S. Werfel’s research while affiliated with Ludwig-Maximilians-Universität in Munich and other places

All the chapters under the part "Dia-Klinik" of the eBook "Fortschritte der praktischen Dermatologie und Venerologie 2002" by Gerd Plewig and Jörg Prinz eISBN: 978-3-642-55661-6 was retracted as we do not have rights to publish these chapters due to legal restrictions.

Background Contact allergy can be a cause of severe disease. The consequences of contact allergic reactions are often underestimated. Case reports We report on a 10-year-old girl, a 10-year-old boy and a 40-year-old man, who received temporary paint-on “tattoos” (temptoos) with black henna paint in Italy, Turkey or India, respectively. Both the girl and the man had a refreshment of their temptoos within two weeks after the first painting. The patients developed within 10 to 31 days after the first application of the dye an acute local contact dermatitis. The male patients also developed severe, long standing generalized vesicular and crusted eruptions, the boy had constitutional symptoms in addition. The children received systemic steroids because of their significant symptoms, and their skin lesions resolved within several weeks. The man was treated with topical corticosteroids, his dermatitis resolved also slowly within several weeks after recurrent generalized eczematous eruptions. Besides, he developed textile dermatitis when wearing black clothes. In all three patients marked post-inflammatory hypo- or hyperpigmentations were seen at the sites of the temptoos after resolution of the contact dermatitis. All three individuals had no indications of prior contact sensitization. Patch testing with the standard series yielded a 3+ reaction to p-phenylendiamine (PPD; 1%) in the 10-year-old girl. The boy and the man were patch tested with 0,1% PPD, they developed also 3+ reactions. Furthermore, the girl showed patch test reactions to structurally related compounds. Conclusion We want to draw attention to the serious hazards of these temptoos. They contain PPD in such a high concentration that they can cause sensitization and manifestation of allergic contact dermatitis even after a single application. Temptoo contact dermatitis often leaves cosmetically disturbing hypo- or hyperpigmentation, sometimes even scars. Contact allergy to PPD and structurally related compounds persists for a long time, even lifelong, thus causing significant restrictions of private life and occupational possibilities.

Background: Contact allergy can be a cause of severe disease. The consequences of contact allergic reactions are often underestimated. Case reports: We report on a 10-year-old girl, a 10-year-old boy and a 40-year-old man, who received temporary paint-on "tattoos" (temptoos) with black henna paint in Italy, Turkey or India, respectively. Both the girl and the man had a refreshment of their temptoos within two weeks after the first painting. The patients developed within 10 to 31 days after the first application of the dye an acute local contact dermatitis. The male patients also developed severe, long standing generalized vesicular and crusted eruptions, the boy had constitutional symptoms in addition. The children received systemic steroids because of their significant symptoms, and their skin lesions resolved within several weeks. The man was treated with topical corticosteroids, his dermatitis resolved also slowly within several weeks after recurrent generalized eczematous eruptions. Besides, he developed textile dermatitis when wearing black clothes. In all three patients marked post-inflammatory hypo- or hyperpigmentations were seen at the sites of the temptoos after resolution of the contact dermatitis. All three individuals had no indications of prior contact sensitization. Patch testing with the standard series yielded a 3+ reaction to p-phenylendiamine (PPD; 1%) in the 10-year-old girl. The boy and the man were patch tested with 0,1% PPD, they developed also 3+ reactions. Furthermore, the girl showed patch test reactions to structurally related compounds. Conclusion: We want to draw attention to the serious hazards of these temptoos. They contain PPD in such a high concentration that they can cause sensitization and manifestation of allergic contact dermatitis even after a single application. Temptoo contact dermatitis often leaves cosmetically disturbing hypo- or hyperpigmentation, sometimes even scars. Contact allergy to PPD and structurally related compounds persists for a long time, even lifelong, thus causing significant restrictions of private life and occupational possibilities.

Background Delayed type allergy to heparin, which can cause skin reactions to subcutaneously administered heparin, is not rare. If further heparin therapy is necessary, management is problematic. Case reports We report the cases of two female patients who had developed erythematous infiltrations at the injection sites of subcutaneously applied heparin. Few days before an urgent bypass operation, the patients presented for allergologic diagnostics to assess what intraoperative antithrombotic treatment could be used. Allergological investigations revealed erythematous infiltrations typical of delayed-type reactions to the intradermal test with heparin sodium and to the subcutaneous challenge with danaparoid sodium, which had been considered to be used as a substitute for heparin. Considering all circumstances, intravenous administration of heparin sodium was chosen as the most reliable anticoagulant regimen despite the allergic reaction to subcutaneous heparin. After intravenous premedication with corticosteroids and H1- and H2-blocking antihistamines, intravenous heparin sodium was tolerated without reaction intraoperatively. Conclusions In both patients intravenous heparin was tolerated despite a delayed type reaction to subcutaneously administered heparin. As such tolerance is not predictable, careful consideration of risk and benefit as well as careful observation of the patient are necessary in case this approach is used.

