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Allergic contact dermatitis to pharmaceutical topical products containing corticosteroids are not uncommon. The study of these cases must combine patch test with standard series, vehicles, special components of each commercial cream and tixocortol pivalate. The importance of these substance is specially emphasized in that paper.
A case of perioral contact dermatitis due to lip-licking in a 12-year-old girl is discussed. Other perioral lesions are briefly described.
Proper use of patch testing to identify the causes of contact dermatitis requires that the physician use the test where it will have the highest likelihood of benefit. Identifying endogenous dermatoses by morphologic and historical criteria and distinguishing these from likely cases of exogenous dermatoses prior to testing will enhance the number of people helped by applying the patch test procedure. Knowledge of the technical aspects of patch testing and how to instruct patients with positive and negative tests is an essential part of solving complex contact dermatitis problems.
Skin biopsies for immunofluorescent studies were taken from patients with contact dermatitis (positive patch tests), atopic dermatitis and allergic vasculitis for comparison with normal-appearing skin from the same patients, and from healthy controls. A variety of deposits of immunoglobulins, complement components and fibrinogen were demonstrated in 6 out of 20 patients with contact dermatitis, 7 out of 10 with atopic dermatitis, 8 out of 10 with allergic vasculitis, and in 4 out of 20 control individuals. No diagnostic pattern of deposits was found. Elevated serum IgE and eosinophilic counts were found in patients with atopic dermatitis, and high serum IgA and fibrinogen levels were found in the allergic vasculitis group.
Contact sensitivity to drugs administered systemically occurs mainly among healthcare workers, pharmaceutical operatives, and veterinary surgeons. Of the 14,689 patients suspected of contact allergy examined in our department from 1978 to 2001, occupational allergic contact dermatitis from drugs in healthcare workers was diagnosed in 33, the first in 1980. The most common sensitizers were antibiotics such as penicillins, cephalosporins, and aminoglycosides. They accounted altogether for 35 positive patch tests, followed by propacetamol hydrochloride, and ranitidine hydrochloride, which elicited 10 and 7 positive reactions, respectively. The aim of this report is to draw attention to the importance of occupational contact allergy to drugs in healthcare workers. By far the greatest number of the sensitized patients in this series were nurses, there being 26 nurses, 4 veterinarians, 2 pharmacists, and 1 medical doctor.
A 60-year-old man with allergic contact dermatitis to clotrimazole (Lotrimin) is described. Results of patch tests confirmed the reaction to clotrimazole itself and not the vehicle. After negative results of patch tests to other imidazoles, the patient was treated with econazole without complications. A brief review of contact dermatitis to clotrimazole and other imidazoles is included.
BACKGROUND: Arriving at a diagnosis of allergic contact dermatitis is a multistep procedure including the establishing of contact allergy, demonstration of current exposure to the sensitizer, and assessment of clinical relevance. Sometimes, these steps are easy to get through; at other times, there may be problems with every step. OBJECTIVE: To demonstrate the possible difficulties and pitfalls in establishing the presence of contact allergy and diagnosing allergic contact dermatitis from exposure to the preservative methyldibromoglutaronitrile (MDBGN). METHODS: Simultaneous patch-testing with petrolatum preparations of MDBGN at various concentrations, use testing, and chemical analysis with high-performance liquid chromatography (HPLC). RESULTS: Contact allergy to MDBGN was established in two cases, with MDBGN in petrolatum at 0.5%. Results of HPLC investigation of moisturizers used by the patients and yielding positive results on patch and use tests disagreed with the information about preservatives on the labels of the moisturizers and with the Material Safety Data Sheets (MSDSs). CONCLUSIONS: Patch testing with MDBGN in petrolatum at a concentration of less than 0.5% may fail to diagnose a clinically relevant contact allergy. The information on labels of products, on MSDSs, and from manufacturers may not be reliable, which indicates the need for chemical analyses.
Hexamethylenetetramine is an odorless powder and slowly liberates formaldehyde in an acid medium or when heated. It is usually used in the manufacture of formaldehyde resins, rubber and the explosive, cyclonite. It is also used as a hardener in core molding processes. It was reported as one of the formaldehyde releasers and as a cause of formaldehyde contact dermatitis. We report an allergic contact dermatitis due to hexamethylenetetramine, with a positive patch test reaction to hexamethylenetetramine (1% pet.) but not to formaldehyde (2% aq.). We concluded that this case was an allergic contact dermatitis from hexamethylenetetramine itself.
Results concerning 1,000 cases of contact dermatitis with positive patch tests are presented. The allergens which are responsible for about 50% of our cases are: turpentine, nickel, hexavalent chromium and organic mercurial compounds. These results are compared with those of other countries. As in the industrial world there should be information given to the general public to reduce the incidence of contact dermatitis.
