Reduced nickel sensitivity in young Danish women following regulation of nickel exposure.

In most western countries, nickel is the most common contact allergen among young women. In 1991, Denmark implemented a statutory order calling for the reduction of exposure to nickel in nickel-plated items in close contact with the skin. In a retrospective analysis, a comparison is made of the number of positive patch tests to nickel seen in a private practice of dermatology before and after this statutory order was implemented. From 1 January 1986 to 31 December 1989, 35 of 1135 (3.1%) men patch tested and 628 of 3024 (20.8%) women patch tested had positive reactions to nickel. From 1 January 1996 to 31 December 1999, 48 of 1104 (4.3%) men and 424 of 2193 (19.3%) women had positive patch tests to nickel. During the 1st period, 155 of 702 women under the age of 20 (22.1%) had positive patch tests to nickel, compared to 54 of 324 (16.7%) during the second period (p<0.05). The most likely explanations of this decrease in nickel sensitivity are reduced exposure to nickel and increased public awareness of the risk of nickel sensitization.

Brachioradial pruritus.

Twenty-one patients seen in a temperate climate who had a clinical diagnosis of brachioradial pruritus are presented. The history and clinical manifestations of the patients indicate that the symptoms were neuralgiform and caused by cumulative sun exposure.

[Results of treatment of non-melanoma skin cancer in a dermatologic practice. A prospective study]. / Behandlingsresultater af non-melanom hudkraeft i en dermatologisk speciallaegepraksis. En prospektiv undersøgelse.

The study was carried out to determine the results of treatment of a cohort of patients with histologically verified non-melanoma skin cancer diagnosed and followed prospectively for two years in a private practice of dermatology. Throughout the follow-up period, any new non-melanoma skin cancers among this cohort were recorded. Six hundred and forty-six consecutive patients seen in the Dermatology Clinic, Vesterbro 99, Aalborg, Denmark, from July 1, 1990, to June 30, 1993, had a total of 768 tumours that were histologically verified as basal cell carcinoma, squamous cell carcinoma or Bowen's disease. Six hundred and twenty-eight tumours in 526 patients were treated in our clinic, 91% of these with curettage followed by electrocautery. Hundred and twenty patients with a total of 140 tumours were referred to a local hospital for treatment. Thirty-six of the 508 basal cell carcinomas treated in the clinic recurred during the follow-up period, and one mixed tumour (basal cell and squamous cell carcinoma) recurred. During the follow-up period, 151 new non-melanoma skin cancers were detected. In addition, 10 patients each developed 10 or more new tumours.

Can oral challenge with balsam of Peru predict possible benefit from a low-balsam diet?

BACKGROUND: Previous studies have shown that some patients sensitive to balsams and/or fragrances obtain long-term benefits by following a low-balsam diet, whereas others do not. OBJECTIVE: This study was performed to determine whether a low-balsam diet was a helpful long-term treatment for selected patients sensitive to balsam of Peru and/or a perfume mixture and to determine whether oral challenge with balsam of Peru could predict which balsam-sensitive patients might benefit from a reduction in balsam intake. METHODS: Questionnaires were sent to 46 patients with positive patch test results to balsam of Peru and/or a perfume mixture and chronic dermatitis of a morphology consistent with endogenous dermatitis who had experienced improvement after 1 to 2 months on a diet intended to reduce the intake of balsams. The questionnaires were mailed 1 to 3 years after the initiation of the diet treatment to inquire about a possible long-term benefit of the diet. RESULTS: Twenty-eight of the 46 patients stated in the questionnaire that they had long-term benefits from the diet treatment. These included 16 of 22 patients who had reacted to a placebo-controlled oral challenge with 1 g balsam of Peru, 3 of 10 who had no reaction or a placebo reaction to the oral challenge, and 9 of 14 who had not been challenged orally. The efficacy of the diet treatment was not correlated to whether the patient had patch test reactivity to either balsam of Peru, the perfume mixture, or both substances. Food items most commonly mentioned by patients as causing aggravation of their symptoms on at least three different occasions were wine, candy, chocolate, cinnamon, curry, citrus fruit, and flavorings. CONCLUSIONS: In its present form, the oral challenge procedure with balsam of Peru offers only limited assistance in selecting patients who are likely to benefit from diet treatment.

