Angiosarcoma Mimicking Allergic Contact Dermatitis® and Response to Timolol.

BACKGROUND AND OBJECTIVESContact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population.DESIGN AND SETTINGRetrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010.PATIENTS AND METHODSOf the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes.RESULTSOf the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males; P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%; P=.03).CONCLUSIONSPatch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e210–e216.

Epidemiological survey of contact dermatitis in Italy (1984–1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali)

Reflectance confocal microscopy may differentiate acute allergic and irritant contact dermatitis in vivo

Environmental light levels can affect physiological functions, such as general activity, body temperature and metabolism. Irregular lifestyles, such as those involving exposure to light during the night, can exacerbate the clinical symptoms of several inflammatory skin diseases. However, the effects of constant light exposure on immune responses are not fully understood. This study aimed to elucidate the effects of constant light exposure on two major types of skin reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). BALB/c mice were kept under constant light conditions or a normal light and dark cycle, and their ACD and ICD responses were assessed after the topical application of 2,4,6-trinitro-1-chlorobenzene and croton oil, respectively, to the ear skin. Interestingly, in both ACD and ICD, the ear-swelling response and local leukocyte infiltration were aggravated by constant exposure to light, which has previously been shown to severely disturb the behavioural rhythms of mice. In ACD, these findings were accompanied by increases in the numbers of degranulated mast cells and eosinophils. These results suggest that constant light exposure intensifies allergic and non-allergic skin inflammation.

Detection of skin allergy biomarkers for point of care diagnosis of contact dermatitis

Electron Paramagnetic Resonance Study for Defining the Mechanism of Irritant Dermatitis. Irritant Patch Testing in Atopic Individuals. Quantification of Nonerythematous Irritant Dermatitis. Detergents. Permeability of Skin for Metal Compounds. Irritant Dermatitis: Subthreshhold Irritation. Cytokines and Irritant Dermatitis Syndrome. Assay to Quantify Subjective Irritation Caused by the Pyrethroid Insecticide Alpha-Cypermethrin. Prediction of Skin Corrosivity Using Quantitative Structure-activity Relationships. Contamination and Percutaneous Absorption of Chemicals from Water and Soil. Determining an Occupational Dermal Exposure Biomarker for Atrazine Through Measurement of Metabolites in Human Urine by HPLC-accelerator Mass-spectrometry. Partitioning of Chemicals from Water Into Powdered Human Stratum Corneum (Callus). Dermal Exposure of Hands to Pesticides. Iontophoresis. Penetration and Barrier Creams. Fiber. Novel Topical Agents for Prevention and Treatment of Allergic and Irritant Contact Dermatitis. Allergic Contact Dermatitis: Clinical Considerations. Pharmacology, Toxicology and Immunology of Experimental Contact Sensitizers. Modulation of the Dermal Immune Response by Acute Restraint. Textile-dye Allergic Contact Dermatitis Prevalence. Dose-Response Studies in Guinea Pig Allergy Tests. Operational Definition of Allergic Contact Dermatitis. Predictive Immunotoxicological Risk Assessment. Allergic Contact Dermatitis From Transdermal Systems. Animal Models for Immunologic Contact Urticaria and Nonimmunologic Contact Urticaria. Diagnostic Tests in Dermatology. Wound Healing Products. Issues of Toxicity With Dermatologic Drugs During Pregnancy. Roles of Calcium Ions in Skin Barrier. Nuclear Receptors for Psoralen in Cultured Human Skin Fibroblasts. In Vitro Viability Assays. Dermal Penetration of Calcium Salts and Calcinosis Cutis.

