J P Nater’s research while affiliated with University of Groningen and other places

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

The skin is the interface of an organism with its environment, and therefore the basic role of the skin is protection, e. g., against water loss and entrance of external factors, such as irritants. The location of the permeation barrier depends on the physico-chemical characteristics of the substance concerned. Blank has noticed that the water diffusion rate was dependent on the number of stratum corneum layers stripped [5]. Based on this observation, the stratum corneum is considered to provide a uniformly impermeable layer which constitutes the main barrier against diffusional water loss [6]. The epidermal layers underneath the stratum corneum (i. e., viable epidermis) have a predominantly hydrophilic nature; water-soluble substances can be transported easily via the intercellular fluids. Lipophilic substances tend to accumulate and/or bind in the stratum corneum layers [25]. For the majority of compounds, therefore, the stratum corneum is the main penetration barrier [34].

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

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

Patch tests with house dust mite allergens were performed in 21 atopic dermatitis patients with a positive prick test and RAST for house dust mite. Variables in methodology of patch testing, i.e. allergen concentration, application time, and intensity of tape stripping, were studied. Tests were performed with Dermatophagoides pteronyssinus solutions containing 20X, 100X and 500X the prick test concentration and purified HDM antigen: 10 and 50 micrograms/ml P1Ag solution. The series was applied on 8X or 15X tape-stripped and clinically normal skin on the back during 24 and 48 h. Non-specific reactions due to tape stripping, fixation tape or patch test occlusion were frequently observed: after 15X tape-stripping in 3/7 (24-h application) and 6/7 (48-h application) patients, after 8X tape-stripping in 2/19 (24-h application) and 8/19 (48-h application) patients. Reactions clinically assessed as specific occurred in 6/21 (29%) atopic dermatitis patients, 4/6 occurring in the 10 patients with a serum IgE greater than 1000 kU/l. High allergen concentrations and 48 h of application increased the number of patients with specific reactions. If 15X tape-stripping had been omitted, 2/3 patients tested in this manner and showing specific test reactions would have been negative. Further conclusions regarding the value and the preferable method of patch testing with atopic allergens require an in vitro control test.

This chapter discusses the effects of dermatological drugs, topical agents and cosmetics. It reviews the ocular effects of oral retinoids. It examines the effects of retinoids such as hepatotoxieity of retinoids, etretinate (tigason, tegison) and its side effects such as muscle damage, contact allergy of new allergens, which have not caused contact allergy previously have been described and so has been new drugs causing photosensitivity. Transdermal therapeutic systems such as scopolamine, contact dermatitis associated with transdermal therapeutic systems have been examined. Miscellaneous side effects such as anaphylaxis due to chlorhexidine gluconate, diphencyprone, and carcinogenicity of topical mechlorethamine hydrochloride have been explained in this chapter.

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

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

The aims of the investigation were: 1) to study the inter-individual variation in time course of TransEpidermal Water Loss and of clinical manifestations after a 24-h single exposure to Sodium Lauryl Sulphate. This TEWL time course (expressed as the difference in TEWL between the day of patch removal and a subsequent day) reflected the epidermal barrier response to the damage caused by SLS; 2) to investigate the association between the TEWL time course after the single SLS exposure and the TEWL value after 4-day repeated SLS exposure (as a model for cumulative irritation). The 35 healthy subjects tested could be divided into four sub-groups according to the day of their maximum TEWL value after the single SLS exposure (days 2 to 5). For the whole group, inter-individual variation in TEWL course was most pronounced in the first days following the single SLS application. Moreover, there was an inverse relationship (R = -0.61) between TEWL course during the first days after the single exposure and the TEWL value after 4-day repeated exposures. It is concluded that this association illustrates the importance of an adequately responding barrier function against the continuous exposure to irritants in daily life.