Methotrexate in the treatment of mycosis fungoides - a multicenter observational study in 79 patients.

OBJECTIVE: The first report concerning methotrexate (MTX) in the treatment of Mycosis fungoides (MF) was published in 1964 by Wright. The mechanism of MTX action in the treatment of primary cutaneous T-cell lymphoma (CTCL) has been not explained in detail yet (the anti-inflammatory, immunomodulating, immunosuppressive, and cytostatic actions have been under discussion). PATIENTS AND METHODS: This is a retrospective analysis of 79 MF patients in 4 dermatology clinical centers in Poland. Data are presented in terms of the duration, use of MTX, the effectiveness of treatment with MTX in terms of time required to achieve remission, the disease stage, route of administration, age at diagnosis and the dosage. Moreover, the occurrence of side effects depending on the route of administration and duration of therapy with MTX was analyzed. RESULTS: The analysis has revealed that 56 patients (70,9%) had achieved remission on the MTX. The remission began in the 1st month of therapy in 20% of patients, lasted 4 to 6 months in 50% of cases. At least 12 months' remission was confirmed in 25% of patients (2-year-long only in 10% and 3-year-long in 5% of patients). The time to remission was related to the stage of disease at diagnosis as well as to minimal and maximal dose of MTX. The total therapeutic dose of MTX was found important for the course of the disease: higher total dose had prolonged the remission. CONCLUSIONS: Despite the common use of MTX in MF patients, relatively few clinical studies have been published. The response of MF subjects to MTX seems to depend on the stage and, more importantly, the dose of MTX treatment. Methotrexate appears to be an effective treatment at every stage of MF; however, it is not devoided of side effects such as infections and elevated level of aminotransferases, which are most common.

European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14.

BACKGROUND: Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. OBJECTIVE: To evaluate the current spectrum of contact allergy to allergens present in the European baseline series (EBS) across Europe. METHODS: Retrospective analysis of data collected by the European Surveillance System on Contact Allergies (ESSCA, www.essca-dc.org) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. RESULTS: Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. CONCLUSION: Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed.

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

Occupational contact dermatitis to acrylates in a manicurist.

We report the case of a manicurist who developed an allergic skin reaction to acrylates, manifested by bullous lesions on fingertips and eczema of the hands and ears. Patch tests showed positive reactions to 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethyleneglycol dimethacrylate, triethyleneglycol dimethacrylate, 1,6-hexandiol diacrylate, 2-hydroxyethyl acrylate and triethyleneglycol diacrylate. Because of her skin disorder, she had to give up her job. She was not correctly advised on retraining and started to work as a dental nurse. Soon after re-exposure to acrylates in dental materials, she experienced recurrence of the skin symptoms.

The European standard series in 9 European countries, 2002/2003 -- first results of the European Surveillance System on Contact Allergies.

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.

[Photosensitivity induced skin diseases]. / Choroby skóry wywolane nadwrazliwoscia na swiatlo.

The causes of skin diseases associated with photosensitivity are presented. The combined effect of light and exogenous light sensitizing substances leads to the occurrence of phototoxic and photoallergic reactions, and what is more, UVA spectrum is most active in their pathogenesis. The light sensitizing compounds are contained in cosmetic preparations, drugs and certain plants. They are characterized by a tricyclic structure and the ability to absorb ultraviolet radiation. The light sensitizing properties are exhibited primarily by non-steroid anti-inflammatory drugs, preservatives, sun filters, phenothiazine derivatives and odorants. Photoallergic reactions may be of occupational nature. The majority of reports found in the literature concern farmers, gardeners, fruit-growers and breeders, as well as representatives of other occupations. They usually emerge after the contact with pesticides of the thiocarbamide group, tetrachloroisophthalonitryl and veterinary drugs. The cases of occupational eczema in farmers and gardeners induced by the effect of light sensitizing plants have also been reported. In addition, the photoallergy diagnostic methods are discussed.

Occupational skin diseases among the nurses in the region of Lódz.

We examined 223 nurses from the Lódz region, referred to the Nofer Institute of Occupational Medicine in 1995-99 because of suspected occupational dermatoses. The diagnosis of contact allergy was based on the positive results of patch tests, and immediate allergy to common allergens and latex on the results of prick tests, as well as on the determinations of specific IgE antibodies. Contact allergy was diagnosed in 66.4% of nurses. The most frequent sensitisers were quaternary ammonium compounds (benzalkonium) (23.8%), nickel (21.5%) and formaldehyde (20.6%); allergy was somewhat less frequently caused by thimerosal (14.3%), fragrances (12.1%), glutaraldehyde (10.8%), cobalt (9.9%), thiurams (6.7%) or glyoxal (4.9%). Allergy to rubber was diagnosed in 40 patients (17.9%), including 25 cases of immediate allergy to latex, 8 cases of contact dermatitis from thiuram rubber curing accelerators, and 7 cases of mixed allergy. It has been concluded that the contact with disinfectants (40.8% of allergic nurses), metals (30.9%) and rubber (17.9%) was the most frequent source of allergy in this group of medical personnel.

