Photo-patch and patch tests in patients with dermatitis over the photo-exposed areas: A study of 101 cases from a tertiary care centre in India.

BACKGROUND: Many patients with dermatitis over photo-exposed body areas are positive to many contact allergens and have a pre-existing allergic contact dermatitis. METHODS: This study included patients who presented to a tertiary centre in India with dermatitis on photo-exposed body areas suspected of chronic actinic dermatitis. Their detailed histories were recorded and cutaneous and systemic examinations were performed. Patch testing was done in all the patients and photo-patch testing was carried out in 86 patients. RESULTS: Altogether 101 patients were included (69 males, 32 females). The most common presentation was lichenified hyperpigmented plaques on the photo-exposed sites. Photosensitivity was recorded in 64 (63%) patients and summer exacerbation in 52 (52%). Exposure to the Parthenium hysterophorus weed was recorded in 70 (69%) patients, 27 (26.7%) had a history of hair dye application and 20 (20%) had a history of atopy. Photo-patch test was positive in 11 (12.8%) patients and patch testing was positive in 71 (70%). Parthenium hysterophorus was the most common allergen implicated and was positive in three (4%) photo-patch and 52 (52%) patch tests. Other positive photo-patch test allergens were perfume mix, balsam of Peru, thiuram mix, Compositae mix and promethazine hydrochloride. Other common patch test allergens were parthenolide, colophony, fragrance mix and p-phenylenediamine (PPD) base. CONCLUSION: In the Indian population parthenium and perfume mix are the most common photoallergens in patients with dermatitis over photo-exposed areas, while parthenium, colophony, fragrance mix and PPD are the common positive allergens.

Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm.

The etiology of cheilitis is often not readily apparent. We present a case series of four patients with allergic contact cheilitis (ACC) secondary to exposure to peppermint oil contained in a lip balm product. These patients developed eczematous dermatitis involving their lips and perioral skin. They were tested with the North American Contact Dermatitis Group standard series as well as with an expanded series of flavoring agents, sunscreens, plant and fragrance components, and their own products. The lip balm contained potential sensitizers such as propolis, lanolin, coconut oil, almond oil, peppermint oil, and vitamin E. Our patch-test results showed that peppermint oil was the most likely culprit in these patients' ACC. Peppermint oil is less commonly reported as causing ACC than are more common contactants such as balsam of Peru or nickel sulfate. However, with the widespread use of lip balms containing peppermint oil, more cases of peppermint oil-induced ACC may be expected.

Systemic contact dermatitis.

Systemic contact dermatitis (SCD) describes a cutaneous eruption in response to systemic exposure to an allergen. The exact pathologic mechanism remains uncertain. The broad spectrum of presentations that are often nonspecific can make it difficult for the clinician to suspect this disease, but it is an important diagnosis to consider in cases of recalcitrant, widespread, or recurrent dermatitis, in which patch testing often reveals allergy to nickel or balsam of Peru. Diagnosis and appropriate management can be life-altering for affected patients. This article on SCD provides an overview of the disease with descriptions of common allergens and some insight into the possible mechanism of action seen in SCD.

Identification of the constituents of balsam of peru in tomatoes.

BACKGROUND: Studies show that balsam-restricted diets result in significant improvement of systemic contact dermatitis in patients with contact allergy to balsam of Peru (BOP). While tomatoes have been implicated as a frequent cause of BOP-related dermatitis, the presence of BOP in tomatoes has never been confirmed. OBJECTIVES: High-performance liquid chromatography coupled with mass spectrometry (liquid chromatography [LC]-MS) and UV spectrometry (LC-UV) was used to detect the possible presence of BOP constituents in tomatoes. METHODS: Samples of beefsteak, cherry, and plum tomatoes were extracted in ethyl acetate and analyzed with LC-MS and LC-UV for the presence of the following sensitizing constituents of BOP: benzoic acid, benzyl alcohol, trans-cinnamic acid, cinnamic alcohol, cinnamyl cinnamate, coniferyl alcohol, eugenol, isoeugenol, and methyl cinnamate. RESULTS: The initial LC-MS analysis of each tomato extract showed multiple peaks. Two of these peaks had molecular weights of 134 and 180, which correspond to cinnamic alcohol and coniferyl alcohol, respectively. The analysis did not show peaks corresponding to the molecular weights of the remaining compounds. Cochromatography of tomato extract with cinnamic alcohol and coniferyl alcohol using LC-UV further suggested the presence of these compounds in the tomato extract. CONCLUSION: Coniferyl alcohol and cinnamic alcohol, constituents of BOP, are present in beefsteak, cherry, and plum tomatoes.

