Epicutaneous patch test results in children and adults with allergic contact dermatitis in Karlovac county: a retrospective survey.

The aim of the study was to evaluate the results of epicutaneous patch testing with a standard series of contact allergens in children suspected to have allergic contact dermatitis (ACD), and to compare the results of patch testing between children and adults. Clinical records of children defined as patients aged ≤18 years and adults examined at Department of Dermatology and Venereology, Karlovac General Hospital, for suspicion of ACD during the 1994-2009 period were reviewed. Epicutaneous patch testing with a standard series of contact allergens, manufactured by the Institute of Immunology, Zagreb, Croatia, was performed in group 1 consisting of 412 children (274 female and 138 male, mean age 13.4 years, range 4-18 years) and group 2 consisting of 4440 adult patients (2918 female and 1522 male, mean age 40.3 years, range 19-81 years). The most common six allergens differed between the two groups. Adult subjects were divided into three age subgroups: 19-40 (n=1708), 41-60 (n=1570) and 61-81 (n=1162 subjects). The high sensitization rate in younger subgroup and lower sensitization rate in the oldest group compared to adult patient group as a whole was statistically significant (P<0.05). In children, the most common positive reactions were recorded to nickel sulfate (25.4%), thimerosal (17.8%), cobalt chloride (11.6%), fragrance mix (8.9%), white mercury precipitate (6.2%), formaldehyde (4.7%) and other allergens (25.4%). In adult patients, positive reactions were most common to nickel sulfate (32.6%), cobalt chloride (10.8%), fragrance mix (9.0%), wood tars (7.1%), potassium dichromate (6.6%), balsam of Peru (5.1%) and other allergens (28.8%). The group of children included 179 (43.4%) atopic subjects (according to Hanifin and Rajka criteria) and 233 (56.6%) non-atopic subjects. There was no statistically significant between-group difference and no statistically significant difference in nickel sulfate, cobalt chloride, fragrance mix and balsam of Peru sensitization between children and adult patients. A higher sensitization rate in children versus adults was recorded for thimerosal, white mercury precipitate and formaldehyde. Less frequent sensitization in children versus adults was found for wood tars and potassium dichromate. It is concluded that pediatric ACD exists and is more common than previously recognized. Sensitization to allergens differs between children and adults.

Skin disease in a geriatric patients group in outpatient dermatologic clinic Karlovac, Croatia.

To determine the characteristic pattern and frequency of dermatoses in dermatologic patients over 65 years we used electronic data base of General hospital Karlovac and conducted a retrospective cross sectional study evaluating age, sex and proportion of dermatoses. Total number of patients was 3200. There were 822 (25.69%) patients older than 65 years, and 2378 (74.31%) patients aged from 18-64 years. Ratio male/female in population over 65 years in our study was 0.76:1. Males had higher frequncy of verrucae vulgares 26 (7.3%) and dermatitis nummularis 47 (13.2%) then female and that difference was statistically significant. Female had higher frequency of keratosis acitinca 124 (26.61%) and fibroma 23 (4.94%), and that difference was statistically significant. The ten most common diagnosis in population over 65 years old were: keratosis actinica in 184 patients (22.38%) verrucae seborrhoicae in 156 (18.98%), dermatitits nummularis in 77 patients (9.37%), dermatitis allergica e contactu in 60 (7.30%) patients, mycosis in 56 (6.81%) patients, psoriasis in 51 (6.20%), verrucae vulgares in 39 (4.74%), fibromas in 27 (3.28%), naevi in 9 (1.09%) and acne in 1 (0.12%) patient. The number of patients with diagnosis of keratosis actinica, verrucae seborrhoicae and mycoses in population over 65 years old are greater then in younger subpopulation and that difference was statistically significant. There are specific pattern of frequency of dermatoses in elderly. Verrucae seborrhoica, keratosis actinica and mycoses are more common then in general population. In elderly risk for development of skin cancer is increased. Early detection of skin cancers and treatment of precanceroses is of utmost interest of health providers.

Mechanisms of drug hypersensitivity reactions and the skin.

The skin is an organ most often affected by adverse drug reactions. Because of limited reactivity of the skin, different drugs may induce the same reactions on the skin, even if the same drug may induce different adverse drug reactions. Many of these adverse drug reactions do not include immunological mechanisms, most of them are non-immunological processes. Adverse drug reactions which involve an immune system, may appear different times after drug administration. The severity of reactions is not dependent on the time at which adverse drug reaction appeared, even if some life threatening adverse drug reactions appear immediately after a drug administration. Four types of immunological reactions, (according to Cooms and Gell), may be involved in a drug adverse reaction. The first type of reaction (anaphylactic reaction) begins early after drug administration and different severities of the reactions could exist. The second type, known as cytotoxic hypersensitivity, begins after some minutes to a few hours after a drug administration. Third and fourth types of immunological reactions begin usually hours to days after drug administration. Some types of immunological reactions may begin days to weeks after drug administration. Sensitization to the drugs must be happen early, since re-exposition to the drug leads to the adverse drug reactions. The way of sensitization sometimes determines which immune mechanism will be involved and which clinical reaction will appear. Tests in vivo and in vitro can be used in the diagnosis of adverse drug reactions. All these tests are more or less limited to a false positive or false negative reaction and possibilities of serious reactions in tests. Provocations tests give the most satisfactory results but they may be dangerous and life threatening. We must carefully choose the skin tests and apply them according to the suspected pathomechanism of adverse drug reaction geneses and estimate the usefulness and the risks of the tests. Serious adverse drug reactions (i.e. Sy Steven-Johnson, lupus-like disease etc.) should not be tested. Some novel patents will have important implications in administration, diagnosis, and prevention of adverse drug reactions.

