Achille Sertoli
Viene riferita l?attività dermato-allergologica espletata in Italia negli ultimi 25 anni, dal 1982 al 1998 dal GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali) e poi dal 1999 dalla SIDAPA (Società Italiana di Dermatologia Allergologica, Professionale e Ambientale), erede del GIRDCA. Sono riportati gli argomenti delle oltre 30 ricerche multicentriche svolte, elencati i 7 Congressi SIDAPA con i loro principali temi ed infine brevemente richiamate le principali attività di ricerca con i relativi riferimenti bibliografici, di 16 dei 24 Centri di riferimento che hanno risposto alla richiesta di informazioni in merito.
The allergological dermatology activities conducted in the past 25 years, from 1982 to 1998 by the GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali), and subsequently from 1999 by the SIDAPA (Società Italiana di Dermatologia Allergologica, Professionale ed Ambientale), the successor of GIRDCA, are reported. The subjects of over 30 multicentre studies conducted are reported. The seven SIDAPA congresses and their subjects are listed and the main activities of 16 out 24 Reference Centres, who responded to the related request for information, are reported.
An Goossens
This article gives a review on cosmetic allergens, the most important culprits being fragrances and preservative agents. Since routine patch testing with the fragrance mix in the standard series detects only part of all fragrance-sensitive individuals, testing with additional markers such as fragrance-mix II is being recommended. With preservatives, important shifts in allergenicity have occurred over the years, and their spectrum varies considerably from country to country. Although the methyl(chloro)isothiazoline mixture has been recommended to be used in rinse-off products only, it may still be found in leave-on products on the market and allergenic reactions from it seem to be rising. Methyldibromo glutaronitrile has been banned from use in cosmetics since March 2007 by the European Union. With regard to hair dyes, other potential allergens than p-phenylenediamine and p-toluenedi- amine (may also induce immediate-type reactions) have been identified. (Meth)acrylates are causing reactions to artificial nails preparations, both in clients but particularly in manicurists. Last but not least, natural ingredients, among which plant extracts and herbal remedies, have become very popular in recent years; they should be avoided by fragrance-sensitive subjects. Other potential (and often overlooked) cosmetic sensitizers are emulsifiers and/or vehicle components. Examples are: alkyl glucosides, e.g. decyl glucosides (also a component of the sunscreen agent methylene bis-benzotriazolyl tetramethylbutylphenol); copolymers such as PVP/eicosene and PVP/hexadecane copolymers; ethylhexyl-glycerin (syn.: octoxyglycerin); butylene glycol and pentylene glycol, widely used because of their solvent, humectant and antibacterial effects.
This article gives a review on cosmetic allergens, the most important culprits being fragrances and preservative agents. Since routine patch testing with the fragrance mix in the standard series detects only part of all fragrance-sensitive individuals, testing with additional markers such as fragrance-mix II is being recommended. With preservatives, important shifts in allergenicity have occurred over the years, and their spectrum varies consid- erably from country to country. Although the methyl(chloro)isothiazoline mixture has been recommended to be used in rinse-off products only, it may still be found in leave-on products on the market and allergenic reactions from it seem to be rising. Methyldibromo glutaronitrile has been banned from use in cosmetics since March 2007 by the European Union. With regard to hair dyes, other potential allergens than p-phenylenediamine and p-toluenedi- amine (may also induce immediate-type reactions) have been identified. (Meth)acrylates are causing reactions to artificial nails preparations, both in clients but particularly in manicurists. Last but not least, natural ingredients, among which plant extracts and herbal remedies, have become very popular in recent years; they should be avoided by fragrance-sensitive subjects. Other potential (and often overlooked) cosmetic sensitizers are emulsifiers and/or vehicle components. Examples are: alkyl glucosides, e.g. decyl glucosides (also a component of the sunscreen agent methylene bis-benzotriazolyl tetramethylbutylphenol); copolymers such as PVP/eicosene and PVP/hexadecane copolymers; ethylhexyl-glycerin (syn.: octoxyglycerin); butylene glycol and pentylene glycol, widely used because of their solvent, humectant and antibacterial effects
Leonardo Bianchi, Stefano Simonetti e Luca Stingeni
Mycobacterium (M) chelonae è un micobatterio non tubercolare responsabile di infezioni della cute e, in minor misura, di organi interni, per lo più per contaminazione ambientale in seguito a procedure medicochirurgiche; sono coinvolti soprattutto soggetti con immunodepressione, specie farmaco-indotta. Le manifestazioni cutanee, singole o disseminate, sono eterogenee (noduli sodi e/o fluttuanti, pustole, ulcere, cellulite, panniculite); le localizzazioni viscerali sono varie. La diagnosi si basa, oltre che sull?obiettività clinica, su esami colturali da tessuti infetti, seguiti da tipizzazione del microrganismo con metodiche molecolari. La terapia prevede l?utilizzo di claritromicina, da sola o, in caso di resistenza, in associazione ad amikacina e/o linezolid e/ o ciprofloxacina. E? riportato il caso di un?ottantenne, affetta da artrite reumatoide in trattamento cronico corticosteroideo, che presentava lesioni nodulo-nodose in regione surale destra; l?esame colturale ha consentito di isolare M chelonae. Vengono brevemente esaminati la tassonomia del micobatterio non tubercolare e gli aspetti clinico-epidemiologici e diagnostico-terapeutici delle infezioni da esso causate.
