Skin Sensitization to Remiderm and Cross-sensitization to Hydroxyquinoline Compounds.

EDITSHAL and usually, as in the present case, constructional apraxia will be detected with or without ideational apraxia, alexia, or sensory agnosia. Interpretation of Gerstmann's syndrome as an easily demonstrated and memorable pointer to diffuse cerebral damage accords well with this case, where there is no reason to suspect a highly focal lesion. Gerstmann's syndrome does not seem to have been reported in association with penicillin anaphylaxis. There can be little doubt that in this case the curious neurolo-gical manifestations were secondary to hypotension and cerebral oedema associated with anaphylactoid shock. Summary An anaphylactoid reaction to oral penicillin in a 46-year-old woman is described: after hours of unconsciousness and weeks of confusion she was left with a residual Gerstmann's syndrome. These reactions are less rare than is generally supposed. Symptomatology, treatment, diagnosis, and mechanism are discussed, and some of the relevant literature is briefly reviewed. The use of local corticosteroid preparations on the skin is increasing, and to counter skin infection antibiotics and antiseptic preparations are being added more frequently. Because of epidermal sensitization to antibiotics, exemplified by the increase in neomycin sensitivity (Kirton and Munro-Ashman, 1965), and the development of antibiotic resistance, " antiseptic preparations are becoming more popular " (Vickers, 1964), and the chief of these is the hydroxyquinoline group. This paper reports the cases of three patients who showed skin sensitization to Remiderm, which contains a new antiseptic, halquinol (Quixalin), 0.75 %, with 0.025 % triamcinolone in either a cream or Plastibase. In addition to sensitization to halquinol they showed cross-sensitivity to related hydroxyquinoline compounds. The possibility that sensitivity may be present should be borne in mind whenever these or new related compounds are used on the skin or systemically. Case Reports Case 1.-A woman aged 24 showed sensitization dermatitis to Remiderm after the second application of ointment to gravitational ulcers. She had used Vioform ointment six months previously, which produced irritation. Case 2.-A woman aged 31, after using Remiderm for gravita-tional dermatitis, immediately had acute exacerbation with generalized spread of dermatitis. She had used Vioform two years previously. Case 3.-A man aged 58 had gravitational dermatitis which was made worse by Remiderm. He had used Vioform two years previously. Inivestigations.-Halquinol contains three derivatives of hydroxy-quinoline. Two of these, 5,7-dichloro-8-hydroxyquinoline and 5-chloro-8-hydroxyquinoline, were skin-tested, and all three patients showed strongly positive patch tests to them and to halquinol after 24 hours (see Table). The third constituent (less …