[Hand eczema and occupational disorders]. / Eczéma des mains et maladie professionnelle.

Hand eczema (HE) is a frequent skin disease, combining endogenous and exogenous factors. Occupational -or work-related- hand eczema (OHE) is frequently a chronic and relapsing disease, due to irritant and allergenic contacts. Burden of disease is important, since OHE strikes quality of life of the patient, has significant social and economic impact, and may jeopardize his professional future. The management of OHE combines etiological assessment, efficient symptomatic treatment and adaptation of working conditions.

[Interpretation and relevance of patch testing: false-positive and false-negative test reactions, compound allergy, cross-sensitivity]. / Interprétation et pertinence des patch-tests : faux-positifs et faux-négatifs, allergies composées, allergies croisées.

This chapter reviews pitfalls and mistakes in patch testing. Most sources of false-positive and false-negative reactions are indicated and analysed. Cross-sensitivity among allergens is discussed and compound allergy is debated. Keys for establishing relevance are indicated, for a better reading and interpretation of patch testing by practitioners (trainees or experienced dermatologists).

Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema.

BACKGROUND: Hand eczema is a long-lasting disease with a high prevalence in the background population. The disease has severe, negative effects on quality of life and sometimes on social status. Epidemiological studies have identified risk factors for onset and prognosis, but treatment of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system for hand eczema is needed. OBJECTIVES: The present study attempts to characterize subdiagnoses of hand eczema with respect to basic demographics, medical history and morphology. METHODS: Clinical data from 416 patients with hand eczema from 10 European patch test clinics were assessed. RESULTS: A classification system for hand eczema is proposed. CONCLUSIONS: It is suggested that this classification be used in clinical work and in clinical trials.

Routine patch testing with frullanolide mix: an European Environmental and Contact Dermatitis Research Group multicentre study.

Contact sensitivity to plants containing 1 or more sesquiterpene lactones (SLs) is difficult to diagnose. The mixture of SLs (SL mix) has been shown to detect only about 60% of sensitized individuals. In order to improve the diagnosis of sensitization to plants containing SLs, we have tested a mixture of frullanolides contained in Frullania dilatata and Frullania tamarisci at 3 different concentrations (0.01%, 0.033% and 0.1% in petrolatum). 8605 consecutive eczema patients in 1 North American and 15 European dermatology departments were tested with this mix, and 0.35% of positive cases to the different concentrations were found. Routine use of this mix permitted detection of only a small percentage of extra cases and did not improve the SL mix score. The frullanolide mix should therefore be restricted to investigations in particular geographical zones and/or in particular occupations.

[Allergic vasculitis following ingestion of celecoxib?]. / Allergische Vaskulitis nach Einnahme von Celecoxib?

A 76-year-old patient developed cutaneous vasculitis on the lower legs on the 8th day of treatment with the selective cox-2-inhibitor celecoxib (Celebrex((R))) and the proton-pump inhibitor omeprazole. The patient had no history of allergic reactions. The patient had already been treated previously with omeprazole without any side effects. A cutaneous biopsy confirmed the diagnosis of leucocytoclastic vasculitis. The purpuric skin lesions regressed within 3 weeks after withdrawing the two newly introduced drugs. We discuss the potential role of Celecoxib in triggering this vasculitis.

[Erythroderma induced by hypercalcitoninemia: two cases]. / Erythrodermie induite par une hypercalcitoninémie.

INTRODUCTION: The most common cause of erythroderma is the extension of a previous cutaneous disease to the entire skin surface, as is the case in mycosis fungoides or drug reactions. Erythroderma related to endocrine disorders has only exceptionally been published. We report two cases of patients suffering from erythroderma probably induced by hypercalcitoninemia. OBSERVATIONS: Case 1. A 69 year-old man had a two year-history of fluctuating erythroderma, resistant to all topical or systemic therapy. After numerous unsuccessful investigations, a high serum calcitonin rate was detected. The pentagastrin test was highly positive, suggesting a medullar carcinoma of the thyroid. Thyroidectomy showed only hyperplasia of C cells. All skin signs disappeared within a few days after surgery. Two years later, there was no recurrence of the erythroderma and the serum calcitonin rate was normal. Case 2. A 58 year-old man suffered from congestive and pruriginous erythroderma for 2 1/2 months, which responded well to topical steroids. Biological investigations done for flushes, showed a raised calcitonin level and highly positive pentagastrin test. Thyroidectomy also revealed simple hyperplasia of the C cells. No recurrence of the erythroderma was noted during the 6 month follow-up. DISCUSSION: These are the first cases of erythroderma associated with hypercalcitoninemia. The causal role of calcitonin is probable in the first case, because of 1) long duration of skin signs before the hypercalcitoninemia; 2) quick post-operative recovery, in parallel with the decrease in calcitonin level; 3) absence of recurrence after thyroidectomy; 4) absence of other proven causes. Erythroderma may have resulted from dilation of the skin vessels, since calcitonin and calcitonin gene related peptide are powerful vasodilators.