- Email: [email protected]
C066 How shall we organize prevention in the occupational setting?
s72
Courses
-European
Society
of Contact
consistent with bacterial super antigens being responsible. Of further importance is the observation that streptococcal super antigens can induce expression of the skin homing receptor, CLA, on lymphocytes, thereby providing a mechanism for this effect.
Dermatitis:
Prevention
of Contact
Dermatitis
European Society of Contact Dermatitis: Prevention of Contact Dermatitis I CO64 Can we prevent contact dermatitis? T.L. Diepgen. Dept. of Dermatology
I CO62 The spectrum of lupus erythematosus J.D. Bos. Department of Dermatology A0235, Academic Medical
Centel;
University
of Amsterdam,
The Netherlands
Lupus erythematosus (LE) is an autoimmune disease with a wide variety of clinical symptoms. The best model of LE skin lesion formation is that in which W induces nuclear antigens to move to the keratinocyte membrane, becoming available for antinuclear antibody binding, with subsequent immune complex formation, membrane attack complex assembly, and keratinocyte damage, perhaps accompanied by antibody-dependent cellular cytotoxicity. Alternatively, induction of fas and fas-ligand may lead to keratinocyte apoptosis with subsequent inflammation. The clinical spectrum of skin diseases varies from histopathologically non-specific to specific. Specific LE includes acute, subacute and chronic discoid forms, with congenital LE as a variant of subacute LE, and LE profundus as a variant of chronic discoid LE. Therapy follows a full diagnostic survey including serology. The prescription of sunscreens and topical class IV steroids forms the start. When unsuccessful, hydroxychloroquine is the first choice systemic agent. When insufficient, it may be combined with systemic prednisone. Other modalities such as dapsone, azathioprine and clofazimide are less well studied. A revival of thalidomide seems underway. 0CO63 Bullous autoimmune H. Hintner, J.W. Bauer. Department Hospital
Salzburg,
Salzburg,
diseases of Dermatology,
General
Austria
In recent years the primary structure of many constituents of desmosomes and the cutaneous basement membrane zone (BMZ) has been described. This advance in skin biology has been facilitated by the use of specific autoantibodies (AA), which occur in the sera of patients with bullous autoimmune diseases like pemphigus, pemphigoid and epidermolysis bullosa acquisita (EBA). The AA were isolated from patients sera using affinity-columns, immunoblotting, immunprecipitation and various molecular-biologic techniques. Desmoglein I and III (pemphigus foliaceus and vulgaris, respectively), bullous pemphigoid (BP) antigen (AG)I, BPAG2 (BP, Herpes gestationis, cicatrical pemphigoid [CP]), ladinin (linear IgA dermatosis), Laminin 5 (CP) and type VII collagen (EBA) have been identified as essential adhesion molecules in desmosomes and the cutaneous BMZ. The pathomechanisms in autoimmune bullous disorders include activation of enzyme-systems, which destroy adhesion molecules. In addition, antibody-mediated direct sterlc hinderance of adhesion structures is discussed. Further analysis of the pathophysiology of these autoimmune bullous disorders will enhance our knowledge regarding the function of the skin and provide us with new tools in treatment.
