[Pattern of contact sensitization to paraphenylenediamine and its detection in hair dyes]. / Patrón de sensibilización por contacto a parafenilendiamina y su detección en tintes capilares.

BACKGROUND: One of the greatest challenges in occupational dermatology is the identification of chemical substances used by patients in their work in order to determine their allergenic potential. Numerous techniques have been described for the identification of allergenic compounds. These tests must be sensitive, specific, and safe. We describe a study to detect the presence of paraphenylenediamine (PPD) in hair dyes that are commercially available in Spain. MATERIAL AND METHODS: We undertook an experimental study involving qualitative and semiquantitative detection of PPD in hair dyes sold in Spain. The qualitative technique we used was a previously described colorimetric method involving dilution of the dye with isopropyl alcohol followed by addition of a reagent solution (1g of vanilla in 15 ml of isopropyl alcohol and 7.5 ml of hydrochloric acid). A quantitative study was then done in which the dye was extracted in 96% ethanol and subjected to 1-dimensional thin-layer chromatography. RESULTS: A total of 15 brown and 12 blonde dyes were analyzed. PPD was identified in all of the brown dyes analyzed, irrespective of whether it was indicated (n = 12) or not (n = 3) in the composition. PPD was found in 6 of the 9 blonde dyes that indicated it in the composition and 2 of the 3 in which it was not indicated. Semiquantitative analysis by thin-layer chromatography revealed that the concentration of PPD in brown hair dyes (mean, 3%) was higher than in blonde dyes (mean, 0.1-0.3%). CONCLUSIONS: The presence of PPD in hair dyes is related to the color of the dye. It is consistently present in darker dyes and at low levels in blonde dyes. This study highlights the clinical and epidemiological importance of identifying allergens in dermatology, particularly in occupational dermatology.

[Importance of epidemiologic surveillance in contact dermatitis: Spanish surveillance system on contact allergies]. / Importancia de la vigilancia epidemiológica en el eczema de contacto. La Red Española de Vigilancia de Alergia de Contacto.

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described.

[Epidemiology of contact dermatitis in Spain. Results of the Spanish Surveillance System on Contact Allergies for the year 2008]. / Epidemiología del eczema de contacto en España. Resultados de la Red Española de Vigilancia en Alergia de Contacto (REVAC) durante el año 2008.

BACKGROUND: The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units. OBJECTIVES: The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. MATERIAL AND METHODS: Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. RESULTS: Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. CONCLUSIONS: The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series.

Infliximab for the treatment of hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa is a chronic inflammatory disease characterized by significant morbidity. Current medical therapies are usually only minimally effective. OBJECTIVE: To assess the efficacy and safety of infliximab monotherapy for the treatment of severe extensive refractory forms of hidradenitis suppurativa. DESIGN: A retrospective study in a group of 6 patients who received treatment with infliximab for hidradenitis suppurativa, in the Dermatology Department of the University Hospital of Puerto Real in the last year. The dose was 5-10 mg/kg at weeks 0, 2 and 6, followed by a maintenance dose every 4 weeks. Subjective and objective efficacy was assessed before and after each treatment session. RESULTS: All patients experienced improvement in subjective symptoms after the initial dose. A decrease in exudation, the size and number of lesions and less development of fistulous tracts were observed. The patients were followed up during 6 months. Treatment was generally well tolerated and there was only one mild reaction to the infusion in the form of headache. No patient required treatment discontinuation due to adverse effects. CONCLUSIONS: Infliximab was shown to be an effective therapeutic alternative for severe extensive forms of hidradenitis suppurativa when it is used as monotherapy.

[Pseudoxanthoma elasticum. A X-ray microanalytic study]. / Pseudo-xanthome élastique: étude avec microanalyse de rayons X.

We present a very typical case of pseudo-xanthoma elasticum (PXE) with very remarkable cutaneous lesions, a great number of angioid streaks and, at the moment, with no involvement of the peripheral vascular system. From a genetic standpoint, we believe it must be considered as recessive Type I. An X-ray microanalysis was performed showing intense Ca and P deposits in the affected areas as well as complete absence of Si.

