povidone-iodine and Dermatitis--Atopic

Antiseptic agents can cause skin irritation and lead to severe problems, especially for individuals with atopic diatheses. We investigated the effect of 4 different antiseptic agents using an atopic dermatitis (AD) model mouse. NC/Nga mice were subcutaneously injected with mite allergen (Dp) to induce AD-like skin lesions (ADSLs), and an application of 0.2% (w/v) benzalkonium chloride (BZK), 10% (w/v) povidone-iodine (PVP-I), 80% (v/v) ethanol (Et-OH), or 0.5% (v/v) chlorhexidine gluconate (CHG) was applied to the ear envelope. BZK induced a significant increase in the severity of the clinical score, infiltration of inflammatory cells, local expression of inflammatory cytokines in subcutaneous tissue, and total serum immunoglobulin (Ig) E. PVP-I increased the clinical score, number of mast cells, and production of inflammatory cytokines, and total serum IgE. Et-OH increased the clinical score and number of inflammatory cells, but showed no effect on serum IgE levels. No differences in any parameters were observed between CHG and the vehicle. Collectively, the results suggest the severity of the ADSL was related in part to the strength of the immunoreaction. These findings suggest that CHG could offer the lowest risk of inducing ADSL in individuals with atopic dermatitis and that medical staff and food handlers with AD could benefit from its use.

Topics: Animals; Benzalkonium Compounds; Chlorhexidine; Dermatitis, Atopic; Ethanol; Hand Sanitizers; Male; Mice; Povidone-Iodine

Hypersensitivity to drugs is a complex diagnostic challenge. Detailed medical history remains the mainstay of drug hypersensitivity evaluation, which further determines diagnostic procedures, especially the types of skin tests to be performed. The current paper presents the case of a female patient with coexisting features of supposed immunoglobulin E (IgE) dependent allergic hypersensitivity to fluoroquinolones and those of non-IgE dependent allergic hypersensitivity to povidone-iodine. Hypersensitivity was diagnosed based on the appropriately selected skin tests.

Topics: Adult; Anti-Infective Agents, Local; Dermatitis, Atopic; Drug Eruptions; Facial Dermatoses; Female; Fluoroquinolones; Humans; Immunoglobulin E; Povidone-Iodine; Skin Tests

Povidone-iodine (PVP-I) is widely used in antiseptic agents. Immediate allergic reaction to PVP-I preparations is very rare and often overlooked, as it is difficult to diagnose. Polyvinylpyrrolidone (PVP) is thought to play a role in the underlying mechanism. We examined the usefulness of the histamine release test (HRT) for definite diagnosis of PVP allergy.. A 9-year-old boy with eosinophilia (1,500/microl) and elevated total IgE (1,376 IU/ml) was suspected clinically of having a PVP allergy, as he had anaphylaxis twice when he was administered a PVP-I solution for impetigo contagiosum. Skin prick tests (SPTs) were performed with a PVP-I solution, PVP (K30), gentamicin sulfate and 2 other medicines containing PVP. HRT was assessed using peripheral blood basophils.. SPTs to PVP-I solution, PVP-K30 and other medicines were all negative. Histamine release was observed on stimulation by PVP in the presence of autologous serum, although it was not observed in the absence of autologous serum.. This observation was in line with the clinical findings that anaphylaxis had not developed despite the long use of PVP-I solution, but developed only when he received PVP-I solution treatment where basophils could contact PVP-I in the presence of serum, which was probably due to a broken skin and vessel condition. Furthermore, our results suggest the usefulness of HRT in the diagnosis of PVP allergy, and the possibility that negative SPT does not entirely rule out PVP allergy.

Topics: Anaphylaxis; Anti-Infective Agents, Local; Child; Dermatitis, Atopic; Humans; Impetigo; Male; Pharmaceutic Aids; Povidone; Povidone-Iodine

Atopic dermatitis (AD) is frequently associated with intestinal and cervical lesions. Staphylococcus aureus produces many kinds of toxins, the bacterial superantigens. The detection rate of toxins was 80.1% from 196 S. aureus strains. Neurological examinations revealed abnormalities in 59 out of 81 AD patients. Cervical magnetic resonance imaging (MRI) was performed in 46 patients randomly and showed abnormal findings in 38 of these patients. In 23 patients who underwent MRI and duodenal biopsy, 3 were found to be normal neurologically and 2 patients showed normal duodenal tissue. However, 18 patients had abnormal findings both on neurological examination and in duodenal tissue. Serial duodenal biopsy tests were performed in 10 AD patients. In 5 patients, the findings of chronic duodenitis disappeared after the therapy with povidone-iodine. These data indicate that the therapy was effective not only for the skin lesions, but improved gastrointestinal tract lesions and cervical myelopathy, by eradicating bacterial superantigens.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Antitoxins; Bacterial Toxins; Cervical Vertebrae; Child; Dermatitis, Atopic; Drug Resistance, Bacterial; Duodenitis; Female; Humans; Immunoglobulin E; Male; Povidone-Iodine; Spinal Cord Diseases; Spinal Diseases; Staphylococcal Infections; Staphylococcus aureus; Superantigens; Treatment Outcome

