RESUMEN
A case report of a dentist presenting with allergic contact dermatitis to methacrylates present in dental bonding agent applied on the dorsum of a gloved hand. The patient presented with a localized dermatitis to the dorsum of the non-dominant hand which can be described as a 'manual tray sign'.
Asunto(s)
Dermatitis Alérgica por Contacto , Dermatitis Profesional , Eccema , Dermatosis de la Mano , Humanos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Metacrilatos/efectos adversos , Dermatitis Profesional/etiología , Dermatitis Profesional/complicaciones , Eccema/complicaciones , Torso , Dermatosis de la Mano/inducido químicamente , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/complicaciones , Pruebas del Parche/efectos adversosRESUMEN
BACKGROUND/PURPOSE: Tricyclic antidepressants (TCAs) are still widely used and are available to purchase without prescription in some countries. Awareness of adverse cutaneous drug reactions is essential. METHOD: We reported a case of photo-distributed hyperpigmentation due to imipramine and carried out a systematic search of the related articles using the search terms "tricyclic antidepressants" or "tricyclicâ¯antidepressiveâ¯agents",â¯and "hyperpigmentation" or "photosensitivity disorder". Fiftyâ¯non-duplicate citations were identified of which 28 articles which were independently assessed in full. The review was registered in PROSPERO, CRD42018107338. RESULTS: The remaining 25 articles met our inclusion criteria. Photo-distributed hyperpigmentation tricyclic antidepressant-induced photosensitivity reactions (TIPs) was the most common presentation. In 21 cases, this presented as an asymptomatic discolouration of exposed sites. Imipramine (81%), amitriptyline (9.5%), desipramine hydrochloride (4.8%) and mirtazapine (4.8%) were reported to be the culprit drugs. Nineteen were female with a mean age at presentation of 55 years. Mean duration from commencing the culprit drug until the development of discolouration was 10.4 years. Mean daily dose was 222.7 mg for imipramine. Histology was characteristic with golden-brown or brownish granules deposited in dermis. Staining for Masson-Fontana and MEL-5 was positive in all cases. Phototesting had not been done in cases prior to ours (negative 3 months after discontinuation of imipramine). Three further reports of suspected TIP presented with non-specific and eczematous eruption. The two presentations were reported along with systemic problems (thrombocytopenia and hepatic injury). CONCLUSIONS: This systematic review highlights the characteristic features of exposed site hyperpigmentation of TCA-induced photosensitivity occurring after prolonged drug exposure in many cases.
Asunto(s)
Hiperpigmentación , Trastornos por Fotosensibilidad , Antidepresivos Tricíclicos/efectos adversos , Femenino , Humanos , Hiperpigmentación/patología , Imipramina/efectos adversos , Trastornos por Fotosensibilidad/inducido químicamente , Piel/patologíaRESUMEN
During COVID-19 infection, reduced function of natural killer (NK) cells can lead to both compromised viral clearance and dysregulation of the immune response. Such dysregulation leads to overproduction of cytokines, a raised neutrophil/lymphocyte ratio and monocytosis. This in turn increases IL-6 expression, which promotes scar and thrombus formation. Excess IL-6 also leads to a further reduction in NK function through downregulation of perforin expression, therefore forming a pathogenic auto-inflammatory feedback loop. The perforin/granzyme system of cytotoxicity is the main mechanism through which NK cells and cytotoxic T lymphocytes eliminate virally infected host cells, as well as being central to their role in regulating immune responses to microbial infection. Here, we present epidemiological evidence suggesting an association between perforin expression and resistance to COVID-19. In addition, we outline the manner in which a pathogenic auto-inflammatory feedback loop could operate and the relationship of this loop to genes associated with severe COVID-19. Such an auto-inflammatory loop may be amenable to synergistic multimodal therapy.
