Kontaktna alergijska preosjetljivost na klostridiopeptidazu s kloramfenikolom u bolesnice s venskim ulkusom potkoljenice

Contact dermatitis caused by topical drugs is rather common all over the world. A case is presented of a 76-year-old female patient with venous leg ulcer, who developed contact sensitivity to Clostridium peptidase with chloramphenicol, i.e. Iruxol, a topical antiulcerative used for years for leg lesions. Patch testing confirmed sensitivity to Iruxol, and specific testing for chloramphenicol confirmed sensitivity to the antibiotic component of the ointment. Contact allergic dermatitis is a very common disease in patients with lower limb ulcer and venous hypostatic dermatitis.Lijekovi za lokalnu primjenu česti su uzročnici kontaktnog dermatitisa širom svijeta. Opisuje se slučaj 76-godišnje bolesnice s venskim ulkusom u koje se je tijekom dugogodišnje terapije rana na potkoljenicama razvila kontaktna preosjetljivost na klostridiopeptidazu s kloramfenikolom, topičnim pripravkom za liječenje ulkusa poznatim pod imenom Iruxol. Kod bolesnice se epikutanim testom potvrdila preosjetljivost na mast Iruxol, dok se izoliranim testiranjem na kloramfenikol potvrdila preosjetljivost na antibiotsku sastavnicu pripravka. Kontaktni alergijski dermatitis česta je pojava u bolesnika s venskim ulkusom i hipostatičnim dermatitisom

The most frequent contact allergens in patients with contact dermatitis in the Slavonski Brod region

Cilj je ovog rada bio prikazati rezultate epikutanog testa standardnom serijom alergena na Odjelu za kožne i spolne bolesti Opće bolnice "Dr. Josip Benčević" u Slavonskom Brodu tijekom protekle dvije godine te ih usporediti s rezultatima testiranja u Alergološkoj ambulanti Klinike za kožne i spolne bolesti u Zagrebu i rezultatima testiranja brojnih inozemnih autora. Rezultati epikutanog mjesta standardnom serijom od 20 alergena uspoređivani su između Klinike za kožne i spolne bolesti, te Opće bolnice "Dr. Josip Benčević". Kroz 24 mjeseca ispitanici alergološke ambulante Odjela za kožne i spolne bolesti u Slavonskom Brodu testirani su standardnom serijom. Na Klinici za kožne i spolne bolesti na istu seriju alergena testirani su bolesnici u petogodišnjem periodu. Od naših bolesnika 172 su imala pozitivne reakcije, od toga 88 jednu pozitivnu reakciju, 60 dvije pozitivne reakcije, te 24 tri i/ili više pozitivnih reakcija. Najčešće pozitivne reakcije imali smo na nikal sulfat, kao što je vidljivo i u rezultatima Alergološke ambulante Klinike za kožne i spolne bolesti. Statistički značajne pozitivne reakcije zabilježene su kod tri alergena: nikal sulfat, kobalt klorid i smjesa mirisa. U našem dvogodišnjem praćenju učestalost pozitivnih epikutanih testova na nikal sulfat, formaldehid, Quarternium 15, te timerosal je podjednaka, dok je kod smjese mirisa, neomycin sulfata, kobalt klorida i peruanskog balzama nešto niža.The goal of this paper is to show the results of the epicutaneous (patch) test with standard allergens at the Department of Dermatology and Venerology of General Hospital "Dr. Josip Benčević" in Slavonski Brod in the past two years. The goal is also to compare these results with the results from the Allergological Infirmary in the Department of Dermatology and Venerology in Zagreb University Hospital Center. The results of patch testing with 20 standard allergens from General Hospital "Dr. Josip Benčević" and from the Department of Dermatology and Venerology in Zagreb University Hospital Center have been compared. In our "Dr, Josip Benčević" Hospital patients were tested during 2004 and 2005. In the Department of Dermatology and venerology in Zagreb University Hospital Center patients were tested in a five-year period. There were 172 patients with positive test results, out of which 88 had one positive reaction, 60 had two positive reactions, and 24 had three or more positive reactions. NiSO4 (or Nickel-sulfate) was the most common cause for the positive test reaction. The same compound was also the most common cause in the Department of Dermatology and Venerology in Zagreb University Hospital Center. Statistically significant positive reactions were present in three allergens: nickel sulfate, cobalt chloride and fragrance mix. In the two-year follow up (monitoring) frequency of epicutaneous (patch) test positive reactions on nickel sulfate, formaldehyde, Quarterinum-15 and Thimerosal is almost the same, while the frequency of positive reactions on fragrance mix, neomycin sulfate, cobalt chloride and balsam of Peru is somewhat lower