M chelonae is a non-tuberculous mycobacterium which is responsible for cutaneous and visceral infections, usually caused by environmental contamination, which can often follow surgical treatments. Immunosuppressed patients, particularly those taking immunosuppressive medications, are those most frequently involved. Cutaneous lesions, single or disseminated, can appear as firm or fluctuant nodules, pustules, ulcers, cellulitis, panniculitis, and can sometimes mimic other cutaneous diseases such as Sweet?s syndrome, acne or lupus. Visceral localizations are various. Diagnosis is based on the clinical features and cultural tests on infected tissues, followed by microorganism tipization using molecular methods. Treatment is based on the use of clarithromycin in monotherapy or, in the case of resistance, in association with amikacin and/or linezolid and/or ciprofloxacin. The case of a 80-year-old woman affected by rheumatoid arthritis chronically treated with oral corticosteroid, who showed nodular colliquative lesions on her right leg is reported. A cultural test from a biopsy speciment isolated M chelonae. The tassonomy of this non-tuberculous mycobacterium and its clinical, epidemiological, diagnostic and therapeutical aspects are briefly reviewed.
Domenico Bonamonte, Giovanni Profeta, Caterina Foti, Gianni Angelini
La processionaria del pino, Thaumetopoea pityocampa Schiff, è un lepidottero fito- e xilofago, responsabile del ritardo di crescita e della morte di alcune specie di pini, tra cui quello marittimo, e di cedri presenti sulle coste del Mediterraneo. Oltre al danno alla natura, il bruco causa eruzioni papulo-orticariose, in genere a tipo strofulo, nell'uomo e in animali domestici (cani, pecore) a causa di particolari peli urticanti presenti negli stadi larvali L3, L4 ed L5. Questi peli, cavi all'interno, non hanno fori in superficie e pertanto penetrando nella cute si spezzano e rilasciano una sostanza urticante. L'eruzione cutanea si osserva in ambiente professionale ed extraoc- cupazionale. La contaminazione avviene nelle pinete, raramente in città , dove tuttavia possono esserci pini infestati. Diverse sono le modalità di contaminazione: contatto cutaneo diretto con i nidi o con le processionarie e contatto aeromediato con i peli sospesi nell'aria. L'eruzione da contatto con la processionaria del pino si osserva nella tarda primavera ed in particolare da aprile a giugno, soprattutto in gitanti ed amanti di picnic in pinete. La patologia indotta dalla processionaria del pino interessa, oltre alla cute, gli occhi e le vie respiratorie, rispettivamente per contatto ed inalazione dei peli presenti nell'ambiente. L'eruzione cutanea inizia 1-12 ore dopo il contatto con i peli e si manifesta soggettivamente con prurito intenso e persistente e obiettivamente con lesioni papulose escoriate su una base edematosa; possono anche essere evidenti lesioni papulobollose. Ciascuna lesione evolve in 3-4 giorni e lascia una macula ipercromica che a sua volta persiste per 2 settimane circa. La diagnosi è suffragata dalla presenza della stessa dermatite in altre persone dell?entourage del paziente, dalle sedi interessate (in genere quelle scoperte) e soprattutto dal dato anamnestico di un recente soggiorno in pineta. Il meccanismo patogenetico dell'affezione è duplice: meccanico, per infissione dei peli nella cute, e farmacologico, per l'azione istamino-liberatrice della sostanza presente all'interno dei peli. La stessa azione farmacologica è diretta e, verosimilmente, anche indiretta IgE-mediata. Le lesioni oculari possono essere precoci (bruciore, iperemia ed edema della congiuntiva e delle palpebre, seguiti da fotofobia, intensa lacrimazione e formazione di noduli congiuntivali) e tardive (cheratite, irite, uveite, cataratta e glaucoma). Nonostante i considerevoli danni all'uomo e all'ambiente, il problema della infestazione da processionaria del pino è sottovalutato. La stessa letteratura medica contiene scarse osservazioni e di frequente la conoscenza del problema è demandata alla stampa.
