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Secretan's syndrome is characterized by hard persistent edema of the dorsum of the hands. Usually, the condition is self-inflicted, but the authors have seen four cases that were occupationally related. The patients were fishing divers, and the mechanism appeared to be the constrictive action of the tight diver suit and pricks from sea urchin spines. Lymphographic abnormalities were present in one case.

such as hydration, barrier function, skin penetration by various compounds, and early stages of contact reactions, whether irritant or immune. In this context, the diverse interactions between T lymphocytes and the presenting antigen cells, macrophages, and Langerhans cells remain to be explained, as does the functional significance of the numerous cytokines, including the interleukins (ILs), especially IL-l, IL-Z, and IL-4, the interferons, and the intercellular adhesion molecules, such as intercellular adhesion molecule 1 (ICAM-l).’ These recently discovered molecules seem to be involved in skin inflammatory processes and in antigen presentation. The continued experimental exploration of the immune mechanisms of contact allergy by immunologists can be confidently expected to provide valuable data, not only of theoretical importance, but also of practical value in the prevention of and desensitization in contact hypersensitivity.2

The survey was carried out between January 1988 and June 1990. It consisted in a clinical and allergological study of 1489 housewives, 880 of which had contact dermatitis at their hands. (group of "cases"). The other 609 represented the control group. The anamnesis was gathered with a guided questionnaire: the questions concerned familiar and personnel pathology, use of detergents and cosmetics, use of means of prevention and therapies. Patch tests with haptens of GIRDCA series and with the most common detergent components were performed. In 98% of cases hands were the lace of beginning of symptoms; in the group of "cases" 46% were positive to at least one patch test. Nickel sulphate gave positivities in the 28% of cases. Results of the search of this metal (and of chrome and cobalt) in detergents are described. Other possible occasions of contact are described. Other causes of sensitization are represented by rubber additives, by perfumes and by preservatives. Cutipositivities for detergents are very really limited. Means of protection, in particular barrier creams, are described as scarcely used.

Secrétan's syndrome is characterized by hard persistent edema of the dorsum of the hands. Usually, the condition is self-inflicted, but the authors have seen four cases that were occupationally related. The patients were fishing divers, and the mechanism appeared to be the constrictive action of the tight diver suit and pricks from sea urchin spines. Lymphographic abnormalities were present in one case.

Two cases are described of acute contact dermatitis from an antifungal cream, containing pyrrolnitrin, employed for the treatment of tinea cruris. Positive reactions to pyrrolnitrin and to a chemically related substance, 1-chloro-2,4 dinitrobenzene, were put into evidence.

Cell-mediated immunity (CMI) was investigated in a series of patients with epithelial tumours of the skin and with Kaposi's sarcoma. In all 53 patients the peripheral blood lymphocyte count showed no substantial difference from the control values. The blasts count after phytohaemagglutinin stimulation in 30 patients ranged from 40 – 50% with no noticeable difference from the control values. Intradermal tests with the staphylococcal antigen, PPD-tuberculin and streptokinase-streptodornase carried out in 59 patients proved negative in a significant number of cases, mainly those of Kaposi's sarcoma. The non immune inflammatory response to chemical irritant (benzalkonium chloride) was more often negative (17 of 59 cases) than in controls (5 of 30 subjects). The DNCB sensitization test carried out in 28 patients was negative in 5 cases (2 cases of late basal-cell epithelioma, 2 cases of advanced squamous-cell carcinoma and 1 case of Kaposi's sarcoma). The findings do not thus indicate the presence of a gross CMI defect in the material studied, which would be borne out by all the tests employed. The sometimes discordant results of the various tests suggest the existence of partial CMI defects in certain tumours, but mainly in Kaposi's sarcoma. Such partial defects, encountered even in early neoplasms, coexist, in some cases, with failure of inflammatory response to chemical irritants.

A series of 14 cases of Sporotrichosis cutanea is reported. Epidemiological and clinical aspects of the disease are discussed in the light of recent data. In addition to cultures, the diagnostic methods to he considered include an indirect immunofluorescence test, which is positive at variable titre and for which use may he made of normal human antiserum or anti-immunoglobulin, mainly IgG and IgM, antisera. The mainstay of the treatment is preparations of iodine, with trimethoprim-sulpha-methoxazole as a possible alternative.

