with an identical period in 1988 and 1989.2 Therefore, we performed a retrospective study on allergic reactions to hydrocortisone-17-butyrate in standard series in the years 1986 through 1989, including our earlier data from 1986 and 1987,3 and compared the number of allergic reactions to hydrocortisone-17-butyrate to that of other allergens in the standard patch test series. SUBJECTS AND METHODS.— Inpatients and outpatients undergoing patch testing due to suspected contact hypersensitivity in the department

TO THE EDITOR.— A recent article in the Archives showed that topical cyclosporine applied to the test site of guinea pigs previously sensitized with 2,4-dinitrochlorobenzene (DNCB) inhibits the elicitation reaction of contact sensitivity.1 Similar reports showing that topical cyclosporine is capable of inhibiting allergic and/or irritant contact sensitivity reactions in guinea pigs2,3 have suggested the use of topical cyclosporine in patients with contact allergy. In a recent report, topical cyclosporine showed some inhibitory effect in patch test reactions to nickel in patients with nickel contact dermatitis.4To study whether topical cyclosporine has an effect in human DNCB-induced contact hypersensitivity, we applied topical cyclosporine in eight separate rechallenge experiments to test sites on three male volunteer subjects who had been previously sensitized with 600 μg of DNCB in a 60-μL Finn chamber. Pretreatment with topical cyclosporine on a tape-stripped skin area used for rechallenge was also studied. For