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Allergic contact dermatitis to glutaraldehyde was found in 13 health-care workers with hand dermatitis. Concomitant sensitivity to other chemicals was noted in 10. The positive patch test response was only evident for every 2nd observation in 4. The eruption persisted for more than 6 months in 10 subjects. In 5, the skin disease forced the worker to leave his occupation.
The rare association of lepromatous leprosy and allergic contact dermatitis due to chromium in cement was confirmed clinically and biologically in a male patient. The apparent lack of influence of lepromatous leprosy on the development and maintenance of this dermatitis dependent upon cell-mediated immune mechanisms is discussed.
BACKGROUND: Microscopic features of experimentally induced allergic contact dermatitis (ACD) have been reported; however, the histologic characteristics of environmentally induced ACD have not been definitively elucidated. OBJECTIVE: This pilot study was conducted to describe the histologic features most useful in differentiating ACD from other forms of eczematous dermatitis. METHODS: A retrospective chart review of patients who underwent evaluation for contact dermatitis was performed. The results of skin biopsy were reviewed in a blinded manner, and two subgroups were compared: gold standard ACD cases and control cases (eczematous dermatitis with negative results of patch testing). RESULTS: Of 317 cases reviewed, 39 fulfilled the inclusion criteria. Many histologic similarities were noted: both subgroups had substantial acanthosis and lymphocytic infiltration. In addition, present to a moderate degree in both groups were hyperkeratosis, spongiosis, eosinophils, and dermal dendritic fibrohistiocytic (DFH) cells. However, compared with the control cases, eosinophilic spongiosis and multinucleate dermal DFH cells were found to a considerably greater degree in the standard ACD cases. CONCLUSIONS: Eosinophilic spongiosis and multinucleate dermal DFH cells, in the presence of acanthosis, lymphocytic infiltrate, dermal eosinophils, and hyperkeratosis, are particularly suggestive of ACD. While such findings alone are not diagnostic of ACD, the presence of these combined histologic features supports the pursuit of patch testing in cases of chronic eczematous dermatitis.
There is little information available regarding barriers to return-to-work (RTW) in workers with contact dermatitis. The purpose of this study was to survey occupational health and safety personnel to determine their perceptions regarding RTW barriers for workers with contact dermatitis. The study was conducted during an occupational health and safety research conference attended by stakeholders from labour, management, injured workers, government, safety associations, occupational health and safety practitioners and researchers. The attendees were presented with 3 pictures of varying degrees of work-related hand contact dermatitis and were asked to list the 3 key barriers or challenges in RTW for individuals with contact dermatitis. 21 individuals completed the survey. Issues identified in descending order of frequency were concern of ongoing dermatitis, ability to do the job safely, appearance, ability to accommodate, personal protective equipment, fear that the rash was contagious, workplace attitudes and pain. While some of these issues are potentially common to RTW situations in general, others are more specific to health problems which have a visible manifestation. Increased awareness of and attention to these possible barriers to RTW may lead to better RTW outcomes.
A case of allergic contact dermatitis to cinchocaine is presented to highlight the confusion regarding the classification of, and cross-reactivity between, topical anaesthetic agents and the inadequacy of the use of benzocaine as a single screening agent for topical anaesthetic contact allergy. Our patient presented with a 10-day history of acute perianal dermatitis. Allergic contact dermatitis to Proctosedyl ointment, which was applied for 3 weeks prior, was suspected. On patch testing, he reacted to cinchocaine, a constituent of Proctosedyl ointment, and to the actual product, but had no reaction to benzocaine or lignocaine.
Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.
BACKGROUND AND OBJECTIVE: The prevalence of allergic contact dermatitis is high. Patch testing is the standard procedure to detect contact sensitivity. More than 3000 allergens are known, today. On the basis of the data of this study the top allergens are presented. PATIENTS AND METHODS: The retrospective analysis is based on the patch test results collected by the Information Network of Departments of Dermatology in 2004. Data of 9948 patients (6175 female und 3773 male) referred for the evaluation of suspected contact allergy were analysed to determine the frequency of sensitization to the 10 most common contact allergens. RESULTS: The top ten allergens were nickel sulphate (frequency of sensitization standardized for sex and age 17.2 %), fragrance mix (7.2 %), balsam of Peru (6.7 %), cobalt chloride (6.5 %), potassium dichromate (5.3 %), colophony (4.6 %), lanolin alcohol (4.3 %), p-phenylenediamine (4.2 %), ammoniated mercury (3.5 %) und methyldibromoglutaronitrile/phenoxyethanol (3.4 %) in 2004. CONCLUSIONS: Even after healing of the skin lesions of allergic contact dermatitis, it must be considered that sensitization persists indefinitely. Therefore, patients have to be informed exactly about their relevant contact allergens to ensure complete avoidance. To do so, physicians need a detailed knowledge of the most common contact allergens which are discussed in this paper.
A single clinical report describes photoallergic contact dermatitis to bisphenol A, with subsequent persistent light reactivity, in a group of eight outdoor workers. In a mouse model we have induced photoallergic contact dermatitis to bisphenol A; sites of photochallenge reactions flared when later tested with UVA alone. Attempts to induce photoallergy to bisphenol A in guinea pigs failed.
