Toxic Dermatitis Research Articles

Interleukin-10 in dermatology

In recent years the investigation of cytokines has been a focus of scientific interest in order to understand the pathogenesis of a variety of diseases. In additions cytokines are increasingly being used for therapeutic purposes, including dermatologic disorders. IL-10 is a recently described cytokine with anti-inflammatory and immunosuppressive qualities which plays an important role in immunoregulation. The overexpression of this mediator has been proven in some inflammatory dermatoses as well as in various skin tumors. These observations help to understand down regulatory events in hyper-inflammatory conditions such as allergic or toxic dermatitis on the one hand and the suppression of an adequate anti-tumor response and thereby the progression of malignant tumors on the other hand. Recent investigations indicate a relative IL-10 deficiency in psoriasis. Initial therapeutic applications of IL-10 in psoriasis underline the pathophysiological importance of this cytokine.

Spontaneous skin ulceration and defective T cell function in CD18 null mice.

A null mutation was prepared in the mouse for CD18, the beta2 subunit of leukocyte integrins. Homozygous CD18 null mice develop chronic dermatitis with extensive facial and submandibular erosions. The phenotype includes elevated neutrophil counts, increased immunoglobulin levels, lymphadenopathy, splenomegaly, and abundant plasma cells in skin, lymph nodes, gut, and kidney. Very few neutrophils were found in spontaneously occurring skin lesions or with an induced toxic dermatitis. Intravital microscopy in CD18 null mice revealed a lack of firm neutrophil attachment to venules in the cremaster muscle in response to N-formyl- methionyl-leucyl-phenylalanine. A severe defect in T cell proliferation was found in the CD18 null mice when T cell receptors were stimulated either by staphylococcal enterotoxin A or by major histocompatibility complex alloantigens demonstrating a greater role of CD11/CD18 integrins in T cell responses than previously documented. The null mice are useful for delineating the functions of CD18 in vivo.

Light and electron microscopic findings in human epidermis reconstructed in vitro upon topical application of liposomal tretinoin.

The topical application of tretinoin is a well-established approach to the treatment of acne vulgaris. However, induced inflammation, clinically addressed as a "flare-up", is a major drawback. Recently, clinical and experimental investigations have hinted at a better tolerability, with equal efficacy, if the active compound is liposomally encapsulated. Using epidermis reconstructed in vitro, we compared the morphological changes upon topical application of a liposomal form (0.05% and 0.025%) and conventional form (0.05%) light and electron microscopically. After 24 h several remarkable changes of the stratum corneum with all treatment modalities, representing inhibition of keratinisation wanted in acne vulgaris, were seen. When preparations of equal strength, i.e. 0.05%, were compared, the changes representing toxic dermatitis in the epidermis were more marked with the conventional form. Epidermis reconstructed in vitro treated with the liposomal forms showed no significant differences due to either concentration. It is suggested that these changes correspond to the flare-up on clinical grounds. The in vitro findings further corroborate the hypothesis that liposomal encapsulation can increase the benefit/risk ratio of an active compound applied to the skin.

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.

A Rash and Chemical Burns in a Cowboy Exposed to Permethrin

Permethrin is a semisynthetic pyrethoid used in agriculture as an insecticide and acaricide. It is especially effective on ectoparasites. When used correctly, it can be safe but when diluted incorrectly, it can cause a rash inconsistent with a toxic dermatitis and chemical burns. The case presented in this article demonstrates the necessity of obtaining an adequate history of chemical exposure and the problem of obtaining the history from cantankerous individuals. It also demonstrates the range of skin lesions that results from using permethrin incorrectly. Once the diagnosis was made, the rash cleared with topical and oral steroids and antibiotics. The physician was able to intervene in a positive manner after establishing rapport with the patient by cautioning the patient not to misuse the pesticide.

Toxic dermatitis induced by 10-ethyl-10-deazaaminopterin (10-EdAM), a novel antifolate

A new methotrexate analog, 10-ethyl-10-deaza-aminopterin (10-EdAM), was found to induce a particular form of skin toxicity different than the skin rash reported to result from methotrexate. At histologic examination, it was found to be a toxic dermatitis that clinically most often first appears on the lower legs but can occur anywhere in the body, especially if treatment is continued. Nine cases are reported. A specific risk factor could not yet be identified. Discontinuation of 10-EdAM administration leads to complete healing; concomitant corticosteroid treatment also induces healing.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, M.D. Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, M.D. Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, M.D. Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, M.D. Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, Group Health Associates, Cincinnati, OH.

