Allergic contact hand dermatitis due to constituents of nitrile gloves

Purpose: This report of a case of allergic contact hand dermatitis due to constituents of nitrile gloves is to bring to the attention of practitioners four important practice points: 1) allergic contact dermatitis may occur due to exposure to chemicals in nitrile gloves; 2) skin patch testing is used to identify the causative allergens; 3) targeted allergens may be necessary in addition to the baseline European standard series if the standard series is unhelpful; and 4) there are potential interventions to manage nitrile glove dermatitis. Findings: A laboratory analyst had occupational exposure to several allergens and had worn latex gloves. She was exposed to laboratory chemicals and powdered ore dust, containing precious metals. She developed hand dermatitis and was relocated to administrative duties not requiring glove use. Her dermatitis cleared but recurred when she returned to the laboratory and started using nitrile gloves. On history, nitrile gloves and platinum group metal ore dust were consistently associated with her hand dermatitis, but laboratory chemicals were not. Latex-specific immunoglobulin E (IgE) was negative, as were skin patch tests for 13 allergens in the metal series, including salts of platinum group metals. She had positive allergic reactions to cobalt chloride, formaldehyde, nickel sulphate, and quaternium 15 in the European standard series patch tests. She did not react to the rubber chemicals in the European standard series, including thiuram mix. The patient was then tested with the rubber additives series because of the glove-relatedness of her hand dermatitis. She had positive reactions to three thiuram compounds used as accelerators in rubber gloves. The patient went on vacation during which time her dermatitis improved. She was relocated to a position without glove use or ore contact and her dermatitis did not recur. Conclusions: An analytic laboratory worker developed hand allergic contact dermatitis due to nitrile glove constituents. The diagnosis is supported by the improvement in her dermatitis after cessation of glove use, negative metal series patch tests, and positive patch tests to accelerators found in rubber gloves. Nevertheless, a contribution to the dermatitis by metals in the platinum group metal ore dust cannot be excluded. Recommendations: Nitrile glove constituents should be considered in wearers who develop hand dermatitis. Skin patch testing is recommended to investigate putative agents. Specific patch test series for more targeted testing may be required

Dermatite néonatale: à propos de 116 cas recueillis dans un CHU d'Abidjan / Newborns dermatitis: about 116 cases collected in a university hospital in Abidjan

Objectifs : Déterminer le profil épidémiologique des dermatoses du nouveau-né et de décrire les différents aspects cliniques des dermatoses néonatales observées. Matériel et méthodes : L'étude s'est déroulée au Centre hospitalier universitaire de Cocody (Abidjan). L'étude était transversale, à visée descriptive et analytique, réalisée sur la base d'un recrutement prospectif. Ont été inclus, les nouveau-nés ayant été vus en consultation externe ou en hospitalisationdu 4 avril 2018 au 23 août 2018 chez qui le médecin pédiatre avait observé des lésions cutanées et/ou muqueuses.Ensuite,le diagnostic était posé par le dermatologue référant de l'étude. Résultats : Pendant la période d'étude, 116 nouveau-nés ont été recensés. La moyenne d'âge était 16,86 ± 8,4 jours avec un âge médian de 19 jours. Lesex ratio (H/F) était de 1. Dans plus de la moitié (53,5%) des cas, les lésions évoluaient depuis moins de 5 jours. Une dermatose transitoire était diagnostiquée dans plus de la moitié des cas (51,7%) et dans près du tiers des cas (32,6%) une dermatose infectieuse. Les dermatoses transitoires du nouveau-né étaient dominées par la miliaire sudorale (40%), l'érythème toxique (23%), la desquamation néonatale (10,7%) et l'hyperplasie néonatale (10,7%). Les taches mongoloïdes représentaient3,3% des cas. Les dermatoses infectieuses étaient essentiellement représentées par des infections mycosiques (68,4%) et bactériennes (31,6%). Les autres dermatoses néonatales observées étaient dominées par dermite du siège (64,3%) et les nævi congénitaux (21,5%). Plus de la moitié (57,1%) des cas d'érythème toxique néonatal survenaient entre le 6e et le 10e jour de vie. L'âge moyen des patients présentant une dermatose transitoire était de 14,31 jours contre 19,41 jours pour ceux présentant les autres dermatoses. La différence observée au niveau de l'âge était statistiquement significative (p < 0,05). Conclusion: Les dermatoses néonatales sont multiples et variées. Certaines sont transitoires, ne nécessitant pas toujours de prise en charge thérapeutique. Leur diagnostic n'est pas toujours évident pour le pédiatre d'où la nécessité d'une étroite collaboration entre pédiatres et dermatologues afin d'améliorer la démarche diagnostique et parfois thérapeutique

Aims: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis. Procedure: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist. Results: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05). Conclusion: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published

Assessment of adverse reactions to latex gloves use among nurses at Mankweng Hospital, Limpopo Province, South Africa

