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Allergic Contact Dermatitis (Skin Allergies)

(continued)

Follow-Up continued...

Patient Education:
 

  • Patients have the best prognosis when they are able to remember the materials to which they are allergic and how to avoid further exposures.
  • Provide patients with as much information as possible concerning the chemical to which they are allergic, including all known names of the chemical.
  • Web sites, standard textbooks, and the TRUE test kit contain basic information about the chemicals.
  • Susceptible individuals need to read the list of ingredients before applying American cosmetic products to their skin, since preservative chemicals are used widely in consumer, medical, and workplace products. The same chemical may have different names when used for consumer or industrial purposes.
  • Provide pamphlets with color pictures of poison ivy to individuals allergic to the plant. The American Academy of Dermatology also has pamphlets on ACD and hand eczema.

 

Miscalleneous

Medical/Legal Pitfalls:
 

  • ACD is a major occupational disease, and individuals may be temporarily unable to work. Many require modification of the workplace to continue working. Hopefully, a thorough history and patch testing minimize the risk of iatrogenic complications from systemic corticosteroids and other immunosuppressives.

Special Concerns:
 

  • The safety of patch testing in pregnancy has not been studied; however, the minute amounts of allergens applied appear unlikely to be absorbed in sufficient amounts to harm the fetus. Nonetheless, as with all treatments in pregnant women, the benefits of testing should be weighed against any potential, albeit undocumented, risk.

Pictures

Caption: Picture 1. Chronic stasis dermatitis with allergic contact dermatitis to quaternium-15, a preservative in moisturizer. Allergic contact dermatitis produces areas of erythema in areas of atrophie blanche and varicose veins.

Skin Allergies Photo

 

Caption: Picture 2. Erythema multiformelike reaction that developed acutely following hair dying

Skin Allergies Photo

 

Caption: Picture 3. Allergic contact dermatitis to nickel in a necklace

Skin Allergies Photo

 

Caption: Picture 4. Severe allergic contact dermatitis resulting from preservatives in sunscreen. Patch testing was negative to the active ingredients in the sunscreen.

Skin Allergies Photo

 

Caption: Picture 5. Onycholysis developing from allergic contact dermatitis to formaldehyde used to harden nails

Skin Allergies Photo

Bibliographty

 

  • Assier-Bonnet H, Revuz J: [Topical neomycin: risks and benefits. Plea for withdrawal]. Ann Dermatol Venereol 1997; 124(10): 721-5[Medline].
  • Cohen DE, Brancaccio R, Andersen D, Belsito DV: Utility of a standard allergen series alone in the evaluation of allergic contact dermatitis: a retrospective study of 732 patients. J Am Acad Dermatol 1997 Jun; 36(6 Pt 1): 914-8[Medline].
  • Cohen LM, Cohen JL: Erythema multiforme associated with contact dermatitis to poison ivy: three cases and a review of the literature. Cutis 1998 Sep; 62(3): 139-42[Medline].
  • Diepgen TL, Coenraads PJ: The epidemiology of occupational contact dermatitis. International Archives of Occupational & Environmental 1999; 72: 496-506.
  • Guin JD, Phillips D: Erythroderma from systemic contact dermatitis: a complication of systemic gentamicin in a patient with contact allergy to neomycin. Cutis 1989 Jun; 43(6): 564-7[Medline].
  • Hogan DJ: The prognosis of occupational contact dermatitis. Occup Med 1994 Jan-Mar; 9(1): 53-8[Medline].
  • Kist JM, el-Azhary RA, Hentz JG: The contact allergen replacement database and treatment of allergic contact dermatitis. Arch Dermatol 2004 Dec; 140(12): 1448-50[Medline].
  • Kligman AM: The identification of contact allergens by human assay. 3. The maximization test: a procedure for screening and rating contact sensitizers. J Invest Dermatol 1966 Nov; 47(5): 393-409[Medline].
  • Larkin A, Rietschel RL: The utility of patch tests using larger screening series of allergens. Am J Contact Dermat 1998 Sep; 9(3): 142-5[Medline].
  • Lawley TJ, Kubota Y: Cell adhesion molecules and cutaneous inflammation. Semin Dermatol 1991 Sep; 10(3): 256-9[Medline].
  • Marks JG, Belsito DV, DeLeo VA, et al: North American Contact Dermatitis Group patch test results for the detection of delayed-type hypersensitivity to topical allergens. J Am Acad Dermatol 1998 Jun; 38(6 Pt 1): 911-8[Medline].
  • Rajagopalan R, Anderson RT, Sarma S, et al: An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis. Am J Contact Dermat 1998 Sep; 9(3): 149-54[Medline].
  • Rietschel RL, Fowler JR Jr: Fisher's Contact Dermatitis . 5th ed. Lippincott, Williams & Wilkins: 2001.
  • Shaffer MP, Belsito DV: Allergic contact dermatitis from glutaraldehyde in health-care workers. Contact Dermatitis 2000 Sep; 43(3): 150-6[Medline].
  • Shah M, Lewis FM, Gawkrodger DJ: Nickel as an occupational allergen. A survey of 368 nickel-sensitive subjects. Arch Dermatol 1998 Oct; 134(10): 1231-6[Medline].
  • Tadd C, Feldman S, Thompson S: Only 33% of Visits for Skin Disease in the US in 1995 Were to Dermatologists: Is Decreasing the Number of Dermatologists the Appropriate Response? Dermatology Online Journal 4 1998; 4:[Full Text].
  • Templet JT, Hall S, Belsito DV: Etiology of hand dermatitis among patients referred for patch testing. Dermatitis 2004 Mar; 15(1): 25-32[Medline].
  • Thompson T, Belsito DV: Allergic contact dermatitis from a diisocyanate in wool processing. Contact Dermatitis 1997 Nov; 37(5): 239[Medline].

 

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