[Persistent desquamation of the lips]. / Descamación persistente de los labios.

We communicate a case of chronic cheilitis described for R. Degos as a "persistent scaling of the lips", with a clear psychological component. There has been ostensible improvement with dermatologic and psychiatric treatment.

[Zoon's plasmocytary balanitis. Treatment by circumcision and a review of the literature]. / Balanitis plasmocitaria de Zoon. Tratamiento mediante circuncisión y revisión de la literatura.

One case of plasma-cell balanitis of Zoon is reported. An excellent therapeutic result was obtained by means of the circumcision. A review of the disease is made, with special attention in the clinical and histological differential diagnosis, and the last contributions in electronic microscopy are commented.

[Tuberculous ulcer of the palate. Apropos of a case]. / Ulcera tuberculosa de paladar. A propósito de un caso.

We present a case of orificial tuberculosis in a male of 51, consisting on an ulcer in the pallatum. This diagnosis lead us into finding an advanced active pulmonary tuberculosis which the patient ignored. We want also to emphasize the importance of a correct differential diagnosis regarding oral cavity ulcers, among which we must always keep in mind that tuberculosis is still quite common in our environment, as well as squamous cell carcinoma, reticulum cell sarcoma, eosinophilic granuloma, stomatitis ulceromembranous.

[Benzoyl peroxide in the treatment of decubitus ulcers]. / Peróxido de benzoilo en el tratamiento de úlceras de decúbito.

We communicate a case of pressure sore (decubitus ulcer) treated with 20% topic benzoyl peroxide in O/W emulsion with very satisfactory results. This substance feeds hyperbaric oxygen. Benzoyl peroxide also has antimicrobial, antipruriginous and antifungal properties all of them contributing to shorten the evolution of the lesions.

Cutaneous endometriosis.

A 32-year old patient presented with an asymptomatic, non-specific tumour located at the site of a previous cesarian scar. The tumor had never bled but its size changed and the color and consistency varied coinciding with the menstrual cycle. The dermatopathologic study showed the existence of ectopic endometrial glandular tissue in the whole thickness of the reticular dermis.

[Keratoderma palmoplantaris varians (striata et areata), a form of chronic idiopathic acrokeratosis described by Degos]. / Queratodermia palmoplantar varians (striata et areata) tipo acroqueratosis esencial crónica de Degos.

We report a case of a 15-year-old boy with hyperkeratotic lesions that were linear or striated on the palms and nummular on the soles. He was the only family member known to be affected, suggesting that the condition could be attributed to a de novo mutation or the recessive form of keratoderma palmoplantaris striata, described by Degos as chronic idiopathic acrokeratosis. The lesions did not improve with topical treatments (keratolytic agents, emollients, or corticosteroids) or oral retinoids. We observed that scratching of the affected areas was the main reason for deterioration of the lesions.

Allergic contact dermatitis in children.

INTRODUCTION: Allergic contact dermatitis (ACD) is equally as likely in infancy as in adulthood, and represents 20% of all cases of dermatitis in children. Its true prevalence and incidence are, however, unknown. MATERIALS AND METHODS: We have conducted a retrospective study over 10 years of a group of patients aged 15 years or less, with clinical suspicion of ACD. Patch tests were performed in accordance with the standards of the GEIDC. RESULTS: The study covered 96 patients with a mean age of 10.57+/-0.67 years. The zones most frequently affected by eczemas were those of diffuse distribution (28% of patients) and of the hands (27%). We found at least one positive response in 52% of the cases. The most frequent allergens were thiomersal (21%), mercury (19%) and nickel (18%). We have found a statistically significant association between age of less than 15 years and positive response to thiomersal [P<0.01; OR: 8.5 with confidence interval (CI) 95%: 5.08

Rhinoscleroma in three siblings.

