Free Article on Topical Steroid addiction – withdrawal

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Free article on topical steroid addiction – “Cortisol production by keratinocytes [skin cells] might work to regulate or moderate the friction between the outer environment and inner immune system by suppressing excessive inflammation or immune reaction. However, prolonged or excessive use of TCS induces skin atrophy which can make barrier function weak. Moreover, the decreased self-production of cortisol by the keratinocytes can cause hypersensitivity. The author considers it is one of the mechanisms of TSA or rebound phenomenon after TSW.”

Fukaya M1. .Histological and Immunohistological Findings Using Anti-Cortisol Antibody in Atopic Dermatitis with Topical Steroid Addiction.   2016 Mar;6(1):39-46. doi: 10.1007/s13555-016-0096-7. Epub 2016 Feb 2.  Dermatol Ther (Heidelb)

“Abstract

INTRODUCTION:

Though topical steroid addiction (TSA) in patients with atopic dermatitis (AD) has been recently discussed as a clinical problem, there are very few studies about its mechanism. The purpose of this study was to elucidate histological and immunohistological characteristics of TSA using anti-cortisol antibody.

METHODS:

Skin biopsy specimen from eight patients with AD was stained by anti-cortisol antibody (Biorbyt, orb79379). Subjects consisted of a child patient with a short history of topical corticosteroids (TCS) application, an adult patient with a long history of TCS application, and six adult patients who have experienced topical steroid withdrawal (TSW) and the rebound phenomenon.

RESULTS:

The staining in the epidermis by anti-cortisol antibody presented patchy defects in the child patient, the patient with a long history of TCS application, and two patients at the rebound period. Parakeratosis with poor formation of corneal layer was obvious in the child patient, the patient with a long history of TCS application, two patients recovered from TSA, and two patients at the rebound period.

CONCLUSION:

Prolonged application of TCS might suppress the cortisol production of keratinocytes which is poorly developed at the early ages before childhood and completed naturally as to growth. Rebound phenomenon after TSW can occur due to the relative insufficiency of cortisol in the epidermis and the immature corneal layer formation.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799038/

Not all nickel allergy reactions are delayed

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Nickel allergy early reactions reported within 30 min of contact!

 Nickel allergy in a Danish population 25 years after the first nickel regulation.

 Ahlström MG1, Menné T1, Thyssen JP1, Johansen JD1.

Author information

 Contact Dermatitis. 2017 Apr 7. doi: 10.1111/cod.12782. [Epub ahead of print]

Abstract

BACKGROUND:

Nickel in metallic items has been regulated in Denmark since 1990; however, 10% of young Danish women are still sensitized to nickel. There is a need for continuous surveillance of the effect of regulation.

OBJECTIVES:

To identify current self-reported metallic exposures leading to dermatitis in nickel-allergic patients, and the minimum contact time needed for dermatitis to occur.

METHODS:

A questionnaire was sent to all patients who reacted positively to nickel sulfate 5% pet. within the last 5 years at the Department of Dermatology and Allergy, Gentofte Hospital.

RESULTS:

The response rate was 63.2%. Earrings were the foremost cause of dermatitis after the EU Nickel Directive had been implemented, followed by other jewellery, buttons on clothing, belt buckles, and wrist watches. Dermatitis reactions within 10 min of contact were reported by 21.4% of patients, and dermatitis reactions within 30 min of contact were reported by 30.7% of patients. [Noting nickel allergy early reactions]

CONCLUSIONS:

Nickel exposures that led to implementation of a nickel regulation seem to persist. The durations of contact with metallic items to fall under the current REACH regulation of nickel correspond well with the results of this study.

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

KEYWORDS:

EU directive; allergic nickel dermatitis; metallic items; nickel; prolonged direct contact

TSW

Facing topical steroid withdrawal TSW – health matters

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TSW – topical withdrawal syndrome

Facing up to withdrawal from topical steroids 

By Mary C. Smith, RN, MSN; Susan Nedorost, MD; and Brandie Tackett, MD

“Topical corticosteroids applied to the face to treat these symptoms can cause steroid rosacea and steroid addiction syndrome, resulting in new symptoms that perpetuate the topical steroid usage.”  “withdrawal … which is called steroid addiction syndrome.”