Adverse reaction to latex is a common problem among nurses and other health care workers. The aim of the present study was to determine the prevalence of adverse reactions to latex amongst nurses at Mankweng Hospital. A cross sectional study was carried out amongst 235 nurses at Mankweng Hospital using a self-administered questionnaire to collect information about history of allergic reaction; family history; signs and symptoms of adverse reactions after using latex gloves. Among 155 nurses who responded to the questionnaire (66 response rate); 41 (26) had a family history of allergic reactions; with asthma as the commonest allergic condition reported. Fifty four respondents (n= 54; 35) reported having had signs and symptoms of adverse reaction after using latex gloves. The most common features associated with adverse reaction to latex gloves were sneezing (n=32; 21); itching nose (n=24; 16); itching eyes (n=21; 14); runny nose (n=18; 12); cough (n=16; 11); skin redness (n=13; 9); skin redness (n=13; 9); hives (n=12; 8); scratchy throat (n=9; 6); light headedness (n=10; 7) and swelling and rash in area(s) of contact (n=11; 7). There was significant association between family history and occurrence of adverse reaction to latex gloves (p=0.029). Accordingly; this study concludes that adverse reaction to latex gloves is prevalent among nurses at Mankweng Hospital; and poses the potential for harmful effects to nurses. These effects may vary in severity from skin problems to anaphylactic shock. It is therefore important to educate nurses about the prevalence; presentation and prevention of adverse reaction to latex

An Approach to Mild to Moderate Atopic Eczema

Atopic eczema is a chronic; relapsing inflammatory disease of the skin characterised by dryness and itching; with typical distribution on the elbows and knees in younger children and on the cubital and popliteal fossae in older children and adults. It can be classified as mild; moderate or severe

An Overview of Topical Treatment for Atopic Eczema

Atopic eczema is a chronic; relapsing inflammatory disease of the skin. It is characterised by dry; itchy skin and a typical distribution on the elbows and knees in younger children; and the cubital and popliteal fossae in older children and adults. Treatment modalities include emollients; topical corticosteroids; calcineurin inhibitors; phototherapy and immunosuppressive therapy. This article provides a brief overview of topical treatments for atopic eczema

Atopic Dermatitis: Tacrolimus Vs. Topical Corticosteroid Use

Atopic dermatitis (AD); the dermatological manifestation of the atopic diathesis; has a variety of clinical presentations. It is a chronic and relapsing inflammatory disorder; requiring a multifaceted treatment approach. Topical corticosteroids are the backbone of therapy. However; concerns over adverse drug reactions associated with their long-term application limit their use.Tacrolimus; on the other hand; has been shown to be effective in stabilising the symptoms of AD in the long-term setting; without the side-effects that hamper the use of topical corticosteroids. Long-term safety data up to ten years are available in the literature. Despite this; the US Food and Drug Administration (FDA) black box warning of possible malignancies has resulted in much debate among experts.The main focus of this article is to compare the safety and efficacy of topical corticosteroids to calcineurin inhibitors; particularly tacrolimus. Furthermore; the aim is to evaluate the place of tacrolimus in AD therapy. A brief overview of the condition and other treatment modalities will also be discussed

Herpes Zoster ophthalmicus and HIV seropositivity in South-south Nigeria

Herpes zoster is a painful vesiculobullous dermatitis which occurs as a result of previously established varicella zoster virus infection. It is a well established fact that Herpes zoster ophthalmicus is a well known marker of human immune deficiency virus infection even in Africans. The aim of this study is to determine if indeed the herpes zoster condition is a marker for the immune deficiency condition called AIDS in our locality and whether the positivity is related to age or not. A total of 20 consecutive patients that presented between 2003 and 2006 with herpes zoster ophthalmicus were examined retrospectively as to their Human Immune deficiency virus (HIV) status. Their presentation; clinical findings and clinical course are also analyzed. Of the 20 patients examined; there was a male preponderance of 4:3 with most patients above 40 years (35.4between 41-50 years) and half of them were married. Out of the twelve (n=12; 60) patients whose serum was tested for human immunodeficiency virus; eight (n=8; 40) were negative; while four (n=4; 20) were positive for the virus .Eight were not tested. Using 40 years of age as the cutoff; those above 40 years (12 in number); two (n=2; 25) were seropositive while 9 were negative (75). For those below 40 years (8 in number); two (n=2; 25) were positive while six were negative (75).Upon treatment with antivirals (Zovirax ) in the majority of cases there was complete resolution in 8 (57) of the patients with most of the sequelae occurring in those of them who are seropositive.Correlation of impaired immune status with Herpes zoster affectation was found to be more obvious in the younger than 40 years group.Treatment with antivirals gave good resolution in most cases. Blinding complications were found more in those who were seropositive

