MEK inhibitor-induced paronychia in a paediatric population: A tertiary centre experience.

The cutaneous toxicity of MEK inhibitors may limit treatment adherence. The authors present a retrospective study of 41 paediatric patients with NF-1 undergoing therapy with selumetinib and propose a treatment algorithm.

Familial Cases of PENS: A Review of the Literature.

Papular epidermal nevus with "skyline" basal cell layer (PENS) is a keratinocytic nevus that can occur sporadically or has a familial transmission. There are 5 families reported with PENS, in which there are 2 family members affected with each case. We present the sixth familial case, with the peculiarity of being the first time in which there are 3 family members with PENS, while reviewing the other cases described until now. In addition, we present a new histopathological finding, an inflammatory lichenoid infiltrate on the upper dermis in PENS lesions. This finding could be the result of trauma to the biopsied lesion, or it may represent a new inflammatory histological variant.

Pediatric Kaposi's sarcoma associated with immune reconstitution inflammatory syndrome.

Immune reconstitution inflammatory syndrome (IRIS) represents paradoxical immune-mediated inflammation in response to an infecting pathogen, occurring after initiation of antiretroviral therapy (ART), concomitantly with immune system recovery. It has also been described in Kaposi's sarcoma (KS). We report a case of a 9-year-old Guinean girl, who developed Kaposi's sarcoma, following introduction of ART. KS associated with immune reconstitution inflammatory syndrome is rare, especially in children, but with the increased use of ART is becoming more prevalent.

Allergic contact dermatitis caused by (meth)acrylates in nail cosmetic products in users and nail technicians - a 5-year study.

BACKGROUND: The increasing use of long-lasting nail aesthetic products has led to a growing number of cases of allergic contact dermatitis (ACD) caused by (meth)acrylates in recent years. OBJECTIVES: To provide information on ACD caused by (meth)acrylates related to nail cosmetic products. METHODS: We retrospectively reviewed files of patients with ACD caused by (meth)acrylates related to nail cosmetic products, who were patch tested between January 2011 and December 2015 in 13 departments of dermatology in Portugal. RESULTS: Two-hundred and thirty cases of ACD caused by (meth)acrylates (55 technicians, 56 consumers, and 119 with mixed exposure) had been documented, mostly as chronic hand eczema (93%). The most common sensitizers were: 2-hydroxyethyl methacrylate (HEMA), which was positive in 90% of the tested patients, 2-hydroxypropyl methacrylate (HPMA), which was positive in 64.1%, and ethyleneglycol dimethacrylate, which was positive in 54.5%. CONCLUSION: HEMA and HPMA were the most frequent positive allergens. HEMA, which identified 90% of cases, can be considered to be a good screening allergen. The high number of cases of ACD caused by (meth)acrylates in nail cosmetic products certainly warrants better preventive measures at the occupational level, and specific regulation in the field of consumer safety.

Secondary Skin Plasmacytomas.

A 78-year old man was diagnosed in 2006 with IgAκ multiple myeloma (MM) (stage III-A). The patient was referred to our dermatology department in 2012 for evaluation of erythematous skin nodules on the anterior right aspect of the thorax; the skin lesions were noted during hospitalization for multiple bone fractures. He was on fourth-line chemotherapy (with vincristine/adriamycin/dexamethasone) because of constant disease progression. The patient was unaware of the skin lesions' evolution over time and did not recall when they had first appeared. He had no pain, itching, or spontaneous bleeding.

Transient symptomatic zinc deficiency in a preterm exclusively breast-fed infant.

A 5-month-old female infant, preterm, exclusively breast-fed, presented with a 2-month history of erythematous, erosive, and crusted patches and plaques in a peri-oral, scalp, genital, and peri-anal distribution. A clinical diagnosis of zinc deficiency was confirmed by a low serum zinc level in the infant and decreased maternal breast milk zinc. Complete resolution occurred within two weeks of oral zinc supplementation. Acquired zinc deficiency is a rare nutritional disorder of infants. Early diagnosis and adequate treatment will prevent associated morbidity and complications.

