There exists within the population subsets of individuals who display heightened skin reactivity to materials the majority find tolerable. In a series of investigations, we have examined interrelationships between many of the endpoints associated with the term 'sensitive skin'. In the most recent work, 58 volunteers were treated with 10% lactic acid, 50% ethanol, 0.5% menthol and 1.0% capsaicin on the nasolabial fold, unoccluded, with sensory reactions recorded at 2.5 min, 5 min and 8 min after application. Urticant susceptibility was evaluated with 1 m benzoic acid and 125 mM trans-cinnamic acid applied to the volar forearm for 20 min. A 2 x 23-h patch test was also conducted using 0.1% and 0.3% sodium dodecyl sulfate, 0.3% and 0.6% cocamidopropyl betaine and 0.1% and 0.2% benzalkonium chloride to determine irritant susceptibility. As found in previous studies, increased susceptibility to one endpoint was not predictive of sensitivity to another. In our experience, nasolabial stinging was a poor predictor of general skin sensitivity. Nevertheless, it may be possible to identify in the normal population individuals who, coincidentally, are more generally sensitive to a range of non-immunologic adverse skin reactions. Whether such individuals are those who experience problems with skin care products remains to be addressed.

Background and objective: Chlamydia trachomatis infection is a common sexually transmitted infection with serious sequelae. Excellent access to testing, treatment and contact tracing are an essential part of strategies to control it. With traditional sexual health services overstretched, community pharmacies are well placed to provide this service. They have the potential to improve access by offering chlamydia testing and treatment from high street venues with long opening hours. This study evaluated the feasibility and acceptability to users and pharmacists of this service in independent community pharmacies. Method: A chlamydia testing and treatment service was offered in three community pharmacies in two inner London boroughs for a 3-month pilot. Data on the feasibility and acceptability of the new service were collected via a survey of client experience, indepth semistructured interviews with clients and pharmacists, and structured evaluation reports completed by professional patients paid to visit the pharmacies. Results: 83 tests were taken with eight (9.5%) of these positive for C trachomatis. Of those tested, 94% (n = 73) were women and 71% (n = 56) were from ethnic minorities. 80 clients completed the questionnaires and 24 clients were interviewed. Most clients heard about the service from the pharmacist when requesting emergency contraception and 16% (n = 13) would not otherwise have been tested. Clients valued the speed and convenience of the service and the friendly, non-judgmental approach of the pharmacist. Confidentiality when asking for the service at the counter was suboptimal, and the pharmacist trained to deliver the service was not always available to provide it. Conclusions: Chlamydia testing and treatment in community pharmacies is feasible and acceptable to users. The service increases access among young women at high risk of sexually transmitted infection but not among young men.

IntroductionIn the UK half of all pregnancies are unplanned and half of teenage pregnancies terminated. Southwark and Lambeth have the highest teenage conception rates in London. In 2009, many teenage pregnancies in Southwark led to terminations. A contraception service was established where qualified pharmacists supplied oral contraception (OC) using a patient group direction (PGD). This service evaluation aimed to assess this service delivered in five community pharmacies.MethodsMonthly data were submitted by each pharmacy to the Primary Care Trust on consultations, pills supplied, initial or subsequent supply and client referral. For specified periods consultation time was collected and a clinical notes audit undertaken. Client satisfaction was determined using a structured questionnaire returned to the pharmacy. Mystery shoppers were employed to assess the service.ResultsA total of 741 consultations were undertaken by seven pharmacists at five community pharmacies (October 2009–June 2011) with many (45.5%) occurring following emergency contraception supply. The mean consultation time was 19 minutes . Combined OC was most commonly supplied with nearly half (46.1%) of initial supplies to first-time pill users. Most consultations (92.2%) were with women aged under 30 years, with 22.5% aged under 20. Most consultations were with black or black British clients. Of the 99 women who completed the satisfaction questionnaires, most clients were very satisfied or satisfied with the service and felt comfortable talking to the pharmacist about contraception.ConclusionsTrained pharmacists were clinically competent and provided OC in community pharmacy according to a PGD. This service was accessed by the target population; young women using emergency hormonal contraception who had not previously used OC. Clients were largely very satisfied with the service.

Objectives To test the feasibility of professional patients as a tool for sexual health service evaluation. Professional patients are paid to use services specifically for audit or evaluation purposes without disclosing their identity as evaluators.Methods Professional patients visited five large sexual health departments used by 3000 clients per week in two inner London Boroughs with very high rates of sexual ill health. They recorded their experience on a structured evaluation form. Semi-structured telephone interviews were completed with seven service providers to document their experience of the programme.Results Recruitment and training for professional patients is described. Forty professional patients made 105 visits during two rounds of visits 9 months apart. After 47% (round 1) and 62% (round 2) of visits, the professional patients felt that they would recommend the service to a friend. The professional patients provided detailed and specific feedback on all aspects of service provision. This information was highly valued by service providers who reported few objections from staff to the visits. A small number of examples of very poor care were documented.Conclusions Professional patients are a useful tool for sexual health service evaluation. They provide high quality feedback because they are both ÔexpertsÕ on sexual health service provision and users of sexual health services. This method of evaluation raises ethical issues about the acceptability of deception as part of the evaluation process, the right of staff to anonymity and to refuse to be visited. Professional patient programmes provide an opportunity for regular cycles of user feedback to monitor quality improvement.

To understand the mechanisms involved in immunological tolerance to skin-associated proteins, we have developed trangenic (Tg) mice that express a model self antigen, membrane-bound ABSTRACTS 125 FS01.3 Disperse (yes), orange (yes), 3 (no): what do we test in textile dye dermatitis?Para-phenylenediamine (PPD), an arylamine dye, is a strong allergen causing allergic contact dermatitis. Cytokines such as TNF-a and IL-1beta are key mediators in the initiation of this reaction. Both cytokines are predominantly produced by stimulated monocytes and macroghages. We investigated the responses of PPD and Bandrowski's base (BB), an autoxidation product of PPD in human monocytes. We isolated monocytes from healthy volunteers and incubated them with the allergens. TNF-a and IL-1beta mRNA expression and protein levels were estimated after 45 min, 2 h, 4 h and 24 h after allergen contact. IL-1beta and TNF-alpha were measured in cell culture supernatants by ELISA (n ¼ 7) and mRNA expression was determined by real-time RT-PCR. We found that PPD reduced TNF-a protein secretion by 20-69.9% (n ¼ 6). Further, IL-1beta levels were decreased by 44-98%. The same tendency was found studying IL-1beta and TNF-a mRNA steady state levels (n ¼ 3; 1 h incubation). These effects were substance-specific and not found for PPD derivatives nor for the autoxidation product BB. These findings suggest that PPD may specifically modify immune responses by directly infering with the cellular proinflammatory cytokine network.