Efficacy of new oral rinse containing sodium hyaluronate in xerostomia: A randomized crossover study.

OBJECTIVES: To evaluate the efficacy of a new oral rinse containing sodium hyaluronate and other functional ingredients in reducing xerostomia-associated symptoms. MATERIALS AND METHODS: In this 8-week, double-blind crossover study, xerostomia subjects used all three of GUM®HYDRAL™ Oral Rinse, placebo rinse, and Biotene® Oral Rinse as active control. Visual Analog Scale, a dry mouth questionnaire, Oral Health Impact Profile-14, unstimulated saliva flow rate (USFR), and Revised Oral Assessment Guide (ROAG) were assessed before and after 2 weeks of treatments. RESULTS: Thirty-seven patients completed all three treatment modalities. Subjective measurements were significantly decreased by test product and active control; however, no significant difference was observed between the treatments. Test product and active control demonstrated a significant increase in USFR over 0.2 ml/min, a normal threshold of hyposalivation. Both test product and active control improved a total score of ROAG, whereas the effectiveness of the test product was significantly better than that of other two treatments. CONCLUSIONS: The new oral rinse may be beneficial to improve the quality of life of xerostomia patients as dry mouth symptoms were reduced for both subjective and objective measurements. Test oral rinse was found to be more effective than placebo or active control for some of the objective measurements.

Lack of Association Between Dust Mite Sensitivity and Atopic Dermatitis.

BACKGROUND: Dust mites (DMs) play a role in type I respiratory allergy. Studies relating to DM irritant versus immune reactions are somewhat conflicting in atopic dermatitis (AD). OBJECTIVE: The aim of this study was to assess the diagnostic use of patch testing to DM in patients with AD and other dermatitides. METHODS: We performed a prospective study of 323 adults recruited in a patch testing clinic. Patch testing antigens were DM extract (0.01%, 0.1%, 1%, 10%, and 20% in petrolatum; Chemotechnique) and/or 200 index of reactivity in petrolatum (Stallergenes). Patches were placed and read at 48 hours with delayed readings after 72 to 168 hours. RESULTS: There was no association of DM positivity with AD, asthma, hay fever, or demographic factors. There was no association of DM positivity with the clinical diagnosis or phenotype. The number of positive (+, ++, and +++) and doubtful reactions to Chemotechnique DM extract increased with higher concentrations. Positive reactions to DM had a morphological appearance characterized by numerous discrete erythematous papules and, rarely, papulovesicles. Positive reactions to Stallergenes DM 200 IR were infrequent and all weak reactions, similar to DM 0.01%. CONCLUSIONS: Patch testing to DM does not seem to have clinical use for determining the etiology of dermatitis.

Allergic contact dermatitis from a natural deodorant: a report of 4 cases associated with lichen acid mix allergy.

BACKGROUND: Botanical ingredients used in personal care products are a significant and underreported cause of allergic contact dermatitis. OBJECTIVE: To evaluate allergic contact dermatitis from a widely-used botanical deodorant. METHODS: We conducted patch testing in four patients who were using the botanical deodorant and were referred to the contact dermatitis clinic; three patients had axillary dermatitis and one had dermatitis of the external ear. RESULTS: All four patients had positive patch test reactions to lichen acid mix and D-usnic acid. Of the three patients who were patch tested to the botanical deodorant, all had positive reactions. LIMITATIONS: We did not test to the specific lichen used in the natural deodorant but rather used our own lichen acid mix and d-usnic acid in addition to testing to the actual product. One of the patients declined to be tested with the natural deodorant, but did test positive to the lichen acid mix and d-usnic acid. CONCLUSION: Personal care products such as deodorants may represent a new route of exposure to lichen extract, a known allergen.

Cutaneous and pulmonary sarcoidosis in association with tattoos.

Sarcoidosis encompasses a heterogeneous spectrum of clinical presentations, including sarcoidosis in association with tattoos. We report the development of cutaneous and pulmonary sarcoidosis in a patient with long-standing eyebrow tattoos whose cutaneous sarcoidosis almost completely resolved when treated with tacrolimus 0.1% ointment. A 70-year-old woman with a 3-year history of an erythematous eruption circumscribing her eyebrow tattoos presented with a chronic, nonproductive cough of 8 months' duration. Skin biopsy results demonstrated naked tubercles consistent with sarcoidosis. Results of radiographs and a computed tomography scan of the chest revealed multiple pulmonary nodules with mediastinal and hilar adenopathy. The results of transbronchial biopsy were consistent with the diagnosis of pulmonary sarcoidosis. Initial treatment with oral prednisone only improved the pulmonary sarcoidosis. The cutaneous sarcoidosis almost completely resolved after the addition of tacrolimus 0.1% ointment.

Prevalence of botanical extract allergy in patients with contact dermatitis.

