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Selected highlights of the Second Congress of the European Society of Contact Dermatitis
MEETING REPORT
S e l e c t e d H i g h l i g h t s of the S e c o n d C o n g r e s s of the European Society of Contact D e r m a t i t i s Robert L. Rietschel
CONGRESS of the European iety of Contact Dermatitis was held in Barcelona, Spain, on October 6 to 8, 1994. NICKEL
Metals continue to provide insights and controversy for clinicians and researchers of contact dermatitis. K.E. Andersen used nickel sensitivity to study whether the menstrual cycle affected patch test reactivity. Over a range of .01 to 300 p,g/cm 2, no relationship to menses was found. The European community has developed a standard for consumer nickel items that will require (1) a content of no more than .05%, (2) a release of no more than 0.5 txg/cm2/wk, (3) no nickel in earring posts used during epithelization, and (4) 2 years of normal use for nickel coatings. C. Lid6n found that one drop of synthetic sweat heated to 50°C followed by the dimethylglyoxime test will detect the few cases of nickel exposure in which the dimethylglyoxime test is falsely negative. (L. Kanerva reported two cases in which the dimethylglyoxime test was falsely negative). B. Pilz showed that atomic absorption spectrometry of fingernail clippings could be correlated with occupational exposure to nickel and that hairdressers were not at greater risk to nickel exposure because of their jobs. OTHER METALS
Gold sodium thiosulfate may cause delayed reactions with 35% found after day 7 but before day 21; also, 35% of gold patch test reactions persisted for longer than 2 months with a transformation
From the Department of Dermatology, Ochsner Clinic and Alton OchsnerMedical Foundation, New Orleans,LA. Address reprint requests to Robert L. Rietschel, MD, Ochsner Clinic, 1516JeffersonHighway, New Orleans,LA 70121. Copyright © 1995 by W.B. Saunders Company 1046-199X/95/0602-0013503.00/0 128
from an eczematous to a papulonodular reaction according to H. Hedman. Hedman also noted 1 of 10 patients who had dental gold removed observed disappearance of a persistent facial dermatitis and subsequent recurrence when more gold was placed intraorally. O. Dolen found 4.6% of patients patch tested were positive to gold sodium thiosulfate; all were female, all wore gold jewelry, but the relevance was not clear, although most had eczema of the head and neck. P. Koch performed biopsies on positive patch tests at days 10 to 17 in patients who were positive to gold, mercury, or both and had oral lichen planus-like disease. Seven of eight biopsy specimens were histologically lichenoid. Removal of the metal caused clearing of clinical disease in 6 of 10, improvement in 2 of 10, and no change in 2 of 10. B. Kutting described 35 palladium-positive patients. All but 5 were also nickel positive, and only 2 palladium cases were deemed clinically relevant. The significance of cutaneous reactions to metals, such as gold and palladium, remained an area in which no agreement has been reached as to the proper terminology or meaning to be assigned to these observations. K. Thestrup-Pedersen noted that simple metals, such as cadmium, can induce lymphokines associated with irritant and allergic contact dermatitis in the absence of antigenpresenting cells, which would suggest that they may act as mitogens. AIRBORNE COLOPHONY
Standard patch test allergens can be found to be responsible for unusual forms of dermatitis. A.-T. Karlberg found that eyelid and facial dermatitis could be traced to floor polish that left a dust of colophony for redistribution as an airborne contactant. When the floor polish was changed to a noncolophony-containing product, the eyelid and facial dermatitis of 2 patients, previously thought to
American Journal of Contact Dermatiti$, Vol 6, No 2 (June), 1995: pp 128-129
MEETING REPORT
129
have sick building syndrome and video display terminal dermatitis, permanently resolved. CORTICOSTEROIDS
Corticosteroid allergy continues to be common in the experience of M. Beck (4.5% of patients patch tested). He found 91% of patients (116 of 127) to be identified as corticosteroid-sensitive with a 1% (ethanol) patch test to tixocortol pivalate and budesonide. A. Dooms-Goosens noted more reactions to ethanol (absolute), isopropanol, and aldehydes, such as glutaraldehyde, among corticosteroid-sensitive patients. Fourteen of 2,245 patch test patients were reactive to ethanol (9 to both ethanol and budesonide in petrolatum). Alcohol and aldehyde reactivity could be an irritant reaction related to an enzyme deficiency, and whether it will also be related to corticosteroid metabolism is as yet uncertain. LANOLIN
I. Steel reviewed lanolin allergy and noted that Amerchol L101, which is 90% mineral oil and 10% lanolin alcohol, produces more patch test reactions than 30% wool wax alcohol, but the significance of these reactions is in dispute. CALCIPOTRIOL
