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Background: Painters are among the occupational groups that most commonly experience occupational contact dermatitis, but few investigations exist concerning this occupation., Objectives: To characterize painters with contact dermatitis and identify the most common allergens associated with the occupation. Materials and methods. All patch test results of 219 painters and 1095 matched controls registered by the Danish Contact Dermatitis Group between 2001 and 2010 were analysed., Results: Hand eczema (p < 0.0001) and occupational contact dermatitis (p < 0.0001) were observed significantly more often in the painters than in the group of controls. Sensitizations to the following allergens from the European baseline series were associated with the occupation and were statistically significant: methylchloroisothiazolinone/methylisothiazolinone, epoxy resin, formaldehyde, and quaternium-15. Three different isothiazolinones emerged as the most frequent sensitizers of the allergens tested in addition to the baseline series., Conclusions: The results indicate that painters have an increased risk of developing occupational hand eczema. Isothiazolinones and epoxy resin proved to be the two most frequent sensitizers in painters., (© 2012 John Wiley & Sons A/S.)

There are no published clinical studies evaluating the impact of warts on quality of life after transplantation. The aim of this study was to determine the frequency of self-reported skin warts and skin cancer and their impact on quality of life in kidney transplanted patients, as measured with the Dermatology Life Quality Index (DLQI). Of 740 patients with a functioning renal allograft and were free of dialysis who were surveyed, 568 returned the questionnaires. Patients were asked about general health issues, with a focus on transplantation history, cutaneous warts and whether they had ever had cutaneous cancer. A total of 285 (52%) patients replied that they had warts, and these increased with time since last transplantation, with a p-value < 0.0001. A total of 101 patients (18%) reported that they had ever had skin cancer. The median DLQI was 0 for patients not having warts, 1 for patients with warts, and 2 for patients having warts and skin cancer. In conclusion, renal transplant recipients experience increasing numbers of warts and skin cancer over time, and having skin cancer impairs patients' quality of life to a greater degree than warts.

During the last 2 years, we have performed filaggrin genotyping in patients with eczema seen in our hand eczema clinic. We present pictures of healthy and diseased hands from individuals with filaggrin gene (FLG) mutations to describe a clinical entity of hand eczema. We show that xerosis and hyperkeratosis on the dorsal aspects of the hands and fingers, as well as palmar hyperlinearity, should alert the clinician about a possible inherited barrier abnormality of the skin resulting from FLG mutations. The series of photographs range from the hands of an individual with FLG mutations but no history of eczema, to the hands of individuals with typical and atypical filaggrin hand eczema, and finally to the hands of an individual with FLG mutations and hand eczema caused by exposure to irritants and allergens. We briefly discuss this possible subtype of hand eczema, present pathomechanisms, and indicate the signs that should alert the clinicians about a possible inherited skin barrier defect., (© 2012 John Wiley & Sons A/S.)

The aim of this study was to examine the validity of a Danish adaptation of the Itch Severity Scale (ISS) by exploring the associations between pruritus severity, psychological symptoms, and quality of life in a consecutively recruited sample of 20 patients with atopic dermatitis, 20 with psoriasis, 20 with urticaria, 12 with genital pruritus, 11 with nephrogenic pruritus, and 20 controls with vascular malformations. Convergent and discriminative validity was explored by analysing the associations of the ISS total score and the individual ISS component scores with age, sex, diagnosis, disease severity, sleep quality, depressive symptoms, anxiety, non-specific somatic symptoms, and pruritus-related quality of life impairment. Patients with urticaria reported significantly (p < 0.05) greater pruritus severity scores than the remaining patient groups, and pruritus severity was significantly associated with impaired sleep quality, more depressive symptoms, higher levels of anxiety, more non-specific somatic symptoms, and impaired quality of life. The results also confirmed the multidimensional nature of pruritus, with the affective dimension of pruritus being a better predictor of depressive symptoms, anxiety, and quality of life impairment than the sensory dimension. Finally, our results confirmed previous findings that the associations between pruritus severity and depressive symptoms and somatic symptoms were partly mediated by the effect of pruritus on sleep quality.

