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Resolution of irritant dermatitis with inflammation, edema, and microbial infection
P713
P715
A current review of the lanolin alcohol contact allergy literature Teresa Weber, PhD, Beiersdorf Inc., Norwalk, CT, United States; Alice Gottlieb, MD, PhD, Tufts-New England Medical Center, Boston, MA, United States; Alexandra Kowcz, MBA, Beiersdorf Inc., Norwalk, CT, United States; Andrea Schoelermann, MD, Beiersdorf AG, Hamburg, Germany
Analysis of patch test of mugwort in healthy controls Hee-Ryung Cho, MD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea; Sik Haw, MD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea; Mu-Hyoung Lee, MD, PhD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea
Aim: Evaluate the published literature regarding lanolin alcohol as a potential sensitizing agent. Background: Lanolin or wool wax has been used since the time of the ancient Greeks for therapeutic and cosmetic purposes because of its rich emollient properties. In the last century, products have utilized lanolin alcohol, a purified subfraction of lanolin, to impart emollient and emulsifying benefits. Methods: We reviewed the literature from early suggestions of lanolin allergic reactions in 1939 to the present time, including recent retrospective studies of the results of thousands of patch-tested individuals who presented at clinics in Europe and North America. In addition, the levels of reported putative dermatitis reactions to emollient product formulations containing a specific lanolin alcohol preparation were examined. Results: The data confirm extremely low levels of lanolin alcohol sensitivity in the general population. Among individuals patch-tested in dermatology clinics for suspected allergic dermatitis, the observed rate is about 2%, but varies depending on the specific lanolin alcohol preparation tested. Among lanolin alcohol sensitive individuals, a correlation between leg stasis ulcers/leg dermatitis and lanolin alcohol reactivity has been reported. In contrast to other putative sensitizing agents, positive patch tested persons often tolerate products that contain lanolin alcohol, and significantly fewer individuals have positive patch results when retested 7 months to several years after the primary test. Conclusions: These data suggest that rates of lanolin alcohol sensitivity are very low, and that the characteristics of the observed sensitivity do not mirror that of other common sensitizing agents. 100% sponsored by Beiersdorf Inc.
Mugwort (Artemisia species) is a plant with worldwide distribution that is generally used as a medication in traditional and oriental medicine. There are various forms of mugwort preparations, including infusion, moxibustion, and patch. In Korean herbal medicine, it has been used to treat abdominal pain and various women’s diseases. Moxa, a different preparation of mugwort, also has been used to treat rheumatic arthritis by moxibustion in Chinese medicine. Though it is well known that mugwort pollen can harm humans (acting as an aeroallergen), contact dermatitis caused by the patch preparation of mugwort is rarely reported. A 43year-old Korean male visited our clinic for evaluation and treatment of sharply demarcated erythematous papules on the both arms, hands, neck, and posterior auricle. He had applied the patch preparation of mugwort on exactly the same position to treat his allergic rhinitis. The patch was changed in consecutive days. After 15 days, the skin lesions appeared with severe itching. This case was diagnosed as allergic contact dermatitis (ACD) and confirmed by patch test. To evaluate the frequency of contact dermatitis caused by mugwort, 58 healthy volunteers with no previous history of contact dermatitis caused by any allergen were patch-tested as normal controls with 2.5%, 5%, 10%, and 20% pet. mugwort extract. Seven subjects had positive reactions on day 2, and one subject had a positive reaction on both days 2 and 4. The mean concentration of positive reaction was 10% (10 6 2.3). The positive rate of irritated contact dermatitis was 12.1%, and that of ACD was 1.8%. Compared with positive rates of nickel (18.8% in Korean population), a common sensitizer causing ACD, mugwort induced less ACD. We performed a patch test for 15 consecutive days in 8 out of 57 negative subjects on day 4. All subjects did not have positive reaction. We report a case of contact dermatitis after application of patch preparation of mugwort and the result of patch test of mugwort in healthy controls. Commercial support: None identified.
