scholarly journals Recalcitrant Palmoplantar Pustulosis: Have You Considered Allergic Contact Dermatitis?

2021 ◽  
Vol 79 (2) ◽  
pp. 173-177
Author(s):  
José Neves ◽  
A. Brasileiro ◽  
P. Mendes-Bastos

Palmoplantar pustulosis (PPP) is a chronic and relapsing disease of the palms and soles, which tends to be difficult to treat. Classically it was described as a subtype of psoriasis. Nowadays it is regarded as a separate entity, although plaque-type psoriasis affects concomitantly many patients with PPP. A link between allergic contact dermatitis (ACD) and PPP has been described, and the former may encompass a potential to perpetuate the latter. Hereby we report two cases of difficult to treat plantar pustulosis. Underneath the dermatosis’s refractive nature was an allergic sensitization to potassium dichromate and cobalt chloride. Leather shoes and leather insoles were commonly worn, and both allergens are employed by the leather industry. Clinical remission was achieved in both cases with allergen eviction. Patch testing must be considered in cases of PPP without response to treatment. If relevant sensitization is found, allergen eviction measures are mandatory.

2021 ◽  
Vol 79 (3) ◽  
pp. 221-226
Author(s):  
Alexandre Afonso ◽  
Joana Silva ◽  
Ricardo Silva ◽  
Vânia Pacheco ◽  
Vítor Pinheiro ◽  
...  

Introduction: Chromium has been responsible for occupational skin disease, both irritant and/or allergic contact dermatitis. In order to minimize this problem, regulatory measures limiting its use have been implemented. The impact of these regulations should be monitored over time. Material and Methods: A retrospective study from 2009 to 2018 was carried out in the Department of Dermatology to assess the temporal trend of chromium sensitization evaluated by patch testing with potassium dichromate 0.5% pet, particularly considering age, sex and its relationship with occupational activity. Results: 3277 individuals were studied, 2369 females (72.29%) and 908 males (27.71%). Of those 621 (18.95%) fulfilled criteria for occupational contact dermatitis. Chromium allergy was found in 118 (3.60%) patients, 64 females (54.4%) and 54 males (45.76%). We found that male patients were significantly more frequent (45.76% vs 27.03%; p<0.001), as well as occupational dermatitis (31.35% vs 18.47%; p<0.001), hand dermatitis (53.54% vs 23.52%; p<0.001) and age above 40 years (70.34% vs 56.76%; p=0.003). Discussion/Conclusion: The results show a high prevalence (3.60%) of chromium positive patch tests. In our study, there has not been a significant decrease in sensitization to chromium over the years. Interestingly cases classically related to this allergy (cement in the building industry) are no longer the main cause of the problem. We found other sources such as leather as a main cause of allergic sensitization, suggesting a change of the panorama.


2016 ◽  
Vol 14 (1) ◽  
pp. 14-17
Author(s):  
S. Bhattarai ◽  
A. Rijal ◽  
S. Agrawal

Introduction: Allergic contact dermatitis in Nepal is not an uncommon disorder. Patch testing is a well established method of diagnosing allergic contact dermatitis. Patients with contact dermatitis are well known to have impaired quality of life which often leads to frequent dermatological consultations.Objective: Lack of data from Nepal has prompted us to undertake this study with the aims to know the frequency of allergic contact dermatitis and the commonest contact allergens among the patients with Hand eczema attending the out-patient department of dermatology, B.P. Koirala Institute of Health Sciences and Kathmandu Medical College Teaching Hospital.Material and Methods: A total of 256 patients were included in the study. Out of them 195 with hand eczema agreed to participate and undergo patch testing. The antigens used included the Indian standard series of patch test allergens approved by Contact and Occupational Dermatoses Forum of India.Results: Hundred and ten cases (56.4%) were patch test positive (PTP) at 48 as well as 96 hours to at least one allergen. PTP was seen more commonly in females. The most common allergen in females was nickel sulphate followed by cobalt chloride, gentamicin and mercapto mix while males were positive to potassium dichromate, followed by epoxy resin, fragrance mix and nickel sulphate.Conclusion: Patch testing has proved a useful tool for the detection of allergic contact dermatitis and for identification of contact allergens. When positive reactions correlate with environmental exposure the test usually assists the physician in establishing the cause of dermatitis, hence treating the patients and improving their quality of life.Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.14-17


2019 ◽  
Vol 70 (4) ◽  
pp. 1337-2341 ◽  
Author(s):  
Maria-Magdalena Constantin ◽  
Stefana Bucur ◽  
Clara Matei ◽  
Iuliana Elena Nita ◽  
Traian Constantin

In Romania, data on patch testing are lacking and the significance and applicability of the European baseline series (EBS) needs to be evaluated. The aim of the study was to examine the prevalence of contact allergy to the EBS and to determine the most common post-test sensitization occurred in the population of patients with suspected allergic contact dermatitis in Romania. Demographic data were collected from 252 patients with suspected allergic contact dermatitis. Pacients were patch tested with 28-allergen EBS.The positive patch test was observed in 80.16% patients. The most prevalent contact allergens were nickel sulphate (15.08%), fragrance mix I & II (13.10%) and potassium dichromate (9.52%). Differences in sensitization prevalences to some allergens of the EBS compared with other European countries were recognized. The current EBS is a suitable diagnostic tool for contact allergy in Romania.


