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Various forms of contact dermatitis from Pinus radiata sawdust are described and illustrated by three cases. The sawdust causes industrial dermatitis which can be chronic and the purpose of the paper is to alert Australian practitioners.
Perfumes in soaps cause nondescript patterns of contact dermatitis. Patch testing with balsam of Peru and a fragrance mixture can confirm a sensitivity to a perfume. The use of additive-free soaps determines its clinical relevance.
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Eight hairdressers and four clients were found to be allergic to glyceryl monothioglycolate (GMTG) contained in "acid" permanent waves used in American beauty salons only since 1973. Previous studies in Germany showed that compounds closely related to GMTG were strong sensitizers. In contrast, ammonium thioglycolate (ATG) has been used since 1943 in cold "alkaline" permanent waves both in homes and in salons with no clearly documented cases of contact allergy. Our allergic patients reacted to GMTG in concentrations as low as 0.25%, although their exposure in practice could reach concentrations of 20% to 80%. GMTG-allergic patients reacted to GMTG when it was tested through a variety of glove fabrics. Household-weight neoprene gloves were protective.
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Disturbances of skin barrier function occur in several skin diseases, e.g., atopic dermatitis (AD), irritant/allergic contact dermatitis (ICD, ACD). Skin barrier damage triggers the production of cytokines that stimulate lipogenesis which may also cause inflammatory processes. The aim of this study was to evaluate the efficacy of a topical skin lipid mixture in the treatment of ICD, ACD and AD. 580 consecutive patients suffering from ICD, ACD or AD were treated with a skin lipid mixture containing ceramide-3 and patented nanoparticles. Patients received the lipid mixture alone or in combination with topical corticosteroids until clearance or for 8 weeks. Both treatment groups statistically improved all parameters considered at week 4 and 8 as compared to baseline. Between the 2 treatment groups, there was a statistically significant difference in favour of combined therapy for (ICD, ACD, AD, respectively): erythema, pruritus and overall disease severity; erythema and pruritus; erythema, pruritus, fissuring and overall disease severity. No statistically significant difference was found for (ICD, ACD, AD, respectively): dryness, scaling and fissuring; scaling, fissuring and overall disease severity; dryness and scaling. Between the 2 ACD treatment groups, there was a statistically significant difference in favour of the skin lipid mixture for dryness. In conclusion, the study shows that balanced lipid mixtures are effective in improving barrier properties and the clinical condition of the skin in contact dermatitis.
Contact dermatitis is a common inflammatory skin disorder caused by exposure to various antigens and irritants. It is associated with significant morbidity, and it is one of the most common reasons for worker's compensation claims for skin disease. Based on the mechanism by which contact allergy develops, several types are recognized, including allergic contact dermatitis, irritant contact dermatitis, contact photo-dermatitis and contact urticaria. The clinical presentation of contact dermatitis, regardless of the mechanism, ranges from localized vesicles and bullae on erythematous skin in acute stages to erythematous lichenified plaques in chronic stages. Diagnosis is suggested by the localization of the eruption and the history of exposure to an offending agent. Treatment includes removal of the offending agent in conjunction with use of anti-inflammatory steroid creams, antihistamines and, in severe cases, oral corticosteroids.
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Contact dermatitis is a common skin disease. Disease was diagnosed by a history of contact substance together with geographic distribution of lesion. Up till now, standard patch test is one of the most reliable test to identify and confirm causative agent of allergic contact dermatitis. To determine the rate of positive standard patch test and to identify the common allergen of contact dermatitis in Thailand, we performed the standard patch test in 129 patients, suspected having allergic contact dermatitis at Department of Dermatology, King Chulalongkorn Memorial Hospital, Thailand from June 1, 2003 to September 1, 2004. The rate of positive standard patch test is 59.7% (n = 77/129). The most 3 common positive allergens were nickel sulfate (18.60%), cobalt chloride (17.05%) and fragrance mix (14.73%), respectively. The chance of positive standard patch test significantly correlated with sex (woman), initial diagnosis as contact dermatitis and history of house-worker (p = 0.017, p = 0.005 and p = 0.023, respectively). Whereas, there were no significant correlation between the chance of positive standard patch test and age of patient, location of lesion, history of recurrence, history of atopy, history of drug and food allergy. In addition, history of metal allergy significantly correlated with the chance of positive nickel sulfate or cobalt chloride in standard patch test (p = 0.017). In conclusion, this study demonstrated the prevalence of causative allergen of contact dermatitis in Thai patients using that standard patch test. Moreover, our data shown that the chance positive standard patch test was greater in patient, who were women or initial diagnosed as contact dermatitis or had history of houseworker or history of metal allergy.
Contact dermatitis is an inflammatory skin condition induced by exposure to an environmental agent. Eczema and dermatitis are used synonymously to denote a polymorphous pattern of skin inflammation characterized at least in its acute phase by erythema, vesiculation and pruritus. Substances responsible for contact dermatitis after single or multiple exposures are non protein chemicals, i.e. haptens, that induce skin inflammation through activation of innate skin immunity (irritant contact dermatitis) or both innate and acquired specific immunity (allergic contact dermatitis). The present review will focus on allergic contact dermatitis, a delayed-type hypersensitivity reaction, which is mediated by hapten-specific T cells. Recent advances in the pathophysiology of ACD have shown that the occurrence of ACD, as well as its magnitude and duration, is controlled by the opposite functions of CD8 effector T cells and CD4 regulatory T cells. From these studies ACD can be considered as a breakdown of cutaneous immune tolerance to haptens.
