selected highlights of the second congress of the european society of contact dermatitis

2
MEETING REPORT Selected Highlights of the Second Congress of the European Society of Contact Dermatitis Robert L. Rietschel CONGRESS of the European iety of Contact Dermatitis was held in Barcelona, Spain, on October 6 to 8, 1994. NICKEL Metals continue to provide insights and con- troversy for clinicians and researchers of contact dermatitis. K.E. Andersen used nickel sensitivity to study whether the menstrual cycle affected patch test reactivity. Over a range of .01 to 300 p,g/cm 2, no relationship to menses was found. The Euro- pean community has developed a standard for consumer nickel items that will require (1) a content of no more than .05%, (2) a release of no more than 0.5 txg/cm2/wk, (3) no nickel in earring posts used during epithelization, and (4) 2 years of normal use for nickel coatings. C. Lid6n found that one drop of synthetic sweat heated to 50°C followed by the dimethylglyoxime test will detect the few cases of nickel exposure in which the dimethylglyox- ime test is falsely negative. (L. Kanerva reported two cases in which the dimethylglyoxime test was falsely negative). B. Pilz showed that atomic absorp- tion spectrometry of fingernail clippings could be correlated with occupational exposure to nickel and that hairdressers were not at greater risk to nickel exposure because of their jobs. OTHER METALS Gold sodium thiosulfate may cause delayed reactions with 35% found after day 7 but before day 21; also, 35% of gold patch test reactions persisted for longer than 2 months with a transformation From the Department of Dermatology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans,LA. Address reprint requests to Robert L. Rietschel, MD, Ochsner Clinic, 1516JeffersonHighway, New Orleans,LA 70121. Copyright © 1995 by W.B. Saunders Company 1046-199X/95/0602-0013503.00/0 from an eczematous to a papulonodular reaction according to H. Hedman. Hedman also noted 1 of 10 patients who had dental gold removed observed disappearance of a persistent facial dermatitis and subsequent recurrence when more gold was placed intraorally. O. Dolen found 4.6% of patients patch tested were positive to gold sodium thiosulfate; all were female, all wore gold jewelry, but the rel- evance was not clear, although most had eczema of the head and neck. P. Koch performed biopsies on positive patch tests at days 10 to 17 in patients who were positive to gold, mercury, or both and had oral lichen planus-like disease. Seven of eight biopsy specimens were histologically lichenoid. Removal of the metal caused clearing of clinical disease in 6 of 10, improvement in 2 of 10, and no change in 2 of 10. B. Kutting described 35 palladium-positive pa- tients. All but 5 were also nickel positive, and only 2 palladium cases were deemed clinically relevant. The significance of cutaneous reactions to metals, such as gold and palladium, remained an area in which no agreement has been reached as to the proper terminology or meaning to be assigned to these observations. K. Thestrup-Pedersen noted that simple metals, such as cadmium, can induce lymphokines associated with irritant and allergic contact dermatitis in the absence of antigen- presenting cells, which would suggest that they may act as mitogens. AIRBORNE COLOPHONY Standard patch test allergens can be found to be responsible for unusual forms of dermatitis. A.-T. Karlberg found that eyelid and facial dermati- tis could be traced to floor polish that left a dust of colophony for redistribution as an airborne contac- tant. When the floor polish was changed to a noncolophony-containing product, the eyelid and facial dermatitis of 2 patients, previously thought to 128 American Journal of Contact Dermatiti$, Vol 6, No 2 (June), 1995: pp 128-129

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Page 1: Selected highlights of the Second Congress of the European Society of Contact Dermatitis

MEETING REPORT

Selec ted Highl ights of the Second Congress of the European Society of Contact Dermati t i s

Robert L. Rietschel

CONGRESS of the European iety of Contact Dermatitis was held in

Barcelona, Spain, on October 6 to 8, 1994.

NICKEL

Metals continue to provide insights and con- troversy for clinicians and researchers of contact dermatitis. K.E. Andersen used nickel sensitivity to study whether the menstrual cycle affected patch test reactivity. Over a range of .01 to 300 p,g/cm 2, no relationship to menses was found. The Euro- pean community has developed a standard for consumer nickel items that will require (1) a content of no more than .05%, (2) a release of no more than 0.5 txg/cm2/wk, (3) no nickel in earring posts used during epithelization, and (4) 2 years of normal use for nickel coatings. C. Lid6n found that one drop of synthetic sweat heated to 50°C followed by the dimethylglyoxime test will detect the few cases of nickel exposure in which the dimethylglyox- ime test is falsely negative. (L. Kanerva reported two cases in which the dimethylglyoxime test was falsely negative). B. Pilz showed that atomic absorp- tion spectrometry of fingernail clippings could be correlated with occupational exposure to nickel and that hairdressers were not at greater risk to nickel exposure because of their jobs.

OTHER METALS

Gold sodium thiosulfate may cause delayed reactions with 35% found after day 7 but before day 21; also, 35% of gold patch test reactions persisted for longer than 2 months with a transformation

From the Department of Dermatology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA.

Address reprint requests to Robert L. Rietschel, MD, Ochsner Clinic, 1516Jefferson Highway, New Orleans, LA 70121.

