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Summary: Background: Fragrance contact allergy is common and is currently screened for using the following European baseline series fragrance markers: fragrance mix (FM)I, FMII, Myroxylon pereirae and hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Objectives: To investigate the validity of patch testing using these fragrance markers in detecting fragrance allergy to 26 individual fragrance substances for which cosmetic ingredient labelling is mandatory within the European Union. Methods: We conducted a retrospective review of the patch test records of all patients with eczema who underwent testing using the European baseline series, extended with the individual fragrance substances during the period from 2015 to 2016. Results: Overall, 359 patients (17·2%) reacted to one or more allergens from the labelled fragrance substance series and/or a fragrance marker from the European baseline series. The allergens that were positive with the greatest frequencies were oxidized linalool [n = 154; 7·4%, 95% confidence interval (CI) 6·3–8·6], oxidized limonene (n = 89; 4·3%, 95% CI 3·4–5·2) and Evernia furfuracea (n = 44; 2·1%, 95% CI 1·5–2·8). Of the 319 patients who reacted to any of the labelled fragrance substances, only 130 (40·8%) also reacted to a baseline series fragrance marker. The sensitivity of our history‐taking for detecting fragrance allergy was 25·7%. Conclusions: Given the evolving trends in fragrance allergy, patch testing with FMI, FMII, M. pereirae and hydroxyisohexyl 3‐cyclohexene carboxaldehyde is no longer sufficient for screening for fragrance allergy. [ABSTRACT FROM AUTHOR]

Background Active patch test sensitization is an uncommon phenomenon which may have undesirable consequences for those undergoing this gold-standard investigation for contact allergy. Objectives To perform a retrospective analysis of the results of 241 subjects who were patch tested twice in a monocentre evaluating approximately 1500 subjects per year. Methods Positivity to 11 common allergens in the recommended Baseline Series of contact allergens (European) was analysed: nickel sulphate; Myroxylon pereirae; fragrance mix I; para-phenylenediamine; colophonium; epoxy resin; neomycin; quaternium-15; thiuram mix; sesquiterpene lactone mix; and para- tert-butylphenol resin. Results Only fragrance mix I gave a statistically significant, increased rate of positivity on the second reading compared with the first ( P = 0·011). This trend was maintained when separately analysing a subgroup of 42 subjects who had been repeat patch tested within 1 year; this analysis was done to minimize the potential confounding factor of increased usage of fragrances with a wide interval between both tests. To reduce the confounding effect of age on our data, we calculated expected frequencies of positivity to fragrance mix I based on previously published data from our centre. This showed a marked excess of observed cases over predicted ones, particularly in women in the age range 40–60 years. Conclusions We suspect that active sensitization to fragrance mix I may occur. Similar published analysis from another large group using standard methodology supports our data. [ABSTRACT FROM AUTHOR]

Background There is currently an epidemic of tinea capitis in urban areas of developed countries caused by Trichophyton tonsurans. Recurrence or re-infection with dermatophyte is not uncommon after adequate oral treatment. Asymptomatic carriers who are household contacts may partly explain this observation by forming a reservoir for infection. Patients/methods Two-hundred and nine household contacts of patients with tinea capitis were examined and screened for asymptomatic carriage of dermatophyte. Results Only 7.2% had clinically evident disease yet 44.5% had silent fungal carriage on the scalp. Children under 16 years were much more likely to be carriers than adults ( P < 0.001) and males were less likely than females to be affected ( P < 0.01). Conclusion This evidence poses questions about factors relevant in transmission of dermatophytes. The authors propose that all household contacts of patients with tinea capitis should be offered screening to eradicate a potential reservoir of infection. [ABSTRACT FROM AUTHOR]

Sclerodermatous graft-versus-host disease (GVHD) is a rare complication of bone marrow transplantation. While GVHD is often associated with the beneficial graft vs. tumour effect, it also contributes towards significant morbidity and mortality. No reliably effective treatment has yet been established. We present 10 patients with haematological malignancies who underwent an allogeneic stem cell transplant and developed sclerodermatous GVHD. Donor lymphocyte infusion administered for relapse or reducing donor T-cell chimerism was a known trigger for sclerodermatous GVHD in four of the patients. Treatment with immunosuppressants, psoralen plus ultraviolet A (PUVA) and extracorporeal photopheresis has been largely unsuccessful in their management. Intensive immunosuppression including the use of anti-CD20 monoclonal antibody may have contributed to relapse of leukaemia in one patient 10 years after her transplant. Sclerodermatous GVHD may occur without a preceding lichenoid stage. Clinical heterogeneity is common, although sclerodermatous GVHD has a predilection for the limbs. Treatment options are largely unsatisfactory if conventional immunosuppression fails. PUVA may give some symptomatic benefit and extracorporeal photopheresis seems to be less efficacious than previously published work suggests. [ABSTRACT FROM AUTHOR]