The number of tumor-infiltrating macrophages was estimated in 43 patients with skin cancer, including 18 cases of squamous cell and 25 cases of basal cell carcinoma. Macrophages were identified in cell cultures by 2 assays, namely phagocytosis and resistance to detachment by trypsin. The average percentage of adherent cells for the 2 groups of skin tumors was 4.5 ± 2.6 and 10.2 ± 5.2, respectively, and the difference was statistically significant. Follow-up studies after surgical excision of the primary neoplasm showed a relatively low macrophage content in 2 of the 4 cases in which local recurrences occurred. Preliminary functional studies suggested that soluble factors may be released by neoplastic cells, accounting for the inhibitory effect of tumor cell supernatants on macrophage Chemotaxis in vitro.

In a typical case of congenital self-healing histiocytosis of the Hashimoto-Pritzker type, the results of an ultrastructural examination of a nodule of a 30-day-old patient showed that about 25% of the cells contained unique phagosomes but no regularly laminated bodies. This case of congenital self-healing histiocytosis is an example of concurrent proliferation of two types of histiocytes (one with and one without Langerhans' granules). Since transitional forms were not observed, this finding might indicate the existence of congenital, self-healing forms of histiocytosis X.

Triclocarban was subjected to a profiling of its dermatitis producing potential including irritancy (21-day cumulative irritancy potential and application to 213 normal controls), phototoxicity (method of Marzulli), predictive contact sensitization (modified Draize method), predictive phototesting and battery screening in 2200 dermatitis patients, in an effort to define its relative dermatitis potential. The allergic contact dermatitis potential of triclocarban following bar soap use appears minimal.

An active subpopulation of peripheral blood T-lymphocytes, characterized by rapid (5 min) rosette formation with sheep red blood cells (A-RFC), was measured in patients with acute allergic contact dermatitis. A significant rise in A-RFC occurred in these subjects. The number of total T cells was also increased in the same group of patients, but the percentage of increase was smaller than that found in A-RFC. The significance of A-RFC and their relationship to patient immunological status are discussed.

Contact sensitivity to medicaments and other chemical allergens has been observed in about 30 % of 364 patients with pompholyx. Pompholyx is a recurrent vesicular eruption which increases the incidence of contact sensitivity. The majority of patients tested by means of intradermal and cultural tests did not show any relevant finding on the microbial nature, allergic or not, of pompholyx.

Over the years, changes have had to be made in the list of topical drugs most frequently responsible for allergic contact dermatitis. The 4 most common sensitizers in Italy in the past have been penicillin, sulfonamide, promethazine and neomycin. Now the list is headed by neomycin, benzocaine and ethylenediamine. Antihistamines and parabens are less frequently observed as sensitizers. The increasing topical use of new drugs and additives, as well as older sensitizers, produces reactions to other substances, such as non-steroidal anti-inflammatory agents, some antimycotic drugs, propylene glycol and benzoyl peroxide.

In 541 patients with atopic dermatitis (AD), a history with special reference to food allergy, RAST and challenge tests were performed. In 84 patients cutaneous symptoms (exacerbation of the dermatitis or acute urticaria) were attributed to ingestion of various foods, especially eggs, milk, fish and peaches. While in cases of acute urticaria the history agreed largely with the results of the RAST and challenge test, in patients with exacerbation of the dermatitis, considerable discrepancies came to light between the anamnestic data and the other tests. Therefore the essential role of food allergy, in a consistent number of cases of atopic dermatitis, is unlikely. In the subjects with a family history of atopy, the early introduction of artificial milk neither increases the incidence of atopic dermatitis, nor precipitates its earlier onset, nor?finally?increases the incidence of asthma or food allergy. Only 3 out of 25 subjects with specific lgE antibodies to nuts showed specific lgE to birch, which is an uncommon tree in the South of ltaly.

Patch tests with the standard series of chemical allergens were performed on 8,230 patients having various dermatoses. The frequency of contact sensitization among categories of dermatoses varied markedly. While only 21% of persons whose diagnosis was occupational contact dermatitis reacted allergically to at least one chemical, reactions were observed in 70% of those whose skin had been damaged by mechanical traumas. Cuts, wounds, and abrasions incurred on the job, while not very serious injuries per se, should be regarded as having greater clinical importance insofar as they increase the likelihood of contact sensitization to allergens.