BACKGROUND: Botanical extracts are used widely in over-the-counter products. They are primarily added for fragrance and their purported healing properties. Numerous case reports of allergic contact allergy to botanical extracts have been published; however, little is known regarding the prevalence of allergic reactions to botanical extracts. OBJECTIVE: To determine the prevalence of allergic patch-test reactions to a collection of botanical extracts in patients referred for patch testing. METHODS: A total of 140 patients were patch-tested to a study tray containing 47 botanical extracts. Patients were divided into two groups: (1) a high-risk group consisting of 21 patients with a clinical diagnosis of contact allergy who were using botanical products and whose contact dermatitis was not fully explained by testing to standard allergens and (2) a control group consisting of 119 patients with no history of botanical extract use and who were being evaluated in a contact dermatitis clinic. RESULTS: Ten of 21 patients (47.6%) in the high-risk group had at least one relevant botanical extract positive reaction. Only 4 patients (3.4%) in the control group had a relevant positive reaction. Four patients in the high-risk group had more than one relevant botanical reaction. Tea tree oil caused the most common relevant positive reaction. CONCLUSIONS: Contact allergy to botanicals was common in this highly selected group of patients. Contact dermatitis patients who use botanical products and whose reactions are not fully explained by standard patch testing may benefit from more extensive patch testing to botanical extracts.

Permanent-wave dermatitis: contact allergy to cysteamine hydrochloride.

Cysteamine hydrochloride (CHC) is a newly recognized sensitizer found in permanent-wave solutions. We report the case of a hairdresser who was found to be allergic to CHC. Our allergic patient was patch-tested to various chemicals found in permanent-wave solutions, including CHC (1.0% in petrolatum). Patch-test reactions were positive to CHC, glyceryl thioglycolate, diglyceryl thioglycolate, p-phenylenediamine (PPD), and PPD through a piece of latex glove. Sixty-four controls to CHC (1.0% in petrolatum) had negative results. Household-weight latex gloves were protective against CHC allergy. Persons with CHC-waved hair were not allergic. CHC contained in "neutral" permanent-wave preparations has been used in American beauty salons since 1993. We briefly discuss the introduction and significance of CHC in permanent waves.

Contact urticaria, allergic contact dermatitis, and photoallergic contact dermatitis from oxybenzone.

There is little literature regarding conventional patch tests and photopatch tests to oxybenzone resulting in both immediate- and delayed-type hypersensitivity reactions. A patient was patch-tested and photopatch-tested to various sunscreen chemicals. Both immediate- and delayed-type hypersensitivity reactions were observed with oxybenzone. The positive patch tests were also photoaccentuated. Oxybenzone, a common sunscreen allergen, can result in both contact urticaria and delayed-type hypersensitivity on both conventional patch testing and photopatch testing. Allergic contact dermatitis to sunscreen chemicals has traditionally included contact urticaria, allergic contact dermatitis, and photoallergic contact dermatitis. Due to the recognition of p-aminobenzoic acid (PABA) and its esters as sensitizers, the presence of benzophenones in "PABA-free" sunscreens has become more prevalent, especially in sunscreens with a sun protection factor (SPF) greater than 8. In our patient, immediate- and delayed-type hypersensitivity reactions were seen to oxybenzone (2-hydroxy-4-methoxybenzophenone, 2-benzoyl-5-methoxyphenol, benzophenone-3, Eusolex 4360, Escalol 567, EUSORB 228, Spectra-Sorb UV-9, Uvinul M-40) upon conventional patch testing and photopatch testing.

Cross-reactivity among epoxy acrylates and bisphenol F epoxy resins in patients with bisphenol A epoxy resin sensitivity.

OBJECTIVE: The study's objective was 2-fold: first, to evaluate the potential cross-reactivity between Bis-A epoxy resins and epoxy acrylates and second, to study the cross reactivity between Bis-A epoxy resins and newer Bis-F epoxy resins in patients with allergic contact dermatitis to epoxy resins and had positive patch test to the standard epoxy resin based on bisphenol A. METHODS: Forty-one patients were patch tested to 23 chemicals including epoxy acrylates, Bis-A epoxy resins, and Bis-F epoxy resins, as well as reactive diluents and nonbisphenol epoxy resins. Questions concerning exposure to epoxy resins, occupational history, and problems with dental work were completed. RESULTS: All patients included in the study had positive reactions to the standard Bis-A epoxy resin. Twenty percent (8 of 41) of the patients reacted to at least one of the epoxy acrylates; the most common reaction was to Bis-GMA. Five of 8 patients who reacted to the epoxy acrylates had dental work, but only one patient had problems from her dental work. Six of 8 patients (75%) who reacted to epoxy resins and epoxy acrylates did not react to aliphatic acrylates. Thirty-two percent (13 of 41) reacted to tosylamide epoxy resin, and none reacted to triglycidyl isocyanurate resin. In addition, all patients (100%) had positive reactions to at least one of the Bis-F epoxy resins that were tested. CONCLUSIONS: Most patients with sensitivity to Bis-A epoxy resins do not cross-react with epoxy acrylates. Patients with positive patch test reactions to epoxy acrylates used in dentistry usually do not have symptoms from their dental work. To our knowledge, this is the largest series of patients with sensitivity to the standard Bis-A epoxy resin that have been patch tested with the more recently introduced Bis-F epoxy resins. There is significant cross-reactivity between Bis-A and Bis-F epoxy resins, which can be explained by their structural similarity.