- Email: [email protected]
The improvement in nickel patch testing with a new vehicle
Free conrmur~icalion
FC2.
FC2. Adverse
Adverse drug reactions/Contact dermatitis
FC2-1 Permeation of 2-hyclroxyethyl methacrylate and triethyleneglycol dimethacrylate through disposable protective gloves E.A. Makell, V. VISiniinen, R. Jolanki, T. Estlander, L. Kanerva, K. Alanko. Finnish hstifure of Occupafional Health,
Helsinki,
Firrland
Methacrylate allergy is an increasing problem for dental personnel. This study found out which kind of gloves could protect from methacrylates adequately. Permeation tests according to standard EN 374-3 were carried out for nine different types of disposable gloves. Some tests were made with two glove samples on top of each other. A 50% mixture of 2-hydroxyethyl methacrylate and triethyleneglycol dimethacrylate was used as a test chemical. The results for typical natural rubber latex and PVC materials were a little less than 10 min. Synthetic elastomers and combinations of polyethylene or polyethyleneethylene vinyl alcohol materials with natural rubber brought better results. The breakthrough times of the layers of two gloves were 1.5-2 fold compared to the sum of the breakthrough times of single glove samples. Some disposable gloves can be used as barriers to methacrylates, and double-gloving can be beneficial in reducing skin exposure. Manufacturers should be required to supply more disposable chemical protective gloves that have been type-tested with dental materials.
drug reactions/Conract
s129
dertnatiris
after three weeks. The lymphocytic stimulation test was positive to minocycline. Establishing the diagnosis was difficult due to coexistence of two diseases and because minocycline is a rare cause of hypersensitivity syndrome.
FC2-3 The prevention of nickel induced allergic contact dermatitis by pentoxifylline I+ Sarlcao#u, S. Tunah, E. Billbiil, Z. Palah. Vludug Vniversitesi Tiirkiye
TIP Fakiiltesi,
Dermatoloji
A.B.D.,
Bursa,
We investigated the effect of pentoxifylline, an inhibitor of TNF-, on contact sensitivity response induced by nickel. For induction, open epicutaneous sensitization by NiS0.+6HzO (25% aq) solution has been applied on the backs of 38 albino giunea pigs 5 days a week for 4 weeks. NaCl (0.9%) solution was applied to 10 albino guinea pigs taken as a control group. Nineteen of them developed positive patch test reactions, showing nickel sensitization. Patch tests were repeated after pentoxifylline administration to 10 of the sensitized pigs 20 mg/kg/day orally. At the end of the study, 2/10 of drug treated pigs developed positive patch test reactions while 7/9 of untreated pigs developed positive reactions. These results support the idea that pentoxifylline inhibits nickel induced contact sensitivity response.
FC2-4 Rove beetle (Paederus) dermatitis FC2-2
Hypersensitivity syndrome by minocycline in a patient with infectious mononucleosis
R. Oliveira Soares, R. Silva. V. Sousa Coutinho, J.F?Freitas. E Guerra Rodrigo. Hospital de Santa Maria, Lisboa, Portugal Minocycline is the most widely prescribed systemic antibiotic for acne. Hypersensitivity syndrome is a severe drug-induced eruption, as multivisceral involvment can be responsible for death at an acute stage. It has been reported with carbamazepine, phenytoin, phenobarbital, allopurinol. dapsone and, recently with minocycline. The authors report a case of a 16 years old female with fever and asthenia for the last 15 days. A facial maculopapular rash developed and extended to trunk and limbs in the 24 hours prior to our observation. She was medicated with minocycline for the 10 days before the initial complaints. She was febrile (38°C) and deshydrated. There were palpable cervical and axilar bilateral painful lymph nodes, facial edema, exfoliative erythroderma and scattered vesicles in both forearms. She had leucocytosis with lymphocytosis and eosinophilia, elevation of aspartate aminotransferase and alanine aminotransferase. Cutaneous biopsy showed a lymphocytic perivascular dermal infiltrate and mild keratinocyte necrosis. Epstein-Barr virus serology was positive (ig G and Ig M). Myelogram was normocellular with 30% eosinophils. Therapy was composed of sodiumchloride IV, hydroxizine (50 mg’tid), paracetamol (qid), prednisone (40 mg/d) and simple Vaseline (topical). After 15 days apyrexia and regression of dermatosis occurred. Normalization of the white blood cell count and enzymology
K. Abdel-Hafez. Department University
Hospital,
Assiut,
of Dermatology, Egypt
Assiut
Since 1992, we, in the Dermatology Outpatient Clinic of Assiut University Hospital, have been observing an increasing number of cases of a peculiar dermatitis. The dermatitis was usually of sudden onset. It extended for 1 to 3 days and healed in 1 to 2 weeks. Burning sensation was the main symptom. The dermatitis affected mainly the exposed sites, the neck followed by the face were the commonest affected sites. It was generally erythematovesicular and linear in shape. Kissing lesions were characteristic and observed in about 2% of cases. Eyelid dermatitis was also striking and observed in about 2% of cases. The dermatitis affected persons of all ages and both sexes, as well as all social classes. Affection of more than one member of the family was observed in about 10% of the patients. The incidence of the dermatitis was exclusively during the summer months. The cause of the dermatitis was suggested to be due to the rove beetle, Paederus alfierii.
