Effectiveness of various barrier preparations in preventing and/or ameliorating experimentally produced Toxicodendron dermatitis

Evaluation and Management of Toxicodendron Dermatitis in the Emergency Department: A Review of Current Practices

Toxicodendron dermatitis is an underappreciated disease seen in the emergency department. Although self-limiting, symptoms can be distressing and can last for weeks if untreated, particularly with re-exposure. Continuing research has improved our understanding of specific inflammatory markers that are associated with exposure to urushiol-the compound responsible for Toxicodendron dermatitis-although consensus for treatment remains varied and poorly supported. Owing to the lack of recent primary literature on the topic, many providers rely on historical precedent, expert opinion, and personal experience when treating this disease. This article provides a narrative review of the literature currently available on the effects of urushiol on key molecular and cellular functions and the prevention and treatment of Toxicodendron dermatitis.

Itchy Toxicodendron Plant Dermatitis

Plants such as the Toxicodendron species, consisting of poison ivy, poison oak, and poison sumac, largely contribute to allergic contact dermatitis with itch as a predominate symptom. Many individuals are affected by this skin condition, with approximately 50% to 70% of adults in North America demonstrating a degree of clinical sensitivity to this species of plants. In this review, we discuss the prevalence, pathophysiology, and clinical features of this contact dermatitis, as well as both treatment and prevention directed towards alleviation of itch. Updated research is emphasized throughout this review, although it is evident that this field is evolving, and more research is necessary to enhance treatment.

Contact dermatitis from Eriodictyon parryi: a novel cause of contact dermatitis in California

Allergic contact dermatitis caused by Eriodictyon parryi, better known as poodle-dog bush, is a growing cause of contact dermatitis in California. Blooming after a large fire, E parryi is a threat to reforestation workers as well as countless outdoor enthusiasts across the state. This paper focuses on the epidemiology, identification, immunochemistry, pathophysiology, prevention, and treatment of contact dermatitis from this little-researched plant.

Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized, controlled trial

OBJECTIVES

The aim of the trial was to investigate whether the publicized effects of skin protection creams can be replicated in a real occupational setting during activities that expose the skin.

METHODS

A prospective, randomized, four-tailed controlled pilot trial was performed to compare the effect of skin protection and skin care alone or in combination with cleansing against a control group (only cleansing). Two branches were selected for the investigation: the building industry and the timber industry. A total of 1,006 workers from these two branches were recruited, and out of these 485 workers were examined longitudinally for at least three time points over 1 year (lost for follow-up: 430 workers, exclusion: 91 workers). At each time point, as a primary outcome measure, we assessed the condition of the skin at both hands in a blinded manner and the individual was assigned to one of the following categories: no eczema, mild, moderate and severe eczema. As a secondary outcome measure, the worker's transepidermal water loss (TEWL) was measured under standardized conditions at the back of both hands. In addition, the workers were asked to evaluate their skin condition during the study.

RESULTS

With regard to differences in the occurrence of eczemas, we found only in workers in building industry without application of skin protection or skin care creams a statistical significant increase in the incidence between the first and the second visit and a statistical significant decrease in the incidence between the second and third visit. When evaluating the secondary outcome-measurement changes in the TEWL values, an improvement was found for the group skin protection and skin care in combination and by skin care alone. Females in the timber industry started with better TEWL values than males, which may be due to better overall skin care. In this group we found an improvement for the group skin protection and skin care in combination and by skin protection alone. For skin protection alone, we noted a slight, but not significant improvement in all other groups. The subjective improvement of skin condition was reported from the participants who used skin protection and skin care in combination.

CONCLUSIONS

Taking all these secondary-outcome measurements together, the main result of this study was that skin protection creams alone have a small effect on the skin barrier in workers in the building and timber industries compared with skin care alone or in combination with skin protection.

Plant poisoning

Each year over 100,000 exposures to toxic plants are reported to poison centers throughout the United States. Most of these exposures are of minimal toxicity largely because of the fact that they involve pediatric ingestions, which are of low quantity. The more serious poisonings usually involve adults who have either mistaken a plant as edible or have deliberately ingested the plant to derive perceived medicinal or toxic properties. The plants within this manuscript have been chosen because they have been documented to cause fatalities or account for emergency medicine visits. In this discussion, plants are grouped by their toxins rather than on the basis of their taxonomy.

