bluuebunny/crossref_metadata_2025 huggingface dataset:
Self‐assessed oral health status of ethnic minority residents of South London
Authors: Newton J. T. , Khan F. A. , Bhavnani V. , Pitt J. , Gelbier S. , Gibbons D. E.
Published: March 2003

Abstract – Objective: To determine the self‐assessed oral health status of individuals from minority ethnic communities living in South London. Method: A sample of 1057 individuals from minority ethnic communities (as defined by Office of Censuses and Surveys categories) resident in South London were asked to complete measures of their oral and facial symptoms, the impact of their oral health on their daily functioning and of their satisfaction with the appearance of their teeth and gums. Measures: Self‐assessed oral health status was determined by means of two short scales addressing oral symptoms and the impact of oral health on activities of daily living. Satisfaction with the appearance of the teeth and gums was also assessed. Findings: No significant differences were found between minority ethnic communities in the number of symptoms reported, in the level of impact which such symptoms cause, or in their dissatisfaction with the appearance of their teeth and gums. Reporting of symptoms and impact were mildly though significantly correlated with dissatisfaction. Conclusions: There appears to be little difference between ethnic communities in their reporting of oral and facial symptoms, though these groups report higher levels of dissatisfaction with the appearance of their teeth and gums. Social and demographic factors play an important role in determining perceptions of oral health. The findings should be interpreted with caution given the difficulty of sampling minority ethnic communities and the subsequent limited representativeness of the sample.
Deprivation and oral health: a review
Authors: Locker D.
Published: March 2003

Abstract – The link between socioeconomic status and health, including oral health, is well established. The conventional measures of socioeconomic status used in these studies, such as social class and household income, have a number of weaknesses so that alternatives, in the form of area‐based measures of deprivation, are increasingly being used. This paper reviews epidemiological research linking deprivation and oral health. Four types of study are identified and described: simple descriptive, comparative, analytic and explanatory. These studies confirm that deprivation indices are sensitive to variations in oral health and oral health behaviours and can be used to identify small areas with high levels of need for dental treatment and oral health promotion services. As such, they are likely to provide a useful administrative tool. In terms of research, the studies demonstrate that these measures provide a ready way of controlling for socioeconomic status in studies examining the association between oral health and other variables. However, this research, in largely replicating previous studies using social class, does not address fundamental issues concerning the mechanisms which link social inequality and health. Deprivation measures have a major role to play in research that examines features of people and places, and how they promote and/or damage both oral and general health.
Incidence of dental anxiety in young adults in relation to dental treatment experience
Authors: Thomson W. Murray , Locker David , Poulton Richie
Published: March 2003

Abstract – Objectives: To document the incidence of dental anxiety among individuals aged 18 years at baseline and 26 years at follow‐up, and to determine if dental treatment experience continues to play a significant etiological role with respect to the onset of dental anxiety in young adults. Methods: Dental anxiety scale (DAS; Corah, 1969) scores at ages 15, 18 and 26 were obtained for Study members in the Dunedin Multidisciplinary Health and Development Study. Dental examinations were conducted, and sociodemographic and dental service‐use data were collected using a self‐report questionnaire. Using a case definition of a DAS score of 13 or more, age 18–26 incident cases were identified and their dental treatment experience and service‐use characteristics compared with the remainder. Results: DAS scores at 18 and 26 were available for 792 (80.8%) of the 980 26‐year‐old Study members. An increase in dental anxiety prevalence was observed over the eight‐year period, with an annualized incidence of 2.1%. Fewer incident cases had visited a dentist in the previous eight years, and there were no differences between incident cases and others in their eight‐year DFS, FS or tooth‐loss increments. A subgroup of “recurrent” cases was identified who were dentally anxious at 15 and 26 but not at 18, and their eight‐year incidence of tooth loss due to caries was substantially higher than non‐cases. Conclusions: Aversive conditioning experiences appear to be unrelated to the adult onset of dental anxiety, and it may be that particular temperamental or psychological traits are associated with the condition.
A systematic review of selected caries prevention and management methods
Authors: Bader James D. , Shugars Daniel A. , Bonito Arthur J.
Published: March 2003

Abstract – A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non‐cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries‐active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non‐cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non‐surgical management of non‐cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.
Appropriateness of orthodontic referrals: self‐perceived and normative treatment needs of patients referred for orthodontic consultation
Authors: Chew Ming Tak , Aw Andrew Kian‐Li
Published: March 2003

Abstract  – 

Objectives: The aims of this prospective study were to evaluate the self‐perceived and normative orthodontic treatment needs of children referred for orthodontic consultation and to determine the proportion of children who were inappropriately referred.

Methods: The sample consisted of 257 children with a mean age of 12.0 years (SD = 2.4). An orthodontist assessed the children's normative treatment need using the dental health component (DHC) of the index of orthodontic treatment need (IOTN), and for patients in the mixed dentition the need for interceptive treatment was assessed. Questionnaires were answered by both the child and the parent to assess satisfaction with dental appearance and desire for treatment.

