Phototoxische und photoallergische Reaktionen

Basierend auf einer Wechselwirkung zwischen elektromagnetischer Strahlung meist aus dem UV-Bereich mit einem Photosensibilisator kann eine photoallergische oder eine phototoxische Dermatitis ausgelöst werden. Unter dem Begriff „Photosensibilisatoren“ werden sowohl synthetisch hergestellte als auch natürlich vorkommende Substanzen verstanden, die nach vorheriger Exposition mit Strahlung meist aus dem UV-A-Bereich auf der Haut phototoxische oder photoallergische Reaktionen hervorrufen können. Im Allgemeinen werden phototoxische Reaktionen sehr viel häufiger beobachtet als photoallergische Dermatitiden. Zum Nachweis derartiger Photosensibilisatoren dient eine belichtete Variante des herkömmlichen Epikutan-Tests, der sog. Photopatch-Test. Bei einem vermutlich falsch negativen Photopatch-Test-Befund können darüber hinaus der Photoprick-, Photoscratch- oder der belichtete Intrakutan-Test herangezogen werden. Ist jedoch erst ein Metabolit einer Testsubstanz der eigentliche Photosensibilisator, dann kommt noch die systemische Photoprovokation als Nachweisverfahren infrage. Da im Einzelfall phototoxische von photoallergischen Testreaktionen klinisch nur schwer abzugrenzen sind, können typische Reaktionsmuster, die im Rahmen von sehr umfangreichen Studien eruiert wurden, bei der Differenzierung zwischen phototoxischen und photoallergischen Dermatitiden hilfreich sein.

[Affective mentalizing in Addictive Borderline Personality: A literature review]

This literature review concerns affective mentalizing in borderline addictive personality. This concept postulates the group between addictions and borderline personalities may correspond to Personality Disorders (PDs). First, we will present conceptualizations and evaluations of affective mentalizing. The latter refers to one dimension of mentalization, a process by which an individual interprets his/her mental states and those of others. Lecours and Bouchard proposed a hierarchic model: the Élaboration verbale de l'affect (EVA). They also developed an empiric methodology: the Grille de l'élaboration verbale de l'affect (GEVA). The methodological approach of Lecours fulfils the requirements made by Cho-Kain, Gunderson and Luyten, involving a narrower operationalization of the mentalization concept through the evaluation of its dimensions. Conceptualizations and evaluations enabled focus on mentalization psychopathology. Fonagy and Bateman studied this latter in the subjects with PDs, particularly in Borderline Personality Disorders (BPD). We describe mentalization failure, its etiology and consequences in the BPD. Several forms of mentalization psychopathology are identified. Its etiology is largely environmental. Fonagy and Bateman developed the optimum developmental model of mentalization and referred to it to explain etiology of mentalization failure in BPD. Consequences of mentalization failure explicate its functioning. Mentalization may be considered as essential in their comprehension and their care. Research about mentalization of PDs does not integrate addiction as one comorbidity factor. However, Allen, Fonagy and Bateman describe a bidirectional interaction between mentalization failure and addiction. We propose to examine the mentalization of Borderline Addictive Personality. This concept groups addictions and borderline personalities in just one clinical entity other than their links of co-morbidities.

Von Igeln auf Menschen

The hedgehog is an in Germany previously unrecognized source of human ringworm. Eight hedgehog caretakers from Göttingen and the surrounding area developed dermatophytosis caused by Trichophyton erinacei. Four patients who handled the animals without gloves developed lesions on the hands that were more in keeping with hand eczema, leading to a delay in diagnosis. The other caretakers who wore gloves presented with typical ringworm on the arms, the big toe, the back, the abdomen, and the thighs. Their typical clinical features led to an early diagnosis and treatment.

