P6919Mesotherapy granulomas with L-carnitine

Alberto Alfaro-Rubio, MD, Hospital de Manises, Valencia, Spain; AntonioMartorell-Calatayud, MD, Hospital de Manises, Valencia, Spain; Cristina Pelufo,MD, Hospital de Manises, Valencia, Spain; Liria Terradez, MD, Hospital deManises, Valencia, Spain; Luis Hueso-Gabriel, MD, Hospital de Manises, Valencia,Spain; Maria Luisa Garcia-Melgares, MD, Hospital de Manises, Valencia, Spain

Background: Mesotherapy is a procedure that involves the injection of substancesinto the dermis and subcutaneous tissue. This technique is normally used in thetreatment of various medical conditions and cosmetic fat dissolution. Mesotherapyhas been surrounded by controversy pertaining to efficacy and has been associatedwith localized complications and different adverse effects.

Case report: A 31-year-old woman, striptease dancer, had painful not suppurativenodules located at the points where mesotherapy with Carnicor (L-carnitine) hadbeen applied 8 months ago. Culture was performed from biopsy tissue, and resultednegative for fungi, bacteria, and mycobacteria. Laboratory tests, including completeblood cell count, chemistry and mantoux test, revealed no abnormality, and therewas no significant medical or familiar history of interest. The pathologic analysis ofthe biopsy revealed necrotic granuloma formation without bacterial structures.Treatment consisted on intralesional injections of intralesional injection of2.5 mg/mL triamcinolone acetonide administred one time a month for 3 months.After 30 months of follow-up, no relapse signs were achieved.

Discussion: Mesotherapy is known to produce both the physical and chemicalstimulation of dermis and subcutaneous tissue. A wide variety of mesotherapyproducts are now available worldwide. The main drugs used are nonsteroidalantiinflammatory drugs, muscle relaxants, vasodilators, lipolytics such as amino-phylline and biologics (including vitamins, minerals, and plant extracts). The L-carnitina granuloma is a non well described cause of this rare situation. We reportthis case because it is thought that the adverse effects of mesotherapy may increasebecause it has been popular worldwide. Patients should be informed of thesepossible complications.

AB82

cial support: None identified.

Commer

P6164Modified stinging test: New tolerance predictive test for baby products

Clarence De Belilovsky, Laboratoires Expanscience, Epernon, France; FranckMenu, Laboratoires Expanscience, Epernon, France; Joe Nicholson III, ProductInvestigations Incorporated, Conshohocken, PA, United States; MarjorieBiassette, Laboratoires Expanscience, Epernon, France; Morris Shelanski,Product Investigations Incorporated, Conshohocken, PA, United States; NadegeLachmann, Laboratoires Expanscience, Epernon, France; Philippe Msika,Laboratoires Expanscience, Epernon, France

Background: Tolerance tests for cosmetics intended for infants under three arealready drastic. However, some unpredictable intolerance reactions might occur. Ithas been demonstrated that different preservatives and formulations have variablesensory irritation potentials, independently of objective irritation. Accordingly, weused a modified stinging test to screen two diaper rash prevention formulations (Aand B) which obtained similar objective irritation scores. Indeed, the napkin area isparticularly sensitive because of the permanent occlusive conditions leading to skinbarrier dysfunction and increased susceptibility to discomfort.

Methods: Fifteen stinger women were included in a phase II single blind study.Profuse facial sweating was elicited at temperature of 1008F and 80% relativehumidity. Products A and B were applied on the suborbital, malar and U-labial foldsareas on one side of the face and physiological saline solution on the other. Perceiveddegrees of stinging were recorded at T0, 1 minute, 2.5 minutes and 5 minutes.Scores ranged from 0 (none) to 3 (intense). A Global Score was calculated bysumming up the 2.5 and 5 minutes scores. Clinical relevance of Global Score was:\10 very slight, 11-24 slight to moderate,[25 strong.

Results: Total cumulative stinging scores at \10 seconds/1.0 minutes were 3 forformulation A and 9 for formulation B. Global Scores were respectively 4 and 11.Thus stinging propensity was considered as ‘‘very slight’’ for formulation A and as‘‘slight to moderate’’ for formulation B.

