Patch testing and cross sensitivity study of adverse cutaneous drug reactions due to anticonvulsants: A preliminary report

AIM To evaluate the utility of patch test and cross-sensitivity patterns in patients with adverse cutaneous drug reactions(ACDR) from common anticonvulsants. METHODS Twenty-four(M:F = 13:11) patients aged 18-75 years with ACDR from anticonvulsants were patch tested 3-27 mo after complete recovery using carbamazepine, phenytoin, phenobarbitone, lamotrigine, and sodium valproate in 10%, 20% and 30% conc. in pet. after informed consent. Positive reactions persisting on D3 and D4 were considered significant. RESULTS Clinical patterns were exanthematous drug rash with or without systemic involvement(DRESS) in 18(75%), Stevens-Johnsons syndrome/toxic epidermal necrolysis(SJS/TEN) overlap and TEN in 2(8.3%) patients each, SJS and lichenoid drug eruption in 1(4.2%) patient each, respectively. The implicated drugs were phenytoin in 14(58.3%), carbamazepine in 9(37.5%), phenobarbitone in 2(8.3%), and lamotrigine in 1(4.7%) patients,respectively. Twelve(50%) patients elicited positive reactions to implicated drugs; carbamazepine in 6(50%), phenytoin alone in 4(33.3%), phenobarbitone alone in 1(8.3%), and both phenytoin and phenobarbitone in 1(8.33%) patients, respectively. Cross-reactions occurred in 11(92%) patients. Six patients with carbamazepine positive patch test reaction showed cross sensitivity with phenobarbitone, sodium valproate and/or lamotrigine. Three(75%) patients among positive phenytoin patch test reactions had cross reactions with phenobarbitone, lamotrigine, and/or valproate. CONCLUSION Carbamazepine remains the commonest anticonvulsant causing ACDRs and cross-reactions with other anticonvulsants are possible. Drug patch testing appears useful in DRESS for drug imputability and cross-reactions established clinically.

Quadric SFDI for Laplacian Discretisation in Lagrangian Meshless Methods

In the Lagrangian meshless(particle)methods,such as the smoothed particle hydrodynamics(SPH),moving particle semi-implicit(MPS)method and meshless local Petrov-Galerkin method based on Rankine source solution(MLPG_R),the Laplacian discretisation is often required in order to solve the governing equations and/or estimate physical quantities(such as the viscous stresses).In some meshless applications,the Laplacians are also needed as stabilisation operators to enhance the pressure calculation.The particles in the Lagrangian methods move following the material velocity,yielding a disordered(random)particle distribution even though they may be distributed uniformly in the initial state.Different schemes have been developed for a direct estimation of second derivatives using finite difference,kernel integrations and weighted/moving least square method.Some of the schemes suffer from a poor convergent rate.Some have a better convergent rate but require inversions of high order matrices,yielding high computational costs.This paper presents a quadric semi-analytical finite-difference interpolation(QSFDI)scheme,which can achieve the same degree of the convergent rate as the best schemes available to date but requires the inversion of significant lower-order matrices,i.e.3×3 for 3D cases,compared with 6×6 or 10×10 in the schemes with the best convergent rate.Systematic patch tests have been carried out for either estimating the Laplacian of given functions or solving Poisson’s equations.The convergence,accuracy and robustness of the present schemes are compared with the existing schemes.It will show that the present scheme requires considerably less computational time to achieve the same accuracy as the best schemes available in literatures,particularly for estimating the Laplacian of given functions.

Quadrilateral isoparametric finite elements for plane elastic Cosserat bodies

4-node, 8-node and 8（4）-node quadrilateral plane isoparametric elements are used for the solution of boundary value problems in linear isotropic Cosserat elasticity. The patch test is applied to validate the finite elements. Engineering problems of stress concentration around a circular hole in plane strain condition and mechanical behaviors of heterogeneous materials with rigid inclusions and pores are computed to test the accuracy and capability of these three types of finite elements.

Granulomatous Inflammatory Reaction in Breast Silicone Implants

Introduction： breast implants have been used to correct the size and the form of a breast in post-mastectomy breast reconstruction, for correcting congenital defects and deformities or for purely aesthetic breast augmentation. Silicone breast implants were introduced in the 1960s. They are non without complications, like rupture is or silicone gel bleeding. Materials and methods： the authors present the case of 50 patients, aged 45-55, who presented to our attention after 15 （＋ 5） years of the application of silicone breast implant for the appearance of lumps under the skin in the armpit area. These were palpable, painless except on palpation. The patients reported burning in the affected area, but no other symptoms. Results： considering the presence in each of them of silicone implants, and assuming a possible allergic basis, the authors performed a patch test series S1DAPA produced by F.I.R.M.A Spa, Firenze, ultrasound and MR and blood tests. In all patients the allergy test （patch test） were negative, ultrasound and MR have shown that no hearing was damaged or broken. Blood test showed no abnormalities. Discussion： comparing the authors＇ study with other similar works in the literature, they noted that the reported cases of hypersensitivity type 4 silicone prosthesis was not only initially accompanied by specific symptoms such as urticaria and blistering, but mostly it was found to be a net positive patch test. The absence of urticaria, the low values of lgE and total negativity of patch test confirmed the purely inflammatory nature of the lesions in our patients.

