1/21. Allergic contact gingivostomatitis from a temporary crown made of methacrylates and epoxy diacrylates. Occupational allergic contact dermatitis caused by (meth)acrylates is common in dental personnel, whereas dental acrylic fillings and crowns have rarely been reported to cause problems in dental patients. Here we report on a 48-year-old woman who developed gingivitis, stomatitis, and perioral dermatitis after a temporary crown made of restorative, two-component material had been inserted. The manufacturer stated that the temporary crown base paste and catalyst contained three (meth)acrylates, namely, a proacrylate, which is a modification of 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]propane (BIS-GMA); a tricyclate, which is a saturated, aliphatic, tricyclic methacrylate; and urethane methacrylate. The manufacturer refused to give more exact information on the (meth)acrylates. Patch testing revealed that the patient was highly allergic to BIS-GMA, other epoxy diacrylates, and (meth)acrylates, as well as to the base paste and catalyst of the temporary crown. Accordingly, it was concluded that the allergic reaction was caused by BIS-GMA, or a cross-reacting (meth)acrylate, or other (meth)acrylates in the temporary crown. ( info) |
2/21. Orofacial edema: a diagnostic and therapeutic challenge for the clinician. BACKGROUND AND CONCLUSION: A case of a 41-year-old patient with a 5-year history of chronic recurrent angioedema, refractory to conservative treatment is presented. The results of the case report suggest that in differential diagnosis of angioedema, in addition to usual causes, the allergist-immunologist needs to consider melkersson-rosenthal syndrome, which can present with a variety of symptom-combinations of the classic triad. The distinguishing characteristics of the melkersson-rosenthal syndrome are its refractoriness to the usual anti-inflammatory therapy and the need to consider corrective cosmetic surgery, which may benefit some patients. ( info) |
| A 78-year-old woman had ectropion of both lower eyelids 4 weeks after the appearance of dermatitis around the eyes. Treatment with topical corticosteroids resulted in disappearance of both dermatitis and ectropion within 10 days. No relevant contact allergies were found. Her advanced age and a familial tendency toward edema around the eyes, indicating preexisting loss of elasticity, probably facilitated this apparently rare reaction. ( info) |
4/21. cheilitis caused by contact urticaria to mint flavoured toothpaste. A 26-year-old woman presented with a 12-month history of persistent dermatitis of the lips. She had failed to respond to cosmetic avoidance and therapeutic measures. Patch testing was negative, including her toothpaste and toothpaste flavours. She defied diagnosis until an acute flare followed immediately after dental treatment with a mint flavoured tooth cleaning powder. This led us to prick test her to mint leaves and this was positive. Her cheilitis settled after changing from her mint-flavoured toothpaste. A diagnosis of contact urticaria should be considered in cases of cheilitis of unknown cause. ( info) |
5/21. Multiple corticosteroid allergies. A case of vulval dermatitis and perioral dermatitis due to contact allergy to multiple class D corticosteroids, mometasone furoate and methylprednisolone aceponate is presented. Patch testing with commercially available corticosteroid creams is a simple and useful diagnostic test. Beware of delayed positive reaction, seen on day 8 of the repeat open application test on this patient. ( info) |
| We report the case of a 56-year-old woman who presented with a 2-month history of widespread oral erosion and a 3-day history of small papules on the lower eyelids. No other skin involvement was found. Histopathological examination revealed suprabasal cleft and acantholysis in the lower epidermis of the papule on the lower eyelid and in the lower mucous membrane of the oral mucosa. Intercellular deposits of IgG and C3 were seen in the whole epidermis of the specimen from the papule on the right lower eyelid by direct immunofluorescence study. These deposits were also observed in the biopsy specimen from erosion on the left buccal membrane. Indirect immunofluorescence study using normal human skin as a substrate showed intercellular antibodies directed to the cell surface of the whole epidermis with a titer of 1:40. The titers of antibodies to desmoglein 3 and 1 were 118 and 25.9, respectively, by enzyme-linked immunosorbent assay. The patient was treated with an oral administration of prednisolone (0.75 mg/kg/day) for 9 days, which improved the skin eruptions and oral erosion. The dose of prednisolone was gradually tapered and it took 10 weeks to cease this treatment. These findings suggest that this patient is an unusual case of pemphigus vulgaris (mucosal dominant type) diagnosed from the clinical and histopathological findings, with positive antibodies to desmoglein 3 and 1. ( info) |
