手部湿疹严重指数(HECSI):手部湿疹临床评价的评分系统在观察者间及观察者内的可靠性研究

Background: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). Objectives: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Methods: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. Results: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment, ICC for intraobserver agreement was 0.90. Conclusions: Overall excellent agreement existed for both inter-and intra-observer reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.

Cr(VI)阳性患者的Cr(III)反应性与足部皮炎

Chromium allergy has become synonymous with Cr(VI) allergy.However, real exposure to chromium from leather products may include both Cr(III) and Cr(VI). In this study,we investigate the reactivity to both Cr(VI) and Cr(III) in consecutive patients to analyse the relation between foot eczema/leather exposure and reactivity to Cr(III). From March 2002 to December 2004, 2211 consecutive patients with suspected allergic contact dermatitis were patch tested with 0.5%potassium dichromate (Cr(VI)) and 13%chromium trichloride(Cr(III)). A total of 71 (3.2%) patients had a positive reaction to Cr(VI), of which 31 also had a positive Cr(III) reaction. No Cr(VI) negative patients had a positive reaction to Cr(III). An increased risk of foot dermatitis was found in Cr(VI) positive patients with a concomitant positive or doubtful reaction to Cr(III) compared with Cr(VI) positive patients with no reactions to Cr(III). The increased risk was not due to a higher degree of sensitivity to Cr(VI). Leather was reported most frequently as the suspected cause of chromium dermatitis (54%).However, Cr(VI) allergics having foot eczema and positive or doubtful Cr(III) reactions often had positive reactions to other shoe allergens. Thus, Cr(III) allergy is part of a multiple shoe allergy pattern.

对苯二胺斑贴试验剂量反应研究:阈值及解剖区域的差别

The elicitation response in allergic contact dermatitis for the hair dye substance p-phenylenediamine (PPD) is dose dependent,but threshold concentrations have not previously been investigated. 15 PPD-sensitive patients participated in a serial dilution 48-hr patch test with PPD using 8 concentrations of PPD ranging from 1 to 10 000 on the upper back. Petrolatum was applied as control. Three concentrations (50, 100 and 500 p.p.m. PPD) were also applied to the retroauricular area and on the lateral aspects of the upper arms. 14 of the 15 participants reacted to one or more of the test samples. The threshold value for 10%of the tested persons (ED10) based on+or stronger reactions for PPD on the back was 38 p.p.m. (CI:4.3-100). There were no statistically significant differences in the sensitivity of the three anatomical regions. The upper back is a suitable region for patch testing patients with hair dye dermatitis.

伴有香料引发的呼吸系统症状的湿疹患者的辣椒碱咳嗽反射

Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex and age-matched case control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin.Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n = 11) did not relate to the site of the symptoms in the airways and was not associated with increased capsaicin cough responsiveness.In conclusion, respiratory symptoms elicited by perfume may reflect local hyperreactivity related to defensive reflexes in the airways, and measurements of the capsaicin cough reflex are relevant when patients with lower respiratory symptoms related to environmental perfume exposures are investigated.

儿童重度染发剂过敏反应8例

Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported. As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenediamine (PPD) sensitization of the population has changed simultaneously with an increasing use of hair dyes in this age group. This investigation reports PPD sensitization in children with regard to cause of sensitization, clinical presentation and consequences. Clinical history and patch test results for consecutive children below 16 years of age with suspected hair dye allergic reactions and positive patch tests to PPD were collected over 2 years in 2 Danish dermatology clinics. 8 children aged 12-15 years were collected, and they all reacted to several hair dye ingredients. 5 of the patients were hospitalized, 1 in the intensive care unit. 6 of the patients gave a history of prior reaction to temporary black tattoos. These children showed simultaneous positive patch reactions to N-isopropyl-N-phe-nylp-phenylenediamine and local anaesthetics, while such reaction patterns were not seen in children with hair dye reactions only. The clinical consequences of these reactions are unknown. A re-evaluation of the risk assessment/risk management for hair dyes is required.

低浓度甲基二磷戊二醛可引起接触致敏

Background: The rapidly increasing level of contact allergy to methyldibromog lutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50- 100 p.p.m. Objectives: To determi ne whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized indi viduals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content. Methods: Eighteen volunteerswith contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with t wo moisturizers with a high and a low lipid content, respectively, both containi ng MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left an d the right side of the neck for 14 days, or until a positive re action was seen. If a positive reaction did not develop within the first 14 d ays, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a f urther 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed. Results: Eleven of 18 (61% ) subjects developed der matitis on the test area, of whom 10 developed a positive reaction to the 50 p.p .m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to th e low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs. Conclusions: Even 50 p.p.m. cannot be regarded as a safe con centration for use and the prohibition of MDBGN is scientifically well founded.

对二甲基溴戊二腈接触性过敏:每天1次与每天多次接触的结果

Some types of cosmetic products such ashand soaps and creams are commonly used several times a day, especially in occupational use situations. Little has experimentally been shown of how the daily frequency of the application of an allergen in a product influences the allergic response. This study investigates the allergic responses elicited in presensitized individuals when exposed to a specific amount of allergen applied either in 1 application per day or distributed over 4 applications per day. As model allergen, the cosmetic preservative methyldibromo glutaronitrile (MDBGN) is used. 19 contact allergic individuals and 12 controls participated in a double- blind, randomized use test. To areas on the forearms were applied 2 drops either once daily of a solution containing 0.04% MDBGN or 4 times a day of a solution containing 0.01% MDBGN. 14 of 19 patients developed dermatitis following the application of approximately equal amounts of MDBGN on both arms. Controls were negative. In this experiment, applications of 0.04% MDBGN once daily or 0.01% MDBGN 4 times daily had, in a use test, approximately equal capabilities of provoking allergic contact dermatitis. This adds new knowledge to the risk assessment and regulation of cosmetic allergens. However, these results may be highly allergen dependent, and further studies are needed before more general conclusions can be made.

腋臭剂:异丁子香酚的实验性激发研究

Axillary dermatitis is common and overrepresented in people with contact allergy to fragrances. Many people suspect their deodorants to be the incriminating products. In order to investigate the significance of isoeugenol in deodorants for the development of axillary dermatitis when used by people with and without contact allergy to isoeugenol, patch tests with deodorants and ethanol solutions with isoeugenol, as well as repeated open application tests (ROAT) with roll-on deodorants with and without isoeugenol at various concentrations, were performed in 35 dermatitis patients, 10 without and 25 with contact allergy to isoeugenol. A positive ROAT was observed only in patients hypersensitive to isoeugenol (P < 0.001) and only in the axilla to which the deodorants containing isoeugenol had been applied (P < 0.001). Deodorants containing isoeugenol in the concentration range of 0.0063-0.2%used 2 times daily on healthy skin can thus elicit axillary dermatitis within a few weeks in people with contact allergy to isoeugenol.