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P345 Systemic contact dermatitis resulting from patch testing to vanadium
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Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
clinic for the evaluation of contact dermatitis. He initially noticed intense posterior scalp itching and hypopigmentation 2 days after applying hair dye. Our physical examination demonstrated posterior and occipital scalp hypopigmentation with surrounding hyperpigmented macules. Laboratory testing was unremarkable with a normal eosinophil count. We performed patch testing, which was positive to PPD at the 48 hour and delayed readings. The patient was instructed to avoid PPD-containing dyes, and was prescribed topical desonide as well as UVB therapy. Within 3 weeks, the patient experienced gradual improvement and re-pigmentation of the scalp. Conclusion: Chemical leukoderma may occur due to skin contact with chemicals such as PPD. This patient clinically improved following the avoidance of PPD in conjunction with topical steroids and UV therapy. Clinicians must maintain a high index of suspicion for chemical leukoderma, due to the widespread use of hair dyes and in light.
Scalp Hypopigmentation
P345 SYSTEMIC CONTACT DERMATITIS RESULTING FROM PATCH TESTING TO VANADIUM G. Hudes1, M. Karagic*2, O. Abramian2, M. Ramesh1, 1. Bronx, NY; 2. Philadelphia, PA. Introduction: Sensitization to metals including vanadium post knee and hip implants has been previously reported. We report a case of implant failure that was evaluated by patch testing, found to be sensitized to vanadium chloride, who developed systemic contact dermatitis in response to the patch test. Methods: This is a case of 65-year- old Hispanic female who was referred to the Allergist for evaluation of possible metal allergy after failing the second knee replacement. After her second procedure, she developed a new onset of eczema and dry, scaly and severely pruritic skin on her back. Extensive evaluation did not find any other etiology. The patient underwent 1st round of patch testing with TRUE test that was positive for nickel sulfate, ethylenediamine dihyrochloride and mercapobenzothiazole. Implant failure was attributed to nickel allergy. Prior to surgery the patient underwent second round of patch testing with number of metals used in knee implants including titanium. She was found to have strong positive reaction to Vanadium Chloride. Forty- eight hours after placement of the second patch test panels, she developed generalized eczematous rash, with vanadium being the only new positive reaction. This rash was identical to the rash after primary joint failure. She was treated with oral prednisone and antihistamines with resolution of symptoms. Conclusion: To our knowledge we present a first case of systemic contact dermatitis secondary to vanadium chloride. Physician should be aware of contact hypersensitivity to metals used in orthopedic prosthesis and tailor testing to the alloy of the failing joint and perhaps suggest replacement.
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
clinic for the evaluation of contact dermatitis. He initially noticed intense posterior scalp itching and hypopigmentation 2 days after applying hair dye. Our physical examination demonstrated posterior and occipital scalp hypopigmentation with surrounding hyperpigmented macules. Laboratory testing was unremarkable with a normal eosinophil count. We performed patch testing, which was positive to PPD at the 48 hour and delayed readings. The patient was instructed to avoid PPD-containing dyes, and was prescribed topical desonide as well as UVB therapy. Within 3 weeks, the patient experienced gradual improvement and re-pigmentation of the scalp. Conclusion: Chemical leukoderma may occur due to skin contact with chemicals such as PPD. This patient clinically improved following the avoidance of PPD in conjunction with topical steroids and UV therapy. Clinicians must maintain a high index of suspicion for chemical leukoderma, due to the widespread use of hair dyes and in light.
Scalp Hypopigmentation
P345 SYSTEMIC CONTACT DERMATITIS RESULTING FROM PATCH TESTING TO VANADIUM G. Hudes1, M. Karagic*2, O. Abramian2, M. Ramesh1, 1. Bronx, NY; 2. Philadelphia, PA. Introduction: Sensitization to metals including vanadium post knee and hip implants has been previously reported. We report