T cell subsets (theophylline-sensitive T lymphocytes and T gamma lymphocytes), and the activity of soluble immune response suppressor (SIRS) factor have been investigated in a total of 53 patients with squamous cell carcinoma (SCC) of the skin. Eight of these had metastatic regional lymph nodes. The results showed decreased values for theophylline-sensitive T lymphocytes and elevated values for T gamma cells. Suppressor function evaluated by means of SIRS factor was normal in 36 patients with non-metastatic skin SCC and decreased in 8 with metastatic skin cancer.

Results of a study in 62 patients with urticaria and 30 controls, all under 12 years of age, are reported. The study involved history taking and assays of immunoglobulins A, G, M, D, E, of complement fractions C3c and C4 and estimation of C1 estease inactivator activity in the plasma. Acute urticaria is more frequent than chronic urticaria in children, expecially in subjects with atopic diathesis; papular urticaria (or strophulus infantum) is particularly frequent in children under 6 years of age and in the male. Assays of plasma immunoglobulins demonstrated selective deficiency of IgA in two and significant reduction of this immunoglobulin in a further three cases. The mean levels of IgE proved normal in chronic urticaria, raised in acute urticaria, and very high in papular urticaria. Complement assays demonstrated, in one case, a reduction of C3c below 60 mg/100 ml, persisting after the disappearance of urticaria.

A rare case of hibernoma about the nipple in a 9-year-old boy is presented: the tumour was peculiar not only for the age and region, but also for its superficial, subepidermal site.

Cell-mediated immunity (CMI) was investigated in a series of patients with epithelial tumours of the skin and with Kaposi's sarcoma. In all 53 patients the peripheral blood lymphocyte count showed no substantial difference from the control values. The blasts count after phytohaemagglutinin stimulation in 30 patients ranged from 40-50% with no noticeable difference from the control values. Intradermal tests with the staphylococcal antigen, PPD-tuberculin and streptokinase-streptodornase carried out in 59 patients proved negative in a significant number of cases, mainly those of Kaposi's sarcoma. The non immune inflammatory response to chemical irritant (benzalkonium chloride) was more often negative (17 of 59 cases) than in controls (5 of 30 subjects). The DNCB sensitization test carried out in 28 patients was negative in 5 cases (2 cases of late basal-cell epithelioma, 2 cases of advanced squamous-cell carcinoma and 1 case of Kaposi's sarcoma). The findings do not thus indicate the presence of a gross CMI defect in the material studied, which would be borne out by all the tests employed. The sometimes discordant results of the various tests suggest the existence of partial CMI defects in certain tumours, but mainly in Kaposi's sarcoma. Such partial defects, encountered even in early neoplasms, coexist, in some cases, with failure of inflammatory response to chemical irritants.

Patterns of distribution of allergic contact dermatitis follow a certain order in time. The disease starts at a given site, most often as a unilateral acrodermatitis and, should it become chronic, spreads locally. The subsequent pattern of distribution varies depending on the primary site and the type--occupational or otherwise--of the disease. In this study data collected two decades ago are confronted with the more recent ones relating to 1055 cases of occupational allergic contact dermatitis. Examination of this material brought to light no essential difference between the older and more recent patterns of distribution of secondary sites. The incidence, however, of certain multiple localizations and of the primary or secondary involvement of the face has diminished.

Certain infections such as Kaposi's herpetic eruption, impetigo, recurrent cutaneous herpes simplex and warts are more frequent in subjects with atopic dermatitis. It is likely that the continuous alterations of the skin are more important than immunological factors in increasing the frequency of some infections in subjects with atopic dermatitis. Moreover, these infections do not seem to affect significantly the clinical course of atopic dermatitis.

Many immunological alterations have been reported in atopic dermatitis, and it is likely that in some cases they are capable of worsening the clinical course of atopic dermatitis (AD). More frequently these alterations are responsible for conditions associated with AD such as asthma, food allergy and infections. It seems probable that in some cases they are evidence of a preclinical allergic manifestation. However, in most cases, it is likely that the immunological alterations do not affect significantly the clinical course of the disease.

The expression of Fc-IgG receptors on mononuclear phagocytes (monocytes/macrophages), as well as the activity of soluble immune suppressor supernatant of T-cell proliferation (SISS-T) factor have been investigated in 23 patients with squamous cell carcinoma (SCC) of the lower lip, including 8 patients with metastases in the regional lymph glands. The results demonstrated a significant increase of the expression of Fc-IgG receptors only on circulating monocytes of patients with metastatic SCC. The suppressor function evaluated by means of the SISS-T factor proved normal in patients with nonmetastatic skin SCC and reduced in 8 patients with metastatic SCC.

