[Monthly low-dose immunoglobulin infusion as a maintenance therapy for multifocal motor neuropathy may reduce allergic adverse effects: a case report].

A 41-year-old man with multiple motor neuropathy developed weakness of the left hand at the age of 35 years. The weakness gradually progressed to his right hand. High-dose intravenous immunoglobulin (IVIg) therapy (0.4 g/kg for 5 consecutive days) improved the muscle weakness in the hands but led to the development of generalized severe pompholyx that spread to the skin over the entire body. Because muscle weakness of the hands worsened several months after IVIg therapy, we attempted another course of IVIg therapy. However, antiallergic agents and oral corticosteroids did not suppress the pompholyx induced by the high-dose IVIg. Hence, the treatment was switched to low-dose immunoglobulin therapy (0.4 g/kg for one day) once every month. After more than 8 months of low-dose therapy, only mild form of pompholyx remained and the muscle strength was maintained without further deterioration.

Hand dermatitis: nursing support in the plan of care.

Hand dermatitis is inflammation characterized by redness, scaling, and fissuring clinically and spongiosis histologically. The three main types of hand dermatitis--irritant contact dermatitis, allergic contact dermatitis, and dyshidrotic eczema--are discussed along with nursing assessment, patch testing, and prognosis and prevention.

Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema.

202 patients, 68 males and 134 females, with patch-test-negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals. 55 patients reacted to the mixture of salts as well as to 1 or 2 of the individual salts. 3 other patients were challenged openly with nickel alone. Male patients reacted primarily to chromate and cobalt, while female patients more commonly reacted to nickel and cobalt. 56 patients were instructed to follow diets planned to reduce the daily intake of the respective metals. The dermatitis of 36 patients cleared or improved markedly after 1 month of dieting. Responses to a questionnaire sent to these 36 patients indicated that 28 of them had followed the prescribed diet rigorously or intermittently for at least a year, because they experienced recurrence of the dermatitis if they stopped dieting. 6 noted no long-term benefit and 2 did not respond.