Background The two most common agent groups currently responsible for photoallergic contact dermatitis (PACD) are organic ultraviolet (UV) absorbers in sunscreens and topical nonsteroidal anti-inflammatory drugs (NSAIDs). However, availability of information on the photoallergenic potential of these agents is scarce. Objectives To obtain current information on the frequency of PACD to 19 organic UV absorbers and five topical NSAIDs, including newer agents, in common usage in Europe. Methods A prospective, multicentre photopatch test study was conducted with 1031 patients attending for investigation of suspected PACD in 30 centres across 12 European countries. Results A total of 346 PACD reactions in 200 (19·4%) subjects occurred. PACD was most commonly caused by the topical NSAIDs, ketoprofen (128 subjects) and etofenamate (59 subjects). Of the organic UV absorbers, octocrylene, benzophenone-3 and butyl methoxydibenzoylmethane most frequently elicited PACD. The 'newer' organic sunscreen absorbers rarely led to PACD. There appeared to be an association between the agents ketoprofen, octocrylene and benzophenone-3, with several subjects developing PACD to two or all three agents concomitantly. Allergic contact dermatitis (ACD) was less commonly observed than PACD, comprising 55 reactions in 47 (5%) subjects. Irritant reactions and photoaugmentation and photoinhibition of ACD occurred infrequently. Conclusions The European multicentre photopatch test study has provided current information on the relative frequency of PACD to common photoallergens. Such data will be of value when deciding on which agents to include in a future European 'baseline' photopatch test series.

Nickel is the major cause of allergic contact dermatitis. It is a widely spread metal, being therefore very difficult to avoid. Nickel cutaneous allergy can occur in occupa-tional and non-occupational contexts and can result from direct cutaneous contact, systemic as well as airborne exposure. Such allergy can manifest with typical lesions of allergic con-tact dermatitis or with peculiar features such as follicular erythemato-micropapular-vescicular lesions. Diagnosis of allergic contact dermatitis to nickel is based on patch test-ing, employing nickel sulfate 5% in petroleum jelly. Reactions to patch test have to be assessed at 48-72 hours, and up to 6 days. Nickel contact dermatitis can be managed with the traditional therapeutic approach used in allergic contact dermatitis. As of today, hyposensitization therapy with oral nickel represents to be the only treatment acting on the pathogenetic mechanisms of nickel allergy.

Although sunscreens are widely used by an increasing number of people, they rarely cause adverse reactions such as allergic and photoallergic contact dermatitis. Benzophenone and octocrylene are the sun filters that most commonly cause allergic reactions, however other filters may sometimes play a role as sensitizers. We report a case of an allergic contact dermatitis to tinosorb M®, an organic compound with physical and chemical sun filter features. It contains methylene bis-benzotriazolyl-tetramethylbutylphenol (its active component), water, propylen glycol, xanthan gum and decyl glucoside. This latter is a surfactant that is added to stabilize the compound. Commonly well-tolerated, tinosorb M® has been recently described as sensitizer. It may cause allergic and photoallergic contact dermatitis caused by the filter itself or by decyl glucoside. Due to such sensitizing proprieties, and to the cross-reactivity of decyl glucoside with other glucosides present in several cosmetics, recently a new kind of tinosorb M glucosyde-free has been introduced to the market.

Psoriasis is a chronic inflammatory skin disease with systemic involvement that might predispose to many psoriasis-related comorbidities, such as metabolic syndrome and cardiovascular disorders. Clusterin (Clu), also known as apolipoprotein J (ApoJ), is a highly conserved disulfide-linked heterodimeric glycoprotein implicated in a great variety of physiological and pathophysiological processes including lipid transportation, tissue remodeling, senescence, cell interaction, stress response, inflammation, apoptosis, diabetes mellitus and metabolic syndrome. Serum levels of Clu were assessed in 15 patients with moderate-to-severe psoriasis defined by the presence of a Psoriasis Area and a Severity Index (PASI) value of 10 or more. It was found that the Clu value was significantly higher in patients than in healthy subjects (p <0.001). Our data confirm that the association of psoriatic disease with some comorbidities, especially metabolic and cardiovascular disease, might support the correlation with increased circulating Clu. In particular, it should be pointed out that, according to the recent literature, the Clu could also have a protective role in the comorbidity of psoriasis patients. In addition, it has been published that Clu protects cardiomyocytes against ischemic cell death and is a potential therapeutic agent in the treatment of myocardial infarction; therefore it can be assumed that an artificial enhancement of Clu in the blood could limit the severity of damage also in respect to skin lesions. Although the increase in serum level of Clu was found in all patients with psoriasis, more studies on a larger cohort of patient samples is necessary to confirm the significance of high serum levels of clusterin/ApoJ and to suggest the use of this glycoprotein as an additional new marker in psoriasis pathogenesis. It could be a possibility to improve the prognosis in patients with psoriasis.

