Contact allergy to 2-hydroxy-5-tert-butyl benzylalcohol and 2,6-bis(hydroxymethyl)-4-tert-butylphenol, components of a phenolic resin used in marking pens.

2-hydroxy-5-tert-butyl benzylalcohol and 2,6-bis(hydroxymethyl)-4-tert-butylphenol were identified as contact allergens in a phenolic resin used as a tackifier in the ink of a marking pen, which, after being used directly on the skin, caused an acute contact dermatitis on the hand of a 13-year-old boy. The patient also reacted to 4-tert-butylphenol-formaldehyde resin (BPF resin) 1% pet. included in the European standard series.

Abnormalities of lymphocyte function and phenotypic pattern in a case of toxic epidermal necrolysis.

We examined the blood lymphocyte function and phenotypic pattern in a patient with toxic epidermal necrolysis after taking salazopyrin. We studied cell surface markers, natural killer cell activity and mitogen-induced lymphocyte transformation. Our results point to temporary immunosuppression as evidenced by lymphopenia with a large "null cell" population, reduced natural killer cell activity, and impaired lymphocyte response to mitogens.

Splendore-Hoeppli phenomenon in Pityrosporum folliculitis (pseudoactinomycosis of the skin).

Actinomyces-like granules showing the Splendore-Hoeppli phenomenon have been demonstrated in histologic material, e.g. uterine curettings, in various conditions unrelated to genuine actinomycotic infection. The exact nature of the granules and the mechanism of their formation is open to speculation. We report two patients with a follicular skin eruption (Pityrosporum folliculitis) where pseudoactinomycotic granules were found in the skin biopsies. To the best of our knowledge, such findings have not previously been reported, but supposedly they are not rare. In order to avoid an incorrect diagnosis of actinomycosis, and unnecessary therapy, it is important to be familiar with the phenomenon.

Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study.

Systemic treatment modalities for eradication of multiple therapy resistant genital warts are so far not available. In this study laser treated patients with multiple genital warts received postoperatively either interferon alpha-2b subcutaneously (s.c.) 5 x 10(6) IU or matching placebo three times weekly for four weeks. At the conclusion of the study, 6-8 weeks after discontinuation of therapy, a significantly higher cure rate was found in the group of interferon-treated patients (14 of 27 (52%) patients cured) than among placebo treated patients (5 of 22 (23%) patients cured) (p less than 0.05). The side effects of fever, chills, myalgia, headache and leukopenia occurred more commonly in the interferon treated group than in the placebo group. However, only three of 32 patients discontinued interferon therapy because of side effects. We conclude that the addition of s.c. administered interferon alpha-2b to laser treated patients with chronic therapy resistant genital warts is fairly well tolerated and that it significantly enhances the chance of eliminating the disease.

Use of sodium-chloride separated human skin in detection of circulating anti-basement membrane zone antibodies.

The sensitivity of the indirect immunofluorescence (IIF) technique for detection of circulating basement membrane zone (BMZ) antibodies was evaluated, employing NaCl-separated human skin and intact skin as substrate. Consecutive serum samples from 12 patients with clinically, histologically and immunohistologically verified bullous pemphigoid (BP) were investigated in parallel on both substrates, in dilutions ranging from 1:10 to 1:1,280. All BP sera showed linear deposits of IgG at the BMZ on intact skin, with titres ranging from 10 to 160. On NaCl-separated skin, all BP sera produced a linear epidermal fluorescent band for IgG, with titres ranging from 80 to 1,280. None of the sera showed deposits of IgM anti-BMZ antibodies. Sera from 5 healthy donors (dilutions 1:10) produced no fluorescence, either on intact or on NaCl-separated skin. The serum-titres of circulating anti-BMZ IgG antibodies in 2 patients with corticosteroid-resistant BP were significantly reduced (from 160 to less than 10) during treatment with plasmapheresis, when using NaCl-separated skin as substrate for IIF, whereas the serum-titres showed insignificant reduction (from 20 to less than 10), when using intact skin as substrate. We conclude that the IIF method is more sensitive for detection of circulating anti-BMZ antibodies, when NaCl-separated skin as compared with intact human skin is employed as substrate.

Adult, acquired reactive perforating collagenosis. Report of a case including ultrastructural findings.

A case of reactive perforating collagenosis in an adult male patient with chronic renal failure. Pruritic, umbilicate papules, showing extrusion of collagen fibers through the epidermis were detected histopathologically. Electron microscopy showed absence of basal membrane beneath the perforation and collagen fibers with preserved periodicity passing through widened intercellular spaces with islands of cytoplasmic material.

Atopic dermatitis, house dust mite allergy and month of birth.