Background: Type 17 helper T cells have been suggested to play a pathological role in psoriasis. They secrete several proinflammatory cytokines, including interleukin-17A (also known as interleukin-17). We evaluated the safety and efficacy of ixekizumab (LY2439821), a humanized anti-interleukin-17 monoclonal antibody, for psoriasis treatment., Methods: In our phase 2, double-blind, placebo-controlled trial, we randomly assigned 142 patients with chronic moderate-to-severe plaque psoriasis to receive subcutaneous injections of 10, 25, 75, or 150 mg of ixekizumab or placebo at 0, 2, 4, 8, 12, and 16 weeks. The primary end point was the proportion of patients with reduction in the psoriasis area-and-severity index (PASI) score by at least 75% at 12 weeks. Secondary end points included the proportion of patients with reduction in the PASI score by at least 90% or by 100%., Results: At 12 weeks, the percentage of patients with a reduction in the PASI score by at least 75% was significantly greater with ixekizumab (except with the lowest, 10-mg dose)--150 mg (82.1%), 75 mg (82.8%), and 25 mg (76.7%)--than with placebo (7.7%, P<0.001 for each comparison), as was the percentage of patients with a reduction in the PASI score by at least 90%: 150 mg (71.4%), 75 mg (58.6%), and 25 mg (50.0%) versus placebo (0%, P<0.001 for each comparison). Similarly, a 100% reduction in the PASI score was achieved in significantly more patients in the 150-mg group (39.3%) and the 75-mg group (37.9%) than in the placebo group (0%) (P<0.001 for both comparisons). Significant differences occurred at as early as 1 week and were sustained through 20 weeks. Adverse events occurred in 63% of patients in both the combined ixekizumab groups and in the placebo group. No serious adverse events or major cardiovascular events were observed., Conclusions: Use of a humanized anti-interleukin-17 monoclonal antibody, ixekizumab, improved the clinical symptoms of psoriasis. Further studies are needed to establish its long-term safety and efficacy in patients with psoriasis. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT01107457.).

Psoriasis is a common inflammatory skin disease and obesity constitutes a risk factor for the disease. Obese patients with psoriasis are often more difficult to treat and are at increased risk for dyslipidemia, diabetes, hypertension and cardiovascular disease. Case reports suggest that gastric bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis following gastric banding. Intriguingly, recent studies describe that GLP-1 may convey anti-inflammatory effects in addition to its effects on glucose homeostasis. Also, GLP-1 reduces appetite and gastrointestinal motility including gastric emptying, which reduces food intake and leads to weight loss. Thus, both a direct anti-inflammatory effect of GLP-1 as well as an indirect effect through weight loss could contribute to improvement in psoriasis. A potential involvement of GLP-1 in the remission of psoriasis observed after bariatric surgery offers exciting possibilities for research and eventually perhaps new ways of anti-psoriatic treatment., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Despite the political intention to limit nickel allergy and dermatitis in Europeans, nickel allergy remains frequent. There are several explanations for the persistence of nickel allergy and dermatitis, including the increasing use of mobile phones. Before regulation of nickel release from mobile phones, we showed that eight (19.5%) of 41 mobile phones marketed in Denmark between 2003 and 2007 released nickel in concentrations that may result in nickel allergy and dermatitis. In 2009, the EU Nickel Directive was revised to include nickel-releasing mobile phones., Objectives: To investigate the proportion of mobile phones sold in Denmark that release nickel after regulation., Methods: Metallic parts from 50 randomly selected mobile phones currently for sale in Denmark were tested for nickel release by use of the dimethylglyoxime (DMG)-nickel spot test., Results: Nine (18%) phones showed at least one positive DMG test reaction and two phones had more than one DMG test-positive spot., Conclusions: Apparently, the proportion of mobile phones with significant nickel release remains unchanged, despite the 2009 revision of the EU Nickel Directive. We encourage manufacturers to measure nickel release from metallic components used in the assembly of mobile phones to ensure safe products., (© 2011 John Wiley & Sons A/S.)

Background: Allergic contact dermatitis is a chronic inflammatory T cell mediated disease that can be recalcitrant to existing treatments. Ustekinumab is a monocloncal antibody blocking IL-12 and IL-23, shown to be effective and safe for patients with psoriasis. Despite both IL-12 and IL-23 involvement in contact allergy, the effect of Ustekinumab on allergic contact dermatitis has not been reported., Objectives: To evaluate the clinical effect of Ustekinumab in patients with allergic contact dermatitis., Methods: A retrospective, case cohort study of patients with allergic contact dermatitis treated with Ustekinumab in our department., Results: Five patients had been treated with Ustekinumab for allergic contact dermatitis, with limited effect., Conclusion: Our observation suggests that, although theoretically plausible, Ustekinumab does not seem to be a valuable therapeutic approach for chronic allergic contact dermatitis., (© 2011 John Wiley & Sons A/S.)