Predictive Value of Seborrheic Dermatitis for HIV infection in Lagos; Nigeria

Background: Cutanenous lesions with high frequency in HIV/AIDS patients such as Kaposi's sarcoma; herpes zoster and generalised pruritic papular eruption have unequivocally proven valuable in Africa and elsewhere as predictive signs for HIV infection. Reports have associated a high prevalence of seborrheic dermatitis in HIV infected persons. Aim: To evaluate the predictive value of seborrheic dermatitis in the diagnosis of HIV/AIDS infection in Lagos University Teaching Hospital (LUTH) skin clinic.Methods: A prospective case-control study was conducted at the skin clinic of the Lagos University Teaching Hospital (LUTH) over a 23-month period (April 2001- February 2003). One hundred and eighteen patients with clinically diagnosed seborrheic dermatitis and one hundred and nine controls were tested for HIV seropositivity. Statistical analysis was performed using EPI info version 6.0. P values 0.05 was considered statistically significant. Results: Eleven patients with seborrheic dermatitis were HIV seropositive with a positive predictive value (PPV) of 9.3. Only one (0.9) of the control group was seropositive. It was also found that patients with seborrheic dermatitis who were seropositive were mainly in the older age group (40-59 years) and had more widespread lesions. Conclusion: Seborrheic dermatitis has significant positive predictive value for HIV/AIDS infection and corroborates existing literature. Routine screening of persons over 40 years of age with seborrheic dermatitis or those with widespread lesions is recommended

Eczema in North West of Libya

The life style and demographic structure of Libyan society is changing; and this could affect the epidemiology of certain diseases; including eczema. The aim of this study was to assess the burden of eczema among a selected patient population in the Zliten area in the northwest of Libya. We conducted a retrospective study by reviewing case notes and records in public and private dermatology practices in the Zliten area. The frequency of eczema among patients attending dermatology clinics in the Zliten area was 12.8; and the male to female ratio was almost 1:1. The most affected age group among patients was 20-29 years. Eczema represented a larger proportion of dermatologic conditions during spring and summer. Of all cases of eczema; 72.6were endogenous and 24.9were exogenous (p0.001). The most common type of eczema was contact dermatitis (22.7of all cases); followed by atopic dermatitis (19.7) and pityriasis alba (10.5). In conclusion; eczema is a public health problem in Zliten-Libya; and this necessitates prospective studies to determine its incidence and prevalence

Radiation Recall Dermatitis and Pneumonitis in Zaria : a Case Report

Background: The etiology of radiation recall phenomenon is not well understood. Adriamycin - based cytotoxics are frequently being used as adjuvant chemotherapy in breast cancer treatment in our environment. The phenomenon also occurs in association with radiation. Method: In our search of African literature; there seems to be a paucity of radiation - recall dermatitis and pneumonitis among Africans. We describe the case of a patient with breast cancer that developed radiation recall dermatitis and pneumonitis; secondary to the administration of adriamycin - based cytotoxic chemotherapy. Conclusion: This phenomenon should be considered as a differenial diagnosis of dermatitis and pneumonitis in patients receiving anthracycline - based cytotoxics

Acalypha Wilkesiana : Preliminary In Vitro Microbiological and Clinical Trial on Dermatitis

Acalypha wilkesiana is a common hedging plant in West Africa. Water extract of the red/brown varieties; the Red Acalypha has been used for decades by the local inhabitants for treating skin problems. The water extract of A. wilkesiana was subjected to a clinico-laboratory study to assess its efficacy i.e. ability to clear standard organisms in agar plates and to stop symptoms and clear skin lesions of eczema cases in a 3-week study period. The extract showed significant antibacterial and antifungal properties in vitro and was found to be reasonably useful in the treatment of eczema. No allergy or irritation was documented in the cases used for the study. In a depressed economy as found in most developing countries of Africa; medicinal plants like Acalypha wilkesiana could be used as a cheap and readily available sources of skin medication. More work is required to determine the active ingredients in the crude extract

Les aspects epidemiologies [sic] et cliniques de l'eczema atopique de l'enfant a Lome (Togo)

Une etude retrospective sur dossiers a ete menee afin de determiner le profil epidemiologique et clinique de l'eczema atopique de l'enfant au cours d'une consultation hospitaliere a Lome. Cent onze (111) enfants des 700 consultations pediatriques en deux ans dans le service de dermatologie; avaient un eczema atopique: soit 15;85 pour cent. 90 pour cent de ces enfants avaient un age compris entre un mois et dix ans. Les localisations les plus frequentes etaient: les plis du coude (76;75 pour cent); les creux poplites (63;93 pour cent); la face anterieure du poignet (27;02); et les joues (17;11 pour cent). L'eczema etait surinfecte dans 81;90 pour cent des cas; et etait associe a d'autres affections dans 51;34 pour cent des cas. Les resultats de cette etude; comme ceux d'autres auteurs; confirment le caractere frequent de l'eczema atopique chez le nourrison et le petit enfant. Son evolution en Afrique tropicale est dominee par les surinfections

A survey of skin diseases seen at Korle Bu Teaching Hospital; Accra; Ghana

A survey of 784 consecutive patients seen in the skin clinic at Korle Bu Teaching Hospital; Accra; Ghana is presented. The ratio of males to females was 0.9:1.0. Various skin diseases were seen with dermatitis/eczema being the most common 44.8 per cent while infectious diseases accounted for only 16.8 per cent of the total