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Contact Dermatitis Nov 2021Metal alloys containing contact sensitizers (nickel, palladium, titanium) are extensively used in medical devices, in particular dentistry and orthopaedic surgery. The...
BACKGROUND
Metal alloys containing contact sensitizers (nickel, palladium, titanium) are extensively used in medical devices, in particular dentistry and orthopaedic surgery. The skin patch test is used to test for metal allergy.
OBJECTIVE
To determine whether metal salts, when applied to freshly excised skin at patch test-relevant concentrations and using a method which mimics skin patch testing, cause in changes in the epidermis and dermis.
METHODS
Tissue histology, apoptosis, metabolic activity, and inflammatory cytokine release were determined for two nickel salts, two palladium salts, and four titanium salts.
RESULTS
Patch test-relevant concentrations of all metal salts caused localized cytotoxicity. This was observed as epidermis separation at the basement membrane zone, formation of vacuoles, apoptotic nuclei, decreased metabolic activity, and (pro)inflammatory cytokine release. Nickel(II) sulfate hexahydrate, nickel(II) chloride hexahydrate, titanium(IV) bis(ammonium lactato)dihydroxide, and calcium titanate were highly cytotoxic. Palladium(II) chloride, sodium tetrachloropalladate(II), titanium(IV) isopropoxide, and titanium(IV) dioxide showed mild cytotoxicity.
CONCLUSION
The patch test in itself may be damaging to the skin of the patient being tested. These results need further verification with biopsies obtained during clinical patch testing. The future challenge is to remain above the elicitation threshold at noncytotoxic metal concentrations.
Topics: Apoptosis; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Humans; Nickel; Palladium; Patch Tests
PubMed: 34268774
DOI: 10.1111/cod.13940 -
Canadian Family Physician Medecin de... Jun 2021To provide an approach to identifying topical medicament ingredients that cause allergic contact dermatitis (ACD) and to recognizing common clinical scenarios in which...
OBJECTIVE
To provide an approach to identifying topical medicament ingredients that cause allergic contact dermatitis (ACD) and to recognizing common clinical scenarios in which these ingredients might present.
SOURCES OF INFORMATION
A retrospective chart review was conducted of patients patch tested at the Contact Dermatitis Clinic at St Paul's Hospital in Vancouver, BC, between November 2016 and June 2019. Data from the North American Contact Dermatitis Group from 2015 to 2016 and The Ottawa Hospital patch test clinic from 2000 to 2010 were also reviewed.
MAIN MESSAGE
Topical antibiotics are the most common cause of ACD to medicaments and frequently cause cosensitization to multiple allergens. This hypersensitivity reaction is often seen following surgical procedures and should be distinguished from postoperative infection. Corticosteroid allergy is easy to miss and should be suspected in cases of corticosteroid-sensitive dermatoses that worsen despite appropriate treatment. Topical anesthetics and propylene glycol are other causes of ACD found in many prescription and over-the-counter products.
CONCLUSION
Allergic contact dermatitis is easy to miss and should always be considered in cases of eczematous eruptions. A thorough drug history including all topical products-both prescription and over-the-counter-is critical. Patch testing can help identify specific allergens for the patient to avoid.
Topics: Allergens; Anesthetics, Local; Dermatitis, Allergic Contact; Humans; Patch Tests; Retrospective Studies
PubMed: 34127463
DOI: 10.46747/cfp.6706414 -
BMC Complementary Medicine and Therapies Feb 2023Although topical steroids constitute the first-line therapy for recurrent aphthous ulcers (RAUs), their long-term use often leads to candidiasis. Although cannabidiol... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although topical steroids constitute the first-line therapy for recurrent aphthous ulcers (RAUs), their long-term use often leads to candidiasis. Although cannabidiol (CBD) can be an alternative for pharmacologically managing RAUs due to its analgesic and anti-inflammatory in vivo effects, there is a lack of clinical and safety trials concerning its use. The aim of this study was to evaluate the clinical safety and efficacy of topical 0.1% CBD for managing RAU.
