LITERATURE REVIEW Bruce A. Brod, M D

Marti J i l l Rothe, M D

Salicylate Intoxication in an Infant With Icthyosis Transmitted Through Skin

Ointment: A Case Report

This case report involves a 3-month-old child with lamellar icthyosis. The child presented with diarrhea, vomiting, and low-grade fever. On admis- sion to the hospital, the baby became more ill with signs of dehydration, acidotic breathing, and a metabolic acidosis. During hospitalization, the in- fant's condition deteriorated with generalized con- vulsions and repeated attacks of apnea requiring mechanical ventilation. Careful questioning of the parents showed that an ointment containing 4% salicylic acid was being extensively applied to the infant's skin. Salicylate levels were found to be markedly elevated. Alkaline diuresis was used to treat the child, resulting in a full recovery. The authors stress that the diagnosis of salicylism from topically applied salicylates is elusive and should be considered in infants with acquired, unexplained metabolic acidosis.

Abdel-Magid HM, Ahmed FA: Pediatrics 94: 939-940, 1994

Bruce A. Brod, MD Department of Dermatology

Hahnemann and Medical College of Pennsylvania University

Philadelphia, PA

Lidocaine Adrenaline Tetracaine Gel Versus Tetracaine Adrenaline Cocaine Gel for

Topical Anesthesia in Linear Scalp and Facial Lacerations in Children 5 to 17 Years of Age

This prospective, randomized, double-blinded trial was designed to compare the efficacy of topical lidocaine 4%, adrenaline 1:2000, tetracaine 0.5% (LAT) against the standard topical tetracaine adrenaline cocaine (TAC) gel in reducing pain. The study group consisted of 95 children with linear lacerations to the scalp or face who presented to an inner-city emergency department. Physicians as well as patients and parents separately rated the

overall pain of suturing. Results showed that the LAT gel was equally effective as the commonly used TAC gel in reducing pain. The significance is that the LAT gel is considerably less expensive than the TAC gel. Cost per application was $3 for LAT compared with $35 for TAC. The other advantage of LAT gel is that it does not contain a controlled substance. The authors consider this a preliminary study with a small population size.

Ernst AA, Marvez E, Nick TG, et al: Pediat- rics 95:255-258, 1995

Bruce A. Brod, MD

Minocycline-Induced Rash in an 18-Year-Old Patient

This case report describes an 18-year-old college student who presented to her student health department with a chief complaint of "bruises" on her thighs, shins, and ankles. Her history and physical examination was unremarkable except for the skin lesions along with acne. Because the lesions resembled bruises, a workup was initiated. Results showed a normal urinalysis, prothrombin time, partial thromboplastin time, bleeding time, plate- let count, erythrocyte sedimentation rate, and com- plete blood count with differential. O n examina- tion, she had 2- to 4-cm oval flat lesions on both legs that resembled new bruises. Further history showed that she had been taking 100 mg minocycline hydrochloride to treat acne for 14 months, and a diagnosis of minocycline-induced hyperpigmenta- tion was made. Within 16 months of stopping the medication, the pigmented lesions were no longer visible. The authors conclude that minocycline- induced hyperpigmentation should be included in the differential diagnosis ofpurpura.

Karofsky PS, Williams GP: Arch Pediatr 149: 217-218, 1995

Bruce A. Brod, MD

Synthetic Sport Shorts Folliculitis

This case report shows a cutaneous reaction to synthetic sport shorts, which have become popu-

American Journal of Contact Dermatitis, Vol 6, No 4 (December), 1995: pp 247-249 247

248 LITERATURE REVIEW

lar because of their quick-drying, lightweight, and rip-proof features. A healthy 7-year-old boy pre- sented with a 3-day history of a rash localized to his thighs. He had been wearing loose-fitting synthetic sport shorts made of 100% nylon polyamide for 3 days. Although the shorts were laundered daily, he had been very active and the weather had been very hot. On examination, there was a follicular erup- tion that corresponded to the area of contact with the shorts. After 2 days of not wearing the shorts, the reaction cleared. The author postulates that this was an irritant folliculitis to an offending chemical in the shorts and suggests clothing made of natural material as an alternative.

Rider EA: Arch Pediatr 148:1230-1231, 1994 Bruce A. Brod, MD

The Role of Alternative Therapies in the Treatment of Allergic Disease

Nonconventional therapies for the treatment of allergic disease are reviewed. Hypnosis has been shown to up-regulate or down-regulate immediate and delayed-type hypersensitivity reactions; hypno- sis has also been shown to be effective therapy for chronic urticaria and has reduced symptom severity and reliance on medication in a small group of patients with atopic dermatitis. Vasodilation and alterations in immune function are proposed mecha- nisms by which the effects of hypnosis are medi- ated. Acupuncture has been widely used to treat asthma but has only been studied in a limited fashion for the treatment of cutaneous disease. Once-daily acupuncture for 3 days suppressed de- layed hypersensitivity reactions to trinitrochloroben- zene in mice. Suppression of cutaneous delayed hypersensitivity reactions in mice by acupuncture can be blocked by pretreatment with Naloxone. Alternative therapies often modify the patient's perception of disease, ~elding subjective benefit and possibly altering immune function. Alternative therapies may be beneficial for patients who have failed conventional therapies.

