Topical Medicaments Research Articles

Biophysical measurements of human forearm skin in vivo: effects of site, gender, chirality and time.

BACKGROUND/AIMS: Measurements of transepidermal water loss (TEWL) and skin colour are biophysical techniques commonly used to measure the in vivo skin effects of cosmetics, topical medicaments and chemical irritants. The purpose of this study was to investigate the variability of TEWL and skin colour on human forearm skin as a function of regional variation, gender and preferred chirality over an 8 h period. METHODS: Biophysical measurements of TEWL and skin colour were made at five sites on both forearms of male (n=8) and female (n=9) human volunteers in vivo (38% relative humidity, 21 degrees C). RESULTS: Rates of TEWL at the forearm midpoint were 10% lower than at the forearm extremities (P<0.01). Skin redness (a*) near the wrist was 5-10% higher than at other sites (P<0.05). Rates of TEWL were 5% higher in male volunteers (P<0.05). Red and blue (b*) colour measurements of male forearm skin differed by 18% and 20% in comparison with female, respectively. Rates of TEWL, skin brightness (L*) and b* decreased by 9% (P<0.05), 1.8% (P<0.05) and 4% (P<0.05), respectively, with time whereas a* and skin temperature increased by 4.5% (P<0.01) and 7.2% (P<0.01), respectively. There was a significant correlation between the change in all measured parameters with time. CONCLUSIONS: Significant differences in TEWL and skin colour were identified that may have relevance in the design and interpretation of multivariate analyses of human forearm skin. Diurnal variation of TEWL, skin colour and temperature may have a single underlying mechanism.

Is the face and neck pattern of atopic dermatitis in Japan a special variant?

Background: Adult atopic dermatitis (AD) with severe and refractory eruptions on the face, neck, and upper trunk, although quite rare in western countries, has increased in Japan. Objective: We have tried to clarify the possible causative factors for this particular type of AD, predominantly seen in Japan. Methods: Eighty-seven AD patients (37 men and 50 women) who had severe and refractory facial and neck lesions were patch tested with topical medicaments, cosmetics, and skin-management products. Results: Thirty-seven (42.5%) patients showed positive reactions to more than one of those products: 14 patients to shampoo, rinse, or soap; 11 to topical nonsteroidal anti-inflammatory agents (NSAIDs); 7 to cosmetics; and 6 to corticosteroids. Conclusion: We believe that topical NSAIDs, (which are often prescribed for the treatment of AD in Japan and rarely used for the treatment of eczamatous skin disorders in western countries), as well as common detergents, play important roles in the increased prevalence of AD patients with severe and refractory lesions on the face, neck, and upper trunk in Japan.

Allergic Contact Dermatitis to Preservatives in Topical Medicaments

Allergic Contact Dermatitis to Preservatives in Topical Medicaments

Contact dermatitis in children: 6 years experience (1992-1997).

We report the results of patch tests carried out over the last 6 years (1992 1997) on 141 children. This corresponds to 2.8% of the total patients who were patch tested in our Allergy Department (5,014). These 141 children were patch tested using the TRUE Test standard series and an additional allergen, metallic mercury. Allergens from the Chemotechnique medicaments, cosmetics, plants and shoe series were added in some. The most frequent localization of eczema was to the feet, face and hands and the most frequent suspected causes were costume jewelry, footwear, topical medicaments and cosmetics. The most frequent allergens, assessed by degree of relevance, were first, nickel, followed by cobalt, mercurials (thimerosal and metallic mercury), fragrance and rubber chemicals (naphthyl mix, mercapto mix, carba mix and PPD mix). 13 children, 18% of the total, between the ages of 12 and 14 years, showed positivities relevant to some occupation, i.e., metalworking, building, hairdressing, catering, etc. Once patch tests had been carried out and relevant positive patch tests assessed, the most frequent diagnoses were contact dermatitis 45%, atopic dermatitis 25%, juvenile plantar dermatitis 15%, and other diagnoses in the remaining 15%.

Allergic Contact Dermatitis to Preservatives in Topical Medicaments

Background: Formaldehyde-releasing preservatives are well-known allergens found in many topical preparations including medications. Objective: To analyze the relevance of a positive patch test to formaldehyde-releasing preservatives in medications containing these preservatives. Methods: Patients were recruited with a history of allergy to one of these preservatives. Patch and use testing to the medications, vehicles, and preservatives were performed. The following medications and their respective preservatives were used: Renova 0.05% cream/quaternium-15, Dovonex 0.005% cream/diazolidinyl urea, and Temovate-E 0.05% cream/diazolidinyl urea. Results: Nine patients participated in the study. A positive patch test to the preservative was reproduced in six of nine patients, and a questionable reaction occurred in one. Two patients had a positive patch test to the topical medication and one a questionable reaction. There were no definitive positive patch tests to the vehicle but two questionable ones. Use testing revealed three positive reactions to Renova, one to Renova vehicle, and one to Temovate-E vehicle. Conclusions: The concentration of the preservative in the commercial preparation was often below the threshold necessary to produce a clinical reaction. Use testing is a valuable tool in the complete evaluation of the patient with a positive patch test to a formaldehyde-releasing perservative found in topical medication.

