Search

Contact allergy to nickel could be found in 44.7% of 247 Austrian hairdressers with hand eczema. Two-thirds had become sensitive to nickel during their apprenticeship. The hairdressers' occupational exposure to nickel, chromium and cobalt was screened and different materials were analysed by a flame atomic absorption spectrophotometer. Hairdressers' nails (means = 54.22 ppm) contained ten times more nickel than those of controls (means = 6.5 ppm), but the differences were not statistically significant. Pooled customers' hair gave values of 3 ppm nickel; metals could not be released by shampoos, permanent wave liquids or oxidizing agents. The nickel, chromium and cobalt contents of 8 shampoos were beyond the detection limit of 1 microgram/100 ml. In 2 of 6 hair colours, in 2 bleaching agents and 8 of the 9 permanent liquids analysed (means 0.063 mg/100 ml), nickel could be found in detectable amounts. No metal traces could be detected in Viennese tap water samples which had been collected from a commonly used boiler. First samples of cold tap water collected in Leoben contained only 2 micrograms/100 ml, first hot water samples (60 degrees C) up to 4 micrograms nickel/100 ml; after 5 min of flushing, hot water samples contained 3 micrograms nickel/100 ml. From a nickel rod 13 micrograms/nickel/cm2/h was leached into 15 degrees C cold water and 0.28 microgram/nickel/cm2/h was leached into 70 degrees C hot water. It is recommended that hairdressers be supplied with only nickel-free instruments and that the contents of nickel and chelating agents be analysed in hair cosmetics.

The incidence of contact allergy to a 5% benzoyl peroxide (BP) gel has been studied by patch testing in 222 patients. Positive allergic reactions to BP were found in 3.1% of cases in a general clinical population (94 patients), whereas 5.8% of 69 patients with eczematous dermatoses were found to be BP-sensitized. In a group of acne vulgaris patients having used a commercial 5% or 10% BP gel for a period of 12 days to 3 1/2 years (mean: 10.7 months), positive allergic reactions were found in three cases (5.1%).

Dandruff is a sign of low specificity but high sensitivity for atopic constitution. Of 32 (40%) patients consulting the clinic for other reasons than dandruff, atopic dermatitis, or seborrheic dermatitis, 13 had raised IgE PRIST values of greater than 120 IU/ml. In only 6 (19%) of these patients was screening for atopy completely negative (family and personal history, total and specific IgG, prick test).

Thirty patients with suspected adverse reactions to tetanus- or tick-borne encephalitis-vaccines were subjected to allergy tests. In 8 of 30 patients epicutaneous and/or intracutaneous tests with merthiolate were positive. Testing anorganic mercury, formaldehyde, aluminium hydroxide, gentamycin and egg white (i.c. and RAST), no positive reactions were found. After vaccination - prior to testing - merthiolate - positive patients had suffered from local inflammatory reactions at the injection site, fever and lymphadenopathy (four patients), urticarial (three patients) or lichenoid exanthemas (one patient). Reviewing the literature it is suggested that alternatively merthiolate-free vaccines be provided for sensitized individuals.

A 32-year-old male patient with congenital poikilodermia syndrome is presented. The case history details of blister formation in the past and the association of the characteristic symptoms prompted us to make the diagnosis of Marghescu-Braun-Falco Syndrome in a male patient.

The efficacy and tolerability of a conventional vitamin K1 preparation containing polyoxyethylated castor oil as solubilizer were compared with those of a new compound containing mixed micelles as solubilizer in 30 patients. A statistically significant increase in the thrombotest was detected after treatment in both groups. No hematological or chemical toxicity was observed during the observation period. One patient had an anaphylactoid reaction after intravenous injection of the mixed micelles preparation. Intradermal testing yielded positive results. The authors conclude that intravenous administration of vitamin K preparations should be reserved for acute emergencies.

Due to keratolytic and epidermis-thinning effects 10% urea/w/o is effective in the treatment of papillomatosis cutis verrucosa (lymphostatic papillomatosis). If possible, compression bandages should be used. Indirect lymphography reveals abnormalities of dermal lymphdrainage in papillomatosis cutis verrucosa.