Evidence is increasing that severe psoriasis is an independent cardiovascular risk factor. Results from case-control studies of endothelial dysfunction, a marker of early atherosclerosis, in patients with moderate-to-severe psoriasis have been conflicting and were conducted with operator-dependent and technically demanding ultrasound measurement of brachial artery flow-mediated vasodilation. Therefore, we decided to measure endothelial function and other cardiovascular risk factors in patients with mild-to-moderate psoriasis (n = 30) and controls (n = 30) using a newer and relatively operator-independent technique. No difference was detected between the groups with regards to endothelial function. However, despite the patients experiencing rather mild psoriasis they did exhibit higher levels of certain cardiovascular risk factors, including waist circumference, resting heart rate, systolic and diastolic blood pressures, and plasma levels of triglycerides, very-low-density lipoprotein cholesterol and glycated glucose, compared with controls. This indicates that even mild-to-moderate psoriasis may be regarded as a systemic inflammatory disease, and that an increased risk of cardiovascular morbidity may be present in these mild-to-moderately affected patients in the long-term.

Background: Methylisothiazolinone (MI) used alone is a new preservative causing a high prevalence of contact allergy. The eliciting threshold of MI is unknown. The combination of MI and phenoxyethanol enhances the antimicrobial efficacy of MI., Objectives: The eliciting doses of MI contact allergy in a patch test and a repeated open application test (ROAT) were investigated. In the patch test, it was determined whether phenoxyethanol influenced the reactivity to MI., Methods: Eleven MI-allergic individuals were patch tested with two dilution series of 12 doses of MI and the same 12 doses with phenoxyethanol. The ROAT mimicked the use of a cream preserved with 100, 50 and 5 ppm MI (corresponding to 0.21, 0.105 and 0.0105 µg MI/cm(2))., Results: Phenoxyethanol had no influence on the reactions to MI. The lowest eliciting dose in the patch test was 1.47 µg MI/cm(2). In the ROAT, 7 patients (64%) reacted to 0.21 and 0.105 µg MI/cm(2) and 2 patients (18%) reacted to 0.0105 µg MI/cm(2), corresponding to a cream preserved with 5 ppm MI., Conclusions: A maximum of 100 ppm MI is permitted in cosmetic products. Eighteen per cent of MI-allergic patients reacted to a concentration 20 times lower in a ROAT. The amounts used in cosmetics should be reduced, and the development of MI contact allergy should be monitored closely., (© 2011 John Wiley & Sons A/S.)

Background: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) has been one of the most frequent sensitizers since the 1980s. In 2005, the use of MI alone was approved for the preservation of cosmetic and household products in the EU. Before that, MI was used in industrial products, and the first cases of isolated MI contact allergy were published., Objectives: To present the prevalence and causes of MI contact allergy., Materials and Methods: Patch test results from 2536 dermatitis patients tested with MI at Gentofte University Hospital between May 2006 and February 2010 were analysed. A retrospective investigation of medical records from MI-allergic patients was performed to reveal the causes of their MI contact allergy., Results: Of patch-tested patients, 1.5% had MI contact allergy. It was associated with occupational dermatitis, hand eczema and age above 40 years. Exposure to MI in cosmetic products was found in 12 (32%) cases, and exposure to MI in occupational products was found in 11 (30%) cases; 5 of the 11 were painters., Conclusions: The prevalence of MI contact allergy is already at the same level as that of other sensitizing preservatives, which have been on the market for several years, but no rising trend was identified. MI contact allergy was associated with both occupational and consumer products.

Psoriasis is a chronic inflammatory skin disease, which affects approximately 2.6% of the population in Northern Europe and Scandinavia. In order to achieve disease control, combinations of systemic treatments are sometimes needed for variable time periods. However, no evidence-based guidelines exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination treatments. The most thoroughly investigated combination was retinoid and phototherapy. Further controlled research is needed to define the safest and most effective combination regimens.

This article reviews if local immunosuppression of atopic dermatitis is associated with an increased risk of cancer - as implicated by a warning issued by the FDA and EMEA health authorities because systemic immunosuppression of transplanted patients leads to a significant increase of non-melanoma skin cancer and lymphoma. So far, no studies support that the use of topical immunosuppression increases the risk of local or systemic cancer.

