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Contact allergy to textile resins: an update
ABSTRACTS
59
4 ALLERGIC CONTACT DERMATITIS (ACD) IN PATIENTS WITH PSORIASIS VULGARIS AdeleR.Clark.PA-C, Sharon M. Swartz, PA-C,Elizabctb F. Sherertz, MD Department of Dcmutology, E4mvmanGray School of Medicme Winston-Salem, NC
m: Contact dermatitis IS said to be rare in psoriasis patients, possibly due to aaclcmtcd cpidcmml hmmver, the isomorphx (Kocbncr) response, and lymphocyte functional alterations m: To Identify contact allergy in patients with psoriasis. Mc&&,: A written questionnaire was completed by 100 psoriasis patients aboutcontact bistq flare factors for psoriasis, top& skm cart, mcdicatmns and occupational/bobby cxpasurcs. Of these patbents,20 agreed to be patch t&cd with a standardsueming wies (Hamal) and a 20-1tcm psoriasis patch test tics, which includedingredients that might be found in topical psoriasis I&,&j:
Of the 100 questionnairepatients, 8 suspected a topical mcdicatmn aaveabistow ofatoDv.ll repted reactions to metal jewelry and 29 reported an allergy to pmson ivy. Patchtest results identified 4 of the 20 patients wth 6 positive patch tests to the materials tested: 316 positivcs were lntcrprctcd as relevant to the patient’s psoriasis (coal tar, ethylenediaminc and dithranol), others were to nickel (2) and thimcrosal(l). Five patients had irritant reactions to dlthranol. Conclusion: In this small shrdy, 20% of self selected psoriasis patients had positwe allergx reachons on patch tcstiig A screemng contact and atopx history in psaiwis p&n& may help to ~dmbfy a subset of patients who could benefit from a search for more relevant contact allergens with patch test causedareadionthatworscncdtheirDsoriasis.29
evaluation. This could unprove treatment strategies and possibly reduce
disability.
5
6
AN APPROACHTO TtIE PATIENT WITS COSHETIC INTOLKUNCB sYNDF.oNE Zoe Diana Draelos, MD, Clinical Assistant Professor, Department of Dermatology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
STANDARDIZED EVALUATION DING WITH A LASER DOPPLER
Cosmetic intolerance syndrome presents as a patient noting stinging, burning, tingling, tightness, pruritus, erythema and/or desquamation when leave-on akin care products or cosmetics are applied to the face. These patients generally have tried numerous products unsuccessfully in an effort to avoid symptoms. This subgroup of sensitive skin patients was evaluated to empirically determine a logical clinical approach to treatment. The proposed treawnt, designed to determine cause and effect, is initiated by discontinuing all cosmetics, skin care products, OTC treatment products, and topical prescription products for two weeks. Only a syndet soap and bland moisturizer may be used twice daily. All sources of skin friction should be eliminated. At two weeks, the patient should be evaluated for any underlying dermatoses and treated appropriately for at least two veeke beyond visible disease resolution. Traditional patch testing, photopatch testing. and contact urticaria test& should be inderiaken with s&ial attention to clinically ;elevsnt substances. Facial stina testing with 10% lactic acid should be perfomd to e&luate heightened sensory perception followed by psychological assessment. The patient's leave-on cosmetics, skin care products, and OTC treatment products should be provocative use tested individually. Upon completion of this methodolagy, all date both positive and negative should be analyzed and presented to the patient in the form of products or ingredients to avoid and th0.w appropriate for continued use.
OF PATCH PERFUSION
TEST REAIMAGER.
T. B. Bjamason. National In&tote for Working Life, Solna, Sweden. Department of Dermatology, Karolinska Hospital, Stockholm, Sweden The Laser Doppler Perfusion lmager (LDPI) is a data acquisition and analysis system that generates, processes and displays a two-dimentional colow-coded mapping of tissue perfusion. The LDPI can objectively quantirate spatial heterogeneity of skin perfusion in patch tea reactions without touching the skin. It uses an optical scanner to scan the &in with a low
power laser beam. In the prwence of moving blood cells, Dopplerbroadened backscattered light is detected by a photodetector in the scanner head. The light is transformed into an electrical value proportional to perfusion. We have used the LDPI- instrument (PIM 1.0) L&a Development AB, LinkQing, Sweden to objectively quantitate skin perfusion due to tw beradio reactions as well as irritant reactions due to Diesel oil. To obtain reproducible results, he instrument and the evaluation has to be carefully standardized. The influence of different reading and evaluation parameters will be explained, and we will demonstrate how the instrument can be used to follow serial dilutions of patch test reactions positwe to Kathon CG and nickel sulphate. Ofimprtmce
to ohin
reproducible results is:
- a central localization of the test within the reading area. -a constant distance between the test area and the scanner head. the angle close to 90” between the reading area and the beam. the resolution of the instrument - the size of the reaction. ambient light in the testing room. - patient movements and skin and room temperature.
Evaluation oftestrenction: We suggest the reactions to be evaluated from the center an area corres-
ponding exactly to the patch used for testing.
