Oscar Wilde's skin disease: allergic contact dermatitis?

During the last years of his life, Oscar Wilde (1856-1900) suffered from a suppurating otitis media as well as from an unidentified skin disease. The eruption was localized to his face, arms, chest and back and itched severely. A new theory is suggested, based on the fact that Wilde almost certainly used a dye to conceal his rapidly graying hair. He sensitized himself to p-phenylenediamine and developed a stubborn allergic contact dermatitis. Patch testing, the only proof of such a diagnosis, had not yet been devised.

Evaluation of a self-administered questionnaire on hand dermatitis

The purpose of the study was to evaluate a self-administered questionnaire on hand dermatitis that was developed to identify persons with hand dermatitis in epidemiological studies. A total of 109 nurses were subject to dermatological examination of the hands within 1 month of returning the questionnaire. 2 types of questionnaire diagnoses were made: a 'symptom-based' diagnosis and a 'self-reported diagnosis'. These were compared to the medical diagnosis of hand dermatitis. The prevalence of hand dermatitis in the 12 months before the study, based on the medical diagnosis, was 18.3%. The prevalence according to the symptom-based diagnosis and the self-reported diagnosis was 47.7% and 17.4%, respectively. The sensitivity and specificity of the symptom-based diagnosis were 100% and 64%, respectively. It is concluded that the symptom-based diagnosis can be used as screening instrument for the detection of cases in large study populations, if followed by dermatological examination of persons with a positive diagnosis. The sensitivity and specificity of the self-reported diagnosis were 65% and 93%, respectively. It is concluded that the self-reported diagnosis can be used to obtain a rough estimate of the prevalence, although comparison of prevalence figures between study populations may be distorted due to a difference in reporting of hand dermatitis. The results of the study illustrate the size of the differences in prevalence estimates that may arise as a result of differences in the definition and method of diagnosing hand dermatitis.

Variability in transepidermal water loss of the skin: evaluation of a method to assess susceptibility to contact dermatitis in epidemiological studies

Transepidermal water loss (TEWL) has been suggested to be a measure which can be used to identify subjects at risk for the development of contact dermatitis. Transepidermal water loss is high when the barrier function of the skin is impaired. It is assumed that subjects with a high TEWL have skin which is more permeable to substances causing contact dermatitis. The inter-individual and intra-individual variability of simultaneous TEWL measurements and TEWL measurements over a period of three weeks were estimated in healthy individuals. The intra-individual coefficient of variation (CV) of simultaneous measurements was 13.5%. The intra-individual coefficient of variation of the measurements on consecutive days was somewhat higher (15.1%). The intra-individual coefficients of variation were low compared to the inter-individual coefficients of variation. The results indicate that transepidermal water loss is a stable personal characteristic, which can be studied as a risk factor in epidemiologic studies on contact dermatitis.

Susceptibility to irritants: role of barrier function, skin dryness and history of atopic dermatitis

The susceptibility of the skin to various irritants was investigated with the aim of determining the role of the barrier function of the stratum corneum, skin dryness and whether a history of atopic dermatitis (AD) was a factor. The transepidermal water loss (TEWL) was measured using an evaporimeter and skin hydration using a Corneometer and by visual scoring. The group with a history of AD (n = 20) had a lower pre-exposure barrier function and a higher TEWL value following irritant exposure than the group with a history of allergic contact dermatitis (n = 18) and a control group (n = 18). Clinically dry skin was more susceptible than normal skin, though no difference was noted in the pre-exposure barrier function. The increased susceptibility to irritants in those with a past history of AD was probably due to impaired barrier function and/or the presence of a dry skin.

Evaluation of detergent-induced irritant skin reactions by visual scoring and transepidermal water loss measurement

Transepidermal water loss measurements proved to be more accurate and sensitive than visual scoring in discriminating the irritating action of detergents on the skin. Further, the baseline transepidermal water loss might be a reliable indicator of an individual's susceptibility to weak irritants.

