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PubMed2000

Occupational protein contact dermatitis and paronychia from natural rubber latex.

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.

Adult↗
PubMed2003

Impaired skin barrier and atopic diathesis in perioral dermatitis.

BACKGROUND: Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of perioral dermatitis. PATIENTS AND METHODS: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. RESULTS: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5% vs. 17.7%) and clinical signs of atopic diathesis (> or = 4 features: 72.5% vs. 0%), prick test reactivity (> or = 2 reactive prick tests: 60% vs. 12.9%), and specific IgE against aeroallergens (CAP SX1 classes > or = 2: 60.0% vs. 17.7%). CONCLUSIONS: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of perioral dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of perioral dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function.

Adult↗
PubMed2001

Allergic contact dermatitis to proparacaine with subsequent cross-sensitization to tetracaine from ophthalmic preparations.

We report 2 cases of allergic contact dermatitis (ACD) to proparacaine and tetracaine. Patient 1 is an ophthalmologist with chronic finger pad dermatitis sensitized to the topical anesthetic proparacaine. Despite discontinuance of proparacaine and substitution with a patch test negative agent, tetracaine, his hand dermatitis persisted. Follow up patch testing documented that acquisition of contact allergy to tetracaine as well as thiuram had taken place. Patient 2 had a periocular eczematous dermatitis with ACD to both proparacaine and tetracaine. Cross sensitization between related topical ophthalmologic anesthetics has been suggested to be a rare occurrence. We suggest that allergic sensitization and possible cross-reaction to topical anesthetics in ophthalmologists and ophthalmologic technicians is an occupational hazard. Chronically eczematized skin might result in increased exposure to contact allergens and result in concomitant allergic sensitization. ACD to topical anesthetic agents among ophthalmologists should be recognized as a potential hazard.

Allergens↗
PubMed2003

Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy.

The aetiology of vesicular eruptions on the palms and on the sides of the fingers (pompholyx) is unclear. The present study was undertaken to establish whether tinea pedis, atopic dermatitis or nickel allergy is a risk factor for development of vesicular eruptions. Three-hundred-and-ninety-eight individuals (included from an ongoing population study on hand eczema in twins) were included. A history of previous hand eczema and atopic dermatitis was taken, and a clinical examination including a patch test with nickel was performed. A test sample for tinea pedis was taken from the fourth interdigital space on the right foot. The relative risk for vesicular eruptions present in individuals with tinea pedis was 3.58 (confidence limits 1.19-10.82, p < 0.05). For individuals with atopic dermatitis, relative risk was 1.44 (confidence limits 0.34-6.07, n.s.) and for those with nickel allergy it was 0.45 (confidence limits 0.06-3.36, n.s.). A relationship between tinea pedis and vesicular eruptions on the hands was statistically confirmed in the present study. In this part of the population study material, no association with atopic dermatitis or nickel allergy was observed.

Dermatitis, Allergic Contact↗
PubMed1993

Prevalence of hand dermatitis in different occupations.

The prevalence of hand dermatitis in different occupational groups was estimated using a standardized questionnaire in a series of surveys among workers of a chemical company, a municipal electricity company, municipal public works, nurses and surgical assistants. A survey in a sample of the general population was performed to obtain a reference estimate of the prevalence. The prevalence of hand dermatitis in the general population was 5.2% in men and 10.6% in women. The prevalence of hand dermatitis among the occupational groups ranged from 2.9% in office workers to approximately 30% in nurses. The age-adjusted prevalence ratio (PR) of hand dermatitis in office workers was not significantly elevated compared with the general population. In nurses, the age-adjusted PR was 9.3 among men (95% confidence interval [CI]: 3.6-23.9) and 2.2 among women (95% CI: 1.5-3.5). The PR in surgical assistants was not significantly elevated (PR = 1.4, 95% CI: 0.7-2.6). This suggests that exposure in nurses (frequent washing of the hands), is more harmful to the skin than the less frequent but more intensive exposure in surgical assistants. The age-adjusted PR were also significantly elevated in male manual workers of the chemical company, the electricity company and public works and varied from 2.4 to 2.8. Occasional or regular occupational exposure to a variety of irritants in combination with mechanical stress (as occurs frequently in manual work) may be responsible for this observation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Cement dermatitis in underground workers during construction of the Channel Tunnel.

