Contact hypersensitivity to epoxy resin, methyldibromoglutaronitrile, tixocortol pivalate and budesonide in Hungary: a study in 1448 patients.

AIM: In order to map the frequency of contact hypersensitivity (CH) to epoxy resin, methyldibromoglutaronitrile (MDBGN), tixocortol pivalate (TP) and budesonide patch tests were carried out. METHODS: The tests were performed in 1448 patients. Most patients belong to the allergic and irritative contact dermatitis groups. The tests were administered with the allergens epoxy resin 1%, MDBGN 0.3%, TP 1% and budesonide 0.1%, applied on the back. Reactions were evaluated at 40 min, on day 2 (D2), day 3 (D3) and day 4 (D4). In the patients of the Dept. of Dermatology, Venerology and Dermatooncology of Semmelweis University (patients number =1073) reactions were evaluated on day 7 as well. RESULTS: Epoxy resin elicited immediate reactions in 1 patient at 40 min. Further evaluations showed no difference on D3, D4 and D7 with a frequency of CH of 1.03%. Patch testing for MDBGN did not provoke immediate reactions, evaluations showed an increasing hypersensitivity rate (D2: 0.93%; D7:1.77%). Patch tests with TP yielded no immediate reactions, the frequency of CH increased from 0.47% (D2) to 2.01% (D7). No immediate reactions were observed by budesonide; an increase was seen in frequency of CH (D2:0.93% to D7:3.84%). CH to the studied allergens was observed mostly in allergic contact dermatitis group, to budesonide in irritative contact dermatitis and in atopic dermatitis groups as well. CONCLUSION: The data of the present study are the first results about this four allergens in Hungary and to our knowledge from our region as well.

Long-term post-treatment follow-up of onychomycosis treated with terbinafine: a multicentre trial.

Between 1991 and 1993, 32 cases of fingernail mycosis and 20 cases of toenail mycosis caused by dermatophytes were treated with terbinafine. For 8 weeks, 250 mg of terbinafine was given daily for fingernail infections, and for 12 weeks the same dose was given for toenail involvement; the short-term follow-up was 24 and 48 weeks respectively. A long-term follow-up was performed twice, initially at 24 and then at 48 months after the end of the treatment. For fingernail mycosis, the mycological cure rate was 100% at the end of month 24 and 91% at the end of month 48. Mycological cultures gave negative results in toenail infections in 90% after 24 months and in 86% after 48 months. After 24 months, 23 out of 26 patients (88%) with fingernail and 17 out of 20 patients (95%) with toenail mycosis were clinically cured. After 48 months, 20 out of 22 cases (91%) with fingernail and 10 out of 14 cases (71%) with toenail involvement showed a complete cure.

[Artificial nutrition of patients with toxic epidermal necrolysis (Lyell syndrome)]. / Toxicus epidermalis necrolysisben (Lyell-szindróma) szenvedó beteg mesterséges táplálása.

The authors report the case of a 30-year-old man treated with toxic epidermal necrolysis. Toxic epidermal necrolysis was due to anticonvulsive drug treatment. The patient was admitted with denudated skin surface similar to second-degree burn that covered 90 per cent of the patient's body surface. The patient was isolated and treated, receiving sterile wound care, broad spectrum antibiotic and corticosteroid. Total parenteral nutrition was instituted until the 5th day of care because the patient was unable to take normal food. The energy intake reached 146 kJ/kg bodyweight containing 4 g/kg bodyweight carbohydrates and 2 g/kg bodyweight fat emulsion supplemented with 10-15 g of nitrogen per day. The enteral nutrition was commenced gradually with decreasing parenteral nutrition. The nutritive solutions were supplemented with ions, vitamins and trace elements. The patient left the intensive care unit after 23 days of care. The toxic epidermal necrolysis is a life-threatening dermatological disease and should be treated at intensive care unit. The early recognition of the disease, the intensive care and nutritional therapy may improve the survival of patients with toxic epidermal necrolysis.

