Severe Contact Dermatitis Research Articles

Oriental lacquer, poison ivy, and drying oils

From the oriental lacquer tree Toxicodendron vernicifluum, a sap (emulsion) is obtained the oil-soluble components (urushiol) of which consist of a mixture of 3-n-pentadecylcatechols and very small amounts of 3-n-heptadecylcatechols. Urushiol is the basis of oriental lacquer. The sap is conditioned by removal of most of the water by specific techniques, and the clear liquid is called oriental lacquer. It is used in the Orient for coatings to produce exquisite art objects. Poison ivy also has as its active ingredients 3-n-pentadecylcatechols, but they have a high diene content, which does not cure effectively. In humans 3-n-alkylcatechols cause severe contact dermatitis. The components of drying oils are glycerin esters of fatty acids derived from the families of palmitic (hexadecanoic) and stearic (octadecanoic) acids. In the case of the urushiols, as well as of the glycerides of drying oils, high unsaturation (60%) in the form of trienes in the long aliphatic chains is essential for curing. © 2000 John Wiley & Sons, Inc. J Polym Sci A: Polym Chem 38: 4327–4335, 2000

Effect of Am-80, A Novel Retinoid Derivative, On Contact Hypersensitivity Caused by Repeated Applications of Hapten in Mice

Some retinoids show an anti-inflammatory action through regulation of transcription of various genes. In the present study, the inhibitory effect of 4-((5,6,7,8- tetrahydro-5,5,8,8-tetramethyl-2-naphthyl) carbamoyl) benzoic acid (Am-80), a synthetic retinoid, on mouse contact hypersensitivity provoked by repeated applications of 2,4-dinitrofluorobenzene (DNFB) to the ear was investigated. Five-fold applications of DNFB on ears once per week elicited severe contact dermatitis with marked infiltration of inflammatory cells and elevation of anti-dinitrophenyl (DNP)-IgE antibody in the serum. The Am-80 significantly inhibited ear swelling in a dose-dependent manner. In the histopathologic study, infiltration of inflammatory cells was clearly decreased by Am-80. However, Am-80 did not affect the production of DNP-specific IgE antibody both at the transcriptional and post-transcriptional levels. The effects of Am-80 on the transcriptional level of cytokines, interferon (IFN)-γ, interleukin (IL)-1 and IL-4 in cervical lymph nodes were investigated. Marked elevation of mRNA for all cytokines was observed and Am-80 potently inhibited the expression of IFN-γ mRNA, but not IL-1 and IL-4 mRNA. These findings indicated that Am-80 may inhibit the contact dermatitis at the post-sensitization phase by inhibiting IFN-γ production at the transcriptional level in mice.

Severe toxic contact dermatitis caused by garlic

Severe toxic contact dermatitis caused by garlic

Contact Dermatitis Induced by Chemicals for Hair-dyeing in Hairless Dogs.

Dermatotoxicity of topical application of chemicals for hair-dyeing (CHD) was clinically and histopathologically investigated in hairless dogs. CHD examined were as follows: 1. Resorcinol (RCL), 2. pyrogallol (PGL), 3. tolylene-3, 4-diamine (T34D), 4. tolylene-2, 4-diamine (T24D), 5. ammonium persulfate (AMPS), 6. potassium persulfate (PTPS), 7. hydrogen peroxide (HDPO), and 8. vehicle (control). Severe contact dermatitis characterized by swelling, intense edema, and blister formation was seen at 4 or 5 days application of PGL. Test sites applying T34D and T24D showed striking contact dermatitis from 7 to 10 days application. Especially, the T34D-applying sites showed prominently edematous vesicular reactions followed by moderate pigmentation. At the test site applying AMPS provoked delayed contact dermatitis. At the test sites applying HDPO, severe dermatitis was immediately exhibited. Histopathologically, test sites applying RCL showed remarkable hyperkeratosis. At the test site 5 days application of PGL, intraepidermal blisters contained abundant inflammatory cells. At the test site 10 days application of T34D and T24D, prominent hypertrophy of epidermal cells and infiltration of inflammatory cells in the dermis were observed. These histopathological findings were severer in the test sites applying T34D than T24D. At the site 40 days after the end of topical application of T34D, a few epidermal cells with pyknotic nuclei and eosinophilic cytoplasma were seen in some repairing epithelium. By 40 days after the end of application of T34D, pigmentation was observed in the stratum basale and spinosum. From 20 to 30 days application of AMPS, focal necrosis in the dermal-epidermis junction was noted. In the dermis, prominent inflammatory changes were observed. At the test site 5 days application of HDPO, the epidermis was thickened by intracellular edema and hyperplasia of component cells. Additionally, the epidermis showed prominent parakeratosis. These results revealed that the skin of hairless dogs gave a definitive response to topical application of CHD. Hairless dogs were suggested for laboratory animals to evaluate immediate-and/or delayed-type dermatotoxicity of CHD.

