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Contact dermatitis sparing the eruption of herpes zoster and its periphery.

A 63-year-old male developed allergic contact dermatitis with antibiotic ointment applied to the skin eruptions of herpes zoster. From the result of patch test, fradiomycin sulfate contained in the ointment was identified as the contact sensitizing antigen. Strangely, this contact dermatitis was confined to the area surrounding the sores, sparing the lesions and their periphery. We postulated that a decrease in Langerhans cell activity in the herpes zoster lesions and their peripheral area was primarily responsible for this phenomenon, since an important role of Langerhans cells in host defence against herpes virus infection has recently been demonstrated.

Dermatitis, Contact↗

Dermal contact dermatitis to a disposable electrode plate.

A 50-year-old man developed a dermal type of allergic contact dermatitis after exposure to a disposable electrosurgical electrode. Patch testing did not determine the allergenic component, but the electrode contained none of the substances known to cause dermal contact dermatitis.

Dermatitis, Contact↗

Immunoglobulin and complement bearing polymorphonuclear leukocytes in allergic contact dermatitis and psoriasis vulgaris.

Immunofluorescence techniques were used to demonstrate the presence of immunoglobulin (Ig) and complement (C) bearing polymorphonuclear leukocytes (PMNL) in specimens of skin from the lesions of ten patients with allergic contact dermatitis and of ten with psoriasis vulgaris. The distribution patterns of these Ig- and C-coated cells in the peripheral blood of the twenty patients were also studied. Ten normal healthy controls were included. In cases of allergic contact dermatitis, IgD was the predominant class of Ig on the PMNL. The percentage of C-bearing PMNL were also significantly increased, suggesting that both molecules might be present on the cell memebrane of these cells at the same time. In psoriasis vulgaris, the predominant class of Ig on the PMNL was IgG. The percentage of PMNL coated with C were not signficantly raised. These results suggest that in allergic contact dermatitis the PMNL can be coated with both Ig and C which may render them cytophilic; they also show that in psoriasis vulgaris PMNL can bind Ig. In the ten healthy controls, it was possible to distinguish between those PMNL which are and those which are not bearing immunoglobulin.

Complement System Proteins↗

Localized bullous pemphigoid. A mimic of acute contact dermatitis.

A case of localized bullous pemphigoid that mimicked an acute contact dermatitis around a stoma site is presented. The diagnosis was confirmed by direct immunofluorescence and by indirect immunofluorescence on 1.0 mol/L of sodium chloride split skin. A review of the literature demonstrates 30 previous well-documented cases of localized bullous pemphigoid. As in our case, local factors such as trauma, ultraviolet light, or topical therapy seem to be frequently implicated in the production of lesions. The possibility that these patients might otherwise have subclinical bullous pemphigoid was considered. The disease has a benign course and generally responds to cessation of exacerbating factors and initiation of topical steroid therapy.

Adhesives↗

Direct and indirect nickel-specific stimulation of T lymphocytes from patients with allergic contact dermatitis to nickel.

Fourteen T lymphocyte clones (TLC) specific for the contact allergen nickel were prepared either from lesional tissue biopsies or from peripheral blood of patients with allergic nickel-contact dermatitis. Two nickel-specific TLC, obtained from lesional tissue, responded to nickel without the participation of antigen-presenting cells (APC). This direct stimulation by nickel was not restricted by major histocompatibility complex-encoded molecules, since antibodies against HLA class I and II molecules did not block nickel-specific proliferation. Proliferation of other nickel-specific TLC was dependent on the presence of APC and was diversely restricted by HLA class II molecules. With one exception, the restriction determinants were present on HLA-DR and HLA-DQ molecules. Four TLC recognized nickel in association with subtypes of these serologically defined molecules. Five TLC seemed to recognize nickel in the context of highly unusual restriction determinants, since their restrictions could not be explained by the function of single polymorphic HLA class II epitopes. The absence of HLA class II restrictions and the occurrence of deviant HLA class II restrictions in part of the nickel-specific TLC are suggested to result from direct interactions of nickel with critical immune response molecules.

Antigen-Presenting Cells↗

Contact dermatitis associated with capsaicin: Hunan hand syndrome.

