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BACKGROUND As a result of climate change, we will have to deal more and more often with the consequences of the oak processionary caterpillar. CASE DESCRIPTION In June, we saw a 6-year-old girl with a severely itchy rash all over her body. The rash had developed a day after school and consisted of erythematous papules on an erythematous base. Several other children at the school were suffering from a similar skin rash. The girl also seemed to have a bad cold. We diagnosed 'oak processionary caterpillar dermatitis'. It turned out there was indeed an oak processionary caterpillar nest at her school. The nest was removed. We prescribed cetirizine oral solution, followed by triamcinolone cream, after which the itch and skin rash disappeared. CONCLUSION The oak processionary caterpillar can cause a lot of symptoms in the period from April to July, including skin rash and eye and upper airway symptoms. The symptoms are usually self-limiting and automatically disappear within 2 weeks. In case of severe itching, menthol-based creams, topical corticosteroids and antihistamines may be prescribed.

The local antibiotics are an important addition to the treatment of moderately severe skin infections. Development of contact allergy and bacterial resistance, however, are some of the adverse reactions that may occur. Fusidic acid and tetracycline are the most suitable products for the treatment of superficial primary infections of the skin caused by Gram-positive cocci and secondary infected dermatoses. In case of insufficient effect mupirocin may be tried. Mupirocin is an effective antibiotic in the treatment of nasal carriage of Staphylococcus aureus in cases of increased risk of infection (haemodialysis, continuous peritoneal dialysis, after thoracic surgery). Besides it is an important local antibiotic in the treatment of meticillin-resistant staphylococci in the nose. In order to prevent development of bacterial resistance its further use has to be restricted. Silver sulfadiazine is a good option for the local treatment of infections by Pseudomonas aeruginosa and other Gram-negative bacteria. Erythromycin and clindamycin are useful local antibiotics for the treatment of mild acne vulgaris. Disinfectants are mainly suitable for the use on the intact skin.

Obsessive-compulsive disorder (OCD) is a frequent psychiatric disorder. Patients do not always present with obsessions or compulsions and this may complicate the process of diagnosing and starting adequate treatment. In this article three patients suffering from OCD but not presenting with obsessions or compulsions are discussed. In the first case, in a 42-year-old woman, the presenting symptom is a therapy-resistant dermatitis, due to excessive washing. The second patient, a 27-year-old man, presented with a depression, a frequent comorbid condition. In the third case, a 34-year-old man, the effects on and the suffering of the partner and family of a patient with OCD (they were asked to co-operate in his compulsive behaviour) were the reason for his wife to consult the general practitioner. OCD has a lifetime prevalence rate of 2.5% and is somewhat more frequent in females than in males. The most characteristic symptoms are obsessions and/or compulsions. They cause marked distress, are time consuming (take more than 1 hour a day), and interfere significantly with the person's functioning (occupational, social activities, relationships). Neurobiological studies suggest genetic influences and dysfunctional neuronal circuits in the brain. The treatment of OCD consists of pharmacotherapy and behavioural therapy, but it is a lifelong condition.

Contact allergy to corticosteroids is not rare. In some studies prevalence rates up to 6% have been observed among patients suspected of allergic contact dermatitis. Hypersensitivity occurs especially in individuals who have been suffering for years from atopic dermatitis, contact dermatitis of the hands and feet, or stasis dermatitis caused by chronic venous insufficiency. The clinical picture is rarely that of acute allergic contact dermatitis, because the reaction is mitigated by the anti-inflammatory properties of the corticosteroid itself; the diagnosis must be suspected when eczema does not improve or spreads during topical corticosteroid therapy. Application to the mucous membranes less frequently leads to sensitisation. Most such cases are caused by nasal sprays containing tixocortol pivalate or budesonide. Oral or parenteral administration of corticosteroids to sensitive individuals causes exacerbation of pre-existing contact dermatitis or widespread allergic cutaneous drug reactions. Allergological investigation with corticosteroids presents some specific problems, the most important being occurrence of false-negative reactions. Nevertheless, most sensitive patients can be identified by testing the 'indicator' allergens, budesonide and tixocortol pivalate, which should be added to the routine series of contact allergens. Cross-reactions to other corticosteroids occur frequently. This should be taken into account when prescribing alternative corticosteroid preparations.

In four patients, two women aged 40 and 42 years and two men aged 49 and 37 years, type I allergy to Ficus benjamina was established. Two patients had been sensitized by contact with these pot plants at their homes. The other two patients were plant growers. F. benjamina is a non-flowering, currently very popular pot plant to be found in both private houses and public buildings. The symptoms comprise itching and swelling of the eyelids, tears, running nose, wheezing and dyspnoea. In one plant grower contact urticaria progressing to dermatitis of the hand was the main symptom. Only one patient had a clear-cut atopy. Both plant growers showed a cross-allergy to other Ficus species. Two patients had a cross-allergy to latex and the associated cluster of tropical fruit (banana, kiwi, avocado, and chestnut). Removal of the ficus plants from the homes and change to another crop or to another occupation completely resolved the complaints of these patients.

