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Plant dermatitis: An interactive study
P810
P812
Plant dermatitis: An interactive study Sarah Bowen, MD, Drexel University College of Medicine, Philadelphia, PA, United States; Christopher Skvarka, MD, Drexel University College of Medicine, Philadlephia, PA, United States; Herbert Allen, MD, Drexel University College of Medicine, Philadelphia, PA, United States; Genevieve Abbey, Drexel University College of Medicine, Philadelphia, PA, United States
Management of seborrheic dermatitis with 2% analogue of green tea extract (-EGCg) in a hydrophilic cream. A placebo-controlled, doubleblind study Tanweer Syed, MD, PhD, Syed Skin Care Inc., San Francisco, CA, United States; Raza Aly, PhD, MPH, University of California, San Francisco, CA, United States; Sara Benipoor, MPH, University of Lund, Lund, Sweden, Seyed Ali Ahmad, University of California, Berkeley, CA, United States
The most common plant rashes may be classified as allergic or chemical irritant dermatitis. The dermatitis caused by poison ivy, poison oak, and poison sumac—the ‘‘classic’’ allergic contact dermatitis—involves a delayed type IV hypersensitivity reaction. Consequently, the allergic contact dermatitis caused by poison ivy requires prior sensitization and occurs many hours after exposure to the plant. Chemical irritant contact dermatitis from plants generally occurs in all individuals exposed to adequate amounts of the chemical. The threshold for irritation is lowered when the skin barrier is damaged (ie, florists whose hands are constantly wet). Here we examine the two skin disorders and present 5 cases to illustrate the differences between them. Each case involves true/false statements with encrypted answers. Commercial support: None identified.
Objective: To evaluate the clinical efficacy, tolerability, safety and beneficial effects of 2% analogue of polyphenone (-EGCg, epigallocatechin gallate) incorporated in a hydrophilic cream to treat and manage seborrheic dermatitis. Methods: Preselected subjects (n 5 100, 63M/37F) aged 25to 50 years with clinically diagnosed seborrheic dermatitis were sequentially randomized into two parallel groups. An identical precoded tube containing 50 g (Either active or placebo) was allocated to each subject with instructions on how to topically apply the trial cream 2 times a day for 4 weeks. Cure was defined as absence of complete clinical signs of treated inflammation, scaling and pruritus. Photographic and optical techniques were used both at the baseline and on weekly basis. Results: By the end of the study, marked beneficial imporvement was observed in both the groups. Code disclosure revealed that 2% polyphenone in a hydrophilic cream yielded statistically significantly higher reduction in mean inflammatory lesion count than placebo. Using the investigator’s global assessment, therapeutic success in terms of a clear, minimal, or mild result was documented in 68% of patients treated with 2% polyphenone (-EGCg) cream (P \.0001). Conclusion: The study shows that 2% analogue of polyphenone (-EGCg) in a hydrophilic cream is safe, tolerable and significantly more effective than placebo in reducing the severity of seborrheic dermatitits. 25% is sponsored by Syed Skin Care Inc. 50% is sponsored by Wendy Hiu Wai Wong.
P811 Acrylate dermatitis: Diagnostic clues, chemical background, and preventive measures Mohammad Diab, MD, Ohio State University—Dermatology, Columbus, OH, United States; Mohammad Diab, MD, Ohio State University—Dermatology, Columbus, OH, United States; Jacquelyn Coloe, Ohio State University College of Medicine, Columbus, OH, United States; Matthew Zirwas, MD, Ohio State University—Dermatology, Columbus, OH, United States Acrylates are a major cause of occupational and non-occupational contact dermatitis. We present 7 cases of allergic contact dermatitis to acrylates, which represent the most common presentations, in order to help clinicians recognize allergy to these allergens. In addition, the chemistry of acrylates and the selection of appropriate personal protective equipment will be discussed. Case 1 is a 22-yearold dental technician with hand dermatitis. He was allergic to uncured acrylate resin used in denture making. Case 2 is a 43-year-old printing press operator with hand dermatitis. He was allergic to multifunctional acrylates in the UV activated coating used in the printing process. Case 3 is a 38-year-old countertop assembler with hand dermatitis and fingertip numbness. He was allergic to the methyl methacrylate glue used in gluing countertop surfaces. Case 4 is a 58-year-old nail technician who primarily applied acrylic fingernails. She was allergic to acrylates used in forming acrylic fingernails. Case 5 is a 56-year-old female with swelling and pain of the cheek after placement of a temporary dental crown. She was allergic to acrylates leached from the composite resin material used to form the crown. Case 6 is a 47-year-old with periungual dermatitis and itch. She was allergic to acrylic fingernails that were filled every 3 weeks. Case 7 is a 72-year-old with eyelid dermatitis. She was allergic to acrylic fingernails that were filled every 3 weeks. Acrylate allergy is relatively common. Completely cured acrylic resins with no residual monomer or small polymers are not allergenic. However, 100% cure is unlikely with most resins and small amounts of monomer and small polymers are often released from recently cured acrylics. Individuals working with uncured acylates are at high risk for developing allergy to acrylates. Occupations particularly at risk include nail and dental technicians, industrial workers using acrylate glues, UV printing press operators, and orthopedists and nurses working with bone cement. Chronic allergic contact dermatitis to methyl methacrylate, especially of the fingertips, can lead to fingertip neuropathy, due to nerve inflammation. Acrylates rapidly penetrate most rubber gloves over relatively short time periods. This makes effective protection of the hands difficult. Polyvinyl alcohol and multilayer laminate gloves can offer effective protection. Commercial support: None identified.
