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A case of synergistic postoperative progressive gangrene is presented. After a bibliographic review and a description of the main clinical chacteristics of the condition, the authors emphasize the fact that tests for cell mediated immunity showed slight impairment. Howeves the immediate type sensitivity tests and the leucocyte function were normal. The patient was treated successfully with fusidic acid after other antibiotics had proved ineffective.

The results of the study of 51 patients bearing a Milwaukee corset indicate that they present a mechanical and irritative dermatitis caused by the personal predisposition, the action of the plastic material and the occlusion and humidity produced between skin surface and the corset. The authors suggest the name Occlusive Dermatitis Syndrom for this cases as a subtype of Mechanical Irritative Dermatitis.

A man affected of a femur osteomyelitis was treated with Septopal (Merck) and presented an allergic contact dermatitis on the left thigh, thorax, abdomen with bilateral oedema of eyelids and generalized pruritus. The cause was a co-polymer of methyl-methacrylate-methacrylate of the material of the small balls of Septopal, which liberates gentamycin contained inside through little pores.

Six rejected stainless steel hip prostheses that had been removed from 15 metal sensitive patient were immersed in different solutions in various containers and maintained at 37 degrees C in complete darkness. Two months later by means of atomic absorption spectrophotometric studies we were able to determine the amount of nickel, chrome and cobalt released in a saline solution. When the chromium oxide passivation coat of the metal prostheses is damaged by orthopaedic surgical implantation procedures the prostheses may rust, releasing metallic ions.

There are three types of hand dermatitis in housewives. The most usual are cured when housework is stopped. Another type is that of housewife contact dermatitis which appears on pre-existing endogenous lesions such as dyshidrosis or nummular eczema. The third form is housewife hand contact dermatitis which appears, or coexists with, localized endogenous lesions of the hands. The last two forms are not cured when housework is stopped. In some cases the three forms may coexist or appear one after another. It is not usual for a person suffering from typical flexural atopic dermatitis to present with one of the described three forms of hand dermatitis. Nevertheless, without having some relationship to atopic diathesis no woman could suffer from any of these three forms of dermatitis. In spite of the lack of analytical data, everyday clinical facts (one example being these different forms of housewife hand dermatitis) suggest the need to accept a subgroup of cutaneous atopic diathesis.

An hitherto undescribed type of contact dermatitis in a series of 16 patients is described by the authors. The lesions were localized in the anterior and anterolateral aspects of the thighs and were sharply limited in the area contacting the trouser pockets, manufactured with synthetic fabrics. In 17 patients of this series there was a concomitant dermatitis in the exposed areas of the face and hands. The authors described the processing in the manufacture of these pockets, the end step being the obtention of poliamide, through different precursor substances. The poliamide is treated with different aditives giving rise to the nylon fiber, which is used to manufacture the definitive tissue. A list of adequate allergens and their concentrations used in the 16 patients is given in the paper. The results of the patch tests and the fact that all the clinical symptoms of the patients disappeared after the withdrawal of the tissue pockets and substitution by cotton tissue give a reasonable basis to the hypothesis of contact dermatitis caused by this tissue. However, the true specific allergen is not demonstrated yet.

Among 4600 patients tested in 5 years (1973--77), 5.02% of them (231 cases) presented positivity to Benzidine. Of them 16.4% (38 cases) showed concomitant sensitization to one or more allergens of the tested substances of p-amino compounds group. Among the patients who suffered from clinically diagnosed occupational contact dermatitis and showed a positive reaction to Benzidine, 66% of them showed positive reactions to Benzidine as a unique patch-test positivity, whereas 34% of them reacted to Benzidine and to other allergens as well. The occupations where a sensitization to other allergens as well. The occupations were a sensitization to Benzidine was found in a relatively high number were: mechanical industry, house-wives, construction workers, textile industry, hairdressers, and chemical industry. Histological studies of the patch-tests confirm the allergic nature of the reaction. The sources of eventual sensitization and the significance of the circumstantial positivities to this allergen are discussed.

A case of mastocytosis is presented by the authors. The lesions appeared in early childhood with the typical appearance of urticaria pigmentosa. With the course of the years they changed becoming micropapular and assuming the appearance of the clinical picture described by Griffiths and Daneshbod as pseudoxantomatosis mastocytosis, although some clinical and histological aspects resembled the morphology and structure of the "nevus elasticus".

