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Common allergens in periorbital dermatitis
P1401
P1403
Common allergens in periorbital dermatitis Lilla Landeck, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Ernesto Gonzalez, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Konrad Neumann, PhD, Department of Biometry and Clinical Epidemiology, Charite´- Universita¨tsmedizin Berlin, Berlin, Germany; Lynn Baden, MD, MPH, Centre Dermatology and Aesthetic Medicine, Newton Centre, MA, United States; Peter Schalock, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Allergic contact cheilitis to toothpaste after pediatric liver transplantation: A case series Laura Proudfoot, MBChB, King’s College Hospital, London, Greater London, United Kingdom; Anil Dhawan, King’s College Hospital, London, Greater London, United Kingdom; Elisabeth Higgins, King’s College Hospital, London, Greater London, United Kingdom; Mike Harrison, King’s College Hospital, London, Greater London, United Kingdom Cheilitis is an inflammatory reaction of the lips that may result from endogenous or exogenous causes. Allergic contact cheilitis to toothpaste is uncommonly reported despite the fact they contain a number of contact allergens, including flavorings and preservatives. We report four pediatric cases of allergic contact cheilitis to the same branded toothpaste that developed after liver transplantation in recipients maintained on low-dose tacrolimus and prednisolone. We believe these patients became actively sensitised following transplantation despite immunosuppression. All cases developed a persistent, treatment-resistant, fissured cheilitis involving both the upper and lower lips 1 to 3 years posttransplant. In three cases, areas of secondary impetiginisation had developed in the perioral region. The patients had all initially been diagnosed with an irritant contact dermatitis secondary to lip-licking. All cases tested negative for candidiasis and nutritional deficiencies. Patch testing to the European standard series, fragrance series, and dental series was negative in all cases. However, patch testing revealed persistent 21/31 contact sensitisation reactions to their branded toothpaste and all patients had significant symptom improvement on substitution for an alternative brand. To our knowledge, these are the first reports of acquired allergic contact sensitivities to toothpaste in the transplant population. This series highlights the potential of a branded toothpaste ingredient to stimulate an acquired allergic dermal hypersensitivity reaction in transplant recipients on low-dose immunosuppressive therapy. It may also reflect underreporting of toothpaste allergic contact sensitivities in general. It is crucial to recognise this phenomenon because it can be easily and successfully diagnosed and treated with patch testing and by substitution for an alternative product. This poster presents the four cases with discussion.
Background: Allergic contact dermatitis (ACD) of the periorbital area may result from sensitization to cosmetics, topical drugs, nail preparations, and airborne allergens. Objective: The purpose of our study was to characterize general epidemiologic findings and specific features of contact sensitization in patients tested with a primary complaint of periorbital dermatitis. Results were compared to those tested without periorbital dermatitis. Methods: After obtaining approval from the institutional review board, data were collected from charts reviewed for 266 patients with periorbital dermatitis undergoing patch testing to the standard and supplemental series at the MGH between 1990 and 2006. Results were compared to 981 patients tested for other than periorbital dermatitis. Statistical analyses were carried out by the chi square test. Results: Comparing periorbital patients (PP) and nonperiorbital patients (NPP) with regard to gender and age distribution, significantly (P \.0005) more females were found among PP (PP 87.6%, NPP 65.3%) while the age distribution was similar in both groups. No difference (P ¼ .5) was seen in the number of patients with an atopic background (PP 15.0%, NPP 13.5%) and in the percentage of sensitized (PP 57.5%, NPP 56.0%) in each group. Allergens commonly causing sensitization in periorbital dermatitis consisted of fragrance mix, nickel, and cobalt. When comparing sensitization to specific allergens between PP and NPP no statistically significant difference was evaluated for most common allergens. Allergens with a high clinical relevance ([85%) among PP were nickel, thimerosal, wool alcohols and epoxy resin. Most frequent final diagnoses in both groups were ACD, followed by atopic dermatitis.
Commercial support: None identified.
Conclusion: Allergic contact sensitization in periorbital dermatitis more frequently seen in females, most probably a result of increased use of cosmetic products. Most common allergens are the same as in the NPP group. Therefore, in addition to sensitization because of direct application of sensitizers to the periorbital area, one must always consider the possibility of secondary transfer, such as from the hands. Assessment of the relevance of positive results is important, because most common allergens were not the most relevant. Because allergic contact dermatitis represents a leading etiologic cause of periorbital dermatitis, patch testing should be a standard diagnostic tool. Commercial support: None identified.
