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Several complications have been described, including intravascular injection of hyaluronic acid (HA).[1] Current management of intravascular HA injection is based on early injection of hyaluronidase[2] which should be performed as soon as possible and mandatorily within 72 h of the procedure. A 54-year-old woman, who had received a well-tolerated HA injection 3 years earlier, underwent bilateral HA injections into the nasolabial folds at a private dermatologist's office. Intra-arterial facial injection of hyaluronic acid complicated by Nicolau's dermatitis: Treatment with iloprost. [Extracted from the article]

Drug hypersensitivity reactions (DHRs) are common, and the skin is by far the most frequently involved organ with a broad spectrum of reaction types. The diagnosis of cutaneous DHRs (CDHR) may be difficult because of multiple differential diagnoses. A correct classification is important for the correct diagnosis and management. With these guidelines, we aim to give precise definitions and provide the background needed for doctors to correctly classify CDHR. [ABSTRACT FROM AUTHOR]

Background: There are few population‐based studies assessing the prevalence of skin diseases. Objectives: To estimate the prevalence of five chronic skin inflammatory diseases, i.e. atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo and hidradenitis suppurativa (HS) in France, using validated self‐diagnostic questionnaires. Methods: Population‐based study using a representative sample of the French general population aged more than 15 years and sampling with replacement design. All participants were asked (ii) to fill in a specific questionnaire including socio‐demographic characteristics, (ii) to declare if they have been diagnosed with one or more skin problem or skin diseases during their life, and (iii) to fill in five validated self‐reported questionnaires for AD, psoriasis, AA, vitiligo and HS. Results: A total of 20.012 adult participants responded to the questionnaire of whom 9760 were men (48.8%) and 10.252 (51.2%) were women. We identified a prevalence of 4.65% for AD (931 individuals), 4.42% for psoriasis (885 individuals), 1.04% for AA (210 individuals), 0.46% for vitiligo (93 individuals) and 0.15% for HS (29 individuals), respectively. Limitations: Questionnaire‐based study and possible disease misclassifications. Conclusion: This is the largest population‐based study aiming to estimate the prevalence of five chronic skin inflammatory diseases. [ABSTRACT FROM AUTHOR]

Acrodermatitis chronica atrophicans ( ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis ( LCLB) with a foot tumour. A 64-year-old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described. [ABSTRACT FROM AUTHOR]

Background Modern dressings ( MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers ( CLUs) to evaluate this. Objectives To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. Patients and methods A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. Results Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). Conclusions Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 28-year-old woman who had history of pruritic erythematous scaly dermatitis on both hands and on the neck, after keeping a rabbit as pet. She fed her rabbit with chicory leaves, dandelion, hay, and dry food, and the dermatitis disappeared when the patient stopped feeding her rabbit with chicory.

Background The preservative methylisothiazolinone ( MI) is used in combination with methylchloroisothiazolinone ( MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis ( REVIDAL-GERDA) added MI to its baseline patch testing series in 2010. Objective To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012. Patients/materials/methods We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012. Results Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p < 0.001). Conclusions We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries. [ABSTRACT FROM AUTHOR]

We report the first case of immediate-type hypersensitivity caused by Emla® cream. A 55-year-old woman, after using Emla® cream, went on to develop urticaria. An open test was positive to Emla® cream. Patch tests and prick tests were performed with Emla® cream, the components of Emla® cream (lidocaine, prilocaine and castor oil) and other local anaesthetics. The patch test with lidocaine and the prick test with Emla® cream were both positive. An intradermal test and subcutaneous administration of 3 anaesthetics that had negative patch tests and prick tests were performed and well tolerated, allowing their use. In the literature, anaphylactic reactions to lidocaine injections, delayed-type hypersensitivity after lidocaine subcutaneous injections and contact dermatitis from Emla® cream have all been described. This first case of contact urticaria from Emla® cream was due to lidocaine and did not show any cross-reaction with other local anaesthetics. [ABSTRACT FROM AUTHOR]

Drug skin tests can be helpful in determining the cause of a cutaneous adverse drug reaction (CADR). Patch tests and prick tests can be performed with any commercialized form of a drug. Intradermal tests (IDTs) have a greater value, but their techniques have not been standardized. Moreover, IDTs can be done only if an injectable form of the drug is commercialized and are restricted to patients with nonsevere CADR. Prick tests and IDTs are used in investigating immediate hypersensitivity. Patch tests both with IDTs with delayed readings are helpful for maculopapular rash and generalized or localized eczema. Results obtained with drug skin tests in β-lactam sensitization have been extensively published, but fortunately, during the last few years the value of skin tests in CADR due to other drug classes (e.g., synergistins, platinium salts or radiocontrast medias) was also studied. The analysis of recent literature permits to propose which tests to choose for each clinical feature of CADR and to give the list of all drugs, having had patch tests with positive results but, emphasizes the lack of standardization in performing and reading IDTs. This standardization is absolutely necessary to determine the thresholds of specificity of the IDT. Except for IDTs, drug skin tests induce only rarely adverse reactions. False-positive results can occur and should be considered by testing new products. The negative predictive value of drug skin tests is a crucial point that will have to be studied in more detail in the near future. [ABSTRACT FROM AUTHOR]

