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Cobalt chloride should be added to the ever growing list of contact urticants. This chemical is frequently used as a color indicator in provocative sweat testing. In this case, contact urticaria was probably nonimmunologic in origin. Since diphenhydramine and 48-80 (polymonine block this reaction to cobalt chloride, vasoactive amines are at least partially responsible for the urticaria.

This study elaborates on the effect of occlusive, partially occlusive, and nonocclusive tape systems containing hydrocoritsone on human epidermal mitotic activity that has been increased by tape stripping. The experimental variables included tape delivery systems affording total, partial (50%), or no occlusion to normal human skin. The test corticosteroid was hydrocortisone at a dose range of 1, 4, and 20 microgram/sq cm. Utilizing demecolcine cream, biopsy specimens, were taken and mitotic figures determined. Results suggest that potent antimitotic effects occur equally with semiocclusive and nonocclusive tapes containing hydrocortisone as with total occlusive tapes. Verification of the practicality of this in clinical use will depend on appropriate clinical trials in diseased states.

One percent lindane, widely used to treat scabies and pediculosis, presents toxicologic problems when used excessively. A 16-year-old mentally retarded boy accidentally ingested approximately 392 g of 1% lindane shampoo and recovered. A 2-month-old, 4.5-kg, male infant was found dead in his crib after excessive application of a 1% lindane lotion. In the former patient, initial serum levels of lindane were 206 parts per billion (ppb) declining to 1.0 ppb after 25 days. In the latter, lindane was identified in the brain at a concentration of 110 ppb. Brain levels of lindane were three times greater than the levels found in the blood. Although the relationship of this pesticide exposure to the fatal outcome in the second case was conjectural, it was illustrative of the problem of interpreting CNS events that occur shortly after excessive exposure to this insecticide.

This study was designed to elaborate on the effects of occlusion and corticosteroids on human epidermal mitotic activity. The experimental variables included tape delivery systems that afforded total, partial (50%), or no occlusion to normal human skin. In some experiments, hydrocortisone, flurandrenolide, betamethasone, betamethasone valerate, and fluorometholone were added to these tape systems. Using demecolcine cream, biopsies were taken, and mitotic figures were determined. Results suggest that potent antimitotic effects occur with semiocclusive and nonocclusive tapes that contain corticosteroids, and that total occlusion is not necessary for this physiological effect. This suggests the possibility that the presumably better tolerated nonocclussive and partially occlusive systems might be used as dermatological drug delivery systems.

Lip swelling developed following the use of a cinnamic aldehyde-containing mouthwash in a woman with allergic rhinitis and asthma. Open application of the mouthwash on the antecubital fossae of the patient and control subjects produced immediate erythematous or urticarial responses in all tested individuals. Subsequent investigation established cinnamic aldehyde as the responsible ingredient. The incidence of positive reactions was shown to depend on site of application, vehicle, concentration, and time of reading. Of several related cinnamates, only cinnamic acid produced easily detectable responses at similar concentrations.

Perioral leukoderma simulating vitiligo developed in a 25-year-old woman. A patch test to cinnamic aldehyde was positive; depigmentation was observed at the patch test site three months after initial application. No changes in pigmentation occurred from a concomitant allergic patch test reaction to neomycin sulfate; only hyperpigmentation occurred at the site of an irritant patch test reaction to nonanoic acid. A toothpaste containing cinnamic aldehyde was implicated; perioral hypopigmentation resolved when a toothpaste without cinnamic aldehyde was substituted. A repeated patch test to cinnamic aldehyde again showed depigmentation at the patch test site three months after application.

Three patients employed in electronic assembly operations had allergic contact dermatitis to polyethylene glycol (PEG) dimethacrylate, found in an anaerobic sealant. Clinical features in all three cases consisted of eczema localized predominantly on the distal parts of the fingers and the palmar aspects of fingertips; onycholysis developed in one patient. No cross reactions to methyl methacrylate were observed on patch testing. Guinea pig maximization testing with both the commercially available sealant and the active resin demonstrated that PEG dimethacrylate is a moderate skin sensitizer.

This study determines the percutaneous absorption of hydrocortisone when applied as a single dose or on a repetitive basis. Application was to the shaved ventral forearm of the rhesus monkey, an animal model in which some relevance to man has been shown. Absorption was quantified by measuring 14C in aliquots of urine over five days. There was no substantial difference in total absorption when 13.3 microng/sq cm was applied as a single dose or when the 13.3 microng/sq cm was applied three times, totaling 40 microng/sq cm. However, when 40 microng/sq cm was applied as a single dose, absorption was substantially increased over 13.3 microng/sq cm applied either once or three times. Additionally, when the skin was washed between applications to remove previously applied material in the three application experiment, there was a statistically significant increase over not washing the skin. The clinical importance of these results to man will await appropriate clinical studies.

A double-blind multicenter study compared the antifungal effectiveness of an iodochlorhydroxyquin-hydrocoritsone cream with that of its individual components in 354 patients with cutaneous fungal infections. After seven days of treatment, the combination was considerably better than hydrocortisone or the cream vehicle with respect to erythema, scaling, itching, and patients' and physicians' evaluations. The proportion of patients in the iodochlorhydroxyquin-hydrocortisone and iodochlorhydroxyquin groups who changed from positive results on potassium hydroxide examination at baseline to negative results on potassium hydroxide examination after treatment was significantly greater than that in the hydrocortisone and placebo groups. The conversion rate associated with the iodochlorhydroxyquin-hydrocortisone and the iodochlorhydroxyquin treatments was significantly different from that associated with hydrocortisone alone or placebo treatment.

