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[Footwear contact dermatitis. 11-years' experience].

A clinical review of footwear contact dermatitis is made. The battery of contact allergens for the patch test is proposed. A review of the cases studied in the Department during the last 11 years is presented. In approximately 25 per cent of typically clinical cases it is not possible to establish the exact cause of the contact allergy.

Allergens↗

Occupational allergic contact dermatitis from carnosol, a naturally-occurring compound present in rosemary.

A 56-year-old man, working in a food processing factory, developed contact dermatitis of his hands, forearms, and face after the introduction of a new herb extract (Rosmanox) made from the leaves of rosemary (Rosmarinus officinalis). He reacted to carnosol, the main constituent of Rosmanox. 226 controls were negative. To our knowledge, this is the 1st reported case of contact dermatitis from carnosol.

Abietanes↗

Differential expression of ICAM-1, E-selectin and VCAM-1 by endothelial cells in psoriasis and contact dermatitis.

Adhesion receptors on endothelial cells are considered to be important for cellular influx in tissue. In this regard, skin constitutes a specialised environment for migration of leukocytes during inflammation. Using immuno-enzymatic staining techniques, we compared the in situ expression of ICAM-1, E-selectin, and VCAM-1 on endothelial cells and inflammatory infiltrates in both lesional and non-lesional biopsied skin from two immuno-inflammatory diseases, viz. psoriasis and contact dermatitis. The results were compared with those in skin specimens obtained from normal healthy individuals free from any history of skin disease. Our results show that ICAM-1 and ELAM-1 are upregulated in psoriatic non-lesional and lesional skin. On the other hand, in non-lesional biopsy from contact dermatitis patients, all three AR molecules are sparsely present, similar to the situation in normal skin although they are overtly expressed in the lesional sites. Moreover, VCAM-1 was found to be significantly increased on endothelial cells in the lesional sites of contact dermatitis as compared with biopsied psoriatic specimens. Interestingly VCAM-1 was also found to be present on some T-cells and Langerhans cells in contact dermatitis alone. The present data suggest that in different inflammatory dermatitis, varying adhesion receptor-ligand interactions involving endothelial cells and leukocytes are involved, which may be due to the differing cytokine profiles of perivascularly located T-cells.

Cell Adhesion Molecules↗

Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis.

BACKGROUND: The role of physical friction as an irritant in the causation of contact dermatitis is under-recognized. Frictional dermatitis is defined as an eczematous process in which physical frictional trauma contributes to the induction of a dermatitis process. OBJECTIVES: To examine the clinical background of patients in whom friction was contributing to dermatitis. METHODS: Over a 30-month period during which 2700 new patients were seen, frictional irritancy was identified as playing a role in the dermatosis in 31 cases: in 27 of these, case notes were evaluated for a range of parameters. RESULTS: Physical friction was identified as causing or contributing to the dermatitis in 18 men and nine women, mean age at onset 42 years. The hands, usually the fingers of the dominant hand, were affected in all but two cases. Occupational frictional activities were found in 25 cases: commonly handling small metal components, paper, cardboard or fabric, and driving. Potential frictional activities in hobbies were noted in 12 cases. Wet work irritancy contributed in four cases (15%). Patch testing showed relevant contact allergies as cofactors in seven of 25 subjects tested (26%). Psoriasis was a cofactor in four (15%), and atopic dermatitis in 11. The study was selective, being based in a teaching hospital clinic with a special interest in contact dermatitis. Frictional irritancy is often one of several factors contributing to dermatitis. CONCLUSIONS: The contribution of friction to contact dermatitis is under-recognized probably because dermatologists do not think about the potential for physical forces to induce eczematous changes in the skin.

Adult↗

Multifocal contact dermatitis to nitroderm TTS 5 with extensive postinflammatory hypermelanosis.

Allergic contact dermatitis to nitroglycerin has been previously reported. A localized cutaneous burn-like reaction due to the transdermal device was recently described. We are presenting a case of recurrent allergic contact dermatitis due to nitroglycerin as well as to its delivery device, resulting in numerous patches of postinflammatory hypermelanosis at the sites of application.

Administration, Cutaneous↗

Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome.

