Toxic Contact Dermatitis Research Articles

Community-associated Methicillin-Resistant Staphylococcus aureus (ca-MRSA) as a Pandemic Pathogen: Risk Factors and Implications for Healthcare

Abstract Background A diversity of risk factors for ca-MRSA manifestations has been described so far. Up to date toxic contact dermatitis induced by plants has not been identified as one. Patients and Methods After intense skin contact with poison ivy in the US a 24-year-old Afro-American showed pronounced bullous contact dermatitis on the back of the neck and subsequently massive ca-MRSA furunculitis with proof of Panton-Valentine-leucocidin (PVL). After travelling to Germany, his German girlfriend developed a subacute ca-MRSA, PVL-positive superinfection of a mosquito bite at her lower leg. Both infections required surgical intervention. Results While the male patient displayed contact dermatitis by poison ivy, the female patient demonstrated two risk factors for ca-MRSA: contact with a ca-MRSA positive person and a predisposing skin lesion. Both cases underpin the role of ca-MRSA transmission and the potential severeness of wound infections in young and immunocompetent persons, just to be resolved by invasive intervention. Conclusions Marked and recalcitrant skin or soft tissue infections in otherwise healthy young patients require instant microbiological analysis and surgical intervention flanked by adequate antibiotic therapy. Contact dermatitis induced by plant toxins should be taken into consideration as possible risk factor for the acquisition of ca-MRSA.

Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH.

Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.

Safety evaluation and risk control measures of Psoralea corylifolia

Through a systematic and comprehensive study of domestic and foreign literatures and information, this study aims to trace the herbal origin and the toxicity recorded in ancient and current documents, analyze the safety case reports of Psoralea corylifolia and experimental studies on toxicity in recent years, and make a preliminary summary about the clinical characteristics and potential risk factors of cases related to the safety of P. corylifolia and its preparations. The study involved 84 patients in the safety case reports of P. corylifolia. The adverse events were mainly liver damage (55.95%) and light toxic contact dermatitis (38.10%), sugguesting that P. corylifolia may lead to liver damage and photo toxicity. However, reproductive toxicity and renal damage were only reported in animal studies, but not in clinical reports. Because of its complicated ingredients, the toxic components and mechanisms of P. corylifolia have not been clear at present. Therefore, the authors proposed to strictly apply P. corylifolia in clinic, use it rationally and combine it with other medications. Besides, efforts shall be made to strength the guidance for doctors, the safety monitoring of P. corylifolia and relevant preparations, and actively carry out safety-related basic and clinical studies, so as to give a better guidance to safe medication, full exert the efficacy and avoid the medication risk.

Irritativ-toxische Dermatitis und Exazerbation einer chronischen Plaque-Psoriasis unter Anwendung von Regividerm®

Vitamin B(12) ointment containing avocado oil was praised as nearly free from side effects for the treatment of psoriasis or atopic dermatitis in the German telecast. We report on a 43-years-old patient with chronic plaque psoriasis who used the ointment for about five days. Rapid worsening of the treated areas occurred. At the day of admission we saw an erosive weeping dermatitis on the limbs. Routine blood samples were negative, histological findings revealed an irritated psoriasis with spongiosis and exoserosis. Under an initial systemic antibiotic therapy, local disinfection and topical corticosteroid treatment followed by the use of calcitriol, phototherapy and a short time oral therapy with methotrexate it came to a rapid improvement. Our case shows that in contrast to the report in the telecast Regividerm ® has a risk for the development of considerably strong side effects such as local toxic contact dermatitis.

Hämatogenes Kontaktekzem nach intravesikaler Instillation von Mitomycin C

Mitomycin C is an alkylating chemotherapeutic agent which is instilled intravesically to prevent recurrence of superficial bladder carcinomas. After several cycles of mitomycin C, our patient developed a pruritic genital dermatitis and palmar desquamation. Following exclusion of a fungal infection, we performed patch tests using the standard series, the major basic ointment ingredients, disinfectants, and mitomycin C in concentrations of 0.001 to 0.1%; the resulting diagnosis was allergic contact dermatitis due to delayed-type hypersensitivity to mitomycin C. The skin rash rapidly resolved with application of topical steroids, and the intravesical chemotherapy was changed to doxorubicin. Eczematous skin reactions are quite common side effects after intravesical instillation of mitomycin C. In the majority of cases, they are caused by delayed-type hypersensitivity reactions, presumably elicited by hematogenous spread of the allergen, and not by irritation. The sensitization most likely occurs via the bladder mucosa. In order to differentiate between allergic and toxic contact dermatitis, patch tests with the above-mentioned mitomycin C concentrations are useful. In cases of mild allergic contact dermatitis the intravesical chemotherapy might be continued with concomitant topical steroids.