Friedrich-Alexander-University,
Erlangen,
Germany
Contact dermatitis is a frequent, chronic and possibly disabling disease resulting in considerable social and economic damage to the individual and the community. Therefore, the ideal role of a dermatologist involved in contact dermatology is not only to diagnose and treat patients, but also to determine the etiology of the occupational skin disease and to make recommendations for its prevention. In this lecture it will be demonstrated that understanding the epidemiology of contact dermatitis, that is, knowing the distribution and determinants of disease frequencies, can assist in accomplishing these tasks. Contact dermatitis is a preventable disease and only through the knowledge of its epidemiological characteristics can the goal of prevention be achieved. This presentation will apply the general concept of preventive medicine to dermatology, especially contact dermatitis. The tools of prevention will be presented and their application to contact dermatitis will be discussed in a general sense. I CO65 Can we prevent irritant contact dermatitis? D.A. Basketter. Unilever Environmental Safety Laboratory Sharnbrook,
Bedfordshire,
UK
Irritant contact dermatitis is a fairly common clinical problem, both in its own right and as a complicating or predisposing factor in several other dermatoses. Many chemicals and/or formulations thereof have significant irritant potential and can be an important cause of skin irritation. However, environmental factors also play an important part, as does the predisposition of the individual. Prevention is usually better than cure, but what are the ways to, and chances of, achieving this goal? Limitation of skin exposure to skin irritants is obviously a key factor. In order to manage the risks properly, a vital piece of information is the potency of the irritation hazard presented. Also, it is necessary to understand properly the likely skin exposure and to consider the skin status of the exposed population. Often, it is then possible to design suitable predictive studies which will help define accurately the needs for management of skin exposure and/or the necessity to amend a formulation. Finally, where inappropriate exposure to irritants does occur, then suitable skin protection measures will be necessary to minimise irritant contact dermatitis.
CO66 How shall we organize prevention in the occupational setting? J.E. Wahlberg. Department Dermatology, Karolinska
of Occupational National Institute for Working Hospital, Stockholm, Sweden
and Environmental Life, and
The responsibility for primary prevention rests mainly with manufacturers of chemicals and products, government agencies, consumer organisations, industrial physicians and nurses and
Courses
- European
Photodermatology
safety engineers. For secondary prevention, a greater responsibility is placed on physicians treating the cases (dermatologists, industrial physicians) and on nurses and safety engineers. In Sweden, these groups to be approved-must pass courses at our Institute. The time allotted to occupational dermatoses varies from 2 to 5 full days, where e.g. causes, clinical picture, diagnostics, treatment and prevention are covered. The physicians are specially trained on the role of atopy and preemployment examination; all groups on protective gloves and barrier creams. Our reports, based on work site visits, are usually published - without mentioning the name of the company - in order to disseminate the information to industries with similar conditions of exposure.
Group:
Photobiology
- Therapy
s-l3
with UV
“barrier” and moisturising creams should not only be adequate but must be accompanied with instructions for use. In daily practice, the prevention effort will be beneficial only if the given information is accurate, concrete and in a language the patient can understand.
European Photodermatology Group: Photobiology - Therapy with UV I CO69 Photobiology course - Therapy with UV
Reference
R. Roelandts. Univ. Leuven,
[ 11 G A MellstrGm, .I E Wahlberg, H I Maibach: Protective gloves for occupational use. CRC Press 1994.
Treating patients with a variety of different dermatoses with phototherapy or with photochemotherapy is part of daily practice and is an accepted treatment modality since about 20 years. The purpose of this session is to highlight new developments. One of these is photodynamic therapy (PDT), which is a variant of photochemotherapy using visible light instead of UVA in combination with other photosensitizers than psoralens. Other relatively new developments are the use of TLOl lamps for UVB phototherapy and UVA 1 phototherapy. Further important points to discuss are the improvement of existing treatment schedules in order to increase long-term safety and also efficacy. A newer approach to increase the efficacy is by using different combinations.
CO67 What can European institutions do to prevent contact dermatitis on the continent? Ian R. White. St. John’s Hospital,
London
Institute SE1 7EH, UK
of Dermatology,
St. Thomas’
DGXXlV of the European Commission has as its mandate the protection of the consumer. This applies both to safety and health. Very important Directives are now in place which provide the consumer with guarantees that substances they are exposed to are “safe”. However, there can be differing interpretations on potential “risk”. Preservatives, UV filters and some other substances are required to be evaluated exhaustively before use by the consumer. This does not apply to fragrance compounds. Fragrance compounds have escaped meaningful regulation in the current legislation. A strategy for correction of this important anomaly has been devised. This strategy has been based on an understanding of the methods of work of the advisory committees of the Commission together with the setting up of a multidisciplinary “think tank” to assess problems and suggest solutions.