Rhinoscleroma is a chronic, granulomatous infectious disease that responds poorly to treatment. In recent years an increasing number of cases have been reported in nonendemic areas, explained largely by major migratory movements. We describe rhinoscleroma in three siblings. They had ulcerated but painless lesions, which bled spontaneously, and hemorrhagic scabs or crusts in their noses. In one child, the lesions had destroyed the entire left nasal ala and alar cartilage and most of the right. Dermatopathologic study identified the Mikulicz macrophages that contained organisms. It is possible that disposing factors could have been the neutropenia common to the three children and their poor living conditions. They were treated with a combination of trimethoprim-sulfamethoxazole and cefalexin, for a period of 3 months. We present this unusual case history of three siblings affected by a process that is relatively infrequent in our area of practice and is not considered very contagious. It is important to recognize the clinical signs characteristic of this disease, the diagnosis of which is not easy. Improvements in living conditions, hygiene, and health standards are essential prerequisites for its control and prevention.

Azelastine tablets in the treatment of chronic idiopathic urticaria. Phase iii, randomised, double-blind, placebo and active controlled multicentric clinical trial.

This trial was designed to study the efficacy and tolerability of azelastine in controlling symptoms of chronic idiopathic urticaria, using ebastine as validation group. Fifty-two adult patients were randomised to receive azelastine (4 mg), ebastine (10 mg) or 18 placebo for 21 days. Patients were required to visit the investigating physicians on three different occasions (days 0, 7 and 21). On each of these three study days, investigators assessed itching, wheals and erythema, based on a 4-point scale, and quality of life using a visual-analogue scale and subscale 9 of the Short Form 36 (SF-36) Health Survey. Patients entered daily assessments of itching on diary cards also using a 4-point scale. Furthermore, investigators assessed global efficacy and tolerability of the study medication on day 21 or upon premature discontinuation of the trial. Side effects and compliance were evaluated on each visit. A statistically significant reduction in itching was found for both active treatments compared with placebo. These improvements, which were statistically significant already after 1 day of treatment, continued over the course of 3 weeks. Additionally, both azelastine and ebastine were effective in improving symptoms such as wheals and erythema when compared to placebo. The quality-of-life parameters were unaffected by either treatment. Taste perversion (2 cases) and somnolence (1 case) were the only adverse drug reactions of azelastine. Ebastine, however, seemed to cause more often and more severe symptoms such as fatigue, sleepiness and asthenia. Global assessments of efficacy and tolerability performed by the investigators, also favoured azelastine. In conclusion, both azelastine and ebastine are effective and safe drugs, able to control symptoms of chronic idiopathic urticaria since the first day of treatment, and along a period of 3 weeks.

Vermilionectomy using the W-plasty technique.

We describe a variation of the conventional vermilionectomy consisting of incisions using the W-plasty technique, which allows a more distensible scar with better cosmetic and functional results. Its primary indications are actinic cheilitis and leukoplakia of the lower lip. It is a more complicated technique than the classic one, and requires a larger loss of skin, but the benefits largely outweigh the drawbacks.

Patrón de sensibilización por contacto a parafenilendiamina y su detección en tintes capilares / Pattern of Contact Sensitization to Paraphenylenediamine and its Detection in Hair