The prevalence and morbidity of sensitization to fragrance mix I in the general population.

BACKGROUND: The prevalence of sensitization to fragrance mix (FM) I and Myroxylon pereirae (MP, balsam of Peru) has decreased in recent years among Danish women with dermatitis. OBJECTIVES: This study investigated whether the decrease could be confirmed among women in the general population. Furthermore, it addressed the morbidity of FM I sensitization. METHODS: In 1990, 1998 and 2006, 4299 individuals aged 18-69 years (18-41 years only in 1998) completed a premailed questionnaire and were patch tested to FM I and MP. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The prevalence of FM I and MP sensitization followed an inverted V-pattern among women aged 18-41 years (i.e. an increase from 1990 to 1998, followed by a decrease from 1998 to 2006). Logistic regression analyses showed that 'medical consultation due to cosmetic dermatitis' (OR 3.37, 95% CI 1.83-6.20) and 'cosmetic dermatitis within the past 12 months' (OR 3.53, CI 2.02-6.17) were significantly associated with sensitization to FM I. CONCLUSIONS: In line with trends observed in Danish patients with dermatitis, our results supported a recent decrease in the prevalence of FM I and MP sensitization in Denmark. The study also showed that fragrance sensitization was associated with self-reported cosmetic dermatitis and use of health care related to cosmetic dermatitis.

The effect of different formulations of equivalent active ingredients on the performance of two topical wound treatment products.

Product selection for the management of pressure ulcers or perineal dermatitis is typically based on consideration of active ingredients, but a growing body of evidence suggests that delivery vehicles also may influence product safety and efficacy. A 10-day, randomized, controlled experimental study was conducted to compare the safety and efficacy of two prescription products used for the treatment of pressure ulcers and perineal dermatitis. Both products contain equivalent active ingredients (balsam of Peru, castor oil, and trypsin), but one product delivers these ingredients in an ointment base while the other uses an aerosol spray. Sixty healthy volunteers (> 65 years of age) underwent intentional creation of two equivalent skin wounds (approximately 6 mm in diameter) using an Erbium-YAG laser. Volunteers served as their own control. Wounds were randomized to treatment with one of the balsam of Peru products or saline. Wounds were evaluated every other day. Significant differences between treatments were observed for most outcome variables (edema, scabbing, erythema, epithelialization). Wounds managed with the ointment-based product had lower edema, scabbing, and erythema scores and higher epithelialization scores than the spray or saline managed wounds. The results of this study confirm that formulation of the vehicle base can have a significant effect on product safety and effectiveness.

[Systemic contact eczema against Balsam of Peru]. / Hämatogen-allergisches Kontaktekzem auf Perubalsam.

Balsam of Peru (PB; Myroxylon pereirae) is a natural product derived from resin of a tropical tree (MyroxyIon balsamum (L.) Harms var. pereirae (Royle) Baillon). Because of its antiseptic and aromatic properties PB or PB-components can be found worldwide not only in many health care and cosmetic products, but also in food items and semiluxury food. PB contains a wide variety of potent contact allergens leading to hypersensitivity reactions not only after topical application but also oral uptake. We report a 51-year-old brewer with chronic eczema of the hands who showed delayed-type patch test reactions against PB and fragrance-mix. Oral PB-challenge led to exacerbation of the eczema 5 and in a repeated test 2 days later. We here review this probably quite often overlooked disease and the therapeutic consequences which require profound knowledge about the wide distribution of PB when advising the patient about a PB-restricted diet. In addition, this unusual case report demonstrates that one has to consider marked delayed hypersensitivity reaction when investigating a systemic contact allergy.

A study of new fragrance mixtures.