Protein contact dermatitis to meat is well known in butchers; spices are another source of potential contact allergy and usually are not recognized. We present a first case of contact-dermatitis to spice mix in a 39-year-old-butcher. The patient underwent skin prick testing (SPT) with standard allergens (ALK) and different meat and spice extracts (Stallergènes), scratch-patch testing with spice mix containing glutamate, paprika and other spices. Specific serum-IgE was measured with CAP-FEIA. SPT only showed an immediate-type sensitization to mugwort (+ +), as well as different spices (paprika +, curry +, cumin +) and camomile (+ + +). Scratch-patch tests were negative for different meat, but strongly positive for spice mix (+ + +) after 30 min (wheal and flare) and (+ +) after 48 h (infiltration and vesiculation). Two healthy controls were tested negative for spice mix used from that patient (scratch-patch). Specific IgE was slightly elevated for paprika 0.47 kU/L (CAP class 1), anise 0.43 kU/L, curry 0.36 kU/L and mugwort 3.83 kU/L. Sx1 atopy-multiscreen was 3.8 kU/L due to a sensitization to mugwort alone. The tests performed demonstrate an IgE-mediated contact allergy to spices but also a delayed type allergy to spice mix as a manifestation of the mugwort-spice syndrome in this individual. When testing for occupational dermatitis in butchers, protein contact allergy to spices must also be taken into consideration.

Adult↗

Epidemiologic study of contact dermatitis in hemodialysis patients.

Hemodialysis (H) implies the application of different topical substances (such as antiseptics, plaster and rubber chemicals, etc.) and the contact with potential allergenic materials (like gloves, catheters, needles, etc.). H patients may present contact dermatitis (allergic or irritant) as a consequence of this procedure. The frequency of this dermatitis is not known, as reports of isolated cases constitute the only source of information. The aim of this study was to evaluate the prevalence of contact dermatitis and positive patch tests (PT) in patients treated with chronic maintenance H. Eighty patients (40 females and 40 males) on chronic H were studied. We found a low frequency of eczematous lesions among our H patients (1.25%). PT were carried out with the GEIDC standard panel and a "dialysis" battery. Fourteen patients (17.5%) had positive PT, 3 of them having polysensitization. The most frequent sensitizing agents were p-phenylenediamine (3.75%), carba mix (3.75%) and Betadine solution (3.75%). Irritative patch test reactions were seen in 29 patients (36.2%), all of them due to Betadine solution (povidone-iodine). There was no relationship between the length of time of H, sex, age, history of contact dermatitis or cutaneous examination for dermatitis, and PT results. Regarding our results one might suggest that H is a low source of sensitization, but one has to take into account the state of anergy typical of uremic patients. Although the H procedure could be responsible for those sensitizations, it is also possible that they were acquired before H treatment.

Adult↗

Red sea coral contact dermatitis.

Six of nine adults who developed Red Sea coral contact dermatitis had seafood allergies. Contact with the "fire" coral was followed by a series of skin eruptions starting with an immediate pruritic urticaria-like lesion which forced the victims out of the water. Within minutes the affected area became erythematous and edematous with eventual blister formation approximately 6 hours after the initial contact. The blisters resolved, leaving violaceous papules and plaques in a streaky fashion corresponding to where the coral brushed the skin. The lesions became shiny and lichenoid in 3 weeks while pruritus persisted. Treatment with topical corticosteroids and oral antihistamines reduced the severity of the disease but did not stop its evolution to the lichenoid stage. Complete resolution usually occurred after 15 weeks, leaving residual hyperpigmented macules.

Acute Disease↗

[Allergic eczematous contact dermatitis due to fatty acid polypeptide condensates (author's transl)].

After an electrocardiogram an eczematous contact dermatitis was found on the skin of a 34-year-old soldier, where the contact of the leads had been fixed to the chest and extremities. 5 months later, he caught an eczematous contact dermatitis which spread over the face after irrigation of the external auditory meatus. In both cases, the contact allergen was a fatty acid polypeptide condensate. This article describes the production, properties and application of the fatty acid polypeptide condensates as well as effects and side-effects in comparison to other detergents.

Adult↗

The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations.

10 cases of contact dermatitis which began during the application of povidone-iodine preparations were examined with patch tests using 2 kinds of povidone-iodine preparations and their ingredients, i.e., povidone-iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone-iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone-iodine preparations and povidone-iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinyl-pyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone-iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone-iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone-iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.

Adult↗