AB78
J AM ACAD DERMATOL
P813 Delayed-type hypersensitivity response to subcutaneous heparin Temitope Soares, PharmD, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States; David DiCaudo, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States; Karen Warschaw, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States A 66-year-old female presents with a 5-day history of abdominal rash starting 2 days after hospital discharge. During her hospital stay, she received subcutaneous injections of heparin for deep venous thrombosis (DVT) prophylaxis at the eventual site of the rash. The rash was moderately pruritic, with a mild burning sensation. No fever, fatigue, or previous history of similar rash. Physical examination revealed several large (up to 7 cm) confluent peri-umbilical well-marginated pink-red smoothsurfaced plaques with mild pruritus and burning. Biopsy showed mild spongiosis and focal intraepidermal collections of Langerhans cells. The upper and mid-dermis revealed moderately dense perivascular and interstitial lymphocytic infiltrate with scattered eosinophils. A diagnosis of heparin-induced hypersensitivity response was made. This was thought to be similar to the type IV hypersensitivity reaction that has been commonly associated with vitamin K subcutaneous injections. Many cases of delayed type hypersensitivity reaction to subcutaneous heparin have been reported. This reaction theoretically could imply an increased risk of generalized eczema with intravenous heparin in these patients. However, Gaigl et al reported a prospective study of 28 such patients, subsequently challenged with intravenous heparin, which was well tolerated in all 28 patients. Koch et al reported a study involving extensive allergy testing on 24 patients who developed similar plaques after subcutaneous heparin. Patch, intradermal, and subcutaneous testing was done using unfractionated heparin, low-molecular weight heparin (LMWH) heparinoids, and lepirudin. Two distinct histologic patterns were identified. The first one involved features of allergic contact dermatitis with spongiosis and lymphohistiocytic infiltrate and eosinophils. The second showed features of drug eruption with superficial perivascular and lymphocytic infiltrate with eosinophils. Commercial support: None identified.
FEBRUARY 2007
P812
Plant dermatitis: An interactive study Sarah Bowen, MD, Drexel University College of Medicine, Philadelphia, PA, United States; Christopher Skvarka, MD, Drexel University College of Medicine, Philadlephia, PA, United States; Herbert Allen, MD, Drexel University College of Medicine, Philadelphia, PA, United States; Genevieve Abbey, Drexel University College of Medicine, Philadelphia, PA, United States
Management of seborrheic dermatitis with 2% analogue of green tea extract (-EGCg) in a hydrophilic cream. A placebo-controlled, doubleblind study Tanweer Syed, MD, PhD, Syed Skin Care Inc., San Francisco, CA, United States; Raza Aly, PhD, MPH, University of California, San Francisco, CA, United States; Sara Benipoor, MPH, University of Lund, Lund, Sweden, Seyed Ali Ahmad, University of California, Berkeley, CA, United States
The most common plant rashes may be classified as allergic or chemical irritant dermatitis. The dermatitis caused by poison ivy, poison oak, and poison sumac—the ‘‘classic’’ allergic contact dermatitis—involves a delayed type IV hypersensitivity reaction. Consequently, the allergic contact dermatitis caused by poison ivy requires prior sensitization and occurs many hours after exposure to the plant. Chemical irritant contact dermatitis from plants generally occurs in all individuals exposed to adequate amounts of the chemical. The threshold for irritation is lowered when the skin barrier is damaged (ie, florists whose hands are constantly wet). Here we examine the two skin disorders and present 5 cases to illustrate the differences between them. Each case involves true/false statements with encrypted answers. Commercial support: None identified.
Objective: To evaluate the clinical efficacy, tolerability, safety and beneficial effects of 2% analogue of polyphenone (-EGCg, epigallocatechin gallate) incorporated in a hydrophilic cream to treat and manage seborrheic dermatitis. Methods: Preselected subjects (n 5 100, 63M/37F) aged 25to 50 years with clinically diagnosed seborrheic dermatitis were sequentially randomized into two parallel groups. An identical precoded tube containing 50 g (Either active or placebo) was allocated to each subject with instructions on how to topically apply the trial cream 2 times a day for 4 weeks. Cure was defined as absence of complete clinical signs of treated inflammation, scaling and pruritus. Photographic and optical techniques were used both at the baseline and on weekly basis. Results: By the end of the study, marked beneficial imporvement was observed in both the groups. Code disclosure revealed that 2% polyphenone in a hydrophilic cream yielded statistically significantly higher reduction in mean inflammatory lesion count than placebo. Using the investigator’s global assessment, therapeutic success in terms of a clear, minimal, or mild result was documented in 68% of patients treated with 2% polyphenone (-EGCg) cream (P \.0001). Conclusion: The study shows that 2% analogue of polyphenone (-EGCg) in a hydrophilic cream is safe, tolerable and significantly more effective than placebo in reducing the severity of seborrheic dermatitits. 25% is sponsored by Syed Skin Care Inc. 50% is sponsored by Wendy Hiu Wai Wong.