Results: The distribution of the IOTN grades showed that 73% of the children had definite need while 27% had borderline/no need for orthodontic treatment. Twenty‐six per cent of children and 17% of parents did not express orthodontic concern, even though more than half of these children were in definite need of treatment as assessed by IOTN. The children's orthodontic concern was significantly related to the DHC scores. Out of the 103 children who were in the mixed dentition, only about 16% required interceptive treatment.

Conclusions: The results indicated that a significant number of children were inappropriately referred for orthodontic treatment. Referring dentists need to assess the normative treatment needs of the children as well as the children's and parents' commitment and desire for orthodontic treatment before deciding on the need for referral.
Risk factors for oral soft tissue lesions in an adult Spanish population
Authors: García‐Pola Vallejo M. J. , Martínez Díaz‐Canel A. I. , García Martín J. M. , González García M.
Published: March 2003

Abstract –

Objectives: The aims of this study were (i) to determine the prevalence of oral lesions in adults over 30 years old in the city of Oviedo (Spain), and (ii) to analyze the relationship between the prevalence of oral lesions, toxic habits (tobacco and alcohol) and denture wearers in these patients.

Methods: A representative sample of the adult population in Oviedo (Spain) was obtained through randomized sampling (n = 753); a total of 308 (41%) subjects were finally included in the study. The observed oral pathology was classified according to the WHO criteria and earlier epidemiological studies.

Results: A little over half of all patients (51.1%) had oral lesions. The most frequent lesions were frictional lesion (7.5%), traumatic ulcer (7.1%), denture stomatitis and pseudomembranous candidosis (6.5%), followed by melanin pigmentation (5.8%) and denture‐induced hyperplasia (5.2%), plicated tongue (3.9%), lichen planus and hemangioma (3.2%), angular cheilitis and cheek biting (2.9%), fibrous hyperplasia and coated tongue (2.6%), recurrent aphthae (1.9%) and oral leukoplakia (1.6%). In relation to leukoplakia, the odds ratio (OR) of heavy drinkers was 15.98 and the OR of heavy smokers was 12.37. The OR of heavy smokers or heavy drinkers diagnosed of frictional lesion was four times greater than that of nonsmokers or nondrinkers. The OR of heavy smokers with melanic pigmentations was 4.08. The OR of complete denture wearers with candidosis was 11.38. The OR of partial removable denture wearers with hemangioma was 5.01.

Conclusions: This study shows the relation of heavy tobacco and heavy alcohol to traumatic keratosis and leukoplakia, and of complete dentures to pseudomembranous candidosis, fibrous hyperplasia and stomatitis. Programs designed to eradicate toxic factors (alcohol and tobacco) should, therefore, be implemented with adequate maintenance of dentures.
Oro‐facial pain in the community: prevalence and associated impact
Authors: Macfarlane Tatiana V. , Blinkhorn Anthony S. , Davies Robin M. , Kincey John , Worthington Helen V.
Published: March 2003

Study objective: To determine the prevalence of oro‐facial pain (OFP) in the population and within‐population subgroups and to describe the associated disability. Design: Cross‐sectional population study. Setting: General medical practice in South East Cheshire, United Kingdom. Participants: A random sample of 4000 adults aged 18–65 years of whom 2504 responded (adjusted participation rate 74%). Main results: The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18–25 year age group and the lowest (22%) in the 56–65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain. Conclusions: OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.
Corticosteroid cross‐reactions: an alternative view
Authors: Wilkinson S. M.
Published: March 2003

An alternative view of corticosteroid cross‐reactivity is proposed, based on 2 immune recognition sites on the corticosteroid molecule, 1 influenced by C 6/9 substitution and 1 by C 16/17 substitution. A case report is adduced in support of such a hypothesis.
Placebo‐controlled evaluation of the irritant potential of tacalcitol (1α, 24‐dihydroxyvitamin D3) in healthy volunteers
Authors: Schlotmann K. , Ortland C. , Neumann N. J. , Ruzicka T. , Lehmann P.
Published: March 2003

In the treatment of psoriasis with topical vitamin D3 analogues, lesional and perilesional irritation is the main side‐effect. The aim of this study was to investigate whether local side‐effects generated by tacalcitol, a vitamin D3 analogue, show concentration dependence. 3 different concentrations of tacalcitol (0.4; 4; 40 μg/g ointment) and the vehicle were applied on normal skin of the back of 25 healthy volunteers under occlusive conditions for 5 days. Assessment of erythema, infiltration and scaling as well as measurement of transepidermal water loss (TEWL) was performed on days 1 to 5. On day 5, additional skin barrier tests (DMSO test, alkali resistance test) were performed. Erythema and slight infiltration, but no scaling, were observed in a number of subjects without significant differences. TEWL also did not show significant differences for the test formulations, though there was a tendency towards lower values in the untreated areas. In the skin barrier tests, a tendency towards higher alkali resistance in the test areas treated with 40 μg tacalcitol/g ointment was detected. Thus, under occlusive conditions, the irritant potential of tacalcitol is very low. There is no convincing evidence of concentration dependence in irritation generated by tacalcitol when applied under occlusive conditions.
Multicentre study for the development of an in vivo model to evaluate the influence of topical formulations on irritation
Authors: Schnetz E. , Diepgen T. L. , Elsner P. , Frosch P. J. , Klotz A. J. , Kresken J. , Kuss O. , Merk H. , Schwanitz H. J. , Wigger‐Alberti W. , Fartasch M.
Published: March 2003

