RESUMO
BACKGROUND: The prevalence of lanolin contact allergy in dermatitis patients varies from 1.2% to 6.9%. Different lanolin derivatives are used in patch testing. OBJECTIVES: To determine which combination of lanolin derivatives is most effective in patch testing for the diagnosis of lanolin contact allergy. METHODS: A retrospective analysis of patients patch tested between 2016 and 2017 was performed. Patients were eligible if they had been tested with lanolin alcohol 30% pet., Amerchol L101 50% pet., and a supplementary series containing other lanolin derivatives. Lanolin alcohol and Amerchol L101 were tested in duplicate. RESULTS: Of 594 patients, 28.6% (95% confidence interval [CI]: 25.1%-32.3%) had a positive patch test reaction to at least one lanolin derivative. Reactions to lanolin alcohol (14.7%, 95%CI: 11.3%-18.2%) and Amerchol L101 (15.0%, 95%CI: 11.5%-18.5%) were common in the routinely tested series. Reactions to other test preparations were significantly less frequent (P < 0.05). The addition of Amerchol L101 to lanolin alcohol significantly increased the number of positive cases (odds ratio 1.79, P < 0.001). CONCLUSIONS: The combination of lanolin alcohol and Amerchol L101 is effective in patch testing for the diagnosis of lanolin contact allergy. Routinely testing with other lanolin derivatives may not be worthwhile, as it detects only a few additional patients.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Lanolina/efeitos adversos , Testes do Emplastro/métodos , Adulto , Álcoois/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Feminino , Humanos , Lanolina/análogos & derivados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non-steroidal anti-inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market. It is suggested that an extended list of photoallergens should be photopatch tested in selected cases, along with patients' own products. Two contact allergens, cinnamyl alcohol and decyl glucoside, should be simultaneously patch tested in order to clarify photopatch and patch test reactions, respectively, to ketoprofen and methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb M™).
Assuntos
Alérgenos/efeitos adversos , Dermatite Fotoalérgica/etiologia , Testes do Emplastro/métodos , Guias de Prática Clínica como Assunto , Protetores Solares/efeitos adversos , Dermatite Fotoalérgica/diagnóstico , Europa (Continente) , Feminino , Humanos , Irritantes/efeitos adversos , Masculino , Medição de Risco , Sensibilidade e Especificidade , Sociedades MédicasRESUMO
BACKGROUND: Cosmetic products contribute considerably to the incidence of contact dermatitis. In response to a resolution of the Council of Europe, the National Institute for Public Health and the Environment (RIVM) in The Netherlands set up a pilot project to report undesirable effects attributed to cosmetic products. OBJECTIVES: To provide an overview of undesirable effects attributed to cosmetic products and to identify the ingredients involved. The information could contribute to the assessment of whether current EU legislation on cosmetics provides adequate protection. PATIENTS/METHODS: General practitioners, dermatologists and consumers in The Netherlands completed questionnaires on reported undesirable effects of cosmetics. Dermatologists also carried out patch tests and, where necessary, tests with specific batch ingredients of the associated cosmetic product. A website and a public awareness campaign were launched to encourage consumers to report undesirable effects. RESULTS: Between July 2009 and May 2011, the RIVM received more than 1600 reports. Severe undesirable effects were claimed in 1-4% of the cases. The most frequently reported cosmetic products were make-up and moisturisers, and the most frequently identified allergens were isothiazolinones and fragrance ingredients. Three patients tested positive for co-polymers/cross-polymers. CONCLUSIONS: Further investigations are recommended on the prevalence of isothiazolinone-induced allergic contact dermatitis and the allergenic potential of co-polymers/cross-polymers.
Assuntos
Cosméticos/efeitos adversos , Dermatite Alérgica de Contato/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatite Alérgica de Contato/etiologia , Monitoramento Epidemiológico , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos , Projetos Piloto , Adulto JovemRESUMO
BACKGROUND: According to EU legislation, 26 fragrance substance allergens must be labelled on cosmetic products. For 12 of them, the optimal patch test concentration/dose has not been evaluated. OBJECTIVES: To establish the optimal patch test doses in mg/cm2 for the 12 fragrance substances that are not included in fragrance mix I or II in the European baseline patch test series. MATERIALS AND METHODS: Patch testing with the 12 fragrance substances was performed in a stepwise manner encompassing up to five rounds in at least 100 dermatitis patients for each round. Before patch testing, an individual maximum concentration/dose was determined for each fragrance substance. RESULTS: The predetermined maximum patch test concentrations/doses could be tested for all 12 fragrance substances, with no observable adverse reactions being noted. CONCLUSIONS: For each fragrance substance investigated, it is recommended that half of the maximum patch test dose (mg/cm2) be used for aimed and screening patch testing.