A systematic review of contact dermatitis treatment and prevention

BACKGROUND

Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention.

METHODS

Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence.

RESULTS

In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications.

CONCLUSIONS

A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

Patch testing for allergic contact dermatitis in the allergist office

The identification of allergens responsible for allergic contact dermatitis (ACD) is key to the management of this disease. The patch test (PT) is the only safe, objective, scientific, and practical method for the diagnosis of ACD. There is no single PT panel that will screen all the relevant allergens in a patient's environment. It is generally thought that 20 to 30 allergens in routine screening tests can identify 50% to 70% of clinically relevant ACD. However, the usefulness of patch testing is enhanced with the number of allergens tested. Although the PT might be simple to apply, it might be difficult to read, interpret, and correlate to the patient's symptoms. A familiarity with the patient's environment, the process of the industry in that environment, and the uses of various chemicals in the industry is needed in most cases.

Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine

OBJECTIVES

This study attempts to assess the evidence of the generally recommended three-step programme of skin protection in the prevention of occupational skin disease.

METHODS

The following clinical questions, representative of critical appraisal of this preventive measurement, were generated: (1) Can a skincare regimen effectively reduce or eliminate work-related poor skin conditions? (2) Do protective creams prevent harmful substances from penetrating and adhering to the skin? (3) Is the differentiation between pre-exposure and post-exposure products justified by reliable data? Answers were generated according to the method used in evidence-based medicine by searching the literature, critically appraising the results and applying the results to the clinical questions. For our search we decided to use PubMed as the most convenient access to Medline and because, in contrast to other databases, this access is available free of charge.

RESULTS

To investigate the efficacy of barrier creams as pre-exposure skin protectors various in vitro and in vivo test methods have been developed. Over the past years the test techniques have been improved in order to adopt a real workplace situation. Efforts for standardisation of evaluation criteria have been made, too. Nevertheless, there is a lack of placebo-controlled, randomised clinical trials evaluating the benefit of these products in the prevention of occupational contact dermatitis under real workplace conditions. The literature data are conflicting; some publications report on the positive aspects of skin protection, whereas others stress the negative ones.

CONCLUSION

Not enough data have been accumulated for one to prove the benefit of skin protection measures under real workplace condition. Up to now, it is almost unclear if the various in vitro and in vivo methods used are suitable to simulate real workplace conditions and if these test results can be related to real occupational exposure. For the evidence-based recommendation of skin protection, further studies, especially under daily working conditions evaluating the contribution of each single element of skincare programme (products, frequency of application and education programme) are needed.

Cost-effective post-exposure prevention of poison ivy dermatitis

BACKGROUND

Poison ivy (toxicodendron) dermatitis is the most common allergic contact dermatitis in the USA. No studies have shown an effect of washing after a short period of time for the prevention of binding of urushiol to the skin. Objective To evaluate the efficacy of three different modes of postcontact prevention using a surfactant (Dial ultra dishwashing soap), an oil-removing compound (Goop), and chemical inactivation (a commercial product Tecnu).

METHODS

A consented, unsponsored, volunteer experimental study on medical students from the University of Missouri School of Medicine, Kansas City. Each subject served as his/her own control, comparing four 2.5-cm exposed squares on the inner aspect of the forearm, three of which were treated and one untreated.

RESULTS

Comparisons between the different agents were nonsignificant with P > 0.05. Each treatment, however, was significantly improved over the untreated control.

CONCLUSIONS

Our study showed 70%, 61.8%, and 56. 4% protection with Tecnu, Goop, and Dial, respectively, when compared to the positive control, or to the possible maximum response, with a cost per ounce (in a local drug and automotive store) of $1.25, $0.07, and $0.07, respectively, for a decrease in protection that is nonsignificant.

Rhus (Toxicodendron) dermatitis

This article reviews the current fund of knowledge on poison ivy, poison oak, and poison sumac dermatitis. It is intended as a global summary to provide the primary care provider with the required information and sources for more esoteric academic pursuits. Toxicodendron characteristics, morphology, and biology are reviewed. The overall medical impact is delineated as well as the clinical manifestations, pathophysiology, prevention, and treatment. Historical perspectives are mentioned throughout, as are future trends in research.

