Increased retest reactivity by both patch and use test with methyldibromoglutaronitrile in sensitized individuals

Hyperreactivity on re-exposure of previous allergic contact dermatitis skin areas has been previously demonstrated. This study aimed to investigate in methyldibromoglutaronitrile (MDBGN) allergic patients whether skin with previous allergic dermatitis from MDBGN showed an augmented response on re-exposure by both a patch test challenge and a use test with a liquid soap preserved with MDBGN. MDBGN dermatitis was elicited on the back and arms of sensitized individuals. One month later the previously eczematous areas were challenged with MDBGN. On the back, the test sites were patch-tested with a serial dilution of MDBGN and a use test was performed on the arms with an MDBGN-containing soap. A statistically significant increased response was seen on the areas with previous dermatitis on the back. Eight of the nine patients who developed dermatitis on the arms from the MDBGN-containing soap had an augmented response on areas with prior allergic contact dermatitis. Even though the allergic dermatitis appeared to be healed, an increased reactivity to allergen re-exposure was demonstrated both by patch test and use test challenge.     

The effect of topical cyclosporin A on the elicitation phase of allergic contact dermatitis

The effect of cyclosporin A (CSA) on the elicitation phase of allergic contact dermatitis was investigated. Initially, the ability of CSA to penetrate normal human cadaver skin was determined using 3 different vehicles. 10% CSA in Labrafil was found to be the most effective combination at achieving skin penetration (0.33%). Patients with known contact sensitivities to a variety of allergens were selected. After a 48-h pretreatment with 10% CSA in Labrafil, skin sites were exposed to the appropriate contact allergen. 72 h later, the development of an eczematous patch test reaction was evaluated. Only 1 of 10 patients showed unequivocal signs of suppression of allergic contact dermatitis.     

Case of allergic contact dermatitis due to 1,3‐butylene glycol

1,3‐Butylene glycol (1,3‐BG) is widely used in cosmetics, including low‐irritant skin care products and topical medicaments, as an excellent and low‐irritation humectant. We report a case of allergic contact dermatitis caused by 1,3‐BG. A 28‐year‐old woman suffered from an itchy erythematous eruption on her face. By 2 days of closed patch testing, her own cosmetics and many of the hypo‐irritant skin care products showed positive results. A second patch testing showed positive reaction to 1,3‐BG (1% and 5%). 1,3‐BG was a common component in most of the products that had elicited a positive reaction in the first patch testing. Although allergic contact dermatitis due to 1,3‐BG is not so common, we have to consider 1,3‐BG as a possible contact allergen in the patients presenting with allergic contact dermatitis due to various cosmetics.     

Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva

Irritant and allergic contact dermatitis are commonly seen in patients complaining about itching, burning and irritation in the vulvar area. Irritation often precedes allergic sensitization. Clinically, irritant and allergic contact dermatitis can be difficult to distinguish. Diagnosis is made by history, clinical investigation and patch testing. Recommended patch test series are the standard series, a medicament series, the patient's own topical medicaments, popular remedies and other suspected products. A skin biopsy may be useful to establish the diagnosis of contact dermatitis, but it is usually not helpful for the differential diagnosis between irritant and allergic dermatitis.     

Allergic contact dermatitis from tacrolimus

A 9-year-old boy developed allergic contact dermatitis from tacrolimus ointment. Tacrolimus was proven to be the allergen by right-versus-left double-blinded provocative use testing of tacrolimus ointment 0.1% versus inactive vehicle applied twice daily to normal preauricular and antecubital skin. Facial dermatitis appeared after 1 week and antecubital dermatitis after 7 weeks. Furthermore, patch testing of each individual ingredient was positive only with tacrolimus; a concentration of 2.5% in ethanol was required. Forty control patients had negative patch tests with tacrolimus 5% in ethanol. We hypothesize that the unusually long time required to elicit a positive use test on the arm and the high patch test concentration required on the back are caused by low percutaneous absorption through normal extrafacial skin. This is likely to be caused in part by the high molecular weight of tacrolimus. A similar phenomenon may occur when patch testing with neomycin sulfate.     

Results of evaluating health care workers with prick and patch testing.

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. Recently, much attention has been focused on latex sensitivity, which commonly causes contact urticaria. Most studies have examined the conditions of irritant or allergic contact dermatitis and contact urticaria independently. Therefore, we have little information about the possible occurrence of these conditions in the context of combined assessment including both prick and patch testing. OBJECTIVE: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria in a group of health care workers presenting with skin problems. METHODS: Retrospective review of health care workers assessed by both prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 61% with irritant contact dermatitis, 31% with allergic contact dermatitis, and 27% with contact urticaria to latex. Eleven percent had both allergic contact dermatitis related to thiuram and contact urticaria to latex. Ninety five percent were deemed to be work-related. CONCLUSION: Health care workers presenting with skin complaints should be assessed with both prick and patch testing.     

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.     

Immunofluorescence of the skin in allergic diseases: an investigation of patients with contact dermatitis, allergic vasculitis and atopic dermatitis.