Referral pattern of skin diseases in an acute outpatient dermatological clinic in Copenhagen

The referral pattern of acute dermatologic conditions is not well described in either outpatients or hospitalized patients. The aim of this study is to describe in more detail the skin diseases that were referred for evaluation in an acute outpatient clinic at Bispebjerg Hospital, Copenhagen. In a 3-month period in 2003 a total of 428 consecutive new patients were referred for various skin diseases that needed subacute and acute dermatological evaluation in a university hospital setting. Referral pattern, age ratio and sex ratio were examined retrospectively. Two hundred and twenty-five (53%) of the 428 patients were referred from other hospital clinics in the local area. Sixty-six (15%) were referred from private practising dermatologists and 64 (15%) from general practitioners in the City of Copenhagen. Referral information was not noted in 35 (8%) of the 428 patients. The most prevalent diagnoses were: unspecified eczema (10.7%), drug eruptions (6.3 %), psoriasis (6.3%), atopic dermatitis (5.6%), bacterial skin infections (4.0%), inflammatory skin disorders (3.7%), seborrhoeic dermatitis (3.5%), urticaria (3.0%), seborrhoeic keratosis (3.0%), toxic contact dermatitis (2.8%), ulcus cruris (2.8%), autoimmune diseases (2.8%), malignant skin tumours (2.5%), candidiasis (2.5%), pruritus/prurigo (2.5%) and viral skin infections (2.5%). The fact that drug eruptions are one of the leading causes of acute referral conditions probably reflects the proximity to other hospital settings, where a large number of patients receive several systemic medicaments for various conditions.

P07 The poverty‐one of the reasons for chronic toxic contact dermatitis

The aim of the work is to present the incidence and the main reasons for this illness at women who live in very bad and poor conditions, in town and in village.Material and methods: 137 women were included, who were inspected during the time period of 8 months in 2003. A proper therapy was introduced‐per os and in loco, and all of them were controled for 14 days.Results: All together, 137 women were inspected and they were classified by their age, place of leaving and nationality. The detail anamnesis showed that 80% are housewifes who live in poverty and who are in contact with detergents everyday, becouse they do the dish‐washing and the laundry with hands, without any machines. The following therapies were applicated: corticosteroid and antihystaminic therapy per os and corticosteroid therapy in loco. After 14 days, a control look over was made, and they were given the preparation with vitamin A and lanolinum, for 14 days more. All of them were adviced to use protection gloves when they are in contact with detergents, especially for the laundry.Conclusion: One of the reasons for the appearance of chronic toxic contact dermatitis is the low standard of living when, becouse of the poverty, people can’t use machines and still in the 21th Century they wash the clothes and dishes with hands. The only help at this category of people is to give them advices for using protection gloves.

Severe toxic contact dermatitis caused by garlic

Severe toxic contact dermatitis caused by garlic

Turnover and kinetics of epidermal Langerhans cells and their dendritic precursor cells in experimental contact dermatitis. A correlated ultrastructural-morphometric and immunohistochemical evaluation.

The numerical density of epidermal Langerhans cells (LCs) in contact sensitivity and toxic contact dermatitis is still a matter of controversy, mainly due to changes in the phenotypic markers of this antigen-presenting cell during the skin reactions. Since the electron microscopic detection of Birbeck granules is the most reliable marker for the identification of normal and pathologically altered LCs, we performed an ultrastructural-morphometric time-course analysis to evaluate their epidermal turnover in the earskin of BALB/c mice after painting the ears with the hapten 2,4-dinitrofluorobenzene and the irritant croton oil. The counts revealed degeneration and depletion of epidermal LCs in both allergic and toxic dermatitis. In contrast, a slightly increased number of activated epidermal LCs was found during contact sensitization. All experimental procedures resulted in an enhanced immigration of so-called indeterminate dendritic cells which also became ultrastructurally activated and often showed Birbeck granule-like formations at their cell membrane. Immunohistochemistry with the monoclonal antibody 4F7, a new marker for dendritic precursor cells of LCs, demonstrated a significant increase in these accessory cells in the epidermis. Our results indicate that contact sensitivity and toxic skin reactions are characterized by complex but distinct changes in the turnover, kinetics and cellular properties of epidermal LCs and their dendritic precursor cells.

