Eyelid dermatitis: experience in 203 cases

Allergic contact dermatitis has been considered the most common of the many dermatologic conditions found with eyelid dermatitis. This is a retrospective study of 203 patients who presented with persistent or recurrent eyelid dermatitis with or without dermatitis elsewhere. Almost all underwent patch testing and, when indicated, radioallergosorbent test, skin prick and intradermal tests, and in many cases, usage tests as part of the workup. Relevant allergic contact dermatitis was found in 151 of 203 patients (74.%): 46 (23.%) had protein contact dermatitis, but only 7% had protein contact dermatitis without concurrent allergic contact dermatitis. Less than 1% had irritant dermatitis alone. Twenty-three patients had atopic eczema, of whom 16 also had allergic contact dermatitis, protein contact dermatitis, or both. Other conditions included seborrheic dermatitis (n = 11), psoriasis (n = 7), dry eyes (n = 9), and dermatomyositis or overlapping connective tissue disease (n = 7). Important sources of contact sensitivity include cosmetics, metals, topical medications including corticosteroids, eye medications, dust mites, animal dander, and artificial nails; only 5 cases were caused by nail lacquer. Eyelid dermatitis is a multifaceted clinical problem, but in this group of patients, allergic contact dermatitis was a common cause, even among those with atopic eczema.     

Occupational protein contact dermatitis caused by meat and fish

Background Protein contact dermatitis is a form of contact dermatitis possibly triggered by proteinaceous allergens.
Materials and methods We report two patients with a history of erythematous and urticarial skin reactions followed by transformation into prolonged papular symptoms upon contact with proteinaceous material.
Results The symptoms reported by the patients were reproducible by skin testing with meat (cow) and fish (salmon). Both patients experienced extracutaneous manifestations after ingestion of meat and fish, as proven by oral challenge. Specific immunoglobulin E (IgE) antibodies were detected in the patients' blood.
Conclusions Both cases meet all major criteria of protein contact dermatitis, suggesting IgE-mediated immediate-type hypersensitivity with late-phase cutaneous reactions.     

Nickel dermatitis in infants

8 cases of allergic contact dermatitis to nickel in infants are reported. All showed a papular dermatitis matching the sites of contact. Patch testing was performed on 3 patients, 2 were tested to nickel sulfate in pet. at concentrations of 1.0%, 1.5%, 2.0%. 1 was tested to 2.5% alone. All developed ++ reactions at each concentration tested. We observed a strong association of nickel dermatitis with atopy; 7 of 8 patients had a family history of atopy and 5 of 8 had features of coexistent atopic dermatitis. The relationship between atopy and allergic contact dermatitis is briefly reviewed. Nickel dermatitis may aggravate atopic dermatitis; avoidance of metal contact is crucial in the management of these patients.     

Occupational protein contact dermatitis in food handlers

The preparation of food in restaurant kitchens carries a high risk of occupational dermatoses. Analysis of 33 cases revealed four different etiological types. Simple irritant dermatitis was rare (2 cases), plain contact dermatitis was more common (6 cases). Fifteen patients had relevant patch tests and scratch tests; ten had positive scratch tests only to explain the cause of their dermatitis. The last type was termed protein contact dermatitis. The major type IV allergens incriminated were metals, onion and garlic. The major proteinaceous allergens indicated by history and test results were fish and shell-fish. Open patch tests with the incriminated foods may cause erythema or oedema on normal skin after 20 minutes. Previously eczematous, now normal looking, skin often responds with a crop of dyshidrotic vesicles preceded by erythema and itching 30 minutes after the application of an open test. Examination for specific IgE is not always positive in such cases. Inhalant allergy was rare. The results indicate that food handlers are sensitized by the protein they touch, and then react to later contact with the proteins. Protein contact dermatitis is similarly common among veterinary surgeons, while the importance in other occupational groups remains to be studied.     