Abstract: The management of patients who have developed a contact dermatitis due to topical drugs requires to stop the suspected drug application, to declare, if severe, the adverse drug reaction to a center for drug safety, to treat the patient with corticosteroid ointments, to perform dermatoallergological investigations e.g. drug patch tests in case of contact eczema and diluted prick tests in case of contact urticaria in order to determine whether the adverse drug reaction was due to excipients or to the drug itself. It is also absolutely necessary to advise the patient concerning the avoidance of topical but also systemic readministration of the responsible molecule. An excipient responsible in inducing a contact sensitization to a topical drug can also be found in cosmetics, the name of the responsible excipient has to be given to the patient under the common name but also under the INCI and/or CFTA name. When the drug itself is responsible in inducing a contact allergy it is necessary to determine if cross reactions with other drugs can occur and if the responsible molecule can induce systemic cutaneous adverse drug reactions if the drug is systemically readministred. Among NSAID there is no cross reactions between bufexamac and diclofenac, between salicylamide, glycol salicylate, salicylic acid and acetylsalicylic acid. In case of photosensitization 1) to ketoprofen or 2) piroxicam the topical and/or systemic administration of the following molecules are contraindicated with respectively 1) ketoprofen, tiaprofenic acid, fenofibrate, oxybenzone or 2) piroxicam, thimerosal. A patient sensitized to corticosteroid ointment has to be tested in order to determine which corticosteroid classes are sensitizing. The topical and systemic administrations of molecules belonging to the sensitizing classes (A, B, C, D1 or D2) have to be forbidden. In general, a contact dermatitis due to an antimicrobial drug induces a contraindication in further topical or systemic uses of the drug and to all the molecules belonging to the same class. In most of the cases there is no risk in systemically administering iodine, sulfites or excipients in a sensitized patient who had developed a contact dermatitis to topical medications. [Copyright &y& Elsevier]

Abstract: Patch testing with the suspected compound has been reported to be helpful in determining the cause of a cutaneous adverse drug reaction (CADR) and in studying the pathophysiological mechanisms involved. The main advantages of drug patch tests are that they can be done with no hospital surveillance because they induce only rarely adverse reactions and that any commercialized form of a drug can be used. In contrast, intradermal tests can be performed only with injectable forms or with a pure and sterile form of the drug. It is advised to perform drug patch tests during the 6 months following the CADR as we do not know whether positive results will persist. Due to the possibility that a low concentration might yield false negative results, drug patch tests have to be performed with rather high concentrations of the commercialized form of the drug, mostly diluted at 30% in petrolatum and/or in water. For some drugs and severe CADR, it is necessary to tests with lower concentrations or in other vehicles. Drug patch tests are positive in ca. 32–50% of patients who have developed a CADR. The clinical relevance of drug patch tests depends on the clinical features of the CADR (valuable in testing generalized eczema, systemic contact dermatitis, maculopapular rash, acute generalized exanthematous pustulosis, fixed drug eruption) and on the involved drug. As false positive results can be observed, it is always necessary to consider the relevance of any positive drug patch test. Their specificity and their negative predictive value have not been yet determined. [Copyright &y& Elsevier]

Abstract: Occupational dermatitis (irritant dermatitis, contact urticaria and contact eczema) is frequent among healthcare workers. Irritant hand dermatitis, the most common occupational dermatitis, occurs often in individual who work in a humid environment, who handle disinfectants, and who are required to wash their hands frequently; atopic dermatitis is a risk factor for this condition. Natural rubber latex present in rubber gloves is the most common cause of contact urticaria. Contact eczema can be induced by rubber accelerators (for example, thiurams) present in gloves, and also by disinfectants (glutaraldehyde, dodecyldimethylammonium), disinfectants and detergents, hand creams, acrylates (in dentists), and echography gels. Nurses sometimes develop contact dermatitis to drugs they handle; these allergies should be diagnosed by appropriate skin testing because sensitized individuals may develop a severe, generalized cutaneous adverse reaction if they are subsequently exposed systemically to the sensitizing drug. [Copyright &y& Elsevier]

Objective: To evaluate the characteristics of non-immediate type hypersensitivity reactions with first-line antituberculosis drugs and determine the causative drugs by patch tests and drug provocation tests. Materials and Methods: Baseline data including patients' demographics, disease characteristics, and drug hypersensitivity reaction characteristics were recorded. Patch testing was performed with all the drugs used during hypersensitivity reaction at 1/10 and 1/1 concentrations. Drug provocation tests were performed at 3-day intervals with drugs that had negative patch test results. Results: A total of 32 patients were included in the study. The clinical phenotype was maculopapular eruption in 11(34.4%), dermatitis in 10 (31.3%), drug reaction with eosinophilia and systemic symptoms in 1 (3.1%), and Stevens-Johnson syndrome/Toxic epidermal necrolysis in 10 (31.3%) patients. Combination therapy during the index reaction consisted of isoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E) in 28 (87.5%) patients, Patch tests were performed with 95 drugs consisting of 25 H, 25 R, 21 Z, and 24 E in 25 patients. Results were positive in 8 patients with 10 drugs: 8 (32%) H, 1 (4%) R, and 1 (4.2%) E positivity were detected. Drug provocation tests were performed with 78 drugs (18 H, 23 R, 15 Z, 22 E) in 25 patients and resulted positive with H, R, Z, and E in 16.7% (3 of 18), 21.7% (5 of 23), 46.7% (7 of 15), and 54.5% (12 of 22) of the patients respectively. Negative predictive values of patch tests with H, R, Z, and E were calculated as 87.5% (14/16), 81.8% (18/22), 50% (7/14), and 45% (9/20) respectively. According to the results of the patch tests and provocation tests, the most common culprit of hypersensitivity reactions was found to be E (n=12), followed by H (n=10). Multiple drug hypersensitivity was detected in 9 of 23 (39.1%) patients. Conclusion: Patch testing is useful in the management of non-immediate type hypersensitivity with first-line antituberculosis drugs. However, further studies are needed to determine its predictive value [ABSTRACT FROM AUTHOR]

