1/11. Scleromyxoedema-like changes in four renal dialysis patients.We describe four renal dialysis patients from our hospital who, over a 6-month period, developed erythematous, thickened, indurated dermal plaques. The plaques were limited to the limbs and in three patients there were associated flexion contractures. The clinical features most resembled scleromyxoedema. All patients had previously received at least one renal transplant. Histopathology of the plaques showed features of scleromyxoedema in two patients, whereas the other two showed a different picture, more suggestive of a morphoea-like process. There are important differences between our patients and classical scleromyxoedema. All four patients had normal immunoglobulins and no paraprotein was detected. Almost all cases of classical scleromyxoedema are associated with an IgGlambda paraproteinaemia. We have not yet identified an underlying cause for this cluster of cases in our hospital. It is possible that the skin changes seen may have been precipitated by an environmental agent, such as in 'toxic oil syndrome' and vinyl chloride-induced scleroderma. We discuss the differences between our patients and those with scleromyxoedema, localized or generalized morphoea and environmentally induced scleroderma. We feel that our patients show a constellation of features similar, but not identical, to scleromyxoedema. There has been only one previous report of similar patients. We believe this to be a new and distinct phenomenon.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/11. Occupational allergic contact dermatitis in a company manufacturing boards coated with isocyanate lacquer.Over a short period of time, there was an outbreak of work-related skin lesions among workers at a company producing flooring laminate boards, after the introduction of a water-repellent lacquer based on diphenylmethane-4,4'-diisocyanate (MDI). In 5 workers, patch testing was performed with a standard series, an isocyanate series and work-environmental products when indicated. 3 of the workers were tested with the lacquer, and contact allergy was found with concurrent reactions to 4,4'-diaminodiphenylmethane (MDA). 1 of the 3 workers also showed a simultaneous reaction to MDI, whereas 1 showed a positive reaction to dicyclohexylmethane-4,4'-diisocyanate (HMDI). Of the 2 individuals not tested with the lacquer, 1 reacted to both MDI and MDA, whereas the other reacted to a soap used at work. In 3 of 4 cases, the isocyanate reactions appeared after D3. Occupational contact with isocyanates should not exclusively be focused upon respiratory hazards, as this report shows that skin contamination probably increases the risk of developing contact allergy to isocyanates and isocyanate-related substances. When aiming at diagnosing contact allergy to isocyanates, it is desirable to perform a late reading, as positive reactions appear late. MDA appears to be a good marker for isocyanate hypersensitivity.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
3/11. Successful treatment of recalcitrant palmoplantar psoriasis with etanercept.Palmoplantar psoriasis is a disabling condition characterized by recurrent crops of sterile pustules with associated erythema, fissuring, and scaling. Genetic and environmental factors have been implicated in its etiology. Topical treatments are frequently ineffective. Other treatment options include systemic retinoids, psoralen-UVA (PUVA), and a combination of both. We report a case of successful treatment of recalcitrant palmoplantar psoriasis with etanercept in a 59-year-old woman unresponsive to other treatment modalities.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
4/11. Annular pompholyx.The common manifestation of pompholyx is easily recognized by the clinician. Morphologic variants are known in which the predominant lesions are pustules or desquamation with or without erythema. A patient is described herein whose eruption was composed mainly of arciform, annular, and target-like vesicles. Pompholyx (bubble) is a preferred term because "dyshidrosis" denotes a dysfunction of sweating, which does not occur in this condition. The causes of this eruption have not been determined, but it is likely that a certain genetic predisposition and multiple environmental factors are responsible. Pompholyx should be considered in the differential diagnosis of eruptions with annular pattern.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
5/11. Geomyces pannorum as a possible causative agent of dermatomycosis and onychomycosis in two patients.chrysosporium pannorum (Link) Hughes is a soil keratinophilic fungus present in organic residues, on human skin surface and in the general environment of human beings. Clear evidence for the pathogenicity of this fungus for human beings was lacking. In 1999, a case of fungal infection in a chow-chow dog and its owner was published, where chrysosporium pannorum (Link) Hughes was determined as the only possible infection trigger. The State hygiene Institute in Bratislava repeatedly confirmed the cultivation results. chrysosporium pannorum (Link) Hughes was detected in the material provided by a ZOO: camel, tiger and antelope hair, whereby the same finding as in the dog mentioned above was described, i.e. extensive alopecic foci of various size. Since 2000 the cultivations have been monitored with due care. Eight positive cultivations of chrysosporium pannorum (Link) Hughes have been detected until now, two of them in patients with a flair for horticulture. In a male patient, fingernail onychomycosis with affected skin on forearms, hands and fingers was determined. In a female patient only nail plates were affected. chrysosporium pannorum was confirmed to be the only possible pathogen. Therapy with itraconazole produced excellent results in both patients and no relapses were recorded. Based on our repeated findings it is concluded that the evidence for non-pathogenicity of chrysosporium pannorum should be revised.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