Ficus benjamina (weeping fig) is a widespread indoor ornamental plant. Allergens of Ficus benjamina are a well-known cause of IgE-mediated respiratory diseases. We treated a 32-year-old female who for 10 years had suffered from perennial rhinoconjunctivitis. When dusting her 2 meter high Ficus benjamina, she developed an anaphylactic reaction which resolved without sequelae. Skin prick testing revealed a strong immediate type reaction to a Ficus extract, the serum concentration of specific IgE-antibodies to Ficus was > 100 kU/I (CAP class 6). In view of these strong test reactions and the conclusive history, no challenge tests with Ficus allergens were performed. After removal of the Ficus plants which she had owned for 17 years and after thorough cleaning of her dwelling, the patient's symptoms of perennial rhinoconjunctivitis stopped. The patient also was sensitized to, but not allergic to natural rubber latex, which occurs frequently in Ficus allergy and probably is due to cross reactivity to allergens from both sources. As Ficus benjamina is an important source of indoor allergens, it should not be used in dwellings or work places.

Zusammenfassung Ficus benjamina (Birkenfeige) ist eine in Innenrumen weit verbreitete Zierpflanze. Allergene von Ficus benjamina sind eine bekannte Ursache von IgE-vermittelten respiratorischen Erkrankungen. Wir betreuten eine 32-jhrige Patientin, die seit 10 Jahren an perennialer Rhinokonjunktivitis litt. Beim Abstauben ihrer bis zu zwei Meter hohen Ficus-benjamina-Pflanzen entwickelte sie eine anaphylaktische Reaktion, von der sie sich folgenlos erholte. Beim Pricktest zeigte die Patientin eine ausgeprgte Reaktion auf einen Ficus-Extrakt, im Serum waren spezifische IgE-Antikrper der CAP-Klasse 6 gegen Ficus nachweisbar. Auf Provokationstests mit Ficus-Allergenen konnte unter Bercksichtigung der starken Testreaktionen in Verbindung mit der eindeutigen Anamnese verzichtet werden. Nach Entfernung der seit 17 Jahren vorhandenen Ficus-Pflanzen und grndlicher Reinigung der Wohnung sistierte die perenniale Rhinokonjunktivitis. Zustzlich fand sich bei der Patientin eine bei Ficus-Allergie hufige, als “Kreuzreaktion” zu interpretierende Sensibilisierung gegenber Naturlatex. Als bedeutsamer Allergentrger sollte Ficus benjamina weder in Wohn- noch in Arbeitsbereichen gehalten werden.

Common warts can be highly resistant to conventional treatments such as cryotherapy, laser surgery, salicylic acid and mechanical removal. Intralesional bleomycin has been described as an effective treatment for common warts since 1970. We treated a 27-year-old woman with Sharp's syndrome who was on immunosuppressive drugs and had suffered for nine years from therapy-resistant warts on palms and soles. A bleomycin-prick technique using a bifurcated needle to introduce bleomycin sulfate (1 mg/ml sterile saline solution) into the warts resulted in almost complete remission after 16 treatment sessions.

Verrucae vulgares zeigen häufig äusserste Therapieresistenz gegenüber verschiedenen konventionellen Behandlungsmethoden, wie beispielsweise der Kryo- oder Lasertherapie, Lokaltherapie mit Salizylsäure oder mechanischer Abtragung. Die intraläsionale Applikation von Bleomycin wird seit 1970 bei therapieresistenten Warzen eingesetzt. Über die Jahre entwickelten sich unterschiedliche Applikationsformen des Chemotherapeutikums bei der Behandlung von Warzen. Wir behandelten eine 27-jährige Patientin mit Sharp-Syndrom, die aufgrund der systemischen Immunsuppression über 9 Jahre an therapieresistenten palmaren und plantaren Warzen litt. Bei der Patientin wurde die Bleomycinprickmethode gewählt, bei der Bleomycin (1 mg/ml 0,9% NaCl) mit Hilfe einer Pricklanzette in die Warze appliziert wird. Nach durchschnittlich 16 Behandlungen an Händen und Füßen kam es zur fast kompletten Remission der Warzen. Common warts can be highly resistant to conventional treatments such as cryotherapy, laser surgery, salicylic acid and mechanical removal. Intralesional bleomycin has been described as an effective treatment for common warts since 1970. We treated a 27-year-old woman with Sharp's syndrome who was on immunosuppressive drugs and had suffered for nine years from therapy-resistant warts on palms and soles. A bleomycinprick technique using a bifurcated needle to introduce bleomycin sulfate (1 mg/ml sterile saline solution) into the warts resulted in almost complete remission after 16 treatment sessions.