Researchers active in the field of inflammatory skin diseases from the spectrum of dermatitis and eczema are well aware of a considerable overlap in the clinical pictures and proposed sets of diagnostic criteria for these diseases, which can hardly be overcome through the clinical or epidemiological research. In effect, patients are included in studies based on vague and overlapping criteria, while heterogeneous study populations may, in turn, lead to non-representative outcomes and continued confusion. In this narrative review, a systematics of diseases from the spectrum of dermatitis and eczema is proposed based on the origins of causative factors and the pathomechanisms involved. Difficulties in differentiating between these diseases are discussed, and the extent to which advances in the "omics" sciences might help to overcome them is considered. Of all the "omics" research in this field, more than 90% of the published papers were devoted to atopic dermatitis, with a striking underrepresentation of other diseases from the spectrum of dermatitis and eczema, conditions which collectively exceed the rates of atopic dermatitis by far. A greater "omics" research effort is urgently needed to tackle other dermatitides, like allergic, irritant and protein contact dermatitis, as well as radiation, seborrheic, stasis or autoimmune dermatitis. Atopic dermatitis findings should be validated not only against healthy donors but also other dermatitides. A clinic-oriented approach is proposed for future "omics" studies in the field of dermatitis and eczema. [ABSTRACT FROM AUTHOR]

Patch tests are the gold standard in the work-up of allergic contact dermatitis. Apart from commercial products, it is also of utmost importance to include the patients' own products. Products with unknown content or containing strong irritant, corrosive, toxic or poisonous chemicals should never be patch-tested, though. Recommendations on how to patch-test finished products can easily be retrieved in the literature and in specialised reference books; practical advice on test modalities (test methods, concentrations, vehicles) have been outlined for leave-on and rinse-off cosmetics, household detergents, chemical products (glues, paints), solid materials (gloves, shoes, textiles, leather goods, metal, plastic and rubber items), occupational products, plants, woods and food items. Separate guidelines exist on how to patch-test drugs. Whenever a positive or negative reaction to a product is obtained, practitioners should always question the possibility of a false-positive or a false-negative reaction, respectively. In these cases, additional test procedures may be required (eg testing of separate ingredients, repeated open-application tests, serial dilutions of a chemical or product, glove-repeated application tests). In this article we provide a practical overview for clinicians on how to test patients' own products. [ABSTRACT FROM AUTHOR]

New chemicals are continually being introduced in consumer products such as cosmetics, pharmaceuticals, medical devices, textiles, tattoo inks, rubber materials and footwear. Allergic contact dermatitis (ACD) arising from new sensitisers in such items is a frequent problem in daily practice, and a correct diagnosis is often difficult. In this overview we provide a practical update illustrated by clinical examples of new and sometimes unexpected sensitisers and some old ones in new applications. Notable examples include the emergence of amino acid alkyl amides (AAAs), vitamin C compounds, resorcinol derivatives, glycols, metals (eg tin) and lipid/carbohydrate allergens in cosmetics; benzophenone residues in octocrylene-containing sunscreens, plastics and inks; the replacement of tosylamide/formaldehyde resin in nail varnishes by sensitising copolymers based on phthalic anhydride/adipic acid and (meth)acrylates; epoxy resin as a non-occupational contact allergen in domestically used glues; fragrances (including terpenes) in, for example, (medical) adhesives; persulfates in hot-tub detergents; isothiazolinones in leather wear and rubber gloves; chemicals such as chlorophenols in textiles and acetophenone azine in foot and sportswear; biguanides and quaternary ammonium salts used as antimicrobial agents in cosmetic and non-cosmetic products (eg wound-care products); acrylates and silicone components in medical devices. [ABSTRACT FROM AUTHOR]

Background: Few studies explored the relationship between stasis dermatitis (SD) and allergic contact dermatitis (ACD). Objective: To examine trends, associations, and clinical relevance of ACD in patients referred for patch testing who had a final SD diagnosis. Methods: Retrospective analysis from 2001 to 2016 of 38,723 patients from the North American Contact Dermatitis Group. Results: After patch testing, 303 (0.7%) patients were diagnosed with SD; 46.7% had a concomitant diagnosis of ACD. Patients with vs. without a final SD diagnosis had similar proportions of ≥ 1 positive allergic reaction (59.7% vs. 64.7%; Chi-square, P = 0.0724) but higher odds of allergic reactions to fragrance mix I, bacitracin, quaternium-15, Myroxylon pereirae, benzalkonium chloride, ethyleneurea melamine formaldehyde, diazolidinyl urea, and propylene glycol. The most commonly relevant allergens in patients with final SD diagnosis were fragrance mix I, Myroxylon pereirae, bacitracin, quaternium-15, and formaldehyde. The most common allergen sources were personal care products, topical medications and other health aid products. Conclusion: Nearly half of patients with a final SD diagnosis were also diagnosed with ACD, supporting the role of patch testing in select SD patients. [ABSTRACT FROM AUTHOR]