The intra- and inter-individual variability and reliability of transepidermal water loss measurements

An analysis of variance was conducted to estimate the intra- and inter-individual variations in TEWL on the forearms, by sites (8 measurement sites) and by days (10 different days), in 30 non-exposed healthy individuals. The estimated intra- and inter-individual variations, by sites, were 15.5% and 84.5%, respectively, the sum of the 2 components always being 100%. With the exclusion of the 2 most distal sites near the wrist, which had significantly higher baseline TEWL values and fluctuations in TEWL, an improvement in the intra-individual variation was obtained. Thus, of the 6 sites, the estimated intra- and inter-individual variations were 8.4% and 91.6%, respectively. This finding supports the exclusion of these most distal sites for future investigations. The estimated intra- and inter-individual variations, by days, were 20.6% and 79.4%, respectively. The low site-to-site (8.4%) and day-to-day (20.6%) intra-individual variations, as compared to the large inter-individual variations of the same (91.6% and 79.4%), indicate that baseline TEWL is a stable personal characteristic. Thus, individual susceptible to irritant contact dermatitis (ICD), due to occupational exposure, may be reliably characterized by utilizing their baseline TEWL values, for "prediction" of risk in epidemiological field studies.

Transepidermal water loss with and without sweat gland inactivation

The influence of eccrine sweating on transepidermal water loss (TEWL) was investigated. TEWL was simultaneously measured on both forearms, with and without topical inactivation of the eccrine sweat glands by 0.3 ml of 0.5% aqueous scopolamine hydrobromide (HBr), applied under 1 h occlusive patches. The degree of sweat inhibition, after exercise, was measured at 2, 3 and 4 h after patch removal. In 42 out of 44 subjects, complete sweat inhibition (on exercise) was achieved only at 4 h after removal. After a 15-min rest in a room at 20 degrees C, the pre-exercise TEWL values (at 4 h) on the treated and untreated sites were not different (P greater than 0.05), in 38 out of 44 subjects. By this rest period, sweating due to slight physical, thermal or even emotional stimuli may be prevented in most subjects. In the other 6 subjects, the pre-exercise TEWL values (at 4 h) on the untreated site were 1-1.8 g/m2h higher than (P less than 0.001) on the treated site, due to emotional sweating. Thus, accurate baseline TEWL measurements may only be made after anticholinergic suppression of the sweat glands. In this way, accurate TEWL measurements may be made even outside favourable laboratory conditions, at industrial sites etc., where circumstances are far from ideal. The effect of this agent applied to a skin site previously irritated artificially by a 24-h occlusive sodium lauryl sulphate (SLS, 0.3 ml, 0.5% aq.) patch, was also investigated in 17 subjects. In all subjects, 4 h after removal, sweating (on exercise) was completely inhibited on the scopolamine-treated site, pre-irritated with SLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of susceptibility to an irritant response by transepidermal water loss

The roles of the natural permeability of the stratum corneum to water, and the changes in that permeability effected by a single patch test, were investigated as parameters to predict the susceptibility of the skin to repeated exposures of an irritant. One site on the forearm skin of 27 non-atopic healthy subjects was exposed to a 0.5% concentration of sodium lauryl sulphate by a single occlusive 24-h patch. Another site was exposed to a twice daily 4-day repeated occlusive patch with the same irritant solution. The effects were evaluated by transepidermal water loss measurements made prior to the applications (baseline) on day 1 (BASE), following the single 24-h patch on day 2 (SINGL), and following the 4-day repeated applications on day 5 (REPET). Individuals with higher BASE had higher SINGL (R = 0.80, P less than 0.001) and higher REPET (R = 0.76, P less than 0.001). There was also a significant linear correlation between SINGL and REPET (R = 0.63, P less than 0.001). Multiple linear regression analysis of results, however, indicated that a high baseline TEWL is better indication of an individual's increased susceptibility (high REPET) to weak irritants than a high TEWL value following a single 24-h patch test. Baseline TEWL may therefore be used as a reasonably accurate preliminary "predictive" screening test for susceptibility to irritants.