Toxische Kontaktdermatitis auf Poison Ivy in einem Privatgarten in Deutschland

A couple suffered for 5 years from recurrent eruptions with vesicles and bullae after contact with an unknown "climbing weed" in their private garden in Germany. After this plant was identified as poison ivy and eradicated, their skin problems were solved. This is the first report of poison ivy in this setting. Urushiols in poison ivy are not only strong allergens but also potent irritants. Negative patch tests in the husband suggest that the bullous dermatitis was a toxic reaction.

Röntgenweichstrahltherapie eines Unterlippenkarzinoms nach chronisch-exzessiver Sonnenexposition einer 47-jährigen autistischen Malerin

A 47-year-old autistic painter developed lip cancer after chronic excessive sun exposure. As she feared sun withdrawal during inpatient surgical excision, she refused this first-line treatment and therefore received outpatient X-ray therapy. The reason why she developed premature lip cancer and refused to stay in a hospital and the way she illustrated her "sun addiction" in her pictures is presented. Two years later she was free of recurrence. She has remained a sun worshipper until now, but after X-ray therapy she used daily sunscreens with very high sun protection factors, which attenuated the actinic damage. Considering the specific personality of the autistic painter, outpatient radiation therapy was a good alternative to inpatient surgery.

Lichturtikaria

Solar urticaria serves as a model to illustrate the photodiagnostic approach in rare photodermatoses and to demonstrate how patients can be effectively helped by prophylactic and therapeutic intervention. To accomplish these tasks, advanced knowledge and experience in photodermatology is required, along with equipment which is often available in specialized centers only. A list is attached listing the dermatology departments with photodiagnostic units in Germany, Austria, and Switzerland.

Itraconazole in the treatment of tinea capitis in children. Case reports with long-term follow-up evaluation. Review of the literature

Although griseofulvin is considered the standard treatment of tinea capitis in children, alternatives are being investigated. Our purpose was to determine the efficacy of itraconazole for kerion and noninflammatory tinea capitis. An open label study was performed on five patients. It was planned to treat them with itraconazole until they were mycologically and clinically cured. A 28-112-day course of 100 mg itraconazole daily, combined with a topical antifungal treatment resulted in clinical and mycological cure in all children. One child stopped taking itraconazole after 28 days, before it was clinically cured, because of nausea. Nevertheless, this child also achieved clinical and mycological cure. No other side-effects were reported. In long-term follow-up evaluation of between 2 and 3.5 years no recurrence or reinfection was observed. There was complete regrowth of hair, even after kerion. These findings and the review of the literature suggest that itraconazole offers an alternative to griseofulvin for the treatment of tinea capitis in children, although it is more expensive and not approved by German state authorities for this indication.

[Black nails caused by Proteus mirabilis]

Black nails caused by Proteus mirabilis were seen in a motor mechanic and in a petrol pump attendant. Proteus mirabilis is a gram-negative bacillus that generates hydrogen sulfide. This compound reacts with traces of metals in the nail plate such as zinc, nickel, cobalt, iron, manganese, tin, copper and lead. Metal sulfides blacken the nail plate. The protracted course of the discoloration over months corresponds to the slow reactions of metals with hydrogen sulfide. The disappearance of the blackening after topical treatment with chinosol, tincture of iodine and chloramphenicol solution supports the etiologic connection between black nails and Proteus mirabilis. Wet and dirty work encourages the colonisation of Proteus mirabilis between nail fold and nail plate.

The LuxS family of bacterial autoinducers: biosynthesis of a novel quorum-sensing signal molecule

