Allergic Contact Dermatitis Patients Research Articles

Detection of contact hypersensitivity to corticosteroids in allergic contact dermatitis patients who do not respond to topical corticosteroids

The delayed hypersensitivity development against topical corticosteroids which are used in allergic contact dermatitis (ACD) treatment is an important clinical problem. In our study, 41 ACD patients who did not show any response to topical corticosteroid treatment were patch tested with corticosteroid series and the commercial preparations of corticosteroids and their vehicles. In corticosteroid series, there were budesonide, bethametasone-17-valerate, triamcinolone acetonide, tixocortol pivalate, alclomethasone-17-21-dipropionate, clobetasole-17-propionate, dexamethasone-21-phosphate disodium and hydrocortisone-17-butyrate. We detected positive reaction to corticosteroids in 9 of our cases (22%) (5 single and 4 multiple). The sensitivity was mostly produced by tixocortol pivalate (6 patients). This was followed by triamcinolone acetonide (2 patients) budesonide (2 patients), alclomethasone dipropionate (2 patients), dexamethasone 21 phosphate disodium (2 patients) and betamethasone-17-valerate (1 patient). As a result, it should not be forgotten that the corticosteroids used to treat ACD patients may cause ACD themselves. In ACD patients who did not respond to corticosteroid treatment, routinely applying patch test with corticosteroids should be helpful in directing the treatment.

A clinical and patch test study of patients with positive patch test reactions to fragrance mix in China

The clinical and patch test (PT) features of patients with positive PT reactions to fragrance mix (FM) were studied. 378 consecutive eczema outpatients patch tested with a modified European standard series were analysed. 60 patients (15.9%) reacted to FM. No significant differences could be found between the ages of FM PT-positive and PT-negative patients [median age 40.5 (range from 18 years to 69 years) versus median age 37.5 (range from 5 years to 81 years), rank sum test, P = 0.301]. FM PT-positive rate in confirmed non-cosmetic allergic contact dermatitis patients was 30.4%, which was similar to that in confirmed cosmetic allergic contact dermatitis patients (30.4% versus 30%, chi(2) test, chi(2) = 0.0010, P = 0.972). The FM PT-positive rates were 10.8% in males and 18.2% in females (chi(2) test, chi(2) = 3.3443, P = 0.067). 76.7% of the patients with fragrance contact dermatitis were allergic to Chinese traditional medicine, which is much higher than that for cosmetic allergy (76.7% versus 43.3%, chi(2) test, chi(2) = 6.9446, P = 0.008). The positive PT rate to colophonium in the patients with positive PT reactions to FM is higher than that in the FM PT-negative patients (18.9% versus 3.0%, chi(2) test, chi(2) = 15.5471, P < 0.01). 62.5% of the patients reacted to colophonium were positive to FM. These results show that age has little effect on fragrance contact allergy. Other fragrant products besides cosmetics are also important sources of fragrance contact allergy. Chinese traditional medicine was an important factor in fragrance allergy in China. Patients with positive PT reactions to FM are more likely to react to colophonium.

CCL22‐induced responses are powerfully enhanced by synergy inducing chemokines via CCR4: evidence for the involvement of first β‐strand of chemokine

In an attempt to clarify how cells integrate the signals provided by multiple chemokines expressed during inflammation, we have uncovered a novel mechanism regulating leukocyte trafficking. Our data indicate that the concomitant exposure to CCR4 agonists and CXCL10/IP-10 strongly enhances the chemotactic response of human T lymphocytes. This enhancement is synergistic rather than additive and occurs via CCR4 since it persists after CXCR3 blockade. Besides chemotaxis, other cellular responses are enhanced upon stimulation of CCR4-transfected cells with CCL22/MDC plus CXCL10. Several other chemokines in addition to CXCL10 were able to increase CCL22-mediated chemotaxis. The first beta-strand of the chemokine structure is highly and specifically implicated in this phenomenon, as established using synergy-inducing and non-synergy-inducing chimeric chemokines. As shown in situ for skin from atopic and allergic contact dermatitis patients, this organ becomes the ideal environment in which skin-homing CCR4(+) T lymphocytes can accumulate under the stimulus offered by CCR4 agonists, together with the synergistic chemokines that are concomitantly expressed. Overall, our results indicate that chemokine-induced synergism strengthens leukocyte recruitment towards tissues co-expressing several chemokines.

