Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis.

BACKGROUND: A standardized instrument is needed to rate the overall severity of chronic hand dermatitis (CHD), in particular during clinical trials. OBJECTIVES: To design and validate a photographic guide. METHODS: Initially, five experts were asked to grade 50 photographs of CHD, first individually, then as a consensus-building group, in order to select the photographs included in the guide. Then, a validation session with 11 different dermatologists evaluating 28 patients was conducted to assess the interrater reliability and test-retest reproducibility of the assessment of disease severity, relying on the photographic guide, on two consecutive days. Patient order was randomized, and only diseased hands were visible to prevent any bias in evaluation. RESULTS: The experts reached a consensus for development of a photographic guide composed of five severity levels and four photographs per severity level. Results of the validation session showed a high level of interrater reliability and test-retest reproducibility. CONCLUSIONS: The photographic guide is a reliable tool for assessing the morphological severity of hand dermatitis, and can be used as part of a comprehensive evaluation of disease in international multicentre clinical trials.

Methyldibromoglutaronitrile is an important contact allergen in The Netherlands.

From 15 May to 15 December 1994, 2943 patients suspected of having contact dermatitis (1955 women, 988 men) were patch tested with methyldibromoglutaronitrile 0.3%, 0.1% and 0.05% pet. 119 patients (4.0%; women 4.1%, men 3.8%) proved to be allergic. 71% of the reactions were considered to be relevant. In 2/3 of the patients, causative products were cosmetics, in 1/3 moistened toilet tissues. Testing with methyldibromoglutaronitrile at lower concentrations (0.05% and 0.1%) and with commercial allergens (Euxyl K 400 and methyldibromoglutaronitrile, both containing methyldibromoglutaronitrile 0.1%), resulted in a number of false-negative reactions. All preservatives in the European standard series had lower scores than the 4% positive reactions to methyldibromoglutaronitrile (formaldehyde 2.0%, MCI/MI (Kathon CG) 3.2%, parabens 1.0%, quaternium-15 1.3%). It is concluded that methyldibromoglutaronitrile (present in the commercial preservative Euxyl K 400) is an important contact allergen in the Netherlands in cosmetics and moistened toilet tissues. It should be added to cosmetics series and to proctological series. The optimal test concentration is unknow, but may be 0.3% pet. The concentration of 0.1% methyldibromoglutaronitrile in the currently available commercial allergens appears to be too low, resulting in a number of false-negative reactions.

Contact allergy to cocamidopropyl betaine.

Cocamidopropyl betaine is an amphoteric surfactant used increasingly in cosmetic products. We describe 20 cases of cosmetic allergy to cocamidopropyl betaine; all were caused by shampoo or shower gel. 8 patients were hairdressers, who had occupational allergic contact dermatitis from shampoos. We recommend patch testing cocamidopropyl betaine 1% aq. routinely in hairdressers with dermatitis of the hands, and in all patients suspected of suffering from cosmetic allergy.

Dermatitis in hairdressers (II). Management and prevention.

Hand dermatitis in hairdressers is caused by a variety of factors. Important are the sensitizing and irritant capacities of some hair-cosmetic ingredients, unsafe packaging which causes contamination of the hands, work tables and instruments with hazardous chemicals, absence of protection with adequate gloves and ignorance of safe handling of these chemicals. A strategy is proposed, based on improvement of the safety of ingredients and packaging, use of vinyl gloves and introduction of safe hairdressing procedures. Introduction of this strategy in hairdressing salons with 16 cases of moderate to severe contact dermatitis reduced the number of cases of active dermatitis to 3 in 4 months. The value of pre-employment screening is discussed and the necessity of cooperation of centers of occupational dermatology is emphasized.

Dermatitis in hairdressers. (I). The experience of the past 4 years.

Contact dermatitis among hairdressers is common. In The Netherlands, registered sick leave for hand dermatitis among hairdressers rose from 21,050 days in 1986 to 54,293 in 1991. In a survey among 45 hairdressers in 5 different salons, 12 had a history of hand dermatitis and 16 showed moderate to severe hand dermatitis. After extensive investigations, 13 were classified as having allergic contact dermatitis and 3 cumulative irritant contact dermatitis. In the past 4 years, 103 hairdressers were extensively patch tested and glyceryl thioglycolate (GTG), ammonium persulfate and nickel sulfate were responsible for the majority of positive reactions. Hair dyes and preservatives were responsible for a moderate % of the positive reactions. Positive reactions were also found to cocamidopropyl betaine and sodium coco hydrolyzed animal protein. These 2 allergens show a rather capricious patch test reaction pattern and irritant reactions may easily be confused with allergic. The relevance of positive patch test reactions to these chemicals should always be questioned. Atopy was not a frequent cause of hand dermatitis in this study. Chemicals with a thiol group can be demonstrated with a chemical spot test. With this test, contamination of the hairdressing salon with thioglycolates was demonstrated. It is emphasized that contamination of hairdressing salons with GTG is probably a significant factor in explaining the severe flare-ups in GTG-sensitized hairdressers who no longer use GTG permanent-waving solutions.

Weekly treatment of psoriasis with a hydrocolloid dressing in combination with triamcinolone acetonide. A controlled comparative study.

