1/10. An epidemic of occupational contact dermatitis from an immersion oil for microscopy in laboratory personnel.Since November 1997, 14 successive cases of occupational contact dermatitis were observed in 13 laboratory technicians and 1 physician, working in a genetics laboratory in Leuven (belgium) in 3 laboratories of bacteriology in Strasbourg, Montbeliard and Angers, and in the laboratory of hematology in Bordeaux (france). The dermatitis, located on the hands, forearms and face, relapsed after each exposure to an immersion oil for microscopy. patch tests performed in 10 patients were positive to epoxy resin (ER) in the European standard series (10/10 patients) and to newly formulated Leica immersion oil (7/7), 1 patient testing negatively with the former oil. A breakdown performed in 2 patients with the oil's ingredients confirmed sensitization to liquid modified ER components, contained at >80% concentration in the oil. The presence of DGEBA was demonstrated by HPLC analysis at a /-30% rate. Although the safety data sheet indicated a revision of the formula, nobody was alerted to the risk of sensitization and the need for skin protection. ERs, as a source of occupational allergy, can provoke epidemics of contact dermatitis in industry. This report of epidemic contact dermatitis from ERs, used for their optical properties in an immersion oil for microscopy, emphasizes the need for perpetual vigilance in occupational medicine and the usefulness of multicentre contacts in dermato-allergology.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Recalcitrant atopic dermatitis due to allergy to Compositae.Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Acute allergic contact dermatitis due to para-phenylenediamine after temporary henna painting.The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, middle east, and North africa, and the fad is spreading in other parts of the world. Several cases of para-phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17-year-old girl with blisters over her hands of five-days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completely over the next four weeks leaving post-inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3 reaction to PPD at 48 hours. No reaction was seen at the natural henna site. awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. A new patient education approach in contact allergic dermatitis: the Contact Allergen Replacement database (CARD).BACKGROUND: When a patient is identified by patch testing as being sensitive to a specific contact allergen, he or she is generally advised to read the product labels and avoid products that contain the specific allergen. Patients are often confronted with difficult chemical names, synonyms, and cross-reactants for individual allergens. At the same time, dermatologists may spend a considerable amount of time trying to educate their patients about the avoidance of these allergens and explaining which products may contain them. methods: We applied a new educational approach to inform patients about products that are free of their allergens. RESULTS: We present a patient with multiple contact allergens in whom the Contact Allergen Replacement database was used to educate about specific allergens. This approach has proved to be an invaluable tool for both physicians and their patients in contact allergy counseling.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Allergic contact dermatitis in children: strategies of prevention and risk management.Over recent years, allergic contact dermatitis in children has repeatedly been reported as a significant clinical problem. It is generally accepted that allergic contact dermatitis is rare in the first years of life, and with increasing age (by the age of 10 years) reaches the incidence seen in adults. As in adults, metals are one of the most common sensitizers in children, along with rubber chemicals and fragrances. The influence of fashion trends and lifestyle such as piercing, decorative skin paintings, the hype of natural remedies and cosmetics (e.g. tea tree oil) or the use of cosmetical products with fragrances or herbal ingredients play an important role in developing allergic contact dermatitis. This review aims to give an overview on allergic contact dermatitis in childhood by focussing on strategies for prevention, potential risk factors and recommendations for parents as well as for physicians. By reporting typical cases of our outpatients clinic we point out several characteristics of allergic contact dermatitis. Prevention of allergic contact dermatitis in children is a current problem of interdisciplinary concern not only for dermatologists and paediatricians, but also for midwives. Frequently, children are already exposed at an early age to well-known allergens, and therefore, strategies of avoidance have to gain or regain importance and should start as early as possible.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Allergic contact dermatitis to propolis.A 35-year-old Asian woman was referred to the dermatology clinic with a 2-week history of enlarging, fluid-filled, pruritic lesions on the right foot. The affected area had a recent history of minor trauma for which the patient applied an over-the-counter propolis ointment. At presentation, the patient was also noted to have been using the following, as prescribed by her primary care physician: valacyclovir, ciprofloxacin, terbinafine cream, mupirocin ointment, and 2% hydrocortisone cream. No clinical improvement was observed with these agents. Examination revealed grouped erythematous papules progressing into vesicles and bulla on the lateral side of the right foot. A KOH scraping was negative. We diagnosed the patient with allergic contact dermatitis to propolis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Recurrent anaphylaxis due to unrecognized latex hypersensitivity in two healthcare professionals.BACKGROUND: anaphylaxis is a potentially fatal immediate-type reaction and intense effort may be required to identify the allergen responsible. In some cases, a "hidden" allergen may be responsible that is not apparent in spite of careful clinical assessment. OBJECTIVES: This report describes the assessment of two cases of anaphylaxis in which a search for an allergen was initially not conclusive and the diagnosis of idiopathic anaphylaxis was considered. methods: Two patients were evaluated by various physicians for anaphylaxis with no clear indication of a responsible allergen. Persistence in evaluation led to the identification of the allergen responsible. RESULTS: In two health care workers latex was identified as the "hidden" cause of anaphylaxis. This allergen had not been considered in either case in initial evaluations. Neither patient has had a recurrence of anaphylaxis since latex was identified as the cause of anaphylaxis. CONCLUSIONS: Although latex is widely recognized as a cause of anaphylaxis, it can still be unrecognized in some cases of recurrent anaphylaxis. Latex must be considered as a "hidden" cause of anaphylaxis, particularly in health care workers.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. The dermatologist and workers' compensation. Theory and practice.workers' compensation law is poorly understood by many physicians, including dermatologists. The tenets of this law throughout the country are basic and fairly straight forward, and the most important of them are nearly the same for all of the states. By understanding how the law operates and what is required of physicians, helping patients with their work-related dermatoses can be a gratifying experience.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/10. Contact urticaria from rubber gloves: an occupational skin disorder for health care workers.rubber allergy is an important occupational health problem for an increasing number of patients. It may produce a type I urticarial reaction, or more commonly, a type IV delayed eczematous dermatitis. The risk groups include health care workers, rubber industry workers, and children with spina bifida (meningomyelocele) and urogenital abnormalities. In this report, we describe a physician with a relevant history who was found to have type I hypersensitivity to rubber by prick test and use test. Our aim is to increase awareness among physicians, discuss diagnosis and management, and review the literature.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/10. Contact allergy to hydrocortisone and systemic contact dermatitis from prednisolone with tolerance of betamethasone.BACKGROUND: Contact allergy to corticosteroids is not uncommon. As the clinical pattern that the patients exhibit may be misleading, the discovery at patch testing may be unexpected and solely a result of the fact that marker molecules for corticosteroid contact allergy are incorporated into standard series and that tests are read twice, on D3/4 and D7. OBJECTIVE: We describe a patient allergic to hydrocortisone who was given a cross-reacting corticosteroid, prednisolone, that led to a systemic contact dermatitis. The patient cleared when betamethasone, a non inverted question markNcross-reacting corticosteroid, was administered. methods: The patient was patch tested to a standard series including tixocortol pivalate, and an extended corticosteroid series including betamethasone. RESULTS: Patch testing with tixocortol pivalate provoked an allergic patch test reaction ( ? D3, D7), whereas betamethasone did not. CONCLUSION: Our patient's allergy was undiagnosed for 5 years, and it was not until she was given a cross-reacting corticosteroid, which led to exacerbation of her dermatitis, that her physician suspected corticosteroid allergy. The incorporation of marker molecules for the detection of corticosteroid contact allergy into standard series with two reading occasions, 3 to 4 days apart, is advocated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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