Pieter G M van der Valk, Steven A Devos, Pieter-Jan Coenraads
Evidence-based diagnosis in patch testing.
Contact Dermatitis. 2003 Mar;48(3):121-5.
Abstract/Text
Evidence-based medicine (EBM) is defined as the integration of the best research evidence with clinical expertise and patient values. Based on the principles of EBM, we can conclude that patch testing is cost-effective only if patients are selected on the basis of a clear-cut clinical suspicion of contact allergy and only if patients are tested with chemicals relevant to the problem (high pretest probability). Random patch testing (low pretest probability) should be discouraged. Proper pretest probability assessment can only be done in expert centres, because problem-based testing requires both a thorough knowledge of the patch-test procedure and knowledge about potential sensitizers in a specific environment.
T L Diepgen, P J Coenraads
Sensitivity, specificity and positive predictive value of patch testing: the more you test, the more you get? ESCD Working Party on Epidemiology.
Contact Dermatitis. 2000 Jun;42(6):315-7.
Abstract/Text
Pathophysiological variability affects the results of patch testing. In addition, even a minimal degree of test-imprecision due to this variability has a number of important statistical consequences for the analysis and interpretation of any patch test data set. One such statistical phenomenon that is often overlooked is the dependence of the positive predictive value (i.e., the predictive value of a positive patch test) on sensitivity and specificity, the impact of which is heavily dependent on the proportion of truly allergic subjects that are studied. A 2nd important issue is the fact that patch testing is performed in series, which means multiple tests. If we assume, for example, a patch test series of only 10 allergens, then it can be demonstrated that there is a random probability of over 40%) to find, simply by chance, for at least 1 allergen, a statistically significant difference between 2 groups of patients. Comparison of the results of series between patients calls for statistical adjustments in order to prevent erroneously positive differences and/or associations.
Christen M Mowad
Patch testing: pitfalls and performance.
Curr Opin Allergy Clin Immunol. 2006 Oct;6(5):340-4. doi: 10.1097/01.all.0000244794.03239.8e.
Abstract/Text
PURPOSE OF REVIEW: Contact dermatitis is a common disease process that includes allergic and irritant contact dermatitis. The gold standard for diagnosing allergic contact dermatitis, a type IV delayed hypersensitivity reaction, is patch testing. Patch testing is not a difficult procedure, however, there are several critical components that determine the success of the test: having an appropriate level of suspicion for the diagnosis of allergic contact dermatitis, an adequate threshold for patch testing, the necessary experience to properly interpret the results and to determine their relevance, and the ability to thoroughly educate the patient about the condition.
RECENT FINDINGS: Research shows that patch testing practices differ among individuals and specialties. The level of patch testing education, interest in, and experience with, the procedure can affect the results of the test. Some of these practice differences and how they affect the outcome of patch testing are highlighted.
SUMMARY: Physicians' knowledge and experience with patch testing, their level of interest and access to allergens will determine the performance of this test, the reliability of the results and the benefits gained from this procedure.
J Bourke, I Coulson, J English, British Association of Dermatologists
Guidelines for care of contact dermatitis.
Br J Dermatol. 2001 Dec;145(6):877-85.
Abstract/Text
These guidelines for the management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.
N Frossard, M Melac, O Benabdesselam, G Pauli
Consistency of the efficacy of cetirizine and ebastine on skin reactivity.
Ann Allergy Asthma Immunol. 1998 Jan;80(1):61-5. doi: 10.1016/S1081-1206(10)62941-9.
Abstract/Text
BACKGROUND: At therapeutic dosage, cetirizine and ebastine induce significant inhibition of skin reactivity to histamine. The consistency of their efficacy, that is, efficacy with the least interindividual variability among subjects, has not been carefully assessed, however.
OBJECTIVE: To compare the consistency and efficacy of these antihistamines on skin reactivity.
METHODS: Twenty-four healthy volunteers participated in a randomized double-blind crossover study. The areas of wheals and flares induced by increasing (0, 5, 10, 50, 100, 200, and 300 mg/mL) histamine concentrations, administered by prick tests, were measured before and four hours after intake of 10 mg of each antihistamine, allowing concentration-response curves to be established. The threshold histamine concentrations inducing wheal areas of 3 mm2 (positivity) were calculated by interpolation. The coefficient of variation (SD/mean %) was used to evaluate the consistency of the response.
RESULTS: Pretreatment concentration-response curves were similar, and threshold concentrations identical (0.29 mg/mL and 0.34 mg/mL for cetirizine and ebastine, respectively). For both, curves were lower after treatment than before. After cetirizine, the threshold concentration was significantly higher (217 mg/mL) than after ebastine (0.82 mg/mL) (P < .001), and total inhibition of the wheal reaction was observed in 21 of 24 patients at the lowest histamine concentration and in 17 of 24 at the highest. Ebastine never totally inhibited reaction, even to 5 mg/mL of histamine. Over the entire concentration-response curve, the coefficient of variation for the wheal reaction was 6.3% for cetirizine and 72.6% for ebastine, and, for flares, 11.0% and 83.7%, respectively. Hence, variability was much lower after cetirizine.
CONCLUSION: Our study shows clearly that the efficacy of a single therapeutic dosage of cetirizine is consistently good for suppression of cutaneous reactivity to histamine in healthy volunteers. The need for ebastine to metabolize into the active carebastine might explain its lesser consistency.
A Purohit, M Mélac, G Pauli, N Frossard
Comparative activity of cetirizine and mizolastine on histamine-induced skin wheal and flare responses at 24 h.
Br J Clin Pharmacol. 2002 Mar;53(3):250-4.
Abstract/Text
AIMS: The aim of our study was to compare the activity of cetirizine 10 mg with that of mizolastine 10 mg vs placebo at 24 h after intake in healthy volunteers.
METHODS: This was a double-blind, randomized, placebo controlled, three-way cross-over study with a wash-out period of 7 +/- 2 days between each period. The study included 36 healthy volunteers (18--50 years, mean age = 32 years; 9 males). The objective measurement was the cutaneous reactivity to increasing concentrations of histamine (0, 5, 10, 20, 40, 80, 160 mg ml(-1)) administered by prick tests. The reactivity was evaluated by the wheal and flare areas (mm2). The AUC (area under curves) values of the wheal and flare areas as a function of the log2 transformed histamine concentration were calculated for each subject and treatment, and compared.
RESULTS: A highly significant treatment effect was evidenced both for wheal and flare responses (P = 0.0001). This indicates the good activity of both cetirizine 10 mg and mizolastine 10 mg in inhibiting skin wheal and flare reactions to histamine. In addition, the mean AUC values significantly differed between cetirizine and mizolastine (64.8 and 117.8 log2 (mg ml(-1)) x mm2 for wheal, and 939.4 and 2340.8 for flare, respectively; P = 0.0001), with a superior activity of cetirizine than mizolastine at 24 h after intake both on wheal and flare responses. The tolerance of cetirizine and mizolastine was good. The severity of the adverse events was never more than 'moderate', 'fatigue' being the most frequent reported symptom [cetirizine (6 subjects), placebo (3), mizolastine (5)], followed by 'somnolence' [cetirizine (0), placebo (1), mizolastine (3)]. There was no serious adverse event.