In a within subject comparison, the efficacy and the tolerability of topical treatment with triamcinolone acetonide under a hydrocolloid dressing were compared with triamcinolone acetonide monotherapy, monotherapy with hydrocolloid dressing and triamcinolone acetonide under plastic occlusion. The clinical efficacy of hydrocolloid dressing as a monotherapy and the pronounced clinical efficacy of this occlusive in combination with triamcinolone acetonide were confirmed. Comparing the hydrocolloid dressing (Duoderm E) and the plastic semi-occlusive (Opsite IV 3000), we concluded that the tolerability of both approaches was similar. However, Duoderm E in conjunction with triamcinolone acetonide was highly effective, whereas Opsite IV 3000 in combination with this steroid only had an inconspicuous antipsoriatic potential.

Cosmetic tattooing as a treatment of port-wine stains.

BACKGROUND: Medical treatment for port-wine stains frequently is cosmetically unsatisfactory. An alternative possibility is cosmetic medical tattooing. METHODS: By means of a traditional Japanese tattooing technique, five patients were treated in multiple sessions until the color of the lesion matched that of the surrounding skin. RESULTS: The results were excellent, the skin texture remained normal, and the patients could discontinue cosmetic camouflage. DISCUSSIONS: Cosmetic medical tattooing when carefully done is a valuable addition to the medical armamentarium and may replace more aggressive techniques.

Tattoo removal: tannic acid method of Variot.

BACKGROUND: There are many methods for tattoo removal (e.g., surgery, cryosurgery, laser, dermabrasion), but none can restore the skin to its original state. METHODS: Tattoo removal was obtained with a combination of tattoo machine, tannic acid, and silver nitrate. RESULTS: This technique proved to be effective for the removal of amateur tattoos of any size. The results with professional tattoos were much less satisfactory. The estimation of the depth of pigment in pretreatment biopsies showed no correlation with the success rate of treatment. No indication of systemic side effects on the liver from tannic acid was found in the concentration and amount used in this study. CONCLUSIONS: This technique is effective for the removal of amateur tattoos of any size and is comparable with cryotherapy, infrared coagulation, and focal salabrasion.

Contact allergy to 4-isopropyl-dibenzoylmethane and 3-(4'-methylbenzylidene) camphor in the sunscreen Eusolex 8021.

10 cases of contact allergy from the sunscreen Eusolex 8021 are reported. 5 patients were sensitized to a lipstick, 4 to a sunscreen cream, and 1 reacted to several cosmetic creams. Of 9 patients tested with the 2 ingredients of Eusolex 8021, 5 proved to be allergic to both (chemically unrelated) constituents: 4-isopropyl-dibenzoylmethane and 3-(4'-methylbenzylidene) camphor; 4 were allergic to 4-isopropyl-dibenzoylmethane only. Contact allergy to this recently introduced broad spectrum sunscreen may not be rare. The relevant literature is reviewed.

alpha, beta-Diacryloxypropionic acid, a sensitizing impurity in commercial acrylic acid.

In samples of commercial acrylic acid a strongly contact sensitizing constituent was discovered by application of Freund's Complete Adjuvant Test in guinea pigs. The skin reactions were due to the presence of varying quantities of alpha,beta- diacryloxypropionic acid (DAPA), which was identified after methylation. The commercial product is an example of a composition that defies gas-chromatographic quality-control: Under the circumstances of this analysis the secondary product that is formed during the synthesis of acrylic acid is so unstable that it does not pass polar liquid phases. Distilled acrylic acid does not contain the sensitizing acid.

The sensitizing potential of 2-ethylhexyl acrylate in the guinea pig.

The sensitizing potential of 2-ethylhexyl acrylate in the guinea pig could be demonstrated by Freund's Complete Adjuvant Test. This acrylate ester is a common constituent of adhesive tape. Allergic reactions to several brands of adhesive tape were not observed in 2-ethylhexyl acrylate sensitized animals. Cross reactions with other acrylic monomers were observed.

Cross reaction pattern of 26 acrylic monomers on guinea pig skin.

The cross reaction pattern of acrylic monomers was investigated in 20 groups of animals sensitized to a different acrylic monomer. Animals sensitized to one monoacrylate tend to react to other monoacrylates. Reactions to corresponding monomethacrylates (same alcohol group in the ester) or other monomethacrylates did not occur. Some reactions to di(meth)acrylates were observed. A number of animals sensitized to one monomethacrylate reacted to some other monomethacrylates and to monoacrylates. Reactions to di(meth)acrylates were observed. Animals sensitized to di(meth)acrylates showed hardly any positive cross reaction. A universal screening allergen to detect acrylic monomer sensitizations does not exist. The composition of (industrial) products should be made accessible to the occupational dermatologist in order to prevent the undesirable situation in which a patient suspected of having an acrylic monomer sensitization must be tested with a large series of potent allergens in order to detect the real origin of the sensitization.

Sensitizing potential of 14 mono (meth) acrylates in the guinea pig.

The aim of this study was to investigate differences in the sensitizing potential of 14 mono(meth)acrylates, when tested by the guinea pig maximization test (GPMT) and Freund's complete adjuvant test (FCAT) with an identical, intradermal induction concentration. A new grading classification of the sensitization potential is proposed. Mono(meth)acrylates show a wide range of sensitizing potential. Compared with other (meth)acrylates, methyl methacrylate is a moderate sensitizer. Attention was paid to concomitant sensitization of additives. In 9 of 16 FCATs, concomitant sensitization occurred to the inhibitors hydroquinone and p-methoxyphenol.