Now that calcipotriol is available in the United States, it is helpful to know that J. Setup has observed that at the normal use concentration of 50 tzg/g in the commercial vehicle, a + 1 reaction can be found by patch testing normal (immunologically naive) subjects and that doubtful (+-) reactions may occur in up to 40% of normal subjects. Patients who experience dermatitis when treating their psoriasis with calcipotriol may have negative patch tests. The proper nonirritant patch test concentration is not presently known. LATEX
Latex allergy continues to be of interest, and J. Taylor identified 43 cases of latex allergy. He found 37 by the prick test, 2 by the wear test, and 4 by the radioallergosorbent test. He found that reaction to 1 finger from a latex glove moistened
and worn for 15 to 30 minutes could be compared with reaction to 1 finger from a vinyl glove identically treated and worn on a different finger. If negative results occur with the latex finger, then the whole glove can be similarly worn as a test with vinyl glove control, and then a prick test can be performed to complete the evaluation. Vinyl allergy was observed in 4 patients. Health care workers and patients with spina bifida were particularly at risk for latex allergy. EUXYL K400
C.J.W. Van Ginkel found the cause of perianal itch and eczema to be due to the preservative Euxyl K400 present in moistened toilet tissues in 12 of 16 patients. PLANTS
B. Bj6rkner studied workers in tulip nurseries and found that the plant parts were a suitable patch test material superior to plant extracts and at least the equal of specific allergen testing with Tulipolin A and/or B.P. DeHaan found polyvinyl chloride and latex gloves to provide inadequate protection for Tulipolin A sensitive alstromeria or workers in tulip nurseries. Household weight but not surgical weight neoprene or nitrile gloves and the 4-H glove provided protection for about 4 hours. A. Rothe identified 10 cases of allergy to chicory, all of which were positive to the root to a greater extent than the leaf. Most of these patients were involved in plant cultivation, and 2 flared with oral ingestion of raw chicory but not cooked chicory. FLUTAMIDE
F. Brandfio noted the occurrence offlutamide photosensitivity in 2 patients being treated for prostate cancer with 750 mg daily. One was sensitive to UVA light at I J; the other had a positive photopatch test to flutamide with 5 J of UVA light and a 1% and 10% concentration in petrolatum. Many other interesting reports were presented at this meeting. These reports were selected to be mentioned because of their potential interest to a broad section of North American dermatologists.
S e l e c t e d H i g h l i g h t s of the S e c o n d C o n g r e s s of the European Society of Contact D e r m a t i t i s Robert L. Rietschel
CONGRESS of the European iety of Contact Dermatitis was held in Barcelona, Spain, on October 6 to 8, 1994. NICKEL
Metals continue to provide insights and controversy for clinicians and researchers of contact dermatitis. K.E. Andersen used nickel sensitivity to study whether the menstrual cycle affected patch test reactivity. Over a range of .01 to 300 p,g/cm 2, no relationship to menses was found. The European community has developed a standard for consumer nickel items that will require (1) a content of no more than .05%, (2) a release of no more than 0.5 txg/cm2/wk, (3) no nickel in earring posts used during epithelization, and (4) 2 years of normal use for nickel coatings. C. Lid6n found that one drop of synthetic sweat heated to 50°C followed by the dimethylglyoxime test will detect the few cases of nickel exposure in which the dimethylglyoxime test is falsely negative. (L. Kanerva reported two cases in which the dimethylglyoxime test was falsely negative). B. Pilz showed that atomic absorption spectrometry of fingernail clippings could be correlated with occupational exposure to nickel and that hairdressers were not at greater risk to nickel exposure because of their jobs. OTHER METALS
Gold sodium thiosulfate may cause delayed reactions with 35% found after day 7 but before day 21; also, 35% of gold patch test reactions persisted for longer than 2 months with a transformation
From the Department of Dermatology, Ochsner Clinic and Alton OchsnerMedical Foundation, New Orleans,LA. Address reprint requests to Robert L. Rietschel, MD, Ochsner Clinic, 1516JeffersonHighway, New Orleans,LA 70121. Copyright © 1995 by W.B. Saunders Company 1046-199X/95/0602-0013503.00/0 128