A slime of the times: Two cases of acute irritant contact dermatitis from homemade slime

We describe two cases of acute‐onset erythema, peeling, and pruritus or tenderness isolated to the palmar surface of the hands. A detailed exposure history revealed significant periods of contact with homemade slime; given the clinical findings and timing of exposure, acute contact dermatitis of the hands was suspected. Symptoms and clinical findings resolved after avoidance of the suspected causative contactants. There are few if any reported cases of contact dermatitis to homemade slime in the literature; this serves to highlight the importance of a thorough exposure history in the evaluation of hand dermatitis.     

Protein contact dermatitis in slaughterhouse workers

Protein contact dermatitis, described as "gut eczema" or "fat eczema" by slaughterhouse workers, was first described a decade ago and presents as an itching, vescular eczema on the hands and fingers, a few hours after contact with animal material, especially gut material. In a cross-sectional study of 144 slaughterhouse workers, a cumulative prevalence of current and anamnestic cases of protein contact dermatitis of 22% was found, with the highest prevalence in workers eviscerating and cleansing gut. The scratch patch test was the only skin test showing positive results in workers with protein contact dermatitis, positive reactions being found, however, in less than half the cases.     

Allergic contact dermatitis to topical preparations of bufexamac

In Australia bufexamac is mainly used for pharmacist-initiated local treatment of various dermatoses. The European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended that marketing authorisation for bufexamac-containing preparations be revoked throughout the European Union because of the risk of severe allergic contact dermatitis. We retrospectively reviewed the patch test database at the Skin and Cancer Foundation Inc. and identified 19 cases of positive reactions to bufexamac (5% petrolatum) from 451 people patch tested. The bufexamac reaction was deemed relevant to the presenting dermatitis in 13 of 19 (68%) patients. Bufexamac allergic contact dermatitis is under-reported in the English literature. We wish to emphasise the severity and the unusually polymorphic eruptions observed in some of the cases. Clinicians should consider the possibility of allergic contact dermatitis to bufexamac-containing preparations in all patients where there is a history of exposure, even if used for only a short time.     

Occupational protein contact dermatitis

Occupational contact dermatitis is generally caused by haptens but can also be induced by proteins causing mainly immunological contact urticaria (ICU); chronic hand eczema in the context of protein contact dermatitis (PCD). In a monocentric retrospective study, from our database, only 31 (0.41%) of patients with contact dermatitis had positive skin tests with proteins: 22 had occupational PCD, 3 had non-occupational PCD, 5 occupational ICU and 1 cook had a neutrophilic fixed food eruption (NFFE) due to fish. From these results and analysis of literature, the characteristics of PCD can be summarized as follows. It is a chronic eczematous dermatitis, possibly exacerbated by work, suggestive if associated with inflammatory perionyxix and immediate erythema with pruritis, to be investigated when the patient resumes work after a period of interruption. Prick tests with the suspected protein-containing material are essential, as patch tests have negative results. In case of multisensitisation revealed by prick tests, it is advisable to analyse IgE against recombinant allergens. A history of atopy, found in 56 to 68% of the patients, has to be checked for. Most of the cases are observed among food-handlers but PCD can also be due to non-edible plants, latex, hydrolysed proteins or animal proteins. Occupational exposure to proteins can thus lead to the development of ICU. Reflecting hypersensitivity to very lowconcentrations of allergens, investigating ICU therefore requires caution and prick tests should be performed with a diluted form of the causative protein-containing product. Causes are food, especially fruit peel, non-edible plants, cosmetic products, latex, animals.     