Allergic contact dermatitis in patients with atopic dermatitis: A clinical study

Atopic dermatitis (AD) is a chronically relapsing dermatitis with no known cure. Due to the chronic nature of the condition, frequent and long term topical therapy is used. This may lead to sensitization, resulting in allergic contact dermatitis (ACD). The aim of the study was to observe the frequency of ACD in atopic patients in this part of the country using Indian standard battery. A total number of 30 cases of AD were taken for the study. Diagnosis of AD cases was based on the criteria of Hannifin and Rajka (1980). All the selected cases of AD had mild to moderate grade of severity. All these cases were treated and patch tested during the remission period. The duration of the study was 12 months. Out of the 30 AD cases, 7 cases showed positive ACD with patch test allergens. This study shows that ACD is not uncommon amongst atopic individuals.

P76 Allergic contact dermatitis vs. psoriasis

Background: Psoriasis prevalence in the Spanish population is around 1.4%(2000). The last epidemiological enquire of the GEIDC (2001) showed that 55.11% of the patients revised in specialized units presented Allergic Contact Dermatitis (ACD). Concomitance of both processes has been widely studied being the opinions of the different authors controversial. Palmo‐plantar psoriasis seems to be the most frequent type in patients presenting delayed hypersensitivity.Aim and methods: A retrospective study (2002–2003) of the incidence of ACD in patients previously diagnosed of psoriasis was performed in the allergy unit of our hospital. The aim of our study was to investigate the delayed hypersensitivity among psoriatic patients as well as its clinical relevance in our influence area. 604 consecutive patients were studied. Standard batteries of the GEIDC as well as complementary series (True‐Test and Chemotecnique) were performed. Allergen application and posterior evaluation were done according to the ICDRG rules.Results: We studied 26 patients affected of Psoriasis, (4,3% of total). In contrast to the general population, 9 were female (mean age 49 years) and 17 male (mean age 48,4 years). ACD suggestive lesions were located in the hands of 15 patients, feet in three of them and in 4 patients both. Patch test was negative in 8 cases. The most detected allergens were Nickel and Fragrance‐mix. Occupational origin was discussed in 6 cases. Sensitivity to formaldehyde resins was demonstrated in several patients. Medicamentous origin due to ethylendiamine and Peru Balsam was also demonstrated.Comments: Several revisions about the relationship of ACD and psoriasis have been published in the last years and most of the authors think that there are no differences between healthy, psoriatic and atopic subjects. These studies have focused on adverse drug reactions or standard series of allergens, taking not in consideration an occupational origin. We suggest epicutaneous tests as a reliable method to diagnose ACD in psoriatic patients with chronic and/or refractory lesions in hands.

Using TRUE patch test TM for the diagnosis of allergic contact dermatitis in China

Rationale To test the safety and efficiency of TRUE patch test TM in allergic contact dermatitis patients in China. Methods We used the TRUE patch test series in 100 patients in PUMCH with the chief complain of skin problems during June, 2002 and Feb, 2003. Some of them are diagnosed as allergic contact dermatitis (n=75), while the others were diagnosed as non-allergic-dermatitis(n=25). The results of patch test 48 hrs and 72 or 96 hrs after testing were observed and the systemic and local side-effects of the test were followed up. Results In allergic contact dermatitis group, 57 patients have positive contact history with 53 patient have positive patch test results and 4 patient negative With the sensitivity of TRUE patch test TM being 93.0%. 18 patients had not clear contact history, 11 of which with positive patch test results and 7 with negative results. Five non-allergic-dermatitis patients presented positive results, while others were negative, thus the specificity of the methods 80%. One patient presented late-phased reaction 7 days after the test. None of the tested patients have systemic side-effect, Most of the patients did not present local side-effect except gentle tickle. Conclusions It is safe and effective to use TRUE test TM as a diagnostic detection of allergic contact dermatitis in China.