Although skin protective products to prevent irritant skin reactions are in wide use, neither standardized test models to prove differences in efficacy exist, nor has the quality or the reproducibility of results been evaluated in a multicentre approach. This should be mandatory when developing or testing skin care products. Therefore, we have designed a multicentre study in an approach to find a standardized test procedure for the evaluation of skin protective products. In this irritation study, a repeated short‐time occlusive irritation test (ROIT) with a standardized protocol has been evaluated in 2 phases (12 days and 5 days protocol) in 4 (n=20) respectively 6 (n=33) skilled centres. The skin reaction was induced by 2 irritants (0.5% aq. SLS and toluene, 2× a day for 30 min). Its modification by 3 different cream bases with different hydrophilicity was analyzed. The irritation was monitored by bioengineering methods (TEWL measurement, colorimetry) and by clinical scoring. The evaluation showed that significant results could already be achieved with the 5‐day protocol. Furthermore, in spite of the expected inter‐centre variations due to heterogeneity of the individual threshold of irritation, interpretation of clinical score, and inter‐instrumental variability, the ranking of the vehicles regarding reduction of the irritant reaction was consistent in all centres.
Pine processionary caterpillar as a new cause of immunologic contact urticaria
Authors: Vega J. M. , Moneo I. , Armentia A. , Vega J. , De La Fuente R. , Fernández A.
Published: March 2003

Nowadays, caterpillars are included among the agents that elicit contact urticaria by a non‐immunologic mechanism. Our objective was to find the rôle that an IgE‐mediated mechanism could have among patients with suspected contact urticaria from pine processionary caterpillars. 16 patients with suspected contact urticaria from this caterpillar were studied by prick testing and specific IgE detection by immunoblotting. 87% of the patients had a positive prick test and immunoblotting for caterpillar extract. In these allergic patients, the symptoms associated with urticaria were: angioedema (79%), conjunctivitis (36%) and severe anaphylaxis (14%). The most frequent localizations of the wheals were the neck (100%) and forearms (93%). Angioedema was more frequent on the eyelids (79%). The IgE‐immunoblot detected in the caterpillar extract several reactive bands, with apparent MWs from to 45 to 4kDa. A total of 5 major allergens were identified, but a band around 14kDa proved to be the dominant allergen. Sensitization to Thaumetopoea pityocampa was found to be the most important mechanism of airborne contact urticaria from this caterpillar. Low‐MW proteins are the main IgE binding components of crude caterpillar extract.
Benzalkonium chloride neutralizes the irritant effect of sodium dodecyl sulfate
Authors: McFadden J. P. , Holloway D. B. , Whittle E. G. , Basketter D. A.
Published: March 2003

When benzalkonium chloride (BKC), a cationic surfactant, is added to sodium dodecyl sulfate (SDS), an anionic surfactant, and used in patch testing, on the basis of their known physicochemical interaction, it is possible to predict that there will be a tendency towards a reduction in the expected irritant response when compared to SDS alone. The aim of this study was to investigate whether BKC could reduce the irritant response to SDS when applied after the SDS exposure. 54 non‐atopic adult volunteers were recruited for the study. 20% SDS was applied for 2 h under occlusion. 1% BKC was then applied to the same site. Various controls, including SDS application followed by water for 2 h, were included. The irritant reaction was assessed at 24 h and 48 h. 40 of the 54 subjects had some reaction when SDS was applied for 2 h followed by either benzalkonium chloride or water control under occlusion. In comparison to water control, where BKC was applied after SDS, 20 of the 40 responders had a weaker reaction but only 4 had a stronger response. This study shows that BKC applied to skin exposed to SDS attenuates the resulting irritant reaction.
Platinum in the environment: frequency of reactions to platinum‐group elements in patients with dermatitis and urticaria
Authors: Santucci B. , Valenzano C. , De Rocco M. , Cristaudo A.
Published: March 2003