The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity is best done as an interdisciplinary collaboration between the allergist and cardiologist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropiateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization or switching to an alternative agent. Working togetther, a cardio-allergy team of specialists may offer the best approach to clinical decision making for the indivual paient.

Since human papillomavirus (HPV) is the central casual factor in cervical cancer, understanding the epidemiology and geographical area distribution of the most prevalent HPV genotypes constitutes an important step towards development of strategies of prevention.

Parabens were introduced in the 30s and currently represent the most common preservatives in cosmetics, in topical as well as systemic drugs and in alimentary products. Chemically, they are p-hydroxybenzoic acid alkylesters. Methyl, ethyl, propyl and butylparaben are frequently used, the former two especially. Their great popularity results from a series of useful properties: they are inexpensive, odorless, tasteless, colorless and show an ample anti-bacterial spectrum. Parabens have always been cause of argument, first because of their sensitizing capacities, and recently given their alleged mammary cancerogenic potential and hormonal interferences. From an allergological perspective, parabens constitute weak sensitizers. As a matter of fact, contact allergy incidence to these substances has always been low, and today reaches negligible levels, given their banning from most cosmetic products. Contact allergy highest percentages used to be associated to topical parabens containing drugs which were applied on lesional skin (wounds, ulcers, preexisting contact dermatitis). Percentages have conversely always been low following use of cosmetic products on healthy skin. A recent literature review ruled out parabens responsibility (as contained in antiperspirants) in mammary cancer determinism. These compounds have also been suspected to interfere with sexual hormones. At recommended doses, however, methyl and ethylparaben do not show any hormonal effects in humans. Further studies concerning propyl and butylparaben are advisable, given their possible fertility impairing effect in males which were exposed during their childhood. Key words: breast cancer, contact allergy, cosmetics, hormones, estrogens, parabens, percutaneous absorbtion, p-hydroxibenzoic acid.

CONTEXT: Alkyl glucosides and alkyl poly-glucosides are widely used as wetting agents, surfactants and emulsifiers in several industrial and cosmetic products. They are known as well-tolerated and are usually added to the primary surfactants in order to reduce the irritating potential of the main foaming agents. OBJECTIVE: Recently, some authors suggested that allergic contact dermatitis to alkyl glucosides might be more frequent than suspected. On the other hand, the chemical structures of glucosides do not show potentially allergenic chemical groups or strongly polarized structures. The aim of our study is to investigate alkyl glucosides carrying out a detailed chemical analysis on samples of raw materials to identify potentially allergenic impurities or by-products contained in commercial samples of alkyl glucosides. MATERIALS AND METHODS: We chemically analyzed samples of cocoyl glucoside, decyl glucoside and lauryl glucoside by three different analytical methods, in order to identify any undesired or polluting substances. RESULT: In each of the three samples, we detected the presence of isobornyl acrylate. Its approximate content in the tested samples is 500 ng/g of the product. DISCUSSION: Isobornyl acrylate is not used in the synthesis of alkyl glucosides, but as a plasticizer in many plastic materials. It can be easily released to materials flowing over these surfaces when they have high extraction power, as glucosides. CONCLUSION: Isobornyl acrylate may play a role as hidden allergen, in the form of an impurity collected during the industrial process, explaining some cases of allergic reaction to alkyl glucosides.