Background: Tetrazepam is a muscle relaxant belonging to the benzodiazepine group. Drug eruptions following ingestion of tetrazepam tablets are well known. Objective: To draw the attention to occupational airborne dermatitis and/or hand dermatitis in nurses resulting from crushing of tablets for elderly or disabled people. Methods: Since 2003, 16 nurses with facial (eyelid) and/or hand dermatitis, suspected to be of occupational origin, were patch tested with the medication they handled during work. Results: Ten nurses presented with a positive patch test reaction to tablets containing tetrazepam, 14 controls remaining negative. Some of them also reacted to other drugs. Conclusion: Occupational airborne and/or hand contact dermatitis from tetrazepam might be much more common than suspected by dermatologists, particularly in view of the short period in which all cases have been observed. [ABSTRACT FROM AUTHOR]

Epicutaneous exposure to allergenic proteins is an important sensitization route for skin diseases like protein contact dermatitis, immunologic contact urticaria, and atopic dermatitis. Environmental allergen sources such as house dust mites contain proteases, which are frequent allergens themselves. Here, the dependency of T-helper (TH) cell recall responses on allergen protease activity in the elicitation phase in mice pre-sensitized via distant skin was investigated. Repeated epicutaneous administration of a model protease allergen, i.e. papain, to the back skin of hairless mice induced skin inflammation, serum papain-specific IgE and TH2 and TH17 cytokine responses in the sensitization sites, and antigen-restimulated draining lymph node cells. In the papain-sensitized but not vehicle-treated mice, subsequent single challenge on the ear skin with papain, but not with protease inhibitor-treated papain, up-regulated the gene expression of TH2 and TH17/TH22 cytokines along with cytokines promoting these TH cytokine responses (TSLP, IL-33, IL-17C, and IL-23p19). Up-regulation of IL-17A gene expression and cells expressing RORγt occurred in the ear skin of the presensitized mice even before the challenge. In a reconstructed epidermal model with a three-dimensional culture of human keratinocytes, papain but not protease inhibitor-treated papain exhibited increasing transdermal permeability and stimulating the gene expression of TSLP, IL-17C, and IL-23p19. This study demonstrated that allergen protease activity contributed to the onset of cutaneous TH2 and TH17/TH22 recall responses on allergen re-encounter at sites distant from the original epicutaneous sensitization exposures. This finding suggested the contribution of protease-dependent barrier disruption and induction of keratinocyte-derived cytokines to the recall responses. [ABSTRACT FROM AUTHOR]

Granulomatous dermatitis following the administration of various vaccines has previously been reported. However, cases of cutaneous granulomatosis following the measles, mumps, and rubella (MMR) vaccine have not yet been reported. We report the case of a 3‐year‐old boy with a granuloma annulare‐like reaction following MMR vaccination. [ABSTRACT FROM AUTHOR]

Forming the outer body barrier, our skin is permanently exposed to pathogens and environmental hazards. Therefore, skin diseases are among the most common disorders. In many of them, the immune system plays a crucial pathogenetic role. For didactic and therapeutic reasons, classification of such immune-mediated skin diseases according to the underlying dominant immune mechanism rather than to their clinical manifestation appears to be reasonable. Immune-mediated skin diseases may be mediated mainly by T cells, by the humoral immune system, or by uncontrolled unspecific inflammation. According to the involved T cell subpopulation, T cell–mediated diseases may be further subdivided into T1 cell–dominated (e.g., vitiligo), T2 cell–dominated (e.g., acute atopic dermatitis), T17/T22 cell–dominated (e.g., psoriasis), and Treg cell–dominated (e.g., melanoma) responses. Moreover, T cell–dependent and -independent responses may occur simultaneously in selected diseases (e.g., hidradenitis suppurativa). The effector mechanisms of the respective T cell subpopulations determine the molecular changes in the local tissue cells, leading to specific microscopic and macroscopic skin alterations. In this article, we show how the increasing knowledge of the T cell biology has been comprehensively translated into the pathogenetic understanding of respective model skin diseases and, based thereon, has revolutionized their daily clinical management. [ABSTRACT FROM AUTHOR]

Abstract: Skin diseases represent one of the most common work‐related diseases and may have a detrimental effect on social, personal and occupational aspects of life. Contact dermatitis (CD), which comprises predominately irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), accounts for vast majority of occupational skin diseases, especially in occupations associated with frequent skin contact with irritants and contact allergens. Although ICD and ACD have similar clinical manifestation, their pathophysiology and the role of the skin barrier are different. In ICD, perturbation of the skin barrier is the primary event which sets into motion diverse metabolic processes and triggers activation of innate immunity without the involvement of adaptive immune system. In ACD, a type IV hypersensitivity reaction induced by contact allergens, the skin barrier impairment may evoke innate signalling pathways during the sensitization phase required for the activation of T‐cell adaptive response. Thus, skin barrier impairment may increase the risk of ICD or ACD not only because of enhanced permeability and ingress of irritants and allergens but also by the generation of innate immune signal needed for the induction of allergic response. Hence, an efficient way to prevent CD is to avoid skin barrier damage in the workplace. This review focuses on the skin barrier, how it is affected by skin irritants and how its impairment contributes to the development of ICD and ACD. [ABSTRACT FROM AUTHOR]

The cover page of the journal "Contact Dermatitis," is presented.