FC2-5 The improvement in nickel patch testing with a new vehicle P.D. Pigatto, U. Giaroli, A. Riboldi, A.S. Bigardi. Department of Dermatology Milan, Italy
and IRCCS
Ospedale
Magiore
of Milan,
Objective: We investigated the possibility to improve diagnostic patch testing by using a new vehicle, different than usuals. Nickel sulfate was complexed with phospholipids (patented) for this experimental trial in order to evaluate, in vitro and
s130
Free con~n~rtnicarion
FC2. Adverse
in vivo, the chemical’s bioavailability. percutaneous absorption and clinical response. Methods: 100 patients with nickel allergic contact dermatitis were patch tested. At the same time NiSOJ 5%. 3%. 1%. OS%-new vehicle and NISO4 5%-petrolatum were applied on the back and the results read with the ICDRG scoring system. For in vitro studies NISOJ was complexed with new vehicle and Ruorescein in human keratinocyte cultures. Results: we found a nice correlated clinical response between lower concentrations NISOJ-new vehicle vs standard NlS04 5%-petrolatum. At the experimental level we found an internalization of the complex cultured in human keratinocytes with notes of apopthosis. Conclusions: NISOJ-phospholipids complex can influence bioavailability of the chemicals into the cells as well as percutaneous absorption and clinical response. We think that this vehicle could be used for other aptens. FC2-6
A novel case of acute generalized exanthematous pustulosis secondary minocycline in a black young girl
to
Ph. Beaulieu I.?, J.P. Vignali’, J.F. Devars’. V. Molinie’, A. Pradalie;. ‘Federariorl Francaise de Forntation Continue Dernmtologie; ‘Department Mowier 92700 Colonlbes,
of hternal France
Medecine
Hopital
en L
We report a case of AGEP induced by minocycline in a young black girl. A l6-year-old balck woman suffering from an acne was treated by mynocicline (100 mg a day). On the Zlrst day, she presented an acute disseminated pustulosis. There were nonfollicular small pustules on edematous erythema, burning and pmritic.. She had fever (39°C). The white cell count was 25 200/mm3 with 41% neutrophils,. The liver tes was anorma1 with an increase of aminotransferase (* ALT 20 N, AST ISN). lge arised 19734 IU. Blood and immunologic chemistry was within normal limits. Cultures repeatedly taken from pustular lesions showed negative. Skin biopsy was spongiforme vesicules, papillary oedema and a polymorphous perivascular infiltrates. The goal of this observation is to insist to take care of prescription of minocicline in blacks. Recently, 5 cases (/7) of hypersensitivity syndrom induced by minocycline was described in blacks (2). It probably exists a genetic predisposition. This observation is interesting by the liver failure which is rare in AGEP (I). References [I] Roujeau JC, Biuolac-Sage P, Bourseau C et toll: Acute Generalized Exanthematous Pustulosis. Arch Dermatol 1991; 127: 1333-38. [2] beneton N, Bocquet H. Callot V, Pameix A, Roujeau JC. Revuz: Syndrome d’hypersensibilitb g la mynocicline. 1996: S69: C 102.