Allergic contact dermatitis to preservatives in topical medicaments

Background : Formaldehyde-releasing preservatives are well-knwn allergens found in many topical preparations including medications. Objective : To analyze the relevance of a positive patch test to formaldehyde-releasing preservatives in medications containing these preservatives. Methods : Patients were recruited with a history of allergy to one of these preservatives. Patch and use testing to the medications, vehicles, and preservatives were performed. The following medications and their respective preservatives were used: Renova 0.05% cream/quaternium-15, Dovonex 0.005% cream/diazolidinyl urea, and Temovate-E 0.05% cream/diazolidinyl urea. Results : Nine patients participated in the study. A positive patch test to the preservative was reproduced in six of nine patients, and a questionable reaction occurred in one. Two patients had a positive patch test to the topical medication and one a questionable reaction. There were no definitive positive patch tests to the vehicle but two questionable ones. Use testing revealed three positive reactions to Renova, one to Renova vehicle, and one to Temovate-E vehicle. Conclusions : The concentration of the preservative in the commercial preparation was often below the threshold necessary to produce a clinical reaction. Use testing is a valuable tool in the complete evaluation of the patient with a positive patch test to a formaldehyde-releasing perservative found in topical medication.

Foot dermatitis in children: causative allergens and follow-up.

Allergic contact dermatitis from shoes may have a typical pattern of presentation, but we have found that the distribution of dermatitis is often unhelpful in establishing the diagnosis. In this study, we aimed to define the features of foot dermatitis in children and to assess its outcome, in comparison to adults with foot eruptions. Relevant allergens were found in 15 out of 29 children and 26 out of 57 adults with foot eruptions. The most common allergens in children were rubber chemicals and topical medicaments. Adults showed a similar pattern, but also reacted to clothing dyes. The prognosis in both groups was good, with the dermatitis improving or resolving in 2/3.

ASSESSMENT OF THE SKIN SENSITIZATION POTENTIAL OF TOPICAL MEDICAMENTS USING THE LOCAL LYMPH NODE ASSAY: AN INTERLABORATORY EVALUATION

The murine local lymph node assay (LLNA) is a method for the predictive identification of chemicals that have a potential to cause skin sensitization. Activity is measured as a function of lymph node cell (LNC) proliferative responses stimulated by topical application of test chemicals. Those chemicals that induce a threefold or greater increase in LNC proliferation compared with concurrent vehicle controls are classified as skin sensitizers. In the present investigations we have evaluated further the reliability and accuracy of the LLNA. In the context of an international interlaboratory trial the sensitization potentials of six materials with a history of use in topical medicaments have been evaluated: benzoyl peroxide, hydroquinone, penicillin G, streptomycin sulfate, ethylenediamine dihydrochloride, and methyl salicylate. Each chemical was analyzed in the LLNA by all five laboratories. Either the standard LLNA protocol or minor modifications of it were used. Benzoyl peroxide and hydroquinone, both human contact allergens, elicited strong LLNA responses in each laboratory. Penicillin G, another material shown previously to cause allergic contact dermatitis in humans, was also positive in all laboratories. Streptomycin sulfate induced equivocal responses, in that this material provoked a positive LLNA response in only one of the five laboratories, and then only at the highest concentration tested. Ethylenediamine dihydrochloride dissolved in a 3:1 mixture of acetone with water, or in 4:1 acetone:olive oil (one laboratory), was uniformly negative. However, limited further testing with the free base of ethylene diamine yielded a positive LLNA response when applied in acetone:olive oil (AOO). Finally, methyl salicylate, a nonsensitizing skin irritant, was negative at all test concentrations in each laboratory. Collectively these data serve to confirm that the local lymph node assay is sufficiently robust to yield equivalent results when performed independently in separate laboratories and indicate also that the LLNA is of value in assessing the skin sensitization potential of topical medicaments.

Allergic contact dermatitis to preservatives in topical medicaments

Background: Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis.Objectives: To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to disperse blue dyes in these patients.Methods: We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%).Results: Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments.Conclusions: Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.