Epidemiology of nickel allergy: results of a follow-up analysis of patients with positive patch tests to nickel.

In a previous paper, we reported on nickel sensitivity in 2400 consecutive patients in 5 countries. 3 years later, we reassessed 104 of the 157 nickel-positive patients of this former study and found 13 now to be negative to nickel sulphate. Nearly all the others can no longer tolerate nickel contact. 68 patients were free from nickel dermatitis, 16 showed a very mild eczema or dyshidrosis, and 13 were suffering from chronic hand dermatitis. 42 of 104 patients had changed their occupation, 36 successfully, with clearance of skin lesions. Rehabilitation by avoidance of nickel-containing costume jewelry, wrist-watches and clothing buckles, and by change of occupation, is possible and necessary.

Epidemiology of nickel allergy.

In 2400 consecutive patients at 8 clinics in 5 countries, nickel hypersensitivity was found in 176 cases (7.3%), 19 male (2.1%) and 157 female (10.5%). The incidence ranged from 15 to 38 cases in 300 patients of every department (5.0% Sofia to 12.7% Erfurt). 60.6% of the nickel positives were schoolgirls or younger than 25 years. The exposure time was 3 years, in 49% 1 year or shorter. Most cases (75%) are not occupationally acquired, but due to costume jewelry (31.8%), wrist watches (23.3%), metal clothing buckles (3.4%) including jeans buttons. Job dependent nickel dermatitis is often (36/51 cases) linked with wet work. Atopic dermatitis was found in 8.3% of female nickel allergy. Nickel positivity without a dermatitis history was seen in 9/176 cases (5%). Nickel allergy will become a sex-indifferent phenomenon in Europe, because of the changing customs of adornment.

[Frequency, relevance and latency of chemical allergy in hospitalized patients in Budapest]. / Häufigkeit, Relevanz und Latenz der chemischen Allergie bei Krankenhauspatienten in Budapest.

Epicutaneous tests were performed 1979 using a standard test series of 31 substances on 436 hospitalized patients. The positive results were analysed for relevance and latency. Occupational and environmental origin of sensitization was looked for in both sexes. The order of allergens causing contact dermatitis in women was: Dichromate, phenylbutazone, cobalt (as concomitant allergy?), balsam of Peru, p-phenylene diamine, chloramphenicol, phenyl-isopropyl-p-phenylene diamine, N-phenyl-cyclohexyl-p-phenylene diamine (as concomitant allergy?), mercury amidochlorate, formaldehyde, mercury bichloride (as concomitant allergy?). In men the order of frequency was: dichromate, phenyl-isopropyl-p-phenylene diamine, N-phenyl-cyclohexyl-p-phenylene diamine (as concomitant allergy?), cobalt (as concomitant allergy?), p-phenylene diamine, chloramphenicol, formaldehyde, phenylbutazone, balsam of Peru, mercury amidochlorate, mercury bichloride (as concomitant allergy?). The mode and degree of exposure are important factors influencing the composition of the spectrum of allergens. It is essential to distinguish between relevant and latent sensitization primarily in occupational exposure when decisions concerning the patient's future occupation must be made.

[Frequency and relevance of some cross-, concomitant- and pseudo-cross allergies (author's transl)]. / Häufigkeit und Relevanz der einzelnen chemischen Gruppen- und kopplungsallergien.

Examples of cross-, concomitant- and pseudo-cross allergies are discussed based on the results obtained in a series of patch tests made with 31 chemical allergens. Special attention is paid to the relevance of positivity. Para-group allergy is analysed as an example of cross-allergy. Analysis of various combinations of allergy to p-phenylene diamine and phenylisopropyl-p-phenylene diamine suggests that in addition to the classical cross-allergy, concomitant sensitization may also occur. Concomitant allergy to three metals (chromium, cobalt and nickel) is discussed. Concomitant sensitization to chromium and cobalt has been found to occur most frequently. Associated positivity to various aromatic balsam-like substances (balsam of Peru, turpentine, colophony, wood tar) has been interpreted as pseudo-cross-allergy.