Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome

In spite of not knowing the numbers of people exposed and obviously incomplete reporting, the known mechanisms of alcohol cutaneous intolerance and the literature classified according to mechanisms are listed. Testing techniques for delayed- and immediate-types are proposed.     

Shoe contact dermatitis

The incidence of contact allergy was studied in a series of 165 patients with eczematous dermatitis of the feet correlated clinically with shoe contact. Positive reactions to one or more substances were recorded in 108 patients (65.4%). Among the relevant sensitizers were chromium, paraphenylenediamine, paratertiary butylphenolformaldehyde resin and nickel, while the other allergens were benzocaine, neomycin, balsam of Peru, ethylenediamine and parabens. Allergic contact dermatitis of the feel can he prevented by recognition of the allergens responsible, control of hyperhidrosis and avoidance of topical allergens.     

Fungicide-induced contact dermatitis

Tetrachloroisophthalonitrile (TCPN) is an agricultural and horticultural fungicide used in many parts of the world. In Northern Europe it is also used as a wood preservative.
The substance has well-known toxic properties through skin contact, and has recently been reported as inducing allergic contact dermatitis.
We report an epidemic of contact dermatitis in a Norwegian wooden-ware factory, which we attribute to TCPN. 14 out of 20 workers had skin complaints which were work related. Half of these cases were shown to be of allergic origin.
The toxic and allergic properties of TCPN render this compound unsuitable for use in the wooden-ware industry. A re-evaluation of its use in agriculture and horticulture seems appropriate.     

Allergic contact dermatitis

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.     

Photoallergic contact dermatitis

PURPOSE: To determine whether photoallergic contact dermatitis is as uncommon as it is usually considered to be and to review the associated clinical features. METHODS: We reviewed the literature on photoallergic reactions induced by the topical contact of the skin with a chemical in the presence of, or followed by, exposure to UV or visible light. Some of the more recently observed photo-allergens and those presenting special clinical features are discussed. RESULTS: The literature cites several topical substances that give rise to photoallergic contact dermatitis, some of them only exceptionally but others quite frequently. The clinical features are not always those of a eczematous eruption, and several parts of the body may be affected. CONCLUSIONS: Many topical photoallergic culprits have been reported in the literature, the most important of which are sunscreen agents and, recently, non-steroidal anti-inflammatory agents (NSAIDs). Not at all exceptional is the occurrence of photoaggravation and recurrent transient or even persistent light reactions on previously exposed as well as non-exposed areas (often sparing the original application site), particularly with the NSAID ketoprofen. Moreover, cross-reactions with chemically-related as well as non-chemically related molecules are common. The potentially misleading clinical features observed in some cases, the diversity of the casual substances identified, and the low frequency with which photopatch testing is carried out in general indicate that the occurrence of photoallergic contact dermatitis might well be underestimated.     

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.     

Airborne contact dermatitis

Two elderly individuals suffering from acute recurrent dermatitis of light-exposed skin between spring and autumn were shown to be allergic to feverfew (Tanacetum parthenium) of the Compositae family. Patch tests revealed not only strong reactions to the plant and its constituent parthenolide but also a number of cross-reactions to related species. The source of this contact allergy was dried airborne plant particles that attached themselves to the skin during long periods outdoors. Differentiation between patterns of airborne contact dermatitis and persistent light reaction is possible by several distinct observations, i.e., in patients with airborne contact dermatitis: a) Patch tests with Compositae plant extracts and constituents will be positive. b) There will be no skin lesions in winter. c) Skin regions that are usually not impaired during light exposure will also be involved: the upper eyelids, the retroauricular region, the shady area beneath the chin.