Asunto(s)
COVID-19/inmunología , Síndrome de Liberación de Citoquinas/inmunología , Células Asesinas Naturales/inmunología , Linfohistiocitosis Hemofagocítica/inmunología , Neutrófilos/inmunología , Perforina/metabolismo , SARS-CoV-2/fisiología , Animales , Autoinmunidad/genética , COVID-19/epidemiología , Síndrome de Liberación de Citoquinas/epidemiología , Resistencia a la Enfermedad , Humanos , Interleucina-6/metabolismo , Linfohistiocitosis Hemofagocítica/epidemiología , Perforina/genéticaRESUMEN
Although the development of successful vaccines against coronaviruses may be achieved, for some individuals the immune response that they stimulate may prove to be insufficient for effective host defence. The principle that a relatively strong contact allergen will have an enhancing effect on sensitization compared with a less potent contact allergen if they are co-administered, may not, at first, appear relevant to this issue. However, this augmentation effect is thought to be due to the sharing of common or complementary pathways. Here, we briefly consider aspects of the shared and complementary pathways between skin sensitization induced by exposure to a contact allergen and the immune response to viruses, with particular reference to COVID-19. The relationship leads us to explore whether this principle, which we name here as "co-operative immune augmentation" may be extended to include viral vaccination. We consider evidence that even relatively weak contact allergens, used in vaccines for other purposes, can show enhanced sensitization, which is in keeping with a co-operative augmentation principle. Finally, we consider how the potent contact allergen diphenylcyclopropenone could be employed safely as an enhancer of vaccine responses.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Ciclopropanos/uso terapéutico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vacunas Virales/uso terapéutico , Alérgenos/uso terapéutico , COVID-19 , Vacunas contra la COVID-19 , Desensibilización Inmunológica/métodos , Femenino , Humanos , Masculino , SARS-CoV-2RESUMEN
In the first conundrum, permanent hair dyeing involves the use of aromatic amines such as p-phenylenediamine (PPD), whose oxidation is pivotal to the dyeing process, but also generates potent allergens. Despite prolonged efforts by industry to search for safer alternatives, hair dyeing is still reliant on this type of aromatic amine. In the second conundrum, patch testing with 1% PPD remains the most useful screen for hair dye contact allergy. However, there is a very small but real risk of actively sensitizing the patient. Lowering the PPD concentration below 1% significantly reduces test sensitivity and diagnostic utility. Here, we argue that by applying Friedmann's principles of contact sensitization each conundrum can be addressed from a new perspective. These principles indicate that, when the exposed area of skin is small (<1 cm2 ), induction of contact allergy is sharply reduced, whereas elicitation of allergy is unaffected. Careful reflection on this principle suggests that we can predict where hair dye sensitization is most likely to occur, indicates a strategy to reduce the chance of contact sensitization occurring in consumers as a result of hair dyeing, and how we might mitigate the risk of active sensitization resulting from diagnostic patch testing.
Asunto(s)
Colorantes/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Tinturas para el Cabello/efectos adversos , Fenilendiaminas/efectos adversos , Alérgenos/efectos adversos , Colorantes/química , Cosméticos/efectos adversos , Relación Dosis-Respuesta a Droga , Tinturas para el Cabello/química , Humanos , Pruebas del Parche/métodos , Fenilendiaminas/químicaRESUMEN
BACKGROUND: The association between atopic dermatitis (AD) and contact allergy, remains unclear, with studies to date showing conflicting results. OBJECTIVES: To investigate the prevalence of contact allergy in AD individuals compared to those without AD. METHODS: Results of 46 250 patients patch tested in a single centre over a span of 30 years were reviewed, comparing those with AD with those without AD. Collected data were analysed with corrections for multiple confounding variables, including date of patch testing to account for changes in allergens tested over the period. RESULTS: Nine allergens showed a statistically significant difference between the two groups. Contact allergy to nickel, cobalt and primin was less likely to arise in those with AD, whilst substances found in topical dermatological products were more likely to be associated with AD. CONCLUSIONS: This is the largest single centre study of contact sensitization in atopy reported to date. The previously reported association between contact allergy to sesquiterpene lactone and AD is reinforced. The decreased incidence of metal allergy suggests distinct immunological effector mechanisms in sensitization to these allergens. In keeping with previous publications, exposure to topical treatments for AD can result in sensitisation and contact allergy and clinicians should consider patch testing in AD individuals who report worsening of their skin despite continued treatment with topical medicaments.
Asunto(s)
Alérgenos/efectos adversos , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Dermatitis Atópica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Benzoquinonas/efectos adversos , Estudios de Casos y Controles , Niño , Preescolar , Cobalto/efectos adversos , Dermatitis Atópica/tratamiento farmacológico , Fármacos Dermatológicos/efectos adversos , Femenino , Humanos , Lactante , Recién Nacido , Lactonas/efectos adversos , Masculino , Persona de Mediana Edad , Níquel/efectos adversos , Prevalencia , Estudios Retrospectivos , Sesquiterpenos/efectos adversos , Adulto JovenAsunto(s)
Dermatitis Alérgica por Contacto , Dermatitis Profesional , Humanos , Goma/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Tensoactivos/efectos adversos , Dermatitis Profesional/etiología , Personal de Salud , Pruebas del ParcheRESUMEN
BACKGROUND: Hair dyes represent one of the most important causes of allergic contact dermatitis resulting from the use of cosmetic products. The principal causative chemistry is associated with oxidation products of p-phenylenediamine (PPD) and closely related substances. OBJECTIVES: To examine whether prior application of the antioxidant vitamin C to the skin was able to reduce the cutaneous allergic response to PPD. METHODS: Twenty eight volunteers with a proven history of contact allergy to PPD were recruited. Each was tested with a range of PPD doses and PPD-containing hair dye on untreated skin and skin pretreated for 10 min with a vitamin C formulation. RESULTS: Pretreatment of skin sites with vitamin C led to a reduction in the intensity, or even ablation, of the cutaneous allergic reaction to PPD in â¼75% of cases as compared with untreated skin. CONCLUSIONS: The results suggest that treatment of the skin adjacent to the hair-bearing area with antioxidant could form part of a strategy to reduce the burden of cosmetic allergic contact dermatitis caused by hair dyeing.