Fragrance allergy could be missed without patch testing with 26 individual fragrance allergens.

BACKGROUND: In 2003, the EU Cosmetics Directive stated that 26 fragrance substances must be listed on the cosmetic product ingredient labels. Not all of these 26 fragrance substances are detected by the usual screening markers comprising fragrance mix I, fragrance mix II, and Myroxylon pereirae. OBJECTIVES: To evaluate the usefulness of testing with the 26 individual fragrance substances in addition to the standard fragrance screening markers. MATERIALS AND METHODS: Three hundred and twelve consecutive patients were patch tested with our baseline series and the 26 specific fragrance substances required to be declared on cosmetic product ingredient labels in accordance with the EU Cosmetics Directive. RESULTS: Positive reactions to at least either one of the 26 individual fragrance substances or the usual fragrance screening markers were seen in 84 of 312 patients (26.9%). Fifteen of these 84 patients (17.8%) reacted negatively to the fragrance screening markers. The most common individual fragrance allergens were cinnamyl alcohol (11.2%), cinnamal (9%), and hydroxycitronellal (3.8%). Sixty-two of 312 patients (19.8%) had at least one positive reaction to the fragrance screening markers. CONCLUSION: Additional patch testing with the 26 individual fragrance allergens, or with the commonest fragrance allergens identified within these 26, should be performed to optimize the detection of fragrance allergy. Cinnamyl alcohol and cinnamal are important fragrance allergens in Thailand.

Influence of vitamin C on the elicitation of allergic contact dermatitis to p-phenylenediamine.

BACKGROUND: Hair dyes represent one of the most important causes of allergic contact dermatitis resulting from the use of cosmetic products. The principal causative chemistry is associated with oxidation products of p-phenylenediamine (PPD) and closely related substances. OBJECTIVES: To examine whether prior application of the antioxidant vitamin C to the skin was able to reduce the cutaneous allergic response to PPD. METHODS: Twenty eight volunteers with a proven history of contact allergy to PPD were recruited. Each was tested with a range of PPD doses and PPD-containing hair dye on untreated skin and skin pretreated for 10 min with a vitamin C formulation. RESULTS: Pretreatment of skin sites with vitamin C led to a reduction in the intensity, or even ablation, of the cutaneous allergic reaction to PPD in ∼75% of cases as compared with untreated skin. CONCLUSIONS: The results suggest that treatment of the skin adjacent to the hair-bearing area with antioxidant could form part of a strategy to reduce the burden of cosmetic allergic contact dermatitis caused by hair dyeing.

CHROMOBLASTOMYCOSIS MASQUERADING AS DERMATOPHYTOSIS, WITH THE DESCRIPTION OF A NEW OPPORTUNISTIC SPECIES.

An unusual case of chromoblastomycosis is reported, it resembled dermatophytosis, tinea faciei due to the presence of a well-demarcated scaly ery- thematous patch on the face. The patient was a 63-year-old farmer from central Thailand, who had the skin lesion for 10 years. Mycological and histopathologi- cal investigations of scales and skin biopsy specimen revealed a granulomatous infiltrate with sclerotic bodies, the hallmark of chromoblastomycosis. The infec- tion showed only localized superficial expansion with a scaly patch suggesting a new clinical type of the disease. The causative organism was identified by DNA sequencing as Rhinocladiella phaeophora. R.phaeophora originally was a saprophytic dematiaceous fungus recovered from maize field soil from Colombia. The case was unusual in its clinical presentation and this is the first case of chromoblastomycosis reported to be caused by a new opportunistic species of the genus Rhinocladiella. The disease was not responsive to itraconazole, but was later treated successfully with terbinafine.

Patch testing and histopathology in Thai patients with hyperpigmentation due to Erythema dyschromicum perstans, Lichen planus pigmentosus, and pigmented contact dermatitis.