Little is known about the course of the plasma concentration and the bioavailability of non-steroidal anti-inflammatory drugs ( NSAIDs) contained in dermal patches. We compared an etofenamate prototype patch (patent EP 1833471) and a commercially available diclofenac epolamine patch regarding the bioavailability of the active ingredients relative to respective i.m. applications and regarding their plasma concentration-time course. Twenty-four healthy human volunteers were treated using a parallel group design (n = 12 per group) with a single dermal patch (removed after 12 hr) followed (after a latency of 48 hr) by eight consecutive dermal patches every 12 hr to reach steady-state conditions. The patches were generally well tolerated, but one volunteer treated with etofenamate developed an allergic contact dermatitis. After the first patch, Cmax was 0.81 ± 0.11 (mean ± S.E.M.) ng/mL (reached 12 hr after patch removal) for diclofenac and 31.3 ± 3.8 ng/mL for flufenamic acid (reached at patch removal), the main metabolite of etofenamate. Etofenamate was not detectable. After repetitive dosing, trough plasma concentrations after the eighth dose were 1.72 ± 0.32 ng/mL for diclofenac and 48.7 ± 6.6 ng/mL for flufenamic acid. Bioavailabilities (single dose) relative to i.m. applications were 0.22 ± 0.04% for diclofenac and 1.15 ± 0.06% for flufenamic acid. In conclusion, the relative bioavailability (compared to the respective i.m. application) of both drugs is low. The maximal plasma concentrations after topical administration of these drugs are well below the IC50 values for COX-1 and COX-2, explaining the absence of dose-dependent toxicities. [ABSTRACT FROM AUTHOR]

Background Patients with lower leg dermatitis, chronic venous insufficiency or chronic leg ulcers have a high prevalence of contact sensitization. Objectives To identify the current spectrum of contact allergens in these patients. Patients and methods Data of the Information Network of Departments of Dermatology on 5264 patients with the above diagnoses from the years 2003 to 2014 (study group) were compared with data on 4881 corresponding patients from 1994 to 2003 (historical control group) and with a current control group without these diagnoses (n = 55 510). Results Allergic contact dermatitis was diagnosed less frequently in the study group than in the historical control group (25.9% versus 16.9%; p < 0.001), and contact sensitization to most allergens had declined. The allergen spectrum, however, was largely unchanged. Important allergens are Myroxylon pereirae (balsam of Peru) (14.8% positive reactions), fragrance mix I (11.4%), lanolin alcohol (7.8%), colophonium (6.6%), neomycin sulfate (5.0%), cetearyl alcohol (4.4%), oil of turpentine (3.1%), and paraben mix (2.6%). Patch testing with additional series showed sensitization to Amerchol L-101 (9.7%), tert-butyl hydroquinone (8.7%), framycetin sulfate (5.0%), and gentamicin sulfate (3.1%). Conclusions Topical preparations for treating the above-mentioned conditions should not contain fragrances, Myroxylon pereirae, and colophonium. The special allergen spectrum has to be considered in patch testing. [ABSTRACT FROM AUTHOR]

Background Acute generalized exanthematous pustulosis ( AGEP) is a rare skin condition typically caused by medications. The objective of this study was to examine the clinical features, causes, and outcomes of AGEP at a sole tertiary care center. Methods A retrospective review of patients with AGEP (European Study of Severe Cutaneous Adverse Reactions score of ≥ 5) seen at Mayo Clinic (Rochester, MN, USA) between January 1, 1996, and December 31, 2013, was conducted. Results Of 28 patients (mean age at onset: 56 years), 17 (61%) were women. The development of AGEP was attributed to medications in 25 patients (89%), with clindamycin the most common culprit (six patients). Three patients (11%) had mucous membrane involvement, and 21 (75%) showed systemic involvement. Ten patients (36%) received systemic corticosteroids for treatment of AGEP. Skin findings resolved within 15 days in 26 patients (93%) (mean time to resolution: 7.6 days). In three patients (11%), generalized skin eruptions or dermatitis developed weeks to months after the resolution of AGEP. Twenty-four patients (86%) had a personal history of drug reactions before the development of AGEP. Conclusions A previous history of drug reactions and clindamycin causation were more common in the present cohort than in prior reports. A small subset of patients experienced new-onset non- AGEP skin eruptions within a few months of the resolution of AGEP. [ABSTRACT FROM AUTHOR]

The article evaluates the frequency of contact sensitization in the course of atopic dermatitis (AD) within a sample of Tunisian population. The severity of AD was evaluated by the SCORAD index. The European Standard Series, except primin, was applied to all patients. The European Standard Series was applied to all patients. Patch testing was performed with Finn chambers.

Background: The data on the histology of cutaneous lesions of drug reaction with eosinophilia and systemic symptoms (DRESS) is limited.Aims: To study the histopathology of cutaneous lesions of drug reaction with eosinophilia and systemic symptoms (DRESS) and to identify any features with diagnostic or prognostic significance.Methods: All patients admitted to the dermatology ward of government medical college, Kozhikode from January 1, 2014 to December 31, 2014 with probable or definite DRESS as per the RegiSCAR scoring system and who were willing to undergo skin biopsy were included in this prospective study.Results: The study population comprised of nine patients. The consistent histological finding documented was the predominantly lymphocytic dermal inflammatory infiltrate. Four of the five patients whose histology revealed focal interface dermatitis and keratinocyte vacuolation with or without apoptotic keratinocytes, had elevated liver transaminases. Tissue eosinophilia was associated with disease flares. The presence of atypical lymphocytes in peripheral smear and histological evidence of dense dermal inflammatory infiltrate showed an association with hepatic involvement.Limitations: The main limitations of our study were the small sample size and our inability to carry out a detailed immunohistochemistry work-up.Conclusions: In the appropriate setting, varying combinations of epidermal hyperplasia, spongiosis, parakeratosis and individually necrotic keratinocytes in the background of lymphocyte predominant dermal infiltrate (with some atypia) favor a diagnosis of drug reaction with eosinophilia and systemic symptoms. Female sex, the presence of atypical lymphocytes in peripheral smear, dense dermal inflammatory infiltrate, tissue eosinophilia and interface dermatitis with or without keratinocyte necrosis was associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Introduction Allergic contact dermatitis ( ACD) in children appears to be on the increase, and contact sensitization may already begin in infancy. The diagnosis of contact dermatitis requires a careful evaluation of a patient's clinical history, physical examination, and skin testing. Patch testing is the gold standard diagnostic test. Methods Based on consensus, the EAACI Task Force on Allergic Contact Dermatitis in Children produced this document to provide details on clinical aspects, the standardization of patch test methodology, and suggestions for future research in the field. Results We provide a baseline list of test allergens to be tested in children with suspected ACD. Additional tests should be performed only on specific indications. [ABSTRACT FROM AUTHOR]

