Cases reported "Dermatitis, Atopic"

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1/22. The benefit of patch testing with a corticosteroid at a low concentration.

    BACKGROUND: Patch testing with corticosteroid marker molecules is advocated because testing with all available corticosteroids is impossible in clinical practice. Most commonly used are budesonide, tixocortol pivalate, and hydrocortisone-17-butyrate. We have been patch testing not only with the three markers, but also with two corticosteroid mixes, each consisting of different concentrations of the three markers. OBJECTIVE: We describe a patient allergic to tixocortol pivalate, who was diagnosed by using a lower patch test concentration that recommended, 0.1% in petrolatum, as well as a weak corticosteroid mix, 0.202%. methods: The patient was patch tested to a standard series, including the two corticosteroid mixes and its three constituents. RESULTS: None of the corticosteroid preparations were positive on the first ordinary reading day, day 3, whereas both tixocortol pivalate at 0.1% and the corticosteriod mix at 0.202% were positive on the second ordinary reading day, day 7, whereas all tested corticosteroids in the standard series gave positive reactions on d10. CONCLUSION: The possible benefit of patch testing with a corticosteroid at a low concentration is supported, as is the significance of late readings beyond D4.
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2/22. quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis.

    Atopic dermatitis is a common skin disease characterized by severely pruritic eczematous patches, papular and lichenified plaques, excoriations, cracks, and erosions. photopheresis has been shown to ameliorate the signs and symptoms of atopic dermatitis in some patients. We describe successful results with photopheresis for refractory disease in a patient who chronicled his quality of life weekly for more than 15 years before and during extracorporeal photochemotherapy.
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ranking = 0.0012773289254973
keywords = patch
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3/22. Degradation products of monoterpenes are the sensitizing agents in tea tree oil.

    BACKGROUND: patients using tea tree oil (TTO) topically may become sensitized to this natural remedy. More than 30 cases have been documented in the literature since 1991. OBJECTIVE: Freshly distilled, as well as oxidized TTO, some fractions, and single constituents were used for experimental sensitization in guinea pigs. TTO was stored on a window sill to study the influence of light, oxygen, and warmth. The oxidized oil and different fractions were devoted to experimental sensitization in guinea pigs to determine their sensitizing potency. Fifteen constituents were patch tested in TTO-sensitive patients to find how many may play a role as contact allergens. methods: guinea pigs were sensitized by a modified FCA-method (Freund's complete adjuvant) with freshly distilled TTO, oxidized TTO, the monoterpene and sesquiterpene fraction, and 1, 8-cineole. TTO-sensitive patients were tested with 15 typical constituents and degradation products. Gas chromatographic analysis was used to detect degradation products of the deteriorated TTO. RESULTS: Fresh TTO was revealed to be a very weak sensitizing material whereas oxidized TTO was 3 times stronger. The monoterpene fraction showed to be a stronger sensitizer than the sesquiterpene fraction. All 11 patients reacted mostly with a -plus or even a -plus reaction to alpha-terpinene, terpinolene and ascaridol. alpha-Phellandrene became positive in four patients, myrcene in only two. Gas chromatographic analyses showed that the formation of peroxides increased within 4 days from less than 50 to more than 500 ppm. peroxides, epoxides and endoperoxides were formed. Deterioration products of alpha-terpinene were found to be mainly p-cymene, ascaridol, isoascaridol, a ketoperoxide, and colorless crystals that likely were 1,2,4-trihydroxy menthane. The p-cymene content increased dramatically from 2% to 11.5%. alpha- and gamma-terpinene, as well as terpinolene, were reduced to one half of their former concentration. Ascaridol and isoascaridol have never before been found in TTO. CONCLUSION: tea tree oil kept in open and closed bottles or other containers undergoes photooxidation within a few days to several months, leading to the creation of degradation products that are moderate to strong sensitizers. peroxides, epoxides and endoperoxides, like ascaridol and 1,2,4-trihydroxy menthane, are formed. These must be considered responsible for the development of allergic contact dermatitis seen in individuals treating themselves with the oil. A test series with 15 characteristic constituents is recommended for patch testing.
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keywords = patch test, patch
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4/22. T-lymphocyte cytokine profiles in compositae airborne dermatitis.

    Compositae airborne dermatitis is a well-recognized disorder characterized by erythematosquamous lesions and papules on light-exposed areas. The presence of positive patch test reactions and the absence of specific serum IgE suggest delayed-type hypersensitivity, the murine model of which is characterized by a Th1 cytokine production profile [high amounts of interferon (IFN)-gamma and interleukin (IL)-2; little or no IL-4 and IL-5]. The aim of this study was to evaluate the cytokine profile of T-cell lines and T-cell clones from peripheral blood in a 38-year-old non-atopic male woodcutter affected by seasonal airborne contact dermatitis. The patient showed positive patch test reactions to several Compositae extracts (achillea millefolium, Chamomilla recutita, tanacetum parthenium, T. vulgare) and sesquiterpene lactone mix. On prick testing with Compositae and other plants, serum-specific IgE levels and phototesting were negative or normal. Allergen-specific T-cell lines produced with Compositae extracts showed a good in vitro cell proliferation only to C. recutita extract. Serial cloning performed using the C. recutita-specific T-cell lines revealed an alphabeta CD4 phenotype with high amounts of IFN-gamma and IL-4 in T-cell clones. Thus, these cells expressed a preferential Th0 phenotype. These data suggest that in addition to IFN-gamma, other T-cell derived cytokines, such as IL-4, may play a part in the immunopathogenesis of contact dermatitis.
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keywords = patch test, patch
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5/22. Transient CD30 nodal transformation of cutaneous T-cell lymphoma associated with cyclosporine treatment.