Many bacteria control gene expression in response to cell population density, and this phenomenon is called quorum sensing. In Gram-negative bacteria, quorum sensing typically involves the production, release and detection of acylated homoserine lactone signalling molecules called autoinducers. Vibrio harveyi, a Gram-negative bioluminescent marine bacterium, regulates light production in response to two distinct autoinducers (AI-1 and AI-2). AI-1 is a homoserine lactone. The structure of AI-2 is not known. We have suggested previously that V. harveyi uses AI-1 for intraspecies communication and AI-2 for interspecies communication. Consistent with this idea, we have shown that many species of Gram-negative and Gram-positive bacteria produce AI-2 and, in every case, production of AI-2 is dependent on the function encoded by the luxS gene. We show here that LuxS is the AI-2 synthase and that AI-2 is produced from S-adenosylmethionine in three enzymatic steps. The substrate for LuxS is S-ribosylhomocysteine, which is cleaved to form two products, one of which is homocysteine, and the other is AI-2. In this report, we also provide evidence that the biosynthetic pathway and biochemical intermediates in AI-2 biosynthesis are identical in Escherichia coli, Salmonella typhimurium, V. harveyi, Vibrio cholerae and Enterococcus faecalis. This result suggests that, unlike quorum sensing via the family of related homoserine lactone autoinducers, AI-2 is a unique, 'universal' signal that could be used by a variety of bacteria for communication among and between species.

[Actinic prurigo]

The non-Native American type of actinic prurigo belongs to the group of rare idiopathic photodermatoses and therefore is often diagnosed with delay. The typical clinical and epidemiological features of actinic prurigo are described in a 10 year old girl. Detailed phototesting showed urticarial early onset and prurigo-like late onset reactions towards long-wave UVA. Repetitive photoprovocation with UVB induced delayed development of papules. HLA typing showed the typical association with HLA-DR4, in particular DRB1*0407. Treatment is usually extremely difficult and unrewarding. In this patient, the course was considerably improved by more intense physical photoprotection.

Depigmented hypertrichosis following Blaschko's lines associated with cerebral and ocular malformations: a new neurocutaneous, autosomal lethal gene syndrome from the group of epidermal naevus syndromes?

The lines of Blaschko represent one of the cutaneous patterns of mosaicism followed by various skin disorders. Developmental abnormalities affecting other tissues derived from the embryonic ectoderm and mesoderm are occasionally associated. We describe a 30-year-old man with depigmented, bilateral hypertrichosis and dilated follicular orifices following Blaschko's lines associated with cerebral and ocular malformations. The findings suggest a previously unreported neurocutaneous, autosomal lethal gene syndrome from the group of epidermal naevus syndromes.

Dioxopromethazine-induced photoallergic contact dermatitis followed by persistent light reaction

BACKGROUND

Although photosensitivity after photoallergy to topical phenothiazine antihistamines is well known, there have been no previous reports of dioxopromethazine inducing this phenomenon.

OBJECTIVE

A housewife used 0.5% dioxopromethazine in Prothanon gel for palpebral pruritus and developed severe dermatitis of the lower eyelids with spread to the sun-exposed areas.

METHODS

The minimal erythema doses and the minimal infiltrate doses for ultraviolet A (UVA) and ultraviolet B (UVB) were established before photopatch testing and at intervals up to 497 days thereafter. Test sites were read up to 144 hours after irradiation. Photopatch testing was performed with Prothanon gel, dioxopromethazine hydrochloride 0.001% to 0.5%, and the standard photopatch test tray (Hermal/Trolab). For patch testing, various series of the German Contact Dermatitis Group were applied.

RESULTS

Minimal erythema doses for UVA were diminished before photopatch testing and at intervals up to 500 days after Prothanon gel was discontinued. Exposure to UVB provoked abnormal delayed infiltrated reactions. Clinically the photosensitivity persisted within this period. Photoallergic reactions were seen with Prothanon gel, dioxopromethazine hydrochloride 0.005% to 1.0%, and promethazine hydrochloride 0.1%. The patient gave positive patch test reactions to various fragrance materials, balsam of Peru, costus oil, and propylene glycol.

CONCLUSION

Because topical dioxopromethazine may cause photoallergic contact dermatitis followed by long-lasting photosensitivity even after contact has been discontinued, its withdrawal from the market is recommended.

