Showing papers by "John R. Ingram published in 2012"

A bum deal from wooden toilet seats: reemergence of allergic contact dermatitis.

Abstract: To the Editor: We report a case series of 5 patients who were found to have an allergic contact dermatitis (ACD) to their wooden toilet seats. The patients presented to our contact dermatitis clinic during a 5-year period from 2005 until 2010. In each case, there was a regional eczematous eruption localized to the buttocks and posterior upper thighs with an annular configuration that matched to the shape of the patients’ toilet seats (Fig. 1). Two of the patients were children, one of whom has been reported previously, and the age range was from 3 to 70 years. In 1 child, a relapse of the rash was associated with extended contact with their wooden toilet seat because of subsequent constipation. All 5 patients had positive reactions on patch testing to wood shavings from their toilet seats. A scalpel was used to take scrapings from the varnish coating and from the wood below the coating. Each set of scrapings was prepared at 10% in white soft paraffin for patch testing. The reactions were typically moderate in severity (++) at day 4 (Fig. 2). Two of the patients were patch tested to shavings from their toilet seat’s varnish, and this was negative in both cases. There were no other relevant positive results on patch testing each patient to a modified British Contact Dermatitis Society standard series, including negative results to colophony. In all cases, the localized eczema resolved by switching to a plastic toilet seat or by revarnishing the wooden seat. Microscopic examination of a toilet seat sample from one of the patients confirmed not to react to the surface varnish was undertaken. The wood had distinct growth rings and was diffuse porous, with abundant small vessels in radial multiples, small mainly opposite intervessel pitting, scalariform perforation plates with 14 to 23 bars, and uniseriate homocellular rays between 4 and 35 cells high. These characters indicated that the wood was Alnus species, alder, and reference microscope slides were a good anatomical match. This type of wooden toilet seat is available for purchase. Alnus glutinosa has been found to cause dermatitis of the face and hands in several reports, probably due to wood rather than bark exposure. Analysis of the remaining wooden toilet seats in our case series was not performed; these were described as pine in 2 cases, mahogany medium-density fiberboard in 1 case, and unknown in the other. Toilet seat ACD had been in decline following the replacement of wooden seats with preformed plastic alternatives in the 1960s and 1970s, there being only 1 case report of ACD to a plastic toilet seat. Polyurethane foam, contained within a worn leather toilet seat, has also been reported as a cause of ACD. However, the popularity of wooden seats has increased again, and so there may well be a concomitant rise Address reprint requests to John R. Ingram, DM, 3rd Floor Glamorgan House, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. E-mail: ingramjr@cardiff.ac.uk.

Combination treatment with a tumour necrosis factor antagonist and an oral retinoid: efficacy in severe acral psoriasis?

Abstract: A . FU J IMOTO , 5 Y . SH IMOMURA Laboratory of Genetic Skin Diseases, and Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan Departments of Dermatology, and Biochemistry and Molecular Genetics, American University of Beirut Medical Center, Beirut, Lebanon Jordan University of Science and Technology, Irbid, Jordan Correspondence: Yutaka Shimomura. E-mail: yshimo@med.niigata-u.ac.jp

Fumaric acid esters for psoriasis: patient perceptions of an unlicensed medication [Abstract]

Abstract: Fumaric acid esters (FAEs) are unlicensed for the treatment of psoriasis in the United Kingdom, and as a result there is less information available to patients. The British Association of Dermatologists (BAD) recently produced a patient information leaflet on FAEs. The objective of this evaluation study was to look at whether patients are getting enough information about the drug prior to commencing treatment, how they are getting their information, and whether they could be supported better.