The aim of the present paper is to evaluate whether increasing environmental exposure increases the frequency of the positive prick and patch test reactions to certain chlorinated platinum salts in patients with dermatitis and urticaria. 800 consecutive subjects with contact dermatitis (n=749) and urticaria (n=51) were variously patch and prick tested with 30 haptens of a standard series, with aqueous solutions of, respectively, hexachloroplatinic acid (H2[PtCl6]), potassium tetrachloroplatinate (K2[PtCl4]), sodium hexachloroplatinate (Na2[PtCl6]), iridium chloride (IrCl3), rhodium chloride (RhCl3) and palladium chloride (PdCl2), and with 16 common inhalants. 153 workers, variably exposed in a platinum refinery, were patch and prick tested only with solutions containing platinum‐group elements at various concentrations and with 16 common inhalants. Platinum‐group elements did not elicit positive patch or prick test reactions in non‐occupationally exposed subjects. In contrast, in exposed workers, positive patch test reactions at day 2 and at 25 min, respectively, were found in 2 subjects with hand dermatitis and in 2 with urticaria and asthma. 22 out of the 153 workers, 18 of whom had rhinitis, asthma, and urticaria, gave positive prick test reactions to 1 or more salts. Furthermore, on patch and prick testing, 4 cross‐reactions between platinum, palladium, iridium and rhodium were demonstrated. In conclusion, the test results demonstrate that the present concentration in the environment does not increase the incidence of reactions to platinum salts in patients with dermatitis and/or urticaria. However, if the average level of environmental platinum exposure approaches those existing in industrial settings in the future, we are going to observe more frequent health effects.
Legislative and preventive measures related to contact dermatitis*
Authors: Lidén Carola
Published: March 2003

Legislation can be a useful tool in the prevention of contact dermatitis. This is particularly true for dermatitis due to exposure to the many contact allergens that are chemical substances in products. A brief review is given of the most important European legislation – the EU Nickel Directive, the Cosmetics Directive, the Hazardous Substances Directive and the Hazardous Preparations Directive – and of some national regulations and standardization projects. It is concluded that it is essential that experts on contact dermatitis support, with their expert knowledge, national and European authorities.
Relevance of skin tests with drugs in investigating cutaneous adverse drug reactions
Authors: Barbaud A. , Trechot P. , Reichert‐Penetrat S. , Commun N. , Schmutz J. L.
Published: March 2003

Skin tests with drugs can be of value in investigating patients who have developed cutaneous adverse drug reactions (CADR), but their specificity and relevance remain to be determined. A false‐positive result on skin testing can happen if it is not compared to results in control subjects. When performing intradermal tests (IDT), we have determined the lowest concentrations that induce false‐positive results for many drugs, including betalactam antibiotics, cephalosporins, other antibiotics or non‐steroidal anti‐inflammatory drugs. Some drugs in their commercialized form contain sodium lauryl sulfate and can induce irritation when patch tested as such. When patch tested with colchicine at 10% in pet. or with a Cytotec® pill (containing misoprostol) at 30% in pet., respectively, 80% of the 29 and 9 of the 10 negative controls developed false‐positive results. Lastly, positive results of patch tests with drugs can be related to contact allergy to one of the components of the commercialized form of the drug, without any relevance to the investigation of a CADR, as observed in 2 cases with iodine or avocado oil.
The seamy side of natural medicines: contact sensitization to arnica (Arnica montana L.) and marigold (Calendula officinalis L.)
Authors: Reider N. , Komericki P. , Hausen B. M. , Fritsch P. , Aberer W.
Published: March 2003

Medical remedies of plant origin have gained increasing popularity in recent years. Both anaphylactic and eczematous allergic reactions are on the rise, accordingly. Arnica and marigold, both of the Compositae family, are in widespread use, but only limited data are available on their allergenic potential. We tested 443 consecutive patients, in addition to the European standard and other series, with Compositae mix, sesquiterpene lactone mix, arnica, marigold, and propolis. 5 subjects (∼1.13%) reacted to arnica, 9 (∼2.03%) to marigold. The Compositae mix was positive in 18 cases (∼4.06%). Among them were 3 out of 5 individuals with a sensitization to arnica, and 4 out of 9 who reacted to marigold. Sensitization to arnica and marigold was often accompanied by reactions to nickel, Myroxylon Pereirae resin, fragrance mix, propolis, and colophonium. We conclude that Compositae allergy contributes significantly to the epidemiology of contact dermatitis and that sensitization to arnica and marigold cannot be assessed by testing with the Compositae or sesquiterpene mix alone. As extracts of these plants are frequently used in occupational and cosmetic products, patch testing with additional plant extracts or adjustment of the commercial Compositae mix to regional conditions is recommended.
Occupational allergic contact dermatitis from drugs in healthcare workers
Authors: Gielen K. , Goossens A.
Published: March 2003

Contact sensitivity to drugs administered systemically occurs mainly among healthcare workers, pharmaceutical operatives, and veterinary surgeons. Of the 14,689 patients suspected of contact allergy examined in our department from 1978 to 2001, occupational allergic contact dermatitis from drugs in healthcare workers was diagnosed in 33, the first in 1980. The most common sensitizers were antibiotics such as penicillins, cephalosporins, and aminoglycosides. They accounted altogether for 35 positive patch tests, followed by propacetamol hydrochloride, and ranitidine hydrochloride, which elicited 10 and 7 positive reactions, respectively. The aim of this report is to draw attention to the importance of occupational contact allergy to drugs in healthcare workers. By far the greatest number of the sensitized patients in this series were nurses, there being 26 nurses, 4 veterinarians, 2 pharmacists, and 1 medical doctor.
Evaluation of efficacy of a skin lipid mixture in patients with irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis: a multicenter study
Authors: Berardesca E. , Barbareschi M. , Veraldi S. , Pimpinelli N.
Published: March 2003