[Erythrokeratodermia progressiva symmetrica Darier-Gottron with generalized expression]

A mother and her son presented with erythrokeratodermia progressiva symmetrica Darier-Gottron. Both patients developed symmetrical erythematous and hyperkeratotic plaques on the extremities and face at the age of 6 months. At the age of 2 1/2 years the son suffered from rapid progression of the disease to involve the entire skin. The disease of his mother had shown a similar course, however, with spontaneous regression at the age of 10 years. The clinical features of this generalized condition were identical to congenital lamellar ichthyosis. Light microscopy was non-specific with orthohyperkeratosis, focal parakeratosis and acanthosis. Electron microscopy revealed numerous keratinosomes in the stratum granulosum, keratinosome-derived lamellae in the intercellular space and partly augmented keratohyalin with clumping. In the stratum spinosum short tonofilament bundles with clumping were remarkable. The child experienced a significant and persistent improvement with systemic retinoids. His mother's disease was successfully controlled with intermittent retinoid therapy. With the clinical and ultrastructural criteria presently available, an unambiguous differentiation between erythrokeratodermia progressiva symmetrica, usually a localized disorder of keratinization, however with intermittent generalization, and other disorders of keratinization seems difficult.

Crystal structure of the IIB subunit of a fructose permease (IIBLev) from Bacillus subtilis

The bacterial phosphoenolpyruvate-dependent phosphotransferase system (PTS) mediates both the uptake of carbohydrates across the cytoplasmic membrane and their phosphorylation. During this process, a phosphoryl group is transferred from phosphoenolpyruvate via the general PTS proteins enzyme I, HPr and the sugar-specific components IIA, IIB to the transported sugar. The crystal structure of the IIB subunit of a fructose transporter from Bacillus subtilis (IIBLev) was solved by MIRAS to a resolution of 2.9 A. IIBLev comprises 163 amino acid residues that are folded into an open, mainly parallel beta-sheet with helices packed on either face. The phosphorylation site (His15) is located on the first loop (1/A) at one of the topological switch-points of the fold. Despite different global folds, IIBLev and HPr have very similar active-site loop conformations with the active-site histidine residues located close to the N terminus of the first helix. This resemblance may be of functional importance, since both proteins exchange a phosphoryl group with the same IIA subunit. The structural basis of phosphoryl transfer from HPr to IIAMan to IIBMan was investigated by modeling of the respective transition state complexes using the known HPr and IIAMan structures and a homology model of IIBMan that was derived from the IIBLev structure. All three proteins contain a helix that appears to be suitable for stabilization of the phospho-histidine by dipole and H-bonding interactions. Smooth phosphoryl transfer from one N-cap position to the other appears feasible with a minimized transition state energy due to simultaneous interactions with the donor and the acceptor helix.

Contact and photocontact sensitivity to sunscreens. Review of a 15-year experience and of the literature

This review summarizes published and unpublished data of our 15-year experience with sunscreen allergy and photoallergy. From 1981-1996, 402 patients with suspected clinical photosensitivity were patch and photopatch tested with the commercial sunscreens and facial cosmetics that they had used and with chemical UV absorbers, fragrance materials, preservatives, and emollients. 80 patients (20%) (28 men, 52 women) demonstrated allergic and/or photoallergic contact dermatitis to 1 or more UV absorber(s). In 47 patients with photodermatoses or photo-aggravated dermatoses and in 33 subjects with normal photosensitivity, 91 allergic and 84 photoallergic reactions to UV filters were observed. Over the years sunscreens were added to the test series, which since 1989 comprised the following 10 UV absorbers and which induced allergic (a) and photoallergic (pa) reactions (number, type of reaction): 4 UVA absorbers--isopropyldibenzoylmethane (30a/32pa); butyl methoxydibenzoyl-methane (15a/13pa); benzophenone-3 (3a/9pa); benzophenone-4 (0a/0pa); and 6 UVB absorbers--PABA (2a/2pa); octyl dimethyl PABA (1a/2pa); methylbenzylidene camphor (32a/5pa); octyl methoxycinnamate (3a/4pa); isoamyl p-methoxycinnamate (4a/10pa); and phenylbenzimidazole sulfonic acid (1a/7pa). The frequent (photo)sensitization to isopropyldibenzoylmethane was the reason that its production was discontinued in 1993. 47 patients reacted to fragrance materials, 11 to preservatives and 2 to lanolin alcohol. These constituents were contained in the commercial sunscreens and cosmetics that they had used. Continuous revision of the UV absorber photopatch test series was necessary to be closer to the real frequency of exposure and of reported (photo)allergy to newer sunscreens. Clinicians should consider contact and photocontact allergy, especially in patients with photodermatoses and photo-aggravated dermatoses, and they should perform photopatch testing. Once the culprit has been identified, its INCI (International Nomenclature Cosmetic Ingredients) designation should be given to the patient, who must be warned to avoid products containing the (photo)allergen.

