2,4-二氯-5-甲基嘧啶致刺激性接触性皮炎64例研究

目的 了解2,4-二氯-5-甲基嘧啶(DCP)致接触性皮炎的临床特征,探讨治疗方法及防护措施.方法 对2,4-二氯-5-甲基嘧啶致接触性皮炎的64例患者进行分析.参与企业防护措施的持续改进.结果 64例患者均在接触DCP后1～ 12 min,平均7 min发病.皮损发生于DCP接触部位,表现为边界清楚的水肿性红斑,10例出现水疱,皮损面积58～5 600 cm2.48例自觉灼痛,16例自觉瘙痒.4例头痛,3例恶心、呕吐,1例晕厥.10例在避免接触DCP 1 ～4 d后,于DCP非接触部位出现皮疹,自觉瘙痒.8例皮损组织病理均为表皮细胞内及细胞间水肿,海绵形成,5例表皮内水疱,7例真皮乳头水肿,有炎症细胞浸润.糖皮质激素治疗有效.正压式充气防护服能将作业工人与外界完全隔离,可避免DCP所致接触性皮炎的发生.结论 2,4-二氯-5-甲基嘧啶所致接触性皮炎为刺激性接触性皮炎,少数患者在接触DCP后会发生迟发型过敏反应.正压式充气防护服可起到有效防护.     

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.     

Occupational irritant and allergic contact dermatitis among healthcare workers

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.     

Pediatric “pet consort dermatitis”—Allergic contact dermatitis from transfer of bronopol from a pet cat

Consort dermatitis refers to an allergic contact dermatitis caused by transfer from an intimate contact to a sensitized patient. Although close contact with other humans most commonly provokes consort dermatitis, pets have been the source in a minority of cases. We present a unique case of transfer dermatitis from a patient's cat litter to her forearms. Pediatric dermatologists should be aware of the possibility of consort or “transfer” allergic contact dermatitis from pets.     

Contact dermatitis from dielectric fluids in electrodischarge machining

We report an outbreak of irritant contact dermatitis in the aerospace industry from electrodischarge machining (EDM). 20 workers doing EDM developed irritant contact dermatitis from the dielectric fluid used in EDM, a form of precision metal machining that is widely used in mould making and precision engineering. Dielectric fluid contains hydrocarbons that are aromatic, paraffinic or naphthenic and are skin irritants. Irritant contact dermatitis from dielectric fluid has not been reported previously. EDM will become more widespread and occupational dermatitis from dielectric fluid is likely to become more prevalent in the future. Our experience was that irritant contact dermatitis from dielectric fluid can be prevented by simple preventive measures such as personal hygiene and health education.     

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.     

Contact dermatitis education in dermatology residency programs: can (will) the American Contact Dermatitis Society be a force for improvement?

BACKGROUND: Contact dermatitis accounts for a considerable portion of outpatient clinic visits to dermatologists. The state of education in contact dermatitis at the level of dermatology residency training in the United States has not been examined. OBJECTIVE: To assess the state of education in contact dermatitis in dermatology residency programs in the United States. Method: Cross-sectional survey of directors and chief residents of 105 dermatology training programs accredited by the American College of Graduate Medical Education. RESULTS: Seventy-seven percent of directors and 74% of chief residents responded to the survey. In general, both sets of respondents gave concordant responses although responses from directors were more positive. With respect to didactic education, the vast majority of programs (> 73%) held lecture conferences on contact dermatitis. Less than one-third included contact dermatitis-focused journals in journal club conferences. A bare majority of programs (57% of directors, 53% of chief residents) identified a faculty expert in contact dermatitis, with almost all experts conducting patch-test clinics and providing lectures on contact dermatitis. Seventy-five percent of experts were members of the American Contact Dermatitis Society (ACDS). Although residents in most programs (> 78%) performed patch tests to diagnose contact dermatitis, there were 14 programs in which none of their graduates performed such tests. Moreover, only 27% of programs had rotations dedicated to contact dermatitis and/or patch testing. Finally, directors and chief residents predicted that most graduates will incorporate the TRUE Test and not the more extensive or customized patch tests in their practices. CONCLUSIONS: Several opportunities for improving contact dermatitis education in residency programs were identified, including recruitment or development of more faculty experts in contact dermatitis, creation of rotations dedicated to contact dermatitis, and greater inclusion of contact dermatitis-focused journals in journal club conferences. As the principal interest group for contact dermatitis in the United States, the ACDS is the logical organization to spearhead improvement of contact dermatitis education in residency programs.     