Assuntos
Alérgenos , Cosméticos , Dermatite Alérgica de Contato/diagnóstico , Testes do Emplastro/métodos , Perfumes , Adulto , Alérgenos/efeitos adversos , Cosméticos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Perfumes/efeitos adversosRESUMO
Hand dermatitis is a prevalent disease with an episodic, chronic character. The use of medical resources is high and is often related to reduced (work) functioning. The burden is therefore high for patients and society. Management of hand dermatitis is often unsatisfactory, and for this reason prevention is important. The effectiveness of prevention programmes is, however, unknown. This study evaluates if comprehensive prevention programmes for hand dermatitis, that include worker education as an element, are effective on occurrence, adherence to preventive measures, clinical outcomes and costs compared to usual care or no intervention. The literature was systematically searched using PubMed and Embase, from the earliest to January 2010 for relevant citations. The methodological quality was assessed by two reviewers using the Cochrane criteria. The GRADE approach was used to determine the level of evidence. After reading the full text articles, 7 publications met our inclusion criteria. We found that there is moderate evidence for the effect of prevention programmes on lowering occurrence and improving adherence to preventive measures, and low evidence for the effect on improving clinical outcomes and self-reported outcomes. No studies reporting on costs were found. It can be concluded that there is moderate evidence for the effectiveness of prevention programmes of hand dermatitis versus usual care or no intervention. However, more high quality studies including cost-effectiveness are needed.
Assuntos
Dermatite Ocupacional/prevenção & controle , Dermatoses da Mão/prevenção & controle , Educação em Saúde , Promoção da Saúde , Saúde Ocupacional , Comportamentos Relacionados com a Saúde , HumanosRESUMO
BACKGROUND: The individual and societal burden of hand eczema is high. Literature indicates that moderate to severe hand eczema is a disease with a poor prognosis. Many patients are hampered in their daily activities, including work. High costs are related to high medical consumption, productivity loss and sick leave. Usual care is suboptimal, due to a lack of optimal instruction and coordination of care, and communication with the general practitioner/occupational physician and people involved at the workplace. Therefore, an integrated, multidisciplinary intervention involving a dermatologist, a care manager, a specialized nurse and a clinical occupational physician was developed. This paper describes the design of a study to investigate the effectiveness and cost-effectiveness of integrated care for hand eczema by a multidisciplinary team, coordinated by a care manager, consisting of instruction on avoiding relevant contact factors, both in the occupational and in the private environment, optimal skin care and treatment, compared to usual, dermatologist-led care. METHODS: The study is a multicentre, randomized, controlled trial with an economic evaluation alongside. The study population consists of patients with chronic, moderate to severe hand eczema, who visit an outpatient clinic of one of the participating 5 (three university and two general) hospitals. Integrated, multidisciplinary care, coordinated by a care manager, including allergo-dermatological evaluation by a dermatologist, occupational intervention by a clinical occupational physician, and counselling by a specialized nurse on optimizing topical treatment and skin care will be compared with usual care by a dermatologist. The primary outcome measure is the cumulative difference in reduction of the clinical severity score HECSI between the groups. Secondary outcome measures are the patient's global assessment, specific quality of life with regard to the hands, generic quality of life, sick leave and patient satisfaction. An economic evaluation will be conducted alongside the RCT. Direct and indirect costs will be measured. Outcome measures will be assessed at baseline and after 4, 12, 26 and 52 weeks. All statistical analyses will be performed on the intention-to-treat principle. In addition, per protocol analyses will be carried out. DISCUSSION: To improve societal participation of patients with moderate to severe hand eczema, an integrated care intervention was developed involving both person-related and environmental factors. Such integrated care is expected to improve the patients' clinical signs, quality of life and to reduce sick leave and medical costs. Results will become available in 2011.