Olaquindox-induced airborne photoallergic contact dermatitis followed by transient or persistent light reactions in 15 pig breeders

There have been no previous reports of photosensitivity following photoallergy to airborne olaquindox in a large group. 15 pig breeders, with photo-distributed dermatitis related to olaquindox dust, were investigated to study the nature, promoting factors, and course of this disease. Minimal erythema doses for UVA and UVB were established before photopatch testing and at intervals thereafter. All patients presented with olaquindox-induced photoallergy. In 14 cases, this was followed by prolonged increased sensitivity to UVA. 7 patients also displayed an increased sensitivity to UVB. 13 farmers came into contact with olaquindox in mineral feed (1000 mg/kg) and only 2 in final feed (50 mg/kg). 8 patients avoided further contact with olaquindox because of warnings in the media. Allergies and photoallergies to other occupational substances preceded or followed olaquindox (photo)allergy. Because of their increased sensitivity to light, most of these farmers used sunscreens, and 2 of them developed (photo)allergy to UV-absorbers. As a result of our studies, we recommend photopatch testing for olaquindox in pig breeders with photo-distributed dermatitis. This would enable the early recognition of photoallergy to olaquindox and the prevention of persistent light reaction.

[Curling and kinking of hair caused by etretinate]

In two female psoriasis patients, curling and kinking of the scalp hair developed subsequent to a long-term etretinate therapy. Scanning electron microscopic examination of kinking hair revealed twists with sharp-edged defects and splitting of the cuticle cells in several hairshafts. The quantitative determination of the mechanical parameters of these hairs using a computerized system revealed statistically significant changes from the pattern in the scalp hair of untreated psoriasis patients. This finding suggests etretinate-induced alteration of the expression of the psoriatic phenotype in the keratin composition of hair in psoriasis patients.

Photopatch testing: the 5-year experience of the German, Austrian, and Swiss Photopatch Test Group

A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back of patients with suspected photosensivity. After applications for 24 hours, test sites were irradiated with 10 joules/cm2UVA. Unirradiated controls were included. Readings were performed immediately and 24, 48, and 72 hours after irradiation; responses were qualitatively graded on a 4-point scale. All data were stored and processed by a computer. With computer-assisted analysis of reaction patterns photoallergic reactions were identified and distinguished from phototoxic reactions. Data of 1129 patients were evaluated. Among a total of 2859 positive test reactions in 870 patients, 2041 in 778 patients were found to be photoinduced and 818 in 413 patients were contact reactions; 108 reactions in 83 patients were classified as photoallergic. Nonsteroidal anti-inflammatory drugs, disinfectants, sunscreens, phenothiazines, and fragrances caused most often photoallergic reactions. Many unspecific phototoxic reactions were induced by tiaprofenic acid, promethazine, carprofen, chlorpromazine, fenticolar, wood balsam of Peru, and perfumes. Despite the distinction between photoallergic and phototoxic responses, many test reactions lacked relevance for the patients' dermatoses.