Abstract The guidelines for the management of urticaria in adults and children have been revised and updated recently. However, there are few data in the literature concerning several aspects of this disease in the elderly (e.g., epidemiology, etiopathogenesis, clinical aspects, association with co-morbidities, efficacy and safety profiles of treatments, and management strategies). This is an obvious deficiency in the data, as this disease causes a deterioration in quality of life, affecting the quality of sleep, everyday life habits and activities, and inducing severe disability. Chronic spontaneous urticaria (CSU) can also be associated with internal, infectious, autoimmune, or neoplastic diseases. It is therefore necessary to pay particular attention to these clinical issues through appropriate clinical examinations. At the same time, the specific features of medications used to treat CSU in the elderly should be carefully evaluated, as its pharmacological treatment raises a number of problems related both to the clinical condition of the patient and to concomitant diseases, as well as to the polypharmacotherapy, which is common in older subjects and may cause safety problems because of the drug interactions. Non-sedating new-generation antihistamines are the mainstay treatment of CSU for the elderly. The efficacy and safety of alternative treatment options have not been assessed in the geriatric population with CSU; corticosteroids and cyclosporine (ciclosporin) should be used by this population with extreme caution. Similarly, there are no data regarding the actual safety profile of the new-generation antihistamines at higher doses than those recommended in elderly patients.

BACKGROUND: Etiopathogenesis of nummular eczema is obscure; many causative factors have been proposed. Only a few studies investigated the relevance of contact allergy. OBJECTIVE: This retrospective study aimed to investigate the role of contact allergy in the underlying mechanism of nummular eczema. METHODS: From the 29,323 consecutive patients, we patch-tested for eczematous dermatitis of various type, 1022 (3.5%) with nummular eczema were enrolled. Data were collected for each patient, including age, sex, occupation, symptoms onset and duration, onset and spread sites, and clinical evidence or history of atopy. Histological analyses of acute phase lesions were carried out in some patients. RESULTS: Peak incidence of age at disease onset was found in the third decade of life. Predominant sites of lesions were upper (75.8%) and lower (64.5%) limbs, followed by trunk, dorsum of the hands, and face and neck. Three hundred thirty-two (32.5%) of 1022 patients showed positive reactions to 1 or more allergens. Highest sensitization rates were found with nickel sulfate (10.2%), potassium dichromate (7.3%), and cobalt chloride (6.1%). Histopathology showed less pronounced spongiosis in atopic subjects and the elderly. CONCLUSIONS: Because this study demonstrates that contact allergy is common with nummular eczema, patch testing is strongly advisable in every patient with persistent nummular dermatitis.

Background Disperse dyes are well-known contact sensitizers. However, they are not included in the majority of commercially available baseline patch test series. Objectives To investigate the outcome of patch testing with a textile dye mix (TDM) consisting of eight disperse dyes at dermatology clinics in various countries. Patients/materials/methods Two thousand nine hundred and seven consecutive dermatitis patients at 12 dermatology clinics representing nine countries were tested with a TDM at 6.6%, consisting of Disperse Blue 35, Disperse Yellow 3, Disperse Orange 1 and 3, and Disperse Red 1 and 17, all at 1.0%, and Disperse Blue 106 and Disperse Blue 124, each at 0.3%, provisionally included in the baseline series. Eighty-seven per cent of the patients allergic to the TDM were also tested with the eight separate dyes. Results Contact allergy to TDM was found in 108 patients (3.7%). The frequency of contact allergy varied from 2.1% to 6.9% in different centres. Simultaneous reactivity to p-phenylenediamine was found in 57 of the TDM-positive patients (53%). The most frequent dye allergen among the TDM-positive patients was Disperse Orange 3. The contact allergy could have explained or contributed to the dermatitis in approximately one-third of the patients for whom clinical relevance of the TDM contact allergy was recorded. Conclusions The TDM should be considered for inclusion in the European baseline series. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

BACKGROUND: Photocontact dermatitis to Ficus carica is induced by furocoumarins present in sap. These substances are generally considered to cause phototoxic reactions. OBJECTIVES: We conducted a patch test and histopathological study of patients with phytophoto contact dermatitis from the fig tree to evaluate the mechanism underlying the photoreaction. PATIENTS AND METHODS: Patch and photopatch testing with serial dilutions of two natural furocoumarins [5-methoxypsoralen and 8-methoxypsoralen (8-MOP)] contained in plant sap were performed in 47 patients. A synthetic furocoumarin, 4,5',8-trimethylpsoralen, was also tested. Histopathological analyses were made of some positive photoreactions. RESULTS: Positive photopatch tests reactions to 8-MOP were obtained in 12 of 47 patients, in 4 of them down to a concentration of 0.0001%. Patch tests and photopatch tests to the other two furocoumarins were negative. Histopathological findings on biopsies from positive photopatch tests to 8-MOP showed a dermatitis. CONCLUSIONS: Allergic photoreactions induced by contact with plants containing coumarins are generally regarded as chance findings. This study has demonstrated that phytophoto allergic contact dermatitis resulting from furocoumarins is not an exceptional finding, and should be suspected in subjects with diffuse clinical manifestations in photo-exposed but also non-exposed sites. To differentiate allergic from toxic photoreactions, patch tests need to be performed with serial dilutions of furocoumarins. Histological analysis of a biopsy sample from a positive test site will reveal alterations compatible with a photoallergic contact dermatitis.

