A case of eosinophilic pustular folliculitis (Ofuji's disease) induced by patch and challenge tests with indeloxazine hydrochloride

A 73-year-old male developed disseminated erythema over his entire body after exposure to indeloxazine hydrochloride, a cerebral activator. Patch testing with indeloxazine hydrochloride showed a positive reaction, and plaques, vesicles and pustules developed on the face after the patch test. These had the pathologic feature of eosinophilic pustular folliculitis (EPF, Ofuji's disease). A challenge test also provoked eruptions on the face, trunk, arms and legs, which were compatible with EPF. Moreover, both the patch and challenge tests with indeloxazine hydrochloride induced eosinophilia. This is the first report of drug allergy-induced EPF, where drug sensitivity induced an abnormal eosinophilic response mimicking EPF.

Lithium-induced follicular hyperkeratosis

A wide range of cutaneous reactions have been described in association with lithium therapy. Follicular eruptions have been noted briefly, but are not well documented in the dermatological literature. We report a 68-year-old man who developed a florid erythematous follicular eruption on the extensor surfaces of the limbs, with macular truncal erythema 6 months after commencing lithium therapy. His blood lithium levels were within the therapeutic range and there was no clinical evidence of lithium toxicity. Histology of lesional skin showed perifollicular inflammation and follicular plugging. The eruption improved on drug withdrawal. The cutaneous reactions to lithium and possible pathogenic mechanisms are discussed.

Patch testing with beryllium alloy samples in guinea pigs

An experimental study was conducted in guinea pigs for the predictive assessment of the beryllium alloy hazard in occupational exposure of the skin to beryllium compounds. Guinea pigs were sensitized to beryllium sulfate according to the maximized Magnusson and Kligman test, and challenged with beryllium alloys and metallic copper, beryllium and aluminum samples. Results showed a delayed skin hypersensitivity reaction in 30 to 60% of pre-sensitized guinea pigs challenged with copper-beryllium alloys and aluminum-beryllium alloy. An inflammatory follicular reaction was induced by copper in both controls and pre-sensitized guinea pigs.

Lithium therapy associated with hidradenitis suppurativa: case report and a review of the dermatologic side effects of lithium

Lithium is frequently used in the management of several psychiatric disorders including acute mania, bipolar (manic-depressive) disorder, and recurrent depression. We describe a patient in whom hidradenitis suppurativa developed while the patient was receiving lithium. The cutaneous side effects of lithium are reviewed. The most frequent are psoriasis, acneiform lesions, folliculitis, alopecia, and a maculopapular/macular eruption. Many of these side effects respond less readily to conventional therapy while the patient is receiving lithium.

[Epidermal cysts and folliculitis caused by cyclosporin A]

A 66-year-old man was treated with cyclosporin A (Sandimmun) after a kidney transplant and developed numerous epidermal cysts, comedones and folliculitis in the 2nd year of the immunosuppressive therapy. The eruptions were more marked on the back and in the temporal and retroauricular regions of the face. Histological examination of a cystic tumour revealed a follicular cyst of the acro-infundibular type. While hypertrichosis and gingival hyperplasia are now well known as side effects of cyclosporin A, cystic and acneiform skin lesions must also be attributed to this drug.

[Treatment of gram-negative folliculitis with isotretinoin]

Gram-negative folliculitis is one of the complications of antibiotic treatment of acne. Isotretinoin is recognized as extremely effective for this condition. We describe 2 patients with gram-negative folliculitis following antibiotic treatment for acne who improved after 3-months of treatment with isotretinoin.

Development of folliculitis and pyoderma gangrenosum in association with abdominal pain in a patient following treatment with isotretinoin

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.

Eosinophilic cellulitis and eosinophilic pustular folliculitis

This report describes a patient with a drug reaction and histologic changes of both eosinophilic cellulitis and eosinophilic pustular folliculitis. We propose that some cases of eosinophilic pustular folliculitis, like eosinophilic cellulitis, may occur as a result of a hypersensitivity phenomenon.

