Recalcitrant Course Research Articles

Allergic contact dermatitis from formaldehyde resins in permanent press clothing: An underdiagnosed cause of generalized dermatitis

Formaldehyde resins have been used to impart wrinkle resistance to clothing fabrics since 1926. After several patients with positive patch tests to formaldehyde resins had been examined, a study was undertaken of the records of all patch tests performed at the University of Louisville Patch Test Clinic and the Allergy Section of the Skin and Cancer Clinic of New York University Medical Center from January 1988 through April 1990 to determine the prevalence of positive patch-test reactions to formaldehyde-based textile resins and the clinical and demographic patterns associated with textile resin allergy. Seventeen patients were identified at the two centers. Twelve were allergic to formaldehyde as well as to formaldehyde textile resins. Several clinical patterns were found, including accentuation of dermatitis in areas of tight clothing, primary occurrence in clothing-covered areas, and a chronic recalcitrant course. Ethylene urea melamine formaldehyde resin was the best screening agent with 14 definite positive reactions and one equivocal reaction. Formaldehyde textile resin allergy is more common than has been previously recognized. Patch testing with one or more formaldehyde textile resins is indicated in patients with a particular pattern of dermatitis.

Prevalence of the early warning signs of melanoma among participants in the 1989 Rhode Island skin cancer screening

Discussion. The mechanism of action of cyclosporine is unknown. Inhibition of keratinocyte proliferation and synthesis and/or release of cytokines from inflammatory cells3 have been demonstrated. Both effects may be important for cyclosporine's beneficial action in psoriasis. This case demonstrates the efficacy of cyclosporine in pustular psoriasis of the palms, a disease characterized by its chronic, recalcitrant course. Thus far, one patient has been reported whose disease responded to cyclosporine (14 rug/kg/day). We believe that our observation of the therapeutic efficacy of the drug at daily doses as lowas 4.8 to 2.1 mg/kg is important, particularly because long-term maintenance therapy may be necessary. Recent investigations have shown the relative safety of low-dose cyclesporine regimens. In 29 patients studied by renal biopsy, no signs of nephrotoxicity were observed at doses less than 7.5 rug/kg/day, whereas in five of nine patients taking higher daily doses, nephrotoxicity occurred.l? Journal of the American Academy of Dermatology