[Changes in sunscreening products in West Germany between 1988 and 1989/90]

We give a comparative survey of preparations absorbing UV light, based on data collected in 1988 (740 products) and in 1989/90 (988 products). Regarding the ingredients and the way of labelling of these preparations, our study yielded the following results: 1. With regard to the labelling of all ingredients according to CTFA, the number of sunscreen products increased from 11% in 1988 to 21% in 1989/90, that of cosmetics containing light filters from 26% to 28%. 2. Since, during the period studied, the ingredients of 50% of the preparations were changed, we call for the obligation to make a declaration. 3. Only 14 out of 42 UV filters registered in Europe are used in more than 1% of the preparations. In sunscreen products, UV-A filters increased from 51% to 61%, whereas in cosmetics, they decreased from 46% to 37%. In the 1990 list, the UV-B filters most frequently found in sunscreen products were cinnamates (70%), those least common were PABA and PABA derivatives (19%). 4. Since hazardous UV filters, such as 4-isopropyl-dibenzol methane and 3-(4-methyl-benzylidene) camphor, were eliminated from some of the preparations, the prevalences of individual filter substances have changed between 1988 and 1989/90. 5. Only those UV filters that are currently in use should be checked in the photopatch test. 6. Close cooperation between physicians and manufacturers resulted in making products absorbing UV light safer.

[Review of the literature on adverse reactions to sunscreens 1947 to 1989]

Sunscreens in cosmetics may trigger off photoallergic contact dermatitis. In addition, they can induce allergic, irritant, or phototoxic dermatitis. Adverse reactions may also be caused by fragrances, preservatives, and other ingredients in light-protective cosmetics. We give a survey on 87 publications dealing with this issue, which appeared from 1947 through 1989. The survey comprises information on the nature of the sunscreen or other ingredient as well as the type of reaction observed in 357 patients. We also refer to the sex distribution and summarize the reasons for using products absorbing UV light. Aside from commercial preparations, all UV filters currently in use should be tested in photopatch tests in order to improve the diagnostic tools.

[Photosensitivity following enoxacin and xipamide: combined phototoxic and photo-allergic reaction to enoxacin, photo-allergic reaction to xipamide with subsequent transient light reaction]

In a 51-year-old female patient, we observed a combined phototoxic and photoallergic reaction to Enoxacin, a photoallergic reaction to Xipamide, as well as increased sensitivity to light after withdrawal of the drugs. This unusual diagnosis was based on the clinical picture, graded radiation with UV-A and UV-B, the irradiated intradermal assay, and histological findings. To the best of our knowledge, this is the first report on a photoallergic reaction to Xipamide associated with a combined phototoxic and photoallergic reaction to Enoxacin.

[Photodiagnosis: the modified intradermal test in comparison with other procedures for the detection of phototoxic and photo-allergic drug reactions]

In systemic photosensitivity to drugs, the modified irradiated intradermal assay is a valuable diagnostic tool. We discuss its advantages in comparison to both the less sensitive photopatch and the potentially dangerous and/or bothersome technique of systemic photochallenge.

[The dangers of olaquindox. Photoallergy, chronic photosensitive dermatitis and extreme increased photosensitivity in the human, hypoaldosteronism in swine]

The antibiotic olaquindox, an ingredient added to porker feed to increase overall performance, caused a photoallergic contact eczema and subsequently a chronic photosensitive dermatitis with increased UV-A- and UV-B-sensitivity in a breeder of small pigs. Through the use of sun creams he developed an additional (photo)allergic contact eczema to the sunscreens contained in the creams.

[Preparations containing sunscreens in West Germany 1988]

The commercial UV-absorbing cosmetics and sunscreens which are currently available in Germany are presented in two tables. In addition to the UV-absorbing and light-reflecting sunscreens, we list other ingredients which may cause skin reactions or have special properties. Our survey provides quick information on potential allergens and photoallergens. Well-tolerated alternative preparations can be chosen on the basis of the listed ingredients. Complete declaration of all ingredients in cosmetics and sun cosmetics is necessary in order to facilitate the diagnosis of allergies and photoallergies and should replace comprehensive surveys, which are rapidly outdated.

