A 50-year-old female developed extensive condylomata acuminata in the genito anal region over a period of 12 years. She presented with multiple, verrucous le sions involving the whole genitoanal area plus the adjacent...A 50-year-old female developed extensive condylomata acuminata in the genito anal region over a period of 12 years. She presented with multiple, verrucous le sions involving the whole genitoanal area plus the adjacent perineum and gluteal region which made it impossible to identify the anatomical structures. Proctosc opy was normal. Serology for infectious diseases was negative. Several biopsies showed no signs of malignant transformation. Tumor excision under general anaest hesia was incomplete. Therefore, adjunctive therapy with immunomodulatory agents was administered, utilizing local application of imiquimod cream (3 x weekly) f or 3 months and subcutaneous injections of interferon-alpha-2a (3 million IU 3 x weekly) for 5 months. This treatment regimen resulted in complete remission of all skin lesions with only discrete superficial scarring but no significant los s of anatomical structures or functions. During a 1-year follow-up the patient showed no sign of relapse.展开更多
In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. ...In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. Hence, patch testing with MWF from the patient’s workplace is an important additional diagnostic tool. However, recommendations on how to perform such patch tests vary. We retrospectively analyzed patch test data of the Department of Dermatology in Dortmund, 1992-2003. In 141 metalworkers tested because of suspected occupational contact dermatitis due to MWF, 829 patch tests with 306 samples of MWF were performed. Water-based MWF (wb MWF) were mainly tested in 2 dilution series, i.e. pure (workplace concentration), 10%aq. and 1%aq., and pure, 50%aq. and 10%aq. Positive reactions to wb MWF occurred in 27 patients. Patch testing with wb MWF at workplace concentration resulted in 16.1 %(39/242) positive reactions, with a positivity ratio of 69%and a reaction index of 0. From the analysis of reaction patterns and concomitant reactions,we conclude that most of these positive reactions indicated true contact allergy. With lower concentrations, relevant allergic reactions may be missed. Neat oils were tested as is or diluted from 1 to 50%in olive oil, but no reactions at all were observed. For optimum benefit of patch testing with MWF from the patient’s workplace, breakdown testing is recommended. To overcome the time-consuming difficulties associated with this procedure, we propose a centre for information and documentation of contact allergies due to occupational exposure. Furthermore, full declaration of MWF ingredients is desirable.展开更多
A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, t...A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, test results with the individual constituents and after repeated open application test (ROAT) of FM II are described. Furthermore, cosmetic products which had caused a contact dermatitis in patients were analysed for the presence of the individual constituents. In 1701 patients, the individual constituents of the medium (14%) and the highest (28%) concentration of FM II were simultaneously applied with the new mix at 3 concentrations (break-down testing for the lowest concentration of FM II (2.8%) was performed only if the mix was positive). ROAT was performed with the concentration of the FM II which had produced a positive or doubtful (+or ?+) patch test reaction. Patients’products were ana-lysed for the 6 target compounds by gas chromatography-mass spectrometry (GC-MS). Results:50 patients (2.9%) showed a positive reaction to 14%FM II and 70 patients (4.1%) to 28%FM II. 24/50 (48%) produced a positive reaction to 1 or more of the individual constituents of 14%FM II and 38/70 (54.3%) to 28%FM II, respectively. If doubtful reactions to individual constituents are included, the break-down testing was positive in 74%and 70%, respectively. Patients with a positive reaction to 14%FM II showed a higher rate of reactions to the individual constituent of the 28%FM II:36/50 (72%). Positive reactions to individual constituents in pa-tients negative to FM II were exceedingly rare. If doubtful reactions are regarded as negative, the sensitivity, specificity, positive predictive value and negative predictive value for the medium concentration of FM II towards at least 1 individual constituent was 92.3%(exact 95%confidence interval 74.9-99.1%), 98.4%(97.7-99.0%), 48%(33.7-62.6%) and 99.9%(99.6-100.0%), respectively. For the high concentration, the figures were very similar. The frequency of positive reactions to the individual constituents in descending order was the same for both FM II concentrations:hydroxyisohexyl 3-cyclohexene carboxaldehyde(Lyral.)>citral>farnesol>citronellol >αhexyl-cinnamic aldehyde (AHCA). No unequivocally positive reaction to coumarin was observed. Lyralwas the dominant individualconstituent,with positive reactions in 36%of patients reacting to 14%FM II and 37.1%to 28%FM II. 5/11 patients developed a positive ROAT after a median of 7 days (range 2-10). The 5 patients with a doubtful or negative reaction to 28%FM II were all ROAT negative except 1. There were 7 patients with a certain fragrance history and a positive reaction to either 28%or 14%FM II but a negative reaction to FM I. Analysis with GC-MS in a total of 24 products obtained from 12 patients showed at least 1-5 individual constituents per product:Lyral. (79.2%), citronellol (87.5%), AHCA (58.3%), citral (50%) and coumarin (50%). The patients were patch test positive to Lyral., citral and AHCA. In conclusion, patients with a certain fragrance history and a negative reaction to FMI can be identified by FM II. Testing with individual constituents is positive in about 50%of cases reacting to either 14%or 28%FM II.展开更多
The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patie...The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.展开更多
文摘A 50-year-old female developed extensive condylomata acuminata in the genito anal region over a period of 12 years. She presented with multiple, verrucous le sions involving the whole genitoanal area plus the adjacent perineum and gluteal region which made it impossible to identify the anatomical structures. Proctosc opy was normal. Serology for infectious diseases was negative. Several biopsies showed no signs of malignant transformation. Tumor excision under general anaest hesia was incomplete. Therefore, adjunctive therapy with immunomodulatory agents was administered, utilizing local application of imiquimod cream (3 x weekly) f or 3 months and subcutaneous injections of interferon-alpha-2a (3 million IU 3 x weekly) for 5 months. This treatment regimen resulted in complete remission of all skin lesions with only discrete superficial scarring but no significant los s of anatomical structures or functions. During a 1-year follow-up the patient showed no sign of relapse.
