Monica Corazza, Oriele Sarno, Federica Baldo, Anna Elisabetta Zannoni, Anna Virgili
La dermatite allergica da contatto (DAC) dei piedi è causata principalmente da allergeni presenti nelle calzature. Il trattamento ideale, che consisterebbe nell?allontanamento degli allergeni causali, non è sempre possibile. Nel presente studio viene valutata l?efficacia di calzari costituiti da tessuto bio-ingegneristico come presidio terapeutico in pazienti affetti da DAC da calzature. Il tessuto costituente i calzari, Uretex (Microair® Barrier), è un tessuto tri-strato composto da una maglia in microfibra di poliestere, con strato interno costituito da una membrana microporosa che funge da barriera fisica per allergeni ed irritanti. Sono stati arruolati 10 pazienti che hanno indossato i calzari per 8 settimane. Il quadro clinico e la sintomatologia soggettiva sono stati valutati all?arruolamento e durante le visite di controllo mediante la scala VAS (Visual Analogic Scale). Al termine dello studio il 90% dei pazienti ha ottenuto un miglioramento dello score e dell?obiettività clinica. I calzari barriera, se indossati regolamente, rappresentano una valida opzione terapeutica nella DAC dei piedi.
Foot allergic contact dermatitis (ACD) is a common dermatological disease which negatively influences the quality of life. The ideal treatment of ACD is the removal of contact with the allergens. However, avoiding a specific shoe allergen is often very difficult since there is scarce information about all the materials present in shoes. We have studied the efficiency of allergen-proof fabric barrier socks in a selected group of patients affected by ACD to footwear allergens. Textile engineering has recently developed socks made of a technologic Uretex fabric (Microair® Barrier), a three-layer fabric made of a polyester microfibre, with an internal layer made of a microporous membrane designed to guarantee a physical barrier to allergens and irritants and high perspirability. We enrolled 10 patients affected by foot ACD and asked them to wear their own shoes only in association with the Microair® Barrier socks for a period of 8 weeks. Assessment of clinical severity was performed at the enrolment examination and at each further control (first control after 4 weeks, second and last after 8 weeks) through the decimal visual analogic scale (VAS). Investigators asked patients to quantify separately, from 0 to 10, itch, soreness/pain, and inability to walk due to foot eczema. A total final score was obtained adding each numeric parameter. Photographs of lesions were taken at the enrolment and during follow-up in the same environmental conditions. The use of the protective socks determined both a clinical and a subjective improvement. Regarding symptoms, after 8 weeks patients referred a reduction of itch in 90% and a decrease of pain in 71%, while 58% reported an improvement in their ability to walk. At the end of the study patients were asked to express their personal opinion about their difficulties in following the protocol: 20% (2/10) patients declared that it was difficult to always wear the barrier socks for social reasons and/or for the scarce comfort of these socks; the other patients declared that following the protocol scarcely influenced their personal habits and therefore that it was easy to follow the protocol. Previous studies have shown improvement in skin lesions in eczematous diseases (atopic dermatitis, ACD) after use of barrier textiles. After 2 months of treatment good clinical results were obtained showing improvement of symptoms, rapid skin regeneration and recovery from foot eczema. The best results were observed in the patients who strictly followed the protocol wearing these therapeutical devices every time they wore shoes. The investigated allergen-proof, breathable barrier socks, worn during daily activities, seem to be a promising new, efficient steroid-sparing therapy in the treatment of foot eczema.
