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Modified stinging test: New tolerance predictive test for baby products
P6919
P6441
Mesotherapy granulomas with L-carnitine Alberto Alfaro-Rubio, MD, Hospital de Manises, Valencia, Spain; Antonio Martorell-Calatayud, MD, Hospital de Manises, Valencia, Spain; Cristina Pelufo, MD, Hospital de Manises, Valencia, Spain; Liria Terradez, MD, Hospital de Manises, Valencia, Spain; Luis Hueso-Gabriel, MD, Hospital de Manises, Valencia, Spain; Maria Luisa Garcia-Melgares, MD, Hospital de Manises, Valencia, Spain
New nursing uniforms cause skin symptoms in over half of wearers Emma V. Pynn, MBChB, Welsh Institute of Dermatology, Cardiff, United Kingdom; Mahbub M. U. Chowdhury, MBChB, Welsh Institute of Dermatology, Cardiff, United Kingdom The National Health Service in Wales in the United Kingdom recently introduced new uniforms for clinical nursing and support staff. Issued with instructions for prewear washing, they are made of polyester cotton mix. Anecdotally, many wearers complained about skin reactions. We surveyed our department to assess the prevalence and nature of symptoms. All relevant staff in two dermatology departments were asked to complete an anonymous survey after a week of uniform wearing and where possible again after three months, with linkage of results. They were questioned as to prewear washing, symptoms and subsequent treatment required. 23 staff completed the initial questionnaire, all had washed their uniforms at least twice. 39% found them uncomfortable and in 22% they impacted on ability to work. 57% (13) experienced skin symptoms, 12 being pruritus, most commonly on the neck. Onset was often within hours but always during the first day, 4 staff had to use emollients, 1 stopped wearing the uniform and another had to wear an extra layer of clothing. Of those with symptoms which settled (54%) most were within 2 days of use. Nobody consulted occupational health. 13 completed the second survey, 62% of whom were finding the uniform more comfortable at 3 months, 31% had had skin symptoms since the initial survey of which only half had resolved. Despite following guidance over half of the staff surveyed experienced a skin reaction to the new uniforms, presumably often irritancy. Although the majority were minor and resolved, some required the wearers to abandon the uniform and some persist.
Background: Mesotherapy is a procedure that involves the injection of substances into the dermis and subcutaneous tissue. This technique is normally used in the treatment of various medical conditions and cosmetic fat dissolution. Mesotherapy has been surrounded by controversy pertaining to efficacy and has been associated with localized complications and different adverse effects. Case report: A 31-year-old woman, striptease dancer, had painful not suppurative nodules located at the points where mesotherapy with Carnicor (L-carnitine) had been applied 8 months ago. Culture was performed from biopsy tissue, and resulted negative for fungi, bacteria, and mycobacteria. Laboratory tests, including complete blood cell count, chemistry and mantoux test, revealed no abnormality, and there was no significant medical or familiar history of interest. The pathologic analysis of the biopsy revealed necrotic granuloma formation without bacterial structures. Treatment consisted on intralesional injections of intralesional injection of 2.5 mg/mL triamcinolone acetonide administred one time a month for 3 months. After 30 months of follow-up, no relapse signs were achieved. Discussion: Mesotherapy is known to produce both the physical and chemical stimulation of dermis and subcutaneous tissue. A wide variety of mesotherapy products are now available worldwide. The main drugs used are nonsteroidal antiinflammatory drugs, muscle relaxants, vasodilators, lipolytics such as aminophylline and biologics (including vitamins, minerals, and plant extracts). The Lcarnitina granuloma is a non well described cause of this rare situation. We report this case because it is thought that the adverse effects of mesotherapy may increase because it has been popular worldwide. Patients should be informed of these possible complications.
Commercial support: None identified.
Commercial support: None identified.