The article presents a case study of allergic contact dermatitis caused by acrylic acid used in transcutaneouis electrical nervous stimulation. It highlights the case of 81-year-old man who was referred with erythema, superficial erosions, haemorrhagic crusts and some petechiae on the lower back. It provides explanation of the patient's condition and the factors that caused the disease.

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance. [ABSTRACT FROM AUTHOR]

Stewart-Bluefarb syndrome ( SBS), also known as acroangiodermatitis or pseudo-Kaposi, is a condition rarely encountered. It involves skin lesions that are clinically similar to Kaposi sarcoma but are histologically different, and are usually secondary to an underlying arteriovenous fistula. Treatment of this disease usually involves the correction of the underlying vascular abnormality, with the mainstay of therapy ranging from compression devices for venous stasis, limited oral medications (dapsone and erythromycin) and local wound care including topical steroids. Different methods of treatment showed varied success but none is ideal. We report a case of a lower extremity ulcer in a 22-year-old male recently diagnosed with SBS successfully treated with heparan sulphate (Cacipliq20®). [ABSTRACT FROM AUTHOR]

Skin diseases with an allergic background such as atopic dermatitis, allergic contact dermatitis, and urticaria are very common. Moreover, diseases arising from a dysfunction of immune cells and/or their products often manifest with skin symptoms. This review aims to summarize recently published articles in order to highlight novel research findings, clinical trial results, and current guidelines on disease management. In recent years, an immense progress has been made in understanding the link between skin barrier dysfunction and allergic sensitization initiating the atopic march. In consequence, new strategies for treatment and prevention have been developed. Novel pathogenic insights, for example, into urticaria, angioedema, mastocytosis, led to the development of new therapeutic approaches and their implementation in daily patient care. By understanding distinct pathomechanisms, for example, the role of IL-1, novel entities such as autoinflammatory diseases have been described. Considerable effort has been made to improve and harmonize patient management as documented in several guidelines and position papers. [ABSTRACT FROM AUTHOR]

Background Healthcare workers (or relatives) crushing drug tablets for patients with difficulties in swallowing are at risk of developing sensitization via airborne exposure. Tetrazepam, in particular, is increasingly being described as an important occupational allergen in this regard, although other drugs are also involved. Objectives To identify the allergenic culprits in 4 patients, namely 2 nurses, 1 pharmacy assistant, and 1 spouse, who all regularly crushed tablets of systemic drugs and presented with severe airborne dermatitis. Methods The patients were patch tested with all of the drugs that they handled, as well as with potential cross-sensitizing molecules. Results All 4 patients reacted to tetrazepam and other benzodiazepines, some of which they had not previously come into contact with, which favours cross-reactivity rather than concomitant sensitization. These patients also had positive reactions to several other non-structurally related drugs for which, in some cases, there was no history of exposure. Conclusions Subjects having to crush drugs, in either an occupational or a non-occupational context, and who present with dermatitis suspected of being airborne-induced, should be patch tested with all contacted medicaments, as well as with possible cross-reacting molecules. Prevention by the use of crushing devices and protective measures (gloves and masks) when medications are handled should be advised. [ABSTRACT FROM AUTHOR]

Background Patch testing is less dangerous than oral provocation testing for identification of the causative drug for patients with drug eruption; however, its usefulness for such identification is controversial. Aim To clarify the rates of positive patch testing for patients with drug eruption, classified by causative drugs and clinical features. Methods We analysed results during the period 1990-2010 for 444 patients (151 men, 293 women; mean ± SD age 49.9 ± 18.6 years) who were tested for drug eruption. In the patient group, there were 309 people (69.1%) with maculopapular eruption and 31 (6.9%) with severe drug eruption. The test materials were applied to the back and left for 2 days under occlusion, then results were assessed by the International Contact Dermatitis Research Group ( ICDRG) scoring system 3 days after application. Reactions of + to +++ were regarded as positive. Results Of the 444 patients, 100 (22.4%) had a positive patch test result to a suspected drug. Positive rates were 23.6% and 20.0% for maculopapular eruption and fixed drug eruption, respectively. The class of materials to which most patients reacted positively was contrast medium ( n = 53; 41.1%), followed by drugs acting on the central nervous system ( n = 18; 28.6%). In the latter group, 16 of the 18 patients were positive to antiepileptics. Conclusions Positive rates depend on the causative drug rather than the clinical features of the drug eruption. Patch testing is useful when contrast medium or antiepileptics are suspected to be the causative drugs. However, standardization of patch test materials and method of reading is needed, as well as guidelines regarding when testing should be performed. Although patch testing for drug eruption has significant potential, it requires further validation. [ABSTRACT FROM AUTHOR]