Baseline transepidermal water loss (TEWL) as a prediction of susceptibility to sodium lauryl sulphate

The rôle of different factors in the susceptibility of the skin to weak irritants was studied by means of multiple linear regression models. The skin of 37 healthy subjects was exposed to a solution of sodium lauryl sulphate of low molarity 2 x daily for 4 days. The condition of the skin was evaluated by transepidermal water loss (TEWL) measurements on the 1st day (before exposure, TEWL1) and on the 5th day of exposure (TEWL5), and by a visual scoring system. The TEWL5 value was strongly related to the TEWL1 value (R = 0.71). The influence of such factors as history of mucosal atopy, history of sensitivity to soap, dry skin, skin type, sex and age on the TEWL5 value was negligible. The baseline TEWL level (TEWL1) might be a reliable indication of an individual's susceptibility to weak irritants.

Comparability and reproducibility of the results of water loss measurements: a study of 4 evaporimeters

A study was made of the comparability and reproducibility of the results of measurements of water loss, both in vitro and in vivo, using 4 ServoMed Evaporimeters (3 single-probe and 1 double-probe instrument). The optimum time for recording transepidermal water loss (TEWL) after the initial application of the probe to the skin (in vivo), and the best technique for optimizing the accuracy of measuring TEWL were determined. An evaporation device with a constant level of water loss was constructed for in vitro studies. The volar aspect of the right forearm skin of one subject was used in vivo. Both in vitro and in vivo measurements showed that there were some differences between the results of 4 of the 5 probes. The other probe was distinctly out of range. For all probes, the reproducibility of results of successive measurements was high. Stabilization of TEWL values was reached for all probes from 30-45 s after their initial application to the skin. It is recommended that TEWL be recorded for a further 30-s period, after the initial stabilization (45 s), and that this be taken as the true value. The manufacturer's recommended calibration procedure is based only on adjustments for the standard specified humidities and zero water loss. The importance of incorporating an additional calibration procedure which includes adjustments for an actual standard constant water loss is thus strongly stressed.

The influence of repeated exposure to surfactants on the human skin as determined by transepidermal water loss and visual scoring

The purpose of this study was to develop a new model for the induction of chronic irritant contact dermatitis, which would reflect well the conditions of daily practice. Various weak irritant agents were tested for irritating potency on the skin and the sensitivity of transepidermal water loss (TEWL) measurements in the detection of early skin changes was also studied. 10 widely used surfactants and 1 solubilizer were applied to the skin of the forearms of healthy volunteers in aqueous solutions of 12.5 millimoles/l for 45 min twice daily for 3 weeks. The effect on the skin was evaluated daily by means of TEWL measurements and by a visual scoring system. Each solution caused an increase in TEWL value over time due to the cumulative irritating action on the epidermal barrier. This increase in TEWL was different for the various solutions, resulting in different mean TEWL values on the last day of the experiment. Thus, it was possible to rank the agents according to irritating potency. This ranking order was the same in almost every individual and remained constant during the 3 weeks. In comparison with the visual scoring system, the TEWL measurements were more sensitive in the detection of early changes in the skin.

Maculopapular rash due to coumarin derivatives

The case history is presented of a patient who developed a maculopapular rash following treatment with 3 different coumarin derivatives. Apparently cross-sensitivity between coumarin derivatives may occur.