7/21. herpes simplex virus type 1 corneal infection results in periocular disease by zosteriform spread. In humans and animal models of herpes simplex virus infection, zosteriform skin lesions have been described which result from anterograde spread of the virus following invasion of the nervous system. Such routes of viral spread have not been fully examined following corneal infection, and the possible pathologic consequences of such spread are unknown. To investigate this, recombinant viruses expressing reporter genes were generated to quantify and correlate gene expression with replication in eyes, trigeminal ganglia, and periocular tissue. Reporter activity peaked in eyes 24 h postinfection and rapidly fell to background levels by 48 h despite the continued presence of viral titers. Reporter activity rose in the trigeminal ganglia at 60 h and peaked at 72 h, concomitant with the appearance and persistence of infectious virus. Virus was present in the periocular skin from 24 h despite the lack of significant reporter activity until 84 h postinfection. This detection of reporter activity was followed by the onset of periocular disease on day 4. Corneal infection with a thymidine kinase-deleted reporter virus displayed a similar profile of reporter activity and viral titer in the eyes, but little or no detectable activity was observed in trigeminal ganglia or periocular tissue. In addition, no periocular disease symptoms were observed. These findings demonstrate that viral infection of periocular tissue and subsequent disease development occurs by zosteriform spread from the cornea to the periocular tissue via the trigeminal ganglion rather than by direct spread from cornea to the periocular skin. Furthermore, clinical evidence is discussed suggesting that a similar mode of spreading and disease occurs in humans following primary ocular infection. ( info) |
8/21. Childhood granulomatous periorificial dermatitis in an Asian girl--a variant of sarcoid? Childhood granulomatous periorificial dermatitis (CGPD) is a benign, facial eruption which has previously been reported in prepubertal, Afro-Caribbean children. It is a condition of unknown aetiology, characterized by a monomorphic, papular eruption around the mouth, nose and eyes. Typically the eruption persists for several months but resolves without scarring. The condition can usually be distinguished from sarcoidosis on clinical and histological grounds. To our knowledge, this is the first case of CGPD occurring in an Asian child with sarcoidal histology and is unusual in its persistence for 4 years. We suggest that this case of CGPD may well be a variant of sarcoid. ( info) |
9/21. Extrafacial and generalized granulomatous periorificial dermatitis. BACKGROUND: Granulomatous periorificial dermatitis is a well-recognized entity presenting most commonly in prepubertal children as yellow-brown papules limited to the perioral, perinasal, and periocular regions. The condition is self-limiting and is not associated with systemic involvement. OBSERVATIONS: We reviewed the medical charts of 5 healthy children presenting with extrafacial granulomatous papules in addition to the typical periorificial papules. These extrafacial lesions were clinically and histologically identical to the facial lesions, were self-limiting, and were not associated with systemic involvement. Resolution seemed to be hastened with the use of systemic antibiotic therapy in 4 of the 5 patients. CONCLUSIONS: Extrafacial lesions can occur in granulomatous periorificial dermatitis and do not appear to adversely affect the duration, response to therapy, or risk of extracutaneous manifestations. Overly aggressive evaluation and inappropriate systemic therapy should be avoided. ( info) |
10/21. rosacea-like demodicidosis in an immunocompromised child. Demodex folliculorum is a saprophytic mite of the human pilosebaceous unit. It is rarely found in children. It has been implicated in the development of follicular pityriasis, rosacea-like demodicidosis, pustular folliculitis, blepharitis, and granulomatous rosacea. We describe a 4-year-old boy who developed asymptomatic facial lesions that histologically corresponded to demodicidosis. He was in clinical remission of acute lymphoblastic leukemia and currently receiving maintenance chemotherapy. Exanthems related to D. folliculorum are rare in children. Most cases occur in immunocompromised patients and the clinical and histologic findings are diverse. A differential diagnosis should be established with rosacea and perioral dermatitis. The role of Demodex in the pathogenesis of these disorders is controversial. immunosuppression might increase the number of mites, favoring an inflammatory reaction, or there could exist an impaired cutaneous immunologic response to the parasites. ( info) |