Occupational contact dermatitis among rubber workers.

The occurrence of occupational contact dermatitis among workers in a rubber factory from 1976 to 1980 was studied. Insurance compensation was paid to 50 workers with dermatitis. 21 of the cases were allergic and 27 toxic contact dermatitis, giving a contact dermatitis frequency of 5.6/1000 workers. Paraphenylenediamine compounds were the main cause of allergic contact dermatitis and solvents the main cause of toxic contact dermatitis.

Allergic and toxic contact dermatitis: inflammatory cell subtypes in epicutaneous test reactions.

Histochemical and immunohistochemical techniques were used to identify T lymphocytes, mononuclear phagocytes and plasma cells in situ from allergic and toxic epicutaneous test reactions. Intracellular alpha-naphthyl acetate esterase (ANAE), endogenous peroxidase and immunoglobulin were used as markers for inflammatory cells. In allergic contact dermatitis 76 +/- 7% of all cells were ANAE-positive T lymphocytes, 13 +/- 6% mononuclear phagocytes and 12 +/- 6% ANAE-negative cells. In toxic skin lesions the corresponding values were 64 +/- 20%, 18 +/- 15% and 18 +/- 6%, respectively. There were no statistically significant differences between the allergic and toxic skin reactions. The basic reaction type in allergic and toxic contact dermatitis seems to be similar, with possibly some qualitative and quantitative differences.

The cellular infiltrate in experimental allergic and toxic contact dermatitis. Effect of systemically administered corticosteroids.

The effect of systemically administered corticosteroids on allergic and toxic contact dermatitis in the guinea pig was studied. Dermatitis was provoked with dinitrochlorobenzene (DNCB). The influence of corticosteroids on the sensitization phase was also investigated. The epicutaneous test reactions were assessed with the naked eye, low-power microscopy, and a method based on the counting of infiltrating cells in the upper corium. Prednisolone injected in a dose of 5 mg/kg body weight daily for 4 days starting on the 1st day of sensitization or the 1st day of testing tended to shorten the duration of the contract allergic skin reaction as seen with the naked eye. Microscopically, a decrease in the number of infiltrating basophil granulocytes was found. Prednisolone had no convincing influence on the toxic contract eczematous reaction macroscopically or microscopically. Responses to weakly toxic doses of DNCB tended to fade earlier and to show small displacements of granulocytes in the differential count of infiltrating cells compared to controls. The results suggest that prednisolone given systemically influences only slightly the inflammatory cell infiltration in contact dermatitis in the guinea pig.

Measurement and differentiation of the cellular infiltrate in experimental toxic contact dermatitis

Toxic (irritant) contact dermatitis was elicited by epicutaneous application of dinitrochlorobenzene (DNCB) and croton oil in unsensitized guinea pigs. The course of the skin reaction was studied with the naked eye, low-power microscopy, and a method based on counting of infiltrating cells in the upper corium. A weakly toxic dose of DNCB (100 microgram/cm2) gave marked erythema and moderate swelling, more pronounced 6 h after application of the DNCB than at 24 h or 48 h. A significant increase in mononuclear cells in particular but also in neutrophil and eosinophil granulocytes was noted in the upper corium. A more strongly toxic dose (500 microgram/cm2) gave a similar visible reaction, this too most marked at 6 h, but here there was an increase in neutrophil granulocytes in particular. Over and above predominant mononuclear-cell infiltration, croton oil (10 microgram/cm2) caused a slight increase in basophil cells. The reaction thus resembled a contact allergic reaction. In the light of earlier findings in allergic contact reactions the results suggest that weak stimuli, toxic or allergenic, elicit a non-specific skin response. With stronger stimulation the histological picture is modified and the cellular response acquires a pattern characteristic of toxic or allergic contact dermatitis.