Erythema multiforme (EM) is a hypersensitivity reaction that occurs mainly after exposure to certain medications or in the setting of infection, most commonly that due to herpes simplex virus. Rare cases of EM have been reported after allergic contact dermatitis due to various substances. There has been one case in the literature of EM following Rhus contact dermatitis. We report three patients who developed EM after allergic contact dermatitis due to poison ivy. In all three patients, targetoid lesions developed primarily on the palms and soles, either after a brief course of prednisone or during its taper. Two of the patients have had more than one episode of EM after poison ivy dermatitis. Although EM has been described after allergic contact dermatitis due to a variety of antigens (nickel being the most common), there is only one report in the literature of EM following Rhus contact dermatitis. Given the prevalence of allergic contact dermatitis due to poison ivy, this may be an under-reported complication.
BACKGROUND: Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America. OBJECTIVE: We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis. METHODS: A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed. RESULTS: Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion. CONCLUSION: Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.
One hundred consecutive cases of occupational contact dermatitis diagnosed in Warsaw are discussed. In 79 subjects allergic and in 21 patients irritant occupational dermatitis was found. The most numerous group were workers employed with epoxy resins (20 persons), next came masons (14 subjects), and third medical staff members (12 persons). In 46 patients the standard series was sufficient for diagnosis of allergic occupational contact dermatitis, but in thirty three cases it was indispensable to test them with additional subsances.
BACKGROUND: Occupational skin disease can cause significant morbidity in textile industry workers. Both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) have been reported. OBJECTIVE: The purpose of this study was to characterize and determine the relative frequency of work-related ACD and ICD in textile workers. METHODS: Seventy-two textile industry workers seen during a 5-year period were evaluated for possible work-related contact dermatitis. All patients underwent patch testing with a screening series. Many patients (70%), depending on occupational exposures, also underwent testing with a textile dye and finish series and additional patch tests of specific workplace materials. RESULTS: Twenty-one patients (29%) were diagnosed as having a predominantly work-related ACD. Relevant allergens included textile dyes, textile finishes, and rubber allergens. Twenty-seven patients (38%) were diagnosed as having primarily a work-related ICD. Five patients (7%) were believed to have combined work-related ACD and ICD. Nineteen patients (26%) were believed to have purely non-work-related allergens, irritants, atopy, or other dermatoses as the major factors in their skin disease. The hands were the most common site of involvement. Of the 40 patients with occupational exposure to raw textile products 36 (90%) had a work-related dermatitis and only 4 (10%) had a non-work-related dermatitis. CONCLUSION: In the 72 textile workers evaluated in our clinic, occupational exposures were an important cause of skin disease (74% in our series). Textile workers with job exposures to raw textile materials are at highest risk for work-related dermatitis. Textile industry workers with essentially no textile product exposure were more likely to have non-work-related dermatoses. ICD was only slightly more frequent than ACD. The hands were the most common site of involvement. Because relevant allergens (work-related and non-work-related) were more common than expected, we emphasize the importance of patch testing with standard screening allergens in the diagnostic evaluation of patients with dermatitis who work in the textile industry. In addition, textile dye and finish allergens should also be tested in this patient population, particularly those patients with any textile product exposure.
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BACKGROUND: A new technique, cutaneous field stimulation (CFS), which activates electrically unmyelinated C-fibers, is used to treat localized itch. Its action is similar to that of capsaicin, the pungent agent in hot peppers, which enhances delayed allergic reactions. The aim of the study was to investigate how experimental contact dermatitis responds to CFS. METHODS: Twelve patients with contact dermatitis in response to nickel were treated by CFS for 1 h each for four consecutive days. A flexible plate containing electrodes was applied to a test area on the upper arm and was stimulated by a constant current (0.8 mA). On the fifth day, patients were provoked by epicutaneous application of nickel sulfate (allergic contact dermatitis) and benzalkonium chloride (irritant contact dermatitis), and by intradermal tuberculin (delayed immunologic reaction). Twelve other patients with IgE-mediated allergy were treated by CFS on the lower arm for 1 h and were then pricked with histamine and allergen extracts (wheal volume was measured) and were tested using benzoic acid (nonimmunologic contact urticaria; closed test). Ten of these patients were also treated by CFS for four days, and experiments were performed on the fifth day. RESULTS: Test reactions to nickel, benzalkonium, and tuberculin were found to be unaffected by CFS treatment. Although allergic prick test reactions were enhanced (by 28%) after a single CFS treatment, the associated itch was significantly reduced both after single and repeated CFS treatments (by 65% and 38%, respectively). CONCLUSIONS: Repeated use of CFS to reduce itch has no adverse effects on contact dermatitis.
The T cell response to nickel-modified endogenous peptides is involved in the immunopathogenesis of nickel-induced contact dermatitis. Nickel-reactive T cells described so far display a TH1 lymphokine secretion pattern characterized by high amounts of IFN gamma, but little or no IL-4 and IL-5. In this paper we demonstrate that nickel-reactive T cells can belong to the TH0 and even to the TH2 CD4+ T cell subset. Nickel-reactive T cell clones (TCC) were derived from the lesion of a patient with nickel contact dermatitis. These TCC responded to nickel with the production of high levels of IL-5 and variable amounts of IFN-gamma and IL-4 resembling TH2- or TH0-like cytokine secretion pattern. None of the nickel-reactive TCC showed a clear cut TH1 profile. We show that IL-4 was a growth factor for the TH2 and some of the TH0 TCC. We conclude that nickel is able to induce TH2 cells and that in this patient with a typical nickel-induced contact dermatitis TH2 cells are prevalent and might contribute to the immunopathogenesis of contact dermatitis.