6/11. Some cases of onychomycosis from north india in different working environments.Three fungi, alternaria humicola, A. pluriseptata and aspergillus niger are being reported as new probable etiologic filamentous fungi, causing onychomycosis. The morphology and physiology of these fungi is discussed.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
7/11. Pulling boat hands: a unique dermatosis from coastal new england.We report a previously unrecognized hand dermatosis, pulling boat hands (PBH), occurring in thirteen participants at the Outward Bound School on Hurricane Island, maine. Painful and pruritic macules, plaques, and vesicles developed exclusively while subjects lived aboard a pulling boat, the school's open rowing/sailing craft. Nine of those affected were women and eight had Raynaud's phenomenon or vasospasm. These subjects experienced thirty episodes of PBH during May through October, 1978 to 1982. Histopathology revealed a superficial and deep lymphohistiocytic perivascular infiltrate, subepidermal blister formation, red blood cell extravasation, and dermal capillary thrombosis compatible with cold injury to the skin. All patients experienced prolonged percussion to their hands while rowing as well as a continuous environmental exposure to cold air, wind, humidity, ocean spume, and precipitation. These clinical, histopathologic, and environmental findings suggest a unique syndrome that combines the vascular effects of mechanical trauma from rowing with those of nonfreezing cold injury.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/11. Allergic contact dermatitis in two machinists.Two machinists were seen whose chronic hand dermatitis was explained by allergic sensitivity to a biocide, Tris Nitro (2-[hydroxymethyl]-2-nitro-1,3-propanediol), which was added to their metalworking fluids (cutting oils) to prevent rancidity. The cause of the men's difficulty was first suspected when they had positive patch test reactions to a related biocide, Bronopol (2-bromo-2-nitropropane-1,3-diol), which we added to our standard screening tray because of its presence in more than 500 cosmetic formulations. The detective skills of the patients uncovered the chemical, Tris Nitro, related to Bronopol in their work environment. Most cases of dermatitis seen in machinists are irritant in origin. As we achieve better cooperation from the metalworking fluid industry, perhaps an increasing number of allergens will be identified. When this occurs, a cooperative manufacturer can be invaluable in directing a machinist to a replacement--a well-preserved cutting fluid free of the allergen.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
9/11. Recurrent focal palmar peeling.Recurrent focal palmar peeling, previously known as keratolysis exfoliativa, is an idiopathic condition characterized by chronic palmar and occasionally plantar peeling. It can be exacerbated by environmental factors, and may be misdiagnosed as chronic contact dermatitis. Accurate diagnosis is from the history and examination. It is supported by a negative patch test result. Three cases of recurrent focal palmar peeling are presented, of which two were misdiagnosed as chronic dermatitis. Although there are few references on recurrent focal palmar peeling, it is likely to be a common condition that rarely presents to dermatologists because it is largely asymptomatic. A correct diagnosis is essential due to the social, occupational and legal implications if misdiagnosed.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
10/11. An unusual hypopigmentation in occupational dermatology: presentation of a case and review of the literature.Contact dermatitis to cooling lubricants is commonly encountered in occupational dermatology, but it rarely induces pigmentary skin changes. It is sometimes difficult to differentiate between toxic leukoderma and postinflammatory hypopigmentation when examining a depigmentation. A differential diagnosis is described in the case of a 31-year-old metal worker, spending most of his time on a computer-numerically controlled machine, who presented with cumulative irritant hand dermatitis and secondary hypopigmentation. patch tests gave negative reactions to the European standard series, the disinfection and preservative series, the base preparation and emollient series, the metal series, the mechanical worker series as well as to the cooling lubricant itself. Atopy screening was positive for a variety of pollens. Based on biopsy findings, toxic leukoderma could be diagnosed even though none of the known melanotoxic compounds could be identified in his work environment. The patient was advised to avoid further contact with the regular composed cooling lubricant and the contact eczema improved dramatically, whereas the condition of hypopigmentation got better slowly within weeks under puva therapy.- - - - - - - - - - ranking = 0.5keywords = environment (Clic here for more details about this article) |
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