Contact Allergic Reactions of the Vulva: A 14-Year Review

In women with vulval complaints, irritant contact dermatitis is more common than allergic contact dermatitis, but secondary sensitization has to be taken into consideration since these patients often use several topical medications. The aims of this retrospective study were to establish the prevalence of allergic contact dermatitis in patients with vulval complaints and to verify how many patients with allergic contact dermatitis suffered from a previous pathology. We reviewed patch- and prick-test results from 92 women. The women had all been administered the European Standard series, and most had also been tested for other allergens such as the ingredients of topical pharmaceutical products and cosmetics. Thirty-five patients (38%) presented with one or more positive allergic reactions. For 15 of the patients, these reactions were considered to be relevant to their clinical condition and were most often due to contact dermatitis from topical pharmaceutical products. Three patients presented with positive and relevant contact urticaria syndrome from latex, and two patients presented with protein contact dermatitis from human seminal plasma. Patients with vulval dermatitis are at risk of developing contact sensitivities, particularly to topical pharmaceutical products; therefore, attention should be paid to this problem when such products are prescribed.

Quality of life in patients with allergic contact dermatitis

Background Allergic contact dermatitis (ACD), a common dermatological disorder, often results in ongoing disease and disability. However, relatively little has been published quantifying the quality of life (QoL) of patients with ACD. Objectives This study was conducted to investigate the impact of ACD on QoL and explore prognostic factors that influence outcomes. Methods A total of 428 subjects with ACD were, at varying times after diagnosis, mailed a QoL questionnaire modified from Skindex-16 to include an additional 5 items pertaining to occupational impact. The QoL scores were correlated with subject demographics, disease characteristics, and management techniques to ascertain factors that impact QoL in subjects with ACD. Results The response rate was 35%, with 149 subjects returning the postal survey. Responders reported being bothered most by itching, skin irritation, and persistence of the condition. Of the four scales included in the QoL questionnaire, the emotions scale had the worst composite QoL score, followed by symptoms, functioning, and occupational impact. Patients with ACD of the face were significantly more bothered by the appearance of their skin. Hand involvement and occupationally related ACD were associated with worse QoL scores within the occupational impact and functioning scales. Subjects that had changed jobs because of ACD had more severe QoL impairment than any other group analyzed, with significantly worse scores on 17 of the 21 QoL items. A history of atopic eczema seemed to impart improved outcomes on patients with ACD, and these subjects were less worried about being fired from their jobs. Subjects diagnosed by patch testing more than 36 months after disease onset seemed to have worse QoL scores than those diagnosed earlier in the natural history of the disease. Patients diagnosed by patch testing within the last 6 months had the worst QoL scores, while the best outcomes were reported in subjects patch tested 6 to 12 months ago. A slight decline in QoL was observed 12 months after patch testing, but scores did not diminish back to the level seen immediately after diagnosis. Conclusions ACD has an appreciable effect on QoL, especially when it affects the hands, the face, or is occupationally related. Of the four scales included in our study, the emotions scale suffered the greatest effect. Emotional impact is therefore an important measure of QoL in ACD patients. Outcomes in patients with ACD were improved by early diagnosis and subjects enjoyed their best QoL at 6 to 12 months after patch testing. However, individuals who elected to change jobs because of their skin condition reported significantly worse QoL than those who retained their current positions.

Dermatitis alérgica de contacto por anillo de madera de cocobolo

Abstract—Allergic contact dermatitis in patients who use or handle finished wood objects in their daily life, outside of their work environment, is exceptional. The woods that have most often been described as responsible for these infrequent cases are, the same as in the occupational cases, those known as “exotic” woods from tropical trees. One of these trees is the cocobolo (Dalbergia retusa/obtusa), native to Central America. We present the case of a woman who developed contact eczema on one finger after having worn a ring made of cocobolo wood acquired in a Central American country. The epicutaneous study performed with specific allergens in this wood (obtusaquinone) confirmed the allergic nature of this reaction. We have found no other cases of allergic contact dermatitis from cocobolo wood described in Spain.

Gelatinase expression at positive patch test reactions.