[Causes of occupational allergy in dental nurses. An analysis based on the material collected at The Institute of Occupational Medicine in Lódz]. / Przyczyny uczulenia zawodowego u pomocy dentystycznych, na podstawie materialu Instytutu Medycyny Pracy w Lodzi.

The causes of occupational dermatosis were analysed in 27 dental nurses examined at The Nofer Institute of Occupational Medicine during the years 1995-99. Contact sensitisation (at least one positive epidermal test) was found in 18 subjects (66.7%). Occupational allergic dermatitis was induced most frequently by: glutaraldehyde (7 positive patch tests), nickel (7), benzalkonium (4), formaldehyde (4), fragrances (4), chromium compounds (3), glyoxal (3), and thiuram (3). In the authors' opinion, dental nurses are nowadays sensitised to other chemical compounds than it used to be in the past. The present components of disinfectants (aldehydes, quaternary ammonium bases), metals and rubber are the major etiologic agents that induce occupational allergy.

Occupational allergy to aldehydes in health care workers. Clinical observations. Experiments.

The incidence of allergy to aldehydes (formaldehyde, glutaraldehyde, glyoxal) was examined in 280 health care workers suffering from skin lesions. Allergy was diagnosed in 64 (22.8%) patients. The majority of them (85.9%) were sensitive only to 1 aldehyde. Formaldehyde caused allergy slightly more frequently (13.9%) than glutaraldehyde (12.4%). Only 5 (1.9%) patients were sensitive to glyoxal. The irritant effect of aldehydes to the rabbit eye and skin was tested by the Draize and OECD methods. Formaldehyde and glutaraldehyde showed stronger irritant effect than glyoxal. The sensitizing activity of aldehydes was also confirmed in guinea pigs (using the Maximization Test and the OECD methods). Formaldehyde showed the strongest and most persistent reactions. Significantly higher eosinophil and basophil counts were found in the blood samples of the sensitized guinea pigs. Cytotoxicity of glutaraldehyde and glyoxal was tested on mouse 3T3-L1 fibroblasts by the Neutral Red Uptake and MTT Reduction Assay. It was shown that both aldehydes were cytotoxic, and that the cytotoxic effect of glutaraldehyde was stronger than that of glyoxal.

[The role of formaldehyde in the occurrence of contact allergy]. / Rola formaldehydu w powstawaniu uczulenia kontaktowego.

The authors present the major sources of formaldehyde, and discuss the incidence of contact allergy to this compound in Poland and throughout the world. The attention was turned to an increasing trend in the incidence of allergy in question, as well as to the problem of cross-sensitization to other chemical compounds of the aldehyde group (glyoxal, glutaraldehyde, succinaldehyde and cinnamic aldehyde).

[Eosinophil cationic protein in persons with contact allergy to disinfectants]. / Kationowe bialko eozynofilów u osób z uczuleniem kontaktowym na srodki odkazajace.

The concentration of eosinophil cationic protein (ECP) in blood serum was determined in 53 health service workers (women) with contact allergy to disinfectants and in 16 healthy women using a radioimmunological method. The mean ECP concentration in the study group accounted for 7.518 micrograms/l, and in the control group 4.893 micrograms/l. The concentration of 8.403 micrograms/l (the mean concentration in the control group + 2 SD) was taken as a cut off concentration value. In 17 (32.1%) persons with contact dermatitis, pathological ECP values were found. An increased ECP was observed in persons with positive results of prick test, especially in the case of Dermatophagoides, pollens and latex as well as in those with increased total IgE concentration. Our results indicate the involvement of immediate allergy in the incidence of contact allergy to disinfectants.

[Immediate hypersensitivity in the development of contact sensitivity to disinfectant agents]. / Udzial alergii natychmiastowej w powstawaniu uczulenia kontaktowego na srodki odkazajace.

In 53 female health service workers with contact allergy to disinfectants (formaldehyde, glutaraldehyde, benzalkonium, lisoformine) the results of skin prick tests using common environment allergens were analysed, and concentrations of total IgE in blood serum were identified. In 29 (54.7%) persons positive prick tests (Dermatophytes--21, pollens--21, latex--7, domestic dust--5, goose and duck feathers--3, dog hair--2, and cat hair--1) were noted. In the whole group mean IgE concentration accounted for 88.2 kU/1, whereas in the group with positive skin prick test the value increased to 136.1 kU/1. The authors are of the opinion that in patients with contact allergy to disinfectant some symptoms of atopic diathesis are observed.