Allergic contact dermatitis to propyl gallate and pentylene glycol in an emollient cream.

A 62-year-old man, with a 20-year history of seborrhoeic dermatitis, presented with a worsening of his dermatitis. He had previously been demonstrated to be allergic to various topical corticosteroids, so he had been using an emollient cream (Sebclair), containing piroctone olamine and various anti-inflammatory substances, for 6 months, with good effect. Patch testing to the cream and its ingredients revealed positive reactions to both propyl gallate and pentylene glycol. A positive reaction to propylene glycol was also detected, whereas patch testing to butylene glycol was negative. Complete remission followed avoidance of the offending substances.

Allergic contact dermatitis with a fertilizer containing hydrogen cyanamide (Dormex).

Cyanamide is a chemical substance used in the treatment of chronic alcoholism as well in agriculture as a fertilizer. We report the case of a 28-year-old healthy non-atopic man that developed a severe skin eruption after the accidental penetration of a small amount of Dormex (a plant growth regulator containing cyanamide) through the patient's gloves. Patch tests revealed positive reactions to Dormex 1% pet. and cyanamide at a dilution of 0.1% pet. and 1% pet. We discuss the causes of sensitization in a patients that regularly used protective measures during anti-parasites treatments.

Erythema infectiosum following generalized petechial eruption induced by human parvovirus B19.

Parvovirus B19 is a DNA virus responsible for a wide spectrum of clinical illnesses. Among dermatological manifestations, the most common is erythema infectiosum, also known as the fifth disease. In 1990 Harms et al first described a papular-purpuric gloves and socks syndrome (PPGSS) due to parvovirus B19. It is an acute acral dermatosis characterized by an eruption of petechiae and small purpuric papules affecting the hands and feet in a gloves-and-socks distribution. Recently it was observed that PPGSS may be associated with involvement of the peri-oral region and the chin (acropetechial syndrome) and other sites provoking unusual presentation of the rash. We describe a patient with an acral purpura with the features of the "acropetechial syndrome" involving the buttocks, genital and axillary regions who subsequently developed a maculopapular eruption with the characteristics of the fifth disease. Parvovirus B19 DNA was detected by polymerase chain reaction (PCR) both in skin vasculitic lesions and in the serum during the petechial eruption, before the onset of antibodies. The immune response coincided with the development of the exanthem, suggesting a direct role of parvovirus B19 in the pathogenesis of endothelial cell injury.

Tolerance to calcitriol and tacalcitol in three patients with allergic contact dermatitis to calcipotriol.

We describe 3 cases of psoriatic patients who developed a severe eczematous eruption after the use of calcipotriol ointment. For all of them, the dermatitis recovered after the suspension of the calcipotriol ointment and topical application of corticosteroids. We performed patch tests with the standard series of SIDAPA (Italian Society of Environmental, Occupational and Allergological Dermatology), with an integrative series of vehicles and preservatives, with the commercial ointment containing calcipotriol, with its excipients and, finally, with a series of diluted calcipotriol in isopropanol and petrolatum. They all revealed a strong allergic reaction to calcipotriol and also to its dilution in isopropanol (for all patients) and in petrolatum (only one patient). It is interesting to underline that the reactions always occurred on the legs, even if the patients had applied the ointment elsewhere. We can hypothesize that the venom stasis dermatitis of the legs, associated with xerosis, may have favored the penetration of the drug through the skin, increasing the risk of allergic contact sensitization. Finally, cross-reactivity to other vitamin D3 analogue, tacalcitol, and calcitriol was excluded.

Recalcitrant scalp folliculitis: a possible role of herpes simplex virus type 2.

We report the case of a 70-year-old man with a 1 year history of relapsing folliculitis of the scalp. Bacteriological, mycological and the Tzanck tests from the lesions were negative. Histopathological study showed suppurative perifollicular flogosis. Virological cultures were negative, while HSV nested polymerase chain reaction (nPCR) assays made on swabs and histological sections from the scalp lesions demonstrated the presence of herpes simplex virus type-2 (HSV-2) in all samples. Skin swabs of healthy areas yielded negative results for HSV-2 infection. The folliculitis showed a marked and quick improvement after therapy with famciclovir suggesting a possible etiologic role of HSV-2 in the scalp folliculitis.