Assuntos
Eczema/terapia , Dermatoses da Mão/terapia , Administração dos Cuidados ao Paciente/economia , Equipe de Assistência ao Paciente/economia , Adolescente , Adulto , Análise Custo-Benefício , Dermatoses da Mão/classificação , Dermatoses da Mão/economia , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Administração dos Cuidados ao Paciente/organização & administração , Qualidade de Vida , Projetos de PesquisaRESUMO
Allergic contact dermatitis results from a T-cell-mediated, delayed-type hypersensitivity immune response induced by allergens. Skin dendritic cells (DCs) play a central role in the initiation of allergic skin responses. Following encounter with an allergen, DCs become activated and undergo maturation and differentiate into immunostimulatory DCs and are able to present antigens effectively to T cells. The frequency of allergic skin disorders has increased in the past decades. Therefore, the identification of potential sensitizing chemicals is important for skin safety. Traditionally, predictive testing for allergenicity has been conducted in animal models. For regulatory reasons, animal use for sensitization testing of compounds for cosmetic purposes is shortly to be prohibited in Europe. Therefore, new non-animal-based test methods need to be developed. Several DC-based assays have been described to discriminate allergens from irritants. Unfortunately, current in vitro methods are not sufficiently resilient to identify allergens and therefore need refinement. Here, we review the immunobiology of skin DCs (Langerhans' cells and dermal dendritic cells) and their role in allergic and irritant contact dermatitis and then explore the possible use of DC-based models for discriminating between allergens and irritants.
Assuntos
Dermatite Alérgica de Contato/imunologia , Células de Langerhans/imunologia , Células de Langerhans/fisiologia , Fenômenos Fisiológicos da Pele/imunologia , Movimento Celular/fisiologia , Células Cultivadas , Citocinas/imunologia , Citocinas/metabolismo , Dermatite Alérgica de Contato/fisiopatologia , Humanos , Irritantes/imunologia , Irritantes/farmacologia , Sensibilidade e Especificidade , Testes de Irritação da Pele , Testes CutâneosRESUMO
BACKGROUND: Use of sunscreens has increased dramatically worldwide, and some sunscreen chemicals may be allergens. Ultraviolet (UV) filters are added to various cosmetic products. Cinnamate UV filters are structurally related to cinnamon-related fragrances. OBJECTIVE: The purpose of this study was to determine if 'cinnamon-sensitive' patients show positive photopatch tests to cinnamate UV filters and, therefore, should avoid these UV filters. METHOD: We photopatch tested cinnamon-sensitive patients (n = 18) with cinnamon, cinnamon-related fragrances, Myroxylon pereirae, and two cinnamate UV filters. RESULTS: No positive photopatch test to cinnamate UV filters was found (95% confidence interval 0-13%). DISCUSSION: The risk of developing unwanted allergic contact dermatitis because of cinnamate UV filters in cinnamon-sensitive patients seems to be low, but our study population was small. Therefore, we recommend cinnamon-sensitive patients to perform a use test, for example the repeated open application test, before using cosmetic products containing cinnamate UV filters. In addition, physicians and patients should be aware that many sunscreens contain (cinnamon-related) fragrances and could, therefore, elicit allergic contact dermatitis in cinnamon-sensitive patients, independently from other potential sensitizing components of the sunscreen.
Assuntos
Cinamatos/efeitos adversos , Dermatite Fotoalérgica/diagnóstico , Dermatite Fotoalérgica/etiologia , Protetores Solares/efeitos adversos , Administração Tópica , Adulto , Alérgenos/efeitos adversos , Cinamatos/administração & dosagem , Feminino , Humanos , Masculino , Testes do Emplastro/métodos , Projetos Piloto , Pele/efeitos dos fármacos , Queimadura Solar/prevenção & controle , Protetores Solares/administração & dosagem , Raios UltravioletaRESUMO
BACKGROUND: Contact sensitisation has been identified as a factor associated with poor prognosis for patients with hand eczema. OBJECTIVES: To study implications of contact sensitisation with respect to severity, quality of life (QoL) and subdiagnosis of hand eczema. METHODS: The study was performed as a multi-centre, cross-sectional study from 10 European clinics. All patients were patch tested, and severity of hand eczema assessed by Hand Eczema Severity Index. A multi-variate analysis was performed to explore which factors influenced severity, QoL and sick leave. RESULTS: A total 416 patients were included, and 63% had contact sensitisation to one or more of the tested allergens. More women (66%) than men (51%) were sensitized. No significant association was found between sensitisation to specific allergens, disease severity, QoL or diagnostic subgroups. High age, male sex, atopic eczema and presence of contact sensitisation were independent risk factors for increased severity as measured by Hand Eczema Severity Index. Furthermore, the severity of hand eczema increased by the number of contact sensitisations detected (P = 0.023). High age and personal history of atopic eczema were independent risk factors for low QoL, as measured by Dermatology Life Quality Index, and atopic eczema as well as allergic contact dermatitis as subdiagnosis was associated with increased sick leave. CONCLUSION: Diagnostic subgroups were not found to be related to specific allergens. Contact sensitisation was found to be a risk factor for increased severity of hand eczema, as did high age, male sex and atopic eczema.
