The problem of contact dermatitis.
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Dermatitis↗
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[THEORETICAL QUESTIONS IN CONTACT DERMATITIS].
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Dermatitis↗
[COMMON MATERIALS AS CAUSE OF CONTACT DERMATITIS].
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Dermatitis↗
Relationship of occupation to contact dermatitis: evaluation in patients tested from 1998 to 2000.
BACKGROUND: Both irritant and allergic contact dermatitis can be influenced by occupational and nonoccupational environmental exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing was conducted with the 50 screening allergens of the North American Contact Dermatitis Group and occupational coding by the Surveillance Branch of the National Institute of Occupational Safety and Health. RESULTS: Of the 5,839 patients patch tested for contact dermatitis, 1,097 (19%) were deemed to be occupationally related. Of the occupational cases, 60% were of allergic and 32% were of irritant origin. The hands were the primary body part affected in 64% of allergic occupational cases and 80% of irritant occupational cases. Epoxy resin was the only allergen tested that was associated more with an occupational exposure than nonoccupational exposure. The allergens encountered most frequently in the occupational cases were carba mix, thiuram mix, epoxy resin, formaldehyde, and nickel. The medical field is overrepresented in the data compared with other occupations. CONCLUSIONS: Occupational contact dermatitis frequently was found to be multifactorial and associated with several specific allergens and occupations.
Adult↗
Descriptive epidemiology of contact dermatitis in a university student population.
BACKGROUND: The frequency of irritant and allergic contact dermatitis has been compared in relatively few studies. OBJECTIVE: This report describes the frequency of visits by university students to campus prepaid health plan dermatologists for irritant and allergic contact dermatitis compared with visits for other types of dermatitis and other skin problems. METHODS: Prospective recording of specific dermatologic diagnoses was performed for all visits of students to student health service dermatologists. Diagnoses were then tabulated, rank ordered, and compared. RESULTS: Irritant dermatitis represented 2.3% of all first visits and 1.6% of all total visits. Allergic contact dermatitis accounted for 3.1% of all first and 2.4% of all total visits. Other types of dermatitis were found in 12.5% of all first and 11.1% of all total visits. Contact dermatitis ranked first among types of dermatitis, being seen in 30.0% of first visits for dermatitis and in 27.0% of total visits for dermatitis. CONCLUSION: In this prospective study, contact dermatitis represented a relatively large proportion of visits for dermatitis. Slightly more allergic than irritant contact dermatitis was found. This is at variance with findings in industrial settings that irritant dermatitis generally is more common than allergic contact dermatitis.
Adult↗
A nurse-led clinic in chronic and allergic contact dermatitis.
It has generally been acknowledged that the incidence and prevalence of contact dermatitis has increased in recent years. It can develop at any stage of a person's life span (rare before puberty), and in many different circumstances and occupations. The demand on consultant dermatologists for contact dermatitis services has resulted in the depletion of some essential components to the investigation process, and patient outcomes have been affected. In recent years it has also resulted in the development of nurse-led contact dermatitis services. The traditional role of the dermatology nurse in contact dermatitis is to carry out patch testing. Nurse-led services require the wider acquisition of skills and knowledge in relation to contact dermatitis. This article is an attempt to introduce the complexities of contact dermatitis, and nurse-led services.
Ambulatory Care Facilities↗
Occupational protein contact dermatitis in food handlers.
The preparation of food in restaurant kitchens carries a high risk of occupational dermatoses. Analysis of 33 cases revealed four different etiological types. Simple irritant dermatitis was rare (2 cases), plain contact dermatitis was more common (6 cases). Fifteen patients had relevant patch tests and scratch tests; ten had positive scratch tests only to explain the cause of their dermatitis. The last type was termed protein contact dermatitis. The major type IV allergens incriminated were metals, onion and garlic. The major proteinaceous allergens indicated by history and test results were fish and shell-fish. Open patch tests with the incriminated foods may cause erythema or oedema on normal skin after 20 minutes. Previously eczematous, now normal looking, skin often responds with a crop of dyshidrotic vesicles preceded by erythema and itching 30 minutes after the application of an open test. Examination for specific IgE is not always positive in such cases. Inhalant allergy was rare. The results indicate that food handlers are sensitized by the protein they touch, and then react to later contact with the proteins. Protein contact dermatitis is similarly common among veterinary surgeons, while the importance in other occupational groups remains to be studied.
