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Two cases of diffuse temporary alopecia following contact dermatitis of the scalp
ABSTRACTS
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PATCH TESTING OF A NORMAL AGED POPULATION: TRENDS AND SIGNIFICANCE
pREVENTION OF POISON IVY/OAK ALLERGIC CONTACT DERMATITIS BY QUATERN~UM-18 BENTONITE.
Backaround: Epidermal immune function is observed to decline with age. 0biective: To determine the frequency and relevance of patch testing in a normal aged population. Methods: Patch testing with the North American Contact Dermatitis Group standard tray was performed on 82 healthy volunteers ages 68 to 87 (mean age 75), and compared to 41 healthy medical students (mean age 24). Results: 30 (36,6 percent) of the older population had one or more positive patch tests compared to 6 (14.6 percent) of the control group (p=.012). The total number of individual positive patch tests in the older population was 52 compared to 10 in the control group (p=.0124). Common sensitizers in the older group included Balsam of Peru (7), fragrance (8), neomycin (6), nickel (5), and methylchloroisothiazolinone/ rnethylisothiazolinone {3). In addition, fragrance * sensitive patients in the older group were more likely to report severe itching (without dermatitis). Otherwise, reactions bad past relevance, Conclusion: Factors contributing to increased positive patch test frequency in the older population may include cumulative exposure to potential allergens over time as well as the preserved ability to develop contact allergy.
James G Marks r Jr.. M.D., Penn State Univ., Hershey, PA; Joseph F. Fowler, Jr., M.D., Univ. of Louisville, Louisville, KY; Elizabeth Sherertz, M.D., Bowman G r a y - W F U Med. Center, Winston-Salem, NC; Robert L. Rietschel, M.D., Ochsner Clinic, New Orleans, LA Objective= We investigated the p r e v e n t i o n of poison ivy/oak allergic contact dermatitis with a new topical lotion containing 5% quaternium-18 bentonite. Methods= A single-blind, paired comparison, randomized investigation was used to evaluate the e f f e c t i v e n e s s and safety of quaternium-18 bentonite lotion in p r e v e n t i n g experimentally induced poison ivy/oak allergic contact dermatitis in susceptible volunteers. Quaternium-18 bentonite lotion was applied on one forearm an hour prior to both forearms being patch tested with urushiol, the allergenic resin from poison ivy/oak. The p a t c h tests were removed after four hours and the sites interpreted for reaction two, five, and eight days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed. Results: Two hundred eleven (211) subjects with a history of allergic contact dermatitis to poison ivy/oak were studied. One hundred forty four (144) subjecte had positive reactions to the urushiol. The test sites p r e t r e a t e d with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared to untreated control sites (p<.0001) on all test days. When it occurred, the reaction was consistently later in appearance on treated than on control cites (p<.0001). One o c c u r r e n c e of mild, transient, erythema at the application site was the only side effect from the quaternium-18 bentonite lotion. Conclusions= Quaternium-18 bentonite lotion was effective in preventing or diminishing e x p e r i m e n t a l l y - p r o d u c e d poison ivy/oak allergic contact dermatitis.
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TWO CASES OF DIFFUSE TEMPORARY ALOPECIA FOLLOWING
AEROALLERGEN PATCH TESTING IN ATOPIC DERMATITIS, ALLERGIC RHINITIS AND NON-ATOPIC SUBJECTS Aude S. Nassif_ Frances J. Storrs, Susan J. ToRe, Sal C. Chan, and Jon M. Hanifin, Oregon Health Sciences University, Department of Darmatulogy, portland, Oregon
Heidi C. Manoelsdorf. M.D., Alan B. Fleischer, Jr., M.D. Elizabeth F. Sherortz, M.D. Bowman Gray School of Medicine, Wake Forest University, Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC 27157-1071
CONTACT DERMATITIS OF THE SCALP Kunie Matsumura, M.D. and Hideo Nakayama, M.D., Department of Dermatology, Saiseikai Central Hospital.Tokyo, Japan Case I: A 6 1 - y e a r - o l d w o m a n s u f f e r e d f r o m e r y t h e m a , s w e l l i n g , i t c h i n g o f the s c a l p and e y e l i d s and a m a s s i v e hair loss af ter u s i n g a h a i r d y e . H i s t o p a t h o l o g y of the scalp s h o w e d ~dema and i n f i l t r a t i o n of m o n o n u c l e a r c e l l s in the d e r m i s a l o n g with the a~:rophy of hair f o l l i c l e s . Patch tests s h o w e d that she was h y p e r s e n s i t i v e to o r t h o - a m i n o p h e n o l
w h i c h was
c o n t a i n e d in the h a i r c o l o r s o l u t i o n she used, Case 2: A 23year-old woman suddenly suffered from erythema, swelling, i t c h i n g o f the scalp and f o r e h e a d and a m a s s i v e h a i r loss. Patch test s h o w e d that she was h y p e r s e n s i t i v e to c a n a n g a oiI, and the a l l e r g e n was s u s p e c t e d to have c o m e f r o m a r i n c e she used. H i s t o p a t h o l o g y taken at a r e c o v e r y stage s h o w e d m a r k e d a t r o p h y and d e c r e a s e of h a i r f o l l i c l e s of the scalp. T h e s e two cases are d i f f e r e n t f r o m o r d i n a r y a I o p e c i a d i f f u s a by the p r e s e n c e o f p r e c e e d i n g c o n t a c t d e r m a t i t i s , and the s m o o t h , s i m u l l a n c o u s and c o m p l e t e h a i r g r o w t h a ft er the r e m o v a l of the a l l e r g e n s . We p r o p o s e to call such cases c o n t a c t a l o p e c i a , and it may be a new e n t i t y .