Assuntos
Dermatite de Contato/epidemiologia , Eczema/epidemiologia , Dermatoses da Mão/epidemiologia , Qualidade de Vida , Índice de Gravidade de Doença , Adolescente , Adulto , Fatores Etários , Idoso , Estudos Transversais , Dermatite de Contato/psicologia , Eczema/psicologia , Europa (Continente)/epidemiologia , Feminino , Dermatoses da Mão/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Licença MédicaRESUMO
Local anesthetics are widely used drugs. In contrast to the local anesthetics of the ester group, the ones of the amide group (for example prilocaine and lidocaine) are considered to be rare sensitizers. Positive patch test results to both prilocaine and lidocaine in EMLA cream might indicate potential cross-reactivity.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Toxidermias/diagnóstico , Toxidermias/etiologia , Lidocaína/efeitos adversos , Prilocaína/efeitos adversos , Idoso de 80 Anos ou mais , Anestésicos Locais/efeitos adversos , Dermatite Alérgica de Contato/terapia , Toxidermias/terapia , Feminino , Humanos , Combinação Lidocaína e Prilocaína , Pomadas/efeitos adversosRESUMO
BACKGROUND: In patients with vulval or anogenital dermatitis, irritant contact dermatitis is more common than allergic contact dermatitis. The reported frequency and relevance of contact sensitivity in anogenital dermatitis varies greatly. OBJECTIVE: To determine the frequency and relevance of contact sensitization in a Dutch group of female patients with chronic anogenital complaints. METHODS: We reviewed patch test results of 53 women with chronic anogenital complaints, with sole vulval symptoms in 29 women and sole perianal in 5, in whom inflammatory skin diseases like lichen sclerosus, lichen planus, psoriasis, as well as infectious diseases were unlikely or excluded as a cause of their symptoms. All women were tested with the European baseline series plus additional test series according to their personal history. RESULTS: Thirty-five patients (66%) showed one or more positive test reactions. Seven of these patients (20%) had one or more clinically relevant positive reactions, most often to flavours and spices. CONCLUSION: A considerable number of patients with anogenital dermatitis have a contact sensitization. Clinically relevant reactions were mainly found to spices and flavours. This is in contrast to the data reported in the literature that shows most contact allergies in vulval patients to ingredients of topical medication.
Assuntos
Alérgenos , Doenças do Ânus/induzido quimicamente , Doenças do Ânus/diagnóstico , Dermatite Alérgica de Contato/diagnóstico , Doenças dos Genitais Femininos/induzido quimicamente , Doenças dos Genitais Femininos/diagnóstico , Especiarias/toxicidade , Adulto , Doenças do Ânus/epidemiologia , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Feminino , Doenças dos Genitais Femininos/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro/métodos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Cytokines play an important role in skin inflammation. OBJECTIVES: We determined whether polymorphisms in cytokine genes contribute to the occurrence of occupational chronic irritant contact dermatitis (CICD). METHODS: In a case-control study, 9 polymorphisms in the genes coding for interleukin (IL)-1 alpha, IL-1 beta, IL-8, IL-10, and tumour necrosis factor (TNF)-alpha were determined in 197 patients with CICD. 217 apprentices in vocational training for high-risk occupations for CICD served as controls. RESULTS: For all polymorphisms, no differences in genotype distributions were found between patients and controls. However, in patients with self-reported low levels of wet work and irritant exposure, more TNFA -308 variant genotypes (G/A and A/A) were present compared with those exposed to higher levels or controls, which indicates a TNFA-induced increase of susceptibility. In patients with TNFA -308 variant genotypes, the prevalence of flexural eczema was higher (48% and 57%) compared with that in patients presented with wild-type genotype (30%). Regarding IL1A -889, prevalence of symptoms of dermatitis was lower in apprentices with T/T or C/T genotype (32% and 36%) compared with wild-type genotype (54%, C/C). This indicates a protective effect of these variant alleles in acquiring hand dermatitis. CONCLUSIONS: This study provides evidence that some genetic variations alter susceptibility to (chronic) dermatitis. Knowledge of the impact of genetic differences on the risk of CICD is essential in predictive testing of individuals at risk.