In order to obtain information about the clinical course and immunological background of possible allergic reactions due to penicillin-containing food, nine volunteers with penicillin allergy proved by case history, positive skin tests and/or positive penicilloyl-specific RAST were exposed to penicillin-contaminated pork. For this purpose a farm pig from an inbred strain received "therapeutic" doses of benzyl procain penicillin before being slaughtered. Meat samples were taken from muscle tissues, kidney and liver and analyzed by diffusion and extraction methods. Very small amounts of penicillin were detectable in muscle tissue, whereas kidney material contained up to five times as much (0.12 mcg/g). Except two cases which reacted with itchy sensations after ingestion of penicillin contaminated meat "á la tartare", all probands were clinically free of symptoms. Assaying penicilloyl-specific IgE antibodies by RAST during the trial, a tendency to increased levels in the serum after 2 and 24 h was noted, whereas the titers of BPO-specific IgG antibodies measured by the red cell-linked antigen-antiglobulin reaction (RCLAAR) remained unchanged. It is concluded from this study that small and hidden amounts of penicillin and its derivatives in food seldom induce anaphylactic reactions in penicillin allergic patients.

Among cases of occupational dermatoses, eczema in hairdressers was reported most frequently in Austria during 1981 and 1982. Analysing 247 reports, extensive data could be obtained with regard to predisposition, clinical pattern, course, contact sensitization, skin tests, prognosis, influence on occupational development, rehabilitation, and disability pension. Epicutaneous tests with standard allergens and a hairdressers' screening tray proved to be positive in 71%. Nickel (44,7%) and para-haircolors (40,2%) top the allergen list. With exception of cobalt (19,1%) and balsam of Peru (4%) all other substances tested were found to be positive in less than 4%. 65% of nickel sensitive probands reacted to their occupationally used shampoos, as compared to only 34% of nickel-negative probands. Of hairdressers allergic to para-colors, 48.1% showed positive ECT tests to their haircolors, 4/13 patients allergic to ammonium thioglycollate reacted to permanent wave liquids used at their work. Two thirds of nickel sensitive hairdressers were sensitized during apprenticeship. Alkali resistance (AR) was decreased in 35% of patients tested. AR results from the irritant dermatitis patients were worse than those from persons with contact allergy. Of the hairdressers affected, 61.8% had to discontinue their professions for medical reasons. Of those who continued a hairdresser's career only 32% of patients with allergic contact eczema and 58% of patients with irritant eczema had no skin problems (mean period of observation: 15 months). The proportion of atopics was found to be normal within the patient material, but prognosis is unfavorable once atopic hairdressers have developed hand eczema. After discontinuation of occupation, clinical resolution was slowest in patients allergic to nickel. Of those previously occupied as hairdressers 15% ended up in a wet working environment unsuitable to their skin condition.(ABSTRACT TRUNCATED AT 250 WORDS)

In spite of the development of micro-surgical techniques which enable functioning lymphovenous anastomoses to be formed, surgical interventions are not usually indicated in extremities with lymphedema which are for the most part already irreparably damaged. For want of an effective medicinal alternative compression therapy is still the method of choice. Its mode of action, indication and performance are dealt with. The "manual lymph drainage" which has received much propaganda in recent years shows good results only in the initial stages which are still reversible. In pronounced indurative scleredermas a considerable reduction in volume can be achieved by wrapping the extremity in non-elastic or tubular bandages which must be consistently preserved by compression stockings of class 3 and 4.

In this case report the rarity of the causing agent, Candida parapsilosis, and its endothrix growth is accentuated. The unsuccessful application of local and systemic antimycotics required the surgical abrasion of the infected tissue.

In this survey, the principles of local ulcer treatment and the most common therapeutic techniques are discussed. The data concerning the risk of sensitisation by local therapeutics are presented in the tables 1, 2, 3, 4.