The construction of the Channel Tunnel is one of the largest civil engineering projects ever undertaken. The British drive employed 5900 underground workers, and a number developed dermatitis during 1990/1991. As a result, the Translink Joint Venture (TLJV) Medical Centre set up a surveillance programme aiming to monitor and investigate the men working closely with cement as well as other groups of workers with skin problems. Men attended the Medical Centre voluntarily and were assessed, including history, examination and patch tests to a series of 15 test substances (from the European standard series) where indicated. A programme of education about the hazards of working with cement was instituted, including leaflets, videos, local newspaper articles and personal explanation by the Medical Centre staff. Between January 1990 and January 1992, 1138 men were seen at the Medical Centre regarding their skin and 332 were diagnosed as having occupational dermatitis, past or present. Patch tests were performed on 180 men from all trades. Of the 800 grouters, 466 (58 per cent) were assessed and 111 had a history of occupational dermatitis at some time. Many gave a history of a single episode of dermatitis during a particularly hot and wet phase of tunnelling. Patch tests performed on 86 grouters showed allergy to chromate in 56 (65 per cent). Of the 466 grouters assessed, 17 per cent had positive patch tests to chromate but men with no skin problems past or present were not patch tested. Cobalt allergy was often found with chromate allergy (50 out of 56).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Allergic and non-allergic periorbital dermatitis: patch test results of the Information Network of the Departments of Dermatology during a 5-year period.

Periorbital dermatitis is common and can be due to the external use of ophthalmic drugs. We evaluated patch test results of the Information Network of the Departments of Dermatology. During a 5-year period (1995-99), of a total 49,256 patch-tested patients, 1053 (2.1%) were eventually diagnosed as allergic periorbital contact dermatitis (APD) and 588 (1.2%) as non-allergic periorbital dermatitis (NAPD). Patient characteristics between APD, NAPD and other cases (OCs) differed with respect to sex (19.7% male in both periorbital groups versus 36.3% in OCs), atopic dermatitis (10.4% in APD versus 60.2% in NAPD versus 16.9% in OCs) and age, APD being substantially more often (68.2%) aged 40 and above than NAPD (52.6%). Several of the top allergens in OCs [such as fragrance mix, Myroxylon pereirae resin (balsam of Peru), lanolin alcohol and potassium dichromate] caused significantly fewer positive test reactions in both periorbital groups. In contrast, thimerosal, phenylmercuric acetate, sodium disulfite, gentamicin sulfate, phenylephrine hydrochloride and benzalkonium chloride tested positively significantly more often in APD but not in NAPD, verifying them as true ophthalmic allergens. Finally, in 42 cases (4%) of APD patients, additional allergens were identified by testing of the patients' own substances (mostly beta-blockers, oxybuprocaine and dexpanthenol), supporting the necessity of testing with ophthalmic drugs as is where individual substances are not readily available.

Adult↗
PubMed2004

Irritant hand dermatitis: severity of disease, occupational exposure to skin irritants and preventive measures 5 years after initial diagnosis.

Irritant contact dermatitis (ICD) is often chronic; its aetiology frequently being related to occupational exposure. Management of ICD involves persistent reduction in exposure to skin irritants such as water, detergents and prolonged occlusion by gloves. The aim of this study was to determine the severity of hand dermatitis 5 years after initial diagnosis and to find out what factors were related to this outcome. A questionnaire survey was carried out on severity of hand dermatitis, exposure to skin irritants and preventive measures, 5 years after initial ICD diagnosis. Of a cohort of 201 patients with ICD, 172 received the questionnaire and 124 (72%) responded. 5 years after initial diagnosis, 50% still had medium and 32% severe hand dermatitis. Patients with severe ICD and high exposure showed low levels of prevention and difficulty in changing their occupational exposure. Use of emollients was predominantly therapeutic rather than preventive. Occupation was changed in 57% of cases, of which 46% was permanent. In this population, ICD is a chronic disease; implementation of secondary preventive measures appears to fail. In occupations with high exposure to skin irritants, implementation of permanent exposure reduction is more difficult, compared to occupations with a medium level of exposure. High exposures might have led to change of occupation; medium exposures could have been reduced to low levels. In occupations with high exposure, women were overrepresented.

Dermatitis, Allergic Contact↗
PubMed2005

Exploring the mango-poison ivy connection: the riddle of discriminative plant dermatitis.

A relationship between sensitivity to poison oak or poison ivy and mango dermatitis has been suggested by previous publications. The observation that acute allergic contact dermatitis can arise on first exposure to mango in patients who have been sensitized beforehand by contact with other urushiol-containing plants has been documented previously. We report 17 American patients employed in mango picking at a summer camp in Israel, who developed a rash of varying severity. All patients were either in contact with poison ivy/oak in the past or lived in areas where these plants are endemic. None recalled previous contact with mango. In contrast, none of their Israeli companions who had never been exposed to poison ivy/oak developed mango dermatitis. These observations suggest that individuals with known history of poison ivy/oak allergy, or those residing in area where these plants are common, may develop allergic contact dermatitis from mango on first exposure. We hypothesize that previous oral exposure to urushiol in the local Israeli population might establish immune tolerance to these plants.