CONCLUSIONS: This study shows that cetirizine (10 mg) suppresses skin reactivity to histamine more effectively than mizolastine (10 mg) 24 h after intake in healthy volunteers.
Kazumoto Katagiri, Shoko Arakawa, Yutaka Hatano, Sakuhei Fujiwara
Fexofenadine, an H1-receptor antagonist, partially but rapidly inhibits the itch of contact dermatitis induced by diphenylcyclopropenone in patients with alopecia areata.
J Dermatol. 2006 Feb;33(2):75-9. doi: 10.1111/j.1346-8138.2006.00017.x.
Abstract/Text
Antihistamines have been used for the treatment of not only allergic diseases such as allergic urticaria and rhinitis, but also of eczematous skin diseases because of their anti-pruritic effects. Moreover, the pruritus associated with eczematous diseases is considered to be induced, in part, by histamine. However, it is unclear whether antihistamines inhibit the itch of eczematous diseases in the absence of topical corticosteroids. In this study, we investigated the anti-pruritic effect of the antihistamine, fexofenadine, on the itch of contact dermatitis that was induced by topical application of diphenylcyclopropenone for the treatment for alopecia areata. Thirteen patients with alopecia areata, who had been treated weekly with topical immunotherapy with diphenylcyclopropenone for 3 months to 2 years, recorded the severity of their itching on a visual analog scale before and 3, 6, 12, 24, 48 and 72 h after application of diphenylcyclopropenone for 4 consecutive weeks. Seven patients took fexofenadine during the first and third weeks, and six patients took fexofenadine during the second and fourth weeks. The severity of itching reached a maximum 6-12 h after the induction of the contact dermatitis in most of the patients. However, fexofenadine partially but rapidly reduced the severity of itching for 72 h during the entire period of treatment in the absence of topical corticosteroids. Our results suggest that fexofenadine can be beneficial in the daily management of patients with itching due to eczematous disease.
古江増隆，佐伯秀久，古川福実，ほか：日本皮膚科学会アトピー性皮膚炎診療ガイドライン，日皮会誌，118：325-343, 2008.
M Kawashima, T Tango, T Noguchi, M Inagi, H Nakagawa, S Harada
Addition of fexofenadine to a topical corticosteroid reduces the pruritus associated with atopic dermatitis in a 1-week randomized, multicentre, double-blind, placebo-controlled, parallel-group study.
Br J Dermatol. 2003 Jun;148(6):1212-21.
Abstract/Text
BACKGROUND: Fexofenadine, a nonsedating, H1-receptor selective antihistamine, exhibits consistent efficacy and safety in the treatment of allergic rhinitis and urticaria. The pruritus associated with atopic dermatitis is considered to be induced, in part, by histamine. Therefore, we thought that fexofenadine may be useful in the relief of pruritus associated with atopic dermatitis.
OBJECTIVE: To compare the efficacy of twice-daily fexofenadine hydrochloride (HCl) 60 mg vs. placebo in reducing the pruritus associated with atopic dermatitis.
METHODS: In this randomized, multicentre, double-blind, placebo-controlled study, patients (aged >or= 16 years) with atopic dermatitis underwent a 1-week placebo lead-in period, followed by randomization to fexofenadine HCl 60 mg twice daily or placebo for 1 week. All patients also received topical treatment with 0.1% hydrocortisone butyrate twice daily throughout the study. The primary efficacy endpoint was mean change in pruritus score from baseline. Patients reflectively recorded pruritus scores twice daily (day and night) using a five-point scale (0 = none; 4 = very severe).
RESULTS: Fexofenadine (n = 201) significantly decreased the severity of pruritus compared with placebo (n = 199) (mean change in score -0.75 (unadjusted 95% confidence interval [-0.88, -0.62]) vs. -0.5 [-0.62, -0.38], respectively; P = 0.0005). This improvement was seen after just 1 day of treatment (P = 0.039) and was maintained throughout the treatment period (P = 0.019). Compared with placebo, fexofenadine significantly improved both diurnal (P = 0.0001) and nocturnal pruritus (P = 0.013). In addition, significantly more patients in the fexofenadine group experienced a reduction in the ratio of pruritus area to body surface area compared with those in the placebo group (P = 0.007). The incidence of adverse events was low and similar across all treatment groups.
CONCLUSIONS: Fexofenadine HCl 60 mg twice daily demonstrated a rapid, significant improvement in the pruritus associated with atopic dermatitis, with a safety profile equivalent to that of placebo.
川島眞，原田昭太郎：抗アレルギー薬を併用した標準的薬物療法がアトピー性皮膚炎患者の痒みとQuality of Life (QOL)に及ぼす影響に関する調査，臨皮，60: 661-667, 2006.
秀 道広，古江増隆，池澤善郎ほか：蕁麻疹・血管性浮腫の治療ガイドライン，日皮会誌，115: 703-715, 2005.
Joan Saary, Roohi Qureshi, Valerie Palda, Joel DeKoven, Melanie Pratt, Sandy Skotnicki-Grant, Linn Holness
A systematic review of contact dermatitis treatment and prevention.
J Am Acad Dermatol. 2005 Nov;53(5):845. doi: 10.1016/j.jaad.2005.04.075.
Abstract/Text
BACKGROUND: Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention.
METHODS: Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence.
RESULTS: In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications.
CONCLUSIONS: A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.
S Schliemann-Willers, W Wigger-Alberti, P Elsner
Efficacy of a new class of perfluoropolyethers in the prevention of irritant contact dermatitis.
Acta Derm Venereol. 2001 Nov-Dec;81(6):392-4.
Abstract/Text
Perfluoropolyethers (Fomblin HC products) are chemical non-reactive polymers with special physico-chemical properties that recently showed promise as protective preparations in the prevention of irritant contact dermatitis. We evaluated the efficacy of a new class of perfluoropolyethers (perfluoropolyether phosphate, Fomblin HC/P2) in the prevention of experimentally induced cumulative irritant contact dermatitis if applied prior to irritation. A panel of 20 healthy volunteers was tested with a repetitive irritation test using 4 standard irritants (sodium lauryl sulphate of highest purity, sodium hydroxide, lactic acid and toluene) in a randomized double-blind study. Application sites were assessed clinically and by the use of bioengineering techniques (transepidermal water loss and chromametry). Three gel preparations each containing 5% perfluoropolyether phosphate showed significant efficacy against irritation due to sodium lauryl sulphate and sodium hydroxide, while one test preparation containing 2% showed inferior benefit, indicating a dose-related effect. Preparations containing perfluoropolyether phosphates can be recommended for workplaces with water-soluble irritants. Further studies under real workplace conditions are indicated.