CO68 How can I, the dermatologist, prevent contact dermatitis in my daily practice? D. Perrenoud. Departments Hospitals,
Geneva
of Dermatology, and Lausanne, Switzerland
University
Diagnosing and treating contact dermatitis is of limited benefit if not accompanied by proper advice. Information to the patient on the nature of contact dermatitis (acquisition, specificity and persistence of the sensitisation) and the manner in which to avoid recurrence is essential. Oral and written information about the involved allergen(s) and the possibility of cross-reactions along with their potential sources is mandatory. Due to the complexity (chemistry and nomenclature) of many allergens, prescription of defined safe products (without the allergenic ingredient) is often useful. Access to updated databases on the composition of industrial and home-products and to information-sheets allows satisfactory counselling by the dermatologist. The prescription of gloves,
Belgium
ElCO70 Photodynamic therapy R.-M. Szeimies, M. Landthaler. Dept. qf Dermatology, Regenshurg,
Univ.
of
Germany
A photodynamic reaction is the excitation of a photosensitizer, mainly porphyrin derivatives, by visible light emitted by lasers in the presence of oxygen resulting in the generation of reactive oxygen species (ROS), in particular cytotoxic singlet-oxygen. These ROS mediate cellular and vascular effects depending on the tissue localization of the photosensitizer. These destructive effects of photodynamic therapy (PDT) have been mainly used so far for the treatment of precancerous and cancerous conditions like actinic keratoses, basal cell carcinoma, or initial squamous cell carcinoma. However, clinical trials show that PDT is also effective in the treatment of vascular lesions, e.g. portwine stains, viral or bacterial infections, e.g. condylomata acuminata or acne, and T-cell mediated diseases, e.g. psoriasis or atopic dermatitis. Up to now it is not clear whether the therapeutic efficacy of PDT for these conditions is mediated by primary cytotoxicity - the reaction of light and sensitizer - or by secondary cytotoxicity - the induction of immunomodulatory effects. Future experiments will elucidate the exact mechanisms to define additional indications. Nevertheless the approval of a topical photosensitizer with a standardized protocol for PDT is the prerequisite to conduct prospective randomized clinical trials for the aforementioned indications.
Courses
-European
Society
of Contact
consistent with bacterial super antigens being responsible. Of further importance is the observation that streptococcal super antigens can induce expression of the skin homing receptor, CLA, on lymphocytes, thereby providing a mechanism for this effect.
Dermatitis:
Prevention
of Contact
Dermatitis
European Society of Contact Dermatitis: Prevention of Contact Dermatitis I CO64 Can we prevent contact dermatitis? T.L. Diepgen. Dept. of Dermatology
I CO62 The spectrum of lupus erythematosus J.D. Bos. Department of Dermatology A0235, Academic Medical
Centel;
University
of Amsterdam,
The Netherlands
Lupus erythematosus (LE) is an autoimmune disease with a wide variety of clinical symptoms. The best model of LE skin lesion formation is that in which W induces nuclear antigens to move to the keratinocyte membrane, becoming available for antinuclear antibody binding, with subsequent immune complex formation, membrane attack complex assembly, and keratinocyte damage, perhaps accompanied by antibody-dependent cellular cytotoxicity. Alternatively, induction of fas and fas-ligand may lead to keratinocyte apoptosis with subsequent inflammation. The clinical spectrum of skin diseases varies from histopathologically non-specific to specific. Specific LE includes acute, subacute and chronic discoid forms, with congenital LE as a variant of subacute LE, and LE profundus as a variant of chronic discoid LE. Therapy follows a full diagnostic survey including serology. The prescription of sunscreens and topical class IV steroids forms the start. When unsuccessful, hydroxychloroquine is the first choice systemic agent. When insufficient, it may be combined with systemic prednisone. Other modalities such as dapsone, azathioprine and clofazimide are less well studied. A revival of thalidomide seems underway. 0CO63 Bullous autoimmune H. Hintner, J.W. Bauer. Department Hospital
Salzburg,
Salzburg,
diseases of Dermatology,
General
Austria
In recent years the primary structure of many constituents of desmosomes and the cutaneous basement membrane zone (BMZ) has been described. This advance in skin biology has been facilitated by the use of specific autoantibodies (AA), which occur in the sera of patients with bullous autoimmune diseases like pemphigus, pemphigoid and epidermolysis bullosa acquisita (EBA). The AA were isolated from patients sera using affinity-columns, immunoblotting, immunprecipitation and various molecular-biologic techniques. Desmoglein I and III (pemphigus foliaceus and vulgaris, respectively), bullous pemphigoid (BP) antigen (AG)I, BPAG2 (BP, Herpes gestationis, cicatrical pemphigoid [CP]), ladinin (linear IgA dermatosis), Laminin 5 (CP) and type VII collagen (EBA) have been identified as essential adhesion molecules in desmosomes and the cutaneous BMZ. The pathomechanisms in autoimmune bullous disorders include activation of enzyme-systems, which destroy adhesion molecules. In addition, antibody-mediated direct sterlc hinderance of adhesion structures is discussed. Further analysis of the pathophysiology of these autoimmune bullous disorders will enhance our knowledge regarding the function of the skin and provide us with new tools in treatment.