” The best time to prevent … is when topical corticosteroids are first prescribed.”

” Getting the red out”

” Uncovering steroid rosacea”

” Stopping the cycle”

” Patient teaching”

Call to Action: “Learn to recognize this condition”

Get article here

 

Nickel in Cocoa – speciation

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Food Chem. 2017 Sep 1;230:327-335. doi: 10.1016/j.foodchem.2017.03.050. Epub 2017 Mar 10.

Nickel speciation in cocoa infusions using monolithic chromatography – Post-column ID-ICP-MS and Q-TOF-MS.

Peeters K1, Zuliani T2, Žigon D3, Milačič R4, Ščančar J5.

Author information

Abstract

Nickel (Ni) is considered to be a potentially harmful element for humans. Its levels in foodstuffs are normally low (below 0.2mgkg-1), but sensitive individuals may develop allergy to Ni as a result of dietary consumption. Cocoa contains relatively high Ni concentrations (around 3mgkg-1). Ni bioavailability, its role in the flavour of food and its potential impact on human health depends primarily on its chemical species. However, there is a lack of information about Ni speciation in cocoa. In this work Ni species were separated on a weak convective interaction media diethylamine (CIM DEAE) monolithic chromatographic column and quantified by the post-column isotope dilution inductively coupled plasma mass spectrometry (ID-ICP-MS). The Ni binding ligands in the separated fractions were identified “off line” by quadrupole time-of-flight mass spectrometry (Q-TOF MS). Ni was found to be present in the cocoa infusions as Ni2+ and Ni-gluconate and Ni-citrate complexes.

Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Triggers of ACD – allergens and the jewelry addict

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Discussion of Triggers of Allergic Contact Dermatitis in Accessories – the Jewelry addict

Original article: Nanette B. Silverberg. (2016). The “Jewelry Addict”: Allergic contact dermatitis from repetitive multiple children’s jewelry exposures. Pediatric Dermatology 33: e103-e105

Reviewed by Lauren A. Ivey, MS. MSI & Brittanya A. Limone, MA, BS. MSIII Loma Linda University

  • Nickel Allergic Contact Dermatitis (Ni-ACD) can be a distressing problem, especially for young girls with pierced ears and a love for costume jewelry.
  • Nickel is the most commonly confirmed contact allergen in both children and adults.
  • Confirmed Ni-ACD has increased 3 to 4-fold since 1986.
    • Common sources of nickel exposure in children include jewelry and adornments, electronics, and school chairs.
    • Girls are especially at risk to early nickel exposure through earrings and daily us of costume jewelry (aka “jewelry addict”)
    • Electronics, eg cell phones, laptops, and tablets have increased the frequency of nickel exposure.
  • Silverberg presents a case study of a 9-year-old girl “addicted to costume jewelry” who developed ACD after exposure to different metal- and rubber-containing accessories.
    • Confirmed sources of the allergen exposure included rubber bracelets, cheaper metal jewelry, lip balm case and belt buckles.
    • Physical examination: classic involvement of the antecubital fossa (crease of arms) consistent with a diagnosis of atopic dermatitis, and lichenified plaques on the fingertips and dorsal hands.
    • Notable plaques were seen on the lips and perioral region associated with application of lip balm kept in the metal case.
    • Patch testing revealed a 3+ reaction to nickel (papular variant), 2+ to gold thiosulfate, and 3+ to thiuram, all of which were deemed clinically relevant considering the child’s history with jewelry containing these allergens and her  presentation.
  • Parents and caregivers must remain cognizant of important allergens in jewelry.
  • Because virtually any type of jewelry can be a source of allergy, children who exhibit persistent dermatitis should be tested for suspected allergens based on history and exposure.