A Face Serum Containing Palmitoyl Tripeptide-38, Hydrolyzed Hyaluronic Acid, Bakuchiol and a Polyherbal and Vitamin Blend Improves Skin Quality

A face serum composed of a combination of biologically active compounds was evaluated for safety and efficacy in vitro, in a repeat insult patch test and in a human clinical efficacy trial. The serum inhibited tyrosinase activity modestly, decreased collagenase activity and exhibited notable free radical scavenging activity in vitro. It is gentle to the skin, as the serum did not irritate the skin or produce symptoms of allergic contact dermatitis in the 55 healthy adults that participated in the repeat insult patch test. In the efficacy trial, daily application of the face serum for 30 days significantly increased skin hydration, with all 35 volunteers experiencing improvement. Substantial improvements in skin elasticity, roughness (fine lines and wrinkles), and brightness also occurred during the trial. Dermatological examination also revealed a trend for reduced comedone count with use of the serum. Self-assessment responses revealed that all volunteers experienced improvements in multiple skin quality parameters and that participant perceptions are consistent with the results of the instrumental analyses. These findings indicated that the measured improvements in skin quality are not only statistically significant but are also clinically relevant as they were great enough for users of the face serum to feel and recognize.

Chinese Expert Consensus on Clinical Application of Patch Test (Revised 2020)

Allergic contact dermatitis is a common clinical allergic disease.The patch test is the gold standard for finding and clarifying contact allergens.With the deepening understanding of the epidemiology,pathogenesis,and clinical manifestations of contact dermatitis,as well as the increased requirements for the standardized application of patch tests,the relevant consensus needs to be continuously updated.This consensus is updated on the basis of the version issued in 2015.In this revised version,it refines the selection of clinical indications,improves the judgment end interpretation of results,adds delayed detection and patient education,and so on,which aims to further standardize clinical applications and improve the value of patch test.

Multifactor analysis of patients with oral sensory complaints in a case-control study

Background:There are an increasing number of patients with oral sensory complaints(OSCs)presenting to our dental clinic.For most dentists,it is difficult to distinguish burning mouth syndrome(BMS)from other oral mucosal diseases that may cause symptoms such as burning mouth.It is beneficial to effectively distinguish OSC patients to reduce misdiagnosis and eliminate burning symptoms as much as possible.Methods:Patients with oral burning sensations in the oral mucosal disease clinic were collected from the Peking University Hospital of Stomatology between September 1,2014 and December 31,2018.After excluding oral candidiasis,anemic stomatitis,dental material allergy,and other diseases from patients with oral sensory complaints,basic conditions such as gender,age,education level,job status,hyperglycemia,hypertension,hyperlipidemia,history of brain abnormalities,history of cervical spondylitis,history of thyroid disease,history of thyroid disease and insomnia were obtained.The BMS patients were compared with the control group.The t test and Chi-square test were used for statistical analysis to compare the clinical symptoms of these diseases and explore the risk factors for BMS.Results:In this case-control study,395 patients(321 females and 74 males,mean age 55.26±10.51 years)with oral sensory complaints and 391 healthy controls(281 females and 110 males,mean age 47.11±13.10 years)were enrolled,among which,8.4%(33/395)had oral candidiasis,1.3%(5/395)had dental material allergy,0.8%(3/395)had anemic stomatitis and 0.5%(2/395)had lichen planus.A total of 352 patients were eventually diagnosed with BMS.Anxiety and depression were more severe in BMS patients,as were the incidences of sleep disorders and brain abnormalities.Logistic regression analysis showed that age(odds ratio[OR]=2.79,95%confidence interval[CI]:1.61-4.83,P<0.001),total cholesterol level(OR=2.92,95%CI:1.32-6.50,P=0.009)and anxiety score(OR=1.75,95%CI:1.01-2.77,P=0.017)significantly increased the incidence of BMS.Patients with hyperglycemia(OR=0.46,95%CI:0.23-0.89,P=0.022),low body mass index(BMI:OR=0.57,95%CI:0.34-0.93,P=0.026)and low education level(OR=3.43,95%CI:1.91-6.15,P<0.001)were more likely to suffer from BMS.Conclusions:Oral candidiasis,anemic stomatitis,and dental material allergy with burning symptoms should be excluded from patients with BMS.It is recommended to conduct a questionnaire survey(including anxiety and depression),blood cell analysis,and salivary fungus culture for all patients with an oral burning sensation.It is necessary to conduct a patch test on patients with oral burning sensations and metal restorations.