Occupational contact urticaria and protein contact dermatitis

Irritant dermatitis and eczema are the most prevalent occupational skin diseases. Less common are immediate contact reactions such as contact urticaria and protein contact dermatitis. Occupational contact urticaria can be subdivided into two categories, immunological and non immunological. However, some agents can induce these two types of reactions. Contact urticaria to natural rubber latex is particularly frequent among health care personnel, but contact urticaria to a wide variety of other substances occurs in many other occupations. Among those at risk are cooks, bakers, butchers, restaurant personnel, veterinarians, hairdressers, florists, gardeners, and forestry workers. Protein contact dermatitis in some of these occupations is caused principally by proteins of animal or plant origin, especially among individuals with a history of atopic dermatitis. Diagnosis requires careful interrogation, clinical examination and skin tests (open tests and prick tests with immediate lecture) to identify a particular contact allergen.     

2003年度5城市化妆品皮肤病监测结果分析

目的：分析2003年度5个城市化妆品皮肤病监测结果。方法：以卫生部颁布的《化妆品皮肤病诊断标准及处理原则》(GB17149．1～7-1997)作为诊断标准,用统一的登记表格记录化妆品皮肤病患者的病史资料和相关化妆品的信息,对年度记录的结果进行统计分析。结果：2003年度5家卫生部化妆品皮肤病诊断机构共诊断和处理化妆品皮肤病565例,其中化妆品接触性皮炎486例,占86．02％;化妆品皮肤色素异常27例,占4．78％;化妆品痤疮23例,占4．07％;化妆品毛发损害20例,占3．54％;化妆品光感性皮炎8例,占1．42％;化妆品甲损害1例,占0．18％。涉及的化妆品共计有12类、693种,其中进口产品涉及32个品牌、196种产品,占28．28％;国产及合资企业产品涉及85个品牌、436种产品,占62．92％;美容院自制产品和“三无”产品61种,占8．8％。结论：化妆品皮肤病有持续增长的趋势,加强监测并采取措施减少和预防该类疾病的发生很有必要。     

Cutaneous reactions to surgical preparations and dressings

A prospective study of 100 surgical patients was undertaken to identify causes of contact dermatitis. Patch testing with the North American Contact Dermatitis Standard Series and additional agents used in the surgical preparation and dressing was performed in 11 patients with post-operative dermatitis or a history of tape allergy. 12 patients were diagnosed as having irritant (mechanical) contact dermatitis. One patient had allergic contact dermatitis to benzoin postoperatively; another patient with a history of an adhesive tape reaction had a positive patch test to thiuram mix, rubber accelerators formerly present in adhesive tapes. Our findings indicate that irritant contact dermatitis is a common problem in the surgical patient. Allergic contact dermatitis is less common, occurring in 2 of the 100 patients.     

Plants as the cause of contact allergy diagnosed at the Dermatological Clinic, Medical Academy, in Bia?ystok

In patients with allergic changes hospitalized in the years 1984-1988 in the Department a careful history was obtained for detection of correlations between the appearance of skin lesions and contact with plants. In patients with a positive history patch tests were done with a panel of routine allergens and leaves and/or flowers of certain plants. Positive tests with various plants were obtained in 14 cases. In 6 patients reporting contact with primrose positive tests were obtained with flowers and leaves of this plant, four of five tobacco planters tested who had eczematous lesions of the hands, aave also positive results of the test with tobacco leaves, and in three children reporting contact with butter-cup changes were observed resembling dermatitis pratensis bullosa. In one case allergy to parsnip was demonstrated. It is stressed that plants may give rise to contact dermatitis as well as to allergic-toxic changes.     