Paolo Lisi
Le fotodermatiti costituiscono un gruppo eterogeneo di malattie cutanee causate o aggravate dall?esposizione alle radiazioni ultraviolette (RUV) e/o alla luce visibile (fotodermatiti immunomediate, genofotodermatiti, fotodermatiti da fotosensibilità indotta, dermatiti fotoaggravate). Tra le fotodermatiti da fotosensibilità indotta esogena sono incluse le fotodermatiti da farmaci. Queste sono caratterizzate da alterazioni della cute e/o dei suoi annessi, prevalentemente localizzate alle sedi fotoesposte, non volute e inattese, causate dalla somministrazione di farmaci (sia sistemici che topici), alle dosi abitualmente impiegate, e dalla contemporanea esposizione alle RUV, sia naturali che artificiali. Sulla base dei meccanismi patogenetici vengono distinte in fototossiche e fotoallergiche. Tappe essenziali dell?iter diagnostico sono l?esame clinico (distribuzione e morfologia delle manifestazioni cliniche), l?anamnesi, le indagini strumentali (fototest, fotopatch test, indagini ematochimiche, biopsia cutanea). Ne viene proposta la gestione temporale. La prevenzione e la terapia delle fotodermatiti da farmaci sistemici sono discusse.
Photodermatoses are a heterogenous group of skin diseases caused or aggravated by exposure to ultraviolet radiations and/or visible light. They can be classified in four groups: immunologically mediated photodermatoses (previously called idiopathic photodermatoses), genophotodermatoses (or defective DNA repair disorders), chemical and drug-induced photosensitivity photodermatoses, and photoexacerbated dermatoses. Drug-induced photodermatoses are inflammations of the skin and/or its appendiges, prevalently localized on sun-exposed sites, unintended and unexpected, caused by drugs applied topically or taken systemically and administered to the doses habitually used) and by contemporary exposure to natural or artificial ultraviolet light. Pathogenetically, they are divided into phototoxic or photoallergic reactions. The essential steps in evaluating a photosensitive patient are physical examination (distribution and morphology of the lesions), history, instrumental investigations (phototesting, photopatch testing, laboratory examinations, histopathology). The prevention and therapy of drug-induced photodermatoses are discussed.
Maria Cristina Acciai, Achille Sertoli, Emilia Vanni, Gabriele Ermini, Laura Parrini
Presentiamo un caso di dermatite allergica da contatto professionale in un uomo, non atopico, che ha lavorato negli ultimi 2 anni presso l?acquedotto comunale come addetto al controllo del contenuto in cloro nell?acqua potabile, mediante un metodo colorimetrico basato sull?impiego della N,N-dietil-p-fenilendiamina (DPD Free Chlorine Reagent ® , Hach Lange GmbH, Düsseldorf). La morfologia delle lesioni era prevalentemente di tipo eczematoso e l?esame allergodiagnostico effettuato mediante patch test evidenziava sensibilitizzazione a N,N-dietil-p-fenilendiamina (DPD) e al reagente DPD Free Chlorine ® fornito dal lavoratore e veicolato allo 0,5% e al 2,5% in vaselina. I sintomi clinici sono completamente regrediti quando, a seguito del cambio di mansione, è cessato ogni contatto con il reagente. DPD, che appartiene agli sviluppatori di colore, nel secolo scorso è stato causa di noto e frequente rischio professionale nell?industria fotografica e cinematografica. Attualmente il metodo colorimetrico mediante DPD è utilizzato per svelare la presenza di cloro e misurarne la concentrazione nell?acqua potabile e nelle farine, così come per monitorare la concentrazione del cloro nelle piscine e nelle acque destinate all?allevamento di pesci e molluschi.
We present a case of occupational allergic contact dermatitis in a non-atopic male who has worked in the last 2 years in the municipal waterworks as a technician employed in checking the chlorine content in drinking water. The reagent used is based on N,N-diethyl-p-phenylendiamine (DPD Free Chlorine Reagent ® , Hach Lange GmbH, Düsseldorf). The prevailing clinical morphology of the lesions was eczematous and the patch tests showed contact sensitization to N,N-diethyl-p-phenylendiamine and to DPD Free Chlorine Reagent ® 0.5% and 2.5% in petrolatum. The clinical symptoms cleared up when direct contact with the reagent was avoided as a result of the change of duty. In the last century DPD (belonging to the colour developers) was the cause of well-known and frequent occupational risk in photography and in the film industry. Currently colorimetric method by means of DPD is used in order to reveal the presence of chlorine and to measure its concentration in drinking water and flours as well as to monitor the concentration of chlorine in swimming pools and in water for fish and mollusks breeding.