[Evaluation of sunscreening agents]

Sunscreen preparations are evaluated according to their protection against biological effects of ultraviolet radiation. UV-induced phenomena found on protected skin are compared with those on unprotected skin; thus the sunprotection factor is estimated. In order to assess the photoprotective power of sunscreens, only early UV-induced effects are decisive - such as erythema. PUVA erythema, pigmentation, activation of the ornithine decarboxylase, the influence on Langerhans cells, appearance of 'sunburn' cells, and changes of the DNA metabolism. We report on the various methods to obtain the specific sunprotection factors against UVB and UVA. Water-resistance, photostability, and pharmacokinetics depending on the vehicle are further criteria with regard to the evaluation of sunscreens. We rely on consumers information regarding the following properties of sunscreens: stickness, oily shine, greasiness, discoloration, odor, and tolerance.

[Chilblain lupus erythematosus]

Chilblain lupus erythematosus is a chronic form of lupus erythematosus that is seen predominantly in women and first manifests itself during cold weather as painful purplish acral swellings. These symptoms and possible progression to systemic lupus erythematosus are discussed with regard to two cases. Patients with recurrent or persistent "chilblains" should be investigated histologically and serologically as well as by immunofluorescence.

[Photoallergic and allergic contact eczema caused by dibenzoylmethane compounds and other sunscreening agents]

Dibenzoylmethanes are widely used in Europe in UV-A-absorbing sunscreens. We report on 21 patients with (photo)allergic contact dermatitis from 4-isopropyl-dibenzoylmethane. Six subjects revealed, in addition, (photo)allergic reactions to 4-tert.butyl-4'-methoxy-dibenzoylmethane, seven to 3-(4-methylbenzylidene)-camphor, two to 2-phenyl-benzimidazole-5-sulfonic acid and one to 2-phenyl-5-methylbenzoxazole. Allergic contact dermatitis from 2-phenyl-benzimidazole-5-sulfonic acid has not been reported previously. The relevance of sunscreens as a cause of (photo-)allergic contact dermatitis is discussed.

Combined tar-anthralin versus anthralin treatment lowers irritancy with unchanged antipsoriatic efficacy. Modifications of short-contact therapy and Ingram therapy

In 44 patients with chronic plaque psoriasis anthralin therapy was used as high-strength short-contact therapy in a bilateral comparison of anthralin versus 5% crude coal tar-anthralin combination. These two trials were undertaken with and without ultraviolet (UV) irradiation immediately after anthralin therapy. The combined tar-anthralin therapy was significantly less of an irritant during the first 3 weeks of treatment than anthralin alone, and it did not decrease the antipsoriatic efficacy. The use of UV irradiation, either with anthralin or tar-anthralin combination, did not produce an additional therapeutic effect. These findings lead us to prefer combined tar-anthralin therapy because of its lower irritancy in comparison with anthralin alone and they show the ineffectiveness of additional UV irradiation under the conditions of this study.

Photoallergic and allergic contact dermatitis from dibenzoylmethanes

Dibenzoylmethanes are widely used in Europe in UVA-absorbing sunscreens. We found that 2 of these, 4-isopropyl-dibenzoylmethane and 4-tert.butyl-4'-methoxy-dibenzoylmethane caused allergic or photoallergic contact dermatitis. This is the first report on allergic and photoallergic reactions caused by dibenzoylmethanes.

[Chronic monocytic leukemia]

A case of chronic monocytic leukemia with specific dermal lesions is presented. The patient developed an adenocarcinoma of the cecum.

[Effect of coal tar on cignolin erythema--1 hour treatment of psoriasis with high-dose cignolin with and without tar]

Coal tar applied simultaneously showed a suppressive effect on anthralin erythema. This effect was demonstrated by an epicutaneous test 24 hours (27 patients) and 1 hour (46 patients) after application of various concentrations of anthralin combined with tar 3%. In a clinical study on 9 patients, anthralin 3% alone or combined with tar 10% were administered in a right and left comparison on symmetrical chronic psoriatic lesions for 1 hour daily. Anthralin plus tar exhibited a stronger anti-psoriatic effect than anthralin alone did. Tar reduced the anthralin erythema in the perilesional skin. These findings favor the combination of coal tar and anthralin in the 1-hour treatment schedule of psoriasis.

