Periorbital dermatitis--a recalcitrant disease: causes and differential diagnoses.

BACKGROUND: Periorbital dermatitis is common and frequently recalcitrant to treatment. Due to the exposed and visible location, patients often suffer severely from periorbital dermatitis. OBJECTIVES: To determine the frequency and causes of periorbital dermatitis including contact sensitizers. METHODS: We investigated two cohorts of patients (Erlangen and IVDK without Erlangen) between 1999 and 2004. RESULTS: The differences between the two cohorts with periorbital dermatitis [Department of Dermatology at University Hospital Erlangen (n = 88) and the German Information Network of Departments of Dermatology (IVDK) collective (n = 2035)] were determined by the MOAHLFA (male, occupational dermatosis, atopic eczema, hand dermatitis, leg dermatitis, facial dermatitis, age > or = 40 years) index. Statistically significant factors for periocular eczema are female sex, atopic skin diathesis and age > or = 40 years. In both cohorts allergic contact dermatitis was the main cause of periorbital eczema (Erlangen 44.3%, IVDK 31.6%), followed by periorbital atopic dermatitis (Erlangen 25%, IVDK 14.1%), airborne dermatitis (Erlangen 10.2%, IVDK 1.9%), irritant contact dermatitis (Erlangen 9.1%, IVDK 7.6%), periorbital rosacea (Erlangen 4.5%, IVDK 2.2%), allergic conjunctivitis (Erlangen 2.3%, IVDK included in 'others') and psoriasis (Erlangen 2.3%, IVDK included in 'others'). The most relevant allergens/allergen sources inducing periorbital eczema were consumers' products (facial cream, eye shadow and ophthalmic therapeutics) (31%), fragrance mix (19%), balsam of Peru (10%), thiomersal (10%) and neomycin sulphate (8%); 12.5% of patients with allergic periocular dermatitis could be exclusively elucidated by testing patients' own products. CONCLUSIONS: Our data demonstrate the multiplicity of causes for periorbital eczematous disease manifestation, which requires patch testing of standard trays as well as consumers' products to elucidate the relevant contact sensitization.

[Type IV-allergy due to corticosteroids. Rare and paradoxical]. / Typ-IV-Allergie auf Kortikosteroide. Selten und paradox.

HISTORY AND CLINICAL FINDINGS: A 48-year-old woman developed a skin rash after taking glucocorticoids. INVESTIGATIONS: Positive patch tests revealed type IV allergy (delayed reaction) to several glucocorticoids. In addition an eczema-like rash was produced by an oral provocation test with triamcinolone, although the patch test for this drug had been negative. TREATMENT AND COURSE: We recommended avoidance of the positively-tested corticosteroids and issued a corresponding allergy pass. CONCLUSION: Type IV allergy to glucocorticoids is rare but should be considered whenever patients develop a skin rash after the use of corticosteroids.

[Anaphylactic shock due to French galette. Type I allergic reaction to buckwheat]. / Anaphylaktischer Schock nach Galette-Verzehr Typ-I-Allergie auf Buchweizenmehl.

A 37-year-old woman twice developed a life-threatening anaphylactic reaction after eating galettes, a special French pancake from Brittany. She had tolerated ordinary pancakes and crepes for many years. The allergological work-up revealed a Type I allergic reaction to buckwheat contained in the galettes. A prick test to buckwheat was positive and specific IgE antibodies to buckwheat were found in her serum. In contrast to wheat, buckwheat is not a cereal but a gluten-free knot-grass, initially from Asia. Whenever a patient suffers from allergic reactions due to pastries, a buckwheat allergy should be considered.

[Level of knowledge of patients with type II diabetes mellitus in primary care]. / Nivel de conocimientos de pacientes con diabetes tipo II de atención primaria.

A personal interview to 148 patients was carried out with the aim of getting to know the level of information of type II diabetic patients at an Urban Health Center in Santander. A validated questionnaire made up of 14 questions on general aspects of diabetis, dietetic habits and capability to handle complications was used. The Cronbach's alpha coefficient of questionnaire was 0.69. The correct answer average was 6.3 (IC = 5.9-6.5). Patients were best informed about general aspects and had much less information with regard to the handling of complications and to their diet. The differences among these three sections of questions were significative (p less than 0.001). The patients under diet treatment obtained worse results than those treated with oral hipoglucemiants and insulin. Our results are worse than those reported by other similar populations at a national level. Also, and due to the differences in knowledge within this group, we believe that the establishment of groups and subgroups when educating diabetic patients is possible and also highly recommended.