Adolescent↗
PubMed2005

Allergic contact dermatitis in Iran.

The frequency of sensitization to contact allergens varies in different countries because of both genetic and, more importantly, allergen exposure variations. The objective is to determine the frequency of sensitization to contact allergens in Iranian patients with dermatitis. 250 patients with a clinical diagnosis of contact dermatitis and/or atopic dermatitis were evaluated with a 28-allergen screening series recommended by the German Contact Dermatitis Research Group from September 2002 to April 2004 in Tehran, Iran. The patches were applied on the back of the patients, removed after 24 hr and the readings were taken on 24 hr, 48 hr and 72 hr after application. 126 patients (50.4%) showed at least 1 positive reaction, and 23 patients (9.2%) had more than 2 positive reactions. 189 (84.4%) of 224 positive reactions had past and/or present clinical relevance. The 5 most common allergens were nickel sulfate 70 (28.0%), cobalt chloride 32 (12.8%), para-tertiarybutyl phenol formaldehyde resin 20 (8.0%), potassium dichromate 13 (5.2%) and colophony 13 (5.2%). Contact allergy to nickel sulfate was significantly more common in female patients and in patients under 40 years of age (P < 0.05). Nickel sulfate is the most common contact allergen in Iran, mostly affecting women and younger patients probably because of more exposure.

Adolescent↗
PubMed2005

Transepidermal water loss and incidence of hand dermatitis in a prospectively followed cohort of apprentice nurses.

The purpose of the study was to evaluate the incidence of hand dermatitis, the impact of potential risk factors and the efficacy of skin bioengineering in a prospectively followed cohort of apprentice nurses. 104 participants were prospectively followed for 3 years. Before the start of training, after about 1 year and in the third year of occupational exposure, a standardized questionnaire was distributed, and a clinical examination with skin bioengineering of the dorsum of hand and forearm was performed. The 12-month period prevalence of self-reported symptoms of hand dermatitis was 36.5%[95%-confidence interval (CI) 27.3-46.6] at intermediate follow-up and 43.3% (95%-CI 33.6-53.3) at the final examination. Apprentices with self-reported symptoms at the final examination showed a significant increase of transepidermal water loss (TEWL) at the dorsal hand from 10.15 g/m2h to 13.55 g/m2h. TEWL at this site did, at the initial examination, not differ significantly between persons who later reported symptoms of hand dermatitis at the final examination and those who did not (10.50 g/m2h versus 10.15 g/m2h, respectively). Our results do not support the notion that an increased basal TEWL is a good indicator for hand dermatitis risk.

Adult↗
PubMed2005

Allergic contact dermatitis associated with reactive dyes in a dark garment: a case report.

In this study, we present a case of a patient who has not been occupationally exposed to reactive dyes, but did present with a dermatitis from wearing a dark cotton garment. The patient experienced reactivation of his dermatitis when rewearing a new unwashed dark T-shirt made of 100% cotton (in fact, the patient reported that it had to be washed at least 3 times before the skin reaction disappeared). He presented positive patch tests to 6 reactive dyes from Chemotechnique textile series. The clothing could not be proved as the true cause of the dermatitis, but resolution occurred upon removal of the suspected garment. This suggests that contact allergy to the reactive dyes (he did not react to any other dyes and his garment was a natural fabric) was likely responsible. With this report, we would like to emphasize that reactive dyes, as a class, should be considered as potential allergens, both occupationally and from non-occupational exposure such as garments. If garments containing reactive dyes are not properly rinsed in the manufacturing process, we believe that excess of dye can be retained that may cause allergic contact dermatitis (ACD). As the reactive dyes and their hydrolysis products are very water-soluble, they can be easily washed off to prevent ACD.

Adult↗
PubMed2006

Cutaneous hypersensitivity to Malassezia sympodialis and dust mite in adult atopic dermatitis with a textile pattern.

Atopic dermatitis (AD) patients with predominantly head and neck involvement react to patch tests of the yeast Malassezia sympodialis (Ms). Protein patch testing methods and interpretation are controversial, but subgroups of AD patients may have unique triggers for disease activity. The aim of the study was to identify clinical characteristics of patients who are patch test-positive to Dermatophagoides farinae/pteronyssinus (Df) and Ms and characterize cutaneous cytokine profiles of the atopy patch tests (APTs). 25 AD patients and 27 control dermatitis patients were patch tested with Ms and Df. Qualitative analysis of Th-1 and Th-2 cytokines by RT-PCR mRNA was obtained from positive APTs. Atopic dermatitis patients with a textile pattern or head and neck involvement demonstrated more positive APTs to Ms than control patients. Early positive APTs (<6 hr) did not exhibit a Th-1 type cytokine profile. The subgroup of adult AD patients with head, neck and upper torso pattern of dermatitis seems most likely to react to Ms (and Df). The immune mechanism of protein patch tests includes a Th-1 cell-mediated component after 6 hr or more.