Clinical study of patients with positive reactions in patch tests with local anesthetics

Local anesthetics have been contained in various OTC drugs and the number of cases of allergic contact dermatitis due to local anesthetics has increased recently. Thirty-five hundreds and fourteen cases suspected of suffering from drug eruption or contact dermatitis were the subjects of this study during the 8 years from January, 1988 to December, 1995. One hundred and thirty-eight cases, suspected of having allergic contact dermatitis were patch tested with topical medicaments including local anesthetics and 70 (50.7%) of them showed positive. In 49 of the 60 cases who reacted positively to anesthetics extensive patch tests with the individual ingredients of the products were carried out. The local anesthetics causing positive reactions were as follows (in order of frequency): dibucaine hydrochloride (35 cases: 71.4%), ethyl aminobenzoate (12 cases: 24.5%), lidocaine hydrochloride (2 cases: 4.1%), and procaine hydrochloride (1 case: 2.0%). The number of patients displaying allergies to local anesthetics has increased, especially cases caused by dibucaine hydrochloride. And the total positive reaction rate to dibucaine hydrochloride in the patch tests was 3.7%, which was as high that to the well-known strong sensitizer PPDA (3.9%) and neomycin (2.9%). Forty-three cases sensitive to local anesthetics were also studied for cross-sensitivity.

Contact dermatitis from fatty alcohols.

The aim of this study was to investigate the frequency of sensitization to fatty alcohols in a group of patients with suspected cosmetic or medicament contact dermatitis. From May 1992 to September 1995, we patch tested a series of 5 fatty alcohols on 146 patients. These included 108 females and 38 males aged from 13 to 72 years (mean age 42.5). These patients, who had previously been tested with the GIRDCA standard series, were selected because their clinical lesions or histories indicated topical preparations as the possible source of their contact dermatitis. High-grade fatty alcohols (> 99% pure) were used for testing. 34 patients (23.2%), 25 female and 9 male aged from 14 to 72 years, showed a positive patch test to fatty alcohols, 33 of them to oleyl alcohol. A total of 39 reactions were detected with 5 patients showing more than 1 positive reaction. Our results show that sensitization to oleyl alcohol is not rare in patients with contact dermatitis due to cosmetics or topical medicaments.

Evaluation of human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with nitrocellulose‐replica method and closed patch testing

Closed patch testing and the nitrocellulose-replica method are performed as useful clinical methods for the evaluation of human skin irritation by cosmetics and topical medicaments. Comparison of the sensitivity between microscopic scoring by nitrocellulose-replica method and visual scoring by closed patch test in the detection of skin irritation, however, has not been well studied with statistical analysis. Here, we evaluated human skin irritation by carboxylic acids, alcohols, esters and aldehydes, with different chain length (C8-C18), using both methods. The results of closed patch testing showed that, although the score of skin irritation for carboxylic acids (C8, C12), alcohols (C8) and aldehydes (C8), tested at a concentration of 0.5 m-2.0 m, significantly increased with increasing concentration of the test compounds, ester compounds scarcely caused any irritation on the surface of the skin occluded. In addition, an increase of carbon chain length in the test compounds made it impossible to detect skin irritation. In contrast, the nitrocellulose-replica method could evaluate skin reactions against very weak irritants that gave no macroscopic alterations on the skin surface in the closed patch test. However, the scoring system is somewhat subjective and should be improved to make the analysis more objective.

Occupational contact dermatitis from piroxicam

Contact and photocontact dermatitis to piroxicam started being identified as coinciding with the use of this nonsteroidal anti-inflammatory drug as a topical medicament; until now, case reports are scarce in the literature. A 30-year-old woman, employed as a physical therapist, presented with chronic hand dermatitis. Patch testing and a visit to her place of work confirmed occupational exposure and sensitivity to piroxicam gel. She was also positive to thimerosal and nickel; avoidance of contact with this specific gel resulted in clearing of the dermatitis. Previous sensitization to thimerosal due to the thiosalicylic fraction may constitute a risk for developing piroxicam allergic contact dermatitis because of a cross-reaction phenomena.