The pine caterpillar, Thaumetopoea (T.) pityocampa Schiff, is a phyto- and xilophagus lepidopteran, responsible of the delay in the growth or the death of some types of pines, among which maritime pine present on the Mediterranean coasts, and cedars. Apart from the damage to nature, the pine caterpillar causes papulo-urticarious reactions, generally of the strophulus type, as a result of the urticant hairs present in the last three larval stages (L3, L4, L5), in humans and domestic animals (dogs, sheep). The urticant hairs, hollow on the inside, have no hole or pores and therefore must be broken in the skin to release their urticant substance. Although the dermatitis occurs among out-door profession- als, it is primarily extraprofessional. Contamination generally occurs in pinewoods, rarely in cities, although infested pines may even found in cities. There are various means of contamination: direct contact with the nest or the processional caterpillar, and indirect contact with the hairs suspended in the air. This contact eruption can be observed in the late spring and particularly from April to June, among campers and picnic lovers. The pathol- ogy induced by T. pityocampa Schiff involves the skin, eyes and in rare cases the airways. The cutaneous eruption is favored by sweat, has its onset 1-12 hours after contact with the hairs, and presents subjectively with intense and continuous itching. The eruption consists of papulous, excoriated, and pinkish lesions on an oedematous base. Rarely, the lesions can be bullous. Each lesion evolves over 3 to 4 days and leaves an hyperchromic outcome that lasts about 2 weeks. Diagnosis is aided by the onset of the same eruption in other members of the patient?s party, by the sites affected, and mainly by case history describing a recent stay or walk in or near pinewoods. The pathogenetic mechanism of the affection is mechanic (due to the penetration of the hairs inside the skin), and pharmacological (due to the release of the urticant histamine liberating substance) in nature. The pharmacological mechanism may be direct in the action, and probably also IgE-mediated. Lesions to the eyes can be early orlate. The former manifest with intense burning sensation, hyperemia, and edema of the conjunctiva and eyelids. This is followed by photophobia, abundant secretion, and conjunctival nodules the size of peppercorns, as a reaction to the hairs (ophthalmitis nodosa). Late lesions are secondary to the penetration of the hairs inside the eye; the clinical pictures include chreratitis, iritis, uveitis, cataract, nodules of the iris, and finally glaucoma. Despite the considerable damages to humans and nature, the caterpillar pine infestation is a problem underes- timated; the same medical literature contains rare reports, and often the knowledge of the problem is referred to the media.
Luca Stingeni, Paolo Lisi
E? riportato il caso di un uomo non atopico di 54 anni, affetto da DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) da cefixima, una cefalosporina di terza generazione. La sintomatologia, insorta dopo circa 2 settimane di terapia, era caratterizzata da esantema morbilliforme, edema del volto, congiuntivite e mucosite orale, linfoadenopatie superficiali, febbre e astenia. Gli esami ematochimici hanno evidenziato ipereosinofilia, citolisi epatica, colestasi e insufficienza renale; negativa la sierologia per virosi. Dopo la sospensione della terapia, il quadro è regredito lentamente in circa 2 mesi con terapia corticosteroidea e antistaminica orale. I test cutanei (patch test, prick test, test intradermico), eseguiti 4 mesi dopo la remissione clinica, hanno mostrato reazione ritardata eczematosa in sede di test intradermico con cefixima e con cefuroxima, una cefalosporina di seconda generazione che il paziente non aveva mai assunto nel passato. Il caso riportato conferma il ruolo patogenetico dell?ipersensibilità ritardata nella DRESS. Non ci risultano segnalati in letteratura casi di DRESS associati a terapia con cefixima e confermati dal test intradermico.
We report a case of 54-year-old non atopic man with a drug rash accompanied by eosinophilia and systemic symptoms (DRESS syndrome) which were induced by cefixime, a third-generation cephalosporin. In approximately two weeks from the start of his treatment he had progressively developed a diffuse itching maculopapular morbilliform eruption, facial oedema, oral and conjunctival mucositis, superficial lymphadenopathy, fever and anorexia. Blood tests showed hypereosinophilia, hepatic cytolisis, cholestasis and decreased renal function. Serological findings for viruses were negative. The medication was stopped and the condition improved slowly with oral corticosteroidal and antihistaminic treatment until complete clinical and laboratory remission was reached two months later. Skin testing (patch test, prick test, intradermal test) was performed four months later and showed a delayed eczematous reaction to cefixime and cephuroxime, a second-generation cephalosporin which the patient had never previously taken, on the site of intradermal test. Although the physiopathology of DRESS syndrome has not yet been clarified, our case confirm that nonimmediate type hypersensitivity must be considered in the pathogenesis of this syndrome. To our knowledge, this is the first reported case of DRESS syndrome associated with cefixime treatment and confirmed by an intradermal test.