Chromate-allergic patients challenged orally with potassium dichromate.

30 patients who had positive patch tests to potassium dichromate participated in a placebo-controlled oral challenge with 2.5 mg chromium given as potassium dichromate. 17 reacted to chromate but not to the placebo, 2 reacted to both chromate and the placebo, and 4 reacted to the placebo but not chromate. 7 patients had no reaction. A specific reaction to chromate was most common among patients with dermatitis of the hands and/or feet.

Plantar Trichophyton rubrum infections may cause dermatophytids on the hands.

Over a 2-year period, we saw 37 patients with a diagnosis of dermatophytid on the hands based on 1) culture-proven dermatophytosis on one or both feet; 2) symmetrical, secondary vesicular eruptions on the fingers and/or palmar aspects of the hands; and 3) a resolution in both areas of involvement after treatment of the dermatophytosis on the foot. During the study period, 128 patients had culture-proven dermatophytosis of the feet caused by Trichophyton rubrum. Nine of these (7%) developed dermatophytid. Seventy-eight patients had dermatophytosis of the feet caused by Trichophyton mentagrophytes. Twenty-seven of these (35%) developed dermatophytid. One of 6 patients infected on the feet with Epidermophyton floccosum developed dermatophytid.

Stomatitis or systemically-induced contact dermatitis from metal wire in orthodontic materials.

5 patients with dermatitis or stomatitis related to the use of orthodontic appliances are described. All the patients were patch tested with the European standard series. One had a ++ reaction to potassium dichromate, one a ++ reaction to nickel, and the remaining 3 no positive patch tests. 3 of the patients had recurrent vesicular hand eczema, which flared after oral challenge with 1 of the metals used in their orthodontic appliances. 2 of these 3 patients had negative patch tests. The dermatitis of 4 of the 5 patients cleared completely upon the removal of their metal orthodontic appliances or their replacement with appliances made of acrylics.

Low nickel diet: an open, prospective trial.

BACKGROUND: Nickel-sensitive patients may experience persistent dermatitis even if they avoid cutaneous contact with nickel-plated items. OBJECTIVE: The purpose of the study was to determine whether reduced nickel intake in food reduces the activity of dermatitis in selected nickel-sensitive persons. METHODS: Ninety nickel-sensitive patients who had a flare of dermatitis after oral challenge with 2.5 mg of nickel but had no reaction to a placebo were instructed to adhere to a low-nickel diet. RESULTS: Fifty-eight of the 90 patients benefited in the short term from the diet, whereas 15 others had possible benefit. Seventeen patients did not benefit in the short term. Fifty-five patients who adhered to the diet for at least 4 weeks, and whose dermatitis had cleared or improved at the end of this time, responded to a questionnaire follow-up 1 to 2 years later. Forty of these patients had long-term improvement of their dermatitis. Patients with strongly positive patch tests to nickel had less benefit from the diet than patients with moderately positive patch tests. CONCLUSION: Reduction of the dietary intake of nickel may benefit some nickel-sensitive patients.

Dietary restrictions in the treatment of adult patients with eczema.

Improvement was seen in the dermatitis of 262 of 675 patients who followed a restrictive diet for approximately 1 month. Patients included in the study were sensitive to metal salts, balsams or classical food allergens or reacted to oral challenge with food additives. Also included were patients who did not react to diagnostic tests but who experienced improvement of their dermatitis while maintaining an elimination diet. A follow-up study was carried out 1-3 years after diet treatment was instituted. Each of the 262 patients was asked to complete a questionnaire to describe the long-term course of the dermatitis. 206 responded to the questionnaire, and for 144 of them (70%; 95% confidence limits 64-76%), there was long-term improvement of the dermatitis. Long-term improvement was more common among atopic patients than among non-atopics. Symptoms of contact urticaria were more common among patients with hand eczema than those with other types of eczema.

Oral challenge with food additives.