Fragrance materials are not only present in products primarily used for their scent such as perfume, eau de toilette, deodorant and aftershave, but also in cosmetics, toiletries, household products and industrial materials. Of the general population, approximately one percent are allergic to fragrance materials, men nearly as frequent as women. Of patients consulting the dermatologist because of dermatitis, 6-11% have a positive patch test to the fragrance mix. Allergic contact dermatitis due to fragrances usually consists of erythema and desquamation, often localized in the neck, behind the ears, in the arm-pits or around the eyes. It can worsen pre-existing dermatoses such as hand eczema, atopic dermatitis, perianal dermatitis or vulvar dermatitis. The diagnosis of contact allergy to fragrances is made by epicutaneous tests with the European standard series (including some markers for fragrance sensitivity: the fragrance mix, balsam of Peru and colophony) and the patient's own contact materials. A positive patch test reaction must be followed by evaluation of its relevance. Advice to the patient is directed towards avoidance of fragranced products, if possible, and explanation of how use tests can identify fragranced products which can be used without ill effects.

Nicotine-containing patches are prescribed to facilitate tobacco withdrawal by mitigating abstinence symptoms and diminishing craving. In clinical trials local skin reactions were often recorded as a reaction to the patches. Systemic skin reactions were described, but only rarely. The Netherlands Centre for Monitoring of Adverse Reactions to Drugs received II reports of local and 5 reports of systemic skin reactions to nicotine patches during the period January 1993 until April 1994. Skin reactions usually occur after about 15 days' use and local reactions tend to become worse when treatment is continued. The mechanism of the reaction and the part of the patch to which the skin reacts are still unclear.

In four patients, three women aged 45, 29 and 52 years and a man aged 45 years, allergic contact dermatitis due to 'tea tree' oil was diagnosed. The case of the man was published before. 'Tea tree' oils are essential oils distilled from the leaves of myrtaceous trees and shrubs occurring in Australia and South-East Asia. The 'tea tree' oil available in the Netherlands is distilled from the Melaleuca alternifolia and mainly contains eucalyptol. Eucalyptol is probably the most important allergen.

The recent negative publicity on the cosmetics preservative Kathon CG has made many cosmetic manufacturers look for safer alternatives. The most popular substitute appears to be Euxyl K 400, containing phenoxyethanol and methyldibromoglutaronitrile. Unfortunately, this preservative also induces allergic reactions to cosmetics and (at least in the Netherlands) to 'moist toilet paper'. Therefore, in cases of apparent reactions to cosmetics and of eczema ani, allergy to methyldibromoglutaronitrile should be suspected. Testing the finished products often results in false-negative reactions, and consequently the allergen (suggested concentration 0.05% in petrolatum) should preferably be tested separately.

Two cases of dyshidrotic eczema of the hands caused by perianal allergic contact dermatitis due to Kathon CG in moist toilet paper are described.

We report 6 patients with occupational contact allergy to Alstroemeria cultivars. Four of them presented with the clinical picture of 'tulip fingers'. They all reacted to parts of fresh plants and to tuliposide A. The literature on Alstroemeria allergy is reviewed.

Epoxy resin-containing products of the plastic industry are increasingly employed. We retrospectively studied the incidence and course of epoxy resin contact dermatitis in 2265 patients in whom contact dermatitis was confirmed by patch testing. A positive patch test for epoxy resin was present in 31 patients (1.4%). Exposure to epoxy resin as the cause of contact dermatitis was 'certain' in 10, 'very likely' in 9, 'possible' in 4 and 'unclear' in 8 patients. Exposure to epoxy resin was related to occupational (55%) and leisure time activities (13%). In 48% patch tests were positive for multiple test allergens. Hands (56%), arms (38%) and face (38%) were mainly affected. Re-examination of 26 of 31 patients showed that a favourable course depended on identification of the cause of the exposure to epoxy resin, avoidance of further contact and absence of sensitization to multiple allergens.

A computerized database with the complete composition of pharmaceutical products and some cosmetics helps the patient with an allergic contact dermatitis reaction to avoid his specific allergens. Together with a database with patient information (12000 cases) this product, file serves as the basis for an expert system that assists the dermatologist during his every day clinical practice. The use of the computer in the field of contact dermatitis has gained much interest in the course of the last decade. In fact, the computer can be a particularly helpful tool in: 1. The storage of large amounts of data that can help to identify the patient's allergen microenvironment: --literature: articles related to contact dermatitis problems; --product information such as, for example, the composition of pharmaceutical, cosmetics, and industrial materials; --the dermatologist: the filling in of a standardized anamnesis from also helps to assure that relevant clinical data is not overlooked. 2. The diagnosis of allergic contact dermatitis: on the basis of all these data stored, an expert system can be developed to provide targeted information to assist the physician with the anamnesis of a new patient. Depending on the profile of the patient, several factors that could be at the source of the contact dermatitis, such as the patient's profession, hobbies, and use of pharmaceutical products and cosmetics, can be considered, thus increasing the efficiency of the allergological examination considerably. 3. Research in contact dermatitis: --The data can be used for epidemiological analyses in behalf of the patients, the medical profession, the industry, and the authorities.(ABSTRACT TRUNCATED AT 250 WORDS)