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1.
J Eur Acad Dermatol Venereol ; 38(7): 1329-1346, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38400603

ABSTRACT

Use of medical devices (MDs), that is, glucose sensors and insulin pumps, in patients with Type 1 diabetes mellitus (T1D) has proven an enormous advantage for disease control. Adverse skin reactions from these MDs may however hamper compliance. The objective of this study was to systematically review and analyse studies assessing the prevalence and incidence of dermatitis, including allergic contact dermatitis (ACD) related to MDs used in patients with T1D and to compare referral routes and the clinical investigation routines between clinics being part of the European Environmental and Contact Dermatitis Research Group (EECDRG). A systematic search of PubMed, EMBASE, CINAHL and Cochrane databases of full-text studies reporting incidence and prevalence of dermatitis in persons with T1D using MDs was conducted until December 2021. The Newcastle-Ottawa Scale was used to assess study quality. The inventory performed at EECRDG clinics focused on referral routes, patient numbers and the diagnostic process. Among the 3145 screened abstracts, 39 studies fulfilled the inclusion criteria. Sixteen studies included data on children only, 14 studies were on adults and nine studies reported data on both children and adults. Participants were exposed to a broad range of devices. Skin reactions were rarely specified. It was found that both the diagnostic process and referral routes differ in different centres. Further data on the prevalence of skin reactions related to MDs in individuals with T1D is needed and particularly studies where the skin reactions are correctly diagnosed. A correct diagnosis is delayed or hampered by the fact that, at present, the actual substances within the MDs are not declared, are changed without notice and the commercially available test materials are not adequately updated. Within Europe, routines for referral should be made more standardized to improve the diagnostic procedure when investigating patients with possible ACD from MDs.


Subject(s)
Dermatitis, Allergic Contact , Diabetes Mellitus, Type 1 , Humans , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Prevalence , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/diagnosis , Child , Adult , Blood Glucose Self-Monitoring/instrumentation , Insulin Infusion Systems/adverse effects , Surveys and Questionnaires , Incidence
8.
J Eur Acad Dermatol Venereol ; 33(4): 781-785, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30633375

ABSTRACT

BACKGROUND: Ecthyma gangrenosum (EG) is characterized by the occurrence of erythematous, violaceous or haemorrhagic macules and/or vesicles, often evolving into necrotic ulcers, with a central grey-black eschar. It is a rare skin condition, usually occurring in immunocompromised patients suffering from bacterial sepsis caused by Pseudomonas aeruginosa. However, seemingly healthy children have been diagnosed with this skin disease as well. OBJECTIVES: We report the workup of a case of vulvar EG caused by P. aeruginosa in a toddler, which led to a diagnosis of an underlying neutropenia. Moreover, we provide a brief literature review on those cases of EG where an underlying primary immunodeficiency, neutropenia in particular, was eventually diagnosed. METHODS: A one-and-a-half-year-old girl presented with a history of recurrent (respiratory) infections and the sporadic occurrence of purpuric, vulvar ulcers. Workup consisted of microbiological and haematological investigations, including repeated blood analyses. RESULTS: Bacterial swabs from the vulvar ulcers showed the growth of P. aeruginosa. No concomitant sepsis was present, but laboratory investigations pointed towards a cyclic neutropenia, coinciding with the occurrence of the EG lesions. Topical gentamicin ointment allowed the skin lesions to heal faster. Following the administration of granulocyte colony-stimulating factor (G-CSF), the girl experienced less infections in general and had no recurrence of EG lesions in particular. Treatment with G-CSF could eventually be stopped, and the neutropenia, ultimately transient in nature, completely resolved. CONCLUSION: Children presenting with (anogenital) EG should always alert a physician to consider a potentially underlying immunodeficiency, neutropenia in particular.


Subject(s)
Ecthyma/microbiology , Gangrene/microbiology , Neutropenia/drug therapy , Pseudomonas Infections/complications , Pseudomonas aeruginosa , Vulvar Diseases/microbiology , Anti-Bacterial Agents/therapeutic use , Female , Gentamicins/therapeutic use , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Infant , Neutropenia/complications , Pseudomonas Infections/drug therapy
9.
J Eur Acad Dermatol Venereol ; 33(2): 267-276, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30284765

ABSTRACT

Allergic contact dermatitis (ACD) from isothiazolinones has frequently been described in the literature. Following an epidemic of sensitization to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) in the 1980s, and more recently to MI, the Scientific Committee on Consumer Safety of the European Commission banned their use in leave-on products, while restricting that in rinse-off cosmetics. Despite a decreasing prevalence of ACD from MCI/MI and MI, cases caused by occupational exposure and non-cosmetic isothiazolinone sources are on the rise. Moreover, sensitization to newer and lesser known isothiazolinones has been reported. This paper reviews the epidemiology of contact allergy to different isothiazolinones, clinical presentation of isothiazolinone-induced ACD, most relevant sensitization sources and potential cross-reactions between isothiazolinone derivatives. It also provides an update on recent legislative measures.


Subject(s)
Dermatitis, Allergic Contact/etiology , Dermatitis, Occupational/etiology , Occupational Exposure/adverse effects , Thiazoles/adverse effects , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/physiopathology , Dermatitis, Occupational/epidemiology , Dermatitis, Occupational/physiopathology , Europe/epidemiology , Female , Humans , Immunization , Incidence , Male , Patch Tests , Risk Assessment , Thiazoles/immunology
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