Assuntos
Dermatite Irritante/genética , Dermatite Ocupacional/genética , Predisposição Genética para Doença , Interleucina-1alfa/genética , Polimorfismo de Nucleotídeo Único , Fator de Necrose Tumoral alfa/genética , Adolescente , Adulto , Estudos de Casos e Controles , Doença Crônica , DNA/análise , Dermatite Atópica/genética , Feminino , Frequência do Gene , Genótipo , Dermatoses da Mão/genética , Humanos , Interleucina-10/genética , Interleucina-1beta/genética , Interleucina-8/genética , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND AND OBJECTIVES: Hand eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups. METHODS: A total of 416 patients with hand eczema from 10 European patch test clinics participated in the study. Data on QoL were obtained from a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Severity was assessed by a scoring system (Hand Eczema Severity Index, HECSI) as well as frequency of eruptions and sick leave due to hand eczema. RESULTS: No significant difference was found between males and females with respect to QoL [DLQI median values and 25/75 percentiles for males and females being 7.0 (3-14) and 8.0 (3-13), respectively], although males were more severely affected than females (P < 0.025). A significant positive correlation was found for hand eczema severity and age (P < 0.001), while no significant correlation was found for QoL and age. QoL was found increasingly reduced when sick leave was getting higher (P < 0.001). A statistically significant correlation between QoL (as measured by DLQI) and hand eczema severity as measured by HECSI was found (P < 0.001). No significant difference in QoL was found between diagnostic subgroups. CONCLUSIONS: QoL was found markedly negatively affected in hand eczema patients and was significantly correlated to disease severity. No significant difference in QoL was found between males and females, in spite of significantly more severe eczema in males, indicating that QoL in female patients is more easily affected.
Assuntos
Eczema/psicologia , Dermatoses da Mão/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Dermatite Atópica/classificação , Dermatite Atópica/psicologia , Dermatite de Contato/classificação , Dermatite de Contato/psicologia , Eczema/classificação , Feminino , Dermatoses da Mão/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores Sexuais , Licença Médica , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Fragrances are an important cause of allergic contact dermatitis. We presume that the traditional fragrance mix (FM) detects 70 to 80% of fragrance-allergic patients. FM has an irritant potential. Weak positive reactions may have a greater chance of being irrelevant than strong reactions. OBJECTIVE: To improve the appraisal of FM patch-test reactions, we studied the relevance of reactions of different strength. We also studied the predictive value of the following on the relevance of the initial FM patch-test results: patch-test results of a repeated FM test; results of patch tests with balsam of Peru, colophony, and ingredients of the mix; and (history of) atopic dermatitis. METHODS: One hundred thirty-eight patients who had doubtful positive (?+) or positive (+ to +++) reactions were included in the study. We determined relevance by history taking, location and course of the dermatitis, and additional patch testing. Patients were retested with FM and with each ingredient separately. RESULTS: The relevance of reactions to FM increases with the strength of the reactions. Predictors of relevance are the results of retesting with FM, the results of tests with the ingredients, and a history and/or present symptoms of atopic dermatitis. CONCLUSION: Retesting with FM and its ingredients may add to the benefit of patch testing.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Testes do Emplastro , Perfumes/efeitos adversos , Adulto , Alérgenos/administração & dosagem , Alérgenos/efeitos adversos , Relação Dose-Resposta a Droga , Europa (Continente) , Feminino , Produtos Domésticos/toxicidade , Humanos , Irritantes/efeitos adversos , Masculino , Concentração Máxima Permitida , Perfumes/administração & dosagem , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeAssuntos
Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/etiologia , Desinfetantes/efeitos adversos , Conservantes Farmacêuticos/efeitos adversos , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Formaldeído/efeitos adversos , Humanos , Masculino , Metenamina/efeitos adversos , Metenamina/análogos & derivados , Nitrilas/efeitos adversos , Parabenos/efeitos adversos , Testes do Emplastro , Tiazóis/efeitos adversos , Ureia/efeitos adversos , Ureia/análogos & derivadosRESUMO
OBJECTIVE: To study whether oral psoralen-UV-A (PUVA) with a portable tanning unit at home is as effective as hospital-administered bath PUVA in patients with chronic hand eczema. DESIGN: Open-label randomized controlled trial, with a 10-week treatment period and an 8-week follow-up period. SETTING: Two university hospital dermatology departments in the Netherlands, specializing in hand eczema. PATIENTS: One hundred fifty-eight patients with moderate to severe chronic hand eczema (more than 1 year in duration). INTERVENTIONS: Oral PUVA using methoxsalen capsules and a simple portable commercial facial tanning unit, or hospital-administered bath PUVA with trioxsalen. MAIN OUTCOME MEASURES: The primary outcome was clinical assessment by a hand eczema score (evaluation of desquamation, erythema, vesiculation, infiltration, fissures, itch, and pain, each on a 4-point scale) after 10 weeks of treatment. The secondary outcome was hand eczema score at 8 weeks of follow-up, after completion of treatment. The tertiary outcome was travel cost and time off work. RESULTS: Both groups showed a comparable and substantial decrease in hand eczema score (meaningful clinical improvement). This decrease was maintained during the follow-up period. Patients treated with oral PUVA at home had lower travel costs and less time off work. CONCLUSIONS: Oral PUVA at home has a clinically relevant efficacy, similar to that of hospital-administered bath PUVA. This effect was maintained during an 8-week follow-up period. It resulted in lower travel costs and less time off work.
Assuntos
Assistência Ambulatorial , Eczema/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Serviços de Assistência Domiciliar , Terapia PUVA/métodos , Administração Oral , Adulto , Idoso , Banhos , Cápsulas , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Metoxaleno/administração & dosagem , Metoxaleno/uso terapêutico , Pessoa de Meia-Idade , Terapia PUVA/instrumentação , Resultado do TratamentoRESUMO
The initial step in Langerhans cell (LC) migration from the epidermis to the lymph node involves migration of maturing LC into the dermis. Here, we investigated the migration of LC out of the epidermis after exposure of the skin to contact allergens. Ex vivo intact human skin, epidermal sheets, and LC derived from the MUTZ-3 cell line (MUTZ-LC) were used to determine whether dermal fibroblasts play a role in mediating LC migration towards the dermis. Exposure of epidermal sheets or MUTZ-LC to allergens (nickel sulphate, 2,4-dinitrochlorobenzene, and cinnamaldehyde) or a cytokine maturation cocktail resulted in LC migration towards dermal fibroblasts. This was due to upregulation of CXCR4 on maturing LC and secretion of CXCL12/stromal derived factor-1 chemokine by fibroblasts. Neutralizing antibodies to either CXCL12 or CXCR4 completely blocked migration. Injection of CXCL12 neutralizing antibodies into intact human skin totally inhibited LC migration into the dermis. In contrast, neutralizing antibodies to CCL19/CCL21 did not inhibit migration into the dermis. We describe a novel and essential role of dermis-derived CXCL12 in initiating migration of maturing human LC to the dermis thus permitting their further journey to the draining lymph nodes.
