Is dermatitis palmaris sicca an irritant contact dermatitis?

BACKGROUND: Dermatitis palmaris sicca (DPS) is a common dry-fissured palmar dermatitis in Asian women. It may be an irritant contact dermatitis, but the immunophenotype of the cells in its infiltrate is unknown. OBJECTIVE: The aim of this study was to evaluate the role of inflammatory cells in the pathogenesis of DPS. METHODS: Patch testing was done in 68 patients with DPS, 87 subjects with hand eczema, and 31 healthy subjects. Immunophenotyping of cutaneous inflammatory cells was performed in 8 patients with DPS, 10 subjects with hand eczema, and 8 healthy individuals. RESULTS: Positive patch rates were higher in patients with DPS and those with hand eczema compared with healthy controls, but strong positive (++ or +++) reactions in DPS were fewer compared with hand eczema. Density of CD3, CD4, CD8, and CD68 cells in skin lesions of DPS and hand eczema was significantly higher than that in normal skin. Sparse CD20 cells were present only in hand eczema. Compared with hand eczema, the number of CD3, CD8, CD68, and dermal CD1a cells decreased, but epidermal CD1a cells and CD4/CD8 ratio increased in DPS. CONCLUSIONS: The absolute lack of CD20 cells and relative scarcity of dermal CD8 and CD1a cells in skin lesions might be insufficient to induce contact hypersensitivity, so DPS may be an irritant but not allergic contact dermatitis.

La piel sensible: un síndrome complejo / Sensitive Skin: A Complex Syndrome

Los estudios epidemiológicos ponen de manifiesto que cada vez son más las personas que dicen poseer una piel sensible, presumiéndose una prevalencia del 50% en la población europea. Se trata de una condición cutánea de hiperreactividad cuya manifestación depende de gran variedad de factores y cuya patogénesis no es del todo conocida, aunque diferentes estudios señalan un origen biofísico para este desorden. El diagnóstico objetivo de piel sensible es difícil, ya que la mayoría de los síntomas que presentan los pacientes son subjetivos. Además, no existen pruebas diagnósticas realmente eficaces y con un fuerte componente predictivo, pues la sensibilidad de la piel varía mucho de unas personas a otras. Por otra parte existen numerosas variaciones entre los compuestos que desencadenan respuestas del tipo de piel sensible. Las repercusiones sobre la calidad de vida son importantes y frecuentemente se acompañan de sintomatología psiquiátrica, por lo que el médico dermatólogo debe explorar este campo en la anamnesis. En el tratamiento de esta condición se hace imprescindible la colaboración del paciente y altas dosis de tenacidad por parte del médico (AU)

Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin (AU)

The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function.

OBJECTIVE: To assess the effect of repeated application and removal of adhesive edges from wound-care products on cutaneous irritancy and barrier function in normal volunteer subjects. METHOD: This was a study using a 'repeat-insult patch test'. Adhesive edges from six commonly used wound-care products were applied continuously to the same site (six applications over a 14-day period) in 30 normal volunteer subjects. The test sites were assessed clinically before product reapplication using established ranking scales for cutaneous erythema. The cumulative irritancy score (CIS) for each test site was determined by adding the erythema scores at days 3, 5, 8, 10, 12 and 15. At the study end the barrier function of each test site was assessed by measuring transepidermal water loss (TEWL). RESULTS: The CIS showed that the products fall into two distinct groups, with Mepilex, Tielle and Allevyn giving low scores and Biatain, Comfeel and DuoDERM higher scores. Statistical analysis indicated significant differences (p < 0.05) between Mepilex and Biatain, Mepilex and Comfeel, Mepilex and DuoDERM, Tielle and Biatain, Allevyn and Biatain. The mean TEWL values also indicated that the products fall into two distinct groups: Mepilex, Tielle and Allevyn with low mean values close to that of normal adjacent back skin and Biatain, Comfeel and DuoDERM with much higher mean values. Statistical analysis indicated that Mepilex, Tielle and Allevyn were not significantly different from normal skin (p < 0.05), whereas Biatain, Comfeel and DuoDERM were significantly higher than normal skin and the other products tested. CONCLUSION: The results show clear differences between products; the clinical scores and TEWL measurements indicate that the products fall into two distinct groups. This novel approach seems able to discriminate between adhesive borders and may be useful during product development and in selecting products for clinical trials.

Skin irritation: prevalence, variability, and regulatory classification of existing in vivo data from industrial chemicals.

In vivo rabbit data for skin irritation registered in the European New Chemicals Database (NCD) and an ECETOC Database were evaluated to characterise the distribution of irritation potential among chemicals and to assess the variability of the animal test. These databases could be used to determine experimental and rudimentarily within-laboratory variability, but not between-laboratory variability. Our evaluation suggests that experimental variability is small. Using two classification systems--the system currently used in Europe and the Globally Harmonised System (GHS)--the prevalence of skin irritation data obtained from NCD was analysed. This analysis revealed that out of 3121 chemicals tested, less than 10% showed an irritation potential in rabbits which would require an appropriate hazard label and 64% did not cause any irritation. Furthermore, it appears that in practical use the European classification system introduces bias towards overclassification. Based on these findings, we conclude, that the classification systems should be refined taking prevalence into account. Additionally, prevalence should be incorporated into the design and analysis of validation studies for in vitro test methods and in the definition of testing strategies.