Hongbo Zhai, Fred Brachman, Alessandra Pelosi, Angela Anigbogu, Maria Belinda Ramos, Maria Cecilia Torralba, Howard I. Maibach
A bioengineering study on the efficacy of a skin protectant lotion in preventing SLS-induced dermatitis.
Skin Res Technol. 2000 May;6(2):77-80.
Abstract/Text
BACKGROUND/AIMS: This study evaluated the efficacy of a dimethicone skin protectant lotion against sodium lauryl sulfate (SLS)-induced irritant contact dermatitis (ICD) by clinical visual grading and bioengineering techniques in 12 healthy humans. METHODS: The flexor aspects of both forearms of the subjects were used as test sites. Each test was duplicated to diminish the variations of the test sites. In a random order and a double-blind manner, two test sites were pretreated either with the testing protectant lotion or with its vehicle control prior to contact with SLS. Thirty minutes later, 0.2 ml of 0.5% SLS in a polypropylene chamber was applied to each pretreated site. One additional test site served as a positive control (without lotion), receiving the irritant only. After 24 h of exposure to the irritant, the chambers were removed. The efficacy of protective effect was determined by four parameters: visual scoring (VS), transepidermal water loss (TEWL), skin color (a* value), and cutaneous blood flow volume (BFV). All test sites were assessed with the parameters daily for 5 days. RESULTS: The VS data showed a significant decrease on the site pretreated with protectant lotion in comparison with the SLS-only treated site (P<0.01) and with the site pretreated with control vehicle (P<0.05) (overall for 5 days). TEWL value was significantly decreased in comparison with the SLS-only treated site (P=0.02 at day 2; P=0.008 at day 4; P=0.014 at day 5) and with the site pretreated with the control vehicle (P<0.05) (day 2, 4 and 5). However, the BFV and a* values did not show a statistical difference between protectant lotion, vehicle, and SLS-only treated sites. CONCLUSIONS: This study demonstrated that appropriate dimethicone skin protection products may provide certain benefits from surfactant ICD. The skin protectant lotion may be used to prevent ICD in home or work environments, where skin irritants may induce dermatitis or eczema.
E Held, T Agner
Effect of moisturizers on skin susceptibility to irritants.
Acta Derm Venereol. 2001 May;81(2):104-7.
Abstract/Text
Moisturizers are used for the treatment of dry and irritated skin. The benefit of moisturizers when used on normal skin has recently been challenged, since an earlier study indicated that the increased hydration that follows long-term use of moisturizers on normal skin may facilitate penetration of irritants. The aim of the present study was to evaluate short-term use of 2 different moisturizers used on normal skin: cream A (high lipid content) and B (moderate/low lipid content). Nineteen healthy volunteers applied the moisturizers on the upper arm/forearm 3 times daily for 5 days, while the other upper arm/forearm served as symmetrical control. The day after moisturizer treatment was stopped the skin was challenged with a patch test of sodium lauryl sulphate. Skin reactions were evaluated by bioengineering measuring methods and clinical scoring. Skin response to sodium lauryl sulphate was increased on moisturizer-treated arms compared to controls for one of the moisturizer (cream A), while this was not statistically significant for the other moisturizer (cream B). Data confirm previous indications that some moisturizers when used on normal skin may increase skin susceptibility to irritants.
M Lodén
Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream.
Contact Dermatitis. 1997 May;36(5):256-60.
Abstract/Text
Moisturizers are used daily by many people to alleviate symptoms of clinically and subjectively dry skin. Recent studies suggest that certain ingredients in creams may accelerate the recovery of a disrupted barrier and decrease the skin susceptibility to irritant stimuli. In the present single-blind study, a moisturizing cream was tested for its influence both on barrier recovery in surfactant-damaged skin and on the susceptibility of normal skin to exposure to the irritant sodium lauryl sulphate (SLS). Parameters measured were transepidermal water loss (TEWL) and skin corneometer values, indicating degree of hydration. Treatment of surfactant-damaged skin with the test cream for 14 days promoted barrier recovery, as observed as a decrease in TEWL. Skin corneometer values also normalized more rapidly during the treatment. In normal skin, use of the test cream significantly reduced TEWL after 14 days of treatment, and irritant reactions to SLS were significantly decreased. Skin corneometer values increased after only 1 application and remained elevated after 14 days. In conclusion, the accelerated rate of recovery of surfactant-damaged skin and the lower degree of SLS-induced irritation in normal skin treated with the test cream may be of clinical relevance in attempts to reduce contact dermatitis due to irritant stimuli.
D W Ramsing, T Agner
Effect of glove occlusion on human skin (II). Long-term experimental exposure.
Contact Dermatitis. 1996 Apr;34(4):258-62.
Abstract/Text
Gloves are indispensable in many occupations. Irritant skin reactions from gloves have, however, been reported. In the present study, the effect of long-term glove occlusion on normal skin (6 h/day for 14 days) was studied and, in addition, the effect of a cotton glove worn under the occlusive glove was also studied. 2 studies were performed (studies A and B). Study A: 19 volunteers wore an occlusive glove on normal skin 6 h/day for 14 days. They wore the glove on one hand only, while the other hand served as control. Study B: 18 volunteers wore occlusive gloves on both hands on normal skin. A cotton glove was worn under the occlusive glove on either the left or the right hand. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation by erythema index (Derma-Spectrometer). The gloves used were hypoallergenic non-latex gloves. Results. Study A: glove occlusive on normal skin 6 h/day for 14 days had a significant negative effect on skin barrier function, as measured by TEWL. Study B: the negative effect on skin barrier function from occlusive gloves was prevented by the use of a cotton glove. It is concluded that gloves may be a substantial factor in the pathogenesis of cumulative irritant contact dermatitis, and that recommendations as to their use are important.
E Held, H Lund, T Agner
Effect of different moisturizers on SLS-irritated human skin.
Contact Dermatitis. 2001 Apr;44(4):229-34.
Abstract/Text
Moisturizers are widely used to treat irritant contact dermatitis (ICD). Their use is, however, not well-documented and standardized models for testing skin care products are needed to acquire documentation of their efficacy. The present study was undertaken to evaluate the effect of 6 commonly-used moisturizers on the recovery of irritated human skin. No commercial interests were involved in the study. 36 healthy volunteers had patch tests with SLS 0.5% applied on their forearms/upper arms for 24 h. After irritation of the skin, all volunteers had a moisturizer applied on one forearm/upper arm, respectively, 3 x daily for the following 5 days. The other forearm/upper arm served as an untreated control. Each moisturizer was tested on 12 volunteers and each volunteer tested 2 moisturizers at the same time. Evaluation was done on days 1, 3 and 8 by transepidermal water loss, electrical capacitance, laser Doppler flowmetry, DermaSpectrometry and clinical scoring. All 6 moisturizers were found to accelerate regeneration of the skin barrier function when compared to irritated non-treated skin. The most lipid-rich moisturizers improved barrier restoration more rapidly than the less lipid-rich moisturizers. We suggest this experimental model for further moisturizer efficacy testing.
