Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures.

BACKGROUND: Wool clothing may be perceived as a poor choice for use by individuals with sensitive skin or atopic dermatitis. OBJECTIVES: The aims of the study were to evaluate the effect on atopic dermatitis of wearing fine Merino wool clothing versus standard clothing and to assess the effect of Merino wool clothing on quality of life in children and adults with atopic dermatitis 5 years and older. METHODS: Subjects with mild to moderate atopic dermatitis were assessed in a crossover fashion after wearing Merino wool clothing for 6 weeks and standard clothing for 6 weeks, for Eczema Area and Severity Index, Dermatology Life Quality Index, static Investigator's Global Assessment, and skin hydration. RESULTS: While wearing Merino wool clothing, compared with standard clothing, statistically significant improvements were seen in mean Eczema Area and Severity Index scores, Dermatology Life Quality Index scores, and static Investigator's Global Assessment scores. No significant difference was seen with skin hydration. Wearing Merino wool clothing did not produce any negative cutaneous effects compared with wearing standard clothing. CONCLUSIONS: Merino wool clothing compared with standard clothing provided improvements in severity of atopic dermatitis as well as quality of life in atopic patients.

Physician and Patient Assessment of Triamcinolone Acetonide Spray for Steroid-responsive Dermatoses.

OBJECTIVE: To assess the clinical outcomes of triamcinolone acetonide spray for steroid-responsive dermatoses using investigator and patient global assessment scores and evaluate patient satisfaction. DESIGN: This open-label, single-center, noncomparator study enrolled 42 patients (aged 18 years or older) with dermatoses. Patients were instructed to use triamcinolone acetonide spray 1 to 4 times daily, depending on investigator instructions, for up to 28 days. MEASUREMENTS: Investigators and patients scored the overall severity of dermatoses based on a global assessment scale. Investigators also rated signs and symptoms of dermatoses and evaluated clinical outcomes based on an improvement assessment scale. Patient satisfaction with treatment was assessed at the end of treatment or at Day 28 using a questionnaire. Patients were evaluated on Days 7, 14, 21, and 28. Complete clearing of dermatoses warranted early discontinuation from the study. RESULTS: Triamcinolone acetonide spray effectively improved dermatoses scores, clinical outcomes, and signs and symptoms of dermatoses. More than 80 percent of patients entered the study with moderate or severe dermatoses. Within 14 days, none had severe dermatoses, and by 28 days, 64 percent of patients were completely clear or almost clear. From the patient perspective, 51.3 percent experienced improvement in only three days, and 84.6 percent experienced improvement in seven days. An overwhelming number of patients (95%) preferred triamcinolone acetonide spray over creams and ointments, and more than half experienced a cooling effect upon contact with the spray. CONCLUSION: Triamcinolone acetonide spray is an effective topical corticosteroid that should be considered for patients with steroid-responsive dermatoses of all ranges of severity.

Disproportionated rosin dehydroabietic acid in neoprene surgical gloves.

BACKGROUND: Allergic contact dermatitis (ACD) is a well-recognized immune-mediated disease often associated with the use of vulcanization accelerator-containing latex and nitrile gloves. Potential contact allergens in neoprene (polychloroisoprene, polychloroprene) gloves have not been reported. OBJECTIVE: The objective was to analyze extracts of neoprene surgical and examination gloves for potential contact allergens. METHODS: Four different brands of neoprene-type gloves were purchased, and dichloromethane extracts were derivatized and assayed by gas chromatographic mass spectrometry. A latex surgical glove was used as a negative control. RESULTS: Chemical species consistent with the composition of disproportionated rosin (dehydroabietic acid [DHA], didehydroabietic acid, and other pimaric or isopimaric species) were identified in dichloromethane extracts of neoprene gloves. Levels of DHA, a type IV prohapten that can be air oxidized to an active allergen, ranged from 7 to 31 mg/g of glove. A leaching study of DHA was conducted, and small amounts of DHA leached from the glove materials into artificial sweat. DHA oxidation products were not observed in any of the gloves assayed. CONCLUSION: DHA exposure may occur from neoprene-type glove use, although a potential association with glove ACD has not been established.

Allergen content of patient problem and nonproblem gloves: relationship to allergen-specific patch-test findings.

BACKGROUND: Identification of putative contact allergen and source material is often done by a combination of patch testing and manufacturer-supplied product information. The accuracy of the identification of allergen-source material and level of allergen in that allergen-source material is not known. OBJECTIVE: The objectives of the study were to survey the chemical allergen content of glove allergic contact dermatitis (ACD) patient-identified problem and nonproblem gloves and to evaluate the ability of the patient to discriminate between problem and nonproblem gloves. METHODS: Gloves from patch-tested rubber allergen-positive ACD patients were analyzed for species and amount of rubber allergen. RESULTS: Approximately half the subjects were able to correctly identify their problem and nonproblem gloves. Correct association of a glove with ACD was directly related to patch-test reaction severity and inversely related to the number of glove brands being used by the patient. Of note, thiurams were not detected in any of the gloves examined. CONCLUSIONS: Although patch testing is invaluable in identifying individual allergen sensitivities, the identification of the ACD-causative specific chemical allergen and source material remains problematic. All glove brands used within days prior to and during an ACD episode should be considered potential sources of the contact allergen.

Skin reactions to pimecrolimus cream 1% in patients allergic to propylene glycol: a double-blind randomized study.

BACKGROUND: The low concentration of propylene glycol (PG) in pimecrolimus cream makes it unlikely that the cream will induce a PG-related irritant or allergic contact dermatitis. OBJECTIVE: To assess reactions to pimecrolimus cream in patients who are allergic to PG. METHODS: A pilot double-blind within-patient study in 20 patients, with patch testing followed by a repeated open application test (ROAT). Limitations were that patch tests and ROATs were performed on normal skin, which may be less likely to develop an allergic response than would areas of active dermatitis. RESULTS: Positive PG patch-test results were confirmed in 16 patients. Patch-test scores were compatible with allergic reactions in only two patients. However, ROAT scores were negative for these two patients. Reactions with pimecrolimus or vehicle during ROAT were identified in three patients, but an allergic reaction was uncertain because none of these patients reacted with both pimecrolimus cream and vehicle. Reactions with pimecrolimus were significantly less frequent (p<.01) and less severe (p=.02) than with PG. CONCLUSION: In patients allergic to PG, pimecrolimus cream showed a very low potential to elicit allergic skin reactions.