Contact Allergy to Special and Standard Allergens in Patients with Venous Ulcers

The aim of the study was to determine the prevalence of contact sensitivity in patients with leg ulcers, and possible difference in the rate of contact hypersensitivity to standard series of allergens used in patch testing, and to particular topical agents used in local therapy of leg ulcers in special series, patients with and without atopy. The study included 60 patients, 45 female and 15 male, aged 37–85 (mean 68.37 female and 51.13 male), 30 of them with and 30 without allergic contact dermatitis (ACD) of the leg (control group). The mean duration of leg ulceration was 5.62 years. The two groups of patients underwent testing to standard series allergens and target series allergens including mupirocin, bepanthene, silver sulfadiazine, chloramphenicol + clostridiopeptidase, betamethasone dipropionate, hydrocortisone + oxytetracycline, momethasone, alginate, hydrocolloid, lanolin, pyrogallol, Vaseline, permanganate, Rivanol, povidone-iodine, gentamicin, i.e. local agents most frequently used by the patients. Contact allergic hypersensitivity to standard series allergens was demonstrated in 25 patients with a total of 49 positive reactions and a mean of 1.6 reactions per patient. Positive reactions were most commonly recorded to balsam of Peru, fragrance mix and neomycin sulfate. There were 12 positive reactions to target series allergens, mean 0.4 reactions per patient. Forty-five positive reactions, mean 0.1 reactions per patient, were recorded in the control group. Positive reactions were most commonly demonstrated to corticosteroid ointments, lanolin and bepanthene. Study results did not confirm a statistically significantly higher rate of sensitization to particular topical agents frequently used in the treatment of patients with venous ulcers. Patch testing to standard and special series allergens should be performed in case of prolonged leg ulcer epithelization

Oral Lesions in Patients with Pemphigus Vulgaris and Bullous Pemphigoid

Ova studija obuhvatila je 33 bolesnika hospitaliziranih u Klinici za kožne i spolne bolesti Kliničke bolnice "Sestre milosrdnice". Svrha ove studije bila je usporedba podataka o dobi i spolu, navikama, lokalizaciji kožnih promjena, pojavi simptoma i terapiji u bolesnika s vulgarnim pemfigusom i onih koji boluju od buloznog pemfigoida. Dijagnosticirano je 15 bolesnika s vulgarnim pemfigusom i 18 bolesnika s buloznim pemfigoidom temeljeno na kliničkoj slici, patohistološkoj analizi, direktnoj i indirektnoj imunofluorescenciji, Tzanckovom testu i dezmogleinima. Dobiveni rezultati upućuju na porast učestalosti vulgarnog pemfigusa u bolesnika srednje dobi (46,6% bolesnika između 50 i 70 godina), dok bulozni pemfigoid zahvaća bolesnike starije životne dobi (83,3% bolesnika bilo je starije od 70 godina). Vulgarni pemfigus zahvaća značajnije više žene (66,6%) nego muškarce (33,4%), dok je jednak broj žena i muškaraca bio zahvaćen buloznim pemfigoidom. Bolesnici s objema bolestima su imali promjene kože i/ili sluznice usne šupljine. Većina bolesnika s vulgarnim pemfigusom je imala promjene kože s promjenama na sluznici usne šupljine (86,6%), pri čemu su u 40% slučajeva promjene na sluznici usne šupljine prethodile kožnim promjenama. U samo 16,6% bolesnika s buloznim pemfigoidom su nađene erozije na sluznici usne šupljine. Većina bolesnika je dobivala sistemsku i lokalnu kortikosteroidnu terapiju uz dodatnu sistemsku imunosuprimirajuću terapiju. Pravodobno prepoznavanje vulgarnog pemfigusa i buloznog pemfigoida te odgovarajuća terapija važni su za ishod ovih autoimunih buloznih bolesti.Thirty three patients admitted to the University Department of Dermatology and Venereology, Sestre milosrdnice University Hospital, were included in the study. The purpose of the study was to compare data on age and gender, habits, lesion localization, onset of symptoms and therapy between patients with pemphigus vulgaris and those suffering from bullous pemphigoid. Based on clinical presentation, histopathologic analysis, direct and indirect immunofluorescence, Tzanck smear and desmogleins, 15 cases of pemphigus vulgaris and 18 cases of bullous pemphigoid were diagnosed. The results obtained indicated an increased prevalence of pemphigus vulgaris in middle-aged patients (46.6% of patients were aged between 50 and 70), while bullous pemphigoid predominantly affected elderly individuals (83.3% of patients were older than 70). Pemphigus vulgaris showed a female predominance (female 66.6% vs. male 33.4%), while no sex difference was recorded for bullous pemphigoid. Patients with both diseases presented with cutaneous and/or oral lesions. The majority of patients with pemphigus vulgaris had skin lesions with oral manifestations (86.6%), whereas in 40% of cases oral lesions were preceded by the cutaneous ones. Mucosal erosions were found in only 16.6% of patients with bullous pemphigoid. The majority of patients were administered systemic and topical corticosteroid therapy with adjuvant systemic immunosuppressant therapy. Timely recognition of pemphigus vulgaris and bullous pemphigoid and appropriate treatment are important for the prognosis of these autoimmune bullous disorders