Povidone is an allergic agent present in numerous substances, food and medicines. The authors present the clinical case of a 9-yr-old male child admitted in the emergency room with anaphylaxis, in two occasions separated by a 6-month period. The first episode occurred 5 min after the first oral administration of Fluvermal (flubendazole) and the second occurred 10 min after cutaneous application of Betadine (povidone iodine solution). Previous cutaneous application of this solution and ingestion of mebendazole occurred without apparent adverse reactions. The allergy study revealed eosinophilia, an elevated total IgE level and positive prick-by-prick test for both drugs. A cutaneous prick-by-prick test with povidone (the sole common constituent) was also positive. This is probably the first case described in the literature of anaphylaxis induced by povidone in a child.

Topics: Anaphylaxis; Anti-Infective Agents, Local; Antinematodal Agents; Child; Conjunctivitis, Allergic; Dermatitis, Atopic; Eosinophilia; Humans; Immunoglobulin E; Male; Mebendazole; Pharmaceutic Aids; Povidone; Povidone-Iodine; Skin Tests

The combination of the local disinfection therapy against Staphylococcus aureus with the conventional therapy for atopic dermatitis has been widely used, and the improvement in skin lesions has been reported to be associated with a remarkable decrease in IgE levels and reagin antibody titers. We have already reported that affected organs were not only the skin but also the gastrointestinal tract in a case with atopic dermatitis. In the present study, the duodenal tissues were examined by biopsy in 32 patients with atopic dermatitis, and mild or chronic duodenitis was observed in all samples. Toxins were examined by PCR from 180 Staphylococcus aureus strains obtained from our patients. The detection rate of toxins was 82.8%. In many patients, antitoxin IgE antibody titers corresponding to their types of toxin and IgE levels were decreased in a parallel manner as time passed. We found 1 patient who complained of paresthesia in all four limbs, and her neurological and radiological examinations showed moderate cervical spondylosis. Neurological examinations revealed some abnormalities in 43 out of 50 patients with atopic dermatitis, such as hyperreflexia of the legs. Cervical MRI was carried out randomly and showed abnormal findings in 21 of 25 patients, in whom 18 duodenal tissues were examined by biopsies.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Antibodies, Bacterial; Biopsy; Child, Preschool; Dermatitis, Atopic; Duodenitis; Female; Humans; Immunoglobulin E; Male; Povidone-Iodine; Staphylococcal Skin Infections; Surveys and Questionnaires

For the treatment of atopic dermatitis, a variety of therapies are used including folk medicine. At present, there is no single treatment which is effective to cure the symptoms of atopic dermatitis completely in all patients. We are drawing attention to the high isolation rate of Staphylococcus aureus when starting disinfectant treatment combined with topical steroid therapies for the purpose of killing S. aureus. As a result, we examined many patients in whom almost a complete remission was obtained even after short periods of therapy, though it had been difficult to obtain improvement by conventional treatments. In many patients, IgE values and reagin antibody titer decrease dramatically soon after starting treatment. As a disinfectant, 10% povidone-iodine solution was used. We investigated also the effect of iodine contained in the povidone-iodine solution on the thyroid gland.

Topics: Administration, Topical; Adolescent; Adult; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Child; Dermatitis, Atopic; Emollients; Female; Glucocorticoids; Humans; Immunoglobulin E; Iodine; Iodophors; Male; Medicine, Traditional; Methicillin Resistance; Patient Satisfaction; Petrolatum; Povidone-Iodine; Reagins; Remission Induction; Staphylococcal Skin Infections; Staphylococcus aureus; Surveys and Questionnaires; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine

A case-control study was performed to examine the efficacy of 10% povidone-iodine solution applied to atopic dermatitis patients. The density of Staphylococcus aureus on the eczematous lesions and the lesion severity before and after the topical application of povidone-iodine were compared. We found a 10-100-fold decrease in the density of S. aureus after povidone-iodine treatment in patients colonizing S. aureus at an initial density of > 1000 CFU/10 cm2. Erythema and exudation also decreased after povidone-iodine treatment in patients colonizing S. aureus at an initial density of > 1000 CFU/10 cm2. The 10% povidone-iodine solution disinfected S. aureus cells when added immediately after the cells were mixed in human plasma; however, 10% povidone-iodine solution only reduced the density of S. aureus cells by 10-100-fold when S. aureus cells were harvested after a 24 h incubation in human plasma. Staphylococcus aureus cells harvested after 24 h incubation in human plasma were often surrounded by fibrin bundles and cells circumscribed by fibrin bundles could not be disinfected with 10% povidone-iodine solution. We suggest that S. aureus cells may produce biofilm-like structures in atopic dermatitis patients and that these structures may help S. aureus cells resist the 10% povidone-iodine treatment.

Topics: Administration, Topical; Adolescent; Adult; Anti-Infective Agents, Local; Case-Control Studies; Child; Dermatitis, Atopic; Female; Humans; Male; Microscopy, Electron; Povidone-Iodine; Staphylococcal Skin Infections; Staphylococcus aureus