The role of contact allergy in the spectrum of adverse effects caused by cosmetics and toiletries

Of 982 female clients of beauticians interviewed, 254 (25.9%) claimed to have experienced adverse reactions to cosmetics and toiletries in the preceding 5 years. Most reactions were caused by skin-care products (36.6%), followed by personal cleanliness products (29.5%), eye cosmetics (24.0%), deodorants and antiperspirants (12.6%), and facial make-up products (8.3%). 150 women were patch tested. In the European standard series, only a few positive reactions were seen to possible cosmetic allergens: fragrance mix (n = 3), wool alcohols (n = 3), formaldehyde (n = 2), balsam of Peru (n = 1), and colophony (n = 1). In the cosmetic series, only Kathon CG elicited positive patch test reactions (n = 3). Cosmetic allergy was considered to be "proven" in 3 patients (2.0%), and "possible" in 7 (4.7%). It is concluded that contact allergy is responsible for a minority (less than 10%) of all reactions to cosmetics and toiletries. The majority of reactions are due to irritation from personal cleanliness products such as soaps, shampoos, bath foams and from deodorants, or worsening of pre-existing dermatoses such as seborrhoeic dermatitis and acne.

Allergic contact dermatitis due to rubber chemicals in haemodialysis equipment

6 of 80 haemodialysed patients developed a sub-acute eczematous dermatitis of the area surrounding the arteriovenous shunt in the forearm. Patch tests were positive to rubber chemicals: 6 patients reacted to the thiuram group, 4 of them also to carba compounds. Since the equipment contained only small pieces of rubber, the cause of the allergy remains obscure. It is possible that allergy was caused by short and intermittent contact of the skin with the rubber gloves used by the nursing personnel.

After-work emollient creams: effects on irritant skin reactions

In this study, the influence of 4 after-work emollients on the healing of irritant skin reactions of varying intensity was assessed. To this end 5 patch tests with sodium lauryl sulphate (SLS) 2.5 g/v% were performed on the volar side of the forearm of 30 healthy Caucasian volunteers. Patch tests were removed after 12 h (group A, n = 10), 24 h (group B, n = 10) or 48 h (group C, n = 10). Then standard amounts of the emollients were applicated to the induced skin reactions, twice daily for a period of 5 days. One skin site served as a control. Skin sites were evaluated before, during and after the test period using laser Doppler flow measurements, skin vapor loss measurements and a visual scoring system. In all groups, data obtained from the skin sites treated with the emollients did not differ significantly from the data obtained from the control site. Thus, skin regeneration of the irritant skin reactions was not really enhanced by the application of these preparations. Further investigations on after-work emollient creams with physiologically better adapted constituents are necessary.

Protective effect of barrier creams and spray coatings against epoxy resins

This study evaluates the protective capacity of 4 barrier creams and 2 methacrylate spray coatings against skin contact with epoxy resins. The effect of these materials on the strength and on the surface area of patch test reactions caused by epoxy resin was assessed in 11 volunteers with a known allergy to epoxy resins. Standard amounts of barrier cream and spray coating were applied on the skin. Then patch tests were carried out with epoxy resin on the pretreated sites. After 24 h patches were removed, 48 h thereafter the strength and surface area of the reactions were scored. Results were compared with the score of a control test. The use of 2 barrier creams resulted in a significant reduction of the surface area of the patch test reactions. Spray coatings significantly reduced both the strength and the surface area of the reactions. Our results suggest that methacrylate spray coatings and barrier creams may provide protection against epoxy resins during a test period of 24 h. However, the development of new formulations, adapted more specifically to this purpose, is necessary.

Occupational hand dermatoses in hospital cleaning personnel

Hospital cleaning personnel were examined for occupational dermatoses. 356 persons were included in the study. The age ranged from 20 to 63 years with a mean of 40.1 years. The period prevalence rate of moderate and severe eczema was 12% (10% in men and 19% in women). In 88%, the eczema was of a duration longer than 2 years. Positive patch tests were found in 10% of men and 53% of women with eczema. The main allergens were nickel, cobalt, chromate and rubber chemicals. Positive tests to cleaning agents were rare. One case of contact allergy to sodium dichloro-iso-cyanurate and one to lysol were diagnosed. Irritant factors played a major rôle in most cases (92%). Fungus infection as a cause or complication in hand eczema should not be left out of consideration: in 2 persons, a mycosis of hands and/or fingernails was diagnosed.

