Clinico-allergological pattern of allergic contact dermatitis among 70 Indian children.

Background: Rapid urbanization, westernization of lifestyles, poor quality of objects available and extremely relaxed vigilance on adherence to 'product safety guidelines' make any developing country like India highly susceptible to allergic contact dermatitis (ACD) even in children. There has been no previous attempts to assess the magnitude of childhood ACD in India. Aims: To assess the clinico-allergological profile of ACD in Indian children. Methods: All consecutive children up to 15 completed years of age who were patch tested over the last 3 years were analyzed from the records. Results: A total of 70 children were studied (average age of disease onset 8.39±3.59 years [SD], range 1-15 years and average age of presentation 10.8 ± 2.99 years [SD], range 5-15 years). Relevant allergy was noted in 48.6% of the patients. Age and sex had no significant role on the prevalence of ACD. Common allergens were paraben (43%), potassium dichromate (27%) and fragrance mix (26%). Most relevant allergens were potassium dichromate, paraben and fragrance. Foot was the most commonly involved site (25.7% of patients). Atopy was present in 18 patients (25.7%). A total of 22 irritant reactions were noted in 13 patients. Conclusion: This study reflects the current status of childhood ACD of this region.

Epidemio-allergological study in 155 cases of footwear dermatitis.

BACKGROUND: Footwear dermatitis represents a distinct and common group among all types of contact dermatitis cases seen in India. This ailment, however, often remains undiagnosed, misdiagnosed or empirically diagnosed without pinpointing the contributory allergens. AIMS: This study was undertaken to detect the epidemio-allergological pattern of footwear dermatitis in India. METHODS: A total number of 155 cases with footwear dermatitis were evaluated from July 2005 to June 2006, by detailed history and clinical examination. They were patch tested using Indian Standard Battery (ISB) approved by the Contact and Occupational Dermatoses Forum of India (CODFI) with pre- and post patch-test counseling. RESULTS: The proportion of footwear dermatitis was 24.22% (n=155) among a total of 640 patients patch tested during that period. Females [61.93% (n=96)] were commonly affected than males [38.06% (n=59)]. The ages ranged from 8 to 75 years. The age group that predominantly involved was the fifth decade [24.52% (n=38)]. Occupationwise housewives were most commonly involved [47.48 (n=66)]. Contributory allergens in order of frequency were: potassium dichromate, 45.8% (n=71); cobalt chloride, 38.06% (n=59); paraphenylenediamine, 32.25% (n=50); epoxy resin, 20% (n=31); black rubber mix, 20% (n=31); nickel sulfate, 14.83% (n=23); mercaptobenzothiazole, 12.9% (n=20); colophony, 11.6% (n=18); thiuram mix, 10.32 % (n=16); p-tert-butyl-formaldehyde resin, 9.67% (n=15); and formaldehyde, 4.5% (n=7). Among the different categories of footwear allergens, the highest positivity was shown by leather and leather-related chemicals in 61.9% cases (n=96). CONCLUSION: Footwear dermatitis, a common dermatosis, is mostly caused by leather processing chemicals, metal buckles, black dyes of shoes and socks, adhesives, plastic, rubber shoes and polishing agents in order of frequency.

Mycophenolate mofetil as adjuvant in pemphigus vulgaris.

Pemphigus vulgaris (PV) is a life threatening autoimmune blistering disease of skin and mucous membranes. Advent of systemic steroids has greatly reduced the mortality rate. However, steroids and adjuvant immunosuppressive therapy are nowadays frequent contributory agents of morbidity and mortality of PV. Mycophenolate mofetil (MMF) has been reported to be an effective adjuvant to systemic steroids. It helps in increasing the immunosuppressive effect and minimizing the toxicities by steroid sparing effect. However, its efficacy in refractory cases of PV is not well documented. The lowest possible dose with satisfactory therapeutic efficacy and least side effects is known. We used MMF 1 g/day and systemic steroids in 3 Indian patients with pemphigus vulgaris who were resistant to systemic steroid monotherapy or combination treatment with azathioprine. In our experience, MMF offers an effective adjuvant with minimal side-effects in the treatment of resistant PV.