Sensitization to methylisothiazolinone in a group of methylchloroisothiazolinone/methylisothiazolinone allergic patients.

In the EU, Methylisothiazolinone (MI) was approved as a preservative in cosmetics and household products in 2005. Since then, several cases of MI contact allergy have been reported. We studied the prevalence of MI sensitization in patients allergic to Methylchloroisothiazolinone/Methylisothiazolinone (MCI/MI). From a total of 751 patients submitted to patch testing between 2007 and 2011, 26 were sensitized to MCI/MI 100 ppm aq. Fifteen patients were retested with MCI/MI 100 ppm aq, MI 200 ppm aq and personal products, and the relevance of positive results, concerning the use of personal products, was evaluated. Seven of the 15 MCI/MI positive patients were positive to MI: six patients showed an equally intense reaction to MCI/MI and MI alone, and another one presented with a stronger reaction to the latter compound. All positive reactions were relevant. The use of MI alone as a preservative does not seem to be a safe alternative. In this study, the majority of positive reactions to MCI/MI and MI had similar intensity, although primary sensitization to MI has to be considered according to each individual case; moreover, primary sensitization to MCI with cross-reactivity to MI cannot be excluded. Further studies are needed to determine the optimal concentration for MI patch testing.

Contact allergy to methylchoroisothiazolinone/methylisothiazolinone (MCI/MI): findings from a contact dermatitis unit.

INTRODUCTION: Several preservatives are currently allowed in cosmetic products in the EU. However, only a few of them are strongly represented on the market: formaldehyde, parabens, formaldehyde releasers and methylchoroisothiazolinone/methylisothiazolinone (MCI/MI). MCI/MI has been widely used during recent years for the preservation of aqueous systems in cosmetics, toiletries and in several industrial applications. OBJECTIVE: To describe the frequency of contact allergy to (MCI/MI) in a contact dermatitis unit. MATERIALS AND METHODS: A retrospective study was conducted including all patients submitted to patch testing, from January 2007 to December 2009. RESULTS: In total, 629 consecutive patients with a clinical diagnosis of contact dermatitis were patch tested over a period of 3 years. The frequency of positive reaction to MCI/MI was 2.4% (15/629). Of the positive patients, 26.5% (4/15) gave a history of atopy. The dermatitis was generalized in 4 patients (26.5%), localized to the head and neck in 3 patients, and involved hands or feet in 9 patients. Other allergen sensitivities were found to occur simultaneously in the majority of cases: two patients (2/15) were allergic to fragrance mix 1 (FM1) and one (1/15) was allergic to fragrance mix 2 (FM2) as well as two (2/15) were allergic to chromium and three (3/15) were allergic to nickel. In 80% of the cases (12/15), the reaction was judged to be of current relevance for products used in personal hygiene. CONCLUSION: The frequency of positive reactions to MCI/MI reported in our study is in the middle range thus far reported in European series in the literature. MCI/MI is a very common biocide for use by the general public at the established allowed concentration, which has been subject of successive measures of regulation considering the compound's current nearly ubiquitous presence in cosmetics. Certain factors appear to increase the risk of sensitization, namely chronic dermatitis and the frequent use of leave-on products containing MCI/MI by these patients.

Letter: Allergic contact dermatitis from sculptured acrylic nails: special presentation with a possible airborne pattern.

