Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite.

BACKGROUND: Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America. OBJECTIVE: We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis. METHODS: A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed. RESULTS: Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion. CONCLUSION: Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.

Poison ivy dermatitis. Nuances in treatment.

Acute allergic contact dermatitis due to poison ivy or poison oak is a common presenting complaint in the practices of many primary care physicians. While the clinical features are well described, reported treatment regimens vary in both topical and systemic therapies. We review herein the variability of presenting morphologic features of the disease and common treatment regimens, with attention given to complications of therapy. We also comment on the correct botanical designation, incidence, and immune mechanisms of the disease state and review measures to avoid allergic contact dermatitis due to poison ivy and poison oak.

Toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening condition in which the epidermis blisters and peels in large sheets. The clinical syndrome and diagnosis are reviewed. Current treatment and prevention of complications are discussed. The key to low morbidity and mortality in TEN is early intervention. Physicians should be knowledgeable about TEN and the appearance of the skin in its initial presentation.

Pemphigoid-like bullous eruption related to ibuprofen.

We report two patients who had a bullous eruption limited to the lower extremities when first seen by us. Clinically the eruption resembled limited bullous pemphigoid. In both patients the onset of the eruption was associated with ibuprofen therapy, and lesions promptly resolved after discontinuing the ibuprofen. This type of presentation has not been reported previously as an adverse effect of ibuprofen. Bullous reactions to nonsteroidal anti-inflammatory agents are briefly reviewed.