Seventy-three patients suffering from stasis dermatitis with or without leg ulcers (group A) and 565 patients with other eczemas (group B) were patch tested with a series of 37 vehicle constituents and topical preparations. In group A the most common reactions were obtained with wool alcohols (24.7%), eucerin (21.9%), lanette N (17.2%), lanette O (11.0%) lanette E (8.2%), parabens (9.6%), a number of preparations containing these ingredients, and prophylene glycol (9.6%). In group B there were only positive reactions to lanette E (6.0%, test concentration 20%/vaseline) and sodium lauryl sulfate (5.8% positive, 5%/water), but irritant reactions were suspected in most cases. Additionally, group A patients were patch tested with standard allergens, which most frequently revealed contact allergies to balsam of Peru (19.1%) and mercuric bichloride (6.8%). Among the local antibacterial agents, the most common allergens were neomycin (32.9%) and bacitracin (12.3%). The number of patients with stasis dermatitis who reacted to one or more test substances had increased to 71.3%, as compared to the 57% evaluated in a similar study in 1977.

Contact sensitivity to aluminium is extremely rare. Sensitization occurs during continuous application of aluminium containing antiperspirants or by aluminium adjuvants in vaccines and pollen extracts. Two types of reaction pattern are known: persistent granuloma at the injection site and recurrent eczema. We report a patient with a positive patch test reaction to Al (OH)3, who had been sensitized by aluminium adsorbed triple vaccine, Previous reports are reviewed.

A 26-year aged non-atopic criminological technician reacted to hemp (Cannabis sativa) and hashish with urticarial eruptions on hands and lower arms, rhinitis and conjunctivitis. Rubbing tests with pollenrich hashish were strongly positive. As hemp antigens were unavailable a hyposensitization therapy with hop (Humulus lupulus)--a plant belonging to the Cannabacea family--was begun.

Positive ECT results were found in 29 out of 70 patients (41%) tested for suspected denture sore mouth syndrome. 11 of them reacted to nickel (16%), 4 to benzoyl peroxide, 4 to mercury chloride, but only 3 out of 38 patients reacted to their own prosthetic material. A follow-up study covered a group of 31 patients with dentures. 20 of them had mechanical or material changes made, but only 4 because of ECT results (1 nickel, 1 benzoyl peroxide, 1 own prosthetic material). After elimination of the suspected allergen, these 4 patients showed improvement, but the symptoms did not completely clear. A similar beneficial effect was seen in 13 of the 20 patients, whose dentures were only mechanically adapted; but 6 out of 11 patients without any dental correction showed improvement, as well. Our results suggest that clinically relevant contact allergies are rare in patients with burning mouth syndrome. Mechanical, microbial, and psychic factors have to be taken into consideration, as well.

In a multicenter trial (comprising 258 patients in eight centers) three topical preparations for enzymatic debridement, which are widely used in our country, have been compared in the treatment of leg ulcers. Preparation A is a combination of bovine fibrinolysin and desoxyribonuclease (but without antibiotic); preparation B is a combination of clostridiopeptidase and chloramphenicol and preparation C of trypsin and framycetin sulphate. The results showed no significant difference in the effects of treatment between the preparation. Preparation A however was much better tolerated; preparation B and C induced a lot of side effects. This means that antibiotics in preparations for enzymatic debridement are not of real advantage.

Occupational contact dermatitis of the irritant type with sudden onset was observed in a group of 30 billposters after the introduction of two new pastes. The lesions were most likely caused by acetone-formaldehyde resins, impurities of pentachlorophenol, solvents such as acetone and the alkalinity of one paste.

Only mild symptoms of retinoid intoxication--headache, hallucinations and vertebral pain--were observed after ingestion of 800 mg isotretinoin among other drugs. Transaminases and serum lipids were found within normal range five days later. Mucocutaneous effects due to overdosage were absent.

In the IInd Department of Dermatology, Vienna University, 200 patients (143 female, 57 male) suffering from leg ulcers due to chronic venous insufficiency underwent patch testing with routine allergens, vehicles and their ingredients, as well as topical antibiotics. 114 patients (57%) had contact allergy. Balsam of Peru heads the list of allergens with postive reactions in 22%, closely followed by oil/water emulsions such as Drointin (21%), Ultrasicc (20%) and Ung. emulsificans aqu. (15,5%). The causative agents in these preparations were emulsifiers on the one hand (Lanette O, E, N) and preservatives (parabens) on the other hand. In comparison, allergic reactions to water/oil emulsions were less common. The low index of sensitivity to local antibiotics was also surprising. The results of the present study, in accordance with other reports in the literature, underline the need (1) for full label diclosure of cosmetics and topically-applied drugs and (2) for patch-testing every patient suffering from leg ulcers of long duration.