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Contact dermatitis has traditionally been regarded as a T-lymphocyte-mediated delayed hypersensitivity reaction. This has led authors to focus their studies of this affection on establishing the role played by lymphocytes and the different lymphocyte subpopulations in its pathophysiology. However, as most of the research conducted on contact dermatitis has so far been carried out on experimental animals, we believed it of interest to study the potential alterations to the immune system involved in contact dermatitis in humans. For this purpose, we chose 30 patients suffering from contact dermatitis in whom we studied the blood levels of total lymphocytes, as well as those of CD3, CD4 and CD8, and the CD4/CD8 ratio. These parameters were determined at three clinical stages, namely, the clinical stage (acute phase), a period when the symptoms had subsided (intercrisis phase) and another when the lesions recurred (acute outbreak). The aim of this work was to study the changes in these lymphocyte subpopulations in each of the stages. We also studied a control group consisting of 30 healthy subjects in order to contrast the results obtained. We found no significant differences among the results obtained at the three stages. However, they did differ from those obtained for the control group: the patients had lower CD4 and CD8 levels than their healthy counterparts, the differences only being significant in the acute phase.
Contact dermatitis in patients suffering acne is raising. These reactions are provoked by different sensitizing substances used in the treatment of acne. The Authors review the diverse possibilities of sensitisation in acne patients: contact dermatitis, primary irritation, photoallergy and phototoxicity, and "dermatitis by general administration of the allergen". The diverse acneiform contact dermatitis are reviewed and classified. The importance of acne venenata or contact acne--professional or no--, and different acneiform contact eruptions or by ingestion, is emphasized.
Contact dermatitis in humans and contact hypersensitivity (CHS) in animal models are delayed-type hypersensitivity reactions mediated by hapten-specific T cells. Recently, it has become clear that both CD4(+) Th1 and CD8(+) type 1 cytotoxic T (Tc1) cells can act as effectors in CHS reactions. T-bet has been demonstrated to play an important role in Th1 and Tc1 cell differentiation, but little is known about its contribution to CHS. In the present study, we used C57BL/6 mice transgenic (Tg) for T-bet to address this issue. These Tg mice, which overexpressed T-bet in their T lymphocytes, developed dermatitis characterized by swollen, flaky, and scaly skin in regions without body hair. Skin histology showed epidermal hyperkeratosis, neutrophil, and lymphocyte infiltration similar to that seen in contact dermatitis. T-bet overexpression in Tg mice led to elevated Th1 Ig (IgG2a) and decreased Th2 Ig (IgG1) production. Intracellular cytokine analyses demonstrated that IFN-gamma was increased in both Th1 and Tc1 cells. Furthermore, Tg mice had hypersensitive responses to 2,4-dinitrofluorobenzene, which is used for CHS induction. These results suggest that the level of expression of T-bet might play an important role in the development of contact dermatitis and that these Tg mice should be a useful model for contact dermatitis.
Contact dermatitis is the most frequent type of occupational skin disease. Although prevention of contact dermatitis in the workplace should ideally be accomplished through total elimination of cutaneous exposure to hazardous substances, this is often not feasible. Therefore eight basic elements of a multidimensional approach to prevention have been identified. These elements include recognition of potential cutaneous irritants and allergens, engineering controls or chemical substitution to prevent skin exposure, personal protection with appropriate clothing or barrier creams, personal and environmental hygiene, regulation of potential allergens and irritants within the workplace, educational efforts to promote awareness of potential allergens and irritants, motivational techniques to promote safe work conditions and practices, and preemployment and periodic health screening. A comprehensive prevention program based on this multidimensional approach requires the cooperative efforts of employees, employers, engineers, chemists, industrial hygienists, safety and supervisory personnel, union representatives, governmental agencies, and occupational health practitioners.
Contact dermatitis is a delayed hypersensitivity reaction involving the skin as shock organ. In a delayed cutaneous hypersensitivity reaction to contact with an antigen, the afferent, central and efferent phases of the immune reaction remain untouched and the individual concerned has a nonspecific inflammatory response capacity. Hence, delayed cutaneous hypersensitivity tests and the dinitrochlorobenzene (DNCB) test are of great use in evaluating this type of reaction. This prompted us to evaluate the in vivo response of patients suffering from contact dermatitis, as studies on this topic have been focused on animal experimentation or in vitro techniques. We chose 30 patients with contact dermatitis and studied them at three different stages, namely, when the patients showed the typical clinical signs (acute phase), when the lesions had subsided (intercrisis phase) and when the signs had recurred (acute outbreak). We subjected them to delayed cutaneous hypersensitivity tests and the DNCB test. Both techniques revealed a decrease in the response in the intercrisis phase with respect to the other two phases and to a control group.