Laser-Doppler flowmetry in the investigation of irritant compounds on human skin

The value of laser-Doppler flowmetry was assessed in the evaluation of increased microvascular blood flow caused by the application of low concentrations of irritant compounds on the skin. Laser-Doppler flow values were compared with a visual scoring system for erythema and with skin vapour loss measurements. To this end patch tests were performed on the volar side of the forearm of 24 healthy Caucasian volunteers. The test substances were sodium lauryl sulphate 0.5 g/v%, 1 g/v%, 2 g/v% and phenol 5.0 g/v% in aqua dest. Distilled water served as a control. Laser-Doppler flow and skin vapour loss measurements were performed before and after an application time of 24 h. Data obtained with skin vapour loss measurements and with the visual scoring system demonstrated a statistically significant contribution of substance- as well as subject-related factors to the obtained scoring patterns. The results of laser-Doppler flow measurements were less consistent and could only partly be explained in this way, indicating that other factors also influence the microvascular blood flow in the skin. In this investigation laser-Doppler flowmetry and the visual scoring system were equally sensitive. The results of all three methods make it clear that (analogous to experience in daily life) barrier function impairment and inflammatory response caused by irritant compounds vary in different subjects. For the elucidation of the pathogenesis of irritant contact dermatitis further (longitudinal) investigations on the possible predictive value of skin blood flow measurements will be necessary.

Patch tests with fragrance materials and preservatives

179 patients suspected of cosmetic allergy were patch tested with a series of 16 fragrance materials and 9 preservatives. In 67 patients (37.4%), 1 or more of these substances gave positive reactions. In the group of fragrance materials, the largest numbers of positive patch test reactions were seen to isoeugenol, oak moss, geraniol, alpha-amylcinnamic alcohol, and a mixture of alpha-amylcinnamic aldehyde and alpha-hexylcinnamic aldehyde. The fragrance mix in the ICDRG standard series detected nearly 80% of cases of contact allergy to fragrance materials other than its constituents. In the group of preservatives, Kathon CG and quaternium-15 scored the highest number of positive reactions. It is argued that the commonly used patch test concentrations of 2% for oak moss and geraniol may be too low to detect all cases of sensitization.

Vasoconstrictor and the anti-inflammatory effects of 7 corticosteroids

The vasoconstrictor effect of 7 proprietary corticosteroid creams was compared with their effect on patches of allergic contact dermatitis provoked by patch testing in 20 subjects. A parallel between the blanching effect on the normal skin and the anti-inflammatory effect on the eczematous skin was generally found. A modified patch test method using the Finn chamber technique is described, which (with certain restrictions) offers an opportunity of studying the anti-inflammatory effect of corticosteroids on allergic dermatitis under standard conditions.

Reactions in selected patients to 22 fragrance materials

182 patients on the basis of 6 criteria were suspected of suffering from contact sensitization to cosmetics. 77 (42%) gave a positive reaction to one or more of a series of 22 fragrance and flavor raw materials. The hands were most often involved. Cinnamic alcohol, hydroxycitronellal, eugenol, coumarin, and abitol gave the most common positive reactions; less frequent were cinnamic aldehyde, dihydrocoumarin and dimethylcitraconate. Their relevance could not be traced. However, the first 4 substances were the most frequently identified in 79 suspected cosmetics sent in for analysis by the patients or their physicians. The stability of room-stored petrolatum-fragrance mixtures should be checked.

