The aetiology of eyelid dermatitis: a 10-year retrospective analysis

Few studies have examined the aetiology of eyelid dermatitis across broad demographics. The objectives of this study were (i) to compare the diagnoses of patients with isolated eyelid dermatitis to the diagnoses of patients with additional sites of involvement and (ii) to determine the relevant allergens among patients with allergic eyelid dermatitis. A retrospective analysis of 1215 patients patch tested over 10 years was conducted in this study. Compared to patients without eyelid dermatitis, patients with this entity were more often female. Of the 105 patients with eyelid dermatitis, 43.8% had allergic contact dermatitis (ACD), 36.2% seborrhoeic dermatitis, 11.4% other dermatitis/dermatoses, 7.6% irritant contact dermatitis, 3.8% psoriasis, and 2.9% atopic eczema. With isolated eyelid dermatitis, seborrhoeic dermatitis was the most frequent diagnosis (46.3%) followed by ACD (35.2%). Allergens commonly causing allergic eyelid dermatitis consisted of fragrances, metals, neomycin, oleamidopropyl dimethylamine, tosylamide formaldehyde resin, benzalkonium chloride, and other preservatives. When evaluated according to sites of involvement, seborrhoeic dermatitis was diagnosed most often in patients with isolated eyelid dermatitis, but when dermatitis was distributed to facial or other sites, ACD was the most frequent diagnosis. A majority of the causative allergens for eyelid dermatitis are not present on the Food and Drug Administration-approved panels available in the USA.     

Lichen planus-like atopic dermatitis: expanding the differential diagnosis of spongiotic dermatitis

Spongiotic dermatitis represents a commonly encountered histopathological pattern seen by dermatopathologists. The differential diagnosis of lymphocyte predominant acute spongiotic dermatitis typically entails atopic dermatitis (AD), contact dermatitis, nummular dermatitis, pityriasis rosea and seborrheic dermatitis. Recently, our group has characterized a distinct subtype of spongiotic dermatitis occurring exclusively in heavily pigmented patients. Clinically, lesions of this subtype are nearly indistinguishable from lichen planus. However, the histology is contradistinctive to classic lichen planus. The purpose of this report is to raise awareness among dermatopathologists of this variant as a possible diagnosis in spongiotic dermatitis specimens submitted as lichen planus.     

Scratching behavior in spontaneous- or allergic contact-induced dermatitis in NC/Nga mice

NC/Nga mice have pathological and behavioral features similar to those seen in human atopic dermatitis. There are two known dermatitis models in NC/Nga mice, one being spontaneous-induced dermatitis under conventional conditions and the other 2,4,6-trinitrochlorobenzene (TNCB)-induced allergic contact dermatitis. However, there are significant differences in time course on development of dermatitis. We studied the role of scratching behavior (sign of itch) on the development of dermatitis on spontaneous- and TNCB-induced dermatitis. We measured scratching counts, transepidermal water loss (TEWL), and skin inflammation score, under conventional conditions or by applying 5% TNCB once a week for 6 weeks in NC/Nga mice. In spontaneous-induced dermatitis, scratching counts increased with the passage of time. The scratching counts were significantly increased only 1 week after housing the mice under conventional conditions, but no changes were observed in cases of TNCB-induced dermatitis. In spontaneous-induced dermatitis, TEWL and skin-inflammation score were gradually increased, time-dependently. On the other hand, in TNCB-induced dermatitis, these dependent values rapidly increased and reached a maximum only after 24 h TNCB application. These data suggest that pathogenesis of spontaneous- and allergic contact-induced dermatitis was clearly different. It will be of major interest to identify the pruritic mediators causing profound scratching behavior and scratching-induced aggravation of inflammation in the spontaneous-induced dermatitis, as opposed to the inflammatory mediators that cause contact allergic dermatitis without major scratching.     

Contact allergy to food

Contact allergies to foods, spices, and food additives can occur to individuals in the workplace or at home. Seven different reaction types have been described. These include irritant contact dermatitis, allergic contact dermatitis, contact urticaria, protein contact dermatitis, phototoxic contact dermatitis, photo-allergic contact dermatitis, and systemic contact dermatitis. The causes of each of these are reviewed and an approach to the diagnosis and management of contact allergy to foods, spices, and food additives is formulated.     