Gino Antonio Vena, Michelangelo Vestita, Doriana Apruzzi e Nicoletta Cassano
Pemfigo e pemfigoide costituiscono un gruppo di dermatosi bollose croniche a patogenesi autoimmune, che possono talora essere causate o esacerbate da agenti farmacologici. I principali medicamenti inducenti pemfigo si classificano in tiolici, non tiolici e non tiolici-non fenolici, mentre i più frequenti composti responsabili di pemfigoide bolloso comprendono antinfiammatori non steroidei, agenti cardiovascolari e antimicrobici. La patogenesi delle forme farmaco-indotte è complessa e annovera sia meccanismi di tipo biochimico, sia di tipo immunitario, con smascheramento di siti antigenici e produzione di autoanticorpi. Le manifestazioni cliniche ricalcano quelle delle forme idiopatiche, pur presentando a volte elementi suggestivi dell?eziologia iatrogena. L?istologia e gli studi immunopatologici raramente dimostrano caratteristiche peculiari e distintive rispetto alle forme spontanee. Fondamentale per la diagnosi risulta pertanto l?anamnesi. L?evoluzione clinica può variare, in virtù del farmaco inducente e della predisposizione individuale, da forme autolimitantesi, che regrediscono prontamente dopo la sospensione del medicamento, a forme che assumono il decorso cronico caratteristico delle forme idiopatiche.
Pemphigus is well known for being caused or exacerbated by various factors, including drugs. Evidence supporting the causal role of medications has grown since 1951, when the first case of drug-induced pemphigus was described. The offending medications are generally classified as thiols, phenols and non-thiol non-phenol agents, according to their chemical structure. Most case reports of drug-induced pemphigus are related to thiol compounds, which include penicillamine, bucillamine, captopril, and tiopronine. Clinical features are non-specific and resemble at first other drug eruptions, later developing the typical aspects of either superficial pemphigus or pemphigus vulgaris. The former has been traditionally associated to administration of thiol drugs, while the latter, whose incidence is increasing, is more frequently associated with the use of non-thiol molecules. A peculiar clinical entity, known as contact pemphigus, has recently been described in response to a few topical agents, in particular imiquimod. The offending drugs may promote acantholysis through either a biochemical or an immuno-mediated mechanism, sometimes even both. Drug-induced bullous pemphigoid shows similar clinical, histological and immunopathological characteristics to idiopathic pemphigoid, but it is associated with systemic or topical administration of various medications, especially nonsteroidal antiinflammatory drugs, cardiovascular agents and penicillin and its derivates. The exact mode of pathogenic action of such medications is still unclear. Some drugs may act releasing thiol groups, thus altering hemidesmosome cohesion, while others may unmask hidden antigens or alter immune response by modulating T suppressors activity. Some molecules are also capable of acting synergically. Clinically, the outbreak is usually polymorphic at first, sometimes mimicking other diseases, such as eczematous or urticarial reactions, erythema multiforme, fixed drug eruption, prurigo and others. Some features, however, can suggest the drug origin. Specifically, in drug-induced forms, patients are often younger than patients with idiopathic pemphigoid. Moroever, in drug-induced pemphigoid, Nikolsky sign is usually positive, target-like lesions can be observed on palms and soles, bullae emerge on normal looking skin, and lower limbs and mucous membranes are frequently involved. Clinical course may range from acute, autolimiting and especially steroid-sensible forms to chronic and refractory cases. Diagnosis is based on clinical, histological and immunopathological aspects, and history is the fundamental step towards the identification of the iatrogenic nature