INTRODUCTION: Sculptured artificial acrylic nails are widely used in developed countries. Methylmethacrylate was first reported in 1941 as a cause of allergic contact dermatitis. Since then, occupational contact allergies to acrylates in dentistry, orthopedic surgery, printing industry and other industries have been reported. OBJECTIVE: We describe 3 patients with contact allergy to acrylates in artificial nails. DESIGN AND METHODS: Patch tests with the Portuguese baseline series of contact allergens and an extended series of acrylates was applied. RESULTS: We observed three female patients with allergic contact dermatitis from sculptured acrylic nails. Two of these patients were both customers and also technical nail beauticians. Two patients developed periungual eczema; one patient presented only with eyelid dermatitis and no hand or periungual lesions. The tests showed positive reactions to 2-hydroxyethylmethacrylate (2-HEMA) and 2-hydroxypropylmethacrylate (2-HPMA) in three patients. CONCLUSION: Our cases demonstrate the variety of clinical presentations of allergic contact dermatitis from acrylic nails. They show the need to warn patients of persistent and sometimes permanent side effects of these nails. They also emphasize the importance of cosmetic ingredient labeling.

Hydrogel allergic contact dermatitis and imidazolidinyl urea/diazolidinyl urea.

Hydrogels contain modified carboxymethylcellulose polymer together with propylene glycol as known components. Nowadays, they are common agents used in the treatment of leg ulcer patients, and a possible cause of allergic contact dermatitis. However in the published data, not all the patients with positive patch tests to hydrogels were sensitized to propylene glycol, remaining some allergens to be identified. The authors describe two leg ulcer patients sensitized for different commercial available hydrogels tested "as is", with concomitant patch tested positivity to imidazolidinyl urea (IU) and diazolidinyl urea (DU). Patient A was an 84-year-old male, and patient B was a 77-year-old female, both with a known history of leg ulcer for more than 8 weeks. Patient A was sensitized for Intrasite Gel(®), Hydrogel Nu-Gel(®), Askina Gel(®), neomycin and budesonide. Patient B was sensitized for Intrasite Gel(®), Hydrogel Nu-Gel(®), Askina Gel(®), Hydrosorb Gel(®), Fragance mix 1 and 2, Amerchol, geraniol and citral. They were negative to propylene glycol tested in 5% pet. and 20% aq. IU and DU are formaldehyde-releasing agents, used as antimicrobial preservatives in the formulation of pharmaceutical creams and ointments and are known to cause contact dermatitis. Also, in many studies performed, it has been shown that contact allergy is high in patients with leg ulcers. As result, assessment of the relevance of positive patch test reactions in these patients can be difficult. Although we were not able to get the complete ingredient list of the hydrogels tested, attending to these observations, could be of importance to evaluate the presence of IU/DU in patients with suspected contact dermatitis to hydrogels.

Hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral®) as allergen: experience from a contact dermatitis unit.

INTRODUCTION: Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC)-Lyral® is a widely used synthetic fragrance found in personal care and household products. It is an aldehyde, lipophilic enough to penetrate the skin and is a frequent cause of contact sensitization. OBJECTIVE: Describe the frequency of contact allergy to HICC in a Contact Dermatitis Unit, after its inclusion in baseline patch test series. METHODS: A retrospective study including all patients submitted to patch test, from January 2007 to December 2009. RESULTS: Over a 3-year period, 629 consecutive patients were patch tested. The frequency of positive reactions to HICC was 2.7% (17/629). Of the positive patients, 35% (6/17) gave a history of atopy, 58.8% (10/17) had eczema on the face and neck, 23.5% (4/17) on the hands, 23.5% (4/17) in the axillae, 17.6% (3/17) on the trunk and 6% (3/17) had generalized eczema. All patients were patch positive for more than one allergen: all (17/17) positive to fragrance Mix 2 (FM2); 47% of the patients (8/17) positive to fragrance Mix 1 (FM1); and 23.5% of the patients (4/17) positive to Balsam of Peru. In 94% (16/17) of cases, the reaction was judged to be of current relevance. DISCUSSION: The frequency of positive reactions to HICC of 2.7% found in our population is according to what is described in several European reports, where HICC is still widely used as a fragrance ingredient. In contrast, in North America, the prevalence is lower. All the patients were positive also to FM2. The association found between reactions to FM1 and HICC is also commonly reported and could represent a concomitant sensitization following increased exposure to fragrance allergens. These data confirm the importance of HICC introduction in the baseline patch test series.