Use of 5% lidocaine patch in the management of post-traumatic localized neuropathic pain. Case reports / O uso do emplastro de lidocaína a 5% no manejo de dor neuropática localizada pós-traumática. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: Neuropathic pain is defined as a pain caused by a lesion or condition that affects the somatosensory nervous system. Taking its prevalence into account, in particular post-traumatic localized neuropathic pain, and to discuss ways to manage patients with this condition, considering efficacy and tolerability of proposed treatments, this report presents three clinical cases of patients with post-traumatic localized neuropathic pain treated with 5% lidocaine transdermal patch in both monotherapy and polytherapy. CASE REPORTS: This study reports the cases of three female patients aged between 29 and 81 years with complaints of pain due to trauma, who were managed with 5% lidocaine transdermal patch in prolonged treatment, with a significant improvement in pain. CONCLUSION: According to scientific evidence, the use of 5% lidocaine transdermal patch in post-traumatic localized neuropathic pain as shown efficacy with favorable safety and tolerance. Moreover, it was possible to demonstrate that a 5% lidocaine transdermal patch in a polytherapy format has contributed to improved outcomes with no effect in treatment tolerability.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor neuropática é definida como uma dor provocada por uma lesão ou doença que afeta o sistema nervoso somatossensitivo. Considerando a sua prevalência, em particular dor neuropática localizada pós-traumática, com o intuito de discutir formas de manejar os pacientes portadores dessa condição e avaliando tanto a eficácia quanto a tolerabilidade aos tratamentos propostos, este artigo apresenta três casos clínicos de pacientes portadores dessa condição, tratados com emplastro de lidocaína a 5%, tanto em monoterapia quanto no contexto da terapia multimodal. RELATOS DOS CASOS: Este estudo relata três casos de pacientes do sexo feminino com idades entre 29 e 81 anos e queixas de dor decorrente de trauma, que foram manejadas com emplastro de lidocaína a 5% em tratamento prolongado, com uma significativa melhora do nível de dor. CONCLUSÃO: Em concordância com as evidências da literatura científica, o uso do emplastro de lidocaína a 5% nos casos de dor neuropática localizada pós-traumática relatados mostrou-se eficaz no manejo dessa condição e apresentou perfil de segurança e tolerabilidade favorável. Além disso, foi possível observar também que o emplastro de lidocaína a 5%, quando adicionado em abordagem multimodal, contribuiu para uma melhora no quadro sem prejuízo da tolerabilidade do tratamento.

Erupção pigmentar fixa à nimesulida comprovada por teste de contato / Fixed pigmented erythema from nimesulide proven by patch testing

A erupção pigmentar fixa (EPF) é uma reação cutânea adversa a drogas relativamente comum, envolvendo cerca de 10% de todas as reações de hipersensibilidade a medicamentos (RHM). Envolve uma reação imunológica não imediata, mediada por células T CD8+ sensibilizadas, relacionada ao mecanismo do tipo IVc na classificação de Gell e Coombs. Um dos grupos mais frequentemente implicados nesse tipo de reação é o dos antiinflamatórios. Relatamos o caso de um homem que, 24 horas após iniciar tratamento com nimesulida para lombalgia, apresentou um quadro de lesões cutâneas tipo máculas eritemato-violáceas bem delimitadas e disseminadas pelo corpo. A nimesulida é um fármaco anti-inflamatório não esteroidal (AINE) pertencente à classe das sulfonanilidas, que atua como inibidor seletivo da enzima da síntese de prostaglandina, a ciclo-oxigenase, inibindo preferencialmente a COX-2. O diagnóstico foi comprovado pela realização do teste de contato, também conhecido como patch test, que traduziu positividade na segunda leitura realizada após 72 horas da sua colocação.

Fixed pigmented erythema (FPE) is a relatively common adverse drug reaction, consisting of approximately 10% of all drug hypersensitivity reactions. It involves a non-immediate immune reaction mediated by sensitized CD8+ T cells and related to the type IVc mechanism in the Gell-Coombs classification. One of the groups most frequently involved in this type of reaction is that of anti-inflammatory drugs. We report the case of a man who, 24 hours after starting treatment with nimesulide for low back pain, presented with well-defined cutaneous lesions consisting of erythematous-violaceous macules and spread throughout the body. Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) belonging to the sulfonanilide class that acts as a selective inhibitor of the prostaglandin synthesis enzyme, cyclooxygenase (COX), preferentially inhibiting COX-2. The diagnosis was confirmed by a patch test, which translated positively in the second reading performed 72 hours after its placement.

