Allergic contact dermatitis to Fraxinus americanus and Macherium acutifolium.

Contact allergy to tropical hardwoods and domestic woods are well documented in the literature. The authors document a case of contact allergy to both types of wood in a woodworking artisan.

To patch or not to patch: what is your threshold for patch testing?

Patch testing is as much art as it is science; we all are influenced by our clinical experience as well as by the literature. In an effort to assist those new to this often underutilized technique, we have solicited comments from five experienced clinicians about when to patch test and when not to patch test. Their responses should be a guide for us all.

Formaldehyde-related textile allergy: an update.

Part I of this study explores whether clothing today contains formaldehyde levels likely to cause contact allergy in formaldehyde-allergic patients. Part II of this study examines whether current reactions to textiles may be due to allergy to textile resins and whether individuals with formaldehyde-related textile allergy will react to the newer low formaldehyde resins used in the textile industry. Part I: free formaldehyde was measured in 16 fabric specimens produced in the US and overseas. Additionally, since the textile industry has moved to the use of newer methods for measuring fabric formaldehyde content, the newer methodology was compared with the older methods used in the medical literature. Part II: 10 subjects with known textile contact allergy were patch tested to available Chemotechnique textile resins and 6 new low-formaldehyde resins used by the textile industry. Part I: 8 fabric specimens yielded no detectable formaldehyde and 7 specimens yielded <200 ppm free formaldehyde, using Schiff's reagent and Merck testing methods. 1 specimen showed approximately 2000 ppm formaldehyde, as measured by the Merck test, but only 24 ppm free formaldehyde when retested by the method described in Japanese Law #112. Part II: all subjects reacted strongly to formaldehyde and DMDHEU (the predominant resin currently used in textiles). 6 subjects reacted to EUMF. 2 subjects had mild reactions to the newer low-formaldehyde resins and 1 to the non-formaldehyde Fixapret NF. Our results suggest that most clothing today yields free formaldehyde levels unlikely to cause contact allergy in formaldehyde-allergic individuals. Japanese method #112 is the recommended methodology to measure free formaldehyde in future studies. DMDHEU may now represent the main cause of textile allergy and may be a better screen than EUMF for this problem. Newer resins yielding fabrics with <75 ppm free formaldehyde may cause occasional reactions, but are more likely to be tolerated by individuals with textile contact allergy. Treatment of these individuals should be directed at identification of reliable sources of garments utilizing these newer resins.

Systemic contact dermatitis to hydroxyzine.

Systemic contact dermatitis is an underreported type of delayed hypersensitivity caused by a systemically administered substance. When interpreting patch test reactions, it is important to obtain a history of all current related oral medications. Many oral medications can cross-react with structurally similar topical antigens and induce systemic contact dermatitis. Identification and elimination of the inciting agent can lead to resolution of otherwise chronic, unresponsive eczema. We report a case of systemic contact dermatitis to hydroxyzine in a patient who was patch tested positive to ethylenediamine. Repeated oral provocation with hydroxyzine reproduced her eczema on several occasions. We conclude that systemic contact dermatitis to hydroxyzine, a common medication used to treat pruritus, must be considered as a potential cause for unresponsive eczema.

Use of a semipermeable glove during treatment of hand dermatitis.

Forty-six subjects with hand dermatitis participated in a pilot study comparing a new semipermeable glove to a standard cotton glove. A variety of diagnoses were represented. Each subject received treatment with topical steroids and/or moisturizers and used one each of the experimental and cotton gloves for approximately one month. Physicians scored skin condition before and after treatment. Subjects evaluated skin comfort and practical aspects of using each type of glove. Thirty subjects completed the study protocol. The type of glove used had no impact on skin condition at follow up, with both groups of hands improving. Patients expressed a preference for the experimental gloves, noting improvements in skin and hand comfort, dexterity, cleanliness, and ease of use. Feedback suggested that the gloves will be well tolerated and patient compliance in using the gloves will be high. Evaluation of the gloves' value for prevention and chronic management of hand dermatitis is warranted.

Hereditary mucoepithelial dysplasia. Case report and review of the literature.

Hereditary mucoepithelial dysplasia, a dyshesive, dyskeratotic epithelial syndrome caused by an abnormality in desmosomes and gap junctions, involves the mucosae, skin, hair, eyes, and lungs. A 16-year-old patient had nontender, fire-red mucosae; keratosis pilaris; diffuse, nonscarring alopecia; cataracts; photophobia; corneal vascularization; and decreased visual acuity. Histologic examination of gingival sections showed a dyshesive epithelium with atrophy, dyskeratosis, lack of keratinization, and unusual cytoplasmic inclusions. Results of electron microscopic studies showed a reduced number of desmosomes, amorphous intercellular material, and cytoplasmic inclusions resembling tonofilaments and gap junction material. The patient described in this report represents an apparently sporadic case of hereditary mucoepithelial dysplasia. Other cases described previously in the literature are reviewed. We believe this disorder should be brought to the attention of dermatologists because patients with hereditary mucoepithelial dysplasia have numerous skin problems and are susceptible to recurrent infection and potentially fatal bullous lung disease. Also, misinterpreted abnormal results from cervical Pap smears could lead to hysterectomy being performed unnecessarily on these patients.

Evidence for eosinophil degranulation in the pathogenesis of herpes gestationis.

Herpes gestationis is a pregnancy-related bullous dermatosis of unknown origin with associated tissue and peripheral blood eosinophilia. In this report, eosinophil degranulation in herpes gestationis was studied, and the role that the eosinophil may have as an effector cell that induces tissue damage through deposition of toxic cationic proteins is discussed. Using indirect immunofluorescence with antibody to human eosinophil granule major basic protein, major basic protein was observed both within tissue eosinophils and deposited extracellularly outside eosinophils in the dermis of eight patients with herpes gestationis. Possible mechanisms whereby eosinophils might be activated to degranulate in herpes gestationis are reviewed.

Abatement of Sézary syndrome lesions following treatment with acyclovir.

Sézary syndrome is a malignant form of cutaneous T cell lymphoma in which patients characteristically present with generalized pruritic erythroderma and large numbers of circulating Sézary cells in the peripheral blood. Several previous studies have proposed that viruses may play a role in the cause of cutaneous T cell lymphoma. This report describes a 68-year-old man with Sézary syndrome who received a seven-day course of intravenous acyclovir for treatment of disseminated herpes zoster and was noted to have almost complete disappearance of generalized erythroderma and pruritus. Since acyclovir has been shown to selectively inhibit viral DNA polymerase, the observed clinical response is strong evidence that viruses play a role in the cause of cutaneous T cell lymphoma. Mechanisms that could explain the observed response are discussed, and further studies on the utility of antiviral agents for treatment of cutaneous T cell lymphoma and on possible inhibitory effects of acyclovir on retroviruses are recommended.