BACKGROUND: Erythema dyschromicum perstans (EDP)/Ashy dermatosis (AD), Lichen planus pigmentosus (LPP) and Pigmented contact dermatitis (PCD) are common skin diseases featuring abnormal pigmentation which have overlapping clinical features. OBJECTIVE: To search for differences in the natural history, clinical features, histopathology and relevant contact allergens in patients those were clinically diagnosed as AD, LPP and PCD in our outpatient clinic. METHOD: 43 patients were enrolled into the study. Patients' demographic details, histological findings, DIF staining, provisional and histology diagnosis were recorded. Closed patch tests with standard fragrance and cosmetic series allergens were performed in all patients. RESULT: 36 of the patients were female and all of them had dark skin complexions (Fitzpatrick's skin type IV-V), as normally found in AD and LPP. The most common histological finding was pigmentary alteration followed by lichenoid infiltration. DIF staining was positive in 6 out of 21 cases, the most common pattern being IgM colloid bodies. Patients with a provisional diagnosis of AD and LPP had positive patch tests in 40 and 36.36% of cases, respectively. CONCLUSION: We have found some similarities and differences between these 3 clinically and histologically overlapping pigmentary disorder. Clinical history, histopathology and DIF are necessary together for making the diagnosis. Patch testing should be conducted in all cases that present with AD or LPP.

Hand contact dermatitis in hairdressers: clinical and causative allergens, experience in Bangkok.

BACKGROUND: Hand dermatitis in hairdressers is a common occupational contact dermatitis. Irritant contact dermatitis is thought to be more common. OBJECTIVES: To investigate the causes of hand dermatitis, common allergens, clinical patterns, morphology and onset of lesions among hairdressers. METHODS: Forty four hairdressers who were diagnosed with hand dermatitis in a dermatological outpatient department were included and investigated by patch testing with standard and hairdressing related allergens and/or prick test. RESULTS: Allergic contact dermatitis was diagnosed with a positive patch test reaction in 33 cases (75%), irritant contact dermatitis was found in 11 cases (25%). The clinical manifestations were mostly scaly plaques (68.18%) or vesicles (50%). The most common site of involvement was the palms (38.63%). The common causative allergens were paraphenylenediamine (45.45%), nickel (31.18%), fragrance mix (20.45%), p-toluenediamine sulphate (18.18%), ammonium persulfate (13.63%), and p-aminophenol (13.63%). CONCLUSION: Allergic contact dermatitis is more common among hairdressers, PPD was the most common causative allergen in our study.

Drug eruptions at five institutes in Bangkok.

The study was performed in five hospitals in Bangkok for a period of one year. All in- and outpatients who developed drug eruption from January to December 2001 were enrolled into the study. Physical examinations and complete history-taking were performed by one of the authors. A skin biopsy was done to confirm the diagnosis in every suspected case. Oral challenge test was performed to obtain a definite diagnosis only in some patients with informed consent. Among 212 patients, the most common causative drugs were antimicrobial agents with cephalosporin group in the highest rank. Maculopapular rash was the most common type of drug eruption followed by urticaria and photosensitivity reaction. It was concluded that antimicrobial agents were the predominant causative agents and maculopapular eruption was the most frequent clinical manifestation. New kinds of antimicrobial agents, anti-inflammatory drugs and lipid lowering agents could cause various patterns of drug eruption.

Comparative study of the efficacy of topical corticosteroid: five locally made and one brand name creams.

The aim of this study was to evaluate the efficacy of 5 locally made clobetasol propionate creams compared with a brand name product. The study was divided into 3 parts 1) pharmacological study, 2) vasoconstriction test, and 3) double blind clinical trial. The results showed that the pharmacological properties of the locally made products were not different from the brand name product. Product C and D could diffuse through cellulose acetate membrane 3 fold more than the brand name product. Product D and E caused less vasoconstriction than the brand name product. This double blind study showed that all locally made products could improve psoriasis to the same extent as the brand name product, but there was more recurrence of psoriasis while using all the locally made products. It was concluded that locally made products were as effective as the brand name product in the treatment of psoriasis evaluated over a 2 week peroid, but more recurrence was observed with locally made products.