Acne excoriata--look for allergy!

Acne excoriata (AE) is a frequent variant of self-inflicted skin conditions, which occurs predominantly in females. The condition seems to be almost always found in persons with psychological problems. Therapeutic approaches are often unsatisfying since this special group of patients typically does not recover with dermatological treatment. We report a 37-year-old female patient who had suffered for 5 years from AE. Exact history taking revealed that her manipulations were correlated with episodes of contact with bird products like feathers and eggs. The diagnosis of a bird egg syndrome could be proved by skin prick tests (ALK Abello, Denmark) as well as laboratory results (CAP FEIA, Pharmacia, Sweden), and consequent avoidance of handling bird products was the only but effective therapeutic measurement. In patients with suspected artefactual diseases, we strongly recommend to listen to the patients' complaints in order to make the correct diagnosis and not to overlook a potential stimulus.

Epidemiological significance of bufexamac as a frequent and relevant contact sensitizer.

Bufexamac-containing ointments and creams are widely used by many patients with eczematous disorders as an alternative to topical corticosteroids. Recent studies provide evidence of a notable prevalence of contact sensitization in patch test populations. The aim of this study was to assess the frequency of use of this topically-applied drug by eczema patients in general, and to evaluate its potential to cause allergic contact reactions. 500 routinely patch tested patients (f:m = 377:123) were tested with bufexamac 5% and Parfenac ointment (the only commercial product available in Austria) in addition to the standard and other series of the German Contact Dermatitis Group. The packaging of the commercial product was shown to the entire study population, to decide whether or not they had ever used this product. In addition, their general practitioner was contacted to verify the anamnestic data. A total of 30 patients agreed that they had definitely used bufexamac, 5 others having probably applied it. The indication for and the duration of treatment were noted. Positive and relevant patch test reactions to bufexamac, as well as the bufexamac-containing ointment, were seen in 20 out of these 35 patients (57%), and sensitization occurred even after short-term application. Our study demonstrates that bufexamac has to be assumed to be a topical drug with a very high sensitization rate in an unselected patch test population (4% of 500 patients), and should therefore be added to the standard series.

[Patch testing with the "Austrian standard series"--epidemiologic test values and results]. / Epikutantestung mit der "Standardreihe Osterreich"--Testepidemiologische Kenngrössen und Ergebnisse.

Patch testing for contact allergies is routinely performed by applying a "standard series" of the most frequently occurring contact allergens. Internationally "established" standard series have to be adapted to country- and population-specific factors (i.e., distribution of gender and age, occupational behavior, environmental factors etc.). In 1992 and 1993 altogether 11,690 patients were patch tested in 14 Austrian test centers with the "Austrian standard patch test series" as recommended by the working group "Contact Allergy" of the Austrian Society of Dermatology. Altogether data on 11,544 patients were complete and are analyzed in this study. 71.5% of the test population were female with an average age of 39 years, whereas the male patients had an average age of 40 years. 38.1% of the patients were younger than 30 years, 47.8% were in the group ranging from 31 to 60 years and 14% of the tested patients were older than 60 years. Cutaneous sensitization was found in 51% of the people tested with the "Austrian standard series". This proportion varied between 40.8 and 61.4% from center to center (with more than 100 tested persons). 15 (60%) of the 25 test substances in 1992 and 17 (68%) in 1993 surpassed the limit of a sensitization frequency of 1%. The "hit list" of substances did not differ qualitatively from those of other international studies, with only one remarkable, well described "Austrian-specific" exception, namely the mercury-containing thiomersal (second place).(ABSTRACT TRUNCATED AT 250 WORDS)