Cocamidopropyl betaine allergy.

Cocamidopropyl betaine (CAPB) is a surfactant, and reports of allergic contact dermatitis to this chemical have been reported in the literature. Although most commonly found in rinse-off products, the chemical nonetheless has been shown to induce allergy. The actual component responsible for allergic reaction may be the final compound itself, CAPB, or one of the substances used in its synthesis that may be present as an impurity. Allergy to CAPB is most commonly seen in a head and neck distribution, although other patterns have been identified.

Contact dermatitis due to printer's ink in a milk industry employee: case report and review of the allergen paraphenylenediamine.

Paraphenylenediamine is a common cause of occupational dermatoses in hairdressers, metallurgy workers, and others. Hand dermatitis developed in an employee of a milk packaging facility. The employee's hands were exposed to milk cartons embossed with wet printer's ink on a daily basis for 2 years. The worker was evaluated through a history, physical examination, and patch testing with 50 standard allergens. Patch testing revealed a positive reaction to paraphenylenediamine. The hand dermatitis resolved once the patient instituted protective measures. The worker's reaction might represent a delayed-type hypersensitivity reaction to printer's ink that contained this agent. More likely, the inciting agent was some other ingredient of the printer's ink that cross-reacts with paraphenylenediamine.

Commercial availability of a house dust mite patch test.

The house dust mite long has been studied for its potential role in atopic dermatitis. Its part in the pathogenesis of asthma and allergic rhinitis has been studied and is accepted. Testing for the dust mite allergen in this arena is performed with radioallergosorbent tests (RASTs) and prick testing. For several reasons, including the lack of a standardized testing tool, the difficulty in removing dust from the environment and the lack of association of dust and skin disease by patients, the role of the house dust mite in the pathogenesis of atopic dermatitis and skin disease has been questioned. Chemotechnique Diagnostics (Malmo, Sweden) now provides a standardized dust mite allergen in petrolatum in 2 concentrations. Dermatophagoides mix is a 50:50 mix of Dermatophagoides pteronyssinus and D. farinae at concentrations of 20% and 30%. The availability of a standardized patch test allergen for the house dust mite provides a better tool to investigate the role of this allergen as a contactant.

Methylchloro-isothiazolinone revisited.

Preservatives are a class of allergens that is well represented in testing series. There are 5 preservatives in the TRUE test, 4 preservatives in the European series, and 13 in the North American Series. Methylchloroisothiazolinone/methylisothiozolinone (MCI/MI) (Kathon CG, Rohm and Haas, Spring House, PA) is a relatively new allergen that was introduced in 1980 in the United States. Its use rapidly increased until reports of contact allergy became an issue. Allowable levels of MCI/MI in products, sensitivity rates, and use rates vary by country. The overall incidence of sensitivity for this allergen, as reported by the North American Contact Dermatitis Group, is similar to other allergens in the preservative class.

Allergic contact dermatitis caused by parabens: 2 case reports and a review.

Parabens, methyl, ethyl, propyl, benzyl, and butyl, are the most common preservatives in use today. They are the alkyl esters of p-hydroxybenzoic acid and are used extensively because they are relatively nonirritating and nontoxic and offer good antimicrobial coverage. Testing for paraben allergen can be done by patch testing. Two cases of allergic contact dermatitis (ACD) to parabens are used to discuss the background of parabens, their allergenicity, patch testing issues, and several "paraben paradoxes." Although ACD to parabens has been reported, given the widespread use, it is relatively uncommon. Because of their low rate of allergenicity and their favorable preservative profile and efficacy, parabens remain the number one preservative in use.

Routine testing for Primula obconica: is it useful in the United States?

Allergic contact dermatitis to Primula obconica has long been established. It is considered a significant allergen in Europe and has been included in standard screening there. The allergen is much less common in the United States. The frequency of allergy to P obconica in the United States is difficult to assess because no series of routine testing to this allergen has been reported. The purpose of this study was to evaluate the frequency of primin allergy in routine testing in a referral patch test center. A series of 567 consecutive patch tests was performed that included primin as part of the standard screening. Only one patient had a positive reaction. Although it is frequently missed and often difficult to diagnose, the frequency of primin allergy in this series was too low to indicate including this allergen as part of routine testing.

Contact urticaria from xylene.

Xylene is widely used in medical technology, but there are many concerns about its safety. A 52-year-old woman, employed as a histotechnician, presented with burning, swollen hands. Patch testing and a visit to her place of work confirmed exposure and sensitivity, in the form of contact urticaria, to xylene. The use of xylene-resistant gloves resulted in clearing of the dermatitis. Establishing the diagnosis of contact urticaria from xylene allowed the patient to be cured of her dermatitis and continue working.

Chloroxylenol causing hand dermatitis in a plumber.

Chloroxylenol use has increased and is found in many over-the-counter preparations. Although not a common sensitizer, chloroxylenol's role as a contact allergen and relevance, when positive patch tests are found, is often high. Pre-patch test assessment generally does not identify chloroxylenol as a causative agent. It is increasingly found in liquid soaps particularly in industry and specifically in the health care environment. Even as a wash-off product, this allergen can be a hidden cause of allergic contact dermatitis.

Contact dermatitis to foods and spices.

Cutaneous reactions to foods and spices occur in both the workplace and at home in those who grow, handle, prepare, or cook food. As spices are also used in cosmetics and perfumes other exposures are found. Several patterns have been described upon contact with food including irritant contact dermatitis, allergic contact dermatitis, contact urticaria, phototoxic contact dermatitis, and protein contact dermatitis. The purpose of this article is to review the approach to a patient suspected of having a cutaneous reaction to food or spices, as well as discuss these reactions and the allergens that cause them.

Hormonal influences on women with psoriasis.

Various endogenous factors such as stress and infection are known to influence psoriasis. Previous data suggest that pregnancy has a significant influence on the course of psoriasis. This study explores the effect of pregnancy as well as other hormonal events on psoriasis in women.

Elephantiasis nostras of the lips: a case report.

Elephantiasis nostras (EN) is a clinical entity that usually presents as a persistent swelling of the lower extremities. It has been related to recurrent lymphangitis of bacterial origin that causes a fibrosis and thickening of both epidermal and connective tissue. Although very rare, EN has been previously reported in the lips. This is the first case reported in the oral medicine literature that describes EN involving the lips. We describe the clinical features and a differential diagnosis of the lip lesions and a treatment protocol to which this patient has responded. A diagnosis of EN should be entertained in patients with chronically edematous, scaling lip lesions.

Oral pigmentation representing Laugier-Hunziker syndrome.

Oral pigmentation is seen fairly commonly in dermatologic practice. Several conditions must be considered in the differential diagnosis. We present a patient whose condition highlights the clinical syndrome known as Laugier-Hunziker and provides the opportunity to review the clinical course, pathologic features, and literature of this uncommon syndrome.