Contact dermatitis from a presumed allergy to paraphenylenediamine

Paraphenylenediamine (PPD) is a potent skin allergen found in permanent hair dye and temporary henna tattoo ink. Several cases of adverse skin reactions to PPD have been reported in the literature. Here we present a case involving a patient who acquired a temporary tattoo while vacationing in Mexico and subsequently developed contact dermatitis at the tattoo site. He provided a history of permanent hair dye use in the past with associated cutaneous reaction. Temporary tattoos have become increasingly popular with travelers and as a result so have reports of associated allergic contact dermatitis. Of concern is cross‐reaction of PPD to related compounds, severe reactions in younger populations and sequelae including increased sensitization, permanent scarring, and persistent postinflammatory hyperpigmentation.     

Contact dermatitis to topical acne drugs: a review of the literature

Acne vulgaris is a chronic dermatological disorder that affects the majority of teenagers in the Western world. Topical therapy is widely used to treat mild‐moderate acne and is known as well‐tolerated thanks to its low systemic toxicity, although associated to skin adverse effects. Acne seems to be associated also to an intrinsic alteration of the epidermal barrier, regarding both the upper and the follicular stratum corneum that promotes the onset of such local side effects. The commonest one is irritant contact dermatitis, an event of frequent observation occurring with erythema, burning, dryness, scaling, and itching, usually characterized by low severity and limited duration. Among topical acne drugs, retinoids are the most irritating ones. Another side effect is allergic contact dermatitis: it is rare and mainly associated to benzoyl peroxide.     

Analysis of patch testing results in patients with contact dermatitis in Istanbul,Turkey, from 2012 to 2022

Background

Allergens responsible for allergic contact dermatitis (ACD) differ between populations. They can even change over the years with the effect of environmental factors.

Aims

To evaluate the results of patch testing performed in our center.

Methods

In this study, the thin-layer rapid-use epicutaneous (T.R.U.E.) test results of patients with a diagnosis of ACD between 2012 and 2022 were retrospectively evaluated.

Results

In 431 (42.5%) of the total 1012 patients, a positive reaction to at least one allergen was detected in the patch test. Allergen positivity was most detected for nickel sulphate (16.8%), gold sodium thiosulfate (GST) (6.9%), thimerosal (4.2%), fragrance mix (3.4%), carba mix (3.2%), and cobalt dichloride (2.9%). Nickel sulfate and GST sensitivity was found to be significantly higher in women, fragrance mix sensitivity in men, thimerosal sensitivity in individuals aged under 40 years, colophony and balsam of Peru sensitivity in head and neck dermatitis, and carba mix and thiuram mix sensitivity in atopic individuals.

Conclusions

This study presents comprehensive data from Turkey concerning the sensitivity frequencies for allergens included in the T.R.U.E. test.     

An update on airborne contact dermatitis: 2001-2006

Reports on airborne dermatoses are mainly published in the context of occupational settings. Hence, in recent years, dermatologists and also occupational physicians have become increasingly aware of the airborne source of contact dermatitis, resulting mainly from exposure to irritants or allergens. However, their occurrence is still underestimated, because reports often omit the term 'airborne' in relation to dust or volatile allergens. For the present update, we screened the journals 'Contact Dermatitis' (July 2000 to December 2006); 'Dermatitis', formerly named 'American Journal of Contact Dermatitis'; 'La Lettre du Gerda' (January 2000 to December 2006); and also included relevant articles from other journals published during the same period. This resulted in an updated list of airborne dermatitis causes.     

The immunology of Contact dermatitis

This review summarizes current knowledge of the pathophysiological events which lie behind the development of contact dermatitis. The clinical distinction between allergic and irritant eczema is discussed. New observations are evaluated on our understanding of how allergic and irritant eczema may in many respects be similar, evolving through common physiological pathways of immune inflammation.     

Sites of dermatitis in a patch test population: hand dermatitis is associated with polysensitization

