Compositae dermatitis

Compositae dermatitis is an allergic contact dermatitis. The most important allergens in the Compositae family are sesquiterpene lactones (SL), which are present in the oleoresin fraction of leaf, stem, flower and possibly pollen. Compositae dermatitis is most frequently seen in middle-aged and elderly people in patterns reflecting airborne or direct contact with the allergens. The pattern typically starts in summer and disappears in the autumn or winter. Repeated exposure over many years may lead to a chronic and, at times, a disseminated pattern. Seasonal variation does not occur in occupational Compositae dermatitis. In addition to the classically described airborne pattern of face, 'V' of neck, hands and forearms, hand dermatitis is now recognized to be an equally common presentation. This variability of clinical features, and the frequent occurrence of atopic dermatitis and contact allergy to one or more compounds, highlights the need for routine patch testing with sesquiterpene lactone mix 0.1% (Thermal, Hamburg, Germany), combined with aimed patch testing with Compositae plants and extracts. Avoidance of the plants and plant extracts of this large family can be difficult due to its widespread occurrence in flower, herb and vegetable gardens, urban and rural weed population and native vegetation. Importantly, Compositae plant extracts are present in many cosmetics, shampoos, herbal creams and ingested herbal remedies and tonics.     

Comparison of patch test contact sensitivity to acetone and aqueous extracts of Parthenium hysterophorus in patients with airborne contact dermatitis

Our aim was to compare the degree of patch test positivity to acetone and aqueous extracts of Parthenium hysterophorus in patients with airborne contact dermatitis. We performed patch testing with the Indian standard series (which includes aqueous extracts of parthenium, xanthium and chrysanthemum), and with 1 : 100 and 1 : 200 dilutions of an acetone extract of parthenium in 72 patients with airborne contact dermatitis. All patients showed contact sensitivity to the 1 : 100 dilution and 67 patients had positive allergic reactions to the 1 : 200 dilution of the acetone extract, whereas only 45 patients showed a positive reaction to the aqueous extract of P. hysterophorus. Our results confirm that parthenium allergens are more soluble in acetone than in water, and that the acetone extract is significantly better in detecting contact sensitivity to parthenium in patients with suspected plant dermatitis. Hence, the acetone extract is recommended for routine patch testing.     

Patients with airborne sensitization/contact dermatitis from budesonide-containing aerosols 'by proxy'

Background: Inhalation corticosteroids (CSs), despite their wide use, rarely cause sensitization in subjects administering them.
Objective: To determine the cause of sensitization and/or of allergic contact dermatitis which occurred in air-exposed body areas of patients reacting to corticosteroids and to budesonide, in particular.
Methods: We reviewed the patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U. Leuven Dermatology department during an 18-year period.
Results: Fifteen subjects, not themselves treated by budesonide-containing aerosols, but taking care of/or living together with patients who used them because of a chronic respiratory affection, appeared to have been sensitized by airborne exposure and/or presented with airborne allergic contact dermatitis from them.
Conclusion: Air exposure to inhalation corticosteroids used 'by proxy' and to budesonide, in particular, needs to be taken into account as a potential cause of primary sensitization and/or airborne allergic contact dermatitis, sometimes also in an occupational context.     

Occupational airborne allergic contact dermatitis from methacrylates in a dental nurse

BACKGROUND: There are very few reports of airborne allergic contact dermatitis from methacrylates. OBJECTIVES: To report a dental nurse with facial eczema supposedly caused by airborne methacrylates present in the work environment. METHODS: Patch testing with serial dilutions of several methacrylates and work provocations in environments containing methacrylates was performed. RESULTS: Patch testing with serial dilutions of several methacrylates disclosed a high patch test reactivity. Repeated provocations when working with methacrylates resulted in facial eczema that resolved out of work. Attempts to collect the sensitizers using air pumps for the collection of vapors and filters for the collection of air-born aerosols failed. CONCLUSIONS: The clinical presentation was that of a facial dermatitis due to airborne exposure to methacrylates. It seems likely that 1 or several of these allergens caused the dermatitis.     