Toxic Dermatitis From Awapuhi (Hawaiian Ginger) Shampoo. C.G. Toby Mathias, Group Health Associates, Cincinnati, OH.

中葉無気肺に合併した肺ノカルジア症の1例

Pulmonary nocardiosis is a rare disease. We reported a case of pulmonary nocardiosis associated with middle lobe atelectasis. A 66-year-old female was admitted to Saga Medical School Hospital with complaints of fever, productive cough and hemosputum. Nocardia asteroides was isolated from her sputum and bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim (ST) improved her symptoms and Nocardia asteroides were rapidly eliminated from her sputum. However, she had severe side effects of ST: toxic dermatitis, granulocytopenia and liver dysfunction, whereupon administration of ST was stopped. About two weeks later, Nocardia asteroides appeared again in her sputum. Either netilmicin (NTL) or minocycline (MINO) given consecutively could not eliminate Nocardia asteroides from her sputa. Subsequently a combination therapy of OFLX administration and gentamicin inhalation was tried. This treatment improved her symptoms and eradicated Nocardia asteroides from her sputa completely. In vitro study, ST, MINO and aminoglycosides showed good susceptibility against Nocardia asteroides. In this case, it was revealed that GM inhalation therapy is also very useful for pulmonary Nocardiosis.

Mucocutaneous side effects of brequinar sodium. A new inhibitor of pyrimidine de novo biosynthesis

Brequinar sodium (NSC 368390; DUP 785) is a new inhibitor of pyrimidine de novo biosynthesis which has completed Phase I clinical trials within the framework of the Early Clinical Trials Group of the European Organization for Research and Treatment of Cancer (EORTC). The main side effects of this compound are myelosuppression, nausea and vomiting, stomatitis and/or mucositis, and skin rash. In this report, the authors describe the pattern of mucocutaneous side effects of Brequinar sodium in patients who received the drug by four different schedules: (1) short-term intravenous (IV) infusion every 3 weeks; (2) weekly; (3) twice weekly; and (4) five times daily every 4 weeks. Mucocutaneous toxicities of Brequinar sodium included mainly cytotoxic reactions (stomatitis and/or mucositis and skin rash). However, rare episodes of local reactions (phlebitis at the site of injection), photosensitivity reactions (to sun light), angioneurotic edema, and localized secondary hyperpigmentation of the inflamed skin also occurred. Stomatitis and/or mucositis appeared to be dose-dependent and schedule-dependent. The skin rash consisted of a drug-induced toxic dermatitis which occurred mostly at the highest dose levels. Initial recommendations for the management of mucocutaneous toxicities of Brequinar sodium during Phase II trials are discussed.

STUDIES ON THE SURGICAL SELECTION FOR ACUTE CHOLECYSTITIS WITH CLINICAL COURSE AND ULTRASONOGRAPHIC FINDINGS

It has been debated whether eraly or delayed operation should be selected for surgical management of acute cholecystitis, but there is no definite answer to this argument. Therefore, we studied our 84 acute cholecystitis cases with clinical signs and diagnostic images in order to establish the criteria for surgical selection. This study was to find out for which patients conservative treatment is not adequate. Ultrasonographic (US) study was done to examine (1) US findings during hospitalization (2) US findings of early surgical cases (3) US findings of cases on standby surgery. Early surgery was indicated for 23 patients (27%). Sixty-one patients (73%) could be treated by conservative treatment in the acute stage, and 51 patients underwent elective operations and 10 were discharged without surgery. Of clinical findings, not only pain, fever and local tenderness but also defence musclulare and jaundice were seen in early surgery cases. Severe complications such as liver and/or subphrenic abscess, severe cholangitis, panperitonitits, renal disturbance, toxic dermatitis and shock were found in early surgery cases. Of US findings, not onlyt local tenderness, enlarged gallbladder, thickened gallbladder wall, sonolucent layer and debris in the gallbladder but also bile duct dilatation, liver abscess and fluid collection were seen in early surgical cases.