Histopathology of contact dermatitis

The term contact dermatitis describes the local cutaneous inflammatory reaction provoked by skin exposure to certain chemicals. Some materials have the potential directly to induce irritant reactions at the site of contact. Alternatively, the appearance of contact dermatitis may reflect an allergic reaction. Following primary exposure of susceptible individuals to a contact allergen an immune response is initiated that results in long-lived allergic sensitization. If the sensitized individual is exposed subsequently to the same chemical allergen then a more aggressive secondary immune response is elicited that results in the manifestation of allergic contact dermatitis. Clearly some chemicals are able to cause both irritant and allergic contact dermatitis; the operational distinction being that such agents are likely to induce allergic reactions in sensitized individuals at concentrations below those that are necessary for the development of irritant responses in individuals who are not sensitized. The purpose of this article is to consider the roles epidermal cytokines play in the induction of contact dermatitis, and in particular their influence on the behaviour of epidermal Langerhans cells and immunological processes.

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.

Results of Evaluating Health Care Workers With Prick and Patch Testing

Occupational Chromate Allergy in Singapore: A Study of 87 Patients and A Review From 1983 to 1995

Introduction Dermatoses are a group of diseases that are common among occupational diseases. Occurrence is seen between 10%–40% and is the second most common occupational disease after muscular and skeletal system diseases. In this study¸ we aimed to evaluate the general characteristics of the occupational diseases evaluated by occupational dermatosis in our clinic about 3 years. Methods A total of 23 patients who applied between 2014–2017 were evaluated retrospectively. A detailed business story was taken from the cases and clinical evaluation was done. Materials MSDS information was requested from the workplaces. Patch test was applied to the cases where contact dermatitis was suspected. Other dermatological diseases were excluded and evaluated as allergic and irritant contact dermatitis according to the patch test results. Statistical evaluations were performed using the PASW Statistics for Windows (SPSS Inc. Version 18.0, Released 2009, Chicago, USA) statistical package program. Results When the demographic characteristics were examined, 21.74% of the cases were female and 78.26% were male. The initial area of the lesions was 52%. Six of the cases were diagnosed with other dermatological diseases, 12 with allergic contact dermatitis and 4 with irritant contact The most common allergens were nickel sulphate (73.3%), potassium dichromate (40%) and tiuram (20%). Time interval between onset of lesions and the date they first appeared (latent periods) according to the sectors is given in the tables. Conclusion Occupational dermatoses refer to our clinic, constitute 3.7% of occupational disease-related cases and 5th place among other occupational diseases. It was observed that the cases came from different sectors, mostly male and between 30–40 years old. Occupational history and patch test results are important for diagnosis. Since the latent period is variable, it is not very meaningful in predicting the occurrence of the disease when examined in terms of substance and sectoral distribution.

The diagnosis of combined allergic and irritant contact dermatitis is an accepted subdiagnosis for hand dermatitis, and it is often considered in a patient with contact dermatitis, a positive and relevant patch test result, and wet work exposure. We therefore hypothesize that it is arbitrary for wet work exposure to be taken into consideration in a patient with newly diagnosed relevant contact allergy. Furthermore, an overestimation of the diagnosis will probably occur if the criteria for wet work exposure are applied correctly, as many occupations have an element of wet work. To find the statistically expected number of combined allergic and irritant contact dermatitis cases in 1000 patients, and to evaluate the diagnostic criteria for the diagnosis. One thousand consecutive patients with occupational contact dermatitis from a hospital unit in Denmark were assessed. The expected number of cases with the diagnosis of combined allergic and irritant contact dermatitis was 0.33%, as compared with the observed number of 6.4%. Females occupied in wet occupations were often diagnosed with combined allergic and irritant contact dermatitis (p < 0.005). The diagnosis of combined allergic and irritant contact dermatitis should be used critically to avoid misclassification, and possible criteria for the diagnosis are proposed.

Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms under-pinning each condition, the differentiation between them presents a significant diagnostic challenge. This study aimed to determine whether a combination of clinical evaluation and noninvasive measurements-encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume-could distinguish ICD from ACD. Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments. ICD prompted an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incited a delayed response (72 hours). Noninvasive evaluated parameters such as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (P < 0.05). The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress. The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study was constrained by a limited sample size.