Compositae dermatitis: a survey

Compositae dermatitis in an allergic contact dermatitis, frequently chronic, triggered by plants of the Compositae family. The condition, which is seen, in particular, in middle-aged and elderly persons, typically starts in the summer months with an acute eczema either corresponding to areas exposed to light and air, or corresponding to areas of plant contact; it disappears spontaneously during the fall of the year. Repeated exposure over a number of years may cause severe intractable dermatitis affecting the patient throughout the year. The responsible allergens are sesquiterpene lactones, and investigations to date indicate that the frequency of the allergy is similar to that seen with some of the contact allergens of the standard patch test series. The diagnosis, however, is difficult, partly due to the fact that the clinical picture may be mistaken for a photodermatosis, and partly owing to the difficulty in obtaining commercially available allergens for patch testing. The diagnosis is therefore based on testing with plant extracts, which can cause pronounced local reactions and possibly active sensitization. A survey is given of the possible modes of sensitization, sex and age distribution, the relationship to photosensitivity and atopy, as well as the possible treatment. It is concluded, on the basis of the chronic nature of the disease, and the diagnostic and treatment problems, that continued intensive research into the condition is urgently needed.     

Allergic contact dermatitis from cardamom

A case is presented of a confectioner with a chronic hand dermatitis and positive patch test reactions to cardamom and certain terpenoid compounds present in the dried ripe seeds of cardamom. Cardamom is a popular traditional flavouring agent for baked goods and confectionery. Dermatitis from skin exposure to cardamom has to the best of our knowledge not been reported. We report one case of allergic contact dermatitis to cardamom elicited by terpenes present in the seeds.     

Evolution of clinical pattern of parthenium dermatitis: a study of 74 cases

Our aim was to study the evolution of clinical pattern of parthenium dermatitis. Patients with clinical picture consistent with parthenium dermatitis for 3 years or more along with positive patch test to parthenium were studied. Patients were questioned regarding the site(s) of dermatitis at the onset and change in localization in the following years. Patients were classified into airborne contact dermatitis, chronic actinic dermatitis (CAD) pattern or mixed pattern dermatitis. There were 74 patients (49 men and 25 women) with an age range of 22-70 years and the mean duration of 7.7 years. 60 (39 men and 21 women) patients had airborne contact dermatitis, 5 mixed pattern and 9 CAD pattern at the onset. Of the 60 patients with airborne contact dermatitis, 27 (19 men and 8 women) changed to CAD pattern and 11 (6 men and 5 women) to mixed pattern after an average period of 4.2 years. Of the 19 patients photopatch-tested with parthenium, 3 showed photoallergic reaction and the other 3 showed photoaggravation. Our results suggest that the clinical pattern of parthenium dermatitis undergoes a significant change after the onset, i.e. progresses from airborne contact dermatitis to mixed pattern or CAD pattern.     

Occupational airborne allergic contact dermatitis from 2-aminothiophenol

We report a case of occupational airborne contact dermatitis in a chemical technician working in the pharmaceutical industry, following accidental exposure to the vapors of 2-aminothiophenol (an aromatic hydrocarbon used as a chemical intermediate for chemical and biomedical research). Patch testing showed positive reactions to 2-aminothiophenol 0.1% and 0.01% eth. The importance of patch testing with substances used at work to investigate occupational contact dermatitis is stressed.     

Parthenium dermatitis presenting as photosensitive lichenoid eruption. A new clinical variant

Parthenium hysterophorus is the commonest cause of airborne contact dermatitis (ABCD) in India. The disease usually manifests as itchy erythematous, papular, papulovesicular and plaque lesions on exposed areas of the body. Rarely, however, the disease may present as actinic reticuloid or photocontact dermatitis. We have observed a different clinical variant of this disease where certain patients with Parthenium dermatitis have presented with discrete, flat, violaceous papules and plaques on exposed areas of the body closely simulating photosensitive lichenoid eruption. We had 8 patients, 6 males and 2 females between 30 and 62 years of age, with itchy, violaceous, papules and plaques on the face, neck, ears, upper chest and dorsa of the hands for 6 months to 6.5 years. Four of these patients had a history of improvement of the lesions up to 30% in winter and aggravation of lesions on exposure to sunlight. There was no personal or family history of atopy. Cutaneous examination in all patients revealed multiple flat, violaceous, mildly erythematous papules and plaques on the forehead, sides and nape of neck, ears, 'V' area of the chest, and extensor aspects of the forearms and hands. Skin biopsies from these lesions showed features of chronic non-specific dermatitis. Patch testing with standardized plant antigens showed a positive patch test reaction to Parthenium hysterophorus in all patients, with a titre of contact hypersensitivity (TCH) varying from undiluted to 1 : 100. We conclude that Parthenium dermatitis may occasionally present with lesions very similar to the lesions of photosensitive lichenoid eruption in morphology and distribution. This clinical presentation of Parthenium dermatitis needs to be recognized to avoid misdiagnosis.     