A Di Nardo, G Giusti, L Mantovani, B Bianchi, S Seidenari
Inhibition of elicitation of contact dermatitis in humans by mometasone furoate: evaluation by means of 20-MHz B scanning associated with image analysis.
Dermatology. 1997;195(2):137-41.
Abstract/Text
BACKGROUND: Mometasone furoate (MF) is a new strongly lipophilic steroid which has an anti-inflammatory effect as evaluated by in vivo and in vitro studies.
OBJECTIVE: The objective of the present study was to investigate the degree of inhibition of experimental allergic contact dermatitis induced by the treatment with MF.
METHODS: The therapeutic effect was evaluated by an echographic method associated with image analysis. MF activity was compared to that of hydrocortisone acetate 0.5% (Cortaid Cream, Lachifarma), clobetasone butyrate 0.05% (Eumovate Cream, Glaxo) and clobetasol propionate 0.05% (Clobesol Cream, Glaxo), classified respectively as weak, moderately potent and very potent steroids.
RESULTS: The different corticosteroid formulations employed for inhibiting experimentally induced contact dermatitis reflect the expected rank order of efficacy.
CONCLUSION: MF behaves like clobetasol butyrate ranking as a moderately potent corticosteroid.
J G Marks, J F Fowler, E F Sheretz, R L Rietschel
Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite.
J Am Acad Dermatol. 1995 Aug;33(2 Pt 1):212-6.
Abstract/Text
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.
D A Vidmar, M K Iwane
Assessment of the ability of the topical skin protectant (TSP) to protect against contact dermatitis to urushiol (Rhus) antigen.
Am J Contact Dermat. 1999 Dec;10(4):190-7. doi: 10.1053/AJCD01000190.
Abstract/Text
BACKGROUND: Military personnel have a need for effective protection against cutaneous exposure to chemical warfare agents (CWA). Topical Skin Protectant (TSP) is being developed to supplement chemical warfare protective garments. TSP protects against CWA exposure in animals, but does it work for humans? Because humans should not be tested with live CWA, urushiol (poison ivy) extract was used as a surrogate substance in place of CWA for human efficacy testing of TSP.
OBJECTIVE: Determine whether TSP protects human skin against experimentally-induced urushiol dermatitis.
METHODS: Open urushiol patch testing of 50 rhus-sensitive subjects comparing the 96-hour dermatitis severity scores between TSP protected and TSP unprotected sites. There were 4 paired sites (i.e., protected versus unprotected) per subject. Test sites were scored using a 9-point dermatitis scale of 0.0 to 4.0 (using 0.5 increments).
RESULTS: Analysis of variance of the dermatitis scores from 192 paired sites on 48 evaluable subjects showed that TSP protected sites had mean dermatitis scores about 2 points lower than TSP unprotected sites (P <.001).
CONCLUSION: Although this study does not provide direct scientific evidence that TSP protects humans against the percutaneous absorption of CWA, it does provide circumstantial evidence that this is the case. The fact that TSP is so highly effective against a lipophilic substance like urushiol and that most common vesicant CWAs are lipophilic and are weaponized in oleaginous vehicles, makes the effectiveness of TSP in preventing absorption and dermatitis from CWA seem likely.
S Wöhrl, N Kriechbaumer, W Hemmer, M Focke, W Brannath, M Götz, R Jarisch
A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals.
Contact Dermatitis. 2001 Apr;44(4):224-8.
Abstract/Text
Chelating agents in protective barrier creams have often been used in the prevention of allergic contact dermatitis to nickel. In a pilot study, we demonstrated the preventive effect of 10% diethylenetriaminepentaacetic acid (DTPA) in an oil-in-water emulsion in nickel-sensitized patients. Now we reproduced these results in a randomized, double-blind study. Additionally, we investigated the efficacy of the barrier cream in other clinically relevant metal allergies. Individuals sensitized to various metals had a significant decrease in positive patch test reactions after pre-treatment with the DTPA-cream: 2.5% nickel sulfate (24/28 positive without pre-treatment versus 1/28 with pre-treatment; p<0.0001), 5% nickel sulfate (30/32 versus 15/32; p=0.0003), 1% cobalt chloride (19/20 versus 6/20; p=0.001) and 5% copper sulfate (13/14 versus 5/14; p=0.02). However, the cream had no protective effect with 1% palladium chloride (17/23 versus 16/23) and with 0.5% potassium dichromate (9/13 versus 7/13). We conclude that the DTPA-cream clearly abrogates positive patch test reactions in nickel-, cobalt- and copper-sensitized subjects and that it may therefore be helpful in the management of allergic contact dermatitis.
R Brehler, O Maurer, S Grabbe, T Schwarz
Topically applied pentoxifylline has no effect on allergic patch responses.
J Am Acad Dermatol. 1998 Dec;39(6):1017-21.
Abstract/Text
D W Ramsing, T Agner
Preventive and therapeutic effects of a moisturizer. An experimental study of human skin.
Acta Derm Venereol. 1997 Sep;77(5):335-7.
Abstract/Text
The effect of a moisturizer was tested on experimentally irritated human skin in two studies. In a prevention study, 12 volunteers had both hands immersed into a 0.375% sodium lauryl sulphate solution, 10 min twice daily for 2 days. Before each immersion one hand was treated with the moisturizer; the other hand served as control. In a therapeutic study, 12 volunteers had both hands immersed in the same way as mentioned above. After the last immersion one hand was treated for 5 days with the moisturizer; the other hand served as control. Skin barrier function was evaluated by transepidermal water loss (Evaporimeter), and blood flow was evaluated by laser Doppler flowmetry and skin hydration by electrical capacitance (Corneometer). A significant preventive effect was obtained on the treated hand, compared to the control hand, judged by all measured parameters. A significant therapeutic effect was observed on skin barrier function and on skin hydration on the treated hand, compared to the control hand, while no difference between the hands in blood flow was observed after the end of treatment. The moisturizer could prevent irritant skin reactions induced by a detergent, and it could also accelerate regeneration of the barrier function of irritated skin.
Mellstrom GA, Bowman A: Protective gloves. In Handbook of occupational dermatology, Berlin, Springer, 46-25, 2000.
Zhai H, Schmidt R, Levin C, et al: Prevention and therapeutic effects of a model emulsion on glove-induced irritation and dry skin in man, Occup Environ Med, 50: 134-8, 2002.
Mellstrom GA, Bowman A: Protective gloves. In: Handbook of Occupational Dermatology(Kanerva L, Elsner P, Wahlberg JE, Maibhch HI, eds). Berlin: Springer 416-2, 2000.
J P Hachem, K De Paepe, E Vanpée, M Bogaerts, L Kaufman, V Rogiers, D Roseeuw
Efficacy of topical corticosteroids in nickel-induced contact allergy.
Clin Exp Dermatol. 2002 Jan;27(1):47-50.