Disturbances of skin barrier function occur in several skin diseases, e.g., atopic dermatitis (AD), irritant/allergic contact dermatitis (ICD, ACD). Skin barrier damage triggers the production of cytokines that stimulate lipogenesis which may also cause inflammatory processes. The aim of this study was to evaluate the efficacy of a topical skin lipid mixture in the treatment of ICD, ACD and AD. 580 consecutive patients suffering from ICD, ACD or AD were treated with a skin lipid mixture containing ceramide‐3 and patented nanoparticles. Patients received the lipid mixture alone or in combination with topical corticosteroids until clearance or for 8 weeks. Both treatment groups statistically improved all parameters considered at week 4 and 8 as compared to baseline. Between the 2 treatment groups, there was a statistically significant difference in favour of combined therapy for (ICD, ACD, AD, respectively): erythema, pruritus and overall disease severity; erythema and pruritus; erythema, pruritus, fissuring and overall disease severity. No statistically significant difference was found for (ICD, ACD, AD, respectively): dryness, scaling and fissuring; scaling, fissuring and overall disease severity; dryness and scaling. Between the 2 ACD treatment groups, there was a statistically significant difference in favour of the skin lipid mixture for dryness. In conclusion, the study shows that balanced lipid mixtures are effective in improving barrier properties and the clinical condition of the skin in contact dermatitis.
Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort–spice syndrome
Authors: Anliker Mark David , Borelli Siegfried , Wüthrich Brunello
Published: March 2003

Protein contact dermatitis to meat is well known in butchers; spices are another source of potential contact allergy and usually are not recognized. We present a first case of contact‐dermatitis to spice mix in a 39‐year‐old‐butcher. The patient underwent skin prick testing (SPT) with standard allergens (ALK) and different meat and spice extracts (Stallergènes), scratch‐patch testing with spice mix containing glutamate, paprika and other spices. Specific serum‐IgE was measured with CAP‐FEIA. SPT only showed an immediate‐type sensitization to mugwort (+ +), as well as different spices (paprika +, curry +, cumin +) and camomile (+ + +). Scratch‐patch tests were negative for different meat, but strongly positive for spice mix (+ + +) after 30 min (wheal and flare) and (+ +) after 48 h (infiltration and vesiculation). Two healthy controls were tested negative for spice mix used from that patient (scratch‐patch). Specific IgE was slightly elevated for paprika 0.47 kU/L (CAP class 1), anise 0.43 kU/L, curry 0.36 kU/L and mugwort 3.83 kU/L. Sx1 atopy‐multiscreen was 3.8 kU/L due to a sensitization to mugwort alone. The tests performed demonstrate an IgE‐mediated contact allergy to spices but also a delayed type allergy to spice mix as a manifestation of the mugwort–spice syndrome in this individual. When testing for occupational dermatitis in butchers, protein contact allergy to spices must also be taken into consideration.
Contact allergens in shoe leather among patients with foot eczema
Authors: Van Coevorden A. M. , Coenraads P. J. , Pas H. H. , Van Der Valk P. G. M.
Published: March 2003

Some patients with relapsing foot eczema and a shoe leather allergy, who fail to show positive results with standard series and shoe wear screening tray patch testing, do not respond to the use of hypoallergenic shoe leather. We assume that relevant allergens are present in hypoallergenic shoe leather. We described an experiment to demonstrate the presence of these allergens. Alcoholic extracts were made of green, black and undyed hypoallergenic shoe leather, and the extracts were fractioned by paper chromatography. The resulting chromatograms were cut into 16 equal paper disks and patch tests were performed with extracts and the paper chromatography fractions. Positive reactions were seen to all extracts and to fractions of all types of leather. From analysis of the pattern of positive patch tests we concluded that leather‐related allergens (e.g. tanning agent) and dyes were present in hypoallergenic shoe leather. In these cases, alternatives to shoe leather should be sought, for instance wooden or plastic shoes.
Quantitative aspects of contact allergy to chromium and exposure to chrome‐tanned leather
Authors: Hansen Malene Barré , Rydin Stefan , Menné Torkil , Duus Johansen Jeanne
Published: March 2003