Friedrich-Alexander-University,
Erlangen,
Germany
Contact dermatitis is a frequent, chronic and possibly disabling disease resulting in considerable social and economic damage to the individual and the community. Therefore, the ideal role of a dermatologist involved in contact dermatology is not only to diagnose and treat patients, but also to determine the etiology of the occupational skin disease and to make recommendations for its prevention. In this lecture it will be demonstrated that understanding the epidemiology of contact dermatitis, that is, knowing the distribution and determinants of disease frequencies, can assist in accomplishing these tasks. Contact dermatitis is a preventable disease and only through the knowledge of its epidemiological characteristics can the goal of prevention be achieved. This presentation will apply the general concept of preventive medicine to dermatology, especially contact dermatitis. The tools of prevention will be presented and their application to contact dermatitis will be discussed in a general sense. I CO65 Can we prevent irritant contact dermatitis? D.A. Basketter. Unilever Environmental Safety Laboratory Sharnbrook,
Bedfordshire,
UK
Irritant contact dermatitis is a fairly common clinical problem, both in its own right and as a complicating or predisposing factor in several other dermatoses. Many chemicals and/or formulations thereof have significant irritant potential and can be an important cause of skin irritation. However, environmental factors also play an important part, as does the predisposition of the individual. Prevention is usually better than cure, but what are the ways to, and chances of, achieving this goal? Limitation of skin exposure to skin irritants is obviously a key factor. In order to manage the risks properly, a vital piece of information is the potency of the irritation hazard presented. Also, it is necessary to understand properly the likely skin exposure and to consider the skin status of the exposed population. Often, it is then possible to design suitable predictive studies which will help define accurately the needs for management of skin exposure and/or the necessity to amend a formulation. Finally, where inappropriate exposure to irritants does occur, then suitable skin protection measures will be necessary to minimise irritant contact dermatitis.
CO66 How shall we organize prevention in the occupational setting? J.E. Wahlberg. Department Dermatology, Karolinska
of Occupational National Institute for Working Hospital, Stockholm, Sweden
and Environmental Life, and
The responsibility for primary prevention rests mainly with manufacturers of chemicals and products, government agencies, consumer organisations, industrial physicians and nurses and
Courses
- European
Photodermatology
safety engineers. For secondary prevention, a greater responsibility is placed on physicians treating the cases (dermatologists, industrial physicians) and on nurses and safety engineers. In Sweden, these groups to be approved-must pass courses at our Institute. The time allotted to occupational dermatoses varies from 2 to 5 full days, where e.g. causes, clinical picture, diagnostics, treatment and prevention are covered. The physicians are specially trained on the role of atopy and preemployment examination; all groups on protective gloves and barrier creams. Our reports, based on work site visits, are usually published - without mentioning the name of the company - in order to disseminate the information to industries with similar conditions of exposure.