Management of Wilderness and Environmental Emergencies

Interest and participation in wilderness sports have notably increased in recent years, and, not surprisingly, there has also been a concomitant increased incidence of environment-related injuries and illnesses. Therefore, this book should be a most welcome addition to the libraries of physicians and other health professionals who treat or advise mountaineers, trekkers, skiers, scuba divers, and other outdoors enthusiasts. The book consists of 21 chapters and an appendix that address the major problems common to wilderness sports—hypothermia, heat illness, lightning injuries, burns, solar dermatitis, submersion injuries, hazardous marine life, toxic plant ingestions and dermatitis, mammalian bites, arthropod envenomations, and venomous snake bites. In addition, some specific activities are discussed—alpine and nordic skiing injuries, diving and barotrauma, mountain sickness and other high-altitude illnesses, aerospace medicine, and problems encountered in wildland fire fighters. The chapters are by persons knowledgeable in the clinical and practical aspects of these conditions, especially with regard to

Landmark article Sept 17, 1938: Sodium diphenyl hydantoinate in the treatment of convulsive disorders. By H. Houston Merritt and Tracy J. Putnam.

In a previous study it has been shown that sodium diphenyl hydantoinate is effective in preventing electrically induced convulsive seizures in cats. The drug is relatively nontoxic and well tolerated by the usual laboratory animals. A clinical trial of sodium diphenyl hydantoinate was made in 200 patients with frequent convulsive seizures which had not been relieved by the previous modes of therapy. In 142 such patients who have received the treatment for periods varying from two to eleven months, grand mal attacks were relieved in 58 per cent and greatly decreased in frequency in an additional 27 per cent; petit mal attacks were relieved in 35 per cent and greatly decreased in frequency in an additional 49 per cent, and psychic equivalent attacks were relieved in 67 per cent and greatly decreased in frequency in 33 per cent. There were no fatalities. A toxic dermatitis occurred in ten patients (5 per cent), nonthrombocytopenic purpura in one patient and minor (in many instances, transient) toxic reactions, tremors, ataxia, dizziness and the like in approximately 15 per cent.

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.

Toxic dermatitis in a Finnish textile factory

Toxic dermatitis in a Finnish textile factory

Pruritic papules of pregnancy.

Sixteen cases of pruritic papules of pregnancy were collected during a 32-month period. This dermatosis was introduced to the literature in 1962 but no histopathologic study of it has been published. Histopathologic presentation of pruritic papules of pregnancy is that of toxic dermatitis. This finding is not characteristic of this condition and clinico-pathologic correlation is needed for a definitive diagnosis.

Anaphylaxis From Tolmetin

TOLMETIN SODIUM (Tolectin) is one of the newer nonsteroidal anti-inflammatory agents used in the management of rheumatoid arthritis. The package insert accompanying tolmetin includes many adverse effects of the drug, but there is no mention of anaphylactic shock induced by this agent. This report describes two patients in whom anaphylactic shock developed within 15 minutes of ingesting two 200-mg tolmetin sodium tablets. Report of Cases Case 1.— A 43-year-old woman was admitted to University of California at Los Angeles Hospital for anaphylactic shock. She had a three-year history of rheumatoid arthritis functional class 2, and met the American Rheumatism Association classification for definite rheumatoid arthritis. Previously, she had been treated with phenylbutazone. Gold sodium thiomalate therapy had been discontinued one year before admission because of severe generalized toxic dermatitis after a total of 260 mg had been given. Six months before admission, a facial rash had developed while taking 500

Experimental Staphylococcus Aureus Infections in Humans

S. aureus infections have been consistently induced in normal human skin by applying large inocula to areas degermed with ethanol and kept moist under an occlusive dressing. The ED 50 was approximately 10 3 /cm 2 . With about 10 6 organisms, cm 2 , an erythematous rash appeared in three days which evolved to an intense papulo-vesicular eruption, by six days. Removal of the dressing was followed by swift death of almost all the organisms followed by immediate resolution of the lesion within a few days. There was a great loss of viable cells in the first hour after application which continued for 24 hours; thereafter, the organisms proliferated to a peak density of about 2 ×10 7 /cm 2 . The resident cocci and diphtheroids began to re-enter the site by about the 3rd day and were completely restored by 6 days. The organisms were confined to the surface and did not proliferate within the living portion of the skin. Histopathologically the lesion was a toxic dermatitis with epidermal necrosis, edema, hemorrhange and thrombosis. This clinical entity may be described as toxic pyoderma.