"Hunan hand" is a contact dermatitis resulting from the direct handling of chili peppers containing capsaicin. Capsaicin also is found in an over-the-counter topical agent for treatment of postherpetic neuralgia, diabetic neuropathy, and arthritis. We present the case of a patient with capsaicin-induced dermatitis and discuss the pathophysiology, therapy, and current uses of capsaicin.

Adult↗

Para-chloro-meta-xylenol allergic contact dermatitis in seven individuals.

Seven individuals are discussed who developed allergic contact dermatitis following sensitization to the antibacterial agent parachlorometaxylenol (chloroxylenol, PCMX) contained in either medicated Vaseline or in electro-cardiogram paste. The hazard of PCMX sensitization is great in that this chemical is present in over 30 "across the counter" products. PCMX sensitive people may cross-react to chlorocresol.

Adult↗

Contact dermatitis from ethylenediamine.

This study of seven patients with an allergic contact dermititis from ethylenediamine has shown that sensitisation to topical antihistamines and disodium ethylenediamine tetra-acetate is not inevitable in a allergic contact dermatitis from ethylenediamine.

Administration, Topical↗

A review of contact dermatitis associated with transdermal therapeutic systems.

The literature is reviewed for contact dermatitis associated with transdermal therapeutic systems. Clonidine, nitroglycerin, scopolamine, estradiol and testosterone are utilized in such applications, and fentanyl is under investigation. Most cutaneous reactions are limited to localized dermatitis; however, generalized systemic effects may occur. Investigators are reporting skin-related side-effects in up to 50% of patients using transdermal clonidine; however, with the other agents, this is demonstrated much less frequently. Reactivation of the dermatitis via oral medication, following sensitization to the patch, is noted in rare instances.

Administration, Cutaneous↗

Allergic contact dermatitis from 3-(aminomethyl)-pyridyl salicylate.

2 patients with acute allergic contact dermatitis from 3-(aminomethyl)-pyridyl salicylate are described. Both patients were females with histories of urticaria and showed cross-sensitization to substances of the para group. Clinical manifestations included eczema, angioedema and respiratory effects. In 1 patient, airborne elicitation was suspected. A lymphocyte transformation test confirmed the allergy, with an extremely high response index. 35 normal controls were negative.

Aminopyridines↗

Contact dermatitis after temporary henna tattoos--an increasing phenomenon.

Four patients developed contact dermatitis to black henna tattoos on holiday in the Middle East and Asia. Two to ten days after skin painting an itchy, reddish swelling developed at the site of the tattoo exactly following its sharply demarcated borders. Histological investigation of the lesions revealed spongiotic dermatitis with dense lymphohistiocytic infiltrates. Patch testing in all patients showed a strong reaction to p-phenylenediamine (PPD). The other tests, including standard series and henna powder, were all negative. Healing time after application of topical class III and IV steroids was prolonged. These reports show an impressive side effect of temporary tattoos with possible long-term damage. Rather than henna, the causative agent in the pastes used for temporary tattoos appears to be PPD, a widely used dye that is added to the pastes in high concentrations to produce a darker shade. The growing incidence of this complication requires close observation, while practitioners should be aware of this sensitisation and of possible subsequent allergic reactions, especially after hair colouring with dyes based on PPD.

Adult↗

An overview of the efficacy of topical corticosteroids in experimental human nickel contact dermatitis.

We review controlled trials of corticosteroid effect in experimentally elicited acute nickel contact dermatitis in man, in the hope of clarifying optimal efficacy for clinical use. To maximize discrimination and objectivity, we focus on data with 1 well-characterized allergen, nickel, in studies utilizing bioengineering documentation. Higher potency corticosteroids are effective (unlike in experimental irritant contact dermatitis), but optimum schedules still require definition.

Administration, Topical↗

Study on Chinese common allergens of contact dermatitis.