Group:
Photobiology
- Therapy
s-l3
with UV
“barrier” and moisturising creams should not only be adequate but must be accompanied with instructions for use. In daily practice, the prevention effort will be beneficial only if the given information is accurate, concrete and in a language the patient can understand.
European Photodermatology Group: Photobiology - Therapy with UV I CO69 Photobiology course - Therapy with UV
Reference
R. Roelandts. Univ. Leuven,
[ 11 G A MellstrGm, .I E Wahlberg, H I Maibach: Protective gloves for occupational use. CRC Press 1994.
Treating patients with a variety of different dermatoses with phototherapy or with photochemotherapy is part of daily practice and is an accepted treatment modality since about 20 years. The purpose of this session is to highlight new developments. One of these is photodynamic therapy (PDT), which is a variant of photochemotherapy using visible light instead of UVA in combination with other photosensitizers than psoralens. Other relatively new developments are the use of TLOl lamps for UVB phototherapy and UVA 1 phototherapy. Further important points to discuss are the improvement of existing treatment schedules in order to increase long-term safety and also efficacy. A newer approach to increase the efficacy is by using different combinations.
CO67 What can European institutions do to prevent contact dermatitis on the continent? Ian R. White. St. John’s Hospital,
London
Institute SE1 7EH, UK
of Dermatology,
St. Thomas’
DGXXlV of the European Commission has as its mandate the protection of the consumer. This applies both to safety and health. Very important Directives are now in place which provide the consumer with guarantees that substances they are exposed to are “safe”. However, there can be differing interpretations on potential “risk”. Preservatives, UV filters and some other substances are required to be evaluated exhaustively before use by the consumer. This does not apply to fragrance compounds. Fragrance compounds have escaped meaningful regulation in the current legislation. A strategy for correction of this important anomaly has been devised. This strategy has been based on an understanding of the methods of work of the advisory committees of the Commission together with the setting up of a multidisciplinary “think tank” to assess problems and suggest solutions.
CO68 How can I, the dermatologist, prevent contact dermatitis in my daily practice? D. Perrenoud. Departments Hospitals,
Geneva
of Dermatology, and Lausanne, Switzerland
University
Diagnosing and treating contact dermatitis is of limited benefit if not accompanied by proper advice. Information to the patient on the nature of contact dermatitis (acquisition, specificity and persistence of the sensitisation) and the manner in which to avoid recurrence is essential. Oral and written information about the involved allergen(s) and the possibility of cross-reactions along with their potential sources is mandatory. Due to the complexity (chemistry and nomenclature) of many allergens, prescription of defined safe products (without the allergenic ingredient) is often useful. Access to updated databases on the composition of industrial and home-products and to information-sheets allows satisfactory counselling by the dermatologist. The prescription of gloves,
Belgium
ElCO70 Photodynamic therapy R.-M. Szeimies, M. Landthaler. Dept. qf Dermatology, Regenshurg,
Univ.
of
Germany
A photodynamic reaction is the excitation of a photosensitizer, mainly porphyrin derivatives, by visible light emitted by lasers in the presence of oxygen resulting in the generation of reactive oxygen species (ROS), in particular cytotoxic singlet-oxygen. These ROS mediate cellular and vascular effects depending on the tissue localization of the photosensitizer. These destructive effects of photodynamic therapy (PDT) have been mainly used so far for the treatment of precancerous and cancerous conditions like actinic keratoses, basal cell carcinoma, or initial squamous cell carcinoma. However, clinical trials show that PDT is also effective in the treatment of vascular lesions, e.g. portwine stains, viral or bacterial infections, e.g. condylomata acuminata or acne, and T-cell mediated diseases, e.g. psoriasis or atopic dermatitis. Up to now it is not clear whether the therapeutic efficacy of PDT for these conditions is mediated by primary cytotoxicity - the reaction of light and sensitizer - or by secondary cytotoxicity - the induction of immunomodulatory effects. Future experiments will elucidate the exact mechanisms to define additional indications. Nevertheless the approval of a topical photosensitizer with a standardized protocol for PDT is the prerequisite to conduct prospective randomized clinical trials for the aforementioned indications.