Assuntos
Quimiocina CXCL12/fisiologia , Epiderme/imunologia , Células de Langerhans/fisiologia , Pele/imunologia , Adulto , Alérgenos/imunologia , Movimento Celular , Células Cultivadas , Humanos , Receptores CXCR4/fisiologiaRESUMO
To date, no in vitro test is suitable for routine diagnosis of contact allergy. The aim of our study was to establish improved in vitro test protocol for the detection of antigen-specific responses of lymphocytes from patients with allergic contact dermatitis to nickel (Ni-ACD). Blood leucocytes from 14 Ni-ACD patients and 14 controls were cultured in the presence of 'cytokine cocktails' skewing lymphocytes towards 'type 1' [interferon-gamma (IFN-gamma)-secreting] or 'type 2' [interleukin (IL)-5 and IL-13-secreting] phenotypes. The cocktails consisted of IL-7 and, respectively, either IL-12 or IL-4. Cell responses to nickel were measured with enzyme-linked immunospot assay (ELISpot), enzyme-linked immunosorbent assay (ELISA), and lymphocyte proliferation test (LPT). Significant differences between patients with Ni-ACD and controls were found for the 'type 2' cytokines IL-13 and IL-5, with further increase of allergen-specific responses occurring when cultures were supplemented with IL-7 and IL-4. No significant differences were found for IFN-gamma. The best correlate to clinical diagnosis was LPT with 'type 2' skewing (r= 0.739, P < 0.001), followed by IL-13 ELISpot with 'type 2' skewing (r= 0.654, P < 0.001). The non-radioactive method that correlated best with LPT was IL-2 ELISpot (r= 0.809, P < 0.001). Overall, we conclude that combining ELISpot assay with proposed modifications of culture conditions improves detection of specific lymphocyte responses in contact allergy to nickel.
Assuntos
Alérgenos/imunologia , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/imunologia , Níquel/imunologia , Células Th1/imunologia , Células Th2/imunologia , Estudos de Casos e Controles , Técnicas de Cultura , Dermatite Alérgica de Contato/patologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interferon gama/biossíntese , Interleucinas/biossíntese , Valor Preditivo dos TestesRESUMO
Type 1 and type 2 cytokines are primary mediators in contact allergy and aeroallergen-mediated disorders, respectively. For both types of disease, dendritic cells (DCs) are pivotal in initiating immune hyperresponsiveness. We studied whether contact and respiratory allergens possess intrinsic capacities to polarize DC towards DC1 and DC2 functions, independent of environmental factors. Human monocyte-derived DCs were exposed to the positive controls [type 1: lipopolysaccharide (LPS) + interferon-gamma; type 2: LPS + prostaglandin E(2)], contact allergens [2,4-dinitrochlorobenzene (DNCB), oxazolone (OXA), and nickel sulfate (NiSO(4))], and respiratory allergens [trimellitic anhydride (TMA) and the protein allergen derived from Dermatophagoides pteronyssinus (Der p1)]. The polarizing potentials of the allergens on DCs were determined by the secretion of type 1 [tumour necrosis factor-alpha (TNF-alpha), CXCL10, and interleukin (IL)-12p70] and type 2 (IL-10) cytokines. The contact allergens, DNCB and OXA, induced strict type 1 DC polarization, whereas the respiratory allergens, TMA and Der p1, showed strict type 2 DC polarization. The contact allergen, NiSO(4), induced both DC1 (TNF-alpha and CXCL10 production) and DC2 (decreased IL-12p70/IL-10 ratio) features. These results support the view that allergens have an intrinsic capacity to skew immune responses at the DC level, irrespective of local factors such as those determined by cutaneous or mucosal epithelial microenvironments.
Assuntos
Alérgenos/farmacologia , Citocinas/biossíntese , Células Dendríticas/metabolismo , Dermatite Alérgica de Contato/imunologia , Hipersensibilidade Respiratória/imunologia , Alérgenos/imunologia , Quimiocina CXCL10 , Quimiocinas CXC/biossíntese , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Ensaio de Imunoadsorção Enzimática , Humanos , Interleucina-12/biossíntese , Lipopolissacarídeos , Fator de Necrose Tumoral alfa/biossínteseRESUMO
Mercaptobenzothiazole (MBT) compounds are well known contact allergens. To detect rubber allergic patients we use both MBT (2% in petrolatum) and a mercapto-mix with 4 constituents of 0.5% each in our standard series. In this article the EECDRG presents data of in total 32,475 consecutive tested patients attending the respective contact dermatitis clinics from 11 centres in Europe to determine if the mix and MBT detected the same allergic patients. We found 327 patients positive to the mix or MBT, or to both. 261 were positive to the mix and 254 to MBT. MBT was negative in 73 patients who were positive to the mix. If the mix had not been in the standard series, on average 22% of patients allergic to a mercapto-compound would have been missed, for MBT this would have been on average 20%. All clinics would have missed a significant number of positive reactions if both compounds had not been tested. We conclude, that both the mercapto mix and MBT are required in the standard series.