Adolescent↗
Horizons in pharmacologic intervention in allergic contact dermatitis.
The treatment of allergic contact dermatitis remains a major challenge. Current management strategies consist of elimination of the allergen when possible and therapy for symptoms with topical or systemic corticosteroids. With increasing exposure of the human skin to environmental antigens and haptens, more selective treatment options are needed. Advances in the elucidation of the skin immune system and of the cellular and molecular events in immunologic processes may allow targeted methods of controlling delayed hypersensitivity reactions. This review focuses on mechanisms of established therapeutic agents and new developments, such as FK 506 (tacrolimus), pentoxifylline, and vitamin D3 derivative, for suppression of any phase of allergic contact dermatitis.
Allergens↗
An international survey on the prognosis of occupational contact dermatitis of the hands.
Prognosis is a crucial topic in contact dermatitis. We recently reviewed the extensive literature on the prognosis of contact dermatitis. The majority of patients in these studies had persistent dermatitis. Job changes usually did not lead to a significant improvement for most patients with occupational contact dermatitis. We performed a worldwide survey of colleagues with expertise in treating patients suffering from occupational contact dermatitis of the hands. Of 65 experts, 51 returned questionnaires for analysis. 67% of European and 29% of respondents from Sweden, Denmark, Finland, United States of America, Canada, and Mexico stated that more than 75% of workers with severe hand dermatitis required a job change. 78% of the respondents found that chromate and 57% found that nickel allergy were associated with the worst possible prognosis. 98% felt that barrier creams were no more effective than bland emollients in the prevention of hand dermatitis.
Chronic Disease↗
Allergic contact dermatitis in patients with anogenital complaints.
OBJECTIVE: Allergic contact dermatitis is a common anogenital disease. STUDY DESIGN: The results of patch testing performed on 1,008 patients evaluated for allergic anogenital contact dermatitis from 21 dermatologic departments in the Information Network of Departments of Dermatology (IVDK) from 1992 to 1997 were analyzed. RESULTS: A final diagnosis of allergic contact dermatitis was made in 351 patients (34.8%). Irritant contact dermatitis was diagnosed in 230 patients (22.8%) and other, nonspecified forms of perianal eczema in 228 patients (22.6%). The remaining cases were due to other distinct dermatologic diseases. Analyzing patch test data from this large group of patients showed that the allergen spectrum resembled that of all patients (54,000) tested from 1992 to 1997. However, dibucaine HCl ranked fourth among contact allergens in the study population. Positive reactions to (chloro-)-methyl-isothiazolinone and to benzocaine were observed more frequently among patients with anogenital complaints as compared to the total IVDK population (3.7% vs. 2.5% and 2.7% vs. 1.5%, respectively). In general, active agents of topical medications and popular remedies, preservatives and ointment bases appeared to cause allergic reactions most frequently. CONCLUSION: Patients with chronic anogenital diseases seem to have a high risk of becoming sensitized. For patch testing we recommend the standard series, dibucaine HCl, propolis, bufexamac and other ingredients from topical preparations according to the patient's history.
Adult↗
Prognosis of occupational contact dermatitis in New South Wales, Australia.
570 patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. 336 (59%) were followed up 1 to 5 years later. Roughly 1/3 were healed, 1/3 were improved without complete healing, 1/4 had no change and 1/12 of the patients had deteriorated. The overall improvement rate was in excess of 70%. Data derived from these patients demonstrated that changing the work duties of patients with OCD improved their outcome (p < 0.01), whilst leaving the industry altogether resulted in a greater overall healing rate (p < 0.01). No difference existed between the outcome of irritant contact dermatitis compared with allergic contact dermatitis. Atopics as expected had a worse prognosis. The outcome in the construction industry was significantly poorer than other industries. Patients suffering from allergic contact dermatitis from chromate also had a dismal prognosis.
