Effects of aluminium chloride added to common patch test substances.

BACKGROUND: A modulating effect of aluminium regarding type IV reactions might exist but has not been further investigated. OBJECTIVES: The aim of this study was to investigate the effect on patch test reactions when adding aluminium chloride hexahydrate (Al-Cl) to common test preparations. MATERIALS AND METHODS: Al-Cl in different concentrations was added to nickel sulphate 15.0% aqua (Ni), methylisothiazolinone 0.2% aqua (MI) and fragrance mix I 10.0% aqua/ethanol (FM I). The Ni preparations were tested in 120 consecutive patients. MI and FM I were tested in participants known to have contact allergy to the respective allergen. McNemar's test was used to decide which Ni preparation had the highest sensitivity. Wilcoxon signed-rank test was used to calculate pairwise comparison in summarized test score for the preparations with MI and FM I. RESULTS: Adding Al-Cl 20.0%/30.0% to Ni identified twice as many patients with contact allergy to nickel compared to Ni without Al-Cl. Adding Al-Cl 20.0%/10.0% to MI, decreased the patch test reactivity compared to MI without Al-Cl. No differences in patch reactivity were noticed when adding Al-Cl to FM I. CONCLUSION: Al-Cl 20.0% or 30.0% seems to enhance the patch test reactivity to Ni 15.0% aqua.

Improvement of microstomia in scleroderma after intense pulsed light: A case series of four patients.

INTRODUCTION: Intense pulsed light (IPL) treatment is well known for, for example, photo rejuvenation, where higher cut-off filters are used. The longer wavelengths penetrate deeper in the dermis leading to damage of the collagen and stimulation of new collagen formation, which lead to more soft and elastic skin. Microstomia in systemic sclerosis is the end result of excessive collagen deposition, which makes the perioral skin firm and tight. The patients have difficulties performing oral self-care, and even professional dental care can be complicated. METHODS: Four patients with systemic sclerosis and microstomia were treated with IPL (Ellipse A/S Flex System, Denmark ) in the perioral region. The patients received 3-5 treatments with 4-week interval. Oral opening was measured before and after treatments. results: The oral opening increased approximately 1 mm per treatment in three patients. One patient had temporomandibular joint symptoms of locking and did not have any increase in mouth opening. All four patients felt softening of the perioral skin, and all four patients described that articulation, eating and tooth brushing had become easier. CONCLUSION: IPL can be a new adjunctive alternative in the non-surgical treatment of microstomia in patients with systemic sclerosis.

[Acute generalized exanthematous pustulosis]. / Akut generaliseret eksantematøs pustulose.

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous drug reaction often caused by beta-lactam antibiotics. The reaction is characterized by sudden occurrence of a generalized exanthema, developing within 1-2 days. Hundreds of sterile pustules arise on an oedematous and erythematous base. The cutaneous symptoms are accompanied by fever and neutrophilia. The pustules resolve within 4-10 days once the causative drug has been withdrawn. We hereby present a classical case of amoxicillin-induced AGEP in a 34-year-old woman.

[Penile calciphylaxis]. / Penil kalcifylaksi.

A 64-year-old diabetic man on peritoneal dialysis developed painful necrotic ulcers of the glans penis over a period of six months. On suspicion of atherosclerotic necrosis, a partial resection of his penis was performed. Histological examination showed calciphylaxis. This vasculopathy with calcification and intimal fibrosis in small blood vessels is mostly seen in patients with end-stage renal disease. The condition is characterized by painful livedoid and infiltrated plaques and ulcers. Involvement of the penis is rare, but probably underdiagnosed.

[Is it CNS vasculitis? Essential thrombocythaemia with a normal platelet count]. / Er det vaskulitis i centralnervesystemet? Essentiel trombocytose med normal trombocyttal.

A 58-year old woman was admitted with transient ischaemic attacks. Cerebral MRI was compatible with vasculitis. Blood chemistry was normal, but after 9 months she developed thombocytosis above 600 x 10(9)/L. A bone marrow biopsy showed myeloproliferative changes. Further investigations revealed over-expression of the polycythaemia rubra vera-1 gene and she carried the Janus Kinase-2 mutation, V617F. This case emphasizes that a myeloproliferative disorder should be considered in patients with unexplained ischemic CNS manifestations, even if blood counts are normal.