This paper gives an introduction into the pathomechanism of allergic contact dermatitis and test procedures.

A patient with rosacea-like lesions and transient acantholytic dermatosis (TAD; Grover's disease), who showed follicle mites and perifollicular granulomas in involved skin, is presented. A possible relationship between the infestation with the follicle mite and TAD in this case is discussed.

45 patients (34 patients with PLE, 11 with phototoxic or photoallergic dermatitis) were photopatch tested to tiaprofenic acid. In 23 patients (51%), phototoxic reactions were found. Positive reactions appeared within 0.5 to 48 h of irradiation. Although each patient was irradiated with 2 different UVA light sources, with significantly different energy outputs (10 J/cm2 against 72 J/cm2), the intensity and duration of positive reactions was virtually the same. We found a considerably higher rate of positive reactions than other investigators, independent of the light energy delivered. None of the patients gave a history of previous tiaprofenic acid exposure.

Whereas intolerance reactions against contrast media are a well-known hazard during radiologic procedures, intolerance reactions to other preparations used in radiology are rare. Glucagon, frequently used to induce gastrointestinal hypotonia, is said to have almost no side-effects. A case of anaphylactic reaction during double-contrast upper gastrointestinal examination is reported. Pseudoallergic reaction to propylparaben, a preservative agent in glucagon, is suspected. IgE-antibodies to glucagon could not be detected by RAST.

Ninety patients suffering from recurrent urticaria were orally exposed to 500 mg acetyl salicylic acid (ASA). 36.6% proved to be ASA intolerant in this group. 26 ASA-positive and 18 ASA-negative probands were selected to take part in an additional provocation test with 8 different food additives (preservative and colouring matters). Altogether 31 tests sheets were exaluated. Urticarial reactions were seen after administration of p-hydroxybenzoic acid methylester (5), p-hydroxybenzoic acid propylester (6), benzoic acid (9), sodium benzoate (6), tartrazine (6). Ponceau rouge (5) and indigo carmine (3). Detailed research was carried out on the occurrence of the tested substances. With a diet avoiding salicylates, benzoates and colouring matter 20% of these patients recovered spontaneously and became symptom-free, whilst a further 55% of cases showed marked improvement.

22 patients suffering from long-standing alopecia areata totalis or fere totalis were treated with dinitrochlorobenzene (DNCB) locally. No hair growth was induced in patients with total alopecia, but 3 out of 11 patients with moderate forms showed cosmetically acceptable regrowth. The possible causes of these comparatively poor results are discussed.

The influence of high-heeled shoes on the venous pressure in the lower limbs is studied. In a test series on an exercise band subjects with high heels showed a significantly smaller drop in pressure than subjects wearing flat shoes.

A random group of 37 patients with chronic recurrent urticaria, 26 female and 11 male, was subjected to multidimensional personality tests (Freiburg personality inventory, FPI, Freiburg aggression test, FAF) whereas, deviating from establishing standards, introversion, nervousness, psychosomatic disturbance were more pronounced in the urticaria group, the following traits in deviation from normal standards were not noted: depression, irritability, sociability, emotional instability, composure. Nevertheless, this group appeared to be less communicative, more inhibited, compliant, and less dominant and aggressive. Neither did they show signs of socially accepted expression of negative and annoyed emotions nor socially desirable signs of assertiveness. A high rate of coincidence with other psychosomatic disorders such as frequent headache (18/37), chronic gastritis (19 of 37) and ulcus duodeni (5 of 37) and migraineous headache (6 of 37) was also found in this group. In all cases explorable latent conflictive situations (frequent ambivalence) and negative childhood experience are further indicative of psychosomatic diseases.

16 patients with lower leg dermatitis and venous ulcers had been subject to patch-testing during 1974 to 1977. When retested in 1982, the number of positive reactions per patient increased from 3.82 to 5.87 on an average. 54% of the positive epicutaneous test reactions could be reproduced in the repeated patch test. Meanwhile, 9 of 16 of patients were free of lower leg dermatitis and 8 of them were free of venous ulcers. This paper deals with the problematic nature as well as the likely causes of the apparent inconsistency of epicutaneous test reactions in patients with lower leg dermatitis and venous ulcers.