Relapsing herpes simplex-2 folliculitis in the beard area.

We describe the case of a 52-year-old immunocompetent man with recurrent folliculitis on the left cheek, associated with intense pain. Bacteriological, mycological and Tzanck tests from the lesions were negative. Histopathological study showed an aspecific flogosis pattern. Virological tests carried out on swabs and paraffin-embedded tissue sections from the facial lesions by nested PCR technique (nPCR) demonstrated the presence of herpes simplex virus type 2 (HSV\2) in both samples. Skin swabs from other healthy areas of the face resulted negative for herpetic infection. A diagnosis of recurrent herpetic folliculitis by HSV\2 was made. This case report underlines that even in immunocompetent patients HSV\2 lesions can feature atypical clinical aspects. In dermatological assessment the benefits of routine PCR techniques for differential diagnosis of herpetic infection should be considered above all for the prompt initiation of antiviral therapy and appropriate patient management.

Transverse leukonychia in severe hypocalcemia.

We report the case of a 26-year-old man with acral tetany and muscular cramps of the upper limbs associated with hypocalcemia caused by hypoparathyroidism and celiac disease. Physical examination revealed a transverse leukonychia which disappeared after treatment with calcium lactogluconate, calcium carbonate and calcitriol. Hypocalcemia may induce nail alterations with a double mechanism represented by angiospasm and disorganization of the hard keratin and of the integrin subunits.

Cutaneous manifestations of Mycobacterium gordonae infection described for the first time in Italy: a case report.

INTRODUCTION: Mycobacterium gordonae is one of the least pathogenic of the mycobacteria. This pathogen may produce caseating or non-caseating granulomas, and skin lesions showing acute or chronic inflammation with scattered histiocytes and giant cells have been seen. The mortality rate is less than 0.1%. Mycobacterium gordonae may be a marker of severe immunosuppression in patients infected with human immunodeficiency virus. CASE PRESENTATION: We report a case of Mycobacterium gordonae infection in an 86-year-old woman and discuss the problems inherent to the identification and treatment of this emerging pathogen. Mycobacterium gordonae strain we isolated was resistant to trimethoprim-sulfamethoxazole but sensitive to ciprofloxacin, and long term administration (six months) induced complete healing of the cutaneous abscesses. CONCLUSION: Advanced laboratory diagnostic techniques have improved the isolation and identification of nontuberculous mycobacteria. The diagnosis requires a high index of clinical suspicion, as detection by conventional methods is difficult. To our knowledge, this patient is the first documented case of cutaneous infection from this pathogen in Italy.

Allergic contact dermatitis to regenerated oxidized cellulose contained in a matrix employed for wound therapy.

We describe a case of a 40-year-old non-atopic woman with recurrent leg ulcers because of the factor V Leiden mutation who developed a severe eczematous lesions of the skin surrounding an ulcer of the right leg after the use of a protease-modulating matrix (Promogran, Johnson and Johnson, Gargrave, Skipton, UK). The patient was patch tested with the SIDAPA (Italian Society of Allergological, Occupational and Environmental Dermatology) standard series, a piece of the device as is, of the bovine collagen (Zyderm, Collagen Corporation, Palo Alto, CA, USA) as is, a piece of the gauze containing only regenerated oxidized cellulose (Tabotamp, Johnson and Johnson, Gargrave, North Yorkshire, UK) and of a fold towels in pure cellulose (Foscart, Bassano del Grappa, Italy). Patch tests gave a positive reactions to nickel sulphate and Promogran as is. We showed that the sensitizing agent was regenerated oxidized cellulose, a substance the treatment of ulcers and as is in and in combination with collagen in surgery for intraoperative hemostasis. The case reported suggests that regenerated oxidized cellulose can cause allergic contact dermatitis.

Contact dermatitis with clostridiopeptidase A contained in Noruxol ointment.