P6164 Modified stinging test: New tolerance predictive test for baby products Clarence De Belilovsky, Laboratoires Expanscience, Epernon, France; Franck Menu, Laboratoires Expanscience, Epernon, France; Joe Nicholson III, Product Investigations Incorporated, Conshohocken, PA, United States; Marjorie Biassette, Laboratoires Expanscience, Epernon, France; Morris Shelanski, Product Investigations Incorporated, Conshohocken, PA, United States; Nadege Lachmann, Laboratoires Expanscience, Epernon, France; Philippe Msika, Laboratoires Expanscience, Epernon, France Background: Tolerance tests for cosmetics intended for infants under three are already drastic. However, some unpredictable intolerance reactions might occur. It has been demonstrated that different preservatives and formulations have variable sensory irritation potentials, independently of objective irritation. Accordingly, we used a modified stinging test to screen two diaper rash prevention formulations (A and B) which obtained similar objective irritation scores. Indeed, the napkin area is particularly sensitive because of the permanent occlusive conditions leading to skin barrier dysfunction and increased susceptibility to discomfort.
P7011
Conclusion: Modified stinging test has been useful to optimize the global tolerance screening of baby care products for use on compromised skin. This test is routinely added to our tolerance pack and a characterization of ‘‘very slight stinger’’ is mandatory before use-tests may be initiated.
Patch testing in patients with vulval dermatoses: Changing allergen frequency over 7 years Mei Fong Chin, MBChB, Aneurin Bevan Health Board, Newport, United Kingdom; Cherng Jong, MBBS, Aneurin Bevan Health Board, Newport, United Kingdom; Natalie Stone, MBBS, Aneurin Bevan Health Board, Newport, United Kingdom Vulval itch and eczema are common conditions that can be associated with significant psychosocial distress. Patients often self-medicate with topical pharmaceutical products which may lead to contact allergy. The prevalence of allergic contact dermatitis previously reported ranges from 26% to 49%. Patch test data was collected retrospectively on all patients with vulval symptoms who had been patch tested in our unit over a 7-year period. Categories of data included diagnosis and/or histologic diagnosis, history of atopy, age, positive patch test results, and relevance. 245 women with a mean age of 53 years (range, 4-84) had been patch tested. 29% (71) patients were atopic. 65% (161 of 245) had eczema, because of irritant contact dermatitis, allergic contact dermatitis, or endogenous causes. 60% (147) of patients had at least 1 positive patch test reaction. The highest number of positive reactions were caused by nickel, most of which were considered to be of past relevance. Of the patients with positive reactions, 55% of these were felt to be of current relevance. The allergen responsible for the highest numbers of relevant positive reactions was myroxylon pereirae followed by fragrance mix 1. This was consistent across all 7 years. Neomycin was a leading allergen in the first 3 years of the investigation period but it caused only 3 positive reactions in the later 4 years, all of which were considered of past relevance. This may reflect a change in local prescribing practice. The incidence of methylchloroisothiazolinone/methylisothiazolinone positive reactions has increased in the last 4 years. This may be associated with a rise in the use of wet wipes in the population. Amerchol and wool alcohols remained important allergens in vulval eczema, with numbers of positive reactions staying static. Our results support those of previous studies on patch test results for vulval dermatoses, and give an insight into the changing trends of common culprit allergens in our population. Medicament allergy remains the most important cause of ACD in this patient group.
Commercial support: None identified.
Commercial support: None identified.
Methods: Fifteen stinger women were included in a phase II single blind study. Profuse facial sweating was elicited at temperature of 1008F and 80% relative humidity. Products A and B were applied on the suborbital, malar and U-labial folds areas on one side of the face and physiological saline solution on the other. Perceived degrees of stinging were recorded at T0, 1 minute, 2.5 minutes and 5 minutes. Scores ranged from 0 (none) to 3 (intense). A Global Score was calculated by summing up the 2.5 and 5 minutes scores. Clinical relevance of Global Score was: \10 very slight, 11-24 slight to moderate, [25 strong. Results: Total cumulative stinging scores at \10 seconds/1.0 minutes were 3 for formulation A and 9 for formulation B. Global Scores were respectively 4 and 11. Thus stinging propensity was considered as ‘‘very slight’’ for formulation A and as ‘‘slight to moderate’’ for formulation B.