Contact dermatitis in patients suffering acne is raising. These reactions are provoked by different sensitizing substances used in the treatment of acne. The Authors review the diverse possibilities of sensitisation in acne patients: contact dermatitis, primary irritation, photoallergy and phototoxicity, and "dermatitis by general administration of the allergen". The diverse acneiform contact dermatitis are reviewed and classified. The importance of acne venenata or contact acne--professional or no--, and different acneiform contact eruptions or by ingestion, is emphasized.

Regarding two cases of allergic contact dermatitis caused by geraniol, containing in two different pharmaceutical products, a revision has been made of the preparations of topical application which contain this and other fragrances. At the same time the clinical picture and examination of these cause is reported.

This paper attempts to explain the initial onset in which the population are sensitized to nickel at an early age, above all in females. A study has been made on 200 controls who tolerated metals and on 964 patents who did not tolerate them. The study comprised of patch tests with 8 distinct washers, made of a variety of metals and alloys all containing nickel, and with nickel sulphate to 1% in petrolatum and cobalt salts to 1% in petrolatum. The results, professional and atopic relationship and other considerations are commented.

In the context of contact dermatitis of a none professional character, the shoe allergic contact dermatitis has been mentioned in the literature for many years, in spite of not being frequent. During the last 15 years, our Department of Dermatology has accumulated a certain experience (225 cases) of this. The results have shown that the incriminated allergens have changed during this time.

The authors show the results obtained during the 5-year period 1973-1977 in 4600 patch tested patients in the Allergy Department of Barcelona University. The results obtained with the most common allergens (nickel sulfate, potassium dichromate, para compounds, cobalt and rubber) are studied separately. The results of testing with the allergens with a low incidence of positives are also shown. The results are compared with those published by the NACDG on 1200 patients and by Brun in Geneva on 1000 patients; 5.02% of the tested patients showed sensitization to benzidine.

16 patients with a contact dermatitis limited to the thighs where polyamide trouser pockets contact are described. In a few patients there was also a photosensitive-like flare-up on the uncovered parts, such as face, neck and upper chest. Covered and uncovered lesions disappeared on changing their polyamide pockets to cotton ones. 11 of the 16 patients reacted positively to their own pockets. The clinical features, the histopathological studies and photobiological exploration are exposed. The actual linings used in the dressmaking industry are exposed. The procedures of fabrication and textile finishing of these pockets are described, also the chemicals used in these processes. Four cases showed sensitization to Bisphenol-A, but the intervention of epoxy resins in the fabrication of the pockets was technically denied. The relationship between these patients and other similar reported cases is discussed.

Contact dermatitis, allergic or irritative, is not distributed by chance among the general population, but appears in a determined group of patients. The clinical and anamnestic picture of this group of patients (and that of their close blood relatives) is described. Clinical facts lead us to consider that group of patients as a subgroup of cutaneous atopy. The medical-legal importance which the acceptance of this type of patient could have on occupational contact dermatitis is pointed out. In contact dermatitis the factors of the person suffering the contact rather than those of the contact agents seem to be of decisive power in the response, although at the present moment, the possibility of carrying out analytical studies on the allergens and irritants is easier than on the patients who react to them.

A clinical review of footwear contact dermatitis is made. The battery of contact allergens for the patch test is proposed. A review of the cases studied in the Department during the last 11 years is presented. In approximately 25 per cent of typically clinical cases it is not possible to establish the exact cause of the contact allergy.

In our Department, the incidence of sensitization to cobalt has more than doubled in the last 5 years. 28% of cobalt-sensitive patients showed no other sensitivity. Of isolated cobalt sensitive patients, 68% were housewives. We determined by atomic absorption spectrophotometry with a graphite camera, the cobalt and nickel content of the 30 most popular Spanish domestic detergents and cleaners sold in 1985. 78.6% of them contain considerable amounts of cobalt.

The authors report five cases of a non specific clinical eruption in patients who wore "milwaukee". The lesions appeared 20 to 50 days after they begun to use the "milwaukee", in the zones where the plastic contacted their skin. Negative patch test, and microscopical studies of lesions and patch tests, suggested an irritative non allergic dermatitis.

Changes in the shoe industry have replaced some of the former allergens and introduced some new ones. In 45 cases of shoe contact dermatitis, the lack of response to known allergens inspired the authors to review present-day industrial shoe manufacture. Two new resin allergens for shoe dermatitis have been found: dodecyl mercapthane and polyurethanes. The first is used in the plastics industry to arrest the polymerization process. We suggest the possibility that a certain number of Neoprene sensitizations could be sensitizations to dodecyl mercapthane contained in it. The recommended solution for patch testing is: 0.1% in toluol.