Abstract/Text
In this study we used the nickel contact allergy patch (CAP) test to investigate the effect of topical corticosteroids on allergic contact dermatitis (ACD). On day 1, three CAP tests were applied for 48 h on the forearms of 20 female volunteers with a known nickel ACD. CAP of the right forearm contained 5% nickel, and of the left forearm physiological saline. Clinical scoring, transepidermal water loss and skin hydration were measured on day 1 before CAP application, on day 4 (0, 2 and 6 h) after ACD and from days 5 to 8 (0 h). A topical corticosteroid and its vehicle were applied twice daily starting from day 4 on two ACD sites. Transepidermal water loss values were significantly decreased on the topical-corticosteroid-treated sites in the early phase of ACD (day 4, 6 h after the first application) while clinical efficacy showed significant improvement on days 7 and 8. The vehicle was found to improve skin hydration only on day 8. In conclusion the topical corticosteroid improved the skin barrier function in the early inflammatory phase of ACD (day 4, 6 h). The lack of improvement in transepidermal water loss in the later phase of ACD might be accounted for by the secondary effects of the corticosteroid on proliferation and differentiation of keratinocytes.
A Parneix-Spake, P Goustas, R Green
Eumovate (clobetasone butyrate) 0.05% cream with its moisturizing emollient base has better healing properties than hydrocortisone 1% cream: a study in nickel-induced contact dermatitis.
J Dermatolog Treat. 2001 Dec;12(4):191-7. doi: 10.1080/09546630152696107.
Abstract/Text
BACKGROUND: The emollient base of a topical corticosteroid, through its moisturizing properties, can be a useful treatment adjunct.
OBJECTIVE: To compare the healing properties of Eumovate trade mark (clobetasone butyrate) 0.05% cream with its emollient base, hydrocortisone 1% cream and with no treatment.
METHODS: A single-centre, double-blind, intra-individual, comparative study that involved 18 volunteers with nickel-induced contact dermatitis. Following a positive patch test to nickel, sub-therapeutic amounts (10 micro l = 3 mg cm(-2)) of each of the treatments were applied twice daily for seven days to each of the four test sites.
RESULTS: In terms of the primary endpoint, a physician's global assessment after 7 days of treatment, clobetasone butyrate (CB) 0.05% cream showed a significantly better response than hydrocortisone (HC) 1% cream (78% vs 39%, difference -0.4, 95% CI -0.7 to -0.1; p = 0.046) or no treatment (78% vs 28%, difference -0.5, 95% CI -0.9 to -0.1; p = 0.016). CB 0.05% cream also showed a better response than its emollient base (78% vs 56%), though statistical significance was not achieved. In terms of moisturizing effects, there was no difference in transepidermal water loss (TEWL) between CB 0.05% cream and its emollient base. CB 0.05% cream treated sites did, however, have significantly lower values (i.e. were more moisturized) than untreated sites (difference -8.5, 95% CI -12.0 to -4.86; p < 0.001) or HC 1% treated sites (difference -7.1, 95% CI -11.0 to -3.4; p < 0.001). In terms of skin blanching activity, as expected the steroid-based creams achieved lower colorimetric values than the emollient base cream.
CONCLUSIONS: These results from experimentally induced skin inflammation indicate that CB 0.05% (as Eumovate 0.05% cream) has both more effective anti-inflammatory activity and better moisturizing properties than hydrocortisone 1% cream and that these effects are in part due to its efficient emollient base.
N K Veien, P Olholm Larsen, K Thestrup-Pedersen, G Schou
Long-term, intermittent treatment of chronic hand eczema with mometasone furoate.
Br J Dermatol. 1999 May;140(5):882-6.
Abstract/Text
Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long-term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, chi2-test). Side-effects were minimal. It is concluded that long-term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.
J S English, C B Bunker, K Ruthven, P M Dowd, M W Greaves
A double-blind comparison of the efficacy of betamethasone dipropionate cream twice daily versus once daily in the treatment of steroid responsive dermatoses.
Clin Exp Dermatol. 1989 Jan;14(1):32-4.
Abstract/Text
A total of 97 out-patients with steroid responsive dermatoses (63 eczema, 34 psoriasis) were recruited from two centres. They were randomly allocated in a double-blind manner to receive either betamethasone dipropionate cream twice daily or betamethasone dipropionate cream in the morning and base cream in the evening. The treatment period was 3 weeks. Eighty-five patients completed the study. There were no statistical differences between once daily application and twice daily for all of the parameters studied in both the eczema and psoriasis patients. Analysis of the diary card records, however, showed that symptomatic relief occurred more quickly in eczema patients receiving twice daily application of betamethasone dipropionate cream (P = 0.03). The use of betamethasone dipropionate cream once daily in conjunction with an emollient provides a regime which is as effective as a twice daily application of betamethasone dipropionate.
H Granlund, P Erkko, E Eriksson, S Reitamo
Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema.
Acta Derm Venereol. 1996 Sep;76(5):371-6.
Abstract/Text
Topical corticosteroids are the standard treatment for hand eczema. However, in chronic forms of the disease they are often ineffective or lose their efficacy due to tachyphylaxis. In a previous open study cyclosporine showed efficacy in chronic hand eczema. The aim of this study was to compare oral cyclosporine at 3 mg/kg/day with topical 0.05% beta-methasone-17,21-dipropionate (BDP) cream in the treatment of chronic hand eczema. In a randomized, double-blind study 41 patients with chronic hand eczema resistant to conventional treatment were assigned to either cyclosporine or BDP for 6 weeks. Both cyclosporine and BDP improved the eczema. The total disease activity score decreased to 57% of baseline in the cyclosporine group (mean change -6, SD 4.3; p < 0.001) and to 58% of baseline in the BDP group (mean change -5.7, SD 4; p < 0.001) at the end of treatment. However, between the groups there was no significant difference. Adverse events occurred in 68% of the patients during cyclosporine and in 56% during BDP treatment. With cyclosporine no case of hypertension or increase in serum creatinine above normal levels was recorded. In two patients the serum creatinine levels increased to values 30% above their own baseline values. Relapses occurred to the same extent in both groups. Cyclosporine at 3 mg/kg/day is as effective as topical BDP in the treatment of chronic hand eczema. Low-dose cyclosporine could be useful as an alternative treatment for severe chronic hand eczema in patients unresponsive to conventional treatment.
G Faghihi, F Iraji, A Shahingohar, Ah Saidat
The efficacy of '0.05% Clobetasol + 2.5% zinc sulphate' cream vs. '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema: a double-blind study.
J Eur Acad Dermatol Venereol. 2008 May;22(5):531-6. doi: 10.1111/j.1468-3083.2007.02533.x. Epub 2008 Feb 12.
Abstract/Text
BACKGROUND: Many therapeutic modalities have been suggested for treatment of the chronic hand eczema. Despite good immediate efficacy of some of these treatments, there is high recurrence of the dermatitis following cessation of the treatment.
