Stressful life events and the occurrence of skin cancer.

OBJECTIVE: It is widely acknowledged that emotional states can influence skin conditions, yet limited research has delved into the impact of stress on skin cancer development. This retrospective study sought to expand the perspective on skin cancer risk factors by investigating the complex relationship between stressful life events and the incidence of skin cancer. METHODS: The sample included 268 individuals followed-up in a dermatological clinic, in three groups: Patients who had previously been diagnosed with cutaneous melanoma and are currently in remission (32%), those who had been diagnosed with non-melanoma skin cancer (30%), and a control group who are at risk for skin cancer (38%). Participants filled in questionnaires regarding childhood and adulthood life events, and loss and gain of resources following their subjectively most stressful event in adulthood. Multinomial logistic regression was used to examine the associations of life events with skin cancer occurrence, and mediating and moderating effects of resource loss/gain. RESULTS: Adverse childhood experiences were associated with melanoma occurrence, with the melanoma group reporting significantly more such experiences compared to the control group (p < 0.001). Resource loss from subjectively significant stressful life events in adulthood partially mediated the association between adverse childhood experiences and melanoma incidence. CONCLUSIONS: The findings suggest that there may be intricate connections between stress, life events, adaptation to change, and skin cancer, which future research may further unravel. This study underscores the need for a more comprehensive approach to stress management, coping strategies development, and skin cancer prevention in healthcare settings.

Illness perception and quality of life in patients with contact dermatitis.

BACKGROUND: People's subjective perceptions of illness are important determinants of their ways of coping with health threats and the ensuing physical and mental outcomes, including quality of life (QoL), which has been consistently reported to be impaired by contact dermatitis. OBJECTIVES: To investigate the relationships of subjective illness perceptions and dermatological QoL in atopic, contact and occupational dermatitis patients and a comparison group of patients with other dermatological diseases. PATIENTS AND METHODS: Three hundred and three patients of four diagnostic groups filled in the Brief Illness Perception Questionnaire and the Skindex-16 (+ occupational impact items) Dermatological QoL questionnaire before clinical examination and patch testing. RESULTS: Perceptions of serious consequences, greater symptom burden and more uncertainty and worry were associated with lower QoL (r(s) > 0.50). Overall, patients reported low personal control over their condition and low understanding of the disease (3.5 and 4.8, respectively, on a 0-10 scale). QoL was most impaired among occupational dermatitis patients (mean = 46) and least impaired among patients who were later diagnosed as suffering from conditions other than contact dermatitis (mean = 62). CONCLUSIONS: Identifying critical components of illness perceptions in patients with atopic, contact and occupational dermatitis may enable the design of consultations and interventions to fit patients' perceptions, which could affect their QoL.

Anxiety and depression in patients with allergic and non-allergic cutaneous disorders.

BACKGROUND: Numerous studies have shown that anxiety and depression are more prevalent among patients suffering from chronic skin disorders. OBJECTIVES: The aims of this study were to assess the prevalences of depression and anxiety in patients suffering from chronic skin disorders, focusing particularly on allergic skin conditions. Additionally, we investigated resilience to disease progression using the Sense of Coherence Scale. METHODS: A total of 112 consecutive patients without known psychiatric disease were interviewed and asked to complete questionnaires in order to assess psychiatric symptomatology. The following scales were completed: the Mini International Neuropsychiatric Interview; the Hamilton Anxiety Scale (HAS); the Hamilton Depression Rating Scale (HDRS); and the self-administered questionnaire for the Sense of Coherence Scale (SoCS). RESULTS: Rates of anxiety and depression in patients with allergic and non-allergic conditions were considerably higher than those in the general population. This difference was notable in patients with allergic skin diseases, reaching 58.3 and 48.3%, compared with 15.4 and 23.1% for participants with non-allergic conditions, as measured by the HAS and HDRS, respectively (P < 0.05). Statistically significant negative correlations between scores on the SoCS and scores on the HAS (r = -0.45, P < 0.01) and HDRS (r = -0.37, P < 0.01) were observed. CONCLUSIONS: Our findings support the hypothesis that rates of anxiety and depression are higher among patients suffering from allergic chronic skin disorders. High SoCS scores may protect against the development of psychiatric illness in patients suffering from allergic skin disease.