from an eczematous to a papulonodular reaction according to H. Hedman. Hedman also noted 1 of 10 patients who had dental gold removed observed disappearance of a persistent facial dermatitis and subsequent recurrence when more gold was placed intraorally. O. Dolen found 4.6% of patients patch tested were positive to gold sodium thiosulfate; all were female, all wore gold jewelry, but the relevance was not clear, although most had eczema of the head and neck. P. Koch performed biopsies on positive patch tests at days 10 to 17 in patients who were positive to gold, mercury, or both and had oral lichen planus-like disease. Seven of eight biopsy specimens were histologically lichenoid. Removal of the metal caused clearing of clinical disease in 6 of 10, improvement in 2 of 10, and no change in 2 of 10. B. Kutting described 35 palladium-positive patients. All but 5 were also nickel positive, and only 2 palladium cases were deemed clinically relevant. The significance of cutaneous reactions to metals, such as gold and palladium, remained an area in which no agreement has been reached as to the proper terminology or meaning to be assigned to these observations. K. Thestrup-Pedersen noted that simple metals, such as cadmium, can induce lymphokines associated with irritant and allergic contact dermatitis in the absence of antigenpresenting cells, which would suggest that they may act as mitogens. AIRBORNE COLOPHONY
Standard patch test allergens can be found to be responsible for unusual forms of dermatitis. A.-T. Karlberg found that eyelid and facial dermatitis could be traced to floor polish that left a dust of colophony for redistribution as an airborne contactant. When the floor polish was changed to a noncolophony-containing product, the eyelid and facial dermatitis of 2 patients, previously thought to
American Journal of Contact Dermatiti$, Vol 6, No 2 (June), 1995: pp 128-129
MEETING REPORT
129
have sick building syndrome and video display terminal dermatitis, permanently resolved. CORTICOSTEROIDS
Corticosteroid allergy continues to be common in the experience of M. Beck (4.5% of patients patch tested). He found 91% of patients (116 of 127) to be identified as corticosteroid-sensitive with a 1% (ethanol) patch test to tixocortol pivalate and budesonide. A. Dooms-Goosens noted more reactions to ethanol (absolute), isopropanol, and aldehydes, such as glutaraldehyde, among corticosteroid-sensitive patients. Fourteen of 2,245 patch test patients were reactive to ethanol (9 to both ethanol and budesonide in petrolatum). Alcohol and aldehyde reactivity could be an irritant reaction related to an enzyme deficiency, and whether it will also be related to corticosteroid metabolism is as yet uncertain. LANOLIN
I. Steel reviewed lanolin allergy and noted that Amerchol L101, which is 90% mineral oil and 10% lanolin alcohol, produces more patch test reactions than 30% wool wax alcohol, but the significance of these reactions is in dispute. CALCIPOTRIOL
Now that calcipotriol is available in the United States, it is helpful to know that J. Setup has observed that at the normal use concentration of 50 tzg/g in the commercial vehicle, a + 1 reaction can be found by patch testing normal (immunologically naive) subjects and that doubtful (+-) reactions may occur in up to 40% of normal subjects. Patients who experience dermatitis when treating their psoriasis with calcipotriol may have negative patch tests. The proper nonirritant patch test concentration is not presently known. LATEX
Latex allergy continues to be of interest, and J. Taylor identified 43 cases of latex allergy. He found 37 by the prick test, 2 by the wear test, and 4 by the radioallergosorbent test. He found that reaction to 1 finger from a latex glove moistened
and worn for 15 to 30 minutes could be compared with reaction to 1 finger from a vinyl glove identically treated and worn on a different finger. If negative results occur with the latex finger, then the whole glove can be similarly worn as a test with vinyl glove control, and then a prick test can be performed to complete the evaluation. Vinyl allergy was observed in 4 patients. Health care workers and patients with spina bifida were particularly at risk for latex allergy. EUXYL K400
C.J.W. Van Ginkel found the cause of perianal itch and eczema to be due to the preservative Euxyl K400 present in moistened toilet tissues in 12 of 16 patients. PLANTS
B. Bj6rkner studied workers in tulip nurseries and found that the plant parts were a suitable patch test material superior to plant extracts and at least the equal of specific allergen testing with Tulipolin A and/or B.P. DeHaan found polyvinyl chloride and latex gloves to provide inadequate protection for Tulipolin A sensitive alstromeria or workers in tulip nurseries. Household weight but not surgical weight neoprene or nitrile gloves and the 4-H glove provided protection for about 4 hours. A. Rothe identified 10 cases of allergy to chicory, all of which were positive to the root to a greater extent than the leaf. Most of these patients were involved in plant cultivation, and 2 flared with oral ingestion of raw chicory but not cooked chicory. FLUTAMIDE
F. Brandfio noted the occurrence offlutamide photosensitivity in 2 patients being treated for prostate cancer with 750 mg daily. One was sensitive to UVA light at I J; the other had a positive photopatch test to flutamide with 5 J of UVA light and a 1% and 10% concentration in petrolatum. Many other interesting reports were presented at this meeting. These reports were selected to be mentioned because of their potential interest to a broad section of North American dermatologists.