How to avoid phototoxic reactions in photopatch testing with chlorpromazine

The purpose of this study was to determine the concentration, vehicle, and UVA dose suitable for avoiding phototoxic reactions while revealing photoallergic reactions to chlorpormazine (CPZ) in photopatch testing. Photopatch tests were performed on 27 volunteers with CPZ concentrations between 0.05% and 1% in water or Plastibase with UVA doses of 4 or 7 J/cm2. Photopatch tests were also carried out on 1 patient with photoallergic contact dermatitis to CPZ and an increased UVA sensitivity. The same concentration of CPZ caused phototoxic reactions less frequently and less intensely in Plastibase than in water. The minimal phototoxic concentration of CPZ in Plastibase was 0.5% after irradiation with 4 J/cm2 and 0.1% after irradiation with 7 J/cm2. In the patient with photoallergy to CPZ, a photoallergic reaction was elicited after 0.1% CPZ in Plastibase and a UVA dose of 2 J/cm2. In testing photoallergic reactions to CPZ a concentration of 0.1% in Plastibase and a UVA dose of 4 J/cm2 or less should be used.

Anthralin inflammation versus UV-erythema in psoriatics

Anthralin has been applied in low and high concentrations with and without UV-irradiation in the treatment of psoriasis (Schauder & Mahrle, 1982a,b). We have studied the relationship between the sensitivity to anthralin and UV-irradiation which might possibly help us to give a more individually adapted therapy.

[One-hour-treatment of psoriasis with anthralin and UV-light (author's transl)]

A total of 66 patients with psoriasis was treated with one percent anthralin for one hour (one-hour-treatment) and UV-light. 17 out of 26 out-patients treated with anthralin and UVB showed a good response. In 40 in-patients the one hour regimen was administered in combination with UVA or UVB, in part in right-left side comparison in order to evaluate whether anthralin with UV-light is more effective than anthralin alone. Within six weeks remission was obtained with anthralin alone as well as with combined treatment with anthralin and UVA or UVB. In right-left side comparison UV-light had no significant additional effect in this regimen. The one-hour-treatment was effective but did not seem to be superior to the conventional therapy with anthralin in in-patients. However, the one-hour-treatment is advantageous and convenient for out-patients.

[Combined 1-hour therapy of psoriasis using anthralin and UV light]

Fifty-one patients with psoriasis were treated with 1% anthralin for 1 h (1-h treatment) and UV-light. Seven of 11 out-patients treated with anthralin and UV-B showed a good response. In 40 in-patients the 1-h regimen was administered in right-left side comparison to evaluate (1) whether UV-A or UV-B combined with anthralin was more effective than anthralin alone and (2) whether anthralin was photoactivated by UV-A or UV-B. As to the latter, one body side of the patients was exposed to UV radiation before and the other body side after application of anthralin. In in-patients the response to therapy was monitored by a defined score system. We did not find any significant differences in the paired comparisons. We therefore summarized the different treatment regimens and rated 42% with very good or good, 26% with fair, and 32% with poor. The results show that the 1-h treatment with 1% anthralin seems to be advantageous especially for the treatment of out-patients with circumscribed chronic psoriatic lesions. UV-light did not improve considerably the therapeutic effect of anthralin in the regimen of this study.

[Photosensitization with DTIC therapy in metastatic malignant melanoma]

Photoreactions developed in five of 43 patients being treated for 30 months with repeat doses of DTIC because of metastasing malignant melanoma. An increase in light sensitivity in the UVA and UVB range can be demonstrated by light-testing in the affected patients but not in controls. It shows a decrease with the metabolism of DTIC. The increase in light sensitivity serves as an additional argument to avoid light exposure during and after DTIC injections.