Subject(s)
Azathioprine/adverse effects , Pruritus/chemically induced , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Azathioprine/therapeutic use , Biopsy, Needle , Female , Follow-Up Studies , Humans , Immunohistochemistry , Middle Aged , Patch Tests , Pruritus/pathology , Risk Assessment , Severity of Illness Index , Vasculitis, Leukocytoclastic, Cutaneous/pathologyABSTRACT
We describe 8 cases of occupational airborne irritant contact dermatitis in intensive care unit (ICU) employees caused by synthetic (polypropylene and polyethylene) fibres from an air-conditioning filter. Not until a workplace investigation was conducted, was it possible to clarify the unusual sequence of events. High filter pressure in the intensive care air-conditioning system, maintained to establish an outward airflow and prevent microorganisms from entering the ward, probably caused fibres from the filter to become airborne. Upon contact with air-exposed skin, fibres subsequently provoked skin irritation. Test periods in the ICU with varying filter pressures, in an attempt to improve environmental conditions, led to even higher filter pressure levels and more complaints. The sometimes-very-low humidity might have contributed to development of skin irritation. The fact that most patients recovered quickly after treatment with emollients and changing the filters made it most likely that the airborne dermatitis was of an irritant nature.
Subject(s)
Air Conditioning/adverse effects , Air Pollutants, Occupational/adverse effects , Air Pollutants/adverse effects , Air Pollution, Indoor/adverse effects , Dermatitis, Allergic Contact/etiology , Dust , Adult , Allergens/adverse effects , Dermatitis, Occupational/etiology , Equipment Contamination , Female , Humans , Middle Aged , Occupational Exposure/adverse effects , Respiratory System/drug effects , Risk FactorsABSTRACT
BACKGROUND: UVA-1 has been shown to be effective in the treatment of patients with atopic dermatitis. However, its optimal therapeutic conditions are not yet fully established. METHODS: In an open prospective study we retrospectively compared the effect of 4 weeks therapy (32 patients) with the effect of the usual 3 weeks therapy (29 patients) in patients with atopic dermatitis, using a medium dose UVA-1 cold light (45 J/cm2), 5 days a week. RESULTS: Scoring atopic dermatitis index (SCORAD) and dermatology life quality index (DLQI) quality of life indexes improved significantly during both 3 and 4 weeks UVA-1. Patients who were treated for 4 weeks showed a superior improvement of the SCORAD index [23.12 points, 95% confidence interval (CI) 16.09-30.16, vs. 13.32 points, 95% CI 5.61-21.04, P = 0.059], and the DLQI (5.41 points, 95% CI 2.38-7.88, vs. 3.86 points, 95% CI 1.88-5.84, P = 0.360), compared with patients who were treated for 3 weeks. However, the differences did not reach statistical significance. Only patients who were treated for 4 weeks were able to maintain their improvement 6 weeks after therapy. In both groups 50% of patients had intermittently used mild topical corticosteroids in the follow-up period. CONCLUSION: Extension of UVA-1 therapy from 3 to 4 weeks results in a clinically relevant improvement of the outcome, and more prolonged therapeutic effects, measured by the SCORAD index.
Subject(s)
Dermatitis, Atopic/radiotherapy , Ultraviolet Therapy , Adolescent , Adult , Aged , Dermatitis, Atopic/pathology , Female , Humans , Male , Middle Aged , Prospective Studies , Quality of Life , Radiation Dosage , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Ultraviolet RaysABSTRACT
We describe a case of an HIV-seropositive patient presenting with a severe stomatitis that initially improved with anti-infective agents. Only 13 days after the onset of the stomatitis, the patient developed rapidly progressive constitutional symptoms and a cutaneous eruption. He was diagnosed with a Stevens-Johnson syndrome (SJS) caused by the antiretroviral drug nevirapine (NVP). Despite meticulous supportive care and withdrawal of all drugs, his situation worsened and developed into a toxic epidermal necrolysis (TEN), or Lyell's syndrome, complicated by a toxic hepatitis. Treatment with a novel combination of intravenous immunoglobulins (IVIG) and N-acetylcysteine (NAC) resulted in an exceptionally fast recovery. A literature research revealed no other cases of patients treated with both NAC and IVIG for the combination of TEN and toxic hepatitis. Because of the rapid clinical recovery, this approach merits further investigation. This case report also illustrates the importance of early suspicion of SJS when an HIV-infected patient treated with nevirapine presents with stomatitis.
Subject(s)
Lichen Planus/radiotherapy , Ultraviolet Therapy , Adolescent , Adult , Humans , Male , Middle AgedABSTRACT
The use of computers has increased vastly, occupationally as well as for private use, and in the last decade, a number of reports have been published in which skin problems are ascribed to the (intensive) use of computers. Not only irritant or mechanically induced contact dermatitis has been reported but also allergic contact dermatitis. As this appears to be a new group of occupational dermatoses, we present a brief overview of these cases, and aetiologic factors are discussed.