AB82
J AM ACAD DERMATOL
APRIL 2013
P6441
Mesotherapy granulomas with L-carnitine Alberto Alfaro-Rubio, MD, Hospital de Manises, Valencia, Spain; Antonio Martorell-Calatayud, MD, Hospital de Manises, Valencia, Spain; Cristina Pelufo, MD, Hospital de Manises, Valencia, Spain; Liria Terradez, MD, Hospital de Manises, Valencia, Spain; Luis Hueso-Gabriel, MD, Hospital de Manises, Valencia, Spain; Maria Luisa Garcia-Melgares, MD, Hospital de Manises, Valencia, Spain
New nursing uniforms cause skin symptoms in over half of wearers Emma V. Pynn, MBChB, Welsh Institute of Dermatology, Cardiff, United Kingdom; Mahbub M. U. Chowdhury, MBChB, Welsh Institute of Dermatology, Cardiff, United Kingdom The National Health Service in Wales in the United Kingdom recently introduced new uniforms for clinical nursing and support staff. Issued with instructions for prewear washing, they are made of polyester cotton mix. Anecdotally, many wearers complained about skin reactions. We surveyed our department to assess the prevalence and nature of symptoms. All relevant staff in two dermatology departments were asked to complete an anonymous survey after a week of uniform wearing and where possible again after three months, with linkage of results. They were questioned as to prewear washing, symptoms and subsequent treatment required. 23 staff completed the initial questionnaire, all had washed their uniforms at least twice. 39% found them uncomfortable and in 22% they impacted on ability to work. 57% (13) experienced skin symptoms, 12 being pruritus, most commonly on the neck. Onset was often within hours but always during the first day, 4 staff had to use emollients, 1 stopped wearing the uniform and another had to wear an extra layer of clothing. Of those with symptoms which settled (54%) most were within 2 days of use. Nobody consulted occupational health. 13 completed the second survey, 62% of whom were finding the uniform more comfortable at 3 months, 31% had had skin symptoms since the initial survey of which only half had resolved. Despite following guidance over half of the staff surveyed experienced a skin reaction to the new uniforms, presumably often irritancy. Although the majority were minor and resolved, some required the wearers to abandon the uniform and some persist.
Background: Mesotherapy is a procedure that involves the injection of substances into the dermis and subcutaneous tissue. This technique is normally used in the treatment of various medical conditions and cosmetic fat dissolution. Mesotherapy has been surrounded by controversy pertaining to efficacy and has been associated with localized complications and different adverse effects. Case report: A 31-year-old woman, striptease dancer, had painful not suppurative nodules located at the points where mesotherapy with Carnicor (L-carnitine) had been applied 8 months ago. Culture was performed from biopsy tissue, and resulted negative for fungi, bacteria, and mycobacteria. Laboratory tests, including complete blood cell count, chemistry and mantoux test, revealed no abnormality, and there was no significant medical or familiar history of interest. The pathologic analysis of the biopsy revealed necrotic granuloma formation without bacterial structures. Treatment consisted on intralesional injections of intralesional injection of 2.5 mg/mL triamcinolone acetonide administred one time a month for 3 months. After 30 months of follow-up, no relapse signs were achieved. Discussion: Mesotherapy is known to produce both the physical and chemical stimulation of dermis and subcutaneous tissue. A wide variety of mesotherapy products are now available worldwide. The main drugs used are nonsteroidal antiinflammatory drugs, muscle relaxants, vasodilators, lipolytics such as aminophylline and biologics (including vitamins, minerals, and plant extracts). The Lcarnitina granuloma is a non well described cause of this rare situation. We report this case because it is thought that the adverse effects of mesotherapy may increase because it has been popular worldwide. Patients should be informed of these possible complications.
Commercial support: None identified.
Commercial support: None identified.