Cosmetics with high water content are at a risk of being contaminated by micro-organisms that can alter the composition of the product or pose a health risk to the consumer. Pathogenic micro-organisms such as Staphylococcus aureus and Pseudomonas aeruginosa are frequently found in contaminated cosmetics. In order to avoid contamination of cosmetics, the manufacturers add preservatives to their products. In the EU and the USA, cosmetics are under legislation and all preservatives must be safety evaluated by committees. There are several different preservatives available but the cosmetic market is dominated by a few preservatives: parabens, formaldehyde, formaldehyde releasers, and methylchloroisothiazolinone/methylisothiazolinone. Allergy to preservatives is one of the main reasons for contact eczema caused by cosmetics. Concentration of the same preservative in similar products varies greatly, and this may indicate that some cosmetic products are over preserved. As development and elicitation of contact allergy is dose dependent, over preservation of cosmetics potentially leads to increased incidences of contact allergy. Very few studies have investigated the antimicrobial efficiency of preservatives in cosmetics, but the results indicate that efficient preservation is obtainable with concentrations well below the maximum allowed.

Background: Nickel dermatitis may be caused by frequent and prolonged use of cell phones. Because little is known about the frequency of nickel release from cell phones, it is difficult to estimate the risk of nickel sensitization and dermatitis among their users., Objective: Inspired by a recent case of nickel dermatitis from prolonged cell phone use, the frequency of dimethylglyoxime (DMG)-positive cell phones on the Danish market was investigated., Methods: Five major cell phone companies were contacted. Two were visited, and the DMG test was performed on a sample of their products., Results: 5 of 15 (33.3%) phones from company A and 3 of 26 (11.5%) phones from company B showed at least 1 positive reaction. 3 phones had more than 1 positive DMG spots., Conclusions: This study documents that excessive nickel release (i.e. a positive DMG test) is relatively frequent in a sample of cell phones from the Danish market. Prolonged use of cell phones may in some cases fulfil the criteria for items included in the European Union Nickel Directive. We believe that this new cause of nickel dermatitis should be carefully followed and that regulatory steps may be necessary.

IL-8 is a chemokine that has been implicated in a number of inflammatory diseases involving neutrophil activation. HuMab 10F8 is a novel fully human mAb against IL-8, which binds a discontinuous epitope on IL-8 overlapping the receptor binding site, and which effectively neutralizes IL-8-dependent human neutrophil activation and migration. We investigated whether interference in the cytokine network by HuMab 10F8 might benefit patients suffering from palmoplantar pustulosis, a chronic inflammatory skin disease. Treatment of patients with HuMab 10F8 was well tolerated and significantly reduced clinical disease activity at all five endpoints, which included a >or=50% reduction in the formation of fresh pustules. IL-8 neutralization was monitored at the site of inflammation by assessing exudates of palmoplantar pustulosis lesions. HuMab 10F8 sequestered IL-8 in situ, as observed by rapid dose-dependent decreases of IL-8 concentrations immediately following Ab infusion. These data demonstrate a critical role for IL-8 in the pathophysiology of palmoplantar pustulosis. HuMab 10F8 is capable of interrupting IL-8 activity in vivo and represents a candidate for treatment of inflammatory diseases and other pathological conditions associated with IL-8 overproduction.

The subjective dimensions of pruritus and their associations with psychological symptoms and quality of life were explored in a sample of 40 psoriasis patients. The patients completed a scale with descriptors from the Structured Itch Questionnaire together with measures of depression, distress, sleep quality and pruritus-related quality of life. Psoriasis severity was assessed with the Psoriasis Area and Severity Index. Factor analysis of descriptors confirmed both an affective and a sensory pruritus severity dimension. Multivariate statistics, controlling for age, gender, disease duration and severity, showed affective, but not sensory, pruritus severity to be a significant predictor of depressive symptoms, global distress, impairment of sleep, and pruritus-related quality of life. Mediation analyses indicated that impaired sleep quality partly mediated the association between pruritus severity and psychological symptoms. The results confirm that pruritus is multidimensional and indicate that the affective dimension may be the most important predictor of pruritus-related psychological morbidity, and that the association may be mediated by its negative impact on sleep quality.