Clostridiopeptidase A, also called collagenase 1, is a proteolytic enzyme capable of digesting collagen. Preparations containing clostridiopeptidase A are used topically for the debridement of dermal ulcers, burns and other necrotic lesions to facilitate the formation of granulation tissue and subsequent epithelization. We observed 4 patients with a periulcerative eczema after repeated applications of Noruxol ointment (Smith & Nephew Ltd, L Hull, UK). Patch testing with Noruxol ointment as is and its excipients (soft paraffin and white petrolatum), as well as scaled dilutions of the main ingredient of this topical preparation, clostridiopeptidase A (Firma, Florence, Italy), showed doubtful reactions to Noruxol ointment in 3 patients and a positive reactions only in 1 patient. All patients showed positive reactions to clostridiopeptidase A 1% in pet. This study shows the sensitizing capacity of clostridiopeptidase A that should be tested in all patients with suspect sensitization to Noruxol ointment.

Occupational contact dermatitis to a limonene-based solvent in a histopathology technician.

Recently, D-limonene-based solvents are used as a safe alternative to xylene for histological and cytological application to dissolve paraffin. We report the case of a histopathology technician with a recalcitrant hand contact dermatitis strictly related to the use of a limonene-based solvent agent. Patch tests with SIDAPA (Italian Society of Allergological, Professional and Environmental Dermatology) standard series, limonene-based solvent used by the patient and D- and L-limonene (both oxidized and nonoxidized form) and with Giemsa and methylene blue stains were performed. Patch testing gave positive results to oxidized D- and L-limonene. The patient retired from work and promptly improved and healed the hand eczema. Subsequently, the potential occurrence of limonene oxidation products in the incriminated preparation was investigated using gas chromatography-mass spectrometry. While patch test showed positive reaction to oxidized limonene, chemical analysis failed to detect oxidized limonene in the preparations used by the patient. Considering the strict relation between the use of the preparations and the appearance of symptoms, we can assume that oxidized limonene may be produced during the handling of limonene-based products, especially in the presence of oxidants stains, frequently used in histological laboratories.

Alterated integrin expression in lichen planopilaris.

BACKGROUND: Lichen planopilaris (LPP) is an inflammatory disease characterized by a lymphomononuclear infiltrate surrounding the isthmus and infundibulum of the hair follicle of the scalp, that evolves into atrophic/scarring alopecia. In the active phase of the disease hairs are easily plucked with anagen-like hair-roots. In this study we focused on the expression of integrins and basement membrane components of the hair follicle in active LPP lesions. METHODS: Scalp biopsies were taken in 10 patients with LPP and in 5 normal controls. Using monoclonal antibodies against alpha3beta1 and alpha6beta4 integrins we showed the expression of these integrins and of the basement membrane components of the hair follicle in active LPP lesions and in healthy scalp skin. RESULTS: In the LPP involved areas, alpha3beta1 was distributed in a pericellular pattern, the alpha6 subunit was present with a basolateral distribution while the beta4 subunit showed discontinuous expression at the basal pole and occasionally, basolateral staining of the hair follicle. CONCLUSION: An altered distribution of the integrins in active LPP lesions can explain the phenomenon of easy pulling-out of the hair with a "gelatinous" root-sheath.

Long-term toxic effects of radiations: sarcomatoid carcinoma and multiple basal cell carcinoma of the limbs in chronic radiodermatitis.

A 73-year-old woman was referred to our attention for the presence of severe chronic lymphoedema and neoplastic lesions of the limbs. When she was 19 years old, the patient had undergone X-ray epilation of the limbs to remove unwanted body hair. The neoplastic lesions, observed 2 years before our observation, were excised, and histological examination revealed multiple basal cell carcinomas and a spindle squamous cell carcinoma on the left thigh. The case we observed offers some interesting points of consideration as it shows that in nonexposed areas cutaneous carcinomas can appear many years after irradiation and that the same treatment consequently requires careful follow-up for life. Another point of interest is the particular hystological aspect of neoplastic lesions in the site of radiodermatitis that requires in-depth immunohistochemical investigation for an exact diagnosis. Patients with previous treatment with ionizing radiation also in nonexposed areas need lifelong follow-up to identify cutaneous tumors at an early treatable stage.