P6164 Modified stinging test: New tolerance predictive test for baby products Clarence De Belilovsky, Laboratoires Expanscience, Epernon, France; Franck Menu, Laboratoires Expanscience, Epernon, France; Joe Nicholson III, Product Investigations Incorporated, Conshohocken, PA, United States; Marjorie Biassette, Laboratoires Expanscience, Epernon, France; Morris Shelanski, Product Investigations Incorporated, Conshohocken, PA, United States; Nadege Lachmann, Laboratoires Expanscience, Epernon, France; Philippe Msika, Laboratoires Expanscience, Epernon, France Background: Tolerance tests for cosmetics intended for infants under three are already drastic. However, some unpredictable intolerance reactions might occur. It has been demonstrated that different preservatives and formulations have variable sensory irritation potentials, independently of objective irritation. Accordingly, we used a modified stinging test to screen two diaper rash prevention formulations (A and B) which obtained similar objective irritation scores. Indeed, the napkin area is particularly sensitive because of the permanent occlusive conditions leading to skin barrier dysfunction and increased susceptibility to discomfort.
P7011
Conclusion: Modified stinging test has been useful to optimize the global tolerance screening of baby care products for use on compromised skin. This test is routinely added to our tolerance pack and a characterization of ‘‘very slight stinger’’ is mandatory before use-tests may be initiated.
Patch testing in patients with vulval dermatoses: Changing allergen frequency over 7 years Mei Fong Chin, MBChB, Aneurin Bevan Health Board, Newport, United Kingdom; Cherng Jong, MBBS, Aneurin Bevan Health Board, Newport, United Kingdom; Natalie Stone, MBBS, Aneurin Bevan Health Board, Newport, United Kingdom Vulval itch and eczema are common conditions that can be associated with significant psychosocial distress. Patients often self-medicate with topical pharmaceutical products which may lead to contact allergy. The prevalence of allergic contact dermatitis previously reported ranges from 26% to 49%. Patch test data was collected retrospectively on all patients with vulval symptoms who had been patch tested in our unit over a 7-year period. Categories of data included diagnosis and/or histologic diagnosis, history of atopy, age, positive patch test results, and relevance. 245 women with a mean age of 53 years (range, 4-84) had been patch tested. 29% (71) patients were atopic. 65% (161 of 245) had eczema, because of irritant contact dermatitis, allergic contact dermatitis, or endogenous causes. 60% (147) of patients had at least 1 positive patch test reaction. The highest number of positive reactions were caused by nickel, most of which were considered to be of past relevance. Of the patients with positive reactions, 55% of these were felt to be of current relevance. The allergen responsible for the highest numbers of relevant positive reactions was myroxylon pereirae followed by fragrance mix 1. This was consistent across all 7 years. Neomycin was a leading allergen in the first 3 years of the investigation period but it caused only 3 positive reactions in the later 4 years, all of which were considered of past relevance. This may reflect a change in local prescribing practice. The incidence of methylchloroisothiazolinone/methylisothiazolinone positive reactions has increased in the last 4 years. This may be associated with a rise in the use of wet wipes in the population. Amerchol and wool alcohols remained important allergens in vulval eczema, with numbers of positive reactions staying static. Our results support those of previous studies on patch test results for vulval dermatoses, and give an insight into the changing trends of common culprit allergens in our population. Medicament allergy remains the most important cause of ACD in this patient group.
Commercial support: None identified.
Commercial support: None identified.
Methods: Fifteen stinger women were included in a phase II single blind study. Profuse facial sweating was elicited at temperature of 1008F and 80% relative humidity. Products A and B were applied on the suborbital, malar and U-labial folds areas on one side of the face and physiological saline solution on the other. Perceived degrees of stinging were recorded at T0, 1 minute, 2.5 minutes and 5 minutes. Scores ranged from 0 (none) to 3 (intense). A Global Score was calculated by summing up the 2.5 and 5 minutes scores. Clinical relevance of Global Score was: \10 very slight, 11-24 slight to moderate, [25 strong. Results: Total cumulative stinging scores at \10 seconds/1.0 minutes were 3 for formulation A and 9 for formulation B. Global Scores were respectively 4 and 11. Thus stinging propensity was considered as ‘‘very slight’’ for formulation A and as ‘‘slight to moderate’’ for formulation B.
AB82
J AM ACAD DERMATOL
APRIL 2013