drug reocrions/Contact
IFC2 7
demariris
Cutaneous recipients
diseases
in kidney
transplant
1. Lesnoni La Parola, C. Masini, G. Nanni’. A. Diociaiuti, M. Capuano, A. Gioia, M. Castagneto’, D. Cerimele. Dept. Dernmtolagy; ‘Organ Transplantation University Sacred Heart, Rome, 1tai.v
Unit
Catholic
During the last ten years, 466 renal transplant recipients were followed, with a mean age of 42 years and a male/female ratio of 1.9. More than 50% of the patients complained of cutaneous lesions, which included iatrogenic skin alterations (54% of the lesions), cutaneous infections (41%), skin neoplasms (4.6%). Acne was the most common disease, affecting 21% of the patients. Other steroid related side effects were couperose (7.2%). irsutism (6.5%), seborrhoeic dermatitis (6.2%). The more prevalent side effects due to Cyclosporin A were gingival hypertrophy (6.6%) and hypertrichosis (3%). Cutaneous infections were mainly fungal (47.6%) and viral (27%). Pytiriasis versicolor accounts for 6 I .4% of all fungal infections, with an incidence of 18.4%. Papilloma virus induced lesions, mainly common warts, were 75% of the viral infections, with an incidence of 12.3%. Kaposi’s sarcoma affected 2.15% of patients, and was localized to the skin in 7 patients and visceral in 3 patients. Basal cell carcinomas represented 43% of the neoplasms (incidence I .9%), and no inverted basal cell/squamous cell carcinoma ratio has been observed. associated I FC2 6 Severe reaction to vancomycin with a vancomycin-induced release of sulfidoleukotrienes by leukocytes in vitro A. Busse. J.C. Simon, E. Sch8pf. W. Czech. Departnwnt Dermatology, Germany
University
of Fwibuy,
D-79104
of
Freiburg,
In this presentation we demonstrate a potentially life-threatening reaction to vancomycin and evaluate a possible test for in-vitro diagnosis. We report a case of a 60-y-old woman with a history of a immediate type adverse reaction to vancomycin. Allergological examination showed no cutaneous reactvity in vancomycin skin tests, but provocation with vancomycin i.v.. resulted in an anaphylactic shock. We investigated the effect of vancomycin on the de novo synthesis of sulfidoleukotrienes (sLT) by leukocytes in-vitro. The production of sLT in leukocytes was measured by CAST-ELISA (DPC Biermann, Bad Nauheim). In contrast to controls (n = 3) it was shown that a preincubation of leukocytes with vancomycin (1, IO. 100 pglml) highly enhanced the specific induced (C5a, fmlp) release of sLT in-vitro. There was no influence of vancomycin on the spontaneous, anti-IgE- or lonomycin-induced production of sLT. In summery, we believe that the reaction presented here is rare ‘and differs from the typical “red man syndrom”. Clinicans should be aware that not all reactions from vancomycin can be evaded by slow infusion. Our in-vitro results indicate that measurement of sLT release might be a useful tool to establish a diagnostic in-vitro test for allergic/pseudoallergic drug reactions.
FC2.
FC2. Adverse
Adverse drug reactions/Contact dermatitis
FC2-1 Permeation of 2-hyclroxyethyl methacrylate and triethyleneglycol dimethacrylate through disposable protective gloves E.A. Makell, V. VISiniinen, R. Jolanki, T. Estlander, L. Kanerva, K. Alanko. Finnish hstifure of Occupafional Health,
Helsinki,
Firrland
Methacrylate allergy is an increasing problem for dental personnel. This study found out which kind of gloves could protect from methacrylates adequately. Permeation tests according to standard EN 374-3 were carried out for nine different types of disposable gloves. Some tests were made with two glove samples on top of each other. A 50% mixture of 2-hydroxyethyl methacrylate and triethyleneglycol dimethacrylate was used as a test chemical. The results for typical natural rubber latex and PVC materials were a little less than 10 min. Synthetic elastomers and combinations of polyethylene or polyethyleneethylene vinyl alcohol materials with natural rubber brought better results. The breakthrough times of the layers of two gloves were 1.5-2 fold compared to the sum of the breakthrough times of single glove samples. Some disposable gloves can be used as barriers to methacrylates, and double-gloving can be beneficial in reducing skin exposure. Manufacturers should be required to supply more disposable chemical protective gloves that have been type-tested with dental materials.
drug reactions/Conract
s129
dertnatiris
after three weeks. The lymphocytic stimulation test was positive to minocycline. Establishing the diagnosis was difficult due to coexistence of two diseases and because minocycline is a rare cause of hypersensitivity syndrome.
FC2-3 The prevention of nickel induced allergic contact dermatitis by pentoxifylline I+ Sarlcao#u, S. Tunah, E. Billbiil, Z. Palah. Vludug Vniversitesi Tiirkiye
TIP Fakiiltesi,
Dermatoloji
A.B.D.,
Bursa,
We investigated the effect of pentoxifylline, an inhibitor of TNF-, on contact sensitivity response induced by nickel. For induction, open epicutaneous sensitization by NiS0.+6HzO (25% aq) solution has been applied on the backs of 38 albino giunea pigs 5 days a week for 4 weeks. NaCl (0.9%) solution was applied to 10 albino guinea pigs taken as a control group. Nineteen of them developed positive patch test reactions, showing nickel sensitization. Patch tests were repeated after pentoxifylline administration to 10 of the sensitized pigs 20 mg/kg/day orally. At the end of the study, 2/10 of drug treated pigs developed positive patch test reactions while 7/9 of untreated pigs developed positive reactions. These results support the idea that pentoxifylline inhibits nickel induced contact sensitivity response.