Epicutaneous patch test results in patients with allergic contact dermatitis in Karlovac county--a retrospective survey.

During the 1994-2003 study period, patch testing was carried out in 1102 subjects (740 female and 362 male, mean age 39.8, range 7-81 years) suspected to have allergic contact dermatitis (ACD). Epicutaneous patch test with a standard series of contact allergens was made by the Institute of Immunology, Zagreb, Croatia, according to the Internationational Contact Dermatitis Research Group (ICDRG) rules. During the study period, 399 (36.2%) subjects with one or more positive tests were recorded, and 640 positive tests were observed. The most frequent allergens were nickel sulfate identified in 214 (33.4%), cobalt chloride in 64 (10%), fragrance mix in 60 (9.4%), wood tar in 47 (7.3%), potassium dichromate in 39 (6.1%), balsam of Peru in 29 (4.6%) and other allergens in 187 (29.2%) cases. According to the localization of ACD, hands as the most common site were involved in 535 (48.5%) cases, followed by the face in 167 (15.2%) and other locations in 400 (36.3%) cases. It is concluded that nickel is the principal allergen as the cause of ACD, mostly affecting women. The areas most frequently involved by ACD were the hands and face.

The role of Dermatophagoides pteronyssinus in atopic dermatitis.

The role of Dermatophagoides (D.) pteronyssinus in atopic dermatitis (AD) was investigated by use of skin prick test (SPT) and total and specific IgE (RAST) to D. pteronyssinus. The study included 43 patients (17 male and 26 female), mean age 42.3 (range 19-77) years. All study patients met the Hanifin and Rajka criteria. Patients were divided into two groups: "pure" AD (n=27; 12 male and 15 female), mean age 46.3 (range 19-77) years; and AD with respiratory symptoms (AD+RS, n=16; 5 male and 11 female), mean age 38.4 (range 17-75) years. Control group consisted of 15 healthy subjects (7 male and 8 female; mean age 49.0, range 24-64 years), with no personal or family history and signs of atopy. Both patient groups had a higher total serum IgE than control subjects (p<0.05). In the "pure" AD group, SPT was positive in 5/27 (18.5%) and RAST to D. pteronyssinus in 4/27 patients. In the AD+RS group, SPT was positive in 10/16 (62.5%) and RAST to D. pteronyssinus in 8/16 (50%) patients. Concordance between SPT and RAST was observed in both groups; 80% of SPT positive patients were RAST positive. D. pteronyssinus was found to play an important role as a trigger factor in AD patients.

Atopy patch test with Dermatophagoides pteronyssinus (Dp 1) in atopic dermatitis patients.

The aim of this study was to evaluate the role of Dermatophagoides pteronyssinus (Dp) in atopic dermatitis patients, using atopy patch test (APT) with Dp (extract 1). Twenty patients (males (m) = 9, females (f) = 11, mean age = 46.0 years, range = 19-78 years) with atopic dermatitis were involved in this study. The control group consisted of seventeen healthy subjects (m = 7, f = 10, mean age = 48.3, range = 24-64 years), with no personal or family history and no signs of atopy. Total IgE, specific IgE and a skin prick test were done for all subjects involved in this study. The atopy patch tests were performed with Dp (extract 1) in: 3,000, 10,000, 20,000 and 30,000 biological units per ml (BU/ml) concentrations using glycerol as medium. The total IgE was significantly higher in atopic dermatitis (AD) patients than in a control group with (p < 0.05). After the tests six of twenty patients (30%) had positive APT results in the last two concentrations (20,000 and 30,000 BU/ml). However, all the results were positive after 48 h (and 72 hours), while no positive results were recorded in the control subjects. According to our study, APT with Dp 1 in 20,000 BU/ml and reading time 48 h and 72 hours is to be recommended. The results suggest that APT may detect the trigger factor (Dp) in AD patients.

Epicutaneous patch test reactions in atopic dermatitis patients.

During the 1998-2003 period, patch testing was carried out in 65 atopic dermatitis patients, 20 (31%) male and 45 (69%) female, mean age 34.7 (range 6-77) years. Twenty-six (40%) patients, 7 (27%) male and 19 (73%) female, showed positive reaction to one or more allergens. Allergic reactions were more common in women. The most common allergens were nickel (33.3%), cobalt (11.1%), fragrance mix (11.1%), white mercury precipitate (8.4%), and others (36.1%). There was a significant association between nickel allergy and cobalt allergy. It is concluded that contact hypersensitivity is not rare in patients with atopic dermatitis.