Background Adverse drug reactions pose an increasing diagnostic challenge in hospitals and in outpatient clinics. When consecutive or repeated allergic drug eruptions are suspected, patch testing is a useful diagnostic tool for determining the causative drugs. Objectives The aim of the study was to identify patient cases with multiple delayed-type drug sensitizations by using patch testing. Methods Eight hundred and eleven patients with suspected drug allergy were patch tested during a 9-year period. Results Multiple delayed drug sensitizations were found in 12% of those patients with positive results in drug patch testing. Conclusions Drug patch testing is useful in cutaneous adverse drug reactions where multiple drugs are suspected. Multiple drug sensitizations can be found in a proportion of patients who have delayed drug allergies. In addition to drug reactions with eosinophilia and systemic symptoms, these patients may have repeated exanthemas or contact dermatitis. [ABSTRACT FROM AUTHOR]

Chlorhexidine is a commonly used antiseptic agent in the health-care setting. Although exposure to chlorhexidine is very common, allergic contact dermatitis ( ACD) is rarely reported. We report a case series of ACD to chlorhexidine in health-care workers and discuss our rates of allergy to chlorhexidine, from patch-testing performed at the Skin and Cancer Foundation, Melbourne, Australia. Of 7890 patients patch-tested, 840 patients were tested to 0.5% chlorhexidine diacetate with 28 (3%) positive reactions, 13 (2%) of which relevant to their presenting dermatitis. Altogether 1565 patients were tested to 0.5% chlorhexidine digluconate, with 47 (3%) positive reactions, 16 (1%) of which were relevant. We estimate our rate of relevant chlorhexidine ACD from our total clinic patients, non-occupational and occupational, to be at least 19/7890 (0.24%). Our rate of relevant chlorhexidine ACD in health-care workers is 10/541 (2%). Interestingly, our rates of chlorhexidine allergy are slightly higher than documented elsewhere. This raises the possibility that chlorhexidine is underestimated as an allergen worldwide, and should be tested for in health-care workers where there is a history of exposure. [ABSTRACT FROM AUTHOR]

Fifteen monoclonal antibodies (mAbs) are currently registered and approved for the treatment of a range of different cancers. These mAbs are specific for a limited number of targets (9 in all). Four of these molecules are directed against the B-lymphocyte antigen CD20; 3 against human epidermal growth factor receptor 2 (HER2 or ErbB2), 2 against the epidermal growth factor receptor (EGFR), and 1 each against epithelial cell adhesion molecule (EpCAM), CD30, CD52, vascular endothelial growth factor (VEGF), tumor necrosis factor (ligand) superfamily, member 11 (TNFSF11, best known as RANKL), and cytotoxic T lymphocyte-associated protein 4 (CTLA4). Collectively, the mAbs provoke a wide variety of systemic and cutaneous adverse events including the full range of true hypersensitivities: Type I immediate reactions (anaphylaxis, urticaria); Type II reactions (immune thrombocytopenia, neutopenia, hemolytic anemia); Type III responses (vasculitis, serum sickness; some pulmonary adverse events); and Type IV delayed mucocutaneous reactions as well as infusion reactions/cytokine release syndrome (IRs/CRS), tumor lysis syndrome (TLS), progressive multifocal leukoencephalopathy (PML) and cardiac events. Although the term "hypersensitivity" is widely used, no common definition has been adopted within and between disciplines and the requirement of an immunological basis for a true hypersensitivity reaction is sometimes overlooked. Consequently, some drug-induced adverse events are sometimes incorrectly described as "hypersensitivities" while others that should be so described are not. [ABSTRACT FROM AUTHOR]

Background. Reviews on irritant and allergic airborne contact dermatitis have been previously reported in the literature. Materials and methods. Here, we present an update based on recently published airborne-induced skin reactions. For this survey, we screened the journals Contact Dermatitis, Dermatitis, and included relevant articles from other journals during the period January 2007 to December 2011. We also present the airborne cases observed in our department during the same time period. Results. This survey provides an updated list of causal agents that have produced airborne allergic contact dermatitis, and briefly mentions some other types of skin reaction induced by airborne exposure. The sources of the reactions are multiple: drugs; plants, natural resins, and wood allergens; plastics, rubbers, and glues; preservatives and other chemicals; and metals. Conclusions. Airborne contact dermatitis is frequent, and most of the airborne allergens (and irritants) identified are in occupational settings. Drugs and preservatives have recently become more important causes. Dermatologists and occupational physicians need to be aware of them. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 19-year-old woman who was presented with popular, erythematous, and confluent eruptions in hands. She used lanolin alcohol-containing propolis cream which has been revealed to cause her allergy. The article discusses lanolin alcohol contact allergy and its common occurrence in patients with stasis dermatitis.

