Allergic contact dermatitis from natural rubber latex in atopic dermatitis and the risk of later Type I allergy.

The aims of the study were to assess whether contact dermatitis in children could be due to a delayed hypersensitivity reaction to natural rubber latex (NRL) and to define risk factors for later occurrence of Type I hypersensitivity to this allergen. Among 1800 children investigated for contact dermatitis, 55 were referred on suspicion of rubber allergy and had patch tests to NRL, as well as prick tests and blood tests for specific immunoglobulin E (IgE). A 2-year follow-up was then carried out. Delayed hypersensitivity to NRL was confirmed in 32 children. Patch testing with NRL proved to be positive, and clinical improvement confirmed the diagnosis and relevance of patch tests. 30 of these 32 patients had associated atopic dermatitis (AD). Prick tests and blood tests for specific IgE to latex were negative at the time of diagnosis. A 2-year follow-up showed that 10 of 27 patients presenting initially with a positive patch test without associated Type I sensitization later developed immediate hypersensitivity. Children with AD are at high risk for allergy to NRL protein. Exclusion of this allergen should be strongly advised in atopics because of the dual risk of dermatitis and later evolution into severe Type I hypersensitivity.

[Vulvar contact dermatitis due to seminal allergy: 3 cases]. / Vulvite d'hypersensibilité aux protéines séminales: 3 cas.

BACKGROUND: Contact sensitivity deserves to be assessed in acute vulvitis as well as chronic vulvar dermatitis with a specific orientation toward semen allergy whenever the pathology is post-coital. OBSERVATIONS: Three observations of semen allergy are reported. Two women presented with post-coital vulvitis due to delayed hypersensitivity to semen proteins without associated specific IgE. The type 2 allergy was confirmed by positive patch-tests and disappearance of symptoms when using condoms. Another woman presented with oedematous vulvitis associated with asthma and malaise per and post-sexual intercourse. Positive prick-tests with husband's semen and blood tests for specific IgE led to the diagnosis of type 1 hypersensitivity to semen, with disappearance of both vulvar and systemic symptoms with the use of condoms. DISCUSSION: Immediate or delayed type hypersensitivity may be discovered using prick and patch tests respectively. The observation of vulvitis or vulvar discomfort should promote such investigations, whenever a post-coital chronology is suggested. The good clinical pertinence of positive skin tests must be emphasized. Although type I hypersensitivity to semen is documented in the literature, with easy detection of specific IgE, delayed type 2 allergy presents as an as yet under-diagnosed etiology of post-coital vulvitis. Patch tests may help to confirm that contact dermatitis may be due to seminal proteins.

[Contact urticaria to natural rubber latex in childhood and associated atopic symptoms: a study of 27 patients aged under 15 years]. / Atopie et urticaire de contact au latex chez l'enfant. Etude chez 27 malades de moins de 15 ans.

BACKGROUND: Although natural rubber latex hypersensitivity is considered as a major problem in adult, it may be still misdiagnosed in childhood. PATIENTS AND METHOD: We collected 27 observations of natural rubber latex contact urticaria in children under 15 Years of age, 21 of them aged under 8. RESULTS: All of them where atopic and 19 out of 27 presented with other association paroxystic signs of immediate hypersensitivity, that were lately related to latex allergy (i. e. asthma, rhinitis, conjunctivitis, fainting). Cross-allergy to food allergens was present in 33 p. 100. Average level of specific IgE to natural rubber latex was 21.7 kU/l. One to 4 Years follow up confirmed the benefit of latex eviction on urticaria as well as on associated symptoms. It led to the early detection of ficus allergy in 4 of them. DISCUSSION: This series confirms that atopy is at high risk for natural rubber latex allergy in children. These data suggest that atopic children are exposed too early to latex devices such as pacifiers, toodles of latex toys. Contact urticaria in children must be considered as a possible marker of other respiratory or general symptoms that may have been misconsidered under other etiologies.

[Management of atopic dermatitis: practical guidelines suggested by the conclusion of systematic assessment in 500 children]. / La prise en charge allergologique de l'atopique eczémateux: conclusions pratiques de l'exploration systématique de 500 enfants.