Mario Principato, Iolanda Moretta, Danilo Assalve, Francesco Cittadini, Luca Fortugno
Viene segnalata, per la prima volta in Umbria, una morsicatura da parte di Loxosceles rufescens (Araneae: Scytodidae) in un uomo di 21 anni, alla periferia di Perugia. Il ragno ha aggredito l?uomo di notte, mentre dormiva all?interno della propria abitazione, nel mese di giugno. Immediatamente dopo il morso, il paziente ha percepito alla palpebra inferiore sinistra un forte dolore localizzato. Dopo 24 ore il punto di inoculo è divenuto edematoso e, successivamente, la lesione è evoluta in necrosi; ipertermia e cefalea grave hanno accompagnato la manifestazione cutanea. La terapia antibiotica e corticosteroidea ha determinato remissione dei sintomi e guarigione della lesione
Recorded herein is the first case in Umbria (Central Italy) of a bite from Loxosceles rufescens (Araneae: Scytodidae). The spider bit a 21 years old man who was sleeping indoors in his Perugia home one night in June. Soon after he was bitten the patient felt a strong local pain which was followed by a local edema. During the next 24 hours, he developed fever (39°C) with a severe headache and a whitish necrotic lesion developed at the point of inoculation. After a treatment with antibiotic (amoxicillin and clavulanic acid), betamethasone and cetirizin, the patient recovered in 10 days? time
Anna Maria Riccardo, Gabriella Fabbrocini, Fabio Ayala
Scopo del presente studio è stato quello di approfondire il rapporto esistente tra uso di farmaci, abitudine al fumo e consumo di superalcolici in pazienti affetti da psoriasi. Lo studio è stato condotto con- frontando un gruppo di pazienti con psoriasi (615 soggetti) con un gruppo di controllo (900 soggetti) e valutando il ruolo che alcune variabili considerate, quali il fumo, i superalcolici e l?assunzione di farmaci, hanno sul rischio di contrarre la psoriasi. I risultati confermano che l'abitudine al fumo costituisce un fattore di rischio, tuttavia non abbiamo riscontrato associazione tra abitudine al fumo e psoriasi pustolosa, come ritenuto da altri autori, ma con la forma volgare a placche. Per quanto concerne i farmaci, è stato confermato il rapporto tra molti di essi e comparsa/aggravamento della psoriasi. Dai risultati ottenuti, però, risultano essere coinvolte nel ruolo scatenante anche altre classi di farmaci come i sartani (Odds Ratio = 3,2)
Background: psoriasis is a chronic, multifactorial inflammatory disease that affects about 3% of the general population. This disease is thought to be induced or aggravated by several factors, including excessive alcohol intake, physical and psychological stress, and drugs. Several drugs can interfere with psoriasis in predisposed individuals, even if a family history of psoriasis is absent. The more suspected drugs include lithium, β-blockers, antimalarials and nonsteroidal anti-inflamma- tory drugs (NSAID). The association between alcohol and psoriasis is complex and confusing because many of the initial studies did not control for confounding factors such as tobacco use. Early studies showed no correlation between alcohol consumption and psoriasis. However, as researchers began to control for confounding factors, the results of many studies often showed a significant correlation between alcohol intake and psoriasis. Some studies suggested a relative risk factor of 8.01, particularly in men; these studies did not document an increased risk for psoriasis in women drinking alcohol. Smoking is a risk factor for psoriasis and seems to be associated with the clinical severity of psoriasis. Materials and Methods: we conducted a case-control study to analyse the association between psoriasis and some risk factors for psoriasis, including smoking habits, spirit consumption and drugs. The study was conducted by comparing a group of 615 patients (308 women and 307 men) affected by psoriasis with a group of 900 control subjects (459 women and 441 men). Results: our study shows that smoking constitutes a risk factor in the development of psoriasis. Moreover, we found a dose- response association between smoking and psoriasis. The risk of psoriasis was higher in ex- and current smokers than in non smokers. The relative risk estimates (OR) is 2.6 for ex-smokers and 1.3 for smokers. Our study found an association between smoking and the vulgaris variant of psoriasis but unlike other authors, we did not find any association between smoking and pustular psoriasis. Conclusions: our study confirms the relationship between some drugs and onset/aggravation of psoriasis. Lithium (OR = 5.2), β-blockers and antimalarials (OR = 3.9), interferons (OR = 3.3), sartans (OR = 3.2) and nonsteroidal antinflammatory drugs (OR = 3.0) were variously associated with a personal history of psoriasis.