METHODS
A CBD patch test was performed on 100 healthy subjects. CBD was applied on the normal oral mucosa of 50 healthy subjects 3 times/day for 7 days. Oral examination, vital signs, and blood tests were performed pre- and post-CBD use. Another 69 RAU subjects randomly received one of three topical interventions: 0.1% CBD, 0.1% triamcinolone acetonide (TA), or placebo. These were applied on the ulcers 3 times/day for 7 days. The ulcer and erythematous size were measured on day 0, 2, 5, and 7. Pain ratings were recorded daily. The subjects rated their satisfaction with the intervention and completed a quality-of-life questionnaire (OHIP-14).
RESULTS
None of the subjects exhibited allergic reactions or side effects. Their vital signs and blood parameters were stable before and after the 7-day CBD intervention. CBD and TA significantly reduced ulcer size more than placebo at all time points. The erythematous size reduction was higher in the CBD intervention than the placebo on day 2, while TA reduced the erythematous size at all time points. The pain score in the CBD group was lower compared with placebo on day 5, whereas TA reduced pain more than placebo on day 4, 5, and 7. The subjects receiving CBD reported higher satisfaction than placebo. However, the OHIP-14 scores were comparable among the interventions.
CONCLUSIONS
Topical 0.1% CBD reduced ulcer size and accelerated ulcer healing without side effects. CBD exerted anti-inflammatory effects in the early stage and an analgesic effect in the late RAU stage. Thus, topical 0.1% CBD might be more appropriate for RAU patients who decline to take topical steroids, except for cases where CBD is contraindicated.
TRIAL REGISTRATION
Thai Clinical Trials Registry (TCTR) Number TCTR20220802004. Retrospectively registered on 02/08/2022.
Topics: Humans; Stomatitis, Aphthous; Cannabidiol; Ulcer; Pain; Anti-Inflammatory Agents; Analgesics
PubMed: 36803360
DOI: 10.1186/s12906-023-03886-0 -
Contact Dermatitis Apr 2023Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with...
BACKGROUND
Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society.
OBJECTIVES
To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations.
METHODS
The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n = 46 652) in whom an occupational causation was refuted served as comparison group.
RESULTS
The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time.
CONCLUSIONS
Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives.
Topics: Humans; Dermatitis, Allergic Contact; Patch Tests; Rubber; Epoxy Resins; Dermatitis, Occupational; Allergens; Benzothiazoles
PubMed: 36694979
DOI: 10.1111/cod.14280 -
Clinical Case Reports Nov 2023Middle-aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an...
KEY CLINICAL MESSAGE
Middle-aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an increased risk of developing atrial fibrillation (AF). Assessment in athletes should include long-term arrhythmia monitoring. In addition, it is important to exert patients beyond their calculated target heart rate (HR) during an exercise stress test to detect exercise-induced AF. We suggest this strategy be specifically used for athletes with complaints of intermittent palpitation and chest pain. Referral to an electrophysiologist for a possible ablation procedure should be considered for the management of AF in athletes in whom the use of beta-blockers may limit exercise tolerance. Bleeding risk with the use of oral anticoagulation needs to be adequately evaluated in athletes with AF who engage in high-intensity exercise or activities.
ABSTRACT
The report highlights the case of a 54-year-old Caucasian male (height 5.11', BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high-intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient's heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise-induced AF with high-intensity exercise. Young adults, with or without early coronary artery disease, performing high-intensity endurance exercises may be at risk of developing exercise-induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate-control medications in patients with exercise-induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise-induced AF.
PubMed: 38028109
DOI: 10.1002/ccr3.8242 -
International Journal of Cosmetic... Feb 2021In the present study, we describe the features and functional properties of a new powder cosmetic ingredient, an amorphous mesoporous magnesium carbonate (MMC, also...
OBJECTIVE
In the present study, we describe the features and functional properties of a new powder cosmetic ingredient, an amorphous mesoporous magnesium carbonate (MMC, also named Upsalite ) with regard to physical characteristics as well as functional attributes.