Many patients with moderate-to-severe plaque psoriasis do not respond adequately to methotrexate monotherapy. This pilot study, with a small patient population, was performed to evaluate the effectiveness and safety of etanercept and methotrexate combination in patients with plaque psoriasis and inadequate response to methotrexate. Outpatients with plaque psoriasis (Psoriasis Area and Severity Index > or = 8 and/or body surface area > 10%), despite methotrexate treatment (> or = 3 months; > or = 7.5 mg/week) were randomized to either etanercept with metho nottrexate tapered and discontinued (n = 28) or etanercept with continuous methotrexate (n = 31). Significantly more patients had a Physicians' Global Assessment of "clear"/"almost clear" in the combination group compared with etanercept/methotrexate taper (66.7 vs. 37.0%, respectively; p = 0.025). Adverse events were similar for both groups, with no cases of tuberculosis, malignancies or opportunistic infections reported. Addition of etanercept to methotrexate achieved significant improvement in psoriasis after 24 weeks.

An increasing number of patients undergo soft-tissue augmentation. The quality depends on the applied filler substance, the compliance of the patient and the physician. Long-term adverse reactions are referred to as nodules or granulomas. Nodules following degradable gels and polyacrylamide hydrogel are always caused by bacteria. Nodules following inert, hydrophobic silicone gel and combination gels may emerge years after the injection. They are often caused by a low-grade infection with ensuing enhanced fibrosis and treatment requires a specialist.

Primin was included in the European standard series (ESS) in 1984. In 2000, a primin-free variant of Primula obconica, the main source of contact allergy to primin, was introduced in the market. The aim of this study was to analyse the trends of primin allergy in 13 986 consecutively patch-tested eczema patients over a 20-year period from 1985 to 2004. 151 patients gave a positive patch test to primin. The majority were women, in two-third of patients the patch test was relevant and most presented with hand eczema. Only few of the cases (4.7%) were occupational. A significant decline of contact allergy to primin was seen (P < 0.001) over the years affecting all age groups. The frequency was 0.5% during 2000-2004. Contact allergy has been rare since 2000. The low frequency of positive patch test to primin does not support inclusion in the ESS in our region.

Methylchloroisothiazolinone and methylisothiazolinone (MCI/MI) contact allergy affects 1-3% of patch-tested patients in European centres. The aim of the present study was to evaluate the importance of the factors--time and concentration (dose/per unit area)--in the elicitation capacity by means of a repeated open application test (ROAT) experimental design. The study was designed as a double-blind, placebo-controlled, dose-response ROAT preceded by a diagnostic patch testing. 25 subjects with confirmed MCI/MI allergy and 10 healthy, non-MCI/MI allergic control subjects were exposed to 0.025 microg/cm2 (2 p.p.m.) of MCI/MI/unit area of the skin for 4 weeks. After a wash-out period of at least 4 weeks, the subjects were exposed to 0.094 microg/cm2 (7.5 p.p.m.) of MCI/MI/unit area of the skin for 4 weeks. The study showed the importance of both time and exposure in the elicitation process. It demonstrated that the elicitation threshold for MCI/MI is expected to be in the proximity of 0.025 microg/cm2 although it was not possible to establish a definitive elicitation threshold for MCI/MI in this study.

The morphology of early allergic contact dermatitis reactions was studied in formaldehyde allergic individuals exposed to a cream product preserved with 4 different concentrations of diazolidinyl urea. The study was made using a dose-escalating design in 3 different anatomical regions, the upper arm, neck and face. On the arm and neck, the dominant initial morphology was an eczematous papular eruption. In the face, the initial skin changes were more homogeneous and infiltrated erythema.

The elicitation potential of the cosmetic preservative diazolidinyl urea was studied in formaldehyde- and diazolidinyl urea-sensitized volunteer patients using a stepwise controlled exposure design. The test product was a facial moisturizer, preserved with varying concentrations of diazolidinyl urea, ranging from 0.05% to 0.6%. A repeated open application-like exposure test was performed on volunteers and a control group with the test product containing increasing preservative concentrations, on arm, neck and face, sequentially, for 2 weeks or until dermatitis developed. The preservative action in the cream at different test concentrations was tested in microbial challenge tests and was found effective at all concentrations tested. The study established a non-eliciting concentration of diazolidinyl urea of 0.05% in formaldehyde-sensitive patients and showed that the skin reactivity depends on the anatomical region, increasing from the upper arm to neck and, possibly, to the face. The study design, beginning on the upper arm and moving on to the neck and face seems to be relevant for the study of reactions to cosmetic products. A clear dose-response relationship was seen regarding preservative concentration in the product.