Introducción: Uno de los retos más difíciles en el campo de la Dermatología laboral es la identificación de las sustancias químicas con las que trabaja el enfermo para poder determinar su capacidad alergénica. Se han descrito múltiples técnicas para poder identificar las distintas sustancias alergénicas contenidas en la composición de las sustancias que maneja el enfermo. Estas pruebas de detección de alérgenos deben ser sensibles, específicas y seguras. Presentamos un estudio experimental cuyo objetivo es detectar la presencia de parafenilendiamina entintes capilares comercializados en nuestro país. Material y métodos: Hemos realizado un estudio experimental con el fin de realizar una detección cualitativa y semicuantitativa de parafenilendiamina en tintes capilares comercializados en nuestro país. Como técnica cualitativa utilizamos la técnica de identificación descrita consistente en la dilución del tinte con alcohol isopropílico y con posterioridad se añade la solución reactiva (1 g de vainilla en 15 ml de alcohol isopropílico y 7,5 ml de ácido clorhídrico). Esta prueba da una respuesta colorimétrica que indica la presencia o no del alérgeno en el tinte capilar. Con posterioridad hemos procedido a realizar un estudio cualitativo mediante la extracción del colorante con etanol 96◦, seguido de una cromatografía en capa fina monodimensional. Resultados: Se estudiaron un total de 15 tintes de color castaño o moreno y 12 tintes de color rubio. Este estudio nos permitió identificar la PPD en todos los tintes capilares morenos estudiados, con independencia de que su presencia estuviera indicada (n=12) o no (n=3) en la composición del tinte. Comprobamos la presencia de PPD en 6 de los 9 tintes rubios que indicaban la presencia de PPD en su composición y en 2 de los 3 que no la indicaban. La valoración semicuantitativa mediante cromatografía de capa fina nos permitió confirmar que la concentración de PPD utilizada en los tintes capilares de color moreno era superior (media del 3%) a la de los tintes rubios (media del 0,1-0,3%). Conclusión: La presencia de PPD en tintes capilares está en relación con la coloración del tinte, siendo constante en los de color oscuro y de intensidad baja en los rubios. Este estudio pone de manifiesto la importancia clínica y epidemiológica que tiene la identificación de alérgenos en la Dermatología, y de forma más concreta, en el campo de la Dermatología laboral (AU)

Background: One of the greatest challenges in occupational dermatology is the identification of chemical substances used by patients in their work in order to determine their allergenic potential. Numerous techniques have been described for the identification of allergenic compounds. These tests must be sensitive, specific, and safe. We describe a study to detect the presence of paraphenylenediamine (PPD) in hair dyes that are commercially available in Spain. Material and methods: We undertook an experimental study involving qualitative and semiquantitative detection of PPD in hair dyes sold in Spain. The qualitative technique we used was a previously described colorimetric method involving dilution of the dye with isopropyl alcohol followed by addition of a reagent solution (1 g of vanilla in 15 ml of isopropyl alcohol and 7.5 ml of hydrochloric acid). A quantitative study was then done in which the dye was extracted in 96% ethanol and subjected to 1-dimensional thin-layer chromatography. Results: A total of 15 brown and 12 blonde dyes were analyzed. PPD was identified in all of the brown dyes analyzed, irrespective of whether it was indicated (n = 12) or not (n = 3) in the composition. PPD was found in 6 of the 9 blonde dyes that indicated it in the composition and 2of the 3 in which it was not indicated. Semiquantitative analysis by thin-layer chromatography revealed that the concentration of PPD in brown hair dyes (mean, 3%) was higher than in blonde dyes (mean, 0.1-0.3%). Conclusions: The presence of PPD in hair dyes is related to the color of the dye. It is consistently present in darker dyes and at low levels in blonde dyes. This study highlights the clinical and epidemiological importance of identifying allergens in dermatology, particularly in occupational dermatology (AU)

Importancia de la vigilancia epidemiológica en el eczema de contacto. La Red Española de Vigilancia de Alergia de Contacto / Importance of Epidemiologic Surveillance in Contact Dermatitis: Spanish Surveillance System on Contact Allergies

El eczema de contacto es un problema médico frecuente, con una prevalencia poblacional elevada. Esto implica un importante problema de salud con un impacto a nivel personal, social y económico. Por ello, es necesario invertir esfuerzos en iniciativas de investigación clínica y epidemiológica que nos ayuden a conocer la realidad del eczema de contacto en España. En el presente trabajo se aborda la investigación epidemiológica del eczema de contacto desde el punto de vista práctico, analizando el papel del dermatólogo a la hora de planificar y diseñar estudios en este campo. Se discuten además las ventajas de los trabajos multicéntricos y el rol de las redes de vigilancia epidemiológica tanto a nivel nacional como internacional. Finalmente, se presenta la Red Española de Vigilancia de Alergia de Contacto, nexo entre los dermatólogos españoles y la European Surveillance System in Contact Allergies, definiendo sus objetivos presentes y futuros (AU)

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described (AU)