老年特应性皮炎的诊疗研究进展

 特应性皮炎(AD)是一种与遗传有关的慢性、炎症性、瘙痒性皮肤病。随着社会发展及人口老龄化,老年AD作为AD的一种新临床亚型出现在大家的视野并且受到广泛的关注。不同于其他三型AD（婴儿期、儿童期、成人期）,老年人常患有临床表现相似的其他瘙痒性疾病（如脂溢性皮炎、老年瘙痒症、大疱性类天疱疮等）并且伴有其他潜在病症（如高血压病、心脑血管疾病、糖尿病等）,因此老年AD的诊断与治疗较其他三型复杂。本文主要对老年AD的流行病学、临床特征、诊断、鉴别诊断、治疗与管理进行综述,以引起临床医生对该新临床亚型的重视以及为老年AD的诊断与治疗提供思路。     

Occupational contact dermatitis among rubber workers

The occurrence of occupational contact dermatitis among workers in a rubber factory from 1976 to 1980 was studied. Insurance compensation was paid to 50 workers with dermatitis. 21 of the cases were allergic and 27 toxic contact dermatitis, giving a contact dermatitis frequency of 5.6/1000 workers. Paraphenylenediamine compounds were the main cause of allergic contact dermatitis and solvents the main cause of toxic contact dermatitis.     

Increased scratching counts depend on a decrease in ability of cutaneous prostaglandin D2 biosynthesis in NC/Nga mice with atopic dermatitis

Spontaneous and 2,4,6-trinitrochlorobenzene (TNCB)-induced dermatitis models using NC/Nga mice have been recognized as animal models of atopic dermatitis. We reported that scratching behavior leads to dermatitis in a spontaneous dermatitis but not in a TNCB-induced dermatitis. Prostaglandin D2 (PGD2) suppressed the scratching behavior of NC/Nga mice, suggesting that PGD2 plays a physiological role on inhibiting pruritus. We studied whether there was a difference in skin PG contents between spontaneous and TNCB-induced dermatitis. Spontaneous dermatitis was induced by cohabitation with NC/Nga mice having severe skin lesions. TNCB-induced dermatitis was caused by applications of TNCB. PGD2, PGE2, 6keto-PGF1alpha, and PGF2alpha contents in the skin were examined using enzyme-immunoassay kits. For studying ability to produce skin PGs, PG contents were evaluated after topical treatment of arachidonic acid (AA) or mechanical scratching. In spontaneous dermatitis, PGE2, 6keto-PGF1alpha, and PGF2alpha contents increased with dermatitis, but only PGD2 did not do so. In TNCB-induced dermatitis, PGD2, PGE2, 6keto-PGF1alpha, and PGF2alpha increased. Determination of skin PG contents after AA treatment or mechanical scratching revealed that skin PGD2 production of conventional group of spontaneous dermatitis was lower than the specific pathogen-free group. It seemed that ability of skin PGD2 production was attenuated in spontaneous dermatitis. These results suggest that enhancement of scratching behavior in spontaneous dermatitis was caused by the defect of ability to produce PGD2, which plays a physiological role in inhibiting pruritus, resulting in development of dermatitis.     

Perianal dermatitis and its benign simulants

Perianal dermatitis is one of the most common proctological disorders. Concerning the etiology, three different types of dermatitis must be distinguished-the most common irritative contact dermatitis, atopic dermatitis and allergic contact dermatitis. The correct diagnosis is essential for adequate and successful treatment. A variety of benign and malignant disorders must be considered in the differential diagnosis of anal dermatitis. Dermatitic clinical disorders which do not respond to therapy should always be biopsied.     

Irritant contact dermatitis: a review

Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. The diagnosis of irritant contact dermatitis is often clinical, and may only be possible after the exclusion of allergic contact dermatitis with patch testing. There is no readily available diagnostic test. There is an incomplete understanding of the factors which lead to the development of cumulative irritant contact dermatitis and persistent postoccupational dermatitis. We have used the experience from our tertiary referral occupational dermatology clinic to illustrate various aspects of irritant contact dermatitis, and to highlight the difficulty sometimes encountered in making this diagnosis. We believe that increased awareness of the often pivotal role of irritant contact dermatitis, as well as all the other factors contributing to occupational dermatitis, will lead to improvement in outcomes for patients.     

