Mango dermatitis: Allergic contact dermatitis to Mangifera indica

‘Mango Dermatitis’ is the common term given to allergic contact dermatitis to the sap or skin of the fruit of Mangifera indica. Four patients presented with urticaria and eczematous rash following exposure to mangoes or the trees. Patch testing with diluted sap, crushed leaf, crushed stem and fruit skin was strongly positive.     

Atopiform dermatitis

It is proposed to introduce the term 'atopiform dermatitis' to describe patients who have dermatitis with many of the characteristics of true atopic dermatitis, but who are not atopic. Atopy should be defined as the genetically determined and environmentally influenced syndrome in which the primary immunological abnormality is the production of allergen-specific IgE. It is suggested that by making a distinction between atopiform dermatitis and true atopic dermatitis, subsequent genetic, immunological and therapeutic studies will be improved. Furthermore, atopiform dermatitis would be a more appropriate diagnosis for the atopic dermatitis-like skin diseases that may occur in syndromes such as phenylketonuria, Schwachman's syndrome, Wiskott-Aldrich syndrome, Netherton's syndrome, Job's syndrome, selective IgA deficiency, agammaglobulinaemia and ataxia telangiectasia. In contrast to patients with true atopy, patients with atopiform dermatitis can logically be advised that allergen avoidance is not required, as they have no allergen-specific IgE.     

Occupational contact dermatitis

The dermatologist should be aware of the many facets of occupational skin diseases, which can be caused by physical, chemical, and biological insults. The most common manifestation of occupational skin diseases is contact dermatitis (both irritant and allergic). Three factors point out the importance of occupational skin diseases as diseases that have a public health impact: 1) occupational skin diseases are common; 2) they often have a poor prognosis; and 3) they result in a noteworthy economic impact for society and for an individual. They are also diseases amenable to public health interventions. Specific industries and exposures may put a worker at risk of occupational contact dermatitis. The accuracy of the diagnosis of occupational contact dermatitis is related to the skill level, experience, and knowledge of the medical professional who makes the diagnosis and confirms the relationship with a workplace exposure. Prevention of occupational contact dermatitis is important, and a variety of prevention strategies are available.     

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.     

Occupational dermatitis in bakers: a clue for atopic contact dermatitis

6 patients are described who developed contact dermatitis after cereal contact on atopic skin for periods of 2 to 20 years. 2 patients were wheat flour patch-test-positive. They had punch biopsies taken for standard histological and immunohistochemical investigation by labeling with monoclonal antibodies, anti-DR and anti-IgE. Sections showed features of contact dermatitis. There were many dendritic cells located perivascularly in the papilla and in the epidermidis, intensely positive for monoclonal anti-IgE antibody. In control atopic subjects, there were a few perivascular IgE positive cells, probably mastocytes. This study shows that there may be a relationship between some allergens and atopic eczema in patients exposed to them in the course of their work. In some cases, there was a true allergic contact dermatitis, seen through the clinical and histological characteristics, and the results of immunohistochemical study.     

Allergic contact dermatitis to plant extracts in patients with cosmetic dermatitis

Cosmetic contact allergy is commonly seen in patients undergoing patch testing, with fragrance one of the most frequently implicated ingredients. Many cosmetics contain plant extracts either as a fragrance or for medicinal properties. With a vogue for natural products there is an increase in their use. We have performed a prospective study over a 2-year period looking at the prevalence of contact allergy to plants in patients diagnosed with cosmetic dermatitis. In addition, we have performed a review of the products of two popular cosmetic companies, examining product labelling and the prevalence of use of plant extracts. We suggest that patients allergic to fragrance be advised to avoid plant extracts, which are separately labelled, in their personal care products.     

Persistent post-occupational dermatitis

Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.     

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.     

Atopic contact dermatitis

Contact urticaria appears either as wheal and flare reactions or as dermatitis resembling other types of contact dermatitis. A nonimmunologic form of contact urticaria is seen more frequently than the allergic form of the disease in experimental conditions. However, the immunologic form of contact urticaria is clinically more important. It is often seen in atopic persons working in the food industry or in kitchens.
We can prevent many cases of occupational anaphylactic hand eczema by choosing proper jobs for atopic persons. Especially handling food seems to produce hypersensitivity reactions in atopic more frequently than in nonatopic persons.     

Venison contact dermatitis

A 37-year-old meat inspector presented with a 5-month history of forearm eczema. His symptoms improved at weekends and over holidays but flared within a day of work. Scratch patch tests were strongly positive to fresh venison diaphragm and venison liver and weakly positive to venison hide and blood, and lamb blood. They were negative to other venison and lamb components. Type IV allergy tests with Standard European and fragrance batteries were negative. The eczema cleared with a change in work role, clobetasol-17-propionate cream, flucloxacillin and aqueous cream. He was then able to return to meat inspecting. Provided he was diligent about applying 'Dermashield' barrier foam and minimizing contact with irritants, his eczema has remained well controlled over the last 4 years. Attention to irritant contact dermatitis is important in the management of protein contact urticaria.     

Descriptive epidemiology of hand dermatitis at the St John's contact dermatitis clinic 1983-97

For 15 years, hand dermatitis accounted for a quarter of patients seen in this clinic. The highest proportion occurred in women aged 17-30 years. Overall, the male to female ratio was 0.8, which contrasts with population-based studies. Catering was most frequently associated with occupational hand dermatitis. Other frequent occupational associations included metalworking, hairdressing, healthcare and mechanical work.     

类风湿性嗜中性皮炎

报告1例类风湿性嗜中性皮炎.患者女,60岁.因腰腹部风团样红斑、丘疹及结节伴瘙痒1个月就诊.患者有10年类风湿关节炎病史,类风湿因子阳性.皮肤科检查:腰、背、腹部密集红色或肤色丘疹、结节,或风团样红斑,直径2～4mm,未见糜烂、坏死及结痂.皮损组织病理检查:真皮中性粒细胞呈带状浸润,核尘明显,无血管炎改变.10d后皮损自行消退.