Allergy to Unna boots in four patients.

We report the cases of four patients seen in our department since 1967 with allergic reactions to preservatives in Unna boots. The first three patients had reactions to parabens and the last had a photoallergic reaction to hexachlorophene. Preservative-free Unna boots were successfully applied to patients with allergy to parabens. A table of some currently available Unna boots, detailing their ingredients, is also presented.

Persistent light reaction to hexachlorophene.

The first patient with what appears to be persistent light reaction caused by hexachlorophene alone is reported. Persistent light reaction may occur in patients with milder degrees of photosensitivity, and appropriate photopatch testing should be performed.

What to do about pruritus scroti.

Pruritus scroti is a common clinical disorder that is caused by various inflammatory disorders, infections, infestations, and neoplasms. Laboratory evaluation, including bacterial and fungal cultures, microscopic examination, skin biopsies, and measurement of blood glucose levels, is useful in establishing the diagnosis. Management of pruritus scroti includes avoidance of irritants, allergens, and restrictive clothing and use of topical and systemic agents that provide both symptomatic relief and specific treatment of the underlying cause.

Chronic actinic dermatitis. Study of the spectrum of chronic photosensitivity in 12 patients.

Twelve patients with photodermatitis for longer than 3 months' duration were identified: 1 patient with chronic photocontact dermatitis, 1 with persistent photosensitivity following exposure to a systemic medication, 6 with persistent light reactivity, and 4 with actinic reticuloid. There were 10 men and 2 women, ranging in age from 27 to 81 years, with a mean age of 62 years. The duration of the eruption ranged from 6 months to 20 years. Persistence of photosensitivity to quinidine, which is analogous to persistent light reactivity, was documented in 1 patient, and evolution from photocontact dermatitis to actinic reticuloid was observed in 2 others. These data, along with those reported in the literature, indicate that chronic photocontact dermatitis, persistent photosensitivity to systemic agents, persistent light reactivity, photosensitive eczema, and actinic reticuloid should be considered as entities occurring along a continuum, and the term "chronic actinic dermatitis" is suggested to refer to these entities. Eight (67%) of the 12 patients had skin type VI and 2 others (17%) had skin type V, percentages markedly higher than those of the general patient population, demonstrating that chronic actinic dermatitis is not uncommon among individuals with dark skin.

Extrapolation of the evidence on teratogenicity of chemicals between humans and experimental animals: chemicals other than drugs.

Epidemiologic literature regarding the possible association between malformations and 23 exposures or occupations other than pharmaceutical products, was analysed. The qualitative level of scientific evidence was classified into four categories: high (ethanol, methylmercury, PCBs, laboratory work), limited (anesthetic gases, carbon monoxide), low (hexachlorophene, LSD, nitrous oxide, smelter work, tobacco), and inadequate (all other exposures). Human data for exposures belonging to categories "high" and "limited" were quantitatively compared to results of animal teratogenicity tests of the relevant chemicals. Ethanol, methylmercury, and PCBs have caused malformations in experimental animals, and the effective doses have ranged from 0.2 to 8.0 times the effective human doses. Ethanol and PCBs caused similar types of lesions in some animal species as have been observed in humans.

Effects of drugs and chemicals on the fetus and newborn (2).

Physicians have become increasingly aware of the side effects of specific drugs. Obstetricians and family physicians should especially be cognizant of the implications of the administration of any drug, not only for the pregnant mother but also for the unborn child. In this second installment of our two-part article, we conclude our review of drugs, chemicals, and environmental pollutants that may affect the fetus or newborn.

[Systemic side-effects of topical preparations in children (author's transl)]. / Risques systémiques des médicaments topiques chez l'enfant.

Any topical treatment may lead to systemic side-effects through epidermal penetration. In children the ratio surface treated/weight is usually high, implying greater risk. Factors which determine percutaneous absorption in childhood are reviewed as well as the main drugs which are toxic when applied to the skin.

Neonatal spongioform myelinopathy after restricted application of hexachlorophane skin disinfectant.

At least four out of 97 low birth weight (less than 1750 g) newborn infants who had received only limited skin disinfection with 3% hexachlorophane (HCP) emulsion developed spongioform myelinopathy in association with detectable amounts of HCP in their brains. These four cases were found in a post-mortem survey of 20 out of the 27 infants who died. Another nine of these infants had detectable amounts of HCP in the brain but no myelinopathy. It is at present not possible to define a 'safe" level of exposure to 3% HCP emulsion for small preterm infants in the first 2 weeks of life.

Bilateral optic atrophy caused by chronic oral ingestion and topical application of hexachlorophene.

A 31-year-old woman ingested hexachlorophene (pHisoHex) over a ten-month period. She developed bilateral optic atrophy with no other systemic evidence of neurotoxicity. This cases supports pathologists' findings that the optic nerve and chiasm are particularly sensitive to the poisonous effects of hexachlorophene.