59
4 ALLERGIC CONTACT DERMATITIS (ACD) IN PATIENTS WITH PSORIASIS VULGARIS AdeleR.Clark.PA-C, Sharon M. Swartz, PA-C,Elizabctb F. Sherertz, MD Department of Dcmutology, E4mvmanGray School of Medicme Winston-Salem, NC
m: Contact dermatitis IS said to be rare in psoriasis patients, possibly due to aaclcmtcd cpidcmml hmmver, the isomorphx (Kocbncr) response, and lymphocyte functional alterations m: To Identify contact allergy in patients with psoriasis. Mc&&,: A written questionnaire was completed by 100 psoriasis patients aboutcontact bistq flare factors for psoriasis, top& skm cart, mcdicatmns and occupational/bobby cxpasurcs. Of these patbents,20 agreed to be patch t&cd with a standardsueming wies (Hamal) and a 20-1tcm psoriasis patch test tics, which includedingredients that might be found in topical psoriasis I&,&j:
Of the 100 questionnairepatients, 8 suspected a topical mcdicatmn aaveabistow ofatoDv.ll repted reactions to metal jewelry and 29 reported an allergy to pmson ivy. Patchtest results identified 4 of the 20 patients wth 6 positive patch tests to the materials tested: 316 positivcs were lntcrprctcd as relevant to the patient’s psoriasis (coal tar, ethylenediaminc and dithranol), others were to nickel (2) and thimcrosal(l). Five patients had irritant reactions to dlthranol. Conclusion: In this small shrdy, 20% of self selected psoriasis patients had positwe allergx reachons on patch tcstiig A screemng contact and atopx history in psaiwis p&n& may help to ~dmbfy a subset of patients who could benefit from a search for more relevant contact allergens with patch test causedareadionthatworscncdtheirDsoriasis.29
evaluation. This could unprove treatment strategies and possibly reduce
disability.
5
6
AN APPROACHTO TtIE PATIENT WITS COSHETIC INTOLKUNCB sYNDF.oNE Zoe Diana Draelos, MD, Clinical Assistant Professor, Department of Dermatology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
STANDARDIZED EVALUATION DING WITH A LASER DOPPLER
Cosmetic intolerance syndrome presents as a patient noting stinging, burning, tingling, tightness, pruritus, erythema and/or desquamation when leave-on akin care products or cosmetics are applied to the face. These patients generally have tried numerous products unsuccessfully in an effort to avoid symptoms. This subgroup of sensitive skin patients was evaluated to empirically determine a logical clinical approach to treatment. The proposed treawnt, designed to determine cause and effect, is initiated by discontinuing all cosmetics, skin care products, OTC treatment products, and topical prescription products for two weeks. Only a syndet soap and bland moisturizer may be used twice daily. All sources of skin friction should be eliminated. At two weeks, the patient should be evaluated for any underlying dermatoses and treated appropriately for at least two veeke beyond visible disease resolution. Traditional patch testing, photopatch testing. and contact urticaria test& should be inderiaken with s&ial attention to clinically ;elevsnt substances. Facial stina testing with 10% lactic acid should be perfomd to e&luate heightened sensory perception followed by psychological assessment. The patient's leave-on cosmetics, skin care products, and OTC treatment products should be provocative use tested individually. Upon completion of this methodolagy, all date both positive and negative should be analyzed and presented to the patient in the form of products or ingredients to avoid and th0.w appropriate for continued use.
OF PATCH PERFUSION
TEST REAIMAGER.
T. B. Bjamason. National In&tote for Working Life, Solna, Sweden. Department of Dermatology, Karolinska Hospital, Stockholm, Sweden The Laser Doppler Perfusion lmager (LDPI) is a data acquisition and analysis system that generates, processes and displays a two-dimentional colow-coded mapping of tissue perfusion. The LDPI can objectively quantirate spatial heterogeneity of skin perfusion in patch tea reactions without touching the skin. It uses an optical scanner to scan the &in with a low
power laser beam. In the prwence of moving blood cells, Dopplerbroadened backscattered light is detected by a photodetector in the scanner head. The light is transformed into an electrical value proportional to perfusion. We have used the LDPI- instrument (PIM 1.0) L&a Development AB, LinkQing, Sweden to objectively quantitate skin perfusion due to tw beradio reactions as well as irritant reactions due to Diesel oil. To obtain reproducible results, he instrument and the evaluation has to be carefully standardized. The influence of different reading and evaluation parameters will be explained, and we will demonstrate how the instrument can be used to follow serial dilutions of patch test reactions positwe to Kathon CG and nickel sulphate. Ofimprtmce
to ohin
reproducible results is:
- a central localization of the test within the reading area. -a constant distance between the test area and the scanner head. the angle close to 90” between the reading area and the beam. the resolution of the instrument - the size of the reaction. ambient light in the testing room. - patient movements and skin and room temperature.
Evaluation oftestrenction: We suggest the reactions to be evaluated from the center an area corres-
ponding exactly to the patch used for testing.