Patch-test results of chemotechnique oil and cooling fluid series in patients with suspected occupational contact dermatitis in Israel.

BACKGROUND: There appear to be no published studies on the rates of positive allergic reactions to oil and cooling fluids. OBJECTIVE: To determine the yield of the oil and cooling fluid series from Chemotechnique Diagnostics in patients in Israel who are suspected to have occupational allergic contact dermatitis. METHODS: The authors reviewed the findings in 175 patients with suspected occupational contact dermatitis who worked with oil and cooling fluids and were patch-tested at two dermatologic clinics in Israel from 1999 to 2003. RESULTS: Forty-four patients (all male; mean age, 40.8 years) had 67 positive reactions to 27 of the 35 allergens (86.7% relevant). An occupational cause was established in 39 patients (88.6%). Thirty-seven of the patients with a positive reaction were also tested with the European Standard series. Of these, 22 (59%) had positive reactions to several allergens in the standard series as well. CONCLUSION: To the best of the authors' knowledge, this is the first study of the oil and cooling fluid patch-test series in this setting. The findings indicate that this series serves as an appropriate test for evaluating occupational contact dermatitis and that its composition should not be changed, pending further studies.

Occupational contact dermatitis due to essential oils.

BACKGROUND: Allergic contact dermatitis induced by the occupational use of products containing essential oils has not been studied comprehensively. OBJECTIVES: The aim of the present report was to describe the characteristics, diagnosis, and outcome of 5 patients with occupational contact dermatitis because of essential oils attending our outpatient dermatology clinics over a 2-year period. PATIENTS: These patients are added to the 11 cases reported thus far in the literature. RESULTS: The research shows that for proper diagnosis, patch tests with the standard series and the fragrance series should be performed, in addition to tests with the specific oils to which the patients were exposed. CONCLUSIONS: Patients should be instructed to avoid the allergens identified. Sensitization to essential oils has important implications for the occupational future of affected individuals.

Comparison of reactivity to allergens using the TRUE Test and IQ chamber system.

The reproducibility of the patch test is of great importance to its diagnostic utility. The objective of this study was to quantitatively and qualitatively compare the reproducibility of patch test reactions between the manufacturer-loaded TRUE Test (TT) panel and the investigator-loaded IQ Chamber (IQC) system using the European Standard Series (ESS) (Chemotechnique Diagnostics, Malmö, Sweden). Consecutive patients were simultaneously patch tested with 21 allergens using the TT and IQC system. The concordance and discordance of the 2 methods were analysed. Testing was performed in 207 patients (85 men and 122 women) who yielded 317 positive reactions, 188 with the IQ system and 129 with the TT. A total of 204 tests were positive with both methods, showing a positive concordance rate of 64.4%, with IQC producing more positive results. A high concordance rate of positive results was achieved for Cl+ Me- isothiazolinone (81.5%), nickel sulfate (79%), formaldehyde (76.9%), and paraphenylenediamine (PPD) (72.7%); a moderate concordance was noted for quaternium 15 (66.7%), potassium dichromate (64.3%), and fragrance mix (58.1%); and a low concordance was noted for cobalt chloride (27.6%) and Balsam of Peru (18.2%). The IQC and the TT are similar in finding allergy to allergens with high concordance. The IQC system has an advantage in detecting clinically relevant reactions to allergens that have a moderate and a low concordance.

European Standard Series patch test results from a contact dermatitis clinic in Israel during the 7-year period from 1998 to 2004.

