Impact of atopic dermatitis and loss-of-function mutations in the filaggrin gene on the development of occupational irritant contact dermatitis.

BACKGROUND: Atopic dermatitis (AD) and loss-of-function mutations in the filaggrin gene (FLG) are both associated with chronic irritant contact dermatitis (ICD). As FLG mutations also are a major risk factor for AD, it is not clear whether FLG mutations are an independent risk factor for ICD or whether the risk is mediated by AD. OBJECTIVES: To investigate the relative contribution and interaction of FLG mutations and AD in German patients with occupational ICD and controls (vocational school apprentices). METHODS: A total of 634 patients and 393 controls were genotyped for R501X, 2282del4, R2447X and S3247X. Current or past flexural eczema was used as an indicator of AD. RESULTS: FLG mutations were found in 15·9% of the patients with ICD and 8·3% of the controls, with a crude odds ratio (OR) of 2·09 [95% confidence interval (CI) 1·33-3·28] for the combined genotype. The adjusted OR for FLG mutations, corrected for AD, was 1·62 (95% CI 1·01-2·58). Subjects with AD were at approximately three times higher risk of developing ICD than controls (OR 2·89; 95% CI 2·09-3·99). There was no evidence of an interaction between these two risk factors. CONCLUSIONS: Our results indicate that both FLG mutations and AD increase the risk of ICD. Individuals with concurrent FLG mutations and AD are at the highest risk of developing ICD.

IL1A-889 C/T gene polymorphism in irritant contact dermatitis.

BACKGROUND: Upon skin contact to irritants, interleukin-1 alpha (IL-1α) is released in the stratum corneum as a primary step of skin inflammation. Variations in the IL-1A gene have been shown to alter the expression of IL-1α. This may influence the susceptibility to skin inflammation and the development of irritant contact dermatitis (ICD). OBJECTIVE: To determine effects of an IL1A-889 C/T polymorphism in view of susceptibility to develop irritant contact dermatitis. METHODS: In a case-control study, 478 Caucasian patients with occupational ICD of the hands were genotyped for an IL1A-889 C/T polymorphism. Results were compared to 393 apprentices from the same high risk occupations (controls). RESULTS: Trends of a protective effect of the C → T transition at position IL1A-889 were seen (OR = 0.81; 95% CI: 0.65-1.00). The genotype distribution for IL1A-889 was 52.2% wild type (C/C), 39.2% heterozygous (C/T) and 8.6% homozygous for variant allele (T/T) in patients and 46.0%, 42.7% and 11.4% in controls. Subgroup analysis, which took into account atopy status and exposure, did not reveal a significant effect of this polymorphism for an aberrant risk to acquire for ICD. CONCLUSION: Our study indicates a possible protective effect of the IL1A-889 C/T polymorphism regarding the development of ICD.

Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy.

BACKGROUND: Filaggrin loss-of-function mutations and atopy may alter the clinical course of irritant contact dermatitis (ICD). OBJECTIVE: To investigate the clinical course of patients with occupational ICD according to loss-of-function mutations in the filaggrin gene (FLG) and atopy. METHODS: In a prospective cohort study, the clinical course, use of topical corticosteroids, sick leave, recovery rate and job continuation were investigated in 459 inpatients treated for occupational ICD of the hands. Patients were genotyped for four FLG mutations, examined for atopy and followed for up to 3 years after discharge. RESULTS: Our study included 327 (71·2%) atopic individuals and 132 nonatopic individuals. Overall, 68 patients showed a mutation in the FLG alleles R501X, R2447X, S3247X and 2282del4 (60 atopic and eight nonatopic). Nonatopic patients with ICD responded well to therapeutic approaches, while atopy status made subjects more resistant to therapy, resulting in lower rates of recovery and job continuation and higher use of topical corticosteroids. Carriage of FLG loss-of-function mutations in combination with atopy worsened the course. The risk of abandoning one's profession in this group was significantly increased when compared with 'pure' ICD (odds ratio 3·1) after 3 years. CONCLUSIONS: Patients with atopy are a special risk population for ICD. In the presence of atopy, FLG mutations seem to be a modifier of the severity of the clinical course in ICD. Early-stage identification of this subgroup may result in additional emphasis to these patients regarding the importance of adherence to specific therapeutic interventions.

Airborne contact dermatitis to tetrazepam in geriatric nurses--a report of 10 cases.

BACKGROUND: Tetrazepam, a benzodiazepine, is a frequently used muscle relaxant. The most common adverse reactions are neurological and gastrointestinal. Cutaneous reactions to tetrazepam are rare and occur predominantly after systemic administration. OBJECTIVE: To present 10 health care professionals who developed airborne contact dermatitis to tetrazepam due to occupational exposure to tetrazepam dusts. MATERIALS AND METHODS: We report a series of 10 cases observed in our department between January 2006 and March 2011 where tetrazepam was identified to cause allergic airborne contact dermatitis. Affected individuals were employed as (geriatric) nursing staff, exposed to tetrazepam on a regular occupational basis when crushing tablets for their patients. Upon investigation, patients were patch tested with commercial and customized allergens. This included tetrazepam and in five cases diazepam. Tetrazepam revealed strong positive reactions in all patients. Additional diazepam sensitization was observed in three subjects. Following local treatment and occupational preventive action, patients recovered from their skin symptoms. CONCLUSIONS: Allergic contact sensitization to tetrazepam and cross-sensitization to diazepam seems to be underestimated and not appropriately diagnosed in patch test clinics, as it is so far insufficiently patch tested. They should be considered when allergic contact dermatitis is suspected, particularly in professionally exposed staff, and tested as supplemental allergens.

[Differential diagnosis of intraconal orbital masses using high-resolution MRI with surface coils in 78 patients]. / Differenzialdiagnostik intrakonaler orbitaler Raumforderungen unter Verwendung der hochauflösenden MRT mit Oberflächenspulen anhand von 78 Patienten.

PURPOSE: Over the last decade, MRI has become the standard procedure for the diagnosis of orbital masses. Purpose of the study was to evaluate criteria for differential diagnosis for intraconal masses on MRI in a large patient group. MATERIAL AND METHODS: In a retrospective study, MR examinations of 78 patients with intraconal masses were evaluated. All examinations were performed using surface coils for high spatial resolution. Signal behavior on T2-WI and T1-WI before and after contrast application as well as further tumor characteristics (i. e., shape, size, position, delineation and infiltration) were evaluated. Every diagnosis was proven by histopathological results from extirpation (n = 18) or biopsy (n = 22), or confirmed by other imaging modalities (n = 13) or clinical course (n = 25). RESULTS: Different tumor characteristics are helpful in the differentiation between cavernous hemangioma, lymphangioma, varices, AV malformations and solid tumors. Due to overlapping in the imaging appearance, the differentiation between inflammatory pseudotumor, lymphoma and orbital metastasis was more difficult. CONCLUSION: While high resolution MRI using surface coils allows differentiation between the typical vascular tumors, the differentiation between solid tumors is more difficult. Thus, a histopathologic verification of the diagnosis is necessary in solid tumors.