Author(s):  
V. N. S. Ahamed Shariff ◽  
K. Deepa ◽  
L. Balamurugan ◽  
S. Nirmala

<p class="abstract"><strong>Background:</strong> Allergic contact dermatitis is common dermatoses seen among patients attending dermatology clinics. Allergic contact dermatitis is due to delayed type of hypersensitivity reaction. The diagnosis of allergic contact dermatitis is made by patch testing. A positive reaction to a patch test commonly proves the cause of dermatitis.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was conducted<strong> </strong>to estimate the incidence of various allergens among 150 patch test positive patients with allergic contact dermatitis who had attended the dermatology OPD in Rajiv Gandhi Government General Hospital, Chennai, between October 2014 and September 2016. All the details regarding history, examination findings, investigations and patch test results were collected from case records, the data were tabulated and analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Allergic contact dermatitis to cement was the commonest (44.7%), followed by nickel (10%) and plant antigens (9.3%). The commonest allergen to be tested positive was Potassium dichromate (82 cases), followed nickel (15 cases) and formaldehyde (8 cases). Most of the patients were in the age category between 41 and 50 years (47 cases– 31.33%). Male to female ratio was 2.41:1. 14 were atopic individuals (9.33%) by Hanifin and Rajka's criteria. Allergic contact dermatitis in 103 cases of our study were of occupational in origin (67%).</p><p><strong>Conclusions:</strong> Avoidance of allergen and proper preventive measures in workplace and day to day activities will lead to significant decrease in the morbidity of the disease and improvement in quality of life in patients with allergic contact dermatitis. </p>


2019 ◽  
Vol 11 ◽  
pp. 117863451988055
Author(s):  
Eman Omar Khashaba ◽  
Mohammad A Gaballah ◽  
Ahmed Fathy State ◽  
Mona Elwassefy

Objectives: First, this research was instituted to identify common allergens, and second, to test the association between IL16 gene promoter polymorphism rs4778889 T/C and allergic contact dermatitis (ACD). Methods: A case control study was conducted in dermatology outpatients’ clinic. Study subjects received interview-based semi-structured questionnaire, complete skin examination, IL16 gene promoter was investigated by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) analysis, and IQ Ultra™ patch test units (Chemotechnique Diagnostics AB, Sweden) with 10 substances were used. Results: Most of the prevalent cases had positive patch test (93.3%). The most common clinical presentation of ACD in our patients was itching (96.7%), followed by dryness (86.75%), erythema (76.7%), and fissuring (76.7%). There was higher CC gene distribution among cases, but there was no statistically significant difference. IL16 gene distribution was nearly similar among different clinical presentations. Formaldehyde showed statistically significant higher frequency for CC. The most common allergen found was mercury chloride (76.6%), followed by potassium dichromate (26.6%) and cobalt chloride (20%). Conclusions: The current study found prominent metal sensitization (mercury chloride) over the previously known potassium dichromate. There was no statistically significant IL16 gene distribution among cases compared with control. However, C allele was more frequently encountered in cases. Further studies are required to test the association with IL16 genotype and ACD and highlight the new trends in metal sensitization among cement-exposed workers.


2012 ◽  
Vol 16 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Joseph Doumit ◽  
Melanie Pratt

Background: Patch testing is routinely used in contact dermatitis clinics because it is the gold standard for the evaluation of potential allergic contact dermatitis. Objective: The study was undertaken to evaluate possible differences in reactivity between the Finn Chamber and IQ-Ultra patch-testing methodologies. Methods: Patients were patch-tested simultaneously with the Finn Chamber and IQ-Ultra patch tests. Ten standard allergens set by the North American Contact Dermatitis Group were used for both techniques. Results: Both patch tests had a significant agreement in detecting all of the allergens. An “almost perfect agreement” was noted for ethylenediamine dihydrochloride, quaternium-15, mercapto mix, black rubber mix, balsam of Peru, and nickel sulfate; “substantial agreement” for formaldehyde, bisphenol A epoxy resin, and 4-tert-butylphenol formaldehyde resin; and “moderate agreement” for potassium dichromate. Conclusion: The Finn Chamber and IQ-Ultra patch tests had a good agreement in the detection of the 10 standard allergens that were tested.