Allergic management of AD may be worthwhile since allergy may trigger the disease. A systematic evaluation of sensitizations overtime and study of their clinical involvement in 500 children with AD was carried out, including minor, moderate, and severe patients (defined by clinical scores). Standardized methods assessed the possibility of contact dermatitis as well as IgE dependant allergies. Contact dermatitis concerned fragrances and nickel. Contact dermatitis was observed in minor and moderate AD with a progressive increase: 11% of children under 2 years and 58% in those over 15 years of age. Later in older children, sensitization to cosmetics and occupational allergens occurred in close connection with the specific environment. As for IgE sensitization, investigation should be electived advised in moderate and severe AD. Inhalant allergen sensitization was observed in 66% in moderate AD and 93% in severe AD in the group of 7 or 15 years. Clinical confrontation was a better indicator of cutaneous involvement than atopen patch-test. It mainly concerned respiratory symptoms. In severe AD, food allergy was constantly observed and presented as a marker for severe atopic dermatitis. The main trophallergen differ according to the age and cultural habits: in children under 2 years of age, eggs, peanuts, milk, fish were the main offending agents. Later, main trophallergens were wheat flour, shellfish. Although spontaneous decrease of food allergy is sometimes observed, it must be pointed out that food allergy may still persist as a triggering factor in teenagers as well as in adult-hood. The allergologic diagnosis of atopic dermatitis should not focus on IgE dependent sensitization without patch testing.

[Percutaneous sensitization to almond oil in infancy and study of ointments in 27 children with food allergy]. / Sensibilisation alimentaire percutanée--a propos d'une sensibilisation percutanée à l'amande chez le nourrisson et d'une étude de topiques chez 27 patients atteints d'allergie alimentaire.

A five month old child with atopic dermatitis developed contact dermatitis to almond with positive patch test, positive prick test, and class 4 anti-almond IgE. Focal lesions of persistent eczema were correlated with application of almond oil for 2 month on cheeks and buttocks. The child had not ingested almond and her mother did not report almond intake during her breast-feeding. This observation points to the problems of possible percutaneous sensitisation to food proteins. The study of skin ointments containing components of food origin in 27 food sensitized atopic patients confirm that the choice of an ointment for lesional skin is of importance.

[Bi-symptomatic CINCA syndrome with inaugural urticaria and major articular lesions]. / CINCA syndrome bi-symptomatique avec urticaire inaugurale et lésions articulaires majeures.

BACKGROUND: CINCA syndrome (chronic infantile neurological cutaneous and articular syndrome) observed in young children associates chronic urticaria and rheumatological disorders which may cause deformation of the larger peripheral joints. Neurological signs develop later leading to severe prognosis: chronic meningitis, deafness, mental retardation. We present a bisymptomatic case which was distinctive by the absence of central nervous system involvement after 11 years of course. CASE REPORT: Since the age of six months a female child experienced chronic urticaria with nearly daily episodes. At two years limping was also observed. At nine years, the child had highly deformed knee joints giving a tumoral radiological aspect. The diagnosis of CINCA was made. At the age of 11 years, the child had normal psychomotor development and neurological and biological tests were normal. The knee deformations stablized and the child suffered little from the urticaria. DISCUSSION: This case of infantile chronic urticaria inaugurated a CINCA syndrome, a condition described in France and termed NOMID (neonatal onset multisystem inflammatory disease) in the English literature. Our case was similar to those reported in the literature showing characteristic skin, biological and rheumatological disorders. The absence of neurological involvement is exceptional and has been confirmed by regular surveillance to 11 years of age. Bone pathology showed a pseudotumoral aspect which has not been described previously.

[Creole dyschromia or idiopathic macular hypomelanosis of the melanodermic halfcast of Guillet-Hélénon]. / Dyschromie créole ou hypomélanose maculeuse idiopathique du métis mélanoderme de Guillet-Hélénon.

Melanodermic halfcasts may develop an original cutaneous dyschromia known as "progressive and extensive hypomelanosis" (Guillet-Helenon 1988). This disease is characterized by hypochromic and coalescent macules on the back and abdomen with possible spontaneous improvement within five years, favoured by UV exposure. The disease is not restricted to a limited geographic group: eight observations were collected in melanodermic patients leaving in temperate area. The pathogenesis of the disorder involves a variation in melanosome size and distribution with decrease in production of type IV melanosomes featuring a change of ultrastructural phenotype of melanogenesis. Since it may be misdiagnosed as fungal disease, leprosy or achromic eczema leading to useless laboratory examinations, this specific and frequent disease deserves to be known and recognized.