Eyelid dermatitis: experience in 203 cases

Allergic contact dermatitis has been considered the most common of the many dermatologic conditions found with eyelid dermatitis. This is a retrospective study of 203 patients who presented with persistent or recurrent eyelid dermatitis with or without dermatitis elsewhere. Almost all underwent patch testing and, when indicated, radioallergosorbent test, skin prick and intradermal tests, and in many cases, usage tests as part of the workup. Relevant allergic contact dermatitis was found in 151 of 203 patients (74.%): 46 (23.%) had protein contact dermatitis, but only 7% had protein contact dermatitis without concurrent allergic contact dermatitis. Less than 1% had irritant dermatitis alone. Twenty-three patients had atopic eczema, of whom 16 also had allergic contact dermatitis, protein contact dermatitis, or both. Other conditions included seborrheic dermatitis (n = 11), psoriasis (n = 7), dry eyes (n = 9), and dermatomyositis or overlapping connective tissue disease (n = 7). Important sources of contact sensitivity include cosmetics, metals, topical medications including corticosteroids, eye medications, dust mites, animal dander, and artificial nails; only 5 cases were caused by nail lacquer. Eyelid dermatitis is a multifaceted clinical problem, but in this group of patients, allergic contact dermatitis was a common cause, even among those with atopic eczema.     

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.     

The CXCR3 activating chemokines IP-10, Mig, and IP-9 are expressed in allergic but not in irritant patch test reactions.

Differentiation between allergic and irritant contact dermatitis reactions is difficult, as both inflammatory diseases are clinically, histologically, and immunohistologically very similar. Previous studies in mice revealed that the chemokine IP-10 is exclusively expressed in allergic contact dermatitis reactions. In the present study, we investigated whether the mRNA expression of IP-10 and the related CXCR3 activating chemokines, Mig and IP-9 are also differentially expressed in human allergic contact dermatitis and irritant contact dermatitis reactions. Skin biopsies from allergic (13 cases) and sodium lauryl sulfate-induced irritant patch test reactions (13 cases), obtained 1-72 h after patch testing, were studied by means of an in situ hybridization technique. Results of chemokine mRNA expression were correlated with clinical scoring, histology, and immunohistochemical data including the proportion of inflammatory cells expressing CXCR3, the receptor for IP-10, Mig, and IP-9, and ICAM-1 and HLA-DR expression on keratinocytes. IP-10, Mig, and IP-9 mRNA were detected in seven of nine allergic contact dermatitis reactions after 24-72 h, but not in sodium lauryl sulfate-induced irritant contact dermatitis reactions. ICAM-1 expression by keratinocytes was only found in allergic contact dermatitis reactions and correlated with chemokine expression. Moreover, up to 50% of the infiltrating cells in allergic contact dermatitis expressed CXCR3, in contrast to only 20% in irritant contact dermatitis reactions. In conclusion, we have demonstrated differences in chemokine expression between allergic contact dermatitis and irritant contact dermatitis reactions, which might reflect different regulatory mechanisms operating in these diseases and may be an important clue for differentiation between allergic contact dermatitis and irritant contact dermatitis reactions.     

Occupational protein contact dermatitis and paronychia from natural rubber latex

Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.     

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.     

Skin disorders in amputees

BACKGROUND: Dermatologic problems restrict the normal use of a prosthetic limb. The importance of contact dermatitis to skin morbidity in a population of amputees and the selection criteria for patch testing have not been clearly defined. OBJECTIVE: We describe the range of dermatoses seen in a population of amputees and examine the incidence, causes, and patterns of contact dermatitis. METHODS: This is a questionnaire-based, cross-sectional study of 210 amputees. Those with a skin problem were assessed by a dermatologist. Patch testing was undertaken in patients with persistent dermatitis. RESULTS: A total of 34% of amputees experienced a skin problem. Lesions resulting from friction, pressure, and occlusion are common. Allergic contact dermatitis is seen in a third of patients with stump dermatitis. There are no features that distinguish allergic from irritant (chemical or physical) dermatitis. CONCLUSION: Dermatologic problems are common in prosthetic limb users. Allergic contact dermatitis is a significant problem, and all patients with dermatitis on the residual limb should be patch tested.     