Statistical data on occupational contact urticaria

Data on occupational contact urticaria (protein contact dermatitis included) in Finland during 1990–1994 were analyzed. Altogether 815 cases were reported to the Finnish Register Occupational Diseases during this period, compared with l944 cases of occupational allergic contact dermatitis. Accordingly, the total number Of Occupational allergic contact derma loses was 2759. 29.5% being contact urticaria and 70.5% being allergic contact dermatitis. Occupational contact urticaria was much more common in women 70%) than in men (30%). The 6 most common causes of contact urticaria were (1) cow dander (362 cases=44.4%) (2) natural rubber latex (193 cases -23.7%), (3) Hour, grains and Iced (92 cases=113%), (4) handling of foodstuffs (25 cases=3.1 %), (5) industrial enzymes 14 cases = 1.7%) and (b) decorative plants l3 cases=1.6%), The occupations with the highest numbers occupational contact urticaria were farmers (341 cases), domestic animal attendants (61). bakers (140.5). nurses (42) chefs (40) and denial assistants (28) The ranking list of the most common occupations with occupational contact urticaria per 100,000 employed workers was as follows: (I) bakers (140.5 cases per 10(1,000 employed persons), (2) prepares of processed food. (3) dental assistants. (4) veterinary surgeons. (5) domestic animal attendants. (i) fanners and silviculturalists (7) chefs, cooks and cold buffet managers. (S) dairy workers. (9) horticultural supervisors. (10) laboratory technicians and radiographers, (II) physicians. (12) butchers and sausage makers. (1.1) laboratory assistants, (14) dentists and (15) nurses(121.2 cases per 100.000 employed person). Low-molecular-weight chemicals caused very few cases of occupational contact urticaria, the most common being 2-ethyhexyl very late (5 cases)- To Summarize occupational contact urticaria forms a large group of occupational contact dermatoses. and dermatologists need to he able to diagnose IgE-mediated immediate skin allergic diseases.     

外用皮质类固醇激素皮肤病患者的斑贴试验研究

用含不同皮质类固醇激素外用药的斑试剂对１７２例有外用皮质类固醇激素史的皮肤病患者进行斑贴试验，结果１２例（７．０％）对多种皮质类固醇激素制剂有反应。其阳性率仅次于橡胶促进剂、香料、苯唑卡因及白降汞，是第５位常见的过敏原。皮质类固醇激素过敏多见于钱币状湿疹，瘀积性皮炎等慢性皮肤疾患。临床表现多为皮损迁延不愈，但也可发生急性接触性皮炎。过敏的发生与性别、年龄无关；交叉过敏与多价过敏现象常见；未见全身性反应。     

T cell lymphomatoid contact dermatitis: a challenging case and review of the literature

Lymphomatoid contact dermatitis is a pseudolymphoma with clinical and histological features of allergic contact dermatitis and cutaneous T cell lymphoma. Incorrect diagnosis may lead to unnecessary testing, unnecessary treatment, or patient harm. The objective of this study is to present a case to demonstrate the diagnostic challenge and overlap between allergic contact dermatitis and cutaneous T cell lymphoma in a patient with lymphomatoid contact dermatitis caused by methylchoroisothiazolinone/methylisothiazolinone and paraben mix, and to review the existing literature in order to summarize the demographics, clinical features, allergens and treatments reported for lymphomatoid contact dermatitis. A search of major scientific databases was conducted for English‐language articles reporting cases of lymphomatoid contact dermatitis or additional synonymous search headings. Nineteen articles with a total of 23 patients were analysed. Lymphomatoid contact dermatitis was more common in men, with an average age of 58.5 years. Fourteen unique allergens were identified and confirmed by patch testing. However, no single test or study was diagnostic of lymphomatoid contact dermatitis. Allergen avoidance was the most useful management tool, but selected patients required topical or systemic immunosuppression. In conclusion, without specific diagnostic features, evaluation for lymphomatoid contact dermatitis should include a thorough history and examination, patch testing, and biopsy with immunohistochemistry and clonality studies.     

RECURRENT CONTACT DERMATITIS CAUSED BY MERCURY IN AMALGAM DENTAL FILLINGS

A metal worker had repeated episodes of contact dermatitis over a period of years. Patch tests with 5% ammoniated mercury were strongly positive but occupational contact could not be proved. Recurrence of the dermatitis one day after amalgam dental fillings had been made and again one year later, this time without new fillings, raised the possibility that it was due to the old amalgam fillings. Removal of all the amalgam fillings resulted in a new outbreak of severe dermatitis; during the 5 years ensuing there has been no recurrence. This case history suggests that contact dermatitis may be caused by not only the mercury in new fillings but also by that in old fillings.     