Epidemiología del eczema de contacto en España. Resultados de la Red Española de Vigilancia en Alergia de Contacto (REVAC) durante el año 2008 / Epidemiology of Contact Dermatitis in Spain. Results of the Spanish Surveillance System on Contact Allergies for the year 2008

Introducción: el estudio epidemiológico del eczema de contacto puede realizarse mediante el análisis de los datos obtenidos a partir de la experiencia clínica de las unidades de alergia cutánea. Objetivo: determinar el perfil de los pacientes que acuden a una unidad de alergia cutánea y determinar la prevalencia de sensibilizaciones más frecuente en esta población. Material y métodos: estudio observacional retrospectivo de los 5 hospitales pertenecientes a la Red Española de Vigilancia de Alergia de Contacto (REVAC) durante el año 2008. Todos los pacientes fueron estudiados mediante pruebas epicutáneas con la serie estándar española. Las frecuencias de sensibilización se han estandarizado por sexo y edad. Resultados: se recogieron datos de 1.161 pacientes. Los 5 alérgenos que presentaron positividades más frecuentemente fueron sulfato de níquel (25,88%), dicromato potásico (5,31%), cloruro de cobalto (5,10%), mezcla de fragancias (4,64%) y bálsamo del Perú (4,44%). Los alérgenos menos frecuentes fueron la mezcla de quinoleínas/clioquinol y la mezcla de lactonas sesquiterpénicas. En las mujeres la prevalencia de sensibilización al níquel fue del 35%. Conclusiones: el perfil de sensibilizaciones de España es el esperado para un país del Sur de Europa. El sulfato de níquel sigue siendo el alérgeno más prevalente, siendo especialmente importante en mujeres. La mezcla de quinoleínas/clioquinol y la mezcla de lactonas sesquiterpénicas no han mostrado rentabilidad suficiente para su permanencia en la serie española (AU)

Background: The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units .Objectives: The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. Material and methods: Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. Results: Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone–clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. Conclusions: The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone–clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series (AU)

Nuevas perspectivas terapéuticasen dermatitis atópica / Atopic dermatitis. New therapies for the future

En el momento actual, la meta del tratamiento de la dermatitis atópica es el control de los síntomas. Las nuevas alternativas terapéuticas para estaenfermedad están relacionadas con la aplicación de los nuevos fármacos biológicos que en la actualidad se están ensayando en otros procesos dermatológicosy el desarrollo de nuevas moléculas específicas para el tratamiento de la dermatitis atópica, el eczema de manos u otros tipos de eczema. Eneste artículo realizamos una revisión sobre las principales novedades en cada uno de los grupos terapéuticos de la dermatitis atópica, con especial interéssobre los datos de eficacia y seguridad. Trataremos de los nuevos hidratantes y emolientes (Atopiclair® y N-palmitoiletanolamina), tratamientostópicos (corticoides, antibióticos, antifúngicos, antagonistas de los receptores opiáceos y derivados de la vitamina D), tratamientos físicos (láser decolorante pulsado y láser de excímeros), tratamientos sistémicos (probióticos, ácido docosahexanoico (DHA), montelukast, rosiglitazona y micofenolatode mofetilo) y tratamientos biológicos (omalizumab, rituximab, alefacept, infliximab, etanercept, efalizumab y ustekinumab) (AU)

Control of symptoms is the point in current treatments for atopic dermatitis. New therapeutic alternatives include new biologic drugs currently beingtested in other dermatological processes, as well as the development of new molecules specific for the treatment of atopic dermatitis, hand eczemaand other eczemas. This article includes a review on most important news in every therapeutic group, particularly on effectiveness and safety data. Wewill go over new moisturizing and emollient products (Atopiclair® and N-palmitoylethanolamine), topic treatments (corticoids, antibiotics, antifungaldrugs and antagonists for opiaceous receptors derived from vitamin D), physical treatments (dye laser and excimer laser), systemic treatments (probiotics,docosahexanoic acid (DHA), montelukast, rosiglitazone and mycophenolate mofetil and biologic treatments (omalizumab, rituximab, alefacept,infliximab, etanercept, efalizumab and ustekinumab) (AU)