Author(s):  
Ashok Kumar B. Nagure ◽  
Guruprasad Kalyanrao Y.

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Agents which cause contact dermatitis are simple chemical compounds and by themselves these agents will not cause sensitization and are called haptens. These require another molecule usually a protein called the carrier molecule derived from the epidermis to cause allergic sensitization. The confirmation of contact dermatitis is done by the patch testing. There is no substitute for the patch test in the management of allergic contact dermatitis.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">After selecting the patient suspected to have allergic contact dermatitis the findings were recorded in the proforma which also includes the systemic examination of CVS, CNS, GIT and respiratory system to study systemic correlation if any. Investigation were done which included Hb%, TLC, DLC, urine routine and microscopic examination, patch testing and other special investigations if required. The patient was subjected to patch testing after the acute stage has subsided and the patient was on no therapy with topical or systemic steroids prior to patch testing</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The incidence of allergic contact dermatitis due to cosmetics was found in 7 (5.6%) cases. In that hair dye (PPD) inducing dermatitis was found in 4 (57.4%) and due to hair oil 1 (14.2%), kumkum 1 (14.2%) and Sunsilk shampoo 1 (14.2%). The incidence of PPD sensitivity in this series of 125 cases was 4 (3.2%). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">PPD is a well-known potent sensitizer, it is a chief constituent of the commonly used hair dyes and also some other cosmetics like nail polish.</span></p>


Author(s):  
Ghanshyam K. Verma ◽  
Saru Thakur ◽  
Gita Ram Tegta ◽  
Ajeet K. Negi ◽  
Saurabh Sharma ◽  
...  

<p class="abstract"><strong>Background:</strong> Skin is exposed to a vast variety of chemicals, organic or biological products among fashion seeking community of today’s world. This put them at risk of contact sensitization. Rapid industrialization, westernization of the society and poor labeling laws of cosmetics put us to the threat of “contact sensitization explosion” in near future. To know the drift of common contact sensitizers in the region, patch testing provides an insight into the cause of allergic contact dermatitis. The objective of the study was to determine the commonest allergen responsible for allergic contact dermatitis among patients attending contact dermatitis clinic in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted in the Department of Dermatology of our institution. We reviewed the medical records of all patients who were patch tested over a period of 6 years, using Indian standard series.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 521 patients who were patch tested in the contact dermatitis clinic were included in the study. Nine patients with angry back were excluded. There were 269 males and 243 females. The commonest provisional diagnosis was allergic contact dermatitis secondary to hair dye in 172 (33.3%) patients followed by air borne contact dermatitis to parthenium in 88 (17.3%) patients. The paraphenylenediamine (PPD) being the most common sensitizer in 92 (17.9%) patients was followed by nickel in 86 (16.7%) patients, potassium dichromate in 36 (7%), parthenium in 32 (6%) and fragrance mix in 31 (6%) patients.</p><p class="abstract"><strong>Conclusions:</strong> This study revealed higher prevalence of hair dye dermatitis. Paraphenylenediamine was the most common allergen.</p>


2021 ◽  
Vol 23 (1) ◽  
pp. 16-22
Author(s):  
Arnija Rana ◽  
S Shrestha ◽  
AK Jha ◽  
DP Thapa ◽  
S Joshi ◽  
...  

Allergic contact dermatitis (ACD) is one of the most common diseases presenting to the Dermatology department. The one and only method of preventing as well as treating this disease is avoidance of the allergen causing it. The identification of the allergen causing the ACD is possible by performing patch testing. The purpose of this study was to identify common allergens among patients with ACD using Indian standard series (ISS) of patch test. Clinically suspected cases of ACD were included in the hospital based cross-sectional study from January to December 2017. These cases underwent patch testing with the ISS. The study assessed the following variables: sex, age, occupation, site and positive patch test results. There were a total of 58 patients among which, 36.2% were males and 63.8% were females with a mean age of 32.36±12.51 years. Positive patch test reactions were seen in 63.0% of patients. The most common allergens were nickel sulphate (51.4%), fragrance mix (37.8%), potassium dichromate (8.1%), colophony (8.1%) and black rubber mix (8.1%). Among male, most common allergens were fragrance mix (57.1%), nickel sulphate (28.6%) and potassium dichromate (21.4%) while in female, most common allergens were nickel sulphate (65.2%) and fragrance mix (26.1%). In our study, majority of the allergens were positive. Hence, the ISS used in the study might be suitable in the context of Nepalese population. However, further similar studies on large number of patients with multiple allergens are required to determine the exact number of contact allergens prevalent in our population.


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