文摘In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. Hence, patch testing with MWF from the patient’s workplace is an important additional diagnostic tool. However, recommendations on how to perform such patch tests vary. We retrospectively analyzed patch test data of the Department of Dermatology in Dortmund, 1992-2003. In 141 metalworkers tested because of suspected occupational contact dermatitis due to MWF, 829 patch tests with 306 samples of MWF were performed. Water-based MWF (wb MWF) were mainly tested in 2 dilution series, i.e. pure (workplace concentration), 10%aq. and 1%aq., and pure, 50%aq. and 10%aq. Positive reactions to wb MWF occurred in 27 patients. Patch testing with wb MWF at workplace concentration resulted in 16.1 %(39/242) positive reactions, with a positivity ratio of 69%and a reaction index of 0. From the analysis of reaction patterns and concomitant reactions,we conclude that most of these positive reactions indicated true contact allergy. With lower concentrations, relevant allergic reactions may be missed. Neat oils were tested as is or diluted from 1 to 50%in olive oil, but no reactions at all were observed. For optimum benefit of patch testing with MWF from the patient’s workplace, breakdown testing is recommended. To overcome the time-consuming difficulties associated with this procedure, we propose a centre for information and documentation of contact allergies due to occupational exposure. Furthermore, full declaration of MWF ingredients is desirable.
文摘A new fragrance mix (FM II), with 6 frequently used chemicals not present in the currently used fragrance mix (FM I), was evaluated in 6 dermatological centres in Europe, as previously reported. In this publication, test results with the individual constituents and after repeated open application test (ROAT) of FM II are described. Furthermore, cosmetic products which had caused a contact dermatitis in patients were analysed for the presence of the individual constituents. In 1701 patients, the individual constituents of the medium (14%) and the highest (28%) concentration of FM II were simultaneously applied with the new mix at 3 concentrations (break-down testing for the lowest concentration of FM II (2.8%) was performed only if the mix was positive). ROAT was performed with the concentration of the FM II which had produced a positive or doubtful (+or ?+) patch test reaction. Patients’products were ana-lysed for the 6 target compounds by gas chromatography-mass spectrometry (GC-MS). Results:50 patients (2.9%) showed a positive reaction to 14%FM II and 70 patients (4.1%) to 28%FM II. 24/50 (48%) produced a positive reaction to 1 or more of the individual constituents of 14%FM II and 38/70 (54.3%) to 28%FM II, respectively. If doubtful reactions to individual constituents are included, the break-down testing was positive in 74%and 70%, respectively. Patients with a positive reaction to 14%FM II showed a higher rate of reactions to the individual constituent of the 28%FM II:36/50 (72%). Positive reactions to individual constituents in pa-tients negative to FM II were exceedingly rare. If doubtful reactions are regarded as negative, the sensitivity, specificity, positive predictive value and negative predictive value for the medium concentration of FM II towards at least 1 individual constituent was 92.3%(exact 95%confidence interval 74.9-99.1%), 98.4%(97.7-99.0%), 48%(33.7-62.6%) and 99.9%(99.6-100.0%), respectively. For the high concentration, the figures were very similar. The frequency of positive reactions to the individual constituents in descending order was the same for both FM II concentrations:hydroxyisohexyl 3-cyclohexene carboxaldehyde(Lyral.)>citral>farnesol>citronellol >αhexyl-cinnamic aldehyde (AHCA). No unequivocally positive reaction to coumarin was observed. Lyralwas the dominant individualconstituent,with positive reactions in 36%of patients reacting to 14%FM II and 37.1%to 28%FM II. 5/11 patients developed a positive ROAT after a median of 7 days (range 2-10). The 5 patients with a doubtful or negative reaction to 28%FM II were all ROAT negative except 1. There were 7 patients with a certain fragrance history and a positive reaction to either 28%or 14%FM II but a negative reaction to FM I. Analysis with GC-MS in a total of 24 products obtained from 12 patients showed at least 1-5 individual constituents per product:Lyral. (79.2%), citronellol (87.5%), AHCA (58.3%), citral (50%) and coumarin (50%). The patients were patch test positive to Lyral., citral and AHCA. In conclusion, patients with a certain fragrance history and a negative reaction to FMI can be identified by FM II. Testing with individual constituents is positive in about 50%of cases reacting to either 14%or 28%FM II.
文摘The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.