Background: In recent years, aeroallargan patch testing in AD (atupic dermatitis) has shown various results with positive tests ranging from 17% to 100%. Unclear has been the role of irritant respo~es and whether reactions occur only in AD or in other allergic conditions. Objectives: 1) To compare the frequency and characteristics of positive aeroallergan patch tests in well-defined patients with AD or with no AD but only ARD (allergic respiratory disease) and in non-atopic control subjects. 2) To compare the positive aeroallergen reactions obtained with a standard positive irritant reaction (sodium lauryl sulfate: SLS) in these subjects. 3) To study histopalhology of biopsies on positive aeroallergen patch tests. Methods: 50 patients (20 AD patients, 20 ARD patients and 10 non-atopie control subjects) were prick tested and 48-hour patch tested to 10 common aeroallargans. Irritant patch testing (seven dilutions of SLS) was performed in parallel along with biopsies on positive aeroallegen and irritant patch tests. Results: The percentage of positive aeroallegen patch tests in AD, ARD and controls were, respectively: 35%, 0°,5 and 0%. The positive aeroallergan reactions differed from the irritant reactions, both clinically and histologically. Positive aeroallergen biopsies showed two distinct patterns, usually eczematuus but, in some cases, urticarial histology. Conclusions: Positive patch tests to aeroallergans in AD could clearly not be attributed to irritant reactions and were not observed in the ARD and non-atopie control groups. Histologic sections ofaeroallergen positive patch tests demonstrated variable patterns, possibly indicating these are hybrids of immediate and cellular immune reactions, responses not elicited in subjects with ARE) alone.
59
19
20
PATCH TESTING OF A NORMAL AGED POPULATION: TRENDS AND SIGNIFICANCE
pREVENTION OF POISON IVY/OAK ALLERGIC CONTACT DERMATITIS BY QUATERN~UM-18 BENTONITE.
Backaround: Epidermal immune function is observed to decline with age. 0biective: To determine the frequency and relevance of patch testing in a normal aged population. Methods: Patch testing with the North American Contact Dermatitis Group standard tray was performed on 82 healthy volunteers ages 68 to 87 (mean age 75), and compared to 41 healthy medical students (mean age 24). Results: 30 (36,6 percent) of the older population had one or more positive patch tests compared to 6 (14.6 percent) of the control group (p=.012). The total number of individual positive patch tests in the older population was 52 compared to 10 in the control group (p=.0124). Common sensitizers in the older group included Balsam of Peru (7), fragrance (8), neomycin (6), nickel (5), and methylchloroisothiazolinone/ rnethylisothiazolinone {3). In addition, fragrance * sensitive patients in the older group were more likely to report severe itching (without dermatitis). Otherwise, reactions bad past relevance, Conclusion: Factors contributing to increased positive patch test frequency in the older population may include cumulative exposure to potential allergens over time as well as the preserved ability to develop contact allergy.
James G Marks r Jr.. M.D., Penn State Univ., Hershey, PA; Joseph F. Fowler, Jr., M.D., Univ. of Louisville, Louisville, KY; Elizabeth Sherertz, M.D., Bowman G r a y - W F U Med. Center, Winston-Salem, NC; Robert L. Rietschel, M.D., Ochsner Clinic, New Orleans, LA Objective= We investigated the p r e v e n t i o n of poison ivy/oak allergic contact dermatitis with a new topical lotion containing 5% quaternium-18 bentonite. Methods= A single-blind, paired comparison, randomized investigation was used to evaluate the e f f e c t i v e n e s s and safety of quaternium-18 bentonite lotion in p r e v e n t i n g experimentally induced poison ivy/oak allergic contact dermatitis in susceptible volunteers. Quaternium-18 bentonite lotion was applied on one forearm an hour prior to both forearms being patch tested with urushiol, the allergenic resin from poison ivy/oak. The p a t c h tests were removed after four hours and the sites interpreted for reaction two, five, and eight days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed. Results: Two hundred eleven (211) subjects with a history of allergic contact dermatitis to poison ivy/oak were studied. One hundred forty four (144) subjecte had positive reactions to the urushiol. The test sites p r e t r e a t e d with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared to untreated control sites (p<.0001) on all test days. When it occurred, the reaction was consistently later in appearance on treated than on control cites (p<.0001). One o c c u r r e n c e of mild, transient, erythema at the application site was the only side effect from the quaternium-18 bentonite lotion. Conclusions= Quaternium-18 bentonite lotion was effective in preventing or diminishing e x p e r i m e n t a l l y - p r o d u c e d poison ivy/oak allergic contact dermatitis.