An analysis of the month of birth in 210 patients with atopic dermatitis and a positive prick test towards the house dust mite (Dermatophagoides pteronyssinus) showed a significantly higher prevalence of birth in the interval May to November when compared with the expected distribution (p less than 0.01). A subdivision of the AD patients due to the concomitant presence of asthma showed no differences as the relative risk was nearly the same in the two subgroups. This observation indicates that a consistent seasonal preference of birth in patients with atopic dermatitis only applies to the skin disease and not to coexistent asthma.

IgE in atopic dermatitis: a study of the intercellular fluid.

In 33 adult patients with atopic dermatitis of mild to severe degree the concentration of IgE in serum (S) and intercellular fluid (IF) was studied by suction blister technique. The median value of IF/S-IgE was 0.20 and not different from the ratio 0.21 found in controls. Furthermore, by subdividing the patients into groups with asthma/rhinitis or different severities of eczema no significant differences in the IF/S-IgE ratios were found compared with the controls. In the controls the IF/S-IgE ratio (0.21) was significantly different from the IF/S-IgG ratio (0.32). The median ratio of IF/S-IgE divided by IF/S-IgG was 0.63, which might indicate a reduced passage of IgE into IF compared with IgG presumably dependent on differences in the molecular size or tertiary structure of the proteins.

Fundus fluorescein angiography in generalized scleroderma.

Fundus affliction with generalized scleroderma was studied in 21 patients by ophthalmoscopy, fundus ocular photography and fluorescein angiography. Slitlamp examination of the anterior chamber, the iris and the lens revealed no evident affections. Neither did ophthalmoscopy reveal obvious abnormalities related to scleroderma. Abnormalities of pigmentation were not noted. Visual acuity was normal in 20 patients, and 1 patient had reduced visual acuity due to macular degeneration. Fundus fluorescein angiography was within normal physiological variation in 14, and definitely abnormal in 7 patients as assessed independently by 2 ophthalmologists. Angiographic abnormalities consisted of variable hyperfluorescence of the pigment epithelium layer, and, additionally, in 2 cases minute hyperfluorescence of the retinal layer. These angiographic abnormalities indicated affection of the retinal pigment epithelium probably caused by a vascular lesion of the choroidal layer. Retinal vessels were in general not affected. In conclusion, the choroidal vasculature appears affected in 1/3 of patients with generalized scleroderma as assessed by fundus fluorescein angiography.

Penicillin concentrations in serum following weekly injections of benzathine penicillin G.

Twelve patients with syphilis were treated weekly with injections of 1.44 g (2.4 X 10(6) IU) of benzathine penicillin G for up to 3 weeks. Almost daily, serum penicillin concentrations were measured by a sensitive microbiological agar cup method. An individual and interindividual variation was found. Concentrations below the recommended 0.018 micrograms/ml were found 7 days after the first or second injection in 5 samples. Shorter intervals between injections are recommended.

Psoriasiform napkin dermatitis.

A prognostic study of 18 patients with a diagnosis of psoriasiform napkin dermatitis was performed. The observation period had a duration of 7 to 15 years. Two patients developed psoriasis and two developed atopic dermatitis.

Vitamin D metabolites in generalized scleroderma. Evidence of a normal cutaneous and intestinal supply with vitamin D.

Vitamin D metabolites in serum were analysed in 20 patients with generalized scleroderma. The concentration of 1,25-dihydroxyvitamin D was normal, however, significantly lower concentrations (p less than 0.05) were found in 7 patients with cutaneous calcinosis in comparison with 13 patients with no calcinosis. Concentrations of 25-hydroxyvitamin D, 24-25-dihydroxyvitamin D, and vitamin D-binding protein (Gc globulin) were all within the normal range. The 24,25-dihydroxy-vitamin D level correlated with the duration of disease (r = 0.4453, p less than 0.05), and 25-hydroxyvitamin D tended to correlate (r = 0.3016, NS). The study strongly indicates that cutaneous synthesis, intestinal absorption and hepatic hydroxylation of vitamin D are not deficient in scleroderma. A relative but specific decrease in the renal hydroxylation to 1,25-dihydroxyvitamin D, i.e. the active hormone, as the disease progresses and calcinosis occurs, is suspected.

Increased central cornea thickness in systemic sclerosis.

Central cornea thickness (CCT) was measured in 32 patients with systemic sclerosis by the Haag-Streit pachymeter with improved centrality. Results were compared with measurements in 29 healthy adults matched with respect to sex and age. CCT was increased (P less than 0.001) in patients with systemic sclerosis (mean 0.56 mm, average SD right and left side 0.0297 mm) as compared to the controls (mean 0.51 mm, SD 0.0109 mm). CCT of right and left eye was increased in 69% and 72% of patients with systemic sclerosis as compared to controls (mean 0.51 mm +/- 2 SD). CCT increased during the first 8 years of the disease (correlation coefficient 0.593) reaching a plateau after 8 years (correlation coefficient 0.005). CCT did not increase during medical treatment with collagen inhibitors. Measurement of CCT may be useful as a supplement to other quantitative methods for diagnosis and control of systemic sclerosis.