An increased frequency of contact allergy to methyldibromoglutaronitrile (MDBGN), a commonly used preservative in cosmetics and other consumer products, has been reported in recent years. A high-performance liquid chromatography (HPLC) method for the determination of MDBGN in cosmetic products has been validated in the present study. The identification is performed by reductive electrochemical detection of the bromine present in the molecule. The method is suitable for compliance testing of cosmetic products as well as for the research to support clinical and epidemiological studies.

The aim of the investigation was to compare psychological symptoms and health-related quality of life of dermatology patients and healthy controls. The sample consisted of 333 consecutively recruited patients from four dermatology outpatient clinics, 172 hospitalized dermatological patients from two university hospitals and 293 matched healthy controls. All patients and controls completed Beck's Depression Inventory, the Brief Symptom Inventory and the Dermatology Life Quality Index. Hospitalized patients were more distressed than outpatients and healthy controls and reported greater impairment of disease-related quality of life than outpatients. More hospitalized patients had suicidal thoughts and were characterized as having severe to moderate depression compared with outpatients and controls. Female patients and younger patients were generally more distressed than male patients and older patients, and patients with atopic dermatitis and psoriasis were more distressed than patients with urticaria and eczemas. Disease-related impairment of quality of life was the main predictor of psychological symptoms, when controlling for diagnosis, age, gender, disease duration and disease severity. Although older age was associated with fewer psychological symptoms, our data suggest that skin disease affects quality of life equally in young and older patients. The findings highlight the importance of recognizing disease-related psychological problems and possible psychiatric comorbidity of dermatology patients, especially among patients with atopic dermatitis and psoriasis.

Background: Psoriasis is characterized by infiltration with mononuclear cells. Especially activated memory CD4+ T cells are critical in the pathogenesis. Interaction between the CD4 receptor and the major histocompatibility complex class II molecule is important for T-cell activation., Objective: To test safety and efficacy of a fully human monoclonal anti-CD4 antibody (HuMax-CD4) in the treatment of psoriasis., Design: Multicenter, double-blind, placebo-controlled, randomized clinical trial. Patients Eighty-five patients with moderate to severe psoriasis., Interventions: Subcutaneous infusions of placebo or HuMax-CD4 at doses of 20, 80, 160, or 280 mg once weekly for 4 weeks., Main Outcome Measures: Psoriasis Area and Severity Index (PASI), investigators' and patients' overall response assessment, adverse events, laboratory assessment including total T-cell and subtype counts, CD4 receptor occupancy, and interleukin 2 receptor levels., Results: At week 7, mean PASI was reduced in all treatment groups (95% confidence intervals are in parentheses): placebo, 8% (-3% to 19%); 20 mg, 12% (-6% to 27%); 80 mg, 14% (-14% to 35%); 160 mg, 16% (-4% to 33%); and 280 mg, 24% (-10% to 48%). At the highest dose level, 6 (38%) of 16 patients obtained more than 25% reduction of PASI and 3 (19%) obtained more than 50% reduction of PASI. A dose-dependent decrease in total lymphocyte count was seen and was parallel to a dose-dependent decrease in CD4+ T cells. This decrease was due to a decrease in the memory subset, whereas the naive subset was affected to a minor degree. Four weeks of treatment with HuMax-CD4 was safe and well tolerated., Conclusions: Treatment with HuMax-CD4 led to a moderate, not statistically significant reduction in PASI. The efficacy results obtained after only 4 weeks of treatment suggest that longer treatment would lead to even further reduction of PASI.

In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

The aim of this study was to evaluate whether a moisturizer used on normal skin can increase skin response to allergens. Twelve nickel-allergic volunteers applied a lipid-rich moisturizer on the upper arm 3 times daily for 7 days, while the other upper arm served as a control. A control group followed the same treatment protocol. Following treatment with moisturizer, patch tests with 1% NiCl2 aqueous solution were applied on each upper arm. After 24 and 72 h, skin reactions were evaluated blinded by clinical scoring, and by bioengineering methods measuring transepidermal water loss, skin colour and skin thickness. In the nickel-allergic group the strength of patch-test reactions was increased on the moisturizer-treated arm as evaluated by clinical scoring after 24 h and by measurement of transepidermal water loss and skin thickness after 72 h. In the control group, no significant differences were found. Our findings show that threshold values for elicitation of allergic reactions in already sensitized individuals may be influenced by use of lipid-rich moisturizers.