FC2-4 Rove beetle (Paederus) dermatitis FC2-2
Hypersensitivity syndrome by minocycline in a patient with infectious mononucleosis
R. Oliveira Soares, R. Silva. V. Sousa Coutinho, J.F?Freitas. E Guerra Rodrigo. Hospital de Santa Maria, Lisboa, Portugal Minocycline is the most widely prescribed systemic antibiotic for acne. Hypersensitivity syndrome is a severe drug-induced eruption, as multivisceral involvment can be responsible for death at an acute stage. It has been reported with carbamazepine, phenytoin, phenobarbital, allopurinol. dapsone and, recently with minocycline. The authors report a case of a 16 years old female with fever and asthenia for the last 15 days. A facial maculopapular rash developed and extended to trunk and limbs in the 24 hours prior to our observation. She was medicated with minocycline for the 10 days before the initial complaints. She was febrile (38°C) and deshydrated. There were palpable cervical and axilar bilateral painful lymph nodes, facial edema, exfoliative erythroderma and scattered vesicles in both forearms. She had leucocytosis with lymphocytosis and eosinophilia, elevation of aspartate aminotransferase and alanine aminotransferase. Cutaneous biopsy showed a lymphocytic perivascular dermal infiltrate and mild keratinocyte necrosis. Epstein-Barr virus serology was positive (ig G and Ig M). Myelogram was normocellular with 30% eosinophils. Therapy was composed of sodiumchloride IV, hydroxizine (50 mg’tid), paracetamol (qid), prednisone (40 mg/d) and simple Vaseline (topical). After 15 days apyrexia and regression of dermatosis occurred. Normalization of the white blood cell count and enzymology
K. Abdel-Hafez. Department University
Hospital,
Assiut,
of Dermatology, Egypt
Assiut
Since 1992, we, in the Dermatology Outpatient Clinic of Assiut University Hospital, have been observing an increasing number of cases of a peculiar dermatitis. The dermatitis was usually of sudden onset. It extended for 1 to 3 days and healed in 1 to 2 weeks. Burning sensation was the main symptom. The dermatitis affected mainly the exposed sites, the neck followed by the face were the commonest affected sites. It was generally erythematovesicular and linear in shape. Kissing lesions were characteristic and observed in about 2% of cases. Eyelid dermatitis was also striking and observed in about 2% of cases. The dermatitis affected persons of all ages and both sexes, as well as all social classes. Affection of more than one member of the family was observed in about 10% of the patients. The incidence of the dermatitis was exclusively during the summer months. The cause of the dermatitis was suggested to be due to the rove beetle, Paederus alfierii.
FC2-5 The improvement in nickel patch testing with a new vehicle P.D. Pigatto, U. Giaroli, A. Riboldi, A.S. Bigardi. Department of Dermatology Milan, Italy
and IRCCS
Ospedale
Magiore
of Milan,
Objective: We investigated the possibility to improve diagnostic patch testing by using a new vehicle, different than usuals. Nickel sulfate was complexed with phospholipids (patented) for this experimental trial in order to evaluate, in vitro and
s130
Free con~n~rtnicarion
FC2. Adverse
in vivo, the chemical’s bioavailability. percutaneous absorption and clinical response. Methods: 100 patients with nickel allergic contact dermatitis were patch tested. At the same time NiSOJ 5%. 3%. 1%. OS%-new vehicle and NISO4 5%-petrolatum were applied on the back and the results read with the ICDRG scoring system. For in vitro studies NISOJ was complexed with new vehicle and Ruorescein in human keratinocyte cultures. Results: we found a nice correlated clinical response between lower concentrations NISOJ-new vehicle vs standard NlS04 5%-petrolatum. At the experimental level we found an internalization of the complex cultured in human keratinocytes with notes of apopthosis. Conclusions: NISOJ-phospholipids complex can influence bioavailability of the chemicals into the cells as well as percutaneous absorption and clinical response. We think that this vehicle could be used for other aptens. FC2-6
A novel case of acute generalized exanthematous pustulosis secondary minocycline in a black young girl
to
Ph. Beaulieu I.?, J.P. Vignali’, J.F. Devars’. V. Molinie’, A. Pradalie;. ‘Federariorl Francaise de Forntation Continue Dernmtologie; ‘Department Mowier 92700 Colonlbes,