The results of a 7-year retrospective study (1998-2004) from patch testing with the European Standard Series (ESS) establishing the frequency of sensitization in a contact dermatitis clinic in Israel are presented. 23 allergens were patch tested on 2156 patients, 1462 females (67.8%) and 694 males (32.2%). Atopy and asthma were present in 21.9% of the patients. One or more allergic reactions were observed in 937 patients (43.5%). The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate (13.9%), fragrance mix (7.1%), potassium dichromate (3.8%), Balsam of Peru (3.6%), CL+Me-isothiazolinone (3.4%) and cobalt chloride (3.4%). Allergens which produced the least amount of positive results were primin and clioquinol. Allergic contact dermatitis (ACD) was established in 32.8%, whereas occupationally related allergic (8.0) and irritant contact dermatitis (5.6%) affected a total of 13.6% of the cases studied. The most common clinical forms of dermatitis were chronic dermatitis (47.7%) followed by acute dermatitis (22.8%), and lichenification and hyperkeratosis (7.9%). The hands (30.7%), face and neck (23.9%) and extremities (11.3%) were the most frequently affected areas. Four allergens in our study differed from the top 10 allergens in Europe namely: Cl+Me-isothiazolinone, formaldehyde, 4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure. Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel. In spite of the existing differences with Europe, we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel.

Self-reported skin disease in hydrotherapists working in swimming pools.

The aim of our study was to investigate the risk and characteristics of self-reported skin diseases among hydrotherapists. We attempted to contact 400 adults who participated in 1 of 2 training courses. 248 were reached and 190 of them (76.6%) completed the questionnaires. The data were collected by means of a telephone interview and a detailed questionnaire sent by mail. Statistical analysis included descriptive statistics, univariate and multifactorial analysis. Of those completing the questionnaire (75.8% females and 24.2% males), 44.4% of the hydrotherapists reported on the development of skin disease for the first time after the beginning of work at the swimming pool. The most common symptoms included pruritus and erythematous patches affecting mainly the extremities and trunk. Both smoking and increased exposure hours to pool water were independently associated with skin disease, suggesting a dose-response relationship. We conclude that contact dermatitis should be recognized as an occupational disease in hydrotherapists.

Premenstrual syndrome and associated skin diseases related to hypersensitivity to female sex hormones.

OBJECTIVE: To study skin diseases and hypersensitivity to female sex hormones in patients with the premenstrual syndrome (PMS). STUDY DESIGN: Thirty women answered a questionnaire related to PMS and underwent gynecologic, dermatologic and laboratory examinations. Intradermal testing was performed with estradiol valerate, progesterone and placebo. Desensitization treatment was instituted in 15 patients. RESULTS: Ten patients were diagnosed with PMS and concomitant skin disease, including pruritus vulvae, hyperpigmentation, papular eruption and acne vulgaris (group A). Ten patients diagnosed with PMS but without skin disease served as the first control group (group B). The second control group consisted of 10 healthy women (group C). Immediate and delayed hypersensitivity reactions to sex hormones were observed in all patients with PMS and PMS-related skin diseases (groups A and B) but not in healthy women (group C). Desensitization produced a decrease in PMS symptoms and improvement in the skin disease related to PMS. CONCLUSION: Skin diseases may be a part of PMS. Demonstration of a delayed allergic reaction tofemale sex hormones may uncover a significant pathogenetic mechanism in patients with recurrent skin disease and PMS.

Contact orofacial granulomatosis caused by delayed hypersensitivity to gold and mercury.

Orofacial granulomatosis, an entity with characteristic clinicopathologic features, is thought to be a reactive process. The authors describe orofacial granulomatosis associated with contact allergy to gold in dental crowns in one patient and a possible allergic contact reaction to mercury from dental fillings in another one. Thus allergic contact dermatitis to the metals gold and mercury should be considered as a possible etiologic agent of orofacial granulomatosis.

Atypical and unusual clinical manifestations of contact dermatitis to clothing (textile contact dermatitis): case presentation and review of the literature.

Although the exact incidence of textile contact dermatitis is unknown, recent studies demonstrate that contact dermatitis produced by allergic or irritant reactions to clothing not only is more frequent than previously thought but also increasing. The clinical features of contact dermatitis (CD) caused by clothing may resemble common allergic contact dermatitis or may have atypical presentations. We report on several cases of clothing-induced contact dermatitis with atypical clinical presentations.