METHODS
Physical and functional characterization of MMC, as compared to other common powder cosmetic ingredients (silica, mica, kaolin, talc and starch), was assessed using nitrogen gas adsorption, powder X-ray diffraction, particle size distribution by laser diffraction, scanning electron microscopy (SEM), and oil and moisture uptake tests. The powder ingredients were also applied on human skin and analysed for short- and long-term mattifying effect, and a new method was developed to measure flashback effect. MMC was tested for skin irritation using an in vitro cell model as well as in vivo, through the Human Repeated Insult Patch Test on 50 human volunteers.
RESULTS
Mesoporous magnesium carbonate has a high surface area and pore volume. It has an excellent absorption capacity and can take up both oil and water simultaneously. It provides instant and long-lasting mattifying effect when applied on human skin without drying or irritating skin and exhibits no measured flashback effect.
CONCLUSION
Mesoporous magnesium carbonate has good sensory and visual characteristics as well as excellent absorbing and mattifying properties, suggesting that it has great potential to replace other powder ingredients currently used as fillers and absorbers in powder cosmetics.
Topics: Cosmetics; Humans; Irritants; Magnesium; Porosity; Powder Diffraction; Powders; Skin
PubMed: 33038019
DOI: 10.1111/ics.12670 -
Contact Dermatitis Mar 2023Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions.
BACKGROUND
Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions.
OBJECTIVES
To analyse the frequency and the relevance of positive carvone reactions in a dermatitis population.
METHOD
A retrospective analysis of dermatitis patients consecutively tested with carvone from 2017 to 2021. Data were retrieved from the department's patch-test database.
RESULTS
Of 3554 patients tested with carvone, 28 (0.79%) had a positive reaction. Carvone-positive patients had higher mean age, were significantly more likely female (p < 0.001) and had often an intraoral/lip involvement (p < 0.001). In the carvone-positive group, 50% (n = 14) had a relevant reaction, and in 4 of 14, the relevance was first revealed after test reading. Of the carvone-positive patients, 18 of 28 did not have a coexisting allergy to a fragrance/flavour allergen and of these 44% had a relevant allergy.
CONCLUSIONS
The study suggests that a significant fraction of relevant carvone contact allergies may be overlooked if the allergen is not tested. Furthermore, as the exposure is widespread, inclusion of carvone in the Swedish baseline series may be justified even if the contact allergy prevalence is below 1%.
Topics: Humans; Female; Dermatitis, Allergic Contact; Patch Tests; Retrospective Studies; Allergens; Perfume
PubMed: 36399045
DOI: 10.1111/cod.14249 -
Skin Health and Disease Mar 2022Based on studies at tertiary centres it is known that patch test reading on Day (D) 7 may show additional positive reactions. Female gender, higher age and allergen...
BACKGROUND
Based on studies at tertiary centres it is known that patch test reading on Day (D) 7 may show additional positive reactions. Female gender, higher age and allergen groups of topicals and corticosteroids were identified as predictive factors.
OBJECTIVES
The first aim was to study the value of reading patch tests on D2, D3 and D7 at a secondary referral centre. The second aim was to investigate the predictive potential of the factors sex, age, atopic dermatitis, body location, allergen group and clinical relevance for a positive reaction only on D7.
METHODS
Retrospective data from patients tested between 2013 and 2016 were evaluated. The factors sex, age, atopic dermatitis, body location, allergen group and clinical relevance were tested by regression analysis.
RESULTS
Two hundred and sixty-three out of a total of 396 patients had a positive reaction only on D2, D3 and D7 in 14 (2.5%), 152 (27.5%) and 61 (11.0%) occasions, observed in 10 (2.5%), 108 (27.3%) and 51 (12.9%) patients, respectively. These reactions were deemed relevant in 0 (0%), 12 (2.2%) and 9 (1.6%) occasions, observed 0 (0%), 11 (2.8%) and 9 (2.3%) patients, respectively. Higher age and allergen groups of metals, fragrances and resins were predictive for late positive reactions.