[Pachydermodactyly in adolescents: a sign of discomfort?]. / Pachydermodactylie de l'adolescent: expression d'un mal-être?

BACKGROUND: Pachydermodactyly is an acquired dermatosis related to psychological disturbances. CASE REPORT: A 16 year-old boy presented with fibrous skin hypertrophy of proximal interphalangeal joint areas of both hands suggestive of pachydermodactyly. Skin biopsy confirmed the fibromatous nature of hypertrophy. The personal history of the child confirmed that pachydermocactyly was due to compulsive rubbing stretching movements in a patient with psychological troubles. CONCLUSIONS: Pachydermodactyly, mainly observed among male teenagers, must be considered as an induced dermatosis and distinguished from primary fibromatosis.

Eczema craquelé as a pointer of internal malignancy--a case report.

A case of eczema craquelé associated with gastric adenocarcinoma is reported. There are localized and generalized forms of eczema craquelé, the generalized forms differing from the localized types because they can be signs of metabolic or internal disease such as cancer. The patterns of the condition are reviewed based on the literature and personal observations.

[Hyperimmunoglobulinemia D or periodic fever syndrome. Cutaneous manifestations in 3 cases]. / Syndrome hyper-IgD ou pseudo-maladie périodique. Manifestations cutanées dans 3 observations.

INTRODUCTION: We describe 3 cases of hyperimmunoglobulinemia D syndrome (hyper-IgD syndrome). CASES REPORT: As the 2 first cases are conventional with an onset in childhood, the third one appeared later suggesting possibility of acquired syndrome. The 3 cases presented with one or several skin eruptions during febrile attacks. COMMENTS: Up to now, 64 cases of this syndrome have been described. Skin lesions are observed in 80 p. 100 of patients. In this particular clinical context, they must lead to the diagnosis. This 3 cases and the review of literature show that skin manifestations are polymorphic, transient, not very symptomatic and not correlated to IgD rates. Histological examination may reveal urticarial reaction with leucocytoclasic vasculitis, where IgD could directly or not interact.

[Allergologic survey in 251 patients with moderate or severe dermatitis. Incidence and value of the detection of contact eczema, food allergy or sensitization to air-borne allergens]. / Enquête allergologique chez 251 malades atteints de dermatite atopique modérée ou sévère. Fréquence et intérêt du dépistage de l'eczéma de contact, de l'allergie alimentaire et de la sensibilisation aux aéroallergènes.

INTRODUCTION: Because of the increased recruitment of uncontrolled atopic dermatitis (AD) necessitating chronic use of dermocorticosteroids, we developed a prospective allergologic survey in a serie of 251 patients presenting with moderate or severe AD. PATIENTS AND METHOD: 251 patients were refered for allergologic assessment and followup. The clinical severity was assessed by use of standardized scores. Patients were grouped by age: group 1 (70 children younger than 2 years), group 2 (93 children between 2 and 7 years), group 3 (23 children between 7 and 15 years), group 4 (65 children over 15 years and adults). All the patients were systematically screened for contact dermatitis and IgE mediated sensitization (inhallant and food allergens) with blood tests for IgE, prior to evaluation of clinical relevance. RESULTS: Aero-allergen sensitization was demonstrated in 51 p. 100 of children and 89 p. 100 of adults. It was present earlier in severe AD with main clinical involvement for nose and throat and respiratory symptoms. Clinical responsibility for dermatitis was documented in only 6 p. 100 of AD. Food allergy was early incriminated as flare factors in most of severe AD (96 p. 100 of children and 81 p. 100 of adults) with major and persistant improvement under eviction diet. Main allergens were eggs (46 p. 100), pea-nuts (29 p. 100), shellfish (24 p. 100), milk (20 p. 100), flour (14 p. 100), fish (14 p. 100), soybeans (8.9 p. 100). Food allergy to yeasts (7.2 p. 100) was important in adults. Food allergy is the earliest allergy in the course of severe AD and the number of involved trophallergens increases in older patients. Patch tests were positive in 40 p. 100 of patients (i. e. 31 p. 100 of children and 66 p. 100 of adults) with a greater incidence in moderate AD. Main allergens were metals (54 p. 100), fragrances (19 p. 100), balsam of Peru (10 p. 100), parabens (8 p. 100) and lanoline (4 p. 100). CONCLUSION: When AD is not efficiently controlled by dermocorticosteroids, allergologic screening and treatment of children and adults proves to be very interesting. Specific measures regarding food allergy and contact dermatitis reduce or vanish cutaneous flares. As for inhallant sensitizations, Dermatologists should be awared that they may play a role regarding assessment of sensitization and prevention of respiratory symptoms in moderate and severe AD since the risk of complications is important in both groups.