Watkins AD: Clin Exp Allergy 24:813-825, 1994

MartiJill Rothe, MD Division of Dermatology University of Connecticut

Farmington, CT

Contact Pemphigus: A Subgroup of Induced Pemphigus

The authors review reports of pemphigus provoked by contact with topical substances. Impli- cated contactants include tincture of benzoin, pesti- cides, chromium sulfate, industrial solvents, and chemicals associated with photographic developing and dry cleaning. Previous reports have emphasized a possible role for systemic absorption of the impli- cated chemicals. The authors of this commentary suggest that direct activation of enzymes that disaggregate keratinocyces or provocation of imme- diate and delayed hypersensitivity may be more likely mechanisms by which topical exposures pro- voke pernphigus.

Brenner S, Wolf R, Ruocco V: IntJ Dermatol 33:843-845, 1994

Mufti Jill Rothe, AdD

Insecticide-Induced Lupus Erythematosus

A father and daughter acutely developed photosensitive dermatoses with histological fea- tures consistent with cutaneous lupus erythemato- sus and positive anti-nuclear antibodies after expo- sure to two "bug bombs." The ingredients of the bombs included trichloroethane, propane, metho- prene, and permethrin. Permethrin has been asso- ciated with itching and burning of the face, irrita- tion of the nose and throat, and facial and forearm dermatitis. The temporal relationship between in- secticide exposure and the onset of the cutaneous eruption suggests causality, although the precise mechanism is unclear.

Beer KR, Lorincz AL, Medenica MM, et al: IntJ Dermato133:860-862, 1994

Mufti Jill Rothe, MD

House Dust Mite Allergen Avoidance: A Randomized, Controlled Trial

of Surface Chemical Treatment and Encasement of Bedding

Dust mite allergy as a provocative factor in atopic disease has been receiving increased atten- tion. Active treatment with impermeable covers over mattresses and pillows and spraying carpets and furniture with a tannic acid/acaricidal spray failed to ameliorate symptoms and signs of airway dysfunction in patients with asthma. Levels of house dust mite allergen also were not significantly reduced. Therefore, other measures would be neces-

LITERATURE REVIEW 249

sary to sufficiently control levels of house dust mites.

Marks GB, Tovey ER, Green W, et al: Clin Exp Allergy 24:1078-1083, 1994

MartiJill Rothe, MD

Occupational Asthma in a Latex Doll Manufacturing Plant

A 2 l-year-old woman with a history of allergic rhinitis developed rhinoconjunctivitis, facial flush- ing, chest tightness, and wheezing within minutes of entering a work area where sanding of latex doll parts was being performed. She had worked at the plant for a 2-year period before work-related symp- toms developed. Skin test results to raw latex extract and doll dust extract were positive. Two other workers reported symptoms of flushing, wheezing, and nasal and eye irritation when ex- posed to sanded doll parts. Skin test results in both of these workers to latex as well as ragweed, grass mix, and house dust mite were positive.

Orfan NA, Reed R, Dykewicz MS, et al: J Allergy Clin Immuno194:826-830, 1994

MartiJill Rothe, MD

Occupational Hand Dermatoses of Hairdressers in Tainan City

Patterns of hand dermatoses in Taiwanese hairdressers were investigated. Ninety-eight hair- dressers, including 36 stylists and 62 apprentices, were evaluated. Eighty-two subjects had hand der- matitis. Hand dermatitis was more severe in appren- tices. Lichenification and scaling of the metacarpo- phalangeal joints was associated with shampooing. Eczema of the fingers was associated with contact

sensitivity to nickel, Kathon CG, Captan, and fragrance mix. Hair dye allergy and rubber allergy were uncommon, most likely because Taiwanese people dye their hair infrequently and hairdressers rarely use protective gloves.

Guo YL, Wang B-J, Lee J Y-Y, et al: Occup Environ Med 51:689-692, 1994

MartiJill Rothe, MD

Regulation of Allergen-Specific Immune Responses by CD4 + CD45R + Cells in Patients

With Allergic Contact Dermatitis

Immediate patch test reactions (IPTR) ap- pear within 45 minutes and clear within 2 hours after application of a substance. IPTRs may be followed by a delayed reaction after 48 to 72 hours, typical of allergic contact dermatitis. Twenty pa- tients with suspected contact dermatitis underwent patch testing; all patients showed one or more positive IPTRs to seven allergens (balsam of Peru, cobalt, fragrance, nickel, sorbic acid, paraphenylene- diamine, and P-chloro-M-cresol), and 8 patients showed a delayed reaction to the same allergen. CD4+CD29 + T cells derived during an IPTR or during a positive delayed reaction proliferated in the presence of the specific allergen and autologous monocytes. CD45R + cells were predominant in the case of negative delayed reactions; CD45R + cells could suppress the proliferation of CD29 + cells. IPTRs may be components of delayed reactions.

Baxevanis CN, Papadopoulos NG, Katsarou- Katsari A, et al:J Allergy Clin Immuno194:917-927, 1994

MartiJill Rothe, MD