AIM: Regarding the beneficial effects of the zinc sulfate on the skin, we designed a double blind study to evaluate the efficacy of the '0.05% Clobetasol + 2.5% zinc sulphate' cream versus '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema.
SUBJECTS AND METHODS: This study was a double-blind, right to left, prospective, clinical trial. In total, 47 patients with chronic hand eczema admitted to dermatology center of Isfahan University of Medical Sciences were selected and their right hand or left hand were selected at random to be treated with either the '0.05% Clobetasol + 2.5% zinc sulphate' cream or '0.05% Clobetasol alone' cream twice daily for 2 weeks. All of the patients were treated for 2 weeks and were followed up at weeks 2, 4, 6 and 8 after starting the treatment. For determining the severity of chronic hand eczema, we assessed and scored 4 different characteristics of the lesions including redness; scaling; lichenification and pruritus. The data were analyzed using SPSS program (release 13) and statistical tests including Mann-Whitney test.
RESULTS: Overall, 47 patients (94 samples) were evaluated. All of these patients had similar and symmetrical lesions on their right and left hands. Out of them, 35 patients were females and 12 patients were male. In all of the evaluated characterisitics, the '0.05% Clobetasol + 2.5% zinc sulphate' cream was more effective than '0.05% Clobetasol alone' cream (P < 0.05). The recurrence rate of eczema was significantly lower in the group treated with this combination treatment (P < 0.05).
CONCLUSION: With regard to the encouraging results of the combination treatment with Clobetasol + zinc sulphate, we suggest that in a more extensive clinical trial, the efficacy of this treatment against chronic hand dermatitis be evaluated. In addition, evaluation of this combination therapy against other inflammatory dermatosis seems to be logical.
Ingegärd Anveden, Magnus Lindberg, Klaus E Andersen, Magnus Bruze, Marléne Isaksson, Carola Liden, Mette Sommerlund, Jan E Wahlberg, John D Wilkinson, Carolyn M Willis
Oral prednisone suppresses allergic but not irritant patch test reactions in individuals hypersensitive to nickel.
Contact Dermatitis. 2004 May;50(5):298-303. doi: 10.1111/j.0105-1873.2004.00340.x.
Abstract/Text
A multicentre, randomized, double-blind, crossover study was designed to investigate the effects of prednisone on allergic and irritant patch test reactions. 24 subjects with known allergy to nickel were recruited and patch tested with a nickel sulfate dilution series in aqueous solution, 5% nickel sulfate in petrolatum and 2 dilution series of the irritants nonanoic acid and sodium lauryl sulfate. The subjects were tested x2, both during treatment with prednisone 20 mg oral daily and during placebo treatment. The total number of positive nickel patch test reactions decreased significantly in patients during prednisone treatment. The threshold concentration to elicit a patch test reaction increased and the overall degree of reactivity to nickel sulfate shifted towards weaker reactions. The effect of prednisone treatment on the response to irritants was divergent with both increased and decreased numbers of reactions, although there were no statistically significant differences compared with placebo. It is concluded that oral treatment with prednisone suppresses patch test reactivity to nickel, but not to the irritants tested.
H Granlund, P Erkko, S Reitamo
Comparison of the influence of cyclosporine and topical betamethasone-17,21-dipropionate treatment on quality of life in chronic hand eczema.
Acta Derm Venereol. 1997 Jan;77(1):54-8.
Abstract/Text
In a randomized, controlled parallel group study we have shown that cyclosporine at 3 mg/kg/day is as effective as topical betamethasone-17,21-dipropionate in the treatment of chronic hand eczema. In this study we compared the influence of these therapies on the quality of life. Forty-one patients were treated with either treatment for 6 weeks, after which patients with failure were switched to the other treatment for another 6 weeks. Quality of life was assessed with the Eczema Disability Index (EDI) at baseline and at the end of both treatment periods. The total EDI score decreased significantly and to the same degree in both groups, i.e. from the mean value of 30.5 to 20.9 in the cyclosporine group and from 27.2 to 18.9 in the betamethasone-17,21-dipropionate group. Irrespective of the dimension of the EDI (daily activity, school/work, personal relationship, leisure, treatment), the difference between the treatment groups at the end of the first treatment period was not significant. In the second part of the study a slight further decrease in total score was observed, but without any difference between the groups. There was a significant correlation between changes in the total EDI score and changes in all the clinical assessments, i.e. disease activity, extent of the disease, itch, sleep disturbances and use of emollients. Though the significant correlation between the total EDI and clinical assessments makes quality of life assessments in hand eczema questionable, the missing correlation between some clinical assessments and dimensions of the EDI suggests that EDI views aspects of the disease not covered by clinical measures.
Shin Goo Park, Eui Cheol Lee, Won Kyu Hong, Hee Jin Song, Jeong Hyun Shin
A case of occupational allergic contact dermatitis due to PVC hose.
J Occup Health. 2008;50(2):197-200.
Abstract/Text
C A Egan, T M Rallis, K P Meadows, G G Krueger
Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx.
J Am Acad Dermatol. 1999 Apr;40(4):612-4.
Abstract/Text
We describe 5 patients with severe pompholyx who did not respond to conventional therapy or who had debilitating side effects from corticosteroids. Low-dose methotrexate was added to their treatment regimens and led to significant improvement or clearing with a favorable side-effect profile. In all 5 patients the need for oral corticosteroid therapy was substantially decreased or eliminated, thus decreasing potential corticosteroid-induced morbidity. In this uncontrolled series of patients with recalcitrant palmoplantar pompholyx, methotrexate was an effective treatment and acted as a steroid-sparing agent.
J V Christiansen, P Holm, F Reymann, K Thestrup-Pedersen
Patients' acceptance of etretinate therapy. A retrospective survey of long-term etretinate therapy in chronic keratotic and pustular skin diseases.
Dermatologica. 1984;168(3):122-6.
Abstract/Text
From January 1976 to April 1982 etretinate was used to treat patients with morbus Darier (25 patients), pustulosis palmo-plantaris (72 patients), psoriasis (79 patients), and hyperkeratotic eczema of hands and feet (eczema keratoticum; 41 patients). Dosage of etretinate ranged between 0.5 and 1.0 mg/kg/day. In a retrospective survey at April 1, 1982, we observed a beneficial effect of the drug in all patients with morbus Darier, in 85% of patients with pustulosis palmo-plantaris, in 69% with psoriasis, and in 93% with eczema keratoticum. Many patients experienced side effects. Within 9 months more than half of the patients had stopped treatment primarily due to side effects, except patients with morbus Darier, whose median duration of treatment was 34 months with a range from 7 to 60 months. We will recommend that etretinate is used during short-term or intermittent courses of therapy, except in patients with morbus Darier, where a low dosage of etretinate is able to give a beneficial clinical effect.
Erin Warshaw, Gina Lee, Francis J Storrs
Hand dermatitis: a review of clinical features, therapeutic options, and long-term outcomes.
Am J Contact Dermat. 2003 Sep;14(3):119-37.