Poisoning due to Chinese proprietary medicines

1. To determine the toxic potentials of those Chinese proprietary medicines (CPM) which are commonly used for self-poisoning by adults in Hong Kong, all patients admitted to four of the eight general medical wards at the Prince of Wales Hospital between January 1988 and December 1993 were retrospectively studied. 2. There were 54 women and 17 men with their age ranging from 15 to 86 years. Twenty-three subjects (32%) also took alcohol, chemicals or drugs. Of the 51 subjects (72%) who had taken topical medicaments, 22 had no symptoms while 28 had minor features of gastrointestinal irritation (n = 26), mild (n = 2) or severe (n = 1) salicylate poisoning. Of the 17 subjects (24%) who had taken CPM tablets/capsules, nine had mild symptoms including nausea/vomiting and drowsiness. The three remaining patients (4%) who had ingested liquid CPM preparations were asymptomatic. Elevated plasma salicylate or paracetamol concentrations (> 0.1 mmol l-1) were found in some patients who had taken topical medicaments and CPM tablets/capsules, respectively. All the 71 patients completely recovered. 3. Most of the CPM used for self-poisoning in Hong Kong were of low to moderate toxicity except for those containing wintergreen oil (methyl salicylate).

Atopic dermatitis with severe facial lesions exacerbated by contact dermatitis from topical medicaments

Atopic dermatitis with severe facial lesions exacerbated by contact dermatitis from topical medicaments

Comparative dermatology: A historical overview

Comparative dermatology is the study of cutaneous diseases and tumors that affect both animal and human skin. Skin diseases have been recorded both in humans and in domestic animals since antiquity. One of the first written records of cutaneous disease in animals dates from the year 2130 BCE in an Egyptian veterinary papyrus. 1 Mention of topical medicaments includes the use of beer, honey, wax, and the dung of snakes and lizards. Probably the first reference to comparative dermatology is in the Bible in Exodus 9:9–11, in which Moses records an event where he observes boils breaking in sores on both man and beast. The Greek physician Aesculapius (1321-1243 BCE) and Aristotle (384 BCE) treated and reported skin disease in animals as well as humans; Aristotle studied comparative anatomy and physiology of the skin. During the middle ages, the Roman scholar Pliny the Elder (23–79 CE) wrote a 37-volume text entitled Natural History which mentions many remedies for animal dermatoses. Included were such reprehensible therapies as wet dressings of mouse dung and urine, as well as treatments still used today including astringents and tar and sulfur preparations. There continued to be various publications over the next several centuries recording animal skin diseases, their therapy, and their similarities to human dermatoses.

Occupational allergic contact dermatitis from mercury

Occupational allergic contact dermatitis from metallic mercury is rare. Here we present the only 2 patients with relevant occupational mercury allergy detected at our clinic since 1974. The first patient was a dental nurse who became sensitized to metallic mercury from amalgam when handling uncured amalgam without protective gloves. The second patient had previously been sensitized to mercury from topical medicaments and developed work-related dermatitis when a mercury thermometer was broken at her place of work. Both patients had a positive patch test reaction to metallic mercury.

Sensitivity to topical medicaments among suspected cases of footwear dermatitis

Contact DermatitisVolume 28, Issue 1 p. 44-45 Sensitivity to topical medicaments among suspected cases of footwear dermatitis M. Saha, M. Saha Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorC. R. Srinias, C. R. Srinias Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorS. D. Shenoi, S. D. Shenoi Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorC. Balachandran, C. Balachandran Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorSandhya Acharya, Sandhya Acharya Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this author M. Saha, M. Saha Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorC. R. Srinias, C. R. Srinias Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorS. D. Shenoi, S. D. Shenoi Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorC. Balachandran, C. Balachandran Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this authorSandhya Acharya, Sandhya Acharya Department of Skin and STD, Kasturba Hospital, Manipal - 576 119, Karnataka, IndiaSearch for more papers by this author First published: January 1993 https://doi.org/10.1111/j.1600-0536.1993.tb03331.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume28, Issue1January 1993Pages 44-45 RelatedInformation

Contact sensitization by alternative topical medicaments containing plant extracts. The Dutch Contact Dermatoses Group.

Contact sensitization by alternative topical medicaments containing plant extracts. The Dutch Contact Dermatoses Group.

Patch test reactions in atopic patients.

Patch testing was carried out in 851 atopic patients; 181 atopic dermatitis (AD) patients were additionally tested with 50% dilutions of the test substances. The occurrence of allergic and irritant reactions was frequent, being 57% and 33% for AD patients aged 28-41 years and 19-27 years, respectively. Among age-matched allergic rhinitis (AR)/allergic conjunctivitis (AC) or asthma (A) patients, the number of allergic reactions varied from 25 to 30%, and for irritant reactions was 24%. In all groups, nickel, fragrance-mix, balsam of Peru and neomycin were the commonest allergens. Contact allergy to ingredients of topical medicaments was common among AD patients and patients with severe and long-lasting dermatitis were most frequently sensitized. However, sensitivity to multiple substances was not common among those patients. The number of irritant reactions was considerable, but 50% dilution of the test substances did not solve the problem.