Patch tests were performed according to the European Standard Allergens (ESA) in 204 cases suspected of contact dermatitis. The reaction was positive in 58.33% of the cases. The common allergens were nickel (15.7%), fragrance mix (11.8%) p-phenylenediamine (8.8%), colophony (6.9%), benzocaine (6.4%), formaldehyde (5.9%), black rubber mix (4.9%), cobalt (4.4%), balsam of Peru (3.9%), potassium dichromate (3.4%), thiuram mix (2.9%) and mercapto mix (2.9%). In 85 cases of negative reaction to the European Standard Allergens, 36 were patch tested to suspected agents based on the individual case histories, of which 21 positively reacted. The common sensitizing agents were ampicillin and thiomersal. Of 204 cases, 107 were cases of facial contact dermatitis. Patch tests showed that the most common allergens were p-phenylenediamine (15.9%), nickel (13.1%) and fragrance mix (14.95%).

Adolescent↗

Contact dermatitis to a limb prosthesis.

PROSTHESIS USERS commonly develop various skin problems on the residual limb, directly under the prosthetic device when the device is in direct contact with the skin. Prolonged occlusion and humidity increase the likelihood of developing contact sensitivity to moisturizing creams, medicaments, and materials in the prosthesis itself.1 Allergic contact dermatitis to various prosthetic design materials is uncommon, and the relevance of positive patch-test results to chemicals present in prostheses may be difficult to establish. Most reports of allergic contact dermatitis to prostheses have been concerned with surgical amputees and not congenital amputees. We report a 5-year-old boy with a transverse partial hemimelia who developed allergic contact dermatitis to an adhesive used in his myoelectric prosthesis. Unlike most prostheses, myoelectric prostheses are worn directly against the skin, for surface electromyography electrode contact.

Allergens↗

Contact dermatitis and in-feed exposure to antibiotics among pig feed handlers.

This study aimed to determine the prevalence of contact dermatitis among pig feed handlers, explore the association with exposure to in-feed antibiotics, and determine farmers' awareness of product safety information. One representative from each piggery in Queensland's Wide Bay Burnett Region was interviewed by telephone. Just over 21% of respondents had experienced dermatitis symptoms within the previous two years; 14.8% within the previous 12 months: and 6.7% had current symptoms. Use of at least one in-feed antibiotic was reported by 83.7%. The only antibiotic to show an association with the occurrence of dermatitis was tylosin. Precautionary behaviours were more common among those with dermatitis. Only 18% of respondents were aware of material safety data sheets. The relatively high prevalence of contact dermatitis, high use of antibiotics, low level of precautionary behaviours and poor awareness of material safety data sheets indicates a need for farmer education.

Adult↗

Contact dermatitis to botanical extracts.

A review of the literature of reported cases of contact dermatitis to a variety of natural herbal extracts is Presented. Natural extracts are commonly used ingredients in many cosmetic preparations and homeopathic remedies. Although the term natural botanical extracts inherently purports to have beneficial and benign properties, these extracts can cause adverse reactions in individuals. As such, dermatologists should be cognizant of these agents as possible sources of allergenicity in patients presenting with contact dermatitis.

Cosmetics↗

Effect of a new topical cyclosporin formulation on human allergic contact dermatitis.

We studied the effect of a new topical cyclosporin (CS) formulation on the suppression of allergic contact dermatitis. 4 test sites were outlined on the back of healthy male volunteers. For 7 consecutive days, the test sites were treated as follows: #1: CS formulation (10%), #2: placebo formulation, #3: flumethasone pivalate (FP) formulation (0.02%; #4: no treatment. On day 8, we challenged all test sites in the diphenylcyclopropenone (DCP) sensitized individuals. Photographic and clinical documentation was performed daily. 24 h after the DCP skin challenge, a marked redness accompanied by severe itching and slight pain occurred in the test sites pretreated with CS (#1) and placebo (#2). A considerably milder reaction was noted in the untreated test site (#4) and only a faint redness was noted in the test site pretreated with FP (#3). After 36 h, a further increase in the cutaneous reaction was documented in CS and placebo pretreated test sites (#1, 2). In agreement with other workers, topical CS did not suppress experimentally-induced allergic contact dermatitis in man. On the contrary, in CS and placebo pretreated areas (#1, 2), an increased cutaneous reaction was observed. This observation may be explained by the extensive pretreatment with the topical formulation of CS and placebo, which possibly caused a profound perturbation of the stratum corneum, enabling excessive allergen penetration compared to the untreated area with intact stratum corneum.

Administration, Cutaneous↗