Background Isoeugenol is an important fragrance allergen. The cosmetic industry was recommended voluntarily to reduce concentrations of isoeugenol in finished cosmetic products from 0·2% to 0·02% in 1998. It was suspected that this would reduce the incidence of patch test positivity in individuals undergoing routine patch testing after approximately 2–3 years (the Dillarstone effect). Objectives To review our patch test data since the change in practice by industry, to see if there has been an observable decrease in isoeugenol contact sensitivity. Methods We retrospectively analysed all subjects patch tested to isoeugenol 1% pet. in the St John’s Department of Cutaneous Allergy over a period of 5 years, commencing 3 years after the changes. Results We identified 3636 subjects, 97 of whom were positive for isoeugenol. Year-on-year incidence shows an increasing trend, with an overall incidence of 2·67%. Using the exact Cochran–Armitage test, this ascending trend is statistically significant ( P = 0·0182). Seventy-two of 97 isoeugenol-positive subjects were also positive to fragrance mix I. Other fragrances positive in these 97 patients included Myroxylon pereirae (30%), Evernia prunastri (22%) and eugenol (15%). Conclusions We suspect that the increasing trend may be due to allergen substitution with compounds chemically related to isoeugenol, or which hydrolyse to isoeugenol itself. [ABSTRACT FROM AUTHOR]

Graft-versus-host disease (GvHD) is a common sequel to allogeneic bone marrow transplants, which may be accompanied by desirable graft-versus-tumour effects. Sclerodermatous GvHD is a rare subtype that is very difficult to treat. We report the first case of sclerodermatous GvHD as part of the Koebner phenomenon. We propose that donor lymphocyte infusion and interferon-α were involved in the pathogenesis of this case. [ABSTRACT FROM AUTHOR]

Summary: 香料接触性过敏症是引起湿疹的过敏性皮肤反应的普通原因。接触性过敏症可因皮肤长期反复暴露在过敏原中引起。香料接触性过敏症会通过皮肤接触测试进行诊断(将已知过敏原敷于皮肤上以评估反应)。欧盟规定化妆品应将暴露限制在已知过敏原中。此外,欧盟还规定含有任何26种已知单个香料过敏原的化妆品必须进行标注,以帮助消费者避开其过敏的过敏原。在英国的大部分皮肤科中,医生会通过对以下4种筛查标志物的皮肤接触测试来诊断香料接触性过敏症,而非对所有26种单个香料过敏原一一进行测试:混合香料I、混合香料II、秘鲁香和羟基异己基3‐环已基甲醛。在本研究中,作者审查了2084个湿疹患者记录,这些患者有的对所有单个香料过敏原都进行了皮肤接触测试,而有的仅对香料过敏原筛查标志物进行了测试,从而找出仅通过测试筛查标志物检测出实际香料接触性过敏症的比例。他们发现,仅对筛查标志物进行皮肤接触测试检测出40.8%的实际香料接触性过敏症患者(通过额外测试单个香料过敏原而确诊患有香料过敏症的患者)。他们还发现,大部分香料接触性过敏症患者并不清楚他们接触香料后会加重皮肤反应。作者总结道,目前使用的筛查标志物并不足以诊断香料接触性过敏症。 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the call for full ingredient labelling and uniform nomenclature on medicaments.

The authors reflect on the role of self-tests in the diagnosis of hair dye allergy. Several widely used diagnostic and monitoring self-tests are enumerated. Meanwhile, hair dye allergy has been cited as a serious and increasing public health problem with patch testing, being the gold standard investigation. However, it has been stressed that a safe, sensitive and reproducible screening self-test would be a welcome tool to prevent severe allergic reactions to hair dye.

This article cites a study on a 39-year-old Afro-Caribbean woman with a 6-month history of a diffuse, dark brown discoloration over all her finger and toenails. The discoloration was asymptomatic and she reported no other cutaneous symptoms. She had no symptoms of postural hypertension and routine biochemistry was normal. Cyclophosphamide is a rare but well-described cause of nail pigmentation usually after a cumulative dose over 1.2 grams. The discoloration is first seen proximally on the nail, progresses distally and has been reported to grow out on discontinuation of cyclophosphamide.

A case study of a 46 year old Jamaican car painter presented with an 8 month history of pain and swelling over the left side of his chin, which sometimes discharged purulent material. On examination there were three hard, indurated foci over the left chin. Inspection of the oral cavity revealed severe, chronic periodontal disease involving the lower left premolar teeth. Scanning of the jaw revealed periodontal disease with overlying soft tissue inflammation and evidence of marrow change consistent with low-grade osteomyelitis. It was diagnosed to be cervicofacial actionmycosis. Actinomyces israelii is a Gram-positive anaerobic bacillus which comprises a heterogeneous group related to mycobacteria but resembling fungi.

The article presents a case report of a liquorice extract found in a cosmetic product that caused contact allergy to a 35-year-old female patient. A patient who has no history of atopy underwent a facial chemical exfoliation performed by a beautician. One day after the application, the patient's face became acutely erythematous and swollen, and developed marked periorbital oedema.

Presents a case report of a man with granulomatous amebic encephalitis. Diagnosis of the patient; Treatment of the patient with co-trimoxazole, rifampicin, ketoconazole and azithromycin as well as dexamethasone for cerebral edema; Death of the patient; Importance of considering Balamuthia mandrillaris in the context of a granulomatous skin condition.

Contact allergy data indicates that atopics have heightened oral tolerance to haptens (chemical allergens). We speculate here, that artificially increased oral exposure to chemicals compete with dietary proteins for the development of oral tolerance, predisposing to the acquisition of food protein allergy and representing one driver for the increasing prevalence of protein allergy and/or atopy. Hapten exposure via other surfaces such as the skin and airways might also be important in promoting atopic disease. Consistent with this hypothesis it is notable that over 40 years, with the huge increase in atopic disease, there has also been an increase in dietary hapten exposure through processed food, formula milk and oral antibiotic and drug use.