Background  Sites of dermatitis in larger series of contact allergic patients are rarely reported. Increased risk of polysensitization has been linked only to stasis dermatitis and leg ulcers. However, a large proportion of polysensitized individuals may have dermatitis in other skin areas.
Objectives  To examine the site of dermatitis at time of first appearance in contact allergic individuals with special focus on the distribution of dermatitis in polysensitized individuals and to examine if widespread dermatitis is more frequent in polysensitized than in single/double-sensitized patients.
Methods  A matched case–control study was carried out including 394 polysensitized and 726 single/double-sensitized patients who responded to a postal questionnaire. All subjects were recruited from a hospital patch test population.
Results  The hands were the most frequent and the anogenital region was the least frequent skin area affected with dermatitis. Dermatitis on the hands/wrists [odds ratio (OR) 1·58], in the armpits (OR 1·56) and on the back (OR 1·91) was positively associated with polysensitization. The hands were the only skin area with dermatitis which maintained the association to polysensitization in two subpopulations consisting of, respectively, individuals with and without atopic eczema. Dermatitis on the scalp was negatively associated with polysensitization (OR 0·66) primarily for individuals without atopic eczema. The dermatitis did not seem to be more widespread in polysensitized compared with single/double-sensitized patients.
Conclusions  Special awareness in patients with hand dermatitis seems justified either to prevent development of multiple contact allergies or to document polysensitization as an aetiological factor.     

Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema

BACKGROUND: Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis. OBJECTIVES: To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups. METHODS: Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job. RESULTS: The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19.9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27.2%) compared with those in wet occupations (20.1%) and other occupations (16.5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations. CONCLUSIONS: Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job.     

Allergic and photoallergic contact dermatitis to chlorpromazine

Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.     

Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis

Background:  Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long-term therapy because of potential side-effects. New treatment options are highly appreciated.
Objective:  To study efficacy and safety of tacrolimus in patients suffering from OHD.
Patients and Methods:  In a prospective, open, multicentre study, 29 patients with OHD of predominantly mild-to-moderate severity were treated with tacrolimus ointment (Protopic^® 0.1%) during a 4-week active treatment period with twice daily application followed by a 2-month optional treatment period. Efficacy was evaluated by the use of a standardized hand eczema score and by clinical severity rating, conducted on all study visits (screening, baseline and weeks 2, 4, 6, and 12). Adverse events were recorded for safety evaluation.
Results:  The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Finally, 12 (44%) patients were clear of hand eczema. Worsening of the dermatitis occurred in 2 patients (7%). Clinical grading indicated improvement too. Overall tolerability was good.
Conclusion:  Topical tacrolimus might be an efficacious treatment option for chronic OHD. Blinded and randomized controlled studies are necessary to confirm the results of this pilot study.     

One thousand cases of severe occupational contact dermatitis

Background. Occupational contact dermatitis is frequent, and further understanding of the epidemiology will improve the basis of its prevention. Objectives. To identify occupations at risk for severe occupational contact dermatitis. Methods. The last 1000 cases of severe occupational contact dermatitis seen at our department were identified. Results. The study population comprised 618 females and 382 males. The mean age at onset of irritant contact dermatitis was significantly lower than the mean age at onset of allergic contact dermatitis for both sexes, irrespective of the presence of atopic dermatitis. Females at high riskwere cooks, butchers, beauticians, bakers, and hairdressers, ranging from 23.3 to 96.8 cases per 10 000 workers per year. Males at high risk were painters, cooks, mechanics, locksmiths, and bakers, ranging from 16.5 to 32.3 cases per 10000 workers per year. Conclusions. Occupational contact dermatitis remains frequent, even if only severe cases are considered. It is a concern that no effective, systematic interventions and prevention schemes have been launched in Europe, despite documentation of a significant problem overmany years, and knowledge of risk occupations and risk factors. This study suggests new approaches for general and specific prevention of occupational contact dermatitis.     

初次变应性接触性皮炎小鼠模型的建立与评价

目的 建立并评价初次变应性接触性皮炎（ACD）小鼠模型。方法 用1-氟-2,4二硝基苯（DNFB）分别制作经典ACD小鼠模型及初次ACD模型,在以下3方面对二者进行比较：以激发前后耳肿度为临床观察指标;以ELISA与实时RT-PCR方法检测耳组织中IL-2、INF-γ与IL-4的表达水平;进行局部淋巴结分析（LLNA）,以流式细胞术检测耳引流淋巴结中淋巴细胞增殖与活化的情况。结果 初次ACD小鼠模型耳背部单次用药6天后出现较明显的耳肿度变化,这与经典ACD模型自诱导至炎症出现的时间相同;与经典ACD小鼠模型相似,初次ACD小鼠模型的耳肿度亦呈现出随时间变化的趋势;二者组织浸润细胞均以单一核细胞为主;与正常小鼠相比,二者组织中Th1型细胞因子IL-2与IFN-γ表达均增加,Th2型因子IL-4均未增加,耳引流淋巴结中T淋巴细胞均出现明显增殖与活化。结论 初次ACD模型与经典模型机制相似,均为Th1型变态反应,二者可以互用。