Skin biopsies for immunofluorescent studies were taken from patients with contact dermatitis (positive patch tests), atopic dermatitis and allergic vasculitis for comparison with normal-appearing skin from the same patients, and from healthy controls. A variety of deposits of immunoglobulins, complement components and fibrinogen were demonstrated in 6 out of 20 patients with contact dermatitis, 7 out of 10 with atopic dermatitis, 8 out of 10 with allergic vasculitis, and in 4 out of 20 control individuals. No diagnostic pattern of deposits was found. Elevated serum IgE and eosinophilic counts were found in patients with atopic dermatitis, and high serum IgA and fibrinogen levels were found in the allergic vasculitis group.     

Occupational allergic contact dermatitis caused by diethylenetriamine in carbonless copy paper

Carbonless copy paper, or no carbon required'(NCR) paper, has often been implicated as the cause of skin, respiratory, or general symptoms, but allergy has been verified in only a few cases. A 43-year-old machinist whose work involved the manufacture of NCR paper developed occupational dermatitis on the hands. On patch testing, both the NCR paper and I of the chemicals used to produce the microcapsules of the NCR paper, namely diethylenetriamine (DETA), provoked an allergic reaction. Analysis of the paper showed that it contained enough DETA to induce allergic contact dermatitis. People who handle NCR paper and develop symptoms of contact dermatitis should be patch tested with DETA.     

Atopy patch test reaction to airborne allergens in the diagnosis of atopic dermatitis

The aim of the study was to evaluate the possible use of atopy patch test in the diagnosis of atopic dermatitis and to characterize an optimal standardized system for atopy patch test in terms of allergen concentrations and time of allergen exposure. The study included 36 patients with atopic dermatitis and IgE-mediated airborne allergy. Patients presented positive results of skin prick tests and serum antigen specific IgE against house dust mite allergens and/or selected grass pollen allergens. Control groups consisted either of patients with allergic rhinitis (control group 1) or healthy volunteers with no signs or symptoms of atopy (control group 2). Allergologic diagnostic workup consisted of skin prick test, serum antigen specific IgE and total IgE evaluation, atopy patch test with selected airborne allergens of different concentrations (0.1xSPT, 1xSPT and 10xSPT), time of allergen exposure (8, 24 and 48 h), and readings of the results (8, 24, 48 and 72 h). Positive results of atopy patch test with airborne allergens were obtained in 47.2% of atopic dermatitis patients and none of control subjects. Contact reaction itself and the intensity of reaction were demonstrated to correlate with allergen concentration and time of allergen exposure on atopy patch test. The dose and time response analysis showed the optimal concentration of allergens for atopy patch test to be 10xSPT, 500000 SBE/ml, and optimal evaluation time 24 and 48 h of allergen application. There was no correlation between atopy patch test results and mean serum concentrations of total or antigen specific IgE. Atopy patch test results did not correlate with localization of skin lesions, severity and extensiveness of skin inflammation. A significantly higher contact reactivity to airborne allergens was recorded in the group of atopic dermatitis patients with polyvalent allergy in comparison with atopic dermatitis patients allergic to only one aeroallergen. It is concluded that atopy patch test is the only provocation test currently available with clinical relevance for contact IgE-mediated sensitization in atopic dermatitis patients. Using petrolatum as a vehicle, allergen concentration of 500000 SBE/ml and evaluation time of 24 and 48 h of allergen application may lead to improved atopy patch test results.     

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.     

Erythema multiforme associated with contact dermatitis

A garment worker developed erythema multiforme concurrently with allergic contact dermatitis of the hands. Patch testing revealed sensitivity to nickel (which was present in her scissors) and to paraphenylenediamine (a commercial dye). During the course of the patch-test evaluation, both the hand dermatitis and the erythema multiforme became exacerbated. Later, patch testing to only nickel sulfate resulted in the development of erythema multiforme on the face and hands. The allergic pathogenesis, involving the absorption of an allergen through the skin and resulting in a type III allergic reaction from nickel, is discussed.     

Occupational allergic contact dermatitis from spices

About 1000 patients were investigated at our clinic during 1991 for occupational skin disease. and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove, The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods, Patch testing with spices as is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.     

Three cases of allergic dermatitis due to intravesical mitomycin C.

Irritant contact dermatitis has frequently been described in association with mitomycin instillation into the bladder. Three cases of allergic contact dermatitis in which patch tests demonstrated a type IV hypersensitivity reaction are reported. Patients showing skin reaction during mitomycin C vesical instillation should be patch tested to make a decision whether the drug might be continued (toxic reaction) or discontinued (allergic reaction).     