The preliminary results of a survey carried out by the Institutes of Dermatology of Bari and Florence Universities and by the Clinica del Lavoro of Milan University are analyzed. The survey, whose aim is to identify the causes of contact dermatitis on housewives' hands and whose conclusions are forecasted for June 1990, will examine 1,650 female people, 1,050 of which are ill and 600 are case-controls. The results of the first 617 cases (514 ill and 103 case-controls) are reported. The anamnesis has shown that the hands (in 488 cases) are the most affected part of the body, that the most frequent symptoms are itch and burning sensation (in 410 cases), and that cosmetics, followed by detergents and softeners, are considered by the patients among the products more responsible for these symptoms. The allergic tests, even if with a different percentage of incidence, have shown metals (above all nickel), rubber additives and resins as the main aptens. Another survey, also in progress, concerning the search of metals in detergents and in washing waters for pollution caused by abrasives, pots, Inox sinks, pipes and tabs of the water system, is reported.

A case of Phenergan-induced allergic photo-contact dermatitis in a boy aged 11 years is described. The condition produced a dermatological picture of senile-looking elastosis and citrine skin in exposed areas.

A group of 34 inpatients with contact allergy to para-amino compounds (sulfanilamide, paraphenylenediamine, benzocaine) underwent a series of peroral tests using structurally related substances, sulphonvl ureas (carbutamide, tolbutamide and chlorpropamide), diaminodi-phenyl-sulfone. saccharin and salicyl azosulfapyridine. Sulphonyl ureas given orally can produce a widespread dermatitis in subjects with contact sensitivity to sulfanilamide. but not in those sensitized to paraphenylenediamine and benzocaine.

Three cases of neonatal gangrene of the buttock are reported. They were characterized by: localization to the skin and muscles of one buttock; sudden onset, minutes after birth; sciatic palsy in two of three and absence of known causes, except for an umbilical injection at birth in two of three. This procedure seems responsible in the first two; the etiology of the apparently spontaneous third case is discussed.

Summary Eleven infants, 4 to 5 months old, treated for napkin (diaper), seborrhoeic or atopic dermatitis with topical fluorinated steroids, developed granulomatous lesions in the napkin area. Seven patients were followed up for more than 6 months: in four of them the granulomatous lesions regressed leaving lax atrophic scars. It is suggested that fluorinated steroid creams and plastic pants are the precipitating causes.

SUMMARY A case of systemic mastocytosis is described, characterized by the severity of its cutaneous manifestations (diffuse encephaloid pachydermia, numerous skin tumours reminiscent of molluscum fibrosum, and large comedones) associated with gastro-intestinal disturbances and high blood histamine values but running a benign clinical course.

Nine cases of disease malingering with skin lesions attributed by the patients to occupational factors are reported. History and morphology of the lesions provided sufficient grounds for the diagnosis of occupational dermatitis arterfacta. Four out of nine patients admitted to having produced these artefacts.

1,476/2,320 of our cases of atopic dermatitis (AD) start in the first six months of life. The diagnosis is usually easy, but at this age it is sometimes more difficult, mainly because of lack of or rare evidence of scratching, but also because of the brief clinical history that does not allow observation of the characteristic chronic and relapsing course. Moreover, the major atopic disorders-asthma, rhinitis-usually appears later in the natural history of atopic subjects. From a differential diagnosis point of view, AD is the most definite dermatological disorder at this age. Other not well defined conditions occurring in the first six months of life are usually referred to as infantile seborrheic dermatitis, a name that has been used for at least four different disorders: cradle cap, cradle cap with involvement of inguinal, axillary and retroauricular folds, napkin psoriasis and Leiner's erythroderma. From a clinical point of view, AD in the first months of life is characterized by the prevalence of exudating lesions; moreover, the lack of or the rare evidence of scratching allows us to observe isolated vesicular lesions that are found with difficulty in the further course of the disease.

The incidence of contact allergy was studied in a series of 165 patients with eczematous dermatitis of the feet correlated clinically with shoe contact. Positive reactions to one or more substances were recorded in 108 patients (65.4%). Among the relevant sensitizers were chromium, paraphenylenediamine, paratertiary butylphenolformaldehyde resin and nickel, while the other allergens were benzocaine, neomycin, balsam of Peru, ethylenediamine and parabens. Allergic contact dermatitis of the feet can be prevented by recognition of the allergens responsible, control of hyperhidrosis and avoidance of topical allergens.