Dermatitis, Contact↗
'Airborne' contact dermatitis due to Leica immersion oil.
BACKGROUND: Contact dermatitis has often been described in healthcare staff, resulting essentially from the use of natural rubber latex gloves, antiseptics, and especially aldehydes. This study reports an unusual cause of contact dermatitis in laboratory technicians. MATERIALS AND METHODS: Four patients working in the bacteriology departments of three different hospitals were seen for airborne contact dermatitis. All were patch tested for specific plastics and glues. RESULTS: For all patients, positive patch reactions were obtained with classic epoxy resins, such as diglycidylether of bisphenol, as well as with new types, such as diglycidylether of bisphenol F and an epoxyacrylate resin. CONCLUSIONS: Although phenols and ether handled by the laboratory technicians and an epoxy mastic applied during floor repair were initially suspected, an immersion oil used in light microscopy proved to be the real cause of the dermatitis. To our knowledge, these are the first reported cases due to this type of contact.
Air Pollutants, Occupational↗
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.
Allergens↗
Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group.
Allergic contact dermatitis (ACD) affects approximately 7% of the general population. To evaluate the frequency of ACD in children, we analysed patch test results collected by the Information Network of Departments of Dermatology between 1995 and 2002. Data of 285 children (6-12 year) and 2175 adolescent patients (13-18 year) were analysed to determine the frequency of sensitization to the 30 most common contact allergens, adjusting for age and sex. As control group, we defined adult patients (60-66 year, n = 7904). The top allergens in children were thimerosal, gentamicin sulphate, nickel-II-sulphate, ammoniated mercury, cobalt-II-chloride, fragrance mix, bufexamac, Compositae mix, propylene glycol and turpentine. The overall proportion of sensitized patients according to the patch test results was 52.6% in the children group compared to 49.7% in the adolescent group. These findings were similar in the adult group at 52.2%. The detailed analysis regarding sex, occupation, atopy, site of eczema and age showed distinct patterns in each group indicating age-specific exposures. Atopy-related diseases were more common in children compared to adults. On the basis of the data of this study, the relationship between atopy and the risk of development of ACD, at least in children, needs further investigation.
Adolescent↗
Allergic contact dermatitis: the cellular effectors.
Contact hypersensitivity reactions are mediated by lymphocytic effector cells. Until recently it was believed that the most important of these were CD4+ T lymphocytes. However, there is growing evidence that in many instances the predominant effector cell may be a CD8+ T lymphocyte, with in some instances CD4+ cells performing a counter-regulatory function. Here we review the roles of CD4+ T helper (Th) cells and CD8+ T cytotoxic (Tc) cells, and their main functional subpopulations (respectively, Th1 and Th2 cells and Tc1 and Tc2 cells) in the elicitation of contact hypersensitivity reactions and consider the implications of effector cell selectivity for the biology of allergic contact dermatitis.
CD4-Positive T-Lymphocytes↗
Studies on the reproducibility of allergic contact dermatitis.
Diagnosis of allergic contact dermatitis depends upon the use of epicutaneous patch tests with suspected antigens. It has been claimed that the method is unreliable because of variability. Therefore, we have tested this by comparing responses to various forms of replicate, standardized challenge in nickel-sensitive subjects. Nickel-containing coins applied at 2-4 different sites on the back elicited similar responses in up to 95% of tests. Serial dilutions of nickel sulphate (NiSO4) applied, in duplicate, gave highly reproducible responses on the back. However, the forearm skin was clearly less responsive. Examination of the effect of the quantity of nickel-containing vehicle showed that, above a certain minimal level, this had no effect on the reproducibility of the responses. In conclusion, the immune system can give highly reproducible responses when presented with standard eliciting stimuli.
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