Pustular reaction

No allergic reactions to tungstate were observed in patch testing of 853 individuals who were working or had worked with tungsten carbide in hard metal manufacture. Irritant pustular reactions appeared in 2% of the patch tests. ... 

Isoconazole is mainly used for vaginal infections with Candida albicans. Contact dermatitis has been reported (14), including an unusual case with a papulo-pustular reaction (15). 

Patch Test. In 853 tested workers, 2% showed irritant pustular reactions when exposed to Na2W04. 

Fig. 6 Pustular drug eruption (AGEP) disseminated pustules cover the skin. Histologically, the pustules are intraepidermal and nonfollicular. A patch test reaction to the eliciting drags can lead to a pustular reaction as well for details see text...

Sterile pustules in the skin (Fig. 6), which appear rather rapidly, namely about 3-5 days after the initiation of treatment. The patients have fever and massive leukocytosis in the blood, sometimes with eosinophilia, but no involvement of mucosal surfaces. Epicutaneous patch test reactions during diagnostic work-up can cause a similar pustular reaction locally (Fig. 6). The latter feature allowed a study of the sequence of events in the development of pustules in sensitized patients using sequential biopsies of affected patients (Fig. 6). 

Tincture of iodine is a primary irritant and should be tested by the open method. Patch tests with iodine and potassium iodide may result in a nonspecific papulo-pustular reaction which must be differentiated from a contact allergic response. Patch tests with potassium iodide have been used in the diagnosis of dermatitis herpetiformis (DH) but the frequency and type of reactions expected in DH patients is neither sensitive nor specific. l,3-diodo-2-hydroxypropane, a white tincture of iodine used in Denmark for first aid, caused contact dermatitis in one patient (Hjorth 1972). He had a strong positive patch test, while 20 controls were negative. Contact allergy to iodine itself may exist, but has not been documented. 

Pustular reaction to contactant was first observed in patch-test reaction. The pustules are sterile and are transient. Fisher et al. (1959) reported that metallic salts, e.g., nickel, copper, arsenic and mercurial salts, may produce pustular reaction. Stone and Johnson explained that such reactions may represent an enhanced reaction of prior inflammation, rather than an irritant or allergic reaction, because such a reaction can be elicited in non-nickel-sensitive patients on skin sites previously injected with heat-killed Corynebacte-rial acne organisms (Stone and Johnson 1967). Hjorth reported that atopies are more predisposed to such reactions (Hjorth 1977). The significance of such reaction remains controversial. Wahlberg and Maibach believed that such pustular reactions are usually irritant in nature but may also be a manifestation of allergic reactions (Wahlberg and Maibach 1981). 

Dooms-Goossens A, Loncke S, Michiels SL, et al. (1985) Pustular reactions to hexafluorosilicate in foam rubber. Contact Dermatitis 12 42-47... 

Direct irritation may thus be dehned as an adverse effect of chemicals directly applied to the skin that does not involve prior sensitization and thus initiation by an immune mechanism. Irritation is usually assessed by a local inflammatory response characterized by erythema (redness) and/or edema (swelling). Other responses may be present that do not elicit inflammation such as an increase in skin thickness. Irritant reactions may be classified as acute, cumulative, traumatic, or pustular. However, two classifications are generally used by toxicologists. Acute irritation is a local response of the skin usually caused by a single agent that induces a reversible inflammatory response. Cumulative irritation occurs after repeated exposures to the same compound and is the most common type of irritant dermatitis. 

Krejci-Manwaring JM, Bogle MA, Diwan HA, Duvic MA. Morbilliform drug reaction with histologic featmes of pustular dermatosis associated with bryostatin-1. J Drugs Dermatol 2003 2(5) 557-61. 

Follicular pustular eruption (1981) Kushimoto H +, Arch Dermatol I 17, 444 Jarisch-Herxheimer reaction... 

Fisher AA, Chargrin L, Fleischmayer R, et al. (1959) Pustular patch test reactions. Arch Dermatol 80 742-752 Friedman SF, Perry HO (1985) Erythema multiforme associated with contact dermatitis. Contact Dermatitis 12 21-23 Fry L (1965) Skin disease from color developers. Br J Dermatol 77 456-461... 

AGEP, also termed toxic pustnloderma and pustular drug eruption, is induced in 90 % of cases by drugs and characterized by fever and acnte non-follicular pustular eruptions that overlay erythro-dermic skin. The incidence of the disease is said to be about three to five cases per million per year with a mortality rate of about 5 %. Reactions generally begin with a rash on the face or in armpits... 

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