A case of erythema multiforme and Rhus contact dermatitis is presented herein. Due to the association of nephritis and other complications with Rhus poison oak, we recommend that patients with contact dermatitis due to poison ivy who incur secondary erythema multiforme be hospitalized and closely monitored.
Identifying the etiology of allergic contact dermatitis requires detective work. Not all allergic reactions are eczematous in appearance. The most reliable clinical clue to the allergic nature of the dermatitis is its geographic distribution. Patch testing provides the list of culprit allergens. The mystery is solved when the suspected allergen is found to be relevant and the patient has been adequately instructed in allergen avoidance.
BACKGROUND: The North American Contact Dermatitis Group (NACDG) periodically reports allergen reaction rates and clinical significance. These results are not formally interpreted combining both components into one index. OBJECTIVE: The purpose of this study is to introduce the Significance-Prevalence Index Number (SPIN), which is a parameter that assesses the relative importance of different allergens. METHODS: Data was collected from published studies reported by NACDG from 1984 through 1996. The SPIN for each tested allergen was calculated as the product of the proportion of the population allergic by the weighted clinician-assessed likelihood of relevance of the reaction. RESULTS: In the studies done in 1992 through 1996, fragrance mix, quaternium-15, balsam Peru, formaldehyde, thiuram mix, nickel sulfate, neomycin, bacitracin, carba mix, and paraphenylenediamine were the 10 leading allergens in clinical importance as measured by SPIN. Our SPIN calculations suggest that ethylenediamine and benzocaine have markedly decreased in clinical importance over the past decade, whereas methylchloroisothiazolinone/methylisothiazolinone has become a leading allergen. A number of allergens demonstrate high to intermediate SPIN, yet are not included in the T.R.U.E. test. These clinically important allergens include bacitracin, diazolidinyl urea, glyceryl thioglycate, ethyleneurea melamine-formaldehyde, and imidazolidinyl urea. CONCLUSION: SPIN allows clinicians to incorporate both the allergenicity and the relevance of the allergen into one measure.
Cases of contact dermatitis due to nickel and gold especially in pierced earlobes, are increasing in number the world over. However, the presence of these metal fragments has not been demonstrated in the skin lesions. The aim of this study was to demonstrate nickel and gold in contact dermatitis lesions in pierced earlobes. Skin specimens taken from such earlobe lesions were examined using scanning electron microscopy and x-ray microanalysis. The pierced earrings worn when the lesions appeared were examined by the same techniques, and their analysis confirmed. In nickel dermatitis, small, electron-dense fragments were seen in the specimens examined by scanning electron microscopy, and nickel was detected in locations corresponding to these fragments by x-ray microanalysis. In contact dermatitis due to gold, small dense fragments containing gold were observed. It is suggested that small fragments of nickel and gold remain in the skin lesions of pierced earlobes for a long time, even after the studs have been removed, and cause prolonged irritation and various cutaneous reactions.
Fourteen of twenty-six migrant workers developed contact dermatitis at a single tomato-strawberry farm in Tennessee. Investigation identified one of eleven pesticides used by the farmer, 2,4-dichloro-6-(o-chloroanilino)-s-triazine anilazine; Dyrene), as the cause of the dermatitis in six of seven workers who were available for patch testing. As a result of this investigation, the label on Dyrene has been revised to warn users of possible sensitization.
This case report describes contact dermatitis of the dyshidrotic type of the hands of a worker subjected to minor trauma. The source of the irritation was linked to bacterial endotoxin in latex gloves. Irradiated sterilized gloves and software may contain significant endotoxin levels because the irradiation does not affect endotoxin itself. The irradiation of the bacteria actually increases endotoxin levels when the bacterial count is elevated. Sweating under these gloves may enhance entry into the skin with subsequent reaction as endotoxin is water soluble.
We report 4 patients who developed allergic contact dermatitis after ultrasound investigations. Patch testing was positive with conducting gels, and in 2 cases with propylene glycol. Contact dermatitis to gels is also seen in electrographic practice and after transcutaneous electrical analgesia.
We report a case of occupational allergic contact dermatitis from rhodium sulphate and cobalt chloride in a 29-year-old woman working in a goldsmith's workshop. The relevance and source of sensitization to these metals in our patient is described, and the literature on the subject reviewed.
Severe allergic contact dermatitis from a paint mildewcide, 2-n-octyl-4-isothiazolin-3-one, developed in a worker formulating latex paints within a paint manufacturing company, Guinea pig maximization testing demonstrated this to be a moderate sensitizer. Further cases of allergic contact dermatitis may be encountered as the use of this biocide increases in the market place.