Ultraviolet (UV) radiation is an etiologic cause for non-melanoma skin cancer (basalcell carcinoma and squamouscell carcinoma) and malignant melanoma, but the spectral range promoting the tumor induction is still to be explained. It follows that it is mandatory the complete photoprotection from sunscreens towards the whole UV range. In the European Union, sunscreens are tested on their effectiveness by means of 4 indicators: SPF (Sun Protection Factor), UVA-PF (Protection Factor), SPF/PF-UVA ratio, and critical wave length. However, SPF can confirm that sunscreen products protect us from sunburn under good condition of use. In order to achieve a whole protection, instead, it is also interesting to calculate other indicators to assess protection against non-melanoma skin cancers and to quantify the effectiveness of the product against UVA1 and UVA2. Photostability of sunscreens represents a further significant problem concerning photoprotection. It has been clearly demonstrated that not all UVA and UVB absorbers are sufficiently photostable. Within UV exposure, in fact, some of them may change spectral performance. High SPF value implies the long-lasting photoprotection, but this is only guaranteed when UV filters remain stable throughout the entire period of sun exposure. Thus, the production of photostable products is extremely important. But, most sunscreens on the market do not have a photostability label. Therefore, there is a need for a global uniform claim on UV photoprotection.

Transdermal therapeutic systems (TTS) have become a popular method of drug delivery because they allow drugs to be delivered in a rate-controlled manner, avoiding first-pass metabolism and the fluctuating plasma concentrations encountered with oral medications. Moreover, applying TTS is easy, does not require any assistance as intramuscular or intravenous administration, and provokes fewer side effects than there are with the oral delivery of drugs. Drugs most commonly delivered through TTS are scopolamine, estradiol, nitroglycerin, and clonidine. Unfortunately, TTS may provoke adverse skin reaction as irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). TTS seems to be ideally suited to produce sensitization because they cause occlusion, irritation, and repeated placement of the allergen at the same skin location. Since TTS consist of an adhesive, an active pharmaceutical drug and enhancing agents, sensitization may develop owing to one of these 3 components. The purpose of this manuscript is to review known responsible allergens of ACD to TTS. We describe also a case report about ACD to TTS caused by rivastigmine in a patient affected by Alzheimer's dementia. Rivastigmine is one of the latest drugs indicated as a known culprit allergen of ACD to TTS.

Scalp hair heterochromia presenting in tufts with no underlying skin changes is rare and can be a sign of somatic mosaicism. We describe the case of a healthy 5-year-old boy with this condition.

Summary Psoriasis is a multifactorial disease that can be related to genetic, environmental and immunological causes. Therefore, not only a single factor but different aspects contribute to the onset of the disease, varying from individual to individual. It would be characterized by an abnormal proliferation and differentiation of keratinocytes, mediated by a dysregulation in the auto-immune T cell response in which several cytokines participate, including interleukin (IL)-17, IL-17A, IL-12, IL-22, IL-23. These cells and cytokines are responsible for the aggression on skin cells, inflammation and accelerated reproduction of the cells of the epidermis. Due to the chronic inflammation, psoriasis is frequently associated with other concomitant non-dermatological morbid conditions such as arthropathy which can be complicated by a disabling evolution. Psoriasis is also frequently associated with comorbidities such as cardiovascular diseases (CVD), hyperlipidemia, diabetes and obesity. The knowledge of common inflammatory pathways and of the potential links between psoriasis andother diseases should encourage dermatologists to a multidisciplinary approach to psoriasis and to an optimal management also in the light of new therapeutic