The microbial flora of dermatitic skin, uninvolved skin, and the anterior nares of subjects with atopic eczema were investigated. The carriage rate of Staphylococcus aureus was 79% for the anterior nares, 76% for the uninvolved skin (normal skin), and 93% for lesions. The counts of S aureus were 7.5 X 10(4)/sq cm in lesions and 7.1 X 10(3)/sq cm on adjacent normal skin. Staphylococcus aureus was the predominant organism in the lesions and constituted 91% of the total aerobic bacterial flora. The coagulase-negative staphylococci were the second predominant organisms (9%). On normal skin, coagulase-negative staphylococci were the predominant organisms, constituting 63% of the total flora, followed by S aureus (30% of the bacterial flora). The micrococci counts were lower in the lesions (1.6 X 10(2)/sq cm) and higher on normal skin (9.5 X 10(2)/sq cm). Lipophilic diphtheroids were fewer on normal skin (6.7 X 10/sq cm), and there were none in the lesions. Fifty-eight percent of the strains belonged to group 3, and 38% were nontypeable. Staphylococcus aureus strains belonging to phage groups 2 and 4 were not detected.

To document the effect of salicylic acid on hydrocortisone penetration in vivo in the rhesus monkey, hydrocortisone 14C, with and without salicylic acid, was applied in acetone and the solvent evaporated. The compounds also were applied in a formulation (60% ethanol, 5% propylene glycol, 5% glycerin, 30% water) in which salicylic acid enhances penetration in vitro. There was a difference in the kinetics of hydrocortisone absorption with the two formulations. In acetone, excretion of 14C peaked at 48 hours and then declined. With the other formulation, excretion peaked at 48 hours, maintained to 72 hours, and then declined. There was no statistical difference in the percutaneous absorption of hydrocortisone with the addition of salicylic acid. These in vivo data are in contrast to the reported enhancing effect of salicylic acid obtained with in vitro studies.

A patient had acute stomatitis and dermatitis due to a popular toothpaste containing cinnamon oil flavor. Cinnamon cassia oil is known as a topical sensitizer and was demonstrated to be the offending allergen. Cinnamic aldehyde and related chemicals are used widely, so that patients having cinnamon allergy may be exposed to many sources. There is difficulty in diagnosing allergic contact stomatitis.

The excited skin syndrome, a state of skin hyperirritability often induced by a concomitant dermatitis, is responsible for numerous nonreproducible test results in battery patch testing. We analyzed the mechanisms and circumstances involved in its induction, as well as its clinical importance and frequency. Finally, we provide suggestions about how to deal with patients suspected of having the syndrome.

A woman with atopic dermatitis experienced anaphylactic episodes following intercourse with her husband, with subsequent exacerbations of her atopic dermatitis. Skin testing and an in vitro leukocyte histamine release assay established the diagnosis of immediate hypersensitivity to her husband's seminal fluid; delayed hypersensitivity to seminal fluid could not be demonstrated. Antigen was found in the seminal fluid of nonrelated men. Radioallergosorbent testing detected the presence of circulating IgE antibodies specific for seminal plasma protein. Immunotherapy with seminal plasma may have limited the severity of a subsequent reaction. Serum from the husband and nonrelated men also contained antigen that provoked histamine release from the patient's leukocytes in vitro. The antigen in serum was associated with the globulin fraction and had a temporal relationship to ejaculation, appearing within 12 hours of ejaculation and disappearing within four days.

This study compares percutaneous absorption of hydrocortisone after short and long-term administration. The experimental design was to first apply 14C-hydrocortisone. This was followed by long-term administration of nonradioactive hydrocortisone. Then 14C-hydrocortisone was applied again when urinary excretion of radioactivity from the first application reached minimum detectable levels. Short- (first 14C-hydrocortisone application) and long-term (second 14C-hydrocortisone application) penetrations were compared. The level of absorption of hydrocortisone significantly increased during long-term administration, whether applied in an acetone vehicle or in a 0.9% emulsion ointment base (Eucerin). A placebo study in which only an acetone vehicle was applied for a long period followed by 14C-hydrocortisone application showed no enhanced penetration. It is suggested that long-term application of hydrocortisone alters the penetration barrier, resulting in enhanced penetration. The relevance of this long-term corticosteroid use in man is possibly of great importance.

We assess the percutaneous penetration potential of two commercially distributed semipermanent hair dyes. Utilizing several solvent systems in conjunction with thin-layer chromatography (TLC), we found that the commercial formulations contained at least nine component chemicals. Eight adult volunteers had their hair dyed with these preparations and 24-hour urine specimens were collected daily for five days. The urine was lyophilized and extracted with diethyl ether under acid and alkaline conditions. The TLC of urine from four of the eight subjects, taken from one to four days after dyeing the hair, disclosed a purple spot. This spot, though not identified, was the same with both dye preparations. It is likely that these hair dyes not uncommonly penetrate the skin.

Contact urticaria refers to a wheal-and-flare response occurring on the application of chemicals to intact skin. Standard closed patch tests read at 48 hours after application yield misleading information; observations should be made instead using open patch tests 15 to 30 minutes after application. There are three major subdivisions of the syndrome: nonimmunologic cause (such as application of histamine), immunologic cause (immediate hypersensitivity), and uncertain cause (such as application of ammonium persulfate). Our patient had contact urticaria due to the insect repellent, diethyltoluamide. The experimental data suggest that this case was due to an immunologic response (immediate hypersensitivity) and demarcates the specificity of response. The immunologically mediated cases cover a broad spectrum of manifestations from contact urticaria only to local urticaria plus asthma and, in extreme sensitivity, includes anaphylactoid responses.