The MOAHLFA index of irritant sodium lauryl sulfate reactions: first results of a multicentre study on routine sodium lauryl sulfate patch testing.

In a multicentre study of the German Contact Dermatitis Research Group, sodium lauryl sulfate (SLS) 0.25% and 0.5% aq. has been added to routine allergen patch tests to assess its properties as a convenient diagnostic indicator of individual susceptibility to irritation at the time of patch testing. Previous studies indicated that irritant SLS reactivity may be related to individual factors such as age and sex. As these factors are, in turn, among the important predictors of contact allergy to many allergens, e.g. summarized in the 'MOAHLFA index', the impact of the MOAHLFA factors on irritant SLS patch test reactivity, and thus a potential for confounding, was assessed in the 5971 participating patients. As a result of 2 logistic regression analyses with an irritant reaction to 0.25% and 0.5% SLS, respectively, as outcome, male sex was identified as a relatively weak but significant risk factor (OR 1.38), while age 40 years or older was an even weaker risk factor (OR 1.22 and 1.15, respectively). Upon detailed analysis, no clear age gradient could, however, be identified. 1-day exposure time almost halved the odds of an irritant SLS reaction. In conclusion, this type of SLS patch test can be regarded as robust, indicating individual irritability relatively independent from the individual factors analysed here.

Persistent post-occupational dermatitis.

Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.

Frequency of peristomal complications.

Practicing wound ostomy continence (WOC) nurses see peristomal complications in their ostomy patient population. The exact frequency and cause of these complications are unknown. Research into problems arising from prolonged use of ostomy appliances is lacking. To ascertain the frequency of peristomal complications, two WOC nurses at a major medical center prospectively assessed the peristomal skin of all new ostomy patients returning for their 2-month postoperative check-up using a peristomal complications tool. The study was conducted from August 1999 to August 2000. Descriptive statistics were used to summarize the data. In the course of the study, 161 new ostomy patients were seen, 10 with peristomal complications, for a frequency of 6%. The frequency of peristomal complications was the highest in people with ileal conduits (five of 34, 15%) and ileostomies (four of 46, 9%). Only one of the 81 people with a colostomy developed peristomal complications. All 10 patients had a retracted stoma. Eight had chemical damage (six with irritant dermatitis, two with pseudoverrucous lesions) and two had Candida infections. Although the study sample size is small, the results suggest that patients with ileal conduits and patients with retracted stomas may require more frequent follow-up visits to monitor skin conditions and pouching modifications.

Efficacy of a skin-protective foam in the treatment of chronic hand dermatitis.

BACKGROUND: Irritant and/or allergic hand dermatitis in individuals who are unable to avoid causative exposures is difficult to control. Usefulness of protective creams has been generally unsatisfactory. OBJECTIVE: To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a protective foam containing dimethicone and glycerin. METHODS: Adult male and female subjects with chronic hand dermatitis for at least 12 months, felt to be either allergic, irritant, or combined in nature were given the study foam for routine application after a 2-week observation period. At 2 and 6 weeks the skin was evaluated by the investigator and subject for parameters including redness, scaling, fissuring, blistering, and pruritus on a numerical scale. A global evaluation also was performed. Photographs were taken at each visit. Usage of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed. RESULTS: Thirty-one subjects were enrolled in the study and 28 completed it. The physician and subject's initial global evaluations averaged 6.13 and 5.48, respectively (0-10 scale). The final scores were 3.68 and 4.75, respectively (P < .001 for physician rating; P = .259 for subject rating). Topical corticosteroid usage was reduced in 16 of 30 (53.6%) subjects. Twenty-one of 30 subjects (70.0%) had improved over the course of the study. No adverse effects were noted. CONCLUSION: This protective foam greatly or moderately improved chronic hand dermatitis in a sizable number of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations.

10 cases of contact dermatitis which began during the application of povidone-iodine preparations were examined with patch tests using 2 kinds of povidone-iodine preparations and their ingredients, i.e., povidone-iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone-iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone-iodine preparations and povidone-iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinyl-pyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone-iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone-iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone-iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.

Evaluation of a human patch test for the identification and classification of skin irritation potential.

Current regulations require that the skin irritation/corrosion potential of new chemicals is assessed in the rabbit Draize test, although there are opportunities to use alternative methods to identify the most aggressive materials. Previously, we have proposed that it is possible to employ a strategy that avoids the use of animals and at the same time delivers a more relevant assessment of skin irritation/corrosion potential. The approach is to identify corrosive materials in vitro and then proceed to human volunteer testing for skin irritation. In this study, the human 4-h patch test, its interpretation, and results with 29 test materials are presented. Using 14 materials not classified as "Irritating to skin" by EU criteria, 13 classified as "Irritating to skin" by suppliers, and 2 as "Corrosive - causes burns", it is demonstrated that, by evaluating these on human skin in vitro and in vivo, a significant proportion are either over-classified or under-classified. In conclusion, we are convinced that by application of the approach described in detail here, it is possible to avoid the use of animals, whilst at the same time obtaining an assessment of skin irritation/corrosion potential that is more relevant to man, and which, if required, may be used directly for classification and labelling of substances and preparations within the European Union.