A randomized, placebo-controlled oral challenge with food additives (preservatives and food colorings) was carried out in 101 patients with eczema of undetermined origin who suspected that the intake of certain foods aggravated their dermatitis. 37 reacted to 1 or more of the food additives but not to a placebo, while 16 reacted to the placebo, or both the placebo and food additives. 48 had no reactions. The difference between the number of reactions to the food additives and the number of reactions to the placebo was not statistically significant. The reactions could be reproduced in only 1/3 of those challenged twice. It was not possible to correlate the reactions to food additives to reactivity to specific foodstuffs containing the same additives. If intolerance to food additives is suspected, an elimination diet seems warranted, regardless of whether the patient reacts to oral challenge with food additives.

Diagnostic procedures for eczema patients.

Of 7887 patients with eczema seen in a private dermatological practice over a period of 2 years and 4 months, a specific final diagnosis was found in 5376 (68%), while a final diagnosis of non-specific eczema was made in 2511 cases (32%). The most common final diagnoses were seborrhoeic dermatitis (1351), contact dermatitis (1317), atopic dermatitis (1009) and nummular eczema (822). Battery patch testing was the initial diagnostic procedure performed, and 897 of the 3164 patients who were patch tested had one or more positive patch tests. In 545 cases, the reactions were considered of relevance to the current dermatitis. Tests for immediate-type allergy were carried out in 618 patients, and 284 of these had one or more positive tests. In 86 patients, these test results were of diagnostic significance. 257 patients with positive patch tests were challenged orally with the relevant substance, and 53 of 156 reacted to metal salts, most commonly nickel, while 25 of 101 reacted to orally ingested balsam of Peru. Among patch-test-negative patients, 66 of 408 had positive reactions to one or more metal salts; 41 of 180 reacted to balsam of Peru, while 15 of 41 reacted to various food additives.

Dermatitis induced or aggravated by selected foodstuffs.

The eczema of 113 patients with dermatitis other than classical urticaria or typical atopic dermatitis cleared or showed marked improvement after one to two months of dietary restriction. In their response to a questionnaire completed at least 6 months after the initiation of the diet, 61 (54%) of these patients said that diet restriction was effective in reducing the activity of or preventing recurrence of their dermatitis. Their most common symptoms were recurrent symmetrical hand eczema, anogenital eczema, pruritic papules and excoriations of the trunk as well as a "fixed" type of eczema. Forty-nine of the 113 patients were able to reproduce their symptoms at least 3 times with certain food items, most commonly eggs, milk, tomato, cheese and fish. It is likely that both the classical food allergens and foods containing or producing histamine or other vasoactive substances could be the cause of such dermatoses or act as a non-specific aggravating factor. This type of reactivity was most common among patients with a personal and/or family history of atopic diseases (asthma, hay fever and/or atopic dermatitis). Symptoms corresponding to those of contact urticaria to food items were commonly seen among the patients.

Oral challenge with nickel and cobalt in patients with positive patch tests to nickel and/or cobalt.

During a 3-year period, 146 patients with positive patch tests to nickel and/or cobalt, for whom a systemic cause of dermatitis was suspected, were challenged orally with a single dose of 2.5 mg nickel given as nickel sulphate and 1 mg cobalt given as cobalt sulphate using a double-blind, placebo-controlled method. No following-up was possible for 2 patients. Seventy-five of the remaining 144 (52%) had flares of their dermatitis after challenge with nickel and/or cobalt, while 45 patients (31%) had no reaction and 24 (17%) reacted only to the placebo or to the placebo in combination with nickel or cobalt. Seven out of 13 patients with positive patch tests to cobalt experienced flares of their dermatitis only after challenge with cobalt.

Aluminium allergy.

13 children ranging in age from 1 to 13 years and 1 adult patient had positive patch tests to 2% AlCl3 in water. 13 of them had pruritic excoriated papules, 9 at sites of hyposensitization therapy with aluminium-bound pollen extracts, and 4 at sites of childhood immunization with an aluminium-bound vaccine (Di-Te-Pol). For the 1 adult patient, the positive patch test was not considered to be of current relevance. Aluminium is most likely to sensitize when present in preparations used for immunization.