Development of an objective comedogenicity assay

The rabbit ear comedogenicity assay is useful as a screening procedure for evaluating agents that come in contact with human skin. Controversy exists regarding the reliability of this assay because of differences in results from various laboratories. The subjective nature of the standard method of grading may also contribute to this variation. We use a more objective comedogenicity assay that utilizes increasing follicular orifice size on the rabbit ear as a measure of comedogenic activity. A generally linear increase in the degree of follicular orifice area was noted with several agents evaluated over a four-week application period. Further, a noninvasive Silastic elastomer mold was used to allow measurement of the same follicular orifice areas over time.

Dermatological reactions to lithium: a critical review of the literature

This article reviews clinical reports of dermatological reactions to lithium. Such reactions include maculopapular, acneiform, and follicular eruptions, psoriasis, and other manifestations. Standard psychiatric texts offer the psychiatrist little information concerning the prevalence or seriousness of these reactions, nor do they discuss the effectiveness of various treatment alternatives. More surprisingly, most dermatology texts do not even describe skin reactions to lithium. Dermatological reactions to lithium may occur more commonly than previously documented, but with the exception of some psoriatic cases, management without the need for lithium discontinuation is usually possible.

Occupational irritant contact folliculitis associated with triphenyl tin fluoride (TPTF) exposure

Triphenyl tin fluoride (TPTF) is a bioactive organo-tin compound used in concentrations 2-12% as anti-foulants in boat paints. The chemical is moderately toxic to the skin. An occupational irritant contact folliculitis from TPTF in a marine paint plant worker is described. Contact allergy was excluded by patch testing. An attempt to reproduce the follicular reaction in man, rabbit and guinea pig was unsuccessful.

[Undesirable side effects on the skin caused by lithium therapy--case report and references (author's transl)]

This is a report about a 54 year old woman, who was treated with lithium carbonate because of a manic-depressive illness. As side-effect of this medicament she developed a relapsing hidradenitits suppurativa. After interruption of this therapy the illness of the skin improved, but relapsed, when the therapy with lithium was started again. In this case report we give a survey about side-effects of lithium concerning the skin.

[Problems arising from the use of cosmetics on the lid margin (author's transl)]

Report on clinical and histopathological changes of the conjunctiva after long-term use of cosmetics containing carbon black (mascara, eyeliner) on the lid margin. Penetration of tiny pigmented particles into the stroma of the conjunctiva initially causes a follicular reaction which is evidently toxic, and later, results in a chronic follicular-papillary reaction.

Oil dermatitis: an enquiry into its prognosis

Johnson, M. L., and Wilson, H. T. H. (1971).Brit. J. industr. Med.,28, 122-125. Oil dermatitis: an enquiry into its prognosis. One hundred industrial workers who developed skin disease while working with soluble or cutting oils were seen. Between 6 and 13 years later 87 of these cases were contacted and their subsequent histories obtained. Of these, 42 had oil dermatitis, 10 had oil dermatitis and constitutional eczema, and 17 had constitutional eczema alone. The remainder were suffering from dermatitis other than oil or from folliculitis or could not be classified.

The groups with oil dermatitis and oil dermatitis and associated constitutional eczema had a similar outcome; 60% were clear, 23% better, and 17% unchanged, whereas of the group with constitutional eczema only 35% had cleared with 41% better and 24% unchanged. Of the cases with oil dermatitis 82% had changed their job. Those with mild oil dermatitis who had not lost work had the best prognosis. Of other factors that might influence prognosis there was no direct correlation with the length of time off work, the age of onset or the payment of compensation. However, if the worker continued to be exposed to oil for more than one year after the onset of the dermatitis the chances of subsequent clearing were less than if the exposure was shorter.

Cataracts produced by triparanol. (MER-29)

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