Prevalence, incidence and course of eczema on the hands and forearms in a sample of the general population

In 1979, the inhabitants of a geographically defined area were examined for skin disorders of the hands and forearms. In 1982 this cohort was invited for re-examination. In persons with eczema, patch testing was performed. Irritant factors were found to play a rôle in 73% of the cases, whereas a contact allergy could be detected in 30%. The most frequent allergens were nickel sulphate (20%), potassium dichromate (6%) and cobalt chloride (4%). In some persons with a definite history of allergy to metals, no positive patch test with nickel, chromate or cobalt could be obtained; other mechanisms may be involved. Significantly more positive patch tests were found among persons with an eczema of longer than 2 years duration compared with persons with eczema present for a shorter period of time, indicating that many cases of eczema are primarily of irritant nature, but later complicated by sensitisation. In 41%, the eczema was healed. A poor healing tendency was observed in those with a combination of irritant and allergic eczema. Relatively few ascribed healing to medical treatment.

Hand dermatoses and contact allergic reactions in construction workers exposed to epoxy resins

In 23/135 (18%) workers exposed to epoxy resins, a work-related dermatosis on the hands and/or forearms had been present during the past 3 years. In 9 persons, the occupational dermatosis was still present at the time of investigation. In all workers, patch tests were performed with epoxy resin, isophoronediamine, triethylenetetramine and xylenediamine. Positive patch tests were observed in 27 of the 135 exposed workers (20%) 13 of whom had never previously experienced skin problems. Epoxy resin accounted for the majority of the positive reactions. There was no relation between a history of atopy and the development of contact allergy. Only half of all workers had received any safety instructions. The wearing of gloves (mostly cotton), intended to protect the skin, had an adverse effect.

Skin irritancy of surfactants as assessed by water vapor loss measurements

A method to assess the irritancy of chemicals on human skin that is based on measurements of skin (water) vapor loss (SVL) is presented. The SVL measurements were performed with the Servo Med Evaporimeter in a group of 27 healthy volunteers. Four surfactants, distilled water, and NaCl 0.9% in distilled water were assayed. For the exposures a chamber technique was used. Sodium lauryl sulfate and cocobetaine most markedly influenced the loss of water through the skin. Polysorbate-60 and sodium laurate had less effect on SVL. The mean difference between the test substances were found statistically significant, except for the mean difference between sodium laurate and polysorbate-60 (p greater than 0.1) and between polysorbate-60 and distilled water (p greater than 0.05). The reactions of the tested subjects to the surfactants suggest that each individual has his own pattern of susceptibility to these substances. The mean values of the SVL measurements were compared with the macroscopically perceptible morphologic changes of the exposed test sites. The results of the SVL measurements. The correlation coefficient between the mean values of both methods was found to be high (r = 0.98).

Skin irritancy of commercially available soap and detergent bars as measured by water vapour loss

The irritancy on human skin of 13 toilet soaps was assessed by means of water vapour loss measurements. The tests were performed on healthy skin of the volar side of the forearm in a panel of 33 subjects. The exposures were done using the Finn chamber method. Skin water vapour loss was measured by means of an "evaporimeter". All soaps--tested in 2 g/v% solutions--were found to lead to a statistically significant increase of water vapour loss as compared to the control sites. Synthetic detergents based on alkyl sulfates, particularly Lactacyd, generally had a relatively greater effect on skin vapour loss as compared with the other products. On the whole the differences between the products were small. It appears that every person probably has his own pattern of susceptibility to wash-active agents.

Irritancy of low concentrations of soap and synthetic detergents as measured by skin water loss

The irritancy of low concentrations of commercially available soaps and detergents (surfactants) in bar form was determined by means of measurements of water loss of the skin. The percentage of increase of vapor (water) loss after application of the soap solutions was taken as a measure of skin irritancy. The tests were performed in 19 human volunteers with 1% solutions of Sporex, Devela, Lux, Lactacyd and Aveenoderm. Devela and Lactacyd were found to provoke marked effects, Lux was less harmful whereas Sporex and Aveenoderm did not lead to a considerable increase of skin vapor loss. Longitudinal studies showed that the irritant properties of soap solutions are additive. The results suggest that the influences of the pH of a soap solution on the skin-damaging effort is less important than assumed thus far.

