SummaryBackground. Accelerators in rubber gloves constitute an important group of contact allergens, particularly in healthcare workers. Objectives. To assess the efficacy of accelerator-free medical gloves in the secondary prevention of allergic contact dermatitis caused by rubber accelerators in healthcare workers. Methods. Nine healthcare workers with hand eczema were advised to use acceleratorfree rubber gloves after a diagnosis of allergic contact dermatitis caused by rubber accelerators. Results. Switching from conventional medical single-use gloves containing accelerators to accelerator-free medical gloves led to improvement in all cases, and more than two-thirds of the patients were completely free of symptoms. Conclusion. The use of accelerator-free medical gloves can be an effective alternative in healthcare workers who are allergic to rubber accelerators.
Bowen's disease (BD) is an intra-epidermal carcinoma of the skin, which, if untreated, may progress to invasive squamous cell carcinoma (SCC) in 3-5% of cases (1). BD can occur anywhere on the skin in adults, especially in elderly people. BD usually presents as an asymptomatic circular erythematous scaly patch localized on a sunexposed area. Typically, BD has an excellent prognosis because of its slow evolution and good response to treatment. Although surgery is often the best treatment option for BD, new therapies have emerged in recent years. Alternatives to surgery, such as photodynamic therapy (PDT), cryosurgery, 5-fluorouracil and imiquimod, have been proposed for BD, especially when it is located in sensitive surgical areas (face, fingers, etc.) (1-11). PDT is also used in the treatment of actinic keratoses (AK) and superficial basal cell carcinomas. Its use in other fields of dermatology is under evaluation (12).PDT is based on the application of a photosensitizing product or its precursor, which is activated by a light source of an appropriate wavelength according to the absorption spectrum of the photosensitizer and offers sufficient penetration. Its activation causes the selective destruction of malignant cells via production of reactive oxygen species (ROS). Methyl aminolevulinate (MAL) in its hydrochloride form is a photosensitizing product for cutaneous application, marketed under the name of Metvixia ® . Irradiation is performed using a light source with a wavelength between 570 and 670 nm within the absorption spectrum of porphyrins. PDT using Metvixia ® is abbreviated MAL PDT. The light energy absorbed by the photoactive porphyrin is transferred to oxygen, generating ROS. Two MAL PDT sessions 8 days apart are recommended for the treatment of BD.The effectiveness (complete clearance) of PDT for the treatment of BD is approximately 80%, with recurrences in 10-20% of cases (8,11,13). Side-effects are essentially local erythema, oedema, warmth, burning, tingling and painful sensations (13,14).PDT is considered to be a safe treatment, although its carcinogenic risk has never been studied. However, several cases of SCC after PDT have been reported in the literature (15, 16). We studied the occurrence of SCC following PDT treatment in a series of 105 patients with BD. METHODSA monocentric retrospective study of patients with cutaneous BD treated by PDT between 2007 and 2013 was conducted in the Department of Dermatology at Saint Louis Hospital, Paris, France. Data studied were the patients' age, sex, history of SCC, immunosuppression, location of BD treated by PDT, number of treated lesions, number of PDT sessions performed, response to PDT at 3 months, and occurrence of SCC on a PDT field or outside a PDT field. The fields treated with PDT were classified into 4 regions: head and neck, trunk, upper limbs and lower limbs. The efficacy of PDT on BD 3 months after therapy was qualified as complete response (CR) when complete regression of the lesion occurred, partial response (PR) when part of the BD lesi...
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