Dermatitis in hairdressers

Contact dermatitis among hairdressers is common. In The Netherlands, registered sick leave for hand dermatitis among hairdressers rose from 21,050 days in 1986 to 54,293 in 1991. In a survey among 45 hairdressers in 5 different salons, 12 had a history of hand dermatitis and 16 showed moderate to severe hand dermatitis. After extensive investigations, 13 were classified as having allergic contact dermatitis and 3 cumulative irritant contact dermatitis, fn the past 4 years, 103 hairdressers were extensively patch tested and glyceryl thioglycolate (GTG), ammonium persulfate and nickel sulfate were responsible for the majority of positive reactions. Hair dyes and preservatives were responsible for a moderate % of the positive reactions. Positive reactions were also found to cocamidopropyl betaine and sodium coco hydrolyzed animal protein. These 2 allergens show a rather capricious patch test reaction pattern and irritant reactions may easily be confused with allergic. The relevance of positive patch test reactions to these chemicals should always be questioned. Atopy was not a frequent cause of hand dermatitis in this study. Chemicals with a thiol group can be demonstrated with a chemical spot test. With this test, contamination of the hairdressing salon with thioglycolates was demonstrated. It is emphasized that contamination of hairdressing salons with GTG is probably a significant factor in explaining the severe flare-ups in GTG-sensitized hairdressers who no longer use GTG permanent-waving solutions.     

Anogenital allergic contact dermatitis, the role of spices and flavour allergy

Background: In patients with vulval or anogenital dermatitis, irritant contact dermatitis is more common than allergic contact dermatitis. The reported frequency and relevance of contact sensitivity in anogenital dermatitis varies greatly. Objective: To determine the frequency and relevance of contact sensitization in a Dutch group of female patients with chronic anogenital complaints. Methods: We reviewed patch test results of 53 women with chronic anogenital complaints, with sole vulval symptoms in 29 women and sole perianal in 5, in whom inflammatory skin diseases like lichen sclerosus, lichen planus, psoriasis, as well as infectious diseases were unlikely or excluded as a cause of their symptoms. All women were tested with the European baseline series plus additional test series according to their personal history. Results: Thirty‐five patients (66%) showed one or more positive test reactions. Seven of these patients (20%) had one or more clinically relevant positive reactions, most often to flavours and spices. Conclusion: A considerable number of patients with anogenital dermatitis have a contact sensitization. Clinically relevant reactions were mainly found to spices and flavours. This is in contrast to the data reported in the literature that shows most contact allergies in vulval patients to ingredients of topical medication.     

Severe allergic contact dermatitis induced by paraphenylenediamine in paint-on temporary 'tattoos'

Paraphenylenediamine (PPD) is a black dye with well known sensitizing properties. Its increasing use as a skin paint to produce temporary 'tattoos' has led to recent reports of allergic contact dermatitis. Hitherto, such cases of allergic contact dermatitis due to PPD have been localized to the original site of application of the skin paint. We report two cases of severe allergic reactions to paint-on 'tattoos'. Both of these patients had no prior history of sensitivity to PPD, although case 2 had previously used permanent hair dyes. In both cases, the primary eruption at the 'tattoo' site was followed within days by a generalized eruption which ultimately required treatment with oral corticosteroids, because the initially prescribed topical corticosteroids proved ineffective.     

Allergic contact dermatitis from topical doxepin: Food and Drug Administration's postmarketing surveillance experience

A total of 26 postmarketing cases of allergic contact dermatitis to doxepin 5% cream were reported to the Food and Drug Administration. Our findings suggest that allergic contact dermatitis was more common when treatment duration exceeded the recommended 8 days. Allergic contact dermatitis to doxepin cream should be considered in patients whose condition fails to improve or worsens with doxepin use.