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

Occupational contact dermatitis to gold

A case of occupational contact dermatitis to gold is presented. This is uncommon as gold is relatively insoluble. Allergic contact dermatitis to gold is confirmed by patch testing with gold sodium thiosulfate 0.5% in petrolatum. Occupational contact dermatitis in the gold industry can be reduced by providing workers with more protective gear and better ventilation.     

Shoe contact dermatitis from dimethyl fumarate: clinical manifestations, patch test results, chemical analysis, and source of exposure

Background: The methyl ester form of fumaric acid named dimethyl fumarate (DMF) is an effective mould-growth inhibitor. Its irritating and sensitizing properties were demonstrated in animal models. Recently, DMF has been identified as responsible for furniture contact dermatitis in Europe.
Objective: To describe the clinical manifestations, patch test results, shoe chemical analysis, and source of exposure to DMF-induced shoe contact dermatitis.
Patients, Materials, and Methods: Patients with suspected shoe contact dermatitis were studied in compliance with the Declaration of Helsinki. Patch test results obtained with their own shoe and the European baseline series, acrylates and fumaric acid esters (FAE), were recorded according to international guidelines. The content of DMF in shoes was analysed with gas chromatography and mass spectrometry.
Results: Acute, immediate irritant contact dermatitis and non-immunological contact urticaria were observed in eight adults and two children, respectively. All the adult patients studied developed a delayed sensitization demonstrated by a positive patch testing to DMF ≤ 0.1% in pet. Cross-reactivity with other FAEs and acrylates was observed. At least 12 different shoe brands were investigated. The chemical analysis from the available shoes showed the presence of DMF.
Conclusion: DMF in shoes was responsible for severe contact dermatitis. Global preventive measures for avoiding contact with DMF are necessary.     

Airborne irritant contact dermatitis and conjunctivitis after occupational exposure to chlorothalonil in textiles

Chlorothalonil (tetrachloro-1,3-benzenedicarbonitrile, CAS 1897-45-6) is a pesticide that has been on the market for many years. It is used as a fungicide in agriculture, horticulture, and floriculture; as a wood preservative; and in paint. We report an epidemic of airborne irritant contact dermatitis, conjunctivitis, and upper airway complaints among seamstresses in a Portuguese trailer tent factory, which we attribute to chlorothalonil. All exposed workers had work-related skin symptoms. After patch testing, we showed that none of these were of allergic origin. Instead of allergic reactions, we noticed a delayed type of irritation after 72 hr to chlorothalonil and to the textile extracts containing high concentrations of chlorothalonil. Although allergic and irritant contact dermatitis from chlorothalonil has been described before, this is, as far as we know, the first time that a delayed type of dermatitis, conjunctivitis, and upper airway irritation after exposure to chlorothalonil in tent-cloth is described.     

Is it possible to improve the prognosis in nickel contact dermatitis?

A questionnaire was sent to 143 patients who had shown a positive patch test reaction to nickel sulfate more than 10 years earlier. 91 patients returned the questionnaire, revealing that after the testing, 73 had suffered from dermatitis, 61 especially from hand dermatitis, 37 of these patients were clinically examined and patch tested with standard series and in addition, 12 patients were tested with nickel sulfate and nickel chloride with different occlusion times. At the clinic visit, 23 patients had dermatitis, 16 hand dermatitis, and 11 were symptom-free, 26 of the patients had metal items close to their skin and 21 of them had current dermatitis, 14 hand dermatitis. Of the 11 patients who had no metal exposure, 9 were symptom-free. The association of dermatitis with exposure to metal objects was statistically significant (p < 0.001). Those patients who had current dermatitis had also developed multiple allergies and reacted to nickel with shorter application times in patch tests, as compared to those who were symptom-free. It seemed possible that the prognosis for nickel dermatitis could be improved if nickel-allergic patients would strictly avoid metal contact, especially in clothing and jewelry.     