The potential of trivalent and hexavalent chromium to induce and elicit allergic contact dermatitis and the degree of chromium exposure from leather products are reviewed. Chromium dermatitis is often due to exposure in the occupational environment, with cement being one of the most common chromium sources. However, consumer products such as chromium(III)‐tanned leather products are also an important source of chromium exposure. Apart from Cr(III), which is used for tanning, leather often also contains trace amounts of Cr(VI), which is formed by oxidation of Cr(III) during the tanning process. In a recent study of the Cr(VI) content of leather products bought on the Danish market, 35% of such articles had a Cr(VI) content above the detection limit of 3 p.p.m., ranging from 3.6 p.p.m. to 14.7 p.p.m. Leachable Cr(III) was detected at levels of 430–980 p.p.m. An examination of available dose–response studies showed that exposure to occluded patch test concentrations of 7–45 p.p.m. Cr(VI) elicits a reaction in 10% of the chromium‐sensitive patients. When reviewing repeated open exposure studies, it is seen that either exposure to 5 p.p.m. Cr(VI) in the presence of 1% sodium lauryl sulfate (SLS) or exposure to 10 p.p.m. Cr(VI) alone both elicit eczema in chromium‐sensitive patients. The eliciting capacity of Cr(III) has not been systematically investigated but, compared to Cr(VI), much higher concentrations are needed to elicit eczema.
Immediate loading of implants used for orthodontic anchorage
Authors: Melsen B. , Costa A.
Published: March 2003

The healing around an immediately loaded screw was described and related to the bone type, manner of loading and observation time. In four adult macaca fasicularis monkeys, 16 titanium vanadium screws were inserted into the infrazygomatic crest and two in the symphysis region. Immediately after insertion, screws were loaded with 25‐ and 50‐g Sentalloy springs extending to the canines. Following an observation period of 1, 2, 4 and 6 months, the screws and the surrounding bone were removed. Undecalcified serial sections perpendicular to the long axis were made and the degree of osseointegration studied. Two of the screws were lost immediately after insertion. Of the remaining screws, osseointegration was present around all, but two. The integration was independent of bone type, trabecular or cortical, but increased with time. Based on the results of this study, the use of screws described in the report can be recommended as anchorage units in cases where conventional anchorage is not possible.
Suture biology: Lessons from molecular genetics of craniosynostosis syndromes
Authors: Nah Hyun‐Duck
Published: March 2003

Sutures are critical growth sites in the developing craniofacial skeleton, and equally importantly, they are the target tissues for certain orthodontic therapeutic modalities. For these reasons, suture biology has long been an area of significant interest in orthodontics. In fact, much of our knowledge on sutures, such as structure, ontogeny, growth and development, pathology, and tissue response to biomechanical forces, is based on investigations conducted by orthodontic researchers in the 1950–1970s. Despite their significant impact in the establishment of the current paradigm in suture biology, these earlier studies have not provided much information on the molecular and cellular mechanisms of suture development. Only in the last 5 or 6 years, identification of genes involved in genetic disorders of premature suture closure (syndromes of craniosynostosis) has uncovered the first clues to some key molecules and their specific roles in this process. The list, which is expected to get longer, includes fibroblast growth factor receptors (FGFRs), MSX2, and TWIST. FGFRs belong to a family of cell membrane receptor kinases and bind to their principal ligands, fibroblast growth factors (FGFs). Upon binding to FGFs, FGFRs transduce intracellular signaling cascades and ultimately modify cellular behavior, such as cell proliferation and differentiation. MSX2 and TWIST are transcription factors that bind to regulatory regions of target effector genes and determine their expression. In addition to the above‐mentioned molecules, recent tissue recombination and biochemical studies have added FGFs and transforming growth factors to the list of key molecules in suture biogenesis. The purpose of this article is not to reiterate the earlier classical studies, which have been extensively reviewed by others, but to present the new and exciting developments in the field of suture research at the genetic and cellular levels. These new perspectives and what lies ahead as future challenges in this field are discussed.
Treatment time, outcome, and patient satisfaction comparisons of Damon and conventional brackets
Authors: Eberting Jeffrey J. , Straja Sorin R. , Tuncay Orhan C.
Published: March 2003

Efficiency of treatment mechanics has been a major focus throughout the history of orthodontics. Self‐ligating brackets were developed on the premise that elimination of ligature ties creates a friction‐free environment and allows for better sliding mechanics. It is expected that the self‐ligating bracket will reduce the treatment time. This study was designed to compare the effectiveness and efficiency of Damon self‐ligating (SL) brackets to those brackets ligated with either steel ligatures or elastomeric ‘O’ rings. Not only treatment time and the number of appointments needed were addressed, but the quality of the treatment outcome was also assessed. American Board of Orthodontics (ABO) grading criteria for models and panoramic radiographs were employed. Additionally, a nine‐question survey was sent to the 215‐patients in this study (108 Damon, 107 conventionally‐ligated) to elicit their perceptions of how their orthodontic treatment progressed and finished. The results showed that patients treated with Damon SL brackets had significantly lower treatment times, required significantly fewer appointments, and had significantly higher ABO scores than those treated with conventionally‐ligated edgewise brackets. There were no significant differences in Damon or non‐Damon ABO scores with respect to gender. Damon patients over the age of 21 had significantly higher ABO scores. Conversely, the non‐Damon patients under the age of 21 had significantly higher ABO scores. For pre‐treatment Angle classification, no significant differences were noted. Patient responses showed that Damon patients perceived their treatment time as being shorter than expected. It appears that faster orthodontic treatment can be better as measured by the ABO criteria.
Multiple eruptive dermatofibromas in a patient with HIV infection: case report and literature review
Authors: Kanitakis Jean , Carbonnel Elisabeth , Delmonte Sergio , Livrozet Jean‐Marc , Faure Michel , Claudy Alain
Published: March 2003