Conclusion: Modified stinging test has been useful to optimize the global tolerancescreening of baby care products for use on compromised skin. This test is routinelyadded to our tolerance pack and a characterization of ‘‘very slight stinger’’ ismandatory before use-tests may be initiated.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P6441New nursing uniforms cause skin symptoms in over half of wearers

Emma V. Pynn, MBChB, Welsh Institute of Dermatology, Cardiff, UnitedKingdom; Mahbub M. U. Chowdhury, MBChB, Welsh Institute of Dermatology,Cardiff, United Kingdom

The National Health Service in Wales in the United Kingdom recently introducednew uniforms for clinical nursing and support staff. Issued with instructions forprewearwashing, they aremade of polyester cottonmix. Anecdotally, manywearerscomplained about skin reactions. We surveyed our department to assess theprevalence and nature of symptoms. All relevant staff in two dermatology depart-ments were asked to complete an anonymous survey after a week of uniformwearing and where possible again after three months, with linkage of results. Theywere questioned as to prewear washing, symptoms and subsequent treatmentrequired. 23 staff completed the initial questionnaire, all had washed their uniformsat least twice. 39% found them uncomfortable and in 22% they impacted on ability towork. 57% (13) experienced skin symptoms, 12 being pruritus, most commonly onthe neck. Onset was often within hours but always during the first day, 4 staff had touse emollients, 1 stopped wearing the uniform and another had to wear an extralayer of clothing. Of those with symptoms which settled (54%) most were within 2days of use. Nobody consulted occupational health. 13 completed the secondsurvey, 62% of whom were finding the uniform more comfortable at 3 months, 31%had had skin symptoms since the initial survey of which only half had resolved.Despite following guidance over half of the staff surveyed experienced a skinreaction to the new uniforms, presumably often irritancy. Although the majoritywere minor and resolved, some required the wearers to abandon the uniform andsome persist.

cial support: None identified.

Commer

P7011Patch testing in patients with vulval dermatoses: Changing allergenfrequency over 7 years

Mei Fong Chin, MBChB, Aneurin Bevan Health Board, Newport, UnitedKingdom; Cherng Jong, MBBS, Aneurin Bevan Health Board, Newport, UnitedKingdom; Natalie Stone, MBBS, Aneurin Bevan Health Board, Newport,United Kingdom

Vulval itch and eczema are common conditions that can be associated withsignificant psychosocial distress. Patients often self-medicate with topical pharma-ceutical products which may lead to contact allergy. The prevalence of allergiccontact dermatitis previously reported ranges from 26% to 49%. Patch test data wascollected retrospectively on all patients with vulval symptoms who had been patchtested in our unit over a 7-year period. Categories of data included diagnosis and/orhistologic diagnosis, history of atopy, age, positive patch test results, and relevance.245 women with a mean age of 53 years (range, 4-84) had been patch tested. 29%(71) patients were atopic. 65% (161 of 245) had eczema, because of irritant contactdermatitis, allergic contact dermatitis, or endogenous causes. 60% (147) of patientshad at least 1 positive patch test reaction. The highest number of positive reactionswere caused by nickel, most of which were considered to be of past relevance. Ofthe patients with positive reactions, 55% of these were felt to be of currentrelevance. The allergen responsible for the highest numbers of relevant positivereactions was myroxylon pereirae followed by fragrance mix 1. This was consistentacross all 7 years. Neomycin was a leading allergen in the first 3 years of theinvestigation period but it caused only 3 positive reactions in the later 4 years, all ofwhich were considered of past relevance. This may reflect a change in localprescribing practice. The incidence of methylchloroisothiazolinone/methylisothia-zolinone positive reactions has increased in the last 4 years. This may be associatedwith a rise in the use of wet wipes in the population. Amerchol and wool alcoholsremained important allergens in vulval eczema, with numbers of positive reactionsstaying static. Our results support those of previous studies on patch test results forvulval dermatoses, and give an insight into the changing trends of common culpritallergens in our population. Medicament allergy remains the most important causeof ACD in this patient group.

cial support: None identified.

Commer

APRIL 2013