P714 Resolution of irritant dermatitis with inflammation, edema, and microbial infection Ann Marie Brinton, RN, MSN, Advanced Practice Consultants, El Camino Village, CA, United States; Laura K. S. Parnell, MS, Precision Consulting, Missouri City, TX, United States Irritants on the skin cause an inflammatory reaction to occur and subsequent dermatitis can result. The intensity and duration of the inflammation response depends on the skin environment such as the number of irritants present, potency of each, duration present, pH, and moisture, as well as the immunologic status of the individual. The inflammatory and immune response is further complicated when a secondary microbial infection invades the epidermis and dermis resulting in delayed resolution. Although irritant induced perineal dermatitis is painful and preventable, it is prevalently reported in the literature as [33% in hospitalized adults. This case series of seven ICU and medical/surgical patients with perineal dermatitis were evaluated for treatment and management of their dermatitis. Polymicrobic cultures of Candida albicans and Clostridium difficile, VRE, or MRSA were documented for each person. At baseline evaluation, the skin and lesions were extremely painful, erythematous, and partially denuded despite the use of preventive barriers, antifungal products, and intravenous antibiotics. Patients required various potent analgesics prior to cleaning. Because of the severity of the dermatitis and open lesions, a protease containing miconazol antifungal was initiated. This product was designed to inhibit and down-regulate the inflammatory response while providing antifungal and barrier protection. Dramatic improvement in skin inflammation, erythema, edema, and pain was seen within 12 to 24 hours of the initial application of the product. Analgesic use quickly decreased and patient cooperation increased. Photos show marked improvement in skin condition. Given the tremendous amount of tissue damage, rapid resolution of inflammation was unexpected and unprecedented. Once the skin healed, the product was discontinued. These impressive observations may be partially explained by the proteases inactivating inflammatory mediators, thereby resolving inflammation. Future research comparing protease containing products and assessing the time to resolution of inflammation as well as analgesic type and usage is warranted for a variety of dermatitis etiologies. 85% of all poster and 100% of travel costs sponsored by Swiss-American Products Inc.
FEBRUARY 2008
P716 Challenging pediatric contact dermatitis cases from the University of Miami Mari Paz Castanedo-Tardan, MD, University of Miami, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Aparche Yang, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Elizabeth Alvarez-Connelly, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Sharon E. Jacob, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States The University of Miami Pediatric Contact Dermatitis Unit is a regional referral center dedicated to pediatric patients with contact dermatitis. This unique bilingual clinic is developing tools to improve pediatric patch testing procedures in order to meet the needs of children and their families. This poster presents several challenging cases throughout the year as well as the most frequent allergens noted in our pediatric population. Commercial support: None identified.
J AM ACAD DERMATOL
AB57
P715
A current review of the lanolin alcohol contact allergy literature Teresa Weber, PhD, Beiersdorf Inc., Norwalk, CT, United States; Alice Gottlieb, MD, PhD, Tufts-New England Medical Center, Boston, MA, United States; Alexandra Kowcz, MBA, Beiersdorf Inc., Norwalk, CT, United States; Andrea Schoelermann, MD, Beiersdorf AG, Hamburg, Germany
Analysis of patch test of mugwort in healthy controls Hee-Ryung Cho, MD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea; Sik Haw, MD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea; Mu-Hyoung Lee, MD, PhD, Department of Dermatology, College of Medicine, KyungHee University, Seoul, South Korea
Aim: Evaluate the published literature regarding lanolin alcohol as a potential sensitizing agent. Background: Lanolin or wool wax has been used since the time of the ancient Greeks for therapeutic and cosmetic purposes because of its rich emollient properties. In the last century, products have utilized lanolin alcohol, a purified subfraction of lanolin, to impart emollient and emulsifying benefits. Methods: We reviewed the literature from early suggestions of lanolin allergic reactions in 1939 to the present time, including recent retrospective studies of the results of thousands of patch-tested individuals who presented at clinics in Europe and North America. In addition, the levels of reported putative dermatitis reactions to emollient product formulations containing a specific lanolin alcohol preparation were examined. Results: The data confirm extremely low levels of lanolin alcohol sensitivity in the general population. Among individuals patch-tested in dermatology clinics for suspected allergic dermatitis, the observed rate is about 2%, but varies depending on the specific lanolin alcohol preparation tested. Among lanolin alcohol sensitive individuals, a correlation between leg stasis ulcers/leg dermatitis and lanolin alcohol reactivity has been reported. In contrast to other putative sensitizing agents, positive patch tested persons often tolerate products that contain lanolin alcohol, and significantly fewer individuals have positive patch results when retested 7 months to several years after the primary test. Conclusions: These data suggest that rates of lanolin alcohol sensitivity are very low, and that the characteristics of the observed sensitivity do not mirror that of other common sensitizing agents. 100% sponsored by Beiersdorf Inc.