Clinical analysis, diagnosis, and treatment of a 48-year-old female Filipino with Riehl melanosis

@#INTRODUCTION: Pigmented contact dermatitis (PCD) is characterized by non-eczematous pigmentation associated with contact sensitizers, usually without any active or preceding pruritus and erythema. PCD was first described by Riehl, who identified patients with brown to gray facial pigmentation concentrated on the face most commonly associated with sensitizing chemical such as cosmetics, fragrances, and textiles. CASE REPORT: This is a case of a 48-year-old female Filipino who presents with blue-grey to brown patches on the forehead of 1-year duration with no significant pathologic history. Clinical examination, dermoscopy and histology were consistent with a variant of pigmented contact dermatitis known as Riehl melanosis. Since anamnesis was unremarkable, patch testing was done to identify the contact allergen triggering the symptom. Results obtained a positive reaction to nickel, potassium dichromate, and textile dye. CONCLUSION:Treatment includes the elimination of trigger factors, hence the importance of patch testing in the investigation of its cause. Alongside adequate photoprotection, a combination treatment of 1,064 nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 20% tricholoacetic acid (TCA) peel and oral retinoids, were found safe and effective in the management of facial melanosis. Three-dimensional imaging and dermoscopy were utilized to obtain a more standard and objective pre- and post-treatment comparison.

Pediatric contact dermatitis.

Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control.

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.

Patch Testing in Patients with Lichen Simplex Chronicus / 대한피부과학회지

BACKGROUND: Lichen simplex chronicus (LSC) may develop under various chronic pruritic conditions, such as allergic contact dermatitis (ACD). However, there have been only a few studies on the relationship between ACD and the development of LSC. OBJECTIVE: To investigate the clinical features and frequency of contact sensitization in patients with LSC. METHOD: In a retrospective study, 71 patients with LSC, who had shown resistance to conventional treatment and had been examined with patch tests in the Korean standard series, were evaluated for their clinical features and results of the patch testing. RESULTS: 1. The patients comprised of 32 males and 39 females. The mean age was 51.8 (19-80) years, and the highest incidence was shown in the 50-60 year age range. The predominant sites of the dermatitis were the trunk (25.4%), arms (16.7%), widespread on the body (14.7%), the scalp (9.8%) and the neck (9.8%). 2. Sixty five (91.5%) out of 71 patients showed a positive reaction to one or more allergens. The highest sensitization rates were found with: nickel sulfate (38%), balsam of Peru (25.6%), 4-phenylenediamine base (23.9%), fragrance mix (22.5%), mercury ammonium chloride (18.3%), cobalt chloride (18.3%) and potassium dichromate (15.5%). CONCLUSION: This study shows that contact sensitization may possibly play an etiologic role in the development of LSC, and there are some dominant allergens, including nickel, 4-phenylenediamine, balsam of Peru and fragrance mix. Therefore, when LSC is resistant to conventional treatment, it is important to carry out patch testing, and to bear in mind the possibility of ACD contributing to the development of LSC.

An Epidemiological Study of Contact Dermatitis in Korea ( 1986 - 1993 ) / 대한피부과학회지

BACKGROUND: The first multicenter study on standard patenest results(1983-1986) was tried in Korea. Since then 10 years have elapsed and epidemiologi al data need be updated continuously. OBJECTIVE: To register and compile the results of patch the ig throughout the country and to compare the positivity ard trend with those of previous study. METHODS: Standard patch testings were performed using irachamper on Scanpor tape. The results were analysed by a personal computer program. RESULTS: A total of 2326 patch tested cases(male 539, female 1787) were compiled and analysed. The highest ag distribution was 3rd decade. As the job distribution, housewives and office workers were the mast frequent consisting 33.4% and 12.1% respectively. The face was the most frequently affected site comprising 49.6%. The highesteritization rates were foud with nickel(17.9%), cobalt(13.8%), fragrance mix(12.9%), potass ur dichromate(11.3%), ammoniated mercury(8.7%), neoaycin(7.2%). The lowest positivity inclured black rubber mix(1.0%), primin (1.2%), ethylenediarnine(1.3%), carba mix(1.4%), While nicel epoxy resin and 4-t-butylphenol formaldehyde resin showed increased reactivities, PPD, bacrubber mix, balsam of Peru, quaternium 15, ammceniatct mercury and captan showd a deceased tendency when compared with those of previous study. CONCLUSION: The large scale studies of epidemiology in cortat dermatitis have been performed and they need to be updated and analysed consecutively in the future.

Skin hazards in workers cultivating okra(Hibiscus esculentus Linn) / 日本農村医学会雑誌

The outbreak of skin hazards from okra cultivation was studied by a field survey. About a half (46.2 %) of 186 workers investigated (male, 76 ; female, 110) reported to have experienced pastly or annually skin hazards from okra cultivation.The sites of lesion complained were mostly the arms (47.5%), neck (41.3%), fingers (32.5%) and so forth in total number. The degree of lesions were generally itching (85.0%) and flare (61.3%), but severe cases like vanishing fingerprints (16.3%) and fissures on the fingers (11.3 %) were also revealed. Portion of okra responsible for skin hazards seemed to be mainly leaves, trichomes and pods.<BR>Positive patch test reactions with preparations of immature okra pods in 46 workers (male, 12 ; female, 34), compared to 112 control subjects (male, 84 ; female, 28), were significantly higher in okra workers than in controls, which were 25% in males and 20% in total group.<BR>These results show that okra components cause irritant contact dermatitis and allergic contact dermatitis as well.