of hternal France
Medecine
Hopital
en L
We report a case of AGEP induced by minocycline in a young black girl. A l6-year-old balck woman suffering from an acne was treated by mynocicline (100 mg a day). On the Zlrst day, she presented an acute disseminated pustulosis. There were nonfollicular small pustules on edematous erythema, burning and pmritic.. She had fever (39°C). The white cell count was 25 200/mm3 with 41% neutrophils,. The liver tes was anorma1 with an increase of aminotransferase (* ALT 20 N, AST ISN). lge arised 19734 IU. Blood and immunologic chemistry was within normal limits. Cultures repeatedly taken from pustular lesions showed negative. Skin biopsy was spongiforme vesicules, papillary oedema and a polymorphous perivascular infiltrates. The goal of this observation is to insist to take care of prescription of minocicline in blacks. Recently, 5 cases (/7) of hypersensitivity syndrom induced by minocycline was described in blacks (2). It probably exists a genetic predisposition. This observation is interesting by the liver failure which is rare in AGEP (I). References [I] Roujeau JC, Biuolac-Sage P, Bourseau C et toll: Acute Generalized Exanthematous Pustulosis. Arch Dermatol 1991; 127: 1333-38. [2] beneton N, Bocquet H. Callot V, Pameix A, Roujeau JC. Revuz: Syndrome d’hypersensibilitb g la mynocicline. 1996: S69: C 102.
drug reocrions/Contact
IFC2 7
demariris
Cutaneous recipients
diseases
in kidney
transplant
1. Lesnoni La Parola, C. Masini, G. Nanni’. A. Diociaiuti, M. Capuano, A. Gioia, M. Castagneto’, D. Cerimele. Dept. Dernmtolagy; ‘Organ Transplantation University Sacred Heart, Rome, 1tai.v
Unit
Catholic
During the last ten years, 466 renal transplant recipients were followed, with a mean age of 42 years and a male/female ratio of 1.9. More than 50% of the patients complained of cutaneous lesions, which included iatrogenic skin alterations (54% of the lesions), cutaneous infections (41%), skin neoplasms (4.6%). Acne was the most common disease, affecting 21% of the patients. Other steroid related side effects were couperose (7.2%). irsutism (6.5%), seborrhoeic dermatitis (6.2%). The more prevalent side effects due to Cyclosporin A were gingival hypertrophy (6.6%) and hypertrichosis (3%). Cutaneous infections were mainly fungal (47.6%) and viral (27%). Pytiriasis versicolor accounts for 6 I .4% of all fungal infections, with an incidence of 18.4%. Papilloma virus induced lesions, mainly common warts, were 75% of the viral infections, with an incidence of 12.3%. Kaposi’s sarcoma affected 2.15% of patients, and was localized to the skin in 7 patients and visceral in 3 patients. Basal cell carcinomas represented 43% of the neoplasms (incidence I .9%), and no inverted basal cell/squamous cell carcinoma ratio has been observed. associated I FC2 6 Severe reaction to vancomycin with a vancomycin-induced release of sulfidoleukotrienes by leukocytes in vitro A. Busse. J.C. Simon, E. Sch8pf. W. Czech. Departnwnt Dermatology, Germany
University
of Fwibuy,
D-79104
of
Freiburg,
In this presentation we demonstrate a potentially life-threatening reaction to vancomycin and evaluate a possible test for in-vitro diagnosis. We report a case of a 60-y-old woman with a history of a immediate type adverse reaction to vancomycin. Allergological examination showed no cutaneous reactvity in vancomycin skin tests, but provocation with vancomycin i.v.. resulted in an anaphylactic shock. We investigated the effect of vancomycin on the de novo synthesis of sulfidoleukotrienes (sLT) by leukocytes in-vitro. The production of sLT in leukocytes was measured by CAST-ELISA (DPC Biermann, Bad Nauheim). In contrast to controls (n = 3) it was shown that a preincubation of leukocytes with vancomycin (1, IO. 100 pglml) highly enhanced the specific induced (C5a, fmlp) release of sLT in-vitro. There was no influence of vancomycin on the spontaneous, anti-IgE- or lonomycin-induced production of sLT. In summery, we believe that the reaction presented here is rare ‘and differs from the typical “red man syndrom”. Clinicans should be aware that not all reactions from vancomycin can be evaded by slow infusion. Our in-vitro results indicate that measurement of sLT release might be a useful tool to establish a diagnostic in-vitro test for allergic/pseudoallergic drug reactions.