Expression of OKT6 antigen by Langerhans cells in patch test reactions

Previous studies in humans and guinea pigs indicate that Langerhans cells (LC) participate in elicitation of allergic contact dermatitis. The number and morphology of LC was determined in acute and healed allergic patch test sites, control (petrolatum) sites and normal skin in nickel-sensitive individuals using OKT6 monoclonal antibody and avidin-biotin/peroxidase labeling. Compared to normal skin, the staining intensity and number of epidermal LC was significantly increased in allergic (p less than 0.02) and petrolatum control (p less than 0.02) sites, and in 6- to 8-week old allergic patch test sites (p less than 0.006). The in situ changes in LC induced by petrolatum alone may be a result of the occlusive patch test, or may suggest that petrolatum is not as neutral as previously believed. The nickel-induced increase in LC may indicate changes in the LC present in the epithelium at the time of testing, or migration of additional LC into the epithelium, which can then remain in situ for weeks after the antigenic challenge. The specificity of the LC increase in allergic contact dermatitis is questioned on the basis of the increase noted with petrolatum.     

Allergic contact dermatitis due to diclofenac sodium in eye drops

Eyelid dermatitis and/or periocular dermatitis (ED/PD) is commonly seen in a variety of skin diseases such as seborrheic dermatitis, atopic dermatitis and psoriasis, but is most often associated with allergic contact dermatitis (ACD). Here, a case of ACD in an 82-year-old man is described; he used 0.1% diclofenac sodium eye drops and exhibited pruritic erythema on the eyelids. Patch test for diclofenac sodium eye drops was positive. Further patch tests revealed a positive reaction to diclofenac sodium (monosodium 2-[2, 6-dichlorophenylamino] phenylacetate), which was the main component in the eye drop medicine. Diclofenac sodium is a non-steroidal anti-inflammatory drug (NSAID), and is frequently used in everyday oral medications, topical ointments, gel agents and eye drops. Case reports on ACD caused by diclofenac sodium eye drops are extremely rare. Nevertheless, it is necessary to consider ACD due to diclofenac sodium when a patient with ED/PD has a history of use of diclofenac sodium eye drops.     

Sensitizing agents found in children and adolescents with recalcitrant atopic dermatitis: a cross-sectional study with a pediatric battery

BackgroundAtopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis.ObjectivesTo verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis.MethodsCross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens.ResultsThe prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019).Study limitationsSample size and selection, absence of a control group.ConclusionsA proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.     

Thimerosal positivities: the rôle of SH groups and divalent ions

The clinical efficiency of mitigating contact dermatitis with a Ginkgo biloba extract and carboxyme-thyl-β-1,3-glucan formulation was investigated in a double-blind versus placebo study using 22 subjects (Caucasian women aged 22–55 years) with allergic contact dermatitis from various substances in the European standard series. The formulation was applied to intact skin 2× a day for 2 weeks ("in use" application) prior to a single application of a selected contact allergen under a Finn Chamber for 24 h. Readings were carried out in a blind study by a dermatologist 2 and 3 days after patch removal. Representative photographs were taken of treated, placebo and untreated test areas. 68.2% of the panelists showed significantly reduced skin reactivity ( p = 0.037*) on the treated site 2 days after patch removal, versus untreated and/or placebo sites. This finding indicates that the Ginkgo biloba /carboxymethyl-β-1,3-glucan formulation can mitigate against allergic contact dermatitis.     

317例斑贴试验结果分析

目的：探讨皮炎,湿疹类皮肤病接触性病因及发生规律。方法：用辨敏牌标准筛选斑贴试验试剂盒对患者做斑贴试验。结果：317例患者中阳性者218例,阳性率68．77％,其中湿疹,皮炎,荨麻疹的阳性率明显高于其他病种,痤疮,丘疹性荨麻疹,唇部色素沉着亦有阳性结果。结论：斑贴试验对皮炎,湿疹类皮肤病有确定的指导,防治意义,对某些不典型的皮肤病,如寻常痤疮,丘疹性荨麻疹,唇部色素沉着等应做斑试,以排除接触过敏的可能。     

In vivo nickel allergic contact dermatitis: human model for topical therapeutics

Techniques to determine efficacy of topical agents on allergic contact dermatitis (ACD) may benefit from refinement. The aim of this study was to develop an in vivo human model system for the bioengineering and visual quantification of the effect of topical agents on nickel ACD, and to correlate ACD parameters. 14 nickel patch-test-positive subjects were included in a placebo-controlled, double-blind study after a pre-screening procedure with a standard diagnostic patch test with nickel sulfate in 54 healthy human volunteers. 5% nickel sulfate in petrolatum in a Finn Chamber was applied on forearm skin for 48 h to create a standardized dermatitis. Thereafter, the dermatitis was treated with a model topical agent and a placebo control while recording endpoint parameters daily for 10 days. Resolution was quantified with 4 parameters: visual scoring (VS), transepidermal water loss (TEWL) (Tewameter), skin blood flow volume (BFV) (laser Doppler flowmeter), and skin color (a* value) (Colorimeter). The model agent reduced cutaneous allergic reactions, especially on day 8 to 10, in comparison with the placebo control. A highly significant linear relationship exists among all parameters, except between a* and BFV. This model may provide robust biometrics for determining the efficacy of topical therapeutics on experimentally induced ACD.