Cell-mediated immune reactivity in multiple sclerosis

The primary cellular immune responses in multiple sclerosis (MS) patients as compared with healthy controls were investigated with alpha-HPH and DNCB sensitization tests. The results did not reveal significant differences, indicating that no defect or hyperactive state of the cellular immune system is present in MS patients. Some minor and not significant differences between groups of patients or controls could be related to age differences and the degree of invalidism.

Influence of topically applied corticosteroids on patch test reactions

Four commercially available corticosteroid preparations were assayed for their capacity to suppress patch test reactions with contact allergens (nickel sulfate, nitrofuralum, potassium dichromate, epoxy resin, wood tars and Maneb) in sensitized individuals (n=14). Beta-methasone valerate, betamethasone dipropionate, hydrocortisone-17-butyrate and triamcinolone acetonide (0.05-0.7% solutions in isopropanol or ethanol) were applied under occlusion in amounts of 0.01, 0.02 and 0.04 ml, respectively. Patch tests were performed on the pretreated skin sites. The patches were removed 24 h after application and the reactions were read 15 min and 24 h later. The intensity of the reactions and the size of the infiltrated areas of the pretreated sites were measured and compared with those of a control patch test. Topical application of corticosteroids was found to have a suppressive effect both on the intensity as well as on the size of the epicutaneous reactions. No marked difference in the suppression effect of the four corticosteroids could be observed.

Contact allergy to dithranol

During treatment with a dithranol-containing collodion for common warts, a patient developed a eczematous reaction on the treated sites and the extremities. Patch testing revealed a contact allergy to dithranol. Two applications of the collodion cured the warts within 3 weeks. It is argued that contact allergy to dithranol occurs more frequently than is suspected.

Immune reactivity of women on hormonal contraceptives. Phytohemagglutinin and concanavalin-A induced lymphocyte response

To investigate the influence of sex-steroids on the in vitro correlate of cell-mediated immunity (CMI), blood samples from 49 women on hormonal contraceptives were tested on the lymphocyte response to the mitogens phytohemagglutinin (PHA) and concanavalin A (Con-A). Sixteen women were taking oral contraceptives of combined oestrogen/progestogen of the same brand (low oestrogenic and middle range progestogenic activity); 15 had received intramuscular injections of medroxyprogesterone acetate and 18 women were using a sequential pill. The results were compared with those of 18 women not taking contraceptive steroids and matched for age. No significant changes were observed between the different groups. Considering the previously found alterations in dinitrochlorobenzene (DNCB) skin test reactivity by sex steroids, it is hypothesized that sex-steroids have little or no influence on the central proliferative phase of the immune response, but have a profound effect on the efferent phase.

Suppression of ultraviolet erythema by topical corticosteroids

The effect of three commercially available corticosteroid preparations on ultraviolet (UV) erythema reaction was studied in healthy volunteers. Four series of circles were marked on the skin of their backs. One half of the circle of each series received 0.01 ml of 0.05% betamethasone valerate, 0.1% triamcinolone acetonide and 0.01% hydrocortisone 17-butyrate dissolved in isopropyl alcohol or ethanol and was covered with impermeable plastic. 24 h later, the sites were irradiated with UV light from a Kromayer lamp during 2, 4, 8, 16 or 32 sec. The reactions were evaluated 24 h afterwards. The suppression effect of corticosteroids was expressed as the blanching score (0-3). In a second series of experiments, the reversed sequence was tested: irradiation with UV light was followed by the application of corticosteroids (betamethasone and hydrocortisone). In both series of experiments the blanching effect of the corticosteroids was found to decrease with increasing UV dose. Corticosteroids applied after irradiation were found to have stronger blanching effects. With UV doses of 1 minimum erythema dose (MED), mean blanching scores of 2.3-3.0 were registered, while with doses of 4 MED or more, only small effects were noticed. The three corticosteroid preparations showed comparable suppression effects.