Copyright © 1995 by W.B. Saunders Company 1046-199X/95/0602-0013503.00/0

from an eczematous to a papulonodular reaction according to H. Hedman. Hedman also noted 1 of 10 patients who had dental gold removed observed disappearance of a persistent facial dermatitis and subsequent recurrence when more gold was placed intraorally. O. Dolen found 4.6% of patients patch tested were positive to gold sodium thiosulfate; all were female, all wore gold jewelry, but the rel- evance was not clear, although most had eczema of the head and neck. P. Koch performed biopsies on positive patch tests at days 10 to 17 in patients who were positive to gold, mercury, or both and had oral lichen planus-like disease. Seven of eight biopsy specimens were histologically lichenoid. Removal of the metal caused clearing of clinical disease in 6 of 10, improvement in 2 of 10, and no change in 2 of 10. B. Kutting described 35 palladium-positive pa- tients. All but 5 were also nickel positive, and only 2 palladium cases were deemed clinically relevant. The significance of cutaneous reactions to metals, such as gold and palladium, remained an area in which no agreement has been reached as to the proper terminology or meaning to be assigned to these observations. K. Thestrup-Pedersen noted that simple metals, such as cadmium, can induce lymphokines associated with irritant and allergic contact dermatitis in the absence of antigen- presenting cells, which would suggest that they may act as mitogens.

AIRBORNE COLOPHONY

Standard patch test allergens can be found to be responsible for unusual forms of dermatitis. A.-T. Karlberg found that eyelid and facial dermati- tis could be traced to floor polish that left a dust of colophony for redistribution as an airborne contac- tant. When the floor polish was changed to a noncolophony-containing product, the eyelid and facial dermatitis of 2 patients, previously thought to

128 American Journal of Contact Dermatiti$, Vol 6, No 2 (June), 1995: pp 128-129

Page 2: Selected highlights of the Second Congress of the European Society of Contact Dermatitis

MEETING REPORT 129

have sick building syndrome and video display terminal dermatitis, permanently resolved.

CORTICOSTEROIDS

Corticosteroid allergy continues to be com- mon in the experience of M. Beck (4.5% of patients patch tested). He found 91% of patients (116 of 127) to be identified as corticosteroid-sensitive with a 1% (ethanol) patch test to tixocortol pivalate and budesonide.

A. Dooms-Goosens noted more reactions to ethanol (absolute), isopropanol, and aldehydes, such as glutaraldehyde, among corticosteroid-sensitive patients. Fourteen of 2,245 patch test patients were reactive to ethanol (9 to both ethanol and budes- onide in petrolatum). Alcohol and aldehyde reactiv- ity could be an irritant reaction related to an enzyme deficiency, and whether it will also be related to corticosteroid metabolism is as yet uncer- tain.

LANOLIN

I. Steel reviewed lanolin allergy and noted that Amerchol L101, which is 90% mineral oil and 10% lanolin alcohol, produces more patch test reactions than 30% wool wax alcohol, but the significance of these reactions is in dispute.

CALCIPOTRIOL

Now that calcipotriol is available in the United States, it is helpful to know that J. Setup has observed that at the normal use concentration of 50 tzg/g in the commercial vehicle, a + 1 reaction can be found by patch testing normal (immunologically naive) subjects and that doubtful (+-) reactions may occur in up to 40% of normal subjects. Patients who experience dermatitis when treating their psoriasis with calcipotriol may have negative patch tests. The proper nonirritant patch test concentration is not presently known.

LATEX

Latex allergy continues to be of interest, and J. Taylor identified 43 cases of latex allergy. He found 37 by the prick test, 2 by the wear test, and 4 by the radioallergosorbent test. He found that reaction to 1 finger from a latex glove moistened

and worn for 15 to 30 minutes could be compared with reaction to 1 finger from a vinyl glove identi- cally treated and worn on a different finger. If negative results occur with the latex finger, then the whole glove can be similarly worn as a test with vinyl glove control, and then a prick test can be performed to complete the evaluation. Vinyl al- lergy was observed in 4 patients. Health care workers and patients with spina bifida were particu- larly at risk for latex allergy.

EUXYL K400

C.J.W. Van Ginkel found the cause of peri- anal itch and eczema to be due to the preservative Euxyl K400 present in moistened toilet tissues in 12 of 16 patients.

PLANTS

B. Bj6rkner studied workers in tulip nurseries and found that the plant parts were a suitable patch test material superior to plant extracts and at least the equal of specific allergen testing with Tulipolin A and/or B.P. DeHaan found polyvinyl chloride and latex gloves to provide inadequate protection for Tulipolin A sensitive alstromeria or workers in tulip nurseries. Household weight but not surgical weight neoprene or nitrile gloves and the 4-H glove provided protection for about 4 hours. A. Rothe identified 10 cases of allergy to chicory, all of which were positive to the root to a greater extent than the leaf. Most of these patients were involved in plant cultivation, and 2 flared with oral ingestion of raw chicory but not cooked chicory.

FLUTAMIDE

F. Brandfio noted the occurrence offlutamide photosensitivity in 2 patients being treated for prostate cancer with 750 mg daily. One was sensi- tive to UVA light at I J; the other had a positive photopatch test to flutamide with 5J of UVA light and a 1% and 10% concentration in petrolatum.

Many other interesting reports were pre- sented at this meeting. These reports were selected to be mentioned because of their potential interest to a broad section of North American dermatolo- gists.