Shoe dermatitis

Foot dermatitis can be an extremely disabling problem. Blistering and weeping feet may become secondarily infected and painful fissuring often occurs, resulting in inability to walk. The diagnosis of contact dermatitis due to shoes should be considered in every case of persistent foot dermatitis. It is only by careful patch testing that this diagnosis can be made. The so-called typical clinical pattern of shoe contact dermatitis is often not present. A shoe contact dermatitis can be superimposed on an endogenous foot dermatitis.     

Five cases of contact dermatitis to a trendy pet

Skin contact with animal hair may induce contact urticaria (syndrome) or protein contact dermatitis. We report here 5 cases of dermatitis due to contact with ferrets kept as pets. The nature of the skin lesions, i.e. eczematous dermatitis, as well as the history of our 5 cases point to protein contact dermatitis. Further studies are requested to confirm this hypothesis and to identify the mechanisms and allergens. Physicians must be aware of the possibility of contact dermatitis with ferrets, especially when the patient has no previous history of atopic dermatitis and presents dermatitis of the neck, arm and around mouth.     

Topical E6005, a novel phosphodiesterase 4 inhibitor,attenuates spontaneous itch‐related responses in mice with chronic atopy‐like dermatitis

Atopic dermatitis is a chronic inflammatory cutaneous disease with difficult‐to‐treat pruritus. Although phosphodiesterase (PDE) 4 inhibitors have an anti‐inflammatory effect on inflammatory skin diseases, such as atopic dermatitis, their acute antipruritic activities remain unclear. Therefore, in this study, we examined whether E6005, a novel PDE4 inhibitor, has antipruritic activity in dermatitis, using a mouse model of atopic dermatitis (NC/Nga mice). A single topical application of E6005 inhibited spontaneous hind‐paw scratching, an itch‐associated response and spontaneous activity of the cutaneous nerve in mice with chronic dermatitis. The cutaneous concentration of cAMP was significantly decreased in mice with chronic dermatitis, and this decrease was reversed by topical E6005 application. These results suggest that E6005 increases the cutaneous concentration of cAMP to relieve dermatitis‐associated itching. Thus, E6005 may be a useful therapy for pruritic dermatitis such as atopic dermatitis.     

Contact dermatitis and nutrition

There is a worldwide increase in food and nutrition-related contact dermatitis, including irritant contact dermatitis, allergic contact dermatitis, systemic contact dermatitis, protein contact dermatitis, and photocontact dermatitis. A wide range of patients is affected by this condition, from those who consume certain foods as part of their diet to workers who handle food occupationally. Patch testing, analytical chemistry, and reporting may help in timely recognition of contact allergens. Elimination of exposure to the known food or supplement is imperative for treatment. Currently, more research is needed in order to better define the role that nutrition plays in contact dermatitis.     

Atopic cataract induced by severe allergic contact dermatitis on the face

Although atopic cataracts commonly occur in adolescent and young adult patients with severe atopic dermatitis, we observed a 34-year-old woman with mild atopic dermatitis who abruptly developed atopic cataracts in both eyes when she suffered from severe allergic contact dermatitis on the face. This case seems to suggest that prompt control of severe dermatitis on the face in patients with atopic dermatitis is important for prevention of atopic cataract, whether the dermatitis on the face is atopic or nonatopic in nature.     

Eyelid dermatitis: an evaluation of 150 patients

This study was performed to evaluate eyelid dermatitis in a group of patients of our Allergy Unit between January 1990 and April 1991. Among the 1158 patients seen during this period, 150 had eyelid dermatitis: 135 females and 15 males, with a mean age of 35 years. Of the 150 patients with eyelid dermatitis, 54 had eczema localized to the eyelids only, 49 to the eyelids and face, 19 to the eyelids and hands, and 28 to the eyelids and other sites. 98 patients (65.3%) were diagnosed as having allergic contact dermatitis, 25 (16.6%) irritant contact dermatitis, 21 (14%) atopic dermatitis, and 6 (4%) seborrhoeic dermatitis. Patch test reactions to nickel sulphate, Kathon CG and fragrance-mix occurred more frequently in patients with eyelid dermatitis than in those without.     