Adolescent↗
PubMed1977

T and B lymphocytes in contact and atopic dermatitis.

Twenty patients with contact dermatitis, eighteen with atopic dermatitis, two with mixed dermatitis, and 20 controls were examined for the number of T and B lymphocytes, and serum concentrations of IgD and IgE. Significantly higher counts of B lymphocytes bearing IgE and high serum IgE values were found in the atopic group. No other significant differences were found. In particular, we found a normal frequency of IgD bearing lymphocytes in contact dermatitis, and normal T lymphocyte counts in both groups of patients.

Adolescent↗
PubMed1986

Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis.

The histopathological features of allergic contact dermatitis were compared with those of irritant contact dermatitis in a group of 17 subjects. Each patient received simultaneous patch tests of a known allergen and a standardized irritant (benzalkonium chloride). The cellular changes occurring between 3 h and 7 days after patch test application were studied by light and electron microscopy and immunocytochemistry. No differences were observed between the induced allergic contact dermatitis (ACD) and the irritant contact dermatitis (ICD), either in the responding cell types or the sequence of cellular events. Both reactions showed a predominantly T lymphocyte infiltrate with no polymorphonuclear leukocyte involvement. Apposition of Langerhans cells to lymphocytes in the epidermis was seen in both types of response. Considerable variability in the intensity of reaction to irritant and allergen occurred within individuals. There was no statistically significant difference between the intensity of the reactions to the irritant and the allergen.

Adult↗
PubMed1996

Supplemental tests in the evaluation of occupational hand dermatitis in soldiers.

BACKGROUND: Hand dermatitis in soldiers is a considerable problem. The purpose of the study was to evaluate appropriate screening tests to improve the diagnosis of hand dermatitis in soldiers. MATERIALS AND METHODS: A group of 111 soldiers with occupational dermatitis from contact with fuels and oils underwent "tailored patch tests" with allergens relevant to their field of work and their environment. The control group consisted of 24 soldiers with various jobs similar to those of civilian life, who had not been exposed to oils and fuels. Seventy-three civilian patients, attending the clinic for patch testing, were also included. Twenty soldiers, who had a history of intensive contact with oil and fuels, but no contact dermatitis, and who were admitted because of various skin diseases (fungal infections, acne, etc.) also underwent the supplemental testing and served as an additional control group. RESULTS: Of the soldiers, 31 (29%) showed one or more positive skin tests of the oil series and 30 patients of this group one or more positive reactions to the standard patch tests trays. No patient of the control groups had a positive test to the oil series. CONCLUSIONS: Our results show the value of the supplementary tests as a first-step screening test for detection of oil allergy in soldiers and automobile-mechanics or in workers handling other gasoline- or diesel-powered engineering equipment. The test method appears to be practical, easy to perform, reliable and giving clear and accurate results, with a negligible rate of false positive reactions.

Allergens↗
PubMed2004

Clues to an accurate diagnosis of contact dermatitis.

An accurate diagnosis of allergic contact dermatitis can be achieved by a combination of historical, morphologic, and diagnostic steps. Clues in the history and physical examination can point to an irritant as the source of contact dermatitis. While irritants and allergens share many common features both immunologically and clinically, there are grounds for the distinction. Knowledge of occupational factors is necessary to assess the source of contact dermatitis. A common pitfall is the failure to appreciate the role of endogenous factors in the clinical presentation and overall care of the dermatitis patient. A comprehensive assessment of the patient's environment will lead to appropriate patch tests being applied and a correct diagnosis being reached.

Allergens↗
PubMed2004

Occupational contact dermatitis.

The dermatologist should be aware of the many facets of occupational skin diseases, which can be caused by physical, chemical, and biological insults. The most common manifestation of occupational skin diseases is contact dermatitis (both irritant and allergic). Three factors point out the importance of occupational skin diseases as diseases that have a public health impact: 1) occupational skin diseases are common; 2) they often have a poor prognosis; and 3) they result in a noteworthy economic impact for society and for an individual. They are also diseases amenable to public health interventions. Specific industries and exposures may put a worker at risk of occupational contact dermatitis. The accuracy of the diagnosis of occupational contact dermatitis is related to the skill level, experience, and knowledge of the medical professional who makes the diagnosis and confirms the relationship with a workplace exposure. Prevention of occupational contact dermatitis is important, and a variety of prevention strategies are available.

Allergens↗