Hand and forearm dermatoses among veterinarians.

BACKGROUND: Infectious and non-infectious hand and forearm dermatoses are frequent in daily veterinary medicine. In this specific occupation there is a serious impact of skin disease on the lives and careers of veterinarians. OBJECTIVE: In this study we clarify the different occupational dermatoses on hands and forearms among veterinarians, using data collected in different dermatological patch-test expert centres in Belgium and the Netherlands. METHODS: Instead of questioning veterinarians themselves, which has been done in different studies in the past, we contacted dermatologists in Belgium and the Netherlands, questioning them about their experiences with dermatoses among veterinarians. RESULTS: Seven dermatologists described a total of 58 veterinarians. Infectious dermatoses were described in 12 cases (20.7%). The non-infectious dermatoses (46 cases, 79.3%) can be classified as contact urticaria and as irritant or allergic contact dermatitis. CONCLUSION: While irritant contact dermatitis accounts for the vast majority of hand and forearm dermatoses among veterinarians, contact urticaria and allergic contact dermatitis also significantly contribute to the occupational morbidity. Repeated hand washing, occlusion under rubber gloves, contact with animal protein fluids during obstetric procedures and contact with antiseptic agents, systemic and topical corticosteroids and antibiotics are the most likely causes of hand and forearm dermatoses among veterinarians.

Clinical and molecular abnormalities in lipoid proteinosis.

Lipoid proteinosis (hyalinosis cutis et mucosae) is a rare, autosomal recessive disease. The main clinicopathological features comprise skin and mucous membrane infiltration and scarring with deposition of hyaline material. In this report, we describe a 6-year-old boy in whom a diagnosis of lipoid proteinosis was first suspected when he presented with blisters and erosions at 4 years, a history of life-long dysphonia and a previous epileptic convulsion. The diagnosis was confirmed by histology and identification of a homozygous frameshift mutation, 501insC, in exon 6 of the gene encoding extracellular matrix protein 1, ECM1. Lipoid proteinosis may show protean clinical features and be difficult to diagnose on clinical grounds alone. This case report illustrates that lipoid proteinosis may show protean clinical features and yet remain undiagnosed for many years. Although the gold standard for definite diagnosis remains histology, molecular characterisation of the gene mutation will add to our understanding of genotype-phenotype correlation and perhaps to the development of a rationale for future therapeutics.

Adverse skin reactions to anti-TNF-alpha monoclonal antibody therapy.

Various adverse cutaneous reactions to anti-TNF-alpha monoclonal antibody have been reported. In clinical studies with infliximab (Remicade) adverse drug reactions were most frequently reported in the respiratory system and in the skin and appendages. We describe here 6 patients receiving anti- TNF-alpha therapy (infliximab) for Crohn's disease or rheumatoid arthritis who consulted our out-patient department for adverse cutaneous reactions between November 1999 and February 2002. The following diagnoses were made: leukocytoclastic vasculitis, lichenoid drug reaction, perniosis-like eruption (2 patients), superficial granuloma annulare and acute folliculitis.

An unusual case of palmoplantar keratoderma.

A 55-year-old woman with palmoplantar keratoderma presented an associated hyperhidrosis with distinct odour and maceration. She had had the lesions for about 20 years and this seemed to be an isolated case in her family. This case appeared very unusual because there were no signs of acanthokeratolysis in the biopsies. Two months of treatment with acitretin (Neotigason; 25 mg daily), produced a spectacular result: clearance of all the lesions on both hands and a strong diminution of the lesions on the soles. The Unna-Thost variant of palmoplantar keratoderma usually appears in the first few months of life, and it rarely appears in the third decade. The condition is inherited as an autosomal dominant with high penetrance and expressivity. Our subject appeared to be an exception to these two facts.

Relevance and reproducibility of patch-test reactions to corticosteroids.

We present our patch test findings with dermatocorticosteroids during the period 1995-1999. We retrospectively studied the % of doubtful and positive reactions to each allergen in our corticosteroid series and assessed the relevance of these reactions. To assess reproducibility, we retested 15 patients with doubtful or positive reactions in 1999. The % of + or ++ reactions on D2-D3 and D7 ranged from 0.0% to 0.9% for most of the compounds tested. Hydrocortisone acetate 1% alc.abs./DMSO 50/50 showed a much higher % of positive reactions. Most of these reactions were not relevant and therefore probably due to the irritant nature of the vehicle. An overall reproducibility of 47.2% was obtained. 100.0% of the non-reproducible patch test reactions were not relevant. Definite relevance was much higher in the reproducible + or ++ reactions than in the reproducible doubtful reactions: 100.0% and 18.2%, respectively. We conclude that the mean % of + and ++ reactions to the corticosteroid series on D2-D3 is 0.5%, with an overall reproducibility of 47.2%. Tixocortol pivalate and budesonide proved to be important markers for dermatocorticosteroid allergy.

The risk of active sensitization to PPD.

Para-phenylenediamine (PPD) and para-aminoazobenzene are strong sensitizers. By the patch test procedure, the patient may be sensitized to these agents. Combined testing of para-compounds may increase the risk of active sensitization. We studied the % of positive patch test reactions and their relevance. In order to assess the risk of active sensitization, we compared the % of relevant reactions of both early (2/3 days) and late (7 days) reactions. We also compared the percentage of positive patch test reactions to PPD and their relevance if simultaneously tested with para-aminoazobenzene. We studied the patch test reactions to PPD in the routine series in 2058 patients. In a group of 678 patients we tested PPD and para-aminoazobenzene simultaneously. 4.3% and 3.1% of the patients reacted to PPD, respectively, with and without simultaneous testing with para-aminoazobenzene. We estimated the reactions as relevant in 21.1% and 39.7%, respectively, with and without simultaneous testing with para-aminoazobenzene. We considered none of the late reactions as relevant. We found a high proportion of relevant patch test reactions to PPD, but sensitization to PPD by the patch test procedure is a risk. We state that routine series should not contain PPD. The high number of irrelevant late positive reactions strongly suggests active sensitization. Moreover, PPD is not a ubiquitous allergen and can be tested on a non-routine basis if industrial exposure to para-compounds is suspected or if a specific localization (e.g., head or feet) prompts the testing of PPD. Testing PPD combined with para-aminoazobenzene does lead to a slight increase in positive reactions to PPD (p<0.25) and to an increase in irrelevant reactions (p<0.10).

The relevance of skin prick tests for Pityrosporum ovale in patients with head and neck dermatitis.

BACKGROUND: Patients with atopic dermatitis often develop immunoglobulin E antibodies against the yeast Pityrosporum ovale. This organism may produce positive skin prick reactions in a higher rate in patients with atopic dermatitis of the head, scalp, and neck region. METHODS: We investigated whether positive prick tests to P. ovale were associated with a specific localization in the head and neck region. A total of 589 consecutive patients were prick tested with a P. ovale extract from ALK Abelló. RESULTS: Thirty-seven patients (6.3%) showed a positive reaction to the P. ovale extract. We could not find significant differences in the localizations of the dermatitis and the pattern of reaction to the tested intracutaneous allergens between the 37 patients positive to P. ovale and the control group of 55 subjects with negative reactions. In a subgroup, we found an elevated level of P. ovale-specific IgE in 100.0% of the patients with head and neck dermatitis, compared with 13.6% in the atopic dermatitis patients with lesions in any other localization. CONCLUSIONS: Our results clearly show that P. ovale-specific IgE is strongly related to the head and neck localization of atopic dermatitis, but RAST seems more sensitive than a prick test with the extract we used.