植物致变应性接触性皮炎73例分析

目的　分析观赏植物引起的变应性接触性皮炎的临床特点、诊断及治疗。方法　回顾性分析 95 0例皮炎 湿疹患者的临床特点并用斑贴试验筛选 ,对可疑植物所致者进行植物原物斑贴试验和光斑贴试验。结果　植物所致者 73例 ,占 7.7% ,植物 19种 ,以洒金桃叶珊瑚、变叶木为多。结论　观赏植物是变应性接触性皮炎的常见原因之一。     

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.     

Occupational food-related hand dermatoses seen over a 10-year period

Background. Protein contact dermatitis was originally defined in 1976 by Hjorth and Roed‐Petersen as a distinct kind of dermatitis seen in patients with occupational food contact. Even though occupational skin diseases are frequent in Denmark, little attention has been paid to protein contact dermatitis, and the frequency is unknown. Objectives. To evaluate the frequency of occupational food‐related hand dermatoses and test results in patients occupationally exposed to foods. Materials and Methods. This was a retrospective study based on examinations, including skin prick testing and patch testing, performed at the Department of Dermato‐Allergology, Gentofte University Hospital, Denmark between 2001 and 2010. Results. Of all patients (n = 372), 57.0% had irritant contact dermatitis, 22.0% had protein contact dermatitis, 2.4% had contact urticaria, and 1.8% had allergic contact dermatitis. A suggestion for diagnostic criteria is presented. Frequent risk occupations were cooking in restaurants, baking, and kitchen work. Substantially more patients reacted in skin prick testing with fresh foods than with food extracts. Conclusion. Protein contact dermatitis is a frequent disorder among patients who professionally handle foods, and should be considered to be a distinct clinical entity. When diagnosing protein contact dermatitis and in other food‐related skin prick testing procedures, it is important to include fresh foods.     

Allergic contact dermatitis from chironomids

Although Type I allergy to chironomids is well-known, allergic contact dermatitis caused by these cosmopolitan insects has not previously been reported. In the case we describe in this report, patch tests disclosed a delayed-type hypersensitivity to 4 different species of chironomids (larvae of Chironomus thummi, Chironomus plumosus, and 2 different species of Glyptotendipes) as the probable cause of airborne facial contact dermatitis. An additional asymptomatic immediate-type allergy to chironomids was demonstrated by scratch tests and specific IgE. The possible sources of exposure to chironomids, their allergens and their distribution are discussed with regard to clinical implications.     

Allergic contact dermatitis from para-tertiary-butylphenol-formaldehyde resin (PTBP-FR) in athletic tape and leather adhesive

4 girls with severe allergic contact dermatitis from a brand of athletic tape and a cobbler with allergic contact dermatitis from leather adhesive are presented. Alkylphenol resin with unknown chemical structure had been compounded in both products. One of the girls developed foot dermatitis later from the adhesive used on the inside of new sneakers. By patch testing and chemical analysis of alkylphenol resin and the products, the 5 patients were given a specific diagnosis of allergic contact dermatitis from PTBP-FR.     

A Case of Contact Dermatitis Due to Sodium Bisulfite in an Ophthalmic Solution

We report a case of contact dermatitis due to sodium bisulfite in Tathion^® eye drops. A 72-year-old woman was treated daily with two solutions including Tathion^® eye drops for senile cataract for two years and three months. She developed edema, swelling, erythema, and vesicles on her eyelids. Because contact dermatitis due to a topical medication was suspected, patch testing was performed after disappearance of her eruption. A positive reaction to sodium bisulfite in Tathion^® eye drops was confirmed. Therefore, we diagnosed her eruption as contact dermatitis due to sodium bisulfite. The reaction to sodium sulfite in the next patch testing was negative. To the best of our knowledge, this is the first report from Japan about contact dermatitis caused by this medication.