CONCLUSIONS
D7 patch test reading should also be routinely adopted at secondary referral centres. D7 positive reactions were associated with higher age and sensitization to metals, fragrances and resins.
PubMed: 35665214
DOI: 10.1002/ski2.79 -
Contact Dermatitis Jan 2023Commercial patch test substances do not cover all occupational contact allergens. Workplace materials and in-house test substances are tested to complement the...
BACKGROUND
Commercial patch test substances do not cover all occupational contact allergens. Workplace materials and in-house test substances are tested to complement the investigation of occupational skin disease (OSD).
OBJECTIVES
To quantify the additional value of testing workplace materials and non-commercial in-house test substances in the diagnosis of OSD.
MATERIALS AND METHODS
Patients files of 544 patients patch tested at the Finnish Institute of Occupational Health in 2015-2019 were reviewed for occupation, diagnoses and patch test results.
RESULTS
OSD was diagnosed in 353 (64.9%) of the patients. A total of 206 (37.9%) patients had occupational allergic contact dermatitis (OACD). In 19 (3.5%) patients, the only clues to the diagnoses of OACD were positive reactions to workplace materials, and in 20 (3.7%) patients, the diagnosis of OACD was based on commercially unavailable test substances. In 167 OACD cases diagnosed by commercial test substances, additional causes were found in 17 by testing patients' own and non-commercial test substances. In 43 (7.9%) cases, positive reactions to workplace materials reinforced diagnoses based on commercial test substances. The overall additive value of testing own products was 16.7% (91 cases).
CONCLUSION
We would have missed 39 (18.9%) of our 206 OACD cases if we had solely used commercial test substances.
Topics: Humans; Patch Tests; Dermatitis, Allergic Contact; Dermatology; Dermatitis, Occupational; Occupations; Allergens
PubMed: 35864599
DOI: 10.1111/cod.14191 -
Cancers Dec 2022Surgery for non-small-cell lung cancers (NSCLCs) invading the superior vena cava (SVC) is rarely performed due to surgical complexities and reported poor prognoses....
BACKGROUND
Surgery for non-small-cell lung cancers (NSCLCs) invading the superior vena cava (SVC) is rarely performed due to surgical complexities and reported poor prognoses. Different methods have been described to reconstruct the SVC, such as direct suture, patch use or prosthesis, according to its circumferential involvement. The aim of our study was to analyze the short- and long-term results of different types of SVC resection and reconstruction for T4 NSCLCs.
METHODS
Between January 2000 and December 2019, 80 patients received an anatomical lung resection with SVC surgery in this multicenter retrospective study. The partial resection and direct suture or patch reconstruction group included 64 patients, while the complete resection and prosthesis reconstruction group included 16 patients. The primary endpoints were as follows: long-term survival and disease-free survival. The secondary endpoints were as follows: perioperative complications and 30- and 90-day mortality. Unpaired t-tests or Mann-Whitney U tests for non-parametric variables were applied to discrete or continuous data, and the chi-square test was applied to dichotomous or categorical data. Survival rates were calculated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS
No differences were found between the two groups in terms of general characteristics and surgical, oncological and survival outcomes. In particular, there were no differences in terms of early (50.0% vs. 68.8%, = 0.178) and late complication frequency (12.5% vs. 12.5%, = 1.000), 30- and 90-day mortality, R status, recurrence, overall survival (33.89 ± 40.35 vs. 35.70 ± 51.43 months, = 0.432) and disease-free survival (27.56 ± 40.36 vs. 31.28 ± 53.08 months, = 0.668). The multivariate analysis demonstrated that age was the only independent predictive factor for overall survival.
CONCLUSIONS
According to our results, SVC resection has good oncological and survival outcomes, regardless of the proportion of circumferential involvement and the type of reconstruction.
PubMed: 36551624
DOI: 10.3390/cancers14246138