Development and validation of a quality of life instrument for cutaneous diseases

Background: The Dermatology-Specific Quality of Life (DSQL) instrument is a new tool to quantify the effects of skin disease on physical discomfort and symptoms, psychologic well-being, social functioning, self-care activities, performance at work or school, and self-perceptions. Objective: Our purpose was to describe the reliability and validity of the DSQL in two disease cohorts comprising patients with contact dermatitis and acne vulgaris. Methods: Reliability was assessed from the internal consistency of the items, and correlations were made between DSQL scores from a 3- to 7-day retest. Validity was assessed from correlations of DSQL scales with global ratings of bothersome symptoms and perceived severity and by discrimination of clinically defined severity groups. Results: The DSQL scales had high internal consistency (0.70 to > 0.90) and test-retest reliability ( r = 0.81 to 0.89), and were moderately to highly correlated with patient global ratings of symptom distress ( r = 0.25 to 0.67) and overall disease severity ( r = 0.19 to 0.54). Patients rated with severe contact dermatitis or acne scarring had higher DSQL scores than those with less severe skin disease. Factor analyses found separate dimensions of physical, emotional, and social functioning involvement from skin disease. Conclusion: The DSQL provides valid and reliable assessments of quality of life impacts associated with acne and contact dermatitis. (J Am Acad Dermatol 1997; 37:41–50).

Modulation of Fatty Acid Oxidation Alters Contact Hypersensitivity to Urushiols: Role of Aliphatic Chain β-Oxidation in Processing and Activation of Urushiols

Lithraea caustica, or litre, a tree of the Anacardiaceae family that is endemic to the central region of Chile, induces a severe contact dermatitis in susceptible human beings. The allergen was previously isolated and characterized as a 3-(pentadecyl-10-enyl) catechol, a molecule belonging to the urushiol group of allergens isolated from poison ivy and poison oak plants. Because urushiols are pro-electrophilic haptens, it is believed that the reactive species are generated intracellularly by skin keratinocytes and Langerhans cells. The active species are presumed to modify self proteins which, after proteolytic processing, would generate immunogenic peptides carrying the hapten. The presence of a 15-carbon-length hydrophobic chain should impair antigen presentation of self-modified peptides by class I MHC molecules, either by steric hindrance or by limiting their sorting to the ER lumen. We have proposed that the shortening of the aliphatic chain by beta-oxidation within peroxisomes and/or mitochondria should be a requirement for the antigen presentation process. To test this hypothesis we investigated the effect of drugs that modify the fatty acid metabolism on urushiol-induced contact dermatitis in mice. Clofibrate, a peroxisomal proliferator in mice, increased the immune response to the urushiols from litre by 50%. Conversely, tetradecyl glycidic acid, an inhibitor of the uptake of fatty acids by mitochondria, decreased the hypersensitivity to the hapten. An increase in the level in glutathione by treatment of the animals with 2-oxotiazolidin-4-carboxilic acid lowered the response. Those findings strongly support a role for the fatty acid oxidative metabolism in the processing and activation of urushiols in vivo.

Severe Contact Dermatitis from Chemical Mace Containing 1-Chloroacetophenone

AbstractAerosolized lacrimating agents are widely employed as “safe” criminal deterrents. The most common active ingredient in these products is 1-chloroacetophenone (CN). Although mild and brief skin and eye irritation is frequently seen following exposure to these compounds, severe reactions can occur. We report a patient who sustained a severe contact dermatitis after being sprayed with chemical mace and required hospitalization and aggressive treatment.

Dermatitis in hairdressers (II). Management and prevention.

Hand dermatitis in hairdressers is caused by a variety of factors. Important are the sensitizing and irritant capacities of some hair-cosmetic ingredients, unsafe packaging which causes contamination of the hands, work tables and instruments with hazardous chemicals, absence of protection with adequate gloves and ignorance of safe handling of these chemicals. A strategy is proposed, based on improvement of the safety of ingredients and packaging, use of vinyl gloves and introduction of safe hairdressing procedures. Introduction of this strategy in hairdressing salons with 16 cases of moderate to severe contact dermatitis reduced the number of cases of active dermatitis to 3 in 4 months. The value of pre-employment screening is discussed and the necessity of cooperation of centers of occupational dermatology is emphasized.

Evaluation of customers' complaints about sunscreen cosmetics sold by the Swedish pharmaceutical company

Sweden's pharmacies hold more than a 1/3 of the country's market for sunscreen cosmetics (sunscreens). Customers complaining of skin problems associated with the use of sunscreens obtained from the pharmacies were offered dermatological investigation and tests with standard allergens and sunscreens. 27 of 58 complaining customers were fully investigated, and another 8 partly tested. 2 disease entities, a burning sensation and erythema for one or a few days, and dermatitis with scaling lasting for up to 3 weeks, were about equally common. Contact or photocontact allergy to 2-hydroxy-4-methoxybenzophenone caused severe contact dermatitis in 3 individuals.

Lymphocyte subsets in patients with compositae oleoresin dermatitis and increased UVA sensitivity during treatment with azathioprine.