[Facial myofibroma of the newborn simulating sarcoma]. / Présentation sarcomateuse d'un myofibrome facial du nouveau-né.

INTRODUCTION: Myofibromatosis is a rare but probably under estimated tumor. OBSERVATION: We report a case of a newborn presenting with a facial tumor suggestive of sarcoma. Discrepancy between clinical features and histologic pattern of angioma suggested the diagnosis of myofibroma. The diagnostic of myofibromatosis was made later by specific labelling (actin-smooth muscle) and was confirmed by major spontaneous involution. DISCUSSION: The histology of myofibroma associates fibrous and angiomatous patterns that may be confusing when examining a small biopsy. Due to confusing semiology and histology, subcutaneous myofibromas are certainly misdiagnosed and specific actin labelling (actin, HHF 35) may be of interest. Myofibromas are the most frequent tumor among fibromatoses. The diagnosis should be suspected on the stony consistence of the tumor uncompatible with angiomatous histology. Contrary to multicentric myofibromas of which the prognosis depends on visceral involvement and compressions (72 p. 100 of fatal outcome), solitary subcutaneous myofibroma has a very good prognosis with spontaneous involution.

[Darier-Ferrand dermatofibrosarcoma in children]. / Dermatofibrosarcome de Darier-Ferrand de l'enfant.

BACKGROUND: Dermatofibrosarcoma is a tumor relatively ignored in childhood. CASE REPORT: A 11 year-old boy was referred because he suffered from a tumor of the neck, which had progressively developed after a cervical traumatism occurring 4 years earlier. Examination showed a tumor moderately infiltrated, attached to the overlying erythematous skin. Biopsy showed ill-limited dermal and hypodermal proliferation of fusiform cells with a storiform arrangement. Two successive excisions were necessary and the patient is well 2 years later. CONCLUSION: This case confirms responsibility of previous traumatism, progressiveness of course and necessity of large excision.

[Darier's erythema annulare centrifugum of neonatal onset with a 15 years' follow-up. Efficacy of interferon and role of cytokines]. / Erythème annulaire centrifuge de darier à ddebut néonatal avec 15 ans de suivi. Efficacité de l'interféron et rôle de cytokines.

INTRODUCTION: Darier's erythema annulare centrifugum (EAC) is a disease of unknown etiology. Some observations of EAC in infancy suggest a better prognosis for early EA. The observations presented herein gives different information regarding prognosis and pathogenesis. OBSERVATION: A child presents with typical lesions of EAC from early infancy up to the age of 15 years. Laboratory data are normal. Similar lesions were locally reproduced by intradermal injection by candidine but antifungal drugs were unsuccessful. Many antiinflammatory treatments failed to improve the disease. Because of the improvement during hyperthermic episodes, a treatment by subcutaneous interferon alpha (2 millions U 3 times a week) was given for six months with a dramatic success (with seric increase of TNF alpha and IL2) DISCUSSION: The long term duration of EAC suggests that EA of infancy may represent the early beginning of Darier's EAC. The efficacy of interferon suggests that cytokines are involved in the pathogenesis of EAC.

[Familial erythermalgia treated with pizotifen]. / Erythermalgie familiale trait par pizotifé.

INTRODUCTION: Primary erythermalgia is a rare acrosyndrome due to paroxystic arteriolar dilatation of extremities that become red and congested with warmth and burning sensation or pain. OBSERVATION: We report herein the observation of a primary erythermalgia affecting 3 degrees in the same family (grandfather, uncle/mother, and children with early onset at 6 years): pizotifene, an antiserotoninergic drug proved to be effective in mother and 14-year-old child who had never drawn benefit from any previous treatment. DISCUSSION: Several etiologies may be responsible for erythermalgia according to the clinical type: primary erythermalgia with pediatric onset, and secondary erythermalgia as a reaction to myeloproliferation, other diseases, drug or heavy metal poisoning. Pathophysiology of primary erythermalgia is not clearly understood and the main concern is therapy: in this respect, pizotifene deserves to be considered as a valuable possibility.