Occupational allergic contact dermatitis and airborne contact dermatitis from 5 fungicides in a vineyard worker. Cross-reactions between fungicides of the dithiocarbamate group? *

We report a patient with occupational contact dermatitis due to sensitization to mancozeb and perhaps metiram used in a vineyard. Patch testing showed strong allergic patch test reactions to 2 of the commercially available preparations used (Dithane Ultra® and Polyram WG®). Further patch tests showed allergic patch test reactions to mancozeb (0.5 and 1% pet.) as weak reaction to metiram (1% pet.) as well as to 4 other fungicides of the dithiocarbamate group (maneb, nabam, propineb and zineb), which had never een used in the vineyard.     

Deodorants: an experimental provocation study with isoeugenol

Axillary dermatitis is common and overrepresented in people with contact allergy to fragrances. Many people suspect their deodorants to be the incriminating products. In order to investigate the significance of isoeugenol in deodorants for the development of axillary dermatitis when used by people with and without contact allergy to isoeugenol, patch tests with deodorants and ethanol solutions with isoeugenol, as well as repeated open application tests (ROAT) with roll-on deodorants with and without isoeugenol at various concentrations, were performed in 35 dermatitis patients, 10 without and 25 with contact allergy to isoeugenol. A positive ROAT was observed only in patients hypersensitive to isoeugenol (P<0.001) and only in the axilla to which the deodorants containing isoeugenol had been applied (P<0.001). Deodorants containing isoeugenol in the concentration range of 0.0063-0.2% used 2 times daily on healthy skin can thus elicit axillary dermatitis within a few weeks in people with contact allergy to isoeugenol.     

Allergic contact dermatitis to Plectranthus amboinicus masquerading as chronic leg ulcer

This report discusses a case of a 69-year-old woman who developed chronic non-healing leg ulcers after long-term topical use of Plectranthus amboinicus. The ulcer was proven to be allergic contact dermatitis to P. amboinicus by a patch test. The ulcer healed after discontinuation of P. amboinicus. To the best of our knowledge, this is the first reported case of allergic contact dermatitis to P. amboinicus masquerading as chronic leg ulcer.     

Contact allergy to gold sodium thiosulfate

278 consecutive patients with suspected contact dermatitis were patch tested with the European standard series and gold sodium thiosulfate (0.5% pet.): 13 patients (4.6%) had a positive allergic response to gold sodium thiosulfate (GST). All of these patients were female, with a mean age of 37 years. The most frequent site of eczema in these patients was the head and neck (62%). A seborrhoeic distribution of eczema was common. 46% had involvement of the limbs, 15% had a perianal or perivulval rash. The mean duration of eczema in this group of patients was 15.8 months. 54% of patients allergic to gold were also allergic to nickel. Biopsy of positive patch test reactions to GST were consistent with allergic contact dermatitis.     

Hairdressers presenting to an occupational dermatology clinic in Melbourne,Australia

Background. Hairdressers constitute one of the largest occupational groups attending our occupational dermatology clinic in Melbourne, Australia. Objectives. To perform a retrospective review of the clinical assessments of hairdressers and trainee hairdressers attending our clinic, including patch testing results. Patients/materials/methods. We used our clinic database to identify trainee and qualified hairdressers who had attended our occupational dermatology clinic between January 1993 and December 2010. Results. One hundred and sixty‐four hairdressers and hairdressing apprentices were identified. One hundred and fifty‐seven had a diagnosis of occupational contact dermatitis (OCD), with allergic contact dermatitis being the primary diagnosis in 71% and irritant contact dermatitis in 20%. Involvement of more than one body part was suggestive of allergic contact dermatitis (p = 0.05). Sixty‐five per cent of participants were found to have more than one factor contributing to their OCD. Allergic contact dermatitis was more common in apprentices than in qualified hairdressers. Ammonium persulfate, p‐phenylenediamine, toluene‐2,5‐diamine and glyceryl monothioglycolate were the most common occupational allergens. Nickel allergy was seen in 31% of hairdressers, but considered to be occupationally relevant in only 3%. Conclusions. Multiple sensitizations and multiple factors contributing to OCD in hairdressers are common. More needs to be done to prevent the development of OCD in hairdressers in our geographical region.     

High frequency of contact allergy to gold sodium thiosulfate

When gold sodium thiosulfate was added to the patch test standard series, positive reactions were obtained in 8.6% of 823 consecutive patients with suspect contact allergy. The test reactions were clinically of an allergic type and, in several cases, long-lasting. There was no correlation with other allergens in the standard series. In a special study on 38 patients with contact allergy to gold sodium thiosulfate, the following principal findings were obtained: positive patch tests to the compound itself in dilute concentration; positive patch tests to potassium dicyanoaurate; negative patch tests to gold sodium thiomalate, sodium thiosulfate, and metallic gold; positive intradermal tests to gold sodium thiomalate. Our findings make gold sodium thiosulfate the 2nd most common contact allergen after nickel sulfate. It is suggested that a positive skin test to gold sodium thiosulfate represents gold allergy.     

Autoimmune progesterone dermatitis: absence of contact sensitivity to glucocorticoids, oestrogen and 17-α-OH-progesterone

Autoimmune progesterone dermatitis is a rare condition, characterized by recurrent premenstrual exacerbations of a dermatosis, in which sensitivity to progesterone can be demonstrated. The sensitizing mechanism is unknown. The aim of this study was to test the hypothesis that cross-sensitivity between steroid groups could induce allergy to endogenous progesterone in these patients. 5 patients with autoimmune progesterone dermatitis and 1 with oestrogen-sensitive dermatitis have been patch tested with a corticosteroid series, conjugated oestrogen 1% in petrolatum (pet.), and 17-α-OH-progesterone 2% pet. There were no immediate or delayed reactions at 2 and 4 days to any steroid group. We have therefore been unable to demonstrate steroid cross-sensitivity, or a use for 17-α-OH-progesterone in the investigation of oestrogen - and progesterone-sensitive dermatoses.     

Type IV allergy in the food processing industry: sensitization profiles in bakers,cooks and butchers

Data about the impact of allergic contact dermatitis in food processing occupations are scarce. The objective of this study was to identify the most frequent allergens and sensitization profiles in employees of the food processing industry. The results of patch testing performed in 873 bakers, cooks and butchers suspected of having occupational allergic contact dermatitis from 33 dermatological departments of the Information Network of Departments of Dermatology (IVDK) from 1992 to 1999 were analysed. A final diagnosis of allergic contact dermatitis was made in 213 patients (24.4%). Qualitative and quantitative differences in allergen profiles could be identified. Significantly higher sensitization rates were found in employees in the food processing industry, compared to the total test population, for nickel sulphate (22.4% versus 17.2%, p < 0.0005), thiuram mix (4.9% versus 2.6%, p < 0.0005), formaldehyde (3.5% versus 2.1%, p < 0.005) and Compositae mix (6.2%, p < 0.0005). Significantly lower sensitization rates were found for thimerosal (4.5% versus 6.9%, p < 0.05). For patch testing in food workers, we recommend the standard, the rubber and the Compositae series, as well as patients' own products according to the individual history.