Four patients with severe contact dermatitis resulting from compositae oleoresin were found to have increased sensitivity to ultraviolet light. All showed a clear reduction of Leu-3a-positive lymphocytes (T helper/inducer cells) and cells expressing the Ia phenotype in their blood. The numbers of T suppressor/cytotoxic (Leu 2a) lymphocytes, monocytes and B lymphocytes were within the normal range. Treatment with azathioprine (150 mg daily) improved the eczema. The number of Leu-3a-positive lymphocytes normalized during therapy, but the number of Ia-positive cells did not.

Hot Tub Folliculitis

Pseudomonas aeruginosa folliculitis, occurring in association with use of public hot bath facilities, has been familiar to epidemiologists and some dermatologists since the early 1970s. Since 1975, five reports of epidemics involving 27 to 75 clinically ill persons have been published. 1-3 The importance of reexamining this disease now is that it has become apparent that the same clinical syndrome can occur as isolated cases associated with use of home hot tubs and spas. 4 In such nonepidemic circumstances, when the patient does not relate his illness to hot tub use, this self-limited and benign disease may be mistaken for more serious problems, eg, meningococcal or gonococcal septicemia, atypical virus, severe contact dermatitis, or other serious infection with rash. The illness is similar, whether contracted in public facilities or in a home hot tub, and usually begins six hours to five days after the episode of hot tub use; a

Contact Dermatitis from "Scotchgard," A Stain Repellent for Fabrics

ONE OF US (L.S.G.) recently sustained a severe contact dermatitis from the wearing of slacks treated with "Scotchgard,"* a fluorocarbon-containing formulation designed to impart stain and water repellency to cloth used for garments, furniture covers, and similar items. We are unaware of any report in the medical literature concerning untoward dermatological effects from this product, and the manufacturer has informed us that, to date, they have not received complaints of this nature.¹Since Scotchgard-treated fabrics are now widely sold, it was thought important to call the attention of the medical profession to the possibility that contact with such fabrics can cause dermatitis. In the present case, Scotchgard was proved to be the offending agent, and the cloth itself and the dye were eliminated as causal factors. The patient wore a new pair of Scotchgardtreated slacks for 4 days. About 4 days later, the dorsal surfaces of the hands began

Contact Dermatitis to Phenothiazine Drugs

Since the advent of use of phenothiazine derivatives as “tranquilizing” drugs, physicians have become aware of the occurrence of severe contact dermatitis in response to administration or handling of certain members of this chemical group (1-3). In addition, clinical observations (4) of the course of jaundice in patients taking oral doses of tranquilizers of this group strongly suggest that other side reactions, notably chlor-promazine hepatitis, may well be allergic manifestations. Hepatitis, as well as agranulocytosis, has been accompanied by skin reactions, and the course of the liver sensitization and desensitiza-tion, studied in a group of patients on a protracted course of chl or promazine therapy, seems to indicate that a similar mechanism of drug sensitivity is involved (5). A peculiar type of retinal toxicity, which also seems to have an allergic basis, has been reported with a phenothiazine drug (6).

Cashew nut shell oil for hyposensitization against rhus dermatitis.

The requirements for hyposensitizing Rhus-sensitive persons with specific allergens have been given in a previous paper.¹The present study demonstrates that cashew nut shell oil may be used for this purpose. This material is cheap, easily obtained, stable, and of fairly constant composition. Cashew Nut Shell Oil The cashew tree (Anacardium occidentale) is extensively cultivated in Brazil and India because of the edibility of its nut; however, the nut does not give up its prize easily, for the kernel is encased in a tough shell. The natives solve this problem by roasting the nuts at high temperatures until the rind becomes brittle; a sharp blow then delivers the kernel. During the heating, a brownish oil capable of causing severe contact dermatitis is released from the rind. The shell contains about 35% of oil by weight. Heating causes the honeycombed oil-secreting cells to burst open. More effi

The use of prednisolone (Sterane) in the treatment of severe allergic diseases

We have found prednisolone to be a very effective, convenient, and safe form of corticosteroid therapy. Severe side reactions were not numerous. These subsided quickly with cessation of the drug. It is still our opinion that such medications should be reserved for emergencies, such as symptoms of unusual severity, and intractability to other forms of treatment. Our experience is largely limited to short-term therapy. The ten patients who are being maintained on small doses of prednisolone all have intrinsic asthma with advanced emphysema. It has been impossible in these to interrupt therapy without severe exacerbation of symptoms. Our experience supports the general opinion that peptic ulcer and certain infections are contraindications to its use. Prednisolone is our drug of choice in severe drug reactions (except anaphylaxis requiring epinephrine), acute pollinosis, severe contact dermatitis, and severe urticaria with angioedema. We feel that it shares honors with ACTH in the treatment of intractable asthma.

Cocobolo wood dermatitis: Report of a case due to wooden handles on kitchen knives

About three-quarters of the entire output of cocobolo wood is used for cutlery handles. A case of severe contact dermatitis due to cocobolo wood handles on kitchen knives is reported. The possibility of sensitization to this substance in cases of dermatitis of the hands should be kept in mind.