Background Tetrazepam, a benzodiazepine, is a frequently used muscle relaxant. The most common adverse reactions are neurological and gastrointestinal. Cutaneous reactions to tetrazepam are rare and occur predominantly after systemic administration. Objective To present 10 health care professionals who developed airborne contact dermatitis to tetrazepam due to occupational exposure to tetrazepam dusts. Materials and methods We report a series of 10 cases observed in our department between January 2006 and March 2011 where tetrazepam was identified to cause allergic airborne contact dermatitis. Affected individuals were employed as (geriatric) nursing staff, exposed to tetrazepam on a regular occupational basis when crushing tablets for their patients. Upon investigation, patients were patch tested with commercial and customized allergens. This included tetrazepam and in five cases diazepam. Tetrazepam revealed strong positive reactions in all patients. Additional diazepam sensitization was observed in three subjects. Following local treatment and occupational preventive action, patients recovered from their skin symptoms. Conclusions Allergic contact sensitization to tetrazepam and cross-sensitization to diazepam seems to be underestimated and not appropriately diagnosed in patch test clinics, as it is so far insufficiently patch tested. They should be considered when allergic contact dermatitis is suspected, particularly in professionally exposed staff, and tested as supplemental allergens. [ABSTRACT FROM AUTHOR]

The article presents abstracts on contact dermatitis which include "Skin exposure to metals," by Carola Lidén, "Occupational contact allergy to isocyanates," by Kristiina Aalto-Korte and colleagues, and "Cytokine analysis using multiplex technology in skin irritation research," by J. Lee.

Systemic contact dermatitis is an inflammatory skin disease that may occur in persons with contact allergy when they are exposed to the hapten orally, transcutaneously, per rectum, intravesically, intravenously, or by inhalation. The most common causes of systemic contact dermatitis are drugs used both topically and systemically. Other causes are ubiquitously occurring haptens, such as the metals nickel, cobalt, gold, and chromate, and aromatic substances such as spices. Avoidance of the offending hapten is the most obvious treatment. For some haptens, such as nickel, diet treatment may be effective. Chelation therapy with disulfiram is another therapeutic option in nickel-allergic patients with systemic contact dermatitis. Hyposensitization therapy has been attempted with some success in systemic contact dermatitis caused by nickel and Parthenium hysterophorus. [ABSTRACT FROM AUTHOR]

Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability. To estimate the prevalence of tixocortol-21-pivalate, budesonide and hydrocortisone-17-butyrate allergy in a Danish patch test population and characterize individuals with corticosteroid allergy. Three thousand five hundred and ninety-four patients were patch tested with tixocortol-21-pivalate, budesonide, and hydrocortisone-17-butyrate. Characterization was performed according to the MOAHLFA index and duration of disease. Two per cent had a steroid allergy: 0.8% had a tixocortol-21-pivalate allergy, 1% a budesonide allergy, and 1% a hydrocortisone-17-butyrate allergy. Tixocortol-21-pivalate and budesonide allergy were associated with atopic dermatitis in crude analyses, but only tixocortol-21-pivalate allergy and atopic dermatitis remained associated in adjusted analyses. Leg dermatitis was uniquely associated with tixocortol-21-pivalate allergy. Hydrocortisone-17-butyrate allergy was associated with duration of disease in both crude and adjusted analyses. Chronic dermatoses (atopic dermatitis and leg dermatitis) were identified as risk factors for group A corticosteroid allergy, probably because of more pronounced exposure to group A steroids resulting from ease of access that is exploited by patients with a chronic dermatosis. The duration of disease rather than the dermatosis itself seemed to be important for group B and D2 corticosteroid allergy. [ABSTRACT FROM AUTHOR]

Subacute cutaneous lupus erythematosus (SCLE) is a subset of cutaneous lupus erythematosus with unique immunologic and clinical features. The first description dates back to 1985 when a series of five patients were found to have hydrochlorothiazide-induced SCLE. Since that time, at least 40 other drugs have been implicated in the induction of SCLE. [ABSTRACT FROM AUTHOR]

The ingredients previously reported to cause protective glove allergy are presented and evaluated for strength of evidence. Allergens that have caused both delayed hypersensitivity and contact urticaria are considered for rubber, plastic, leather, and textile gloves. The current guidelines regarding glove manufacture are described. A list of materials confirmed by the industry to be used in glove production is presented together with a suggested series for investigating patients with delayed type hypersensitivity and contact urticaria secondary to glove use. [ABSTRACT FROM AUTHOR]

Background Nurses have a high risk of developing hand eczema due to hand disinfection procedures. Objectives To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). Methods A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. Results The majority (PS 60·1%; MC 69·5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79·2%/52·1%; HW 65·5%/36·2%) compared with an allergenic potential (ADI 10·4%/5·8%; HW 7·8%/3·9%). The prevalence of hand dermatitis in the MC was 13·4% by self-diagnosis and 22·4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. Conclusions Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective study of four patients with allergic contact dermatitis on the face and scalp as a result of hair gel use containing methylisothiazolinone (MI). Topics include the prevalence of allergic contact dermatitis caused in MI in Europe, the significant increase of allergic contact dermatitis caused by MI and patch test results revealing positive reactions to MI.

Background It is well known that patients with chronic wounds frequently acquire clinically relevant contact sensitizations to skin care products. Objectives The aim of our study was to find out the actual frequency of contact sensitivities in patients with chronic wounds in Germany with particular attention to components of products used in modern wound therapy. Methods We examined the results of a prospective clinical investigation on skin patch tests of patients with chronic wounds. Results Altogether, 45 patients with chronic wounds were tested. In 25 (55.5%) of the examined patients, contact sensitization to at least one substance was detected. The most frequent contact sensitizations were to PVP-iodine (20%), balsam of Peru (15.6%) patients, fragrance mix (11.1%), colophony (8.8%) and potassium dichromate (6.7%). We also found sensitization to the wound dressings Varihesive™ (11.1%), Iruxol™ N (6.7%) and Comfeel™ (2.2%). Conclusions We would like to propagate that therapists who are involved in wound treatment should also pay attention on the ingredients of applied modern wound dressings. [ABSTRACT FROM AUTHOR]