Hydroxyisohexyl 3-cyclohexene carboxaldehyde allergy: relationship between patch test and repeated open application test thresholds.

BACKGROUND: Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is a synthetic fragrance ingredient. Case reports of allergy to HICC appeared in the 1980s, and HICC has recently been included in the European baseline series. Human elicitation dose-response studies performed with different allergens have shown a significant relationship between the patch-test threshold and the repeated open application test (ROAT) threshold, which mimics some real-life exposure situations. Fragrance ingredients are special as significant amounts of allergen may evaporate from the skin. OBJECTIVES: The study aimed to investigate the relationship between elicitation threshold doses at the patch test and the ROAT, using HICC as the allergen. The expected evaporation rate was calculated. MATERIALS AND METHODS: Seventeen HICC-allergic persons were tested with a dilution series of HICC in a patch test and a ROAT (duration up to 21 days). Seventeen persons with no HICC allergy were included as control group for the ROAT. Results The response frequency to the ROAT (in microg HICC cm(-2) per application) was significantly higher than the response frequency to the patch test at one of the tested doses. Furthermore the response rate to the accumulated ROAT dose was significantly lower at half of the doses compared with the patch test. The evaporation rate of HICC was calculated to be 72% over a 24-h period. CONCLUSIONS: The ROAT threshold in dose per area per application is lower than the patch test threshold; furthermore the accumulated ROAT threshold is higher than the patch test threshold, which can probably be explained by the evaporation of HICC from the skin in the open test.

Clinical severity and prognosis of hand eczema.

BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Sudden onset of adverse effects due to low-dosage bleomycin indicates an idiosyncratic reaction.

We report a case of possible idiosyncratic reaction in a fifty-two-year-old man with centroblastic malignant lymphoma. Immediately after administration of 20 mg bleomycin intravenously for the first time, the patient developed stomatitis. When readministered a few weeks later the patient developed mucocutaneous manifestations such as stomatitis, symmetrical linear maculopapular exanthema on the neck, trunk, and both arms, and indurated nodules on the palms.

[A mini epidemic of varicella zoster virus reinfection at a department of hematology]. / Miniepidemi af varicel zoster virus reinfektion på en haematologisk afdeling.

Whereas primary infection with varicella zoster virus (VZV) (chickenpox) and reactivation of VZV (shingles) are common and recognized, clinical reinfection with VZV is rare. A little epidemic of presumed reinfection with VZV in six immune-compromised adults is presented here. The epidemic lasted for three months, during which a healthy young woman also developed a primary VZV infection in the form of chickenpox. In the immune-compromised patients, the clinical picture was dominated by disseminated, prolonged and frequently haemorrhagic and necrotic eruptions which may cause diagnostic difficulties. Skin biopsy proved helpful in the diagnosis while demonstration of the VZV antigen in the skin elements was specific and sensitive. All of the patients, with one exception, were treated with acyclovir and dissemination of the infection to the inner organs did not occur. One patient may have died on account of the VZV infection. In conclusion, immune-incompetent patients must be warned against infection from chickenpox or disseminated herpes zoster. In cases of proved exposure, prophylactic treatment with acyclovir should be considered and, in cases of clinical disease, immediate treatment with 10 mg acyclovir per kg body weight should be administered intravenously thrice daily.

[Treatment of gonorrhea at the Venereal Disease Clinic in Copenhagen in 1985. A study of the efficacy of standardized treatment compared with the sensitivity of Gonococcus to penicillin in vitro]. / Behandling af gonoré på Københavns Venereaklinik i 1985. En undersøgelse af effekten af standardbehandling sammenholdt med gonokokkernes følsomhed for penicillin in vitro.

In 1985, a total of 1,140 patients (907 men and 503 women) were treated for gonorrhoea at the Copenhagen County Outpatients Clinic at Rudolph Berghs Hospital. Failure of the standard treatment regimen (pivampicillin plus probenecid; patients stating penicillin allergy received a Sulfotrim-regimen) occurred in 79 (5.6%). A significant association between the in vitro susceptibility to penicillin and the efficacy of the standard treatment regimen was found; among 1,139 patients with uncomplicated urogenital gonorrhoea caused by penicillin susceptible gonococci, the failure rate was low (0.4-1.9%); the failure rate was high in patients infected with penicillin resistant gonococci. Continued surveillance of the in vitro antimicrobial susceptibility of gonococci is recommended as a basis for the choice of standard treatment regimen.

Risk factors for cement eczema.

Risk factors for cement eczema were studied among workers employed in the Danish construction industry. 2 cohorts exposed to cement containing different concentrations of water-soluble chromate were examined. A statistically significant decrease in the number of workers with allergic cement eczema was found in the cohort exposed to cement with the lower water-soluble chromate concentration. Allergic cement eczema was found to have a greater extent of involvement than irritant cement eczema. A 3rd cohort was followed to evaluate individual risk factors. The degree of exposure to wet cement seems to have a certain, though not statistically significant, effect on the risk of developing irritant cement eczema. Individual preventive measures, such as the use of gloves and creams, did not seem to reduce the development of irritant cement eczema.