21
22
TWO CASES OF DIFFUSE TEMPORARY ALOPECIA FOLLOWING
AEROALLERGEN PATCH TESTING IN ATOPIC DERMATITIS, ALLERGIC RHINITIS AND NON-ATOPIC SUBJECTS Aude S. Nassif_ Frances J. Storrs, Susan J. ToRe, Sal C. Chan, and Jon M. Hanifin, Oregon Health Sciences University, Department of Darmatulogy, portland, Oregon
Heidi C. Manoelsdorf. M.D., Alan B. Fleischer, Jr., M.D. Elizabeth F. Sherortz, M.D. Bowman Gray School of Medicine, Wake Forest University, Department of Dermatology, Medical Center Boulevard, Winston-Salem, NC 27157-1071
CONTACT DERMATITIS OF THE SCALP Kunie Matsumura, M.D. and Hideo Nakayama, M.D., Department of Dermatology, Saiseikai Central Hospital.Tokyo, Japan Case I: A 6 1 - y e a r - o l d w o m a n s u f f e r e d f r o m e r y t h e m a , s w e l l i n g , i t c h i n g o f the s c a l p and e y e l i d s and a m a s s i v e hair loss af ter u s i n g a h a i r d y e . H i s t o p a t h o l o g y of the scalp s h o w e d ~dema and i n f i l t r a t i o n of m o n o n u c l e a r c e l l s in the d e r m i s a l o n g with the a~:rophy of hair f o l l i c l e s . Patch tests s h o w e d that she was h y p e r s e n s i t i v e to o r t h o - a m i n o p h e n o l
w h i c h was
c o n t a i n e d in the h a i r c o l o r s o l u t i o n she used, Case 2: A 23year-old woman suddenly suffered from erythema, swelling, i t c h i n g o f the scalp and f o r e h e a d and a m a s s i v e h a i r loss. Patch test s h o w e d that she was h y p e r s e n s i t i v e to c a n a n g a oiI, and the a l l e r g e n was s u s p e c t e d to have c o m e f r o m a r i n c e she used. H i s t o p a t h o l o g y taken at a r e c o v e r y stage s h o w e d m a r k e d a t r o p h y and d e c r e a s e of h a i r f o l l i c l e s of the scalp. T h e s e two cases are d i f f e r e n t f r o m o r d i n a r y a I o p e c i a d i f f u s a by the p r e s e n c e o f p r e c e e d i n g c o n t a c t d e r m a t i t i s , and the s m o o t h , s i m u l l a n c o u s and c o m p l e t e h a i r g r o w t h a ft er the r e m o v a l of the a l l e r g e n s . We p r o p o s e to call such cases c o n t a c t a l o p e c i a , and it may be a new e n t i t y .
Background: In recent years, aeroallargan patch testing in AD (atupic dermatitis) has shown various results with positive tests ranging from 17% to 100%. Unclear has been the role of irritant respo~es and whether reactions occur only in AD or in other allergic conditions. Objectives: 1) To compare the frequency and characteristics of positive aeroallergan patch tests in well-defined patients with AD or with no AD but only ARD (allergic respiratory disease) and in non-atopic control subjects. 2) To compare the positive aeroallergen reactions obtained with a standard positive irritant reaction (sodium lauryl sulfate: SLS) in these subjects. 3) To study histopalhology of biopsies on positive aeroallergen patch tests. Methods: 50 patients (20 AD patients, 20 ARD patients and 10 non-atopie control subjects) were prick tested and 48-hour patch tested to 10 common aeroallargans. Irritant patch testing (seven dilutions of SLS) was performed in parallel along with biopsies on positive aeroallegen and irritant patch tests. Results: The percentage of positive aeroallegen patch tests in AD, ARD and controls were, respectively: 35%, 0°,5 and 0%. The positive aeroallergan reactions differed from the irritant reactions, both clinically and histologically. Positive aeroallergen biopsies showed two distinct patterns, usually eczematuus but, in some cases, urticarial histology. Conclusions: Positive patch tests to aeroallergans in AD could clearly not be attributed to irritant reactions and were not observed in the ARD and non-atopie control groups. Histologic sections ofaeroallergen positive patch tests demonstrated variable patterns, possibly indicating these are hybrids of immediate and cellular immune reactions, responses not elicited in subjects with ARE) alone.