P1404
Granulomatous contact dermatitis secondary to ear piercing: A case report Allyson Black, University of Oklahoma, Oklahoma City, OK, United States; James Stewart, MD, Stewart & Collier, Oklahoma City, OK, United States; Miranda Smith, MD, University of Oklahoma, Oklahoma City, OK, United States Granulomatous contact dermatitis is a rare complication of ear piercing. Manifesting as papules or nodules in locations of ornamental piercing, reports of patch testepositive confirmation of allergy to associated piercing metals have been found. We present a case in which lesions arose in areas where piercing occurred through cartilage while sparing the earlobes. Biopsy showed a sarcoidal granuloma without findings suggestive of a foreign body. Previous reports have shown mixed success with intralesional steroid therapy. Ultimately, surgical excision was required for our patient after intralesional therapy failed to provide improvement.
Occupational protein contact dermatitis caused by fish: Five case reports Pablo Hernandez Bel, MD, Hospital General Universitario Valencia, Valencia, Spain; Altea Esteve Martinez, Hospital General Universitario Valencia, Valencia, Spain; Javier Lopez Davia, Hosptital General Universitario Valencia, Valencia, Spain; Jesus De La Cuadra Oyanguren, Hospital General Universitario De Valencia, Valencia, Spain; Victor Alegre De Miquel, Hospital General Universitario Valencia, Valencia, Spain Protein contact dermatitis is an allergic skin reaction induced principally by proteins of either animal or plant origin. The clinical presentation is that of a chronic dermatitis, and it is often difficult to differentiate between allergic contact dermatitis and other eczematous dermatoses. One distinguishing clinical feature is that acute flares of pruritus, urticaria, edema, or vesiculation are noted minutes after contact with the causative substances. In addition, the patch test result is typically negative, and the scratch or prick test result is positive. The pathogenesis of protein contact dermatitis is unclear but may involve a type I IgE (immediate) hypersensitivity reaction, type IV (cell-mediated delayed) hypersensitivity reaction, and/or a delayed reaction caused by IgE-bearing Langerhans cells. Management involves avoidance of the allergen. We present five cases of occupational protein contact dermatitis caused by fish.
Commercial support: None identified.
Commercial support: None identified.
P1402
MARCH 2010
J AM ACAD DERMATOL
AB49
P1403
Common allergens in periorbital dermatitis Lilla Landeck, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Ernesto Gonzalez, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Konrad Neumann, PhD, Department of Biometry and Clinical Epidemiology, Charite´- Universita¨tsmedizin Berlin, Berlin, Germany; Lynn Baden, MD, MPH, Centre Dermatology and Aesthetic Medicine, Newton Centre, MA, United States; Peter Schalock, MD, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Allergic contact cheilitis to toothpaste after pediatric liver transplantation: A case series Laura Proudfoot, MBChB, King’s College Hospital, London, Greater London, United Kingdom; Anil Dhawan, King’s College Hospital, London, Greater London, United Kingdom; Elisabeth Higgins, King’s College Hospital, London, Greater London, United Kingdom; Mike Harrison, King’s College Hospital, London, Greater London, United Kingdom Cheilitis is an inflammatory reaction of the lips that may result from endogenous or exogenous causes. Allergic contact cheilitis to toothpaste is uncommonly reported despite the fact they contain a number of contact allergens, including flavorings and preservatives. We report four pediatric cases of allergic contact cheilitis to the same branded toothpaste that developed after liver transplantation in recipients maintained on low-dose tacrolimus and prednisolone. We believe these patients became actively sensitised following transplantation despite immunosuppression. All cases developed a persistent, treatment-resistant, fissured cheilitis involving both the upper and lower lips 1 to 3 years posttransplant. In three cases, areas of secondary impetiginisation had developed in the perioral region. The patients had all initially been diagnosed with an irritant contact dermatitis secondary to lip-licking. All cases tested negative for candidiasis and nutritional deficiencies. Patch testing to the European standard series, fragrance series, and dental series was negative in all cases. However, patch testing revealed persistent 21/31 contact sensitisation reactions to their branded toothpaste and all patients had significant symptom improvement on substitution for an alternative brand. To our knowledge, these are the first reports of acquired allergic contact sensitivities to toothpaste in the transplant population. This series highlights the potential of a branded toothpaste ingredient to stimulate an acquired allergic dermal hypersensitivity reaction in transplant recipients on low-dose immunosuppressive therapy. It may also reflect underreporting of toothpaste allergic contact sensitivities in general. It is crucial to recognise this phenomenon because it can be easily and successfully diagnosed and treated with patch testing and by substitution for an alternative product. This poster presents the four cases with discussion.