Matrix metalloproteases (MMPs) are proteolytic enzymes involved in tissue remodelling and extracellular matrix (ECM) turnover. They are secreted in a latent form and activated at the cellular surface by a membrane type-1 MMP (MT1-MMP) and a tissue inhibitor of MMP-2 (TIMP-2) that is also responsible for striking a balance between the proteolytic enzymes and TIMP-2. In allergic contact dermatitis (ACD) patients, MMP-2 and MMP-9, two members of the MMPs family, were increased during the challenge phase, in involved but not uninvolved skin. In contrast, TIMP-2 was more evident in uninvolved than involved skin, while no differences were observed with regard to MT1-MMP staining. Comparing the serum of ACD patients with that of healthy subjects, these differences were not observed. These data suggest that MMP-2 and MMP-9 could play a role in the mechanisms inducing alterations of the epidermal architecture, and in the pathogenesis of the lesions.

Patch testing and aeroallergen intradermal testing in suspected allergic contact dermatitis, unclassified endogenous eczema and non‐atopic chronic urticaria

The purpose of this study was to investigate the significance of contact allergen and aeroallergen sensitization in suspected allergic contact dermatitis (ACD), unclassified endogenous eczema (UEE) and non-atopic chronic urticaria (NACU). 63 cases of suspected ACD, 140 cases of suspected UEE and 21 cases of suspected NACU were patch tested with the standard series of Beijing Medical University and, if available, suspected materials as is. 22 such cases of ACD, 104 such cases of UEE and 42 such cases of NACU were intradermally tested with common aeroallergens. Patients with non-allergic skin disease served as controls. 85.7% of the suspected ACD patients, 57.9% of the suspected UEE patients and 52.4% of the suspected NACU patients were positive on patch testing, and the results in 81.0% of the suspected ACD patients and 23.6% of the suspected UEE patients were considered relevant. No patch test reactions in the NACU patients were considered relevant. 27.1% of the suspected UEE patients, 41.3% of the suspected ACD patients and 14.3% of the suspected NACU patients reacted to 2 or more contact allergens. High positive rates on aeroallergen intradermal testing were also found in suspected NACU (69.0%), UEE (49.0%) and ACD (59.1%) patients. These results support the conclusions that patients with allergic skin diseases will develop multiple sensitization, and that early detection and avoidance of sensitizing allergens is necessary. The exact rôle of aeroallergen sensitization in these diseases needs further study.

Interleukin-17 is Produced by Both Th1 and Th2 Lymphocytes, and Modulates Interferon-γ- and Interleukin-4-Induced Activation of Human Keratinocytes

Interleukin-17 is a T-cell-derived cytokine, detected in skin affected by allergic contact dermatitis and psoriasis, which regulates keratinocyte expression of adhesion molecules and chemokines. In this study, we have analyzed whether interleukin-17 production segregates with a particular T helper (Th) cell subset, and have examined the capacity of interleukin-17 to modulate the activation of keratinocytes induced by Th1 and Th2 cytokines. A panel of 80 nickel-specific CD4+ T cell clones (36 Th0, 30 Th1, and 14 Th2) was isolated from peripheral blood or lesional skin of allergic contact dermatitis patients. Significant amounts (> 50 pg per ml) of interleukin-17 were released by about 50% of activated Th0, Th1, and Th2 cells. Interleukin-17 alone and in cooperation with interleukin-4, or to a lesser extent with interferon-gamma, decreased the interleukin-1 receptor antagonist to interleukin-1alpha ratio in the supernatants as well as in cell lysates from keratinocytes. In addition, interleukin-17 stimulated the release of growth-regulated oncogene-alpha, granulocyte-macrophage colony stimulating factor, and interleukin-6, with synergistic or additive effects when used together with interferon-gamma or interleukin-4. Interleukin-17 and interleukin-4 also increased stem cell factor release, a function that was inhibited by interferon-gamma. Moreover, interleukin-17 and interleukin-4 enhanced interferon-gamma-induced expression of intercellular adhesion molecule 1, but not CD40, on keratinocytes. The constitutive expression of interleukin-17 and interferon-gamma receptors on keratinocytes was not modulated by interleukin-17, interferon-gamma, or interleukin-4, whereas the interleukin-4 receptor was significantly downregulated by interferon-gamma. As a whole, the results indicate that interleukin-17 can participate relevantly in T-cell-mediated skin immune responses by amplifying both interferon-gamma- and interleukin-4-induced activation of keratinocytes.