Abstract/Text
Hand dermatitis is a common skin condition that may be chronic, debilitating, and costly for patients, insurers, and employers. The epidemiology, clinical features, occupational issues, and long-term outcomes of hand dermatitis are summarized in this review. Therapeutic options are also discussed in detail, focusing on treatment of recalcitrant hand dermatitis.
K Rosén, H Mobacken, G Swanbeck
Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment.
Acta Derm Venereol. 1987;67(1):48-54.
Abstract/Text
The efficacy of PUVA and UVB treatment in chronic eczematous dermatitis of the hands was compared in a randomised controlled study including 35 patients who were randomly allocated to PUVA or UVB treatment. One hand was exposed to light and the other served as an untreated control. The dermatitis cleared on the treated hand in all PUVA patients, but in 9 out of 14 there was a relapse within three months. In the UVB group clearing of the skin lesions was not achieved, but compared with the "untreated" hands a statistically significant improvement was found at 12 weeks of treatment. A statistically significant improvement of "untreated" hands was found in both groups. PUVA and UVB treatments are alternative treatment modalities in patients with recalcitrant chronic eczematous dermatitis of the hands. PUVA is superior to UVB.
C E Grattan, A J Carmichael, G J Shuttleworth, I S Foulds
Comparison of topical PUVA with UVA for chronic vesicular hand eczema.
Acta Derm Venereol. 1991;71(2):118-22.
Abstract/Text
Topical PUVA was compared with UVA for the treatment of chronic vesicular hand eczema in a double-blind randomized within-patient trial. Twelve of 15 patients completed 8 weeks' treatment and were followed up for 8 weeks. Both sides improved over the 8-week treatment period (p less than 0.05) and both remained substantially better objectively and subjectively at 8 weeks' follow-up. There was no statistical difference between assessments of the treated hands at any stage. Nine of the patients who completed the study answered a questionnaire up to 18 months later. In 4, eczema was healed, 3 were better on the PUVA-treated hand and 1 on the UVA-treated hand. It is possible that UVA alone is beneficial for chronic hand eczema.
P Sjövall, O B Christensen
Treatment of chronic hand eczema with UV-B Handylux in the clinic and at home.
Contact Dermatitis. 1994 Jul;31(1):5-8.
Abstract/Text
The efficacy of UV-B irradiation, administered by a new unit, Handylux, in patients with chronic hand eczema was investigated. 15 patients were treated in the clinic and 11 patients at home. Treatments were performed 4-5 x weekly for approximately 10 weeks. According to the strict criteria used for clearing, none of the patients cleared during the study, but 18 of the 26 patients were defined as much improved by the investigator, while 17 of the patients considered themselves as > 80% improved. The compliance in both groups was very good and side-effects limited and dose-related. According to our experience, the effect of high dose UV-B in chronic hand eczema is almost comparable to PUVA, and offers an opportunity for patients to treat themselves at home.
C M Schempp, H Müller, W Czech, E Schöpf, J C Simon
Treatment of chronic palmoplantar eczema with local bath-PUVA therapy.
J Am Acad Dermatol. 1997 May;36(5 Pt 1):733-7.
Abstract/Text
BACKGROUND: Systemic PUVA therapy may be useful in the treatment of chronic palmoplantar eczema. Topical PUVA-paint avoids some of the unwanted side effects of systemic psoralens and has been used successfully in the treatment of palmoplantar eczema and psoriasis. However, few data are available on the effectiveness of local bath-PUVA therapy in palmoplantar eczema.
OBJECTIVE: Our purpose was to assess the effectiveness of local bath-PUVA therapy in 28 patients with chronic palmar or plantar eczema or both who were resistant to conventional topical treatment.
METHODS: After fungal or bacterial infection had been excluded in all patients, hands or feet or both were soaked for 15 minutes in warm water containing 1 mg/L 8-methoxypsoralen. Immediately after, the skin was irradiated with increasing doses of UVA, starting with 0.5 J/cm2. PUVA-bath therapy was performed 4 times a week up to a total of 25 treatments. No additional therapy was allowed except emollients.
RESULTS: Excellent or good effects were achieved in 93% of the patients with dyshidrotic and in 86% of the patients with hyperkeratotic eczema. In the patients with dyshidrotic eczema, the cumulative doses and the highest single doses of UVA were lower than those in the patients with hyperkeratotic eczema (21.4 vs 27.9 J/cm2 and 2.4 vs 3.0 J/cm2 of UVA), but this was not statistically significant. No phototoxic reactions were observed.
CONCLUSION: Local bath-PUVA therapy is of value in the management of chronic palmoplantar eczema resistant to standard modes of topical treatment. Compared with topical PUVA-paint, local bath-PUVA therapy has several advantages, particularly the absence of phototoxic reactions, severe hyperpigmentation, and protracted photosensitivity.
M A De Rie, J P Van Eendenburg, A C Versnick, L M Stolk, J D Bos, W Westerhof
A new psoralen-containing gel for topical PUVA therapy: development, and treatment results in patients with palmoplantar and plaque-type psoriasis, and hyperkeratotic eczema.
Br J Dermatol. 1995 Jun;132(6):964-9.
Abstract/Text
Topical photochemotherapy with psoralen and its derivatives 4,5',8-trimethylpsoralen (TMP) and 8-methoxypsoralen (8-MOP), with UVA irradiation, was evaluated with regard to minimum phototoxic dose, concentration, timing of UVA irradiation and systemic and local side-effects, in healthy volunteers. Psoralen (0.005%) in aqueous gel was found to be superior to TMP and 8-MOP in aqueous gel. No hyperpigmentation was seen after topical PUVA treatment with psoralen in aqueous gel. Patients with plaque-type psoriasis (n = 7), palmoplantar psoriasis (n = 7) and hyperkeratotic eczema (n = 2) were treated. Topical PUVA therapy was effective in most psoriasis patients, without the occurrence of local or systemic side-effects. Moreover, hyperkeratotic eczema patients who did not respond to conventional therapy showed partial remission. These results indicate that topical PUVA therapy with psoralen in aqueous gel is a useful therapeutic modality for treatment of psoriasis patients, and patients with recalcitrant dermatoses such as palmoplantar psoriasis and hyperkeratotic eczema.
M Grundmann-Kollmann, S Behrens, R U Peter, M Kerscher
Treatment of severe recalcitrant dermatoses of the palms and soles with PUVA-bath versus PUVA-cream therapy.
Photodermatol Photoimmunol Photomed. 1999 Apr;15(2):87-9.
Abstract/Text
PUVA-bath therapy developed into a first line topical PUVA therapy, and gel and cream preparations have been described as alternative modes of topical 8-MOP application. Because bath-PUVA can be difficult to manage, topical PUVA therapy using 8-MOP gel or cream preparations may become an important alternative when treating localised skin diseases. However, controlled comparisons of efficacy with this alternative topical PUVA therapy are lacking. We therefore compared the efficacy of PUVA-cream therapy with PUVA-bath therapy in 12 patients with recalcitrant dermatoses of the palms and soles using a left/right trial design. These patients responded well to both treatment modalities, meaning that both could be used successfully to treat recalcitrant dermatoses of the palms and soles.