Mugwort (Artemisia species) is a plant with worldwide distribution that is generally used as a medication in traditional and oriental medicine. There are various forms of mugwort preparations, including infusion, moxibustion, and patch. In Korean herbal medicine, it has been used to treat abdominal pain and various women’s diseases. Moxa, a different preparation of mugwort, also has been used to treat rheumatic arthritis by moxibustion in Chinese medicine. Though it is well known that mugwort pollen can harm humans (acting as an aeroallergen), contact dermatitis caused by the patch preparation of mugwort is rarely reported. A 43year-old Korean male visited our clinic for evaluation and treatment of sharply demarcated erythematous papules on the both arms, hands, neck, and posterior auricle. He had applied the patch preparation of mugwort on exactly the same position to treat his allergic rhinitis. The patch was changed in consecutive days. After 15 days, the skin lesions appeared with severe itching. This case was diagnosed as allergic contact dermatitis (ACD) and confirmed by patch test. To evaluate the frequency of contact dermatitis caused by mugwort, 58 healthy volunteers with no previous history of contact dermatitis caused by any allergen were patch-tested as normal controls with 2.5%, 5%, 10%, and 20% pet. mugwort extract. Seven subjects had positive reactions on day 2, and one subject had a positive reaction on both days 2 and 4. The mean concentration of positive reaction was 10% (10 6 2.3). The positive rate of irritated contact dermatitis was 12.1%, and that of ACD was 1.8%. Compared with positive rates of nickel (18.8% in Korean population), a common sensitizer causing ACD, mugwort induced less ACD. We performed a patch test for 15 consecutive days in 8 out of 57 negative subjects on day 4. All subjects did not have positive reaction. We report a case of contact dermatitis after application of patch preparation of mugwort and the result of patch test of mugwort in healthy controls. Commercial support: None identified.
P714 Resolution of irritant dermatitis with inflammation, edema, and microbial infection Ann Marie Brinton, RN, MSN, Advanced Practice Consultants, El Camino Village, CA, United States; Laura K. S. Parnell, MS, Precision Consulting, Missouri City, TX, United States Irritants on the skin cause an inflammatory reaction to occur and subsequent dermatitis can result. The intensity and duration of the inflammation response depends on the skin environment such as the number of irritants present, potency of each, duration present, pH, and moisture, as well as the immunologic status of the individual. The inflammatory and immune response is further complicated when a secondary microbial infection invades the epidermis and dermis resulting in delayed resolution. Although irritant induced perineal dermatitis is painful and preventable, it is prevalently reported in the literature as [33% in hospitalized adults. This case series of seven ICU and medical/surgical patients with perineal dermatitis were evaluated for treatment and management of their dermatitis. Polymicrobic cultures of Candida albicans and Clostridium difficile, VRE, or MRSA were documented for each person. At baseline evaluation, the skin and lesions were extremely painful, erythematous, and partially denuded despite the use of preventive barriers, antifungal products, and intravenous antibiotics. Patients required various potent analgesics prior to cleaning. Because of the severity of the dermatitis and open lesions, a protease containing miconazol antifungal was initiated. This product was designed to inhibit and down-regulate the inflammatory response while providing antifungal and barrier protection. Dramatic improvement in skin inflammation, erythema, edema, and pain was seen within 12 to 24 hours of the initial application of the product. Analgesic use quickly decreased and patient cooperation increased. Photos show marked improvement in skin condition. Given the tremendous amount of tissue damage, rapid resolution of inflammation was unexpected and unprecedented. Once the skin healed, the product was discontinued. These impressive observations may be partially explained by the proteases inactivating inflammatory mediators, thereby resolving inflammation. Future research comparing protease containing products and assessing the time to resolution of inflammation as well as analgesic type and usage is warranted for a variety of dermatitis etiologies. 85% of all poster and 100% of travel costs sponsored by Swiss-American Products Inc.
FEBRUARY 2008
P716 Challenging pediatric contact dermatitis cases from the University of Miami Mari Paz Castanedo-Tardan, MD, University of Miami, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Aparche Yang, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Elizabeth Alvarez-Connelly, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States; Sharon E. Jacob, MD, University of Miami, Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Miami, FL, United States The University of Miami Pediatric Contact Dermatitis Unit is a regional referral center dedicated to pediatric patients with contact dermatitis. This unique bilingual clinic is developing tools to improve pediatric patch testing procedures in order to meet the needs of children and their families. This poster presents several challenging cases throughout the year as well as the most frequent allergens noted in our pediatric population. Commercial support: None identified.
J AM ACAD DERMATOL
AB57