Allergic contact dermatitis in patients with leg ulcers

Allergic contact dermatitis in patients with leg ulcers

The Incidence of Allergic Contact Dermatitis in Patients With Psoriasis Vulgaris

Background: Contact dermatitis is said to be rare in psoriasis patients, possibly because of accelerated epidermal turnover, the isomorphic (Koebner) response, and lymphocyte functional alterations. Objective: To identify contact allergy in patients with psoriasis. Methods: A written questionnaire was completed by 100 patients with psoriasis about contact history, flare factors for psoriasis, topical skin care, medications, and occupational/hobby exposures. Of these patients, 20 agreed to be patch tested with a standard screening series (Hermal) and a 20-item psoriasis patch-test series that included ingredients that might be found in topical psoriasis products. Results: Of the 100 patients, eight suspected a topical medication caused a reaction that worsened their psoriasis, 29 gave a history of atopy, 11 reported reactions to metal jewelry, and 29 reported an allergy to poison ivy. Patch-test results identified four of the 20 patients with six positive patch tests to the materials tested: three of the six positive tests were interpreted as relevant to the patient's psoriasis (coal tar, ethylenediamine and dithranol), two patients tested positive to nickel and one to thimerosal. Five patients had irritant reactions to dithranol. Conclusions: In this small study, 20% of self-selected psoriasis patients had positive allergic reactions on patch testing. A screening contact and atopic history in psoriasis patients may help to identify a subset of patients who could benefit from a search for more relevant contact allergens with patch test evaluation. This could improve treatment strategies and possibly reduce disability.

The incidence of allergic contact dermatitis in patients with psoriasis vulgaris

Background: Contact dermatitis is said to be rare in psoriasis patients, possibly because of accelerated epidermal turnover, the isomorphic (Koebner) response, and lymphocyte functional alterations. Objective: To identify contact allergy in patients with psoriasis. Methods: A written questionnaire was completed by 100 patients with psoriasis about contact history, flare factors for psoriasis, topical skin care, medications, and occupational/hobby exposures. Of these patients, 20 agreed to be patch tested with a standard screening series (Hermal) and a 20-item psoriasis patch-test series that included ingredients that might be found in topical psoriasis products. Results: Of the 100 patients, eight suspected a topical medication caused a reaction that worsened their psoriasis, 29 gave a history of atopy, 11 reported reactions to metal jewelry, and 29 reported an allergy to poison ivy. Patch-test results identified four of the 20 patients with six positive patch tests to the materials tested: three of the six positive tests were interpreted as relevant to the patient's psoriasis (coal tar, ethylenediamine and dithranol), two patients tested positive to nickel and one to thimerosal. Five patients had irritant reactions to dithranol. Conclusions: In this small study, 20% of self-selected psoriasis patients had positive allergic reactions on patch testing. A screening contact and atopic history in psoriasis patients may help to identify a subset of patients who could benefit from a search for more relevant contact allergens with patch test evaluation. This could improve treatment strategies and possibly reduce disability.

The Incidence of Allergic Contact Dermatitis in Patients With Psoriasis Vulgaris

Background: Contact dermatitis is said to be rare in psoriasis patients, possibly because of accelerated epidermal turnover, the isomorphic (Koebner) response, and lymphocyte functional alterations. Objective: To identify contact allergy in patients with psoriasis. Methods: A written questionnaire was completed by 100 patients with psoriasis about contact history, flare factors for psoriasis, topical skin care, medications, and occupational/hobby exposures. Of these patients, 20 agreed to be patch tested with a standard screening series (Hermal) and a 20-item psoriasis patch-test series that included ingredients that might be found in topical psoriasis products. Results: Of the 100 patients, eight suspected a topical medication caused a reaction that worsened their psoriasis, 29 gave a history of atopy, 11 reported reactions to metal jewelry, and 29 reported an allergy to poison ivy. Patch-test results identified four of the 20 patients with six positive patch tests to the materials tested: three of the six positive tests were interpreted as relevant to the patient's psoriasis (coal tar, ethylenediamine and dithranol), two patients tested positive to nickel and one to thimerosal. Five patients had irritant reactions to dithranol. Conclusions: In this small study, 20% of self-selected psoriasis patients had positive allergic reactions on patch testing. A screening contact and atopic history in psoriasis patients may help to identify a subset of patients who could benefit from a search for more relevant contact allergens with patch test evaluation. This could improve treatment strategies and possibly reduce disability.