    BACKGROUND: mycosis fungoides (MF) may evolve from pre-existing chronic atopic or psoriasiform dermatitis and the histology can be equivocal. Early patch and plaque lesions of MF may evolve into tumors, disseminate to lymph nodes, bone marrow, and internal organs, and/or undergo transformation to a large cell size. methods: A patient with a history of "atopic dermatitis" followed by "psoriasis" rapidly developed exfoliative erythroderma and axillary lymphadenopathy following treatment with cyclosporine. At presentation, biopsy specimens of skin lesions and lymph nodes and staging were obtained. We present the treatment and follow-up of this patient and review the medical literature for similar cases. RESULTS: Multiple skin biopsy specimens from lesions revealed changes consistent with low-grade, cutaneous, T-cell lymphoma (MF) without evidence of large cell transformation and psoriasiform epidermal hyperplasia. CD30 large cell transformation was present in the lymph node. Adenopathy and erythroderma resolved without systemic therapy following discontinuation of cyclosporine and treatment with psoralen/ultraviolet A (PUVA), isotretinoin, interferon-alpha, and antimicrobials. CONCLUSIONS: This case documents a close relationship between atopy, psoriasis, and the development of cutaneous T-cell lymphoma, and illustrates that an immunosuppressive agent, cyclosporine, can dramatically alter the course of the disease.
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keywords = patch
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6/22. Recalcitrant atopic dermatitis due to allergy to Compositae.

    Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.
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ranking = 0.3762773289255
keywords = patch test, patch
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7/22. Contact allergy due to lichens in patients with a history of photosensitivity.

    Ten patients with a history of photosensitivity and of a rash showed abnormal reactions to long-wave UVR. The rash occurred particularly in areas exposed to light, though other areas were occasionally involved. The development of the rash could in all patients be related to contact with lichens and although exposure to sunlight usually led to an aggravation of symptoms, some patients, particularly forestry workers, showed exacerbations even during the winter. Positive responses were observed in both irradiated and non-irradiated patch tests with different species of lichen and in several patients irradiation precipitated a stronger response. These findings suggest that lichens can cause both contact and photocontact dermatitis. The suspected allergens contained in these lichens are atranorin, physodalic and pysodic acids.
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ranking = 0.125
keywords = patch test, patch
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8/22. Allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in bacteriology technicians.

    Three cases of allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in a bacteriology laboratory are presented. This chemical, a dye closely related to the common contact allergen para-phenylenediamine, is used in laboratories to screen bacterial culture plates for neisseria gonorrhoeae. The three patients had strongly positive patch test reactions to N,N-dimethyl-para-phenylenediamine, but had negative reactions to para-phenylenediamine. A brief discussion of allergic contact cross-sensitization among compounds with the para-aminophenyl grouping is presented.
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ranking = 0.125
keywords = patch test, patch
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9/22. Reduction of environmental mites improved atopic dermatitis patients with positive mite-patch tests.

    During a series of studies on the involvement of house dust mite antigens in 183 cases of atopic dermatitis, we observed an improvement in two patients following the removal of mites from their environment by means of a thorough housecleaning and replacement of the mattress. Both patients manifested the typical clinical skin lesions of atopic dermatitis and had similar laboratory findings. Although the serum IgE concentrations and specific IgE to dermatophagoides pteronyssinus and dermatophagoides farinae were each relatively low, the results of patch tests with these antigens were positive. Thus, a regimen aimed at reducing the presence of house dust mites can produce clinical improvement in a subset of patients with atopic dermatitis who show contact hypersensitivity to mite antigens on skin testing, but negative results on IgE (RAST; radioallergosorbent technique) testing.
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ranking = 0.625
keywords = patch test, patch
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10/22. Compositae dermatitis in childhood.

    Compositae dermatitis occurred in a 9-year-old boy with a strong personal and family history of atopy. Positive patch test reactions were 2 for dandelion (taraxacum officinale), false ragweed (ambrosia acanthicarpa), giant ragweed (ambrosia trifida), short ragweed (ambrosia artemisifolia), sagebrush (artemisia tridentata), wild feverfew (Parthenium hysterophorus), yarrow (achillea millifolium), and tansy (Tanacetum vulgare) and 1 for dahlia species and English ivy (hedera helix). patch tests were negative for another 30 plants, including cocklebur (xanthium strumarium), dog fennel (anthemis cotula, fleabane (erigeron strigosus), sneezeweed (Helenium autumnale), and feverfew (tanacetum parthenium). The eruption resembled atopic dermatitis morphologically but was prominent on the palms and face and dramatically spared the area of the boy's feet covered by his shoes. The condition has always been seasonal, worsening in summer, especially July, and it clears on avoidance of contact. This case is believed to represent a contact dermatitis to oleoresins of Compositae plants; inhalants as a cause of systemic aggravation are not likely to be important in this patient.
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keywords = patch test, patch
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