Background: Allergic contact dermatitis (ACD) of the periorbital area may result from sensitization to cosmetics, topical drugs, nail preparations, and airborne allergens. Objective: The purpose of our study was to characterize general epidemiologic findings and specific features of contact sensitization in patients tested with a primary complaint of periorbital dermatitis. Results were compared to those tested without periorbital dermatitis. Methods: After obtaining approval from the institutional review board, data were collected from charts reviewed for 266 patients with periorbital dermatitis undergoing patch testing to the standard and supplemental series at the MGH between 1990 and 2006. Results were compared to 981 patients tested for other than periorbital dermatitis. Statistical analyses were carried out by the chi square test. Results: Comparing periorbital patients (PP) and nonperiorbital patients (NPP) with regard to gender and age distribution, significantly (P \.0005) more females were found among PP (PP 87.6%, NPP 65.3%) while the age distribution was similar in both groups. No difference (P ¼ .5) was seen in the number of patients with an atopic background (PP 15.0%, NPP 13.5%) and in the percentage of sensitized (PP 57.5%, NPP 56.0%) in each group. Allergens commonly causing sensitization in periorbital dermatitis consisted of fragrance mix, nickel, and cobalt. When comparing sensitization to specific allergens between PP and NPP no statistically significant difference was evaluated for most common allergens. Allergens with a high clinical relevance ([85%) among PP were nickel, thimerosal, wool alcohols and epoxy resin. Most frequent final diagnoses in both groups were ACD, followed by atopic dermatitis.
Commercial support: None identified.
Conclusion: Allergic contact sensitization in periorbital dermatitis more frequently seen in females, most probably a result of increased use of cosmetic products. Most common allergens are the same as in the NPP group. Therefore, in addition to sensitization because of direct application of sensitizers to the periorbital area, one must always consider the possibility of secondary transfer, such as from the hands. Assessment of the relevance of positive results is important, because most common allergens were not the most relevant. Because allergic contact dermatitis represents a leading etiologic cause of periorbital dermatitis, patch testing should be a standard diagnostic tool. Commercial support: None identified.
P1404
Granulomatous contact dermatitis secondary to ear piercing: A case report Allyson Black, University of Oklahoma, Oklahoma City, OK, United States; James Stewart, MD, Stewart & Collier, Oklahoma City, OK, United States; Miranda Smith, MD, University of Oklahoma, Oklahoma City, OK, United States Granulomatous contact dermatitis is a rare complication of ear piercing. Manifesting as papules or nodules in locations of ornamental piercing, reports of patch testepositive confirmation of allergy to associated piercing metals have been found. We present a case in which lesions arose in areas where piercing occurred through cartilage while sparing the earlobes. Biopsy showed a sarcoidal granuloma without findings suggestive of a foreign body. Previous reports have shown mixed success with intralesional steroid therapy. Ultimately, surgical excision was required for our patient after intralesional therapy failed to provide improvement.
Occupational protein contact dermatitis caused by fish: Five case reports Pablo Hernandez Bel, MD, Hospital General Universitario Valencia, Valencia, Spain; Altea Esteve Martinez, Hospital General Universitario Valencia, Valencia, Spain; Javier Lopez Davia, Hosptital General Universitario Valencia, Valencia, Spain; Jesus De La Cuadra Oyanguren, Hospital General Universitario De Valencia, Valencia, Spain; Victor Alegre De Miquel, Hospital General Universitario Valencia, Valencia, Spain Protein contact dermatitis is an allergic skin reaction induced principally by proteins of either animal or plant origin. The clinical presentation is that of a chronic dermatitis, and it is often difficult to differentiate between allergic contact dermatitis and other eczematous dermatoses. One distinguishing clinical feature is that acute flares of pruritus, urticaria, edema, or vesiculation are noted minutes after contact with the causative substances. In addition, the patch test result is typically negative, and the scratch or prick test result is positive. The pathogenesis of protein contact dermatitis is unclear but may involve a type I IgE (immediate) hypersensitivity reaction, type IV (cell-mediated delayed) hypersensitivity reaction, and/or a delayed reaction caused by IgE-bearing Langerhans cells. Management involves avoidance of the allergen. We present five cases of occupational protein contact dermatitis caused by fish.
Commercial support: None identified.
Commercial support: None identified.
P1402
MARCH 2010
J AM ACAD DERMATOL
AB49