Multiple eruptive dermatofibromas have been reported in the setting of autoimmune diseases treated with immunosuppressive drugs and more recently in the course of human immunodeficiency virus (HIV) infection. We report herein the ninth case of multiple eruptive dermatofibromas associated with HIV infection. The relevant literature is reviewed and the differences of these lesions from “ordinary” dermatofibromas are discussed.
Large plaque parapsoriasis: clinical and genotypic correlations
Authors: Simon Martin , Flaig Michael J. , Kind Peter , Sander Christian A. , Kaudewitz Peter
Published: March 2003

Twelve patients with large plaque parapsoriasis (LPP) were investigated for the presence of predominant T‐cell clones, analyzing the T‐cell receptor (TCR) γ‐chain gene. The diagnostic and prognostic significance of TCR gene rearrangement status was assessed by a correlation with the long‐term clinical follow‐up. Six out of 12 patients showed a clonal T‐cell population. Clinically, among the patients with clonal disease one developed clearcut mycosis fungoides (MF) after a follow‐up of 8 years, in the other 5 patients no such diagnosis could be made after follow‐up of 2–21 years (median: 9 years). In patients with polyclonal infiltrates the lesions remained virtually unchanged. These findings indicate that in LPP TCR gene rearrangement status has no prognostic significance and does not allow distinction of LPP and early MF. Both conditions show a clonal T‐cell infiltrate with similar frequency, are very similar in clinical and histologic presentation and according to recent studies share the same low risk to develop overt MF. Therefore both terms refer to the identical clinical situation. This should be designated as early MF and efforts should concentrate on identifying those patients that are at risk to develop aggressive disease.
Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts
Authors: Bartralot Ramon , Pujol Ramon M. , García‐Patos Vicente , Sitjas Dolors , Martín‐Casabona Nuria , Coll Pere , Alomar Agustí , Castells Antoni
Published: March 2003

To evaluate the histopathological features observed in patients with cutaneous infections due to nontuberculous mycobacteria (NTM) and to compare the histopathological patterns observed in immunosuppressed patients and normal hosts. Twenty‐eight biopsy specimens corresponding to 27 patients with cutaneous infections due to NTM were reviewed. Eighteen biopsies corresponded to normal hosts (14 Mycobacterium marinum, 2 Mycobacterium chelonae, 1 Mycobacterium terrae and 1 Mycobacterium gordonae) and 10 biopsy specimens were obtained from 9 immunosuppressed patients (3 Mycobacterium chelonae, one of which had two biopsies, 1 Mycobacterium abscessus, 2 Mycobacterium kansasii, 1 Mycobacterium marinum, 1 Mycobacterium avium complex and 1 Mycobacterium simiae). A panel of histopathological features was evaluated by two independent observers in each biopsy specimen. Epidermal changes (acanthosis, pseudoepitheliomatous hyperplasia, exocytosis) were mainly observed in M. marinum infections. In immunosuppressed patients the infiltrate tended to be deeper, involving the subcutaneous tissue (100%) with a more diffuse distribution and constant abscess formation. A marked granulomatous inflammatory reaction was observed in 83% of immunocompetent and in 60% of immunosuppressed patients. In immunosuppressed patients a relationship between the chronic evolution of the disease and granuloma formation was demonstrated. A diffuse infiltrate of histiocytes with occasionally foamy appearance was noted in three biopsy specimens from three patients with AIDS. Acute and chronic panniculitis was detected in 8 biopsy specimens. In one biopsy (M. chelonae) an acute suppurative folliculitis was observed. Different histopathological patterns can be noted in biopsy specimens from cutaneous nontuberculous mycobacterial infections. The evolution of the disease and the immunologic status of the host may explain this spectrum of morphological changes. Tuberculoid, palisading and sarcoid‐like granulomas, a diffuse infiltrate of histiocytic foamy cells, acute and chronic panniculitis, non‐specific chronic inflammation, cutaneous abscesses, suppurative granulomas and necrotizing folliculitis can be detected. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous NTM infections. Some histopathological patterns seem more prevalent in immunosuppressed patients.
Failure of detection of mucin in the clear halos around the epidermotropic lymphocytes in mycosis fungoides
Authors: El Darouti M. , Marzouk Salonas A. , Horn Thomas D.
Published: March 2003