Contact sensitivity in pruritus vulvae: Patch test results and clinical outcome

Background : Persistent vulval pruritus is common and may not be associated with signs of a primary vulval dermatosis. Patients with established vulval disease may develop contact sensitivity as a secondary problem after the application of topical therapy. Objective : A retrospective study was performed to establish the prevalence of allergic contact dermatitis in patients with pruritus vulvae. In addition, the results of patch testing in women with vulval lichen sclerosus were compared with those in patients with primary pruritus vulvae and essential vulvodynia. Methods : Over a 5-year period, 121 women with vulval problems were patch tested to the European Standard Series, selected preservatives, perfumes, local anesthetics, medicaments, and a vulval battery. Results : Fifty-seven patients (49%) had one or more relevant allergic positive reactions. Medicaments or their constituents were the most common allergens to give reactions. Seven of the 16 patients (44%) with lichen sclerosus had positive reactions. Symptoms resolved or improved significantly in 67 patients (55.4%) overall. Six of the seven women with lichen sclerosus who had positive reactions noted an improvement in their symptoms. Patients who had a relevant allergy were much more likely to improve than those whose tests were negative ( p < 0.001). Conclusion : Patients with pruritus vulvae and lichen sclerosus are at high risk of contact sensitivity. Patch testing is useful in the management of these patients and many can be helped by allergen avoidance.

Allergic contact dermatitis from azathioprine

A 51-year-old production mechanic for a pharmaceutical company complained of a dermatitis involving his hands. The onset of the eruption coincided with when he was placed on the production packing line for azathioprine tablets. Patch testing showed a positive allergic reaction only to azathioprine diluted in petrolatum. A pharmaceutical product such as azathioprine may need to be considered as a cause for allergic contact dermatitis in patients with a history of exposure during the manufacturing process.

Allergic Contact Dermatitis From Azathioprine

A 51-year-old production mechanic for a pharmaceutical company complained of a dermatitis involving his hands. The onset of the eruption coincided with when he was placed on the production packing line for azathioprine tablets. Patch testing showed a positive allergic reaction only to azathioprine diluted in petrolatum. A pharmaceutical product such as azathioprine may need to be considered as a cause for allergic contact dermatitis in patients with a history of exposure during the manufacturing process.

In vitro T cell response to staphylococcal enterotoxin B superantigen in chronic plaque type psoriasis.

Recent studies have demonstrated the important role of CD4+ T cells in the pathophysiology of psoriasis. One of the current hypotheses is that triggering of the psoriatic inflammatory process could be secondary to CD4+ T cell activation by bacterial superantigens in the skin. In this study, IL-2-derived T cell lines were recovered from the blood and the skin of 4 patients with chronic plaque type psoriasis and of 2 patients with allergic contact dermatitis (ACD). Blood and skin T cell lines were tested for their ability to proliferate in vitro to staphylococcal enterotoxin B (SEB) presented by MHC class II expressing antigen-presenting cells. The results showed a significantly higher SEB-induced T cell proliferation in skin T cell lines as compared to blood T cell lines in 3 out of 4 psoriatic patients and in one of the 2 ACD patients. No difference between the skin and blood T cells for their response to phytohemagglutinin was observed. Furthermore the blood T cell lines from both patients and control individuals responded equally well to SEB. Thus psoriatic skin T cell lines were characterized by an enrichment in SEB-responding T cells. Since similar enhancement of SEB-responsive T cells was occasionally found in ACD patients, we propose that SEB could be an environmental factor associated with rather than responsible for psoriatic inflammation.