米国研究協議会: 環境中ニッケルの由来と分布, 米国研究協議会編:環境汚染物質の生体への影響 3: ニッケル, 東京化学同人, 東京, 1977, 4-53.
鈴木泰夫: 食品の微量元素含有表, 鈴木泰夫編：食品の微量元素含有表, 第一出版, 東京, 1993, 2-169.
P Haudrechy, B Mantout, A Frappaz, D Rousseau, G Chabeau, M Faure, A Claudy
Nickel release from stainless steels.
Contact Dermatitis. 1997 Sep;37(3):113-7.
Abstract/Text
In 1994, a study of nickel release and allergic contact dermatitis from nickel-plated metals and stainless steels was published in this journal. It was shown that low-sulfur stainless steel grades like AISI 304, 316L or 430 (S < or = 0.007%) release less than 0.03 microgram/cm2/week of nickel in acid artificial sweat and elicit no reactions in patients already sensitized to nickel. In contrast, nickel-plated samples release around 100 micrograms/cm2/week of Ni and high-sulfur stainless steel (AISI 303-S approximately 0.3%) releases about 1.5 micrograms/cm2/week in this acid artificial sweat. Applied on patients sensitized to nickel, these metals elicit positive reactions in 96% and 14%, respectively, of the patients. The main conclusion was that low-sulfur stainless steels like AISI 304, 316L or 430, even when containing Ni, should not elicit nickel contact dermatitis, while metals having a mean corrosion resistance like a high-sulfur stainless steel (AISI 303) or nickel-plated steel should be avoided. The determining characteristic was in fact the corrosion resistance in chloride media, which, for stainless steels, is connected, among other factors, to the sulfur content. Thus, a question remained concerning the grades with an intermediate sulfur content, around 0.03%, which were not studied. They are the object of the study presented in this paper. 3 tests were performed: leaching experiments, dimethylglyoxime and HNO3 spot tests, and clinical patch tests; however, only stainless steels were tested: a low-sulfur AISI 304 and AISI 303 as references and 3 grades with a sulfur content around 0.03%: AISI 304L, AISI 304L added with Ca, AISI 304L+Cu. Leaching experiments showed that the 4 non-resulfurised grades released less than 0.5 microgram/cm2/week in acid sweat while the reulfurized AISI 303 released around or more than 0.5 microgram/cm2/week. This is explained by the poorer corrosion resistance of the resulfurized grade. Yet all these grades had the same reaction to the DMG test (negative result), which shows again its lack of sensitivity. In contrast, the HNO3 spot test distinguished AISI 303 from the non-resulfurized grades. Clinical patch tests again showed that some patients (4%) were intolerant to AISI 303, while none were intolerant to the other grades. Thus, this study confirms that non-resulfurized stainless steels (S < or = 0.03%) like Ni-containing 304 and 304L should not elicit Ni contact dermatitis, while the resulfurized grades (S > 0.1%) should be avoided.
足立厚子, 堀川達弥: 全身型金属アレルギー 食餌制限の有効性について, 臨皮, 46: 883-889, 1992.
N K Veien, T Hattel, O Justesen, A Nørholm
Oral challenge with metal salts. (I). Vesicular patch-test-negative hand eczema.
Contact Dermatitis. 1983 Sep;9(5):402-6.
Abstract/Text
202 patients, 68 males and 134 females, with patch-test-negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals. 55 patients reacted to the mixture of salts as well as to 1 or 2 of the individual salts. 3 other patients were challenged openly with nickel alone. Male patients reacted primarily to chromate and cobalt, while female patients more commonly reacted to nickel and cobalt. 56 patients were instructed to follow diets planned to reduce the daily intake of the respective metals. The dermatitis of 36 patients cleared or improved markedly after 1 month of dieting. Responses to a questionnaire sent to these 36 patients indicated that 28 of them had followed the prescribed diet rigorously or intermittently for at least a year, because they experienced recurrence of the dermatitis if they stopped dieting. 6 noted no long-term benefit and 2 did not respond.
H Nakayama, N Nogi, N Kasahara, S Matsuo
Allergen control. An indispensable treatment for allergic contact dermatitis.
Dermatol Clin. 1990 Jan;8(1):197-204.
Abstract/Text
Patch testing is performed to find out the causative allergens for patients, and once they are found, to indicate the exclusive usage of daily necessities that do not contain the causative allergens is necessary, such as when the contact dermatitis is recurrent, persistent, or complicated by secondary hyperpigmentation. Such a procedure has been called "allergen control." Sufficient success has been obtained in the categories of soaps, shampoos, cosmetics, underwear, and some dental metals in Japan with cooperation of industries, and summaries of these investigations are reported.
A Adachi, T Horikawa, T Takashima, M Ichihashi
Mercury-induced nummular dermatitis.
J Am Acad Dermatol. 2000 Aug;43(2 Pt 2):383-5.
Abstract/Text
We report 2 cases of relapsing nummular dermatitis according to mercury sensitivity, which was confirmed by patch testing. Removal of the amalgam from dental metal alloys markedly improved their skin eruptions. One of the patients, a dentist, experienced exacerbation of the eruptions on his lower legs after handling dental amalgam. Hypersensitivity to haptens such as metals is possibly involved in, at least in some patients, the pathogenesis of nummular dermatitis.
北崎祐之、松村光明、馬場史郎: 各種金属アレルゲンにおける対応, 井上昌幸編: GPのための金属アレルギー臨床, デンタルダイアモンド社, 東京, 2003, 118-121.
P D Pigatto, E Gibelli, M Fumagalli, A Bigardi, M Morelli, G F Altomare
Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx.
Contact Dermatitis. 1990 Jan;22(1):27-31.
Abstract/Text
In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low-nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low-nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous "pores". This phenomenon was greatest after DSCG. We suggest that DSCG can help selected cases of pompholyx.
K Kaaber, T Menne, J C Tjell, N Veien
Antabuse treatment of nickel dermatitis. Chelation--a new principle in the treatment of nickel dermatitis.
Contact Dermatitis. 1979 Jul;5(4):221-8.
Abstract/Text
Eleven nickel-hypersensitive patients with chronic, dyshidrotic hand eczema aggravated by oral challenge with 0.6-2.5 mg nickel were treated with 100 mg tetraethylthiuramdisulfide (Antabuse) two to four times daily for 4-10 weeks. Nine of the patients experienced a flare of the dermatitis shortly after initiation of the treatment. During the course of treatment the dermatitis of seven patients cleared, improvement was seen in two patients, and in two the dermatitis remained unchanged. Flare was seen in six patients when the treatment was discontinued. Seven patients experienced side effects such as fatigue, headache and dizziness. The treatment of four patients was discontinued due to side effects. During the treatment high levels of nickel were found in the serum and urine.