Epidermotropic lymphocytes in mycosis fungoides typically reside in clear lacunae. The material forming this space is unknown. Thirty specimens from 30 patients with mycosis fungoides were stained with alcian blue, modified Mowry's colloidal iron and mucicarmine to determine if some form of mucin could be identified. Using these stains, no form of mucin was noted in the lacunae surrounding the epidermotropic lymphocytes of mycosis fungoides. The cause of the clear spaces around epidermotropic lymphocytes in mycosis fungoides remains unexplained, but is unlikely to represent mucin deposition.
A fatal case of pancreatic panniculitis presenting in a young patient with systemic lupus
Authors: Cutlan Robert T. , Wesche William A. , Jenkins Jesse J. , Chesney Thomas M.
Published: March 2003

Background: Subcutaneous fat necrosis associated with pancreatic disease is a rare event. The clinical cutaneous findings are non‐specific erythematous nodules with central softening located predominantly on the lower extremities. The histopathologic features of these lesions are very characteristic and diagnostic.

Methods: We present an unusual case of pancreatic panniculitis associated with lupus pancreatitis in a 21‐year‐old African American female. The patient presented with lower extremity skin nodules, arthralgia, and serositis prior to the diagnosis of systemic lupus and pancreatitis. The skin lesions progressed despite normalization of serum pancreatic enzymes. Following femoral vein catheterization for renal dialysis, she developed a large indurated area over the left lower quadrant, flank, groin, and upper thigh measuring 25 cm. She was treated with repeated debridement, tissue grafts, and hyperbaric oxygen because of a clinical suspicion of necrotizing fasciitis.

Results: Examination of skin biopsies and debrided tissue revealed the pathognomonic features of pancreatic panniculitis without any evidence of necrotizing fasciitis. Organisms were not detected by tissue examination or microbiologic cultures.

Conclusions: This case illustrates the potential role of vascular trauma in the pathogenesis of pancreatic panniculitis.
Langerhans' cell histiocytosis arising at the site of basal cell carcinoma excision
Authors: Simonart Thierry , Urbain Frédéric , Verdebout Jean‐Marc , Feoli Francesco , Lespagnard Laurence , Dargent Jean‐Louis
Published: March 2003

Langerhans' cell histiocytosis (LCH) may be associated with a wide range of neoplastic disorders. However, the combination of a LCH and a basal cell carcinoma (BCC) of the skin still represents a highly unusual condition. In this publication, we report the case of a 48‐year‐old woman who developed a localized LCH involving the area of a previously excised BCC. Although the exact pathogenesis of this peculiar association remains yet to be elucidated, the hypothesis of an exaggerated Langerhans' cell reaction in response to the underlying BCC appears to be attractive.
Palisaded angioleiomyoma
Authors: Baugh William , Quigley Michael M. , Barrett Terry L.
Published: March 2003

Background: We report a case of a palisaded angioleiomyoma, a histopathologic variant of angioleiomyoma with prominent Verocay body formation.

Results: A healthy 31‐year‐old male requested removal of a subcutaneous nodule on the back of his head. The striking Verocay‐like body formation of this tumor led to an initial frozen section diagnosis of neurilemoma. On hematoxylin and eosin staining, areas consistent with an angioleiomyoma were found as well. Immunohistochemistry gave positive reactions for actin and desmin, but was negative for S‐100.

Conclusions: To our knowledge this morphologic pattern in an angioleiomyoma has not been previously described. Palisaded angioleiomyoma should be added to the ever‐expanding list of tumors that demonstrate nuclear palisades.
Acute generalized exanthematous pustulosis (AGEP) – A clinical reaction pattern
Authors: Sidoroff Alexis , Halevy Sima , Bavinck Jan Nico Bouwes , Vaillant Loïc , Roujeau Jean‐Claude
Published: March 2003

Background: A wide range of diseases or reactions can cause pustular eruptions of the skin. In this spectrum there seems to be a subgroup with characteristic clinical features and a typical course which is mostly caused by drugs for which the term acute generalized exanthematous pustulosis (AGEP) has been established.

Objective: To describe the clinical features of AGEP.

Methods: The authors’ experience from a multinational epidemiological study on severe cutaneous adverse reactions and a comprehensive review of the literature were used to provide an overview of the disease and it’s possible causes. An algorithm for validating cases which was established for this study is also presented.

Results: AGEP typically presents with at least dozens of non follicular sterile pustules occurring on a diffuse, edematous erythema predominalty in the folds and/or on the face. Fever and elevated blood neutrophils are common. Histopathology typically shows spongiform subcorneal and/or intraepidermal pustules, a marked edema of the papillary dermis, and eventually vasculitis, eosinophils and/or focal necrosis of keratinocytes. Onset is acute, most often following drug intake, but viral infections can also trigger the disease. Pustules resolve spontaneously in less than 15 days.

Conclusion: The diagnosis AGEP should be considered in cases of acute pustular rashes and detection of the causative drug should be strived for. Knowledge of the clinical features and usual course of this disease can often prevent unnecessary therapeutical measures.