Parthenium dermatitis in India: Past, present and future

Parthenium dermatitis is an immuno-inflammatory disease caused by Parthenium hysterophorus and is the commonest cause of plant dermatitis in India. It is caused by airborne dry and friable plant particles including trichomes, and the most important allergens responsible for allergic contact dermatitis are sesquiterpene lactones. The combined type IV and type I hypersensitivity to parthenium has been recently postulated. In sensitized individuals, it can cause a spectrum of clinical patterns, such as classical airborne pattern, chronic actinic dermatitis-like presentation, mixed pattern dermatitis, exfoliative dermatitis, widespread dermatitis, and other rare patterns. There is definite trend towards change from airborne pattern to chronic actinic pattern in natural history of parthenium dermatitis. Contact sensitivity to parthenium is everlasting, and hence the disease runs a chronic course with exacerbation during summers. Patch testing with acetone or aqueous plant extract is the simplest way of confirming parthenium contact allergy. Management includes avoiding contact with allergen, managing dermatitis with topical corticosteroids/tacrolimus, and other immunosupressives like azathioprine. In future, we expect parthenium dermatitis to become less prevalent due to rapid urbanization and possible development of new biological methods to eradicate the parthenium. Genetic factors associated with susceptibility to parthenium dermatitis need to be studied.     

不同部位的慢性湿疹与斑贴试验相关性研究

皮炎湿疹与多种变应原之间存在联系,并且发现不同部位的皮炎湿疹的常见变应原各不相同。引起面部湿疹和皮炎的致敏原主要为硫酸镍、重铬酸钾、对苯类、芳香混合物,手部主要为硫柳汞、芳香混合物、重铬酸钾、对苯二胺,脐周主要为硫酸镍。斑贴试验有助于明确慢性湿疹和皮炎患者的接触性致敏原,并发现不同部位皮炎和湿疹常见致敏原的不同。提示临床上应根据不同部位的皮炎湿疹采取不同措施。     

Perfil de los pacientes con dermatosis en las manos remitidos a la Unidad de Contacto de un hospital terciario e impacto de las pruebas epicutáneas en el diagnóstico

ObjectiveThis study aimed to define the epidemiological and clinical characteristics of patients referred to a contact dermatitis unit for hand dermatitis.Material and methodsWe retrospectively analyzed patients referred for hand dermatitis to the contact dermatitis unit of the Hospital Germans Trias i Pujol, Barcelona, Spain, between 2004 and 2007.ResultsA total of 96 patients were included. The most common diagnosis was irritant contact dermatitis, followed by allergic contact dermatitis, psoriasis, dyshydrosis, and atopic dermatitis. Standard patch tests were done for all patients and complementary batteries were ordered in 42 (44 %). Patch tests were positive in 59 % of the patients. Positive results were considered of present relevance in 59 %, of past relevance in 6 %, and of unknown relevance in the remaining positive tests. When proposed as the initial diagnosis, allergic contact dermatitis was confirmed in 67 % of the patients. The most frequent clinically relevant allergens were chrome, nickel, rosin, plant allergens, and p-phenylenediamine.ConclusionsHand dermatitis is a frequent presenting complaint in our contact dermatitis unit, with allergic contact dermatitis being the most common. Good correlation was found between presumed diagnosis of allergic contact dermatitis and the finding of clinically relevant allergens.     

Differences between intrafollicular microorganism profiles in perioral and seborrhoeic dermatitis

Although often associated with overuse of topical corticosteroids, perioral dermatitis seems to develop seldom in patients with typical seborrhoeic dermatitis in spite of long-term application of corticosteroids. In order to compare the profiles of intrafollicular microorganisms in the lesions of perioral and seborrhoeic dermatitis, tape-stripped samples were obtained from eight lesions of perioral dermatitis, 10 lesions of seborrhoeic dermatitis, and the perioral skin of 31 normal subjects. After staining with Toluidine blue, resident microorganisms on plucked hair roots were evaluated microscopically. In all patients with perioral dermatitis and two normal subjects, 20-70% of sample hairs were positive for fusiform bacteria regarded as fusobacteria. Malassezia-positive hairs were rarely seen in these cases. Seborrhoeic dermatitis showed the opposite results. Perioral dermatitis may tend to develop under fusiform-bacteria-rich conditions, rather than Malassezia-rich conditions as in the case of seborrhoeic dermatitis.     

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.