OBJECTIVE: To determine the frequency of responses to four mixtures of fragrance materials in routine clinic patients undergoing patch testing for suspect allergic contact dermatitis. The validity of using fragrance mixtures alone, or in combination, was evaluated in terms of predicting allergy to fragrance judged on the basis of finding a response to at least one of the fragrance mixtures. METHODS: A total of 752 subjects were patch tested in five centers worldwide with (1) fragrance mix 8% (FM), (2) balsam of Peru 25%, (3) a mixture of seven of the eight FM 8% ingredients and other fragrance ingredients including jasmine absolute (jasmine/FM mix), and (4) a mixture of five selected natural fragrance ingredients (NM). RESULTS: Of 752 subjects, 100 (13%) had positive patch tests to at least one of the four fragrance mixtures. The age of the patients was 45.2 +/- 18.3 years (mean +/- SD). Ninety-six percent were Caucasian. Facial eruptions and hand involvement were the most common topographic sites. Of subjects exhibiting a positive response, 67% reacted to FM, 63% to the jasmine/FM mix, 47% to the NM, and 38% to balsam of Peru. Testing with FM and NM identified 84% of the perfume-allergic patients. FM 8% tested simultaneously with the jasmine/FM mix identified 86% of the perfume-allergic patients. Testing simultaneously with three test materials combining either the NM or the jasmine/FM mix with balsam of Peru and FM identified 95% of the perfume-sensitive patients. CONCLUSIONS: The simultaneous testing of NM or jasmine/FM mix, in addition to the conventional use of FM 8% and balsam of Peru, increases the sensitivity of testing for fragrance allergy from 81% to 95%.

Dioxopromethazine-induced photoallergic contact dermatitis followed by persistent light reaction.

BACKGROUND: Although photosensitivity after photoallergy to topical phenothiazine antihistamines is well known, there have been no previous reports of dioxopromethazine inducing this phenomenon. OBJECTIVE: A housewife used 0.5% dioxopromethazine in Prothanon gel for palpebral pruritus and developed severe dermatitis of the lower eyelids with spread to the sun-exposed areas. METHODS: The minimal erythema doses and the minimal infiltrate doses for ultraviolet A (UVA) and ultraviolet B (UVB) were established before photopatch testing and at intervals up to 497 days thereafter. Test sites were read up to 144 hours after irradiation. Photopatch testing was performed with Prothanon gel, dioxopromethazine hydrochloride 0.001% to 0.5%, and the standard photopatch test tray (Hermal/Trolab). For patch testing, various series of the German Contact Dermatitis Group were applied. RESULTS: Minimal erythema doses for UVA were diminished before photopatch testing and at intervals up to 500 days after Prothanon gel was discontinued. Exposure to UVB provoked abnormal delayed infiltrated reactions. Clinically the photosensitivity persisted within this period. Photoallergic reactions were seen with Prothanon gel, dioxopromethazine hydrochloride 0.005% to 1.0%, and promethazine hydrochloride 0.1%. The patient gave positive patch test reactions to various fragrance materials, balsam of Peru, costus oil, and propylene glycol. CONCLUSION: Because topical dioxopromethazine may cause photoallergic contact dermatitis followed by long-lasting photosensitivity even after contact has been discontinued, its withdrawal from the market is recommended.

[Comments on the incidence of contact allergy]. / Beobachtungen zur Häufigkeit von Kontaktallergien.

Analysis of positive patch testing during the last years revealed increased occurrence of contact allergy against arnica. Our investigations were done at the Department of Dermatology of the General Hospital, Linz. We take the view that the frequency of this contact allergy represents the consequence of using household remedies containing arnica.

Christmas tree allergy: mould and pollen studies.

A history of respiratory or other allergic symptoms during the Christmas season is occasionally obtained from allergic patients and can be related to exposure to conifers at home or in school. Incidence and mechanism of production of these symptoms were studied. Of 1657 allergic patients, respiratory and skin allergies to conifers occurred in 7%. This seasonal syndrome includes sneezing, wheezing and transitory skin rashes. The majority of patients develop their disease within 24 hours, but 15% experience symptoms after several days' delay. Mould and pollen studies were carried out in 10 test sites before, during and after tree placement in the home. Scrapings from pine and spruce bark yielded large numbers of Penicillium, Epicoccum and Alternaria, but these failed to become airborne. No significant alteration was discovered in the airborne fungi in houses when trees were present. Pollen studies showed release into air of weed, grass and tree pollens while Christmas trees were in the house. Oleoresins of the tree balsam are thought to be the most likely cause of the symptoms designated as Christmas tree allergy.