This review demonstrates that in five studies, carried out in healthy children or in those with non-eczematous dermatoses, there was a high frequency of positive patch test reactions. With the exception of nickel sulfate, similar studies in adults have shown low frequencies in the general population indicating over-diagnosing of contact allergy in the child population. The simplest explanation to this discrepancy is that the concentrations used in adults are not suited for children for all test preparations in the standard series due to their irritant properties. Reduced concentrations - as previously recommended by inter alia Hjorth and Fisher - is warranted for potassium dichromate, nickel sulfate, formalin, and possibly also for the fragrance mix and some rubber chemicals. A 'wish-list' how to further improve accuracy and reliability when patch testing children is presented.
Between April 1991 and December 1993, 1156 patients were patch tested with 18 allergens of industrial lubricants (other than biocides) in 19 dermatologic centers. The numerous ''+''-reactions to cadmium chloride and a certain proportion of reactions to benzoyl peroxide are considered irritant, while contact allergic reactions to p-aminoazobenzene, p-tert.-butylcatechol, abietic acid and the ethanolamines tested were observed quite frequently. Results, changes in composition of the test series, and patch testing with cutting fluids and oils brought in by the patient are discussed.
Peracetic acid (PES) fulfills many required aspects of a modern microbicide used in the chemo-thermal laundry disinfection. Its toxicological profile corresponds to that of organic peroxides and is comparable to hydrogen peroxide. The health risks when working with PES can be considerably reduced through proper protective measures as well as the use of automatic dosing in closed working systems. The decomposition to acetic acid and water allows this compound to be used in many areas.Due to its good microbicide characteristics and its long-term, unproblematic use PES has become, not only for chemo-thermal laundry, an irreplaceable microbicide, which also hardly burdens the environment when used properly.
Patients who have had contact dermatitis from plants can lose interest in an investigation that is prolonged. We suggest measures to accelerate investigation by expediting botanical identification and procurement, literature search, patch testing, and phytochemical study.
Following a general discussion on photobiological basics concerning the appearance and prevention of occupational dermatoses, chronic injuries resulting from light and various occupationally important medical aspects concerning light are presented. Further points of discussion are the particularly affected occupational groups, especially those working in tropic or subtropical regions, as well as the differences between occupational and recreational sun exposure. In addition to sunlight, chronic UV injuries can result from UV emission, such as during welding and in areas where UV light is implemented. The phototoxic reaction, i.e., to plants, occupationally only concerns the so-called ''tar skin''. In contrast to photoallergic skin reactions, i.e., caused by medications or food additives, can possibly disrupt the ability to work. Photodermatoses of other etiology can be provoked or worsened through UV light at work. In the case of the chronic Lupus erythematosus or the erythropoetic protoporphyria a change of the work place is often necessary. However, in the case of porphyria cutanea tarda, proper therapy can reduce photosensitivity.
The data of 811 patients with stasis dermatitis or allergic contact eczema of the legs, who had been tested between November 1989 and July 1993 in one of the partner clinics belonging to the Informational Network of the Departments of Dermatology (IVDK), were studied. Of these, 662 (81.6 %) were over 49 years of age. The following test blocks, as recommended by the German Contact Allergy Group (DKG), were checked: standard series (n = 542), creme base series (n = 475), preservatives (n = 303), medicaments (n = 163), and corticosteroids (n = 52).In the standard series, balsam of peru produced the most positive reactions with 19.3 % of the total, followed by lanolin alcohol with 17.2 %, perfume mix with 15.1 %, neomycin sulphate with 14.8 %, and paraben mix with 9.7 %.In addition to the lanolin alcohols, cetyl stearyl alcohol (12.6 %) dominated the creme basis series. Only 82 patients were tested with Amerchol L 101(R), 50 % in vaseline. Almost all patients with lanolin alcohol allergy reacted to Amerchol L 101; vice versa, however, only about half the patients with a positive reaction to Amerchol L 101 also reacted to lanolin alcohol. Therefore, the test with Amerchol L 101 resulted in a better screening, the relevance of this, however, remains unknown. Polysorbate 40 and 80 as well as isopropylmyristate should only be tested when an exact suspicion is known.Among the preservatives, the parabens in the standard series produced more positive reactions than Kathon(R) CG (4.7 %) and formaldehyde (4.4 %). The more concrete testing with the preservative series produced the highest results for benzalkonium chloride (4.3 %) and Bronopol (3.3 %). Sensitization to thimerosal was observed less often that during the same time frame for the complete IVDK (3.0 vs. 4.5 %). Butylhydroxytoluol, chlorbutanol and zinc-pyrithione produced no reactions, these substances should only be tested under exact suspicion. The most common allergens in the medicament series were the antibiotics neomycine (19.3 %), framycetine (17.6 %), chloramphenicol (12.9 %), and benzoyle peroxide (13.4 %), followed by propolis (9.2 %) and dexpanthenol (8.7 %). Contact allergies to corticosteroids were only observed in single cases. When testing a hydrocortisone creme 1 % (commercially available preparation), the reactions mostly occurred to the creme base or a preservative, but never to hydrocortisone.
The first part of this literature review deals with allergic contact eczemas from chromium and chromate, one of the most important eczematogens in this group. This metal is discussed on the background of the many possibilities of occupational exposure to if, its derivatives and their occurrences.
The acute and chronic results of subcutaneously applied aliphatic hydrocarbons are discussed based on the clinical, pathological, and therapeutic management of a recent case.
Dermatoses have a high occurrence value in the realm of occupational illnesses in Germany. The BK-Nr. 5101 (the occupational insurance list covering dermatoses) are at the top of the list in occurrences when looking at the indication reports of the Organization of Occupational Insurance Providers: 19371 notices were registered in 1993 alone.In addition to the listed occupational diseases there exists the possibility of claiming an occupational dermatosis using 551 of the RVO (3rd book of the state insurance code), which handles these as equivalents to the listed diseases. Here the circumstances under which criteria such occupational dermatoses can be acquired and compensated ie., which illnesses can be considered under these legal aspects, are discussed.
The relevance of positive patch tests to thiomersal still remains a problem. To further evaluate possible causative factors we sent a questionnaire to 55 patients, reacting to thiomersal in the standard series of the German Contact Dermatitis Research Group (DKG) in Jena between 1992 and 1994. Of these 47.3% responded to our questionnaire. A substantial role played employees working in health care professions (57.7%), mostly women (80.8%). Also 24.1% were allergic to disinfectants corresponding to the occupational profile. We found a high proportion of patients who had been vaccinated against hepatitis B and/or diphtheria/tetanus only a few months before the patch test.The part of thiomersal allergies sensitized by ophthalmics was negligible in our group.
Bioban(R) P 1487, consisting of the two active ingredients 4-(2-nitrobutyl)-morpholine (4-2-M) and 4,4'-(2-ethyl-2-nitrotrimethylene) -dimorpholine (4-2-DM), is a preservative recommended for metal-working fluids. The aim of this study was to determine the sensitizing capacities of 4-2-M and 4-2-DM while also investigating the cross-reaction patterns during sensitization rests in the guinea pig.Both active ingredients were demonstrated to be sensitizers, 4-2-DM a strong one and 4-2-M a moderate one. Cross reactivity between 4-2-DM and 4-2-M was demonstrated when 4-2-DM was the sensitizer. Possible cross reactivity between 4-2-M and 4-2-DM with 4-2-M as the sensitizer was indicated.Recently the manufacturer has reduced the content of 4-2-DM in Bioban P 1487. From a dermatological point of view the new composition seems preferable since the risk of sensitization will hopefully diminish.