P811 Acrylate dermatitis: Diagnostic clues, chemical background, and preventive measures Mohammad Diab, MD, Ohio State University—Dermatology, Columbus, OH, United States; Mohammad Diab, MD, Ohio State University—Dermatology, Columbus, OH, United States; Jacquelyn Coloe, Ohio State University College of Medicine, Columbus, OH, United States; Matthew Zirwas, MD, Ohio State University—Dermatology, Columbus, OH, United States Acrylates are a major cause of occupational and non-occupational contact dermatitis. We present 7 cases of allergic contact dermatitis to acrylates, which represent the most common presentations, in order to help clinicians recognize allergy to these allergens. In addition, the chemistry of acrylates and the selection of appropriate personal protective equipment will be discussed. Case 1 is a 22-yearold dental technician with hand dermatitis. He was allergic to uncured acrylate resin used in denture making. Case 2 is a 43-year-old printing press operator with hand dermatitis. He was allergic to multifunctional acrylates in the UV activated coating used in the printing process. Case 3 is a 38-year-old countertop assembler with hand dermatitis and fingertip numbness. He was allergic to the methyl methacrylate glue used in gluing countertop surfaces. Case 4 is a 58-year-old nail technician who primarily applied acrylic fingernails. She was allergic to acrylates used in forming acrylic fingernails. Case 5 is a 56-year-old female with swelling and pain of the cheek after placement of a temporary dental crown. She was allergic to acrylates leached from the composite resin material used to form the crown. Case 6 is a 47-year-old with periungual dermatitis and itch. She was allergic to acrylic fingernails that were filled every 3 weeks. Case 7 is a 72-year-old with eyelid dermatitis. She was allergic to acrylic fingernails that were filled every 3 weeks. Acrylate allergy is relatively common. Completely cured acrylic resins with no residual monomer or small polymers are not allergenic. However, 100% cure is unlikely with most resins and small amounts of monomer and small polymers are often released from recently cured acrylics. Individuals working with uncured acylates are at high risk for developing allergy to acrylates. Occupations particularly at risk include nail and dental technicians, industrial workers using acrylate glues, UV printing press operators, and orthopedists and nurses working with bone cement. Chronic allergic contact dermatitis to methyl methacrylate, especially of the fingertips, can lead to fingertip neuropathy, due to nerve inflammation. Acrylates rapidly penetrate most rubber gloves over relatively short time periods. This makes effective protection of the hands difficult. Polyvinyl alcohol and multilayer laminate gloves can offer effective protection. Commercial support: None identified.
AB78
J AM ACAD DERMATOL
P813 Delayed-type hypersensitivity response to subcutaneous heparin Temitope Soares, PharmD, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States; David DiCaudo, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States; Karen Warschaw, MD, Mayo Clinic Arizona, Scottsdale, AZ, United States A 66-year-old female presents with a 5-day history of abdominal rash starting 2 days after hospital discharge. During her hospital stay, she received subcutaneous injections of heparin for deep venous thrombosis (DVT) prophylaxis at the eventual site of the rash. The rash was moderately pruritic, with a mild burning sensation. No fever, fatigue, or previous history of similar rash. Physical examination revealed several large (up to 7 cm) confluent peri-umbilical well-marginated pink-red smoothsurfaced plaques with mild pruritus and burning. Biopsy showed mild spongiosis and focal intraepidermal collections of Langerhans cells. The upper and mid-dermis revealed moderately dense perivascular and interstitial lymphocytic infiltrate with scattered eosinophils. A diagnosis of heparin-induced hypersensitivity response was made. This was thought to be similar to the type IV hypersensitivity reaction that has been commonly associated with vitamin K subcutaneous injections. Many cases of delayed type hypersensitivity reaction to subcutaneous heparin have been reported. This reaction theoretically could imply an increased risk of generalized eczema with intravenous heparin in these patients. However, Gaigl et al reported a prospective study of 28 such patients, subsequently challenged with intravenous heparin, which was well tolerated in all 28 patients. Koch et al reported a study involving extensive allergy testing on 24 patients who developed similar plaques after subcutaneous heparin. Patch, intradermal, and subcutaneous testing was done using unfractionated heparin, low-molecular weight heparin (LMWH) heparinoids, and lepirudin. Two distinct histologic patterns were identified. The first one involved features of allergic contact dermatitis with spongiosis and lymphohistiocytic infiltrate and eosinophils. The second showed features of drug eruption with superficial perivascular and lymphocytic infiltrate with eosinophils. Commercial support: None identified.
FEBRUARY 2007