Prevention of sodium lauryl sulfate irritant contact dermatitis by Pro-Q aerosol foam skin protectant

Eczematous skin disease is a serious work-related illness. Since 1995, reimbursement by insurance companies for treatment of skin diseases has become the largest cost source in some countries. This study was a randomized controlled trial (N = 20) of the efficacy of Pro-Q, a skin protectant product, in the prevention of contact dermatitis from sodium lauryl sulfate and urushiol, the resinous sap of poison ivy and poison oak. Pro-Q was significantly effective in reducing the irritation from sodium lauryl sulfate but did not prevent the allergic reaction to urushiol.

Plant dermatitis. Possible culprits go far beyond poison ivy

Given the variety of existing plant species in the environment, it is remarkable that people have adjusted as well as they have to the many plants that can cause uncomfortable skin reactions. With a basic understanding of the types of reaction and the common plants that cause each type, physicians can help patients discover the source of the dermatitis and thus prevent reexposure. In immediate contact dermatitis, welts form rapidly after patients brush against an offending plant, but the urticarial rash is short-lived. In irritant contact dermatitis, the skin is traumatized mechanically (eg, with cactus spines) or chemically (eg, with capsaicin from hot peppers), producing a more persistent skin reaction. Phytophotodermatitis occurs when the skin is exposed to sunlight after contact with an offending plant; reactions are erythema, pruritus, vesiculation, and subsequent hyperpigmentation. Allergic contact dermatitis, typified by the rash of poison ivy, is a cell-mediated immune response that occurs in previously sensitized persons. Erythema, vesiculation, and pruritus, which usually heal without causing pigmentary changes, may last for several weeks.

Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite

BACKGROUND

Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America.

OBJECTIVE

We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis.

METHODS

A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed.

RESULTS

Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion.

CONCLUSION

Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.

Horizons in pharmacologic intervention in allergic contact dermatitis

The treatment of allergic contact dermatitis remains a major challenge. Current management strategies consist of elimination of the allergen when possible and therapy for symptoms with topical or systemic corticosteroids. With increasing exposure of the human skin to environmental antigens and haptens, more selective treatment options are needed. Advances in the elucidation of the skin immune system and of the cellular and molecular events in immunologic processes may allow targeted methods of controlling delayed hypersensitivity reactions. This review focuses on mechanisms of established therapeutic agents and new developments, such as FK 506 (tacrolimus), pentoxifylline, and vitamin D3 derivative, for suppression of any phase of allergic contact dermatitis.

Efficacy of skin barrier creams (IV). The repetitive irritation test (RIT) with a set of 4 standard irritants

An improved human model for the quantification of skin barrier creams (BCs) is described. In contrast to the previously published procedure, the back, instead of the forearm, and a total of 4 irritants are used. Due to the larger area, 3 BC formulations can be simultaneously compared to the control field, which receives the irritant only, without BC-pretreatment. On 10 human volunteers, the irritants 10% sodium lauryl sulfate (SLS), 1% sodium hydroxide (NaOH), 30% lactic acid (LA) and undiluted toluene (TOL) were applied via large Finn Chambers for 30 min, 5 x during the 1st week and 4 x during the 2nd week. Taktosan Salbe (water-in-oil emulsion) and RAWI Speerschutzcreme (oil-in-water emulsion) were applied 30 min before contact with the irritants. In order to assess reproducibility and interindividual variation, the BC RAWI was tested in duplicate. Irritant cutaneous reactions were quantified by 4 parameters: erythema score, transepidermal water loss, blood flow volume and stratum corneum hydration by measuring capacitance. The results showed marked differences in efficacy. Taktosan significantly suppressed irritation by SLS, NaOH and LA, which was apparent in nearly all parameters. RAWI caused significant inhibition of SLS irritation, and a positive trend against NaOH and LA was observed. Both BCs failed against TOL. The results of duplicate testing with RAWI showed good reproducibility. The dogma that oil-in-water emulsions are primarily effective against lipophilic irritants, and water-in-oil emulsions against hydrophilic irritants, needs to be re-evaluated on the basis of our findings. This model seems to have potential for further studies on BCs and might elucidate the complex interaction of BCs with irritants.

Dermatologic therapy: 1992

This article reviews therapeutic studies reported in the English-language literature during 1992. Readers should review the original article in full before attempting any experimental or controversial therapy.