季节性接触性皮炎患者白介素4水平与血清总IgE含量的关系

目的 研究季节性接触性皮炎患者血清总IgE产生与白介素4(IL-4)水平的关系。方法 用三抗体免疫放射测定法(IRMA)检测了29例季节性接触性皮炎患者和35例非季节性接触性皮炎患者血清总IgE水平;用ELISA法检测外周血单一核细胞体外培养在PHA诱导后IL-4的分泌,并以24例正常人做对照。结果 季节性接触性皮炎患者的IL-4水平增高(P<0.01),且血清总IgE水平高于正常对照(P<0.01).IL-4水平与血清总IgE水平呈高度正相关(r=0.96,P<0.001).结论 季节性接触性皮炎的发病机理可能不同于非季节性接触性皮炎,其血清总IgE的增高可能与IL-4水平增加有关。     

PICC置管术后透明敷料贴敷致接触性皮炎资料分析

目的：明确972例恶性肿瘤患者置入PICC置管术后因透明敷料所致接触性皮炎的发生率和危险因素。方法：对恶性肿瘤置入PICC导管后因透明敷料所致接触性皮炎患者的性别、年龄、体重指数、cTNM分期、药物过敏史、肿瘤类型、嗜酸性粒细胞和嗜碱性粒细胞水平等可能影响接触性皮炎发生的危险因素进行单因素和多因素分析。结果：972例置入PICC导管肿瘤患者中,有80例接触性皮炎（男21例,女59例）,发生率为8.23％;单因素分析显示,嗜酸性粒细胞水平、睡眠状态、体重指数、药物过敏史与接触性皮炎发生有关（P＜0.05）;多因素分析显示,失眠、肥胖、药物过敏史是接触性皮炎的独立危险因素（P＜0.001）。结论：PICC置管术后因透明敷料所致的相关接触性皮炎的发生率较高。失眠、肥胖、药物过敏史是PICC置管术后透明敷料所致接触性皮炎的独立危险因素。     

Allergic contact dermatitis from the adhesive remover wipe of stoma bags

Skin disorders at ostomy sites are common and include irritant contact dermatitis from the draining fluid and/or the ostomy devices, intertrigo, and bacterial and mycotic infection (1). Allergic contact dermatitis has also been described, from a karaya seal ring (2), stoma adhesive paste (3), and rubber (4). The allergens causing contact dermatitis from ostomy bags, have been defined as epoxy resin (5–7), diaminodiphenylmethane (8) and polyisobutylene (9).     

Allergic contact dermatitis in veterinary surgeons

Thirty-six of 37 veterinary surgeons with incapacitating dermatitis had allergic contact dermatitis, mainly from antibiotics such as spiramycin, Penethamate BP and tylosin. Eight were sensitive to rubber materials. Twenty of 36 had positive prick or scratch tests, mainly to animal hair. The atopic sensitivities were relevant to the contact dermatitis since most of those who have them develop contact reactions from cows' hair and from obstetric work with cows. Protein contact dermatitis seems to be an important predisposing factor for the development of incapacitating allergic contact dermatitis in veterinary surgeons.     

Delayed irritation: Hexanediol diacrylate and butanediol diacrylate

Ephemeral topical contact with hexanediol diacrylate and butanediol diacrylate may cause delayed irritant dermatitis. During 4 years' observation of 20 workers utilizing these substances in the electron beam coating department of a door factory, contact sensitization did not occur. The characteristics of delayed contact irritancy are enumerated. The disease must be distinguished from allergic contact dermatitis, acute irritant dermatitis and cumulative irritant dermatitis.     

Erythema multiforme following application of hair dye

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with varying degrees of blistering and ulceration. Common causes of EM are herpes simplex virus infection, mycoplasma infection, drug hypersensitivity, vaccination and drug-virus interaction. EM induced by contact dermatitis is rare. Paraphenylene diamine, a common ingredient in many hair dyes, is well known to produce allergic contact dermatitis. We report a 35-year-old lady presenting with EM following severe contact dermatitis to hair dye. So far as we know, this is the first report from India describing EM following contact dermatitis.     

Contact dermatitis in military personnel

Military personnel encounter the same allergens and irritants as their civilian counterparts and are just as likely to develop contact dermatitis from common exposures encountered in everyday life. In addition, they face some unique exposures that can be difficult to avoid owing to their occupational duties. Contact dermatitis can be detrimental to a military member's career if he or she is unable to perform core duties or avoid the inciting substances. An uncontrolled contact dermatitis can result in the member's being placed on limited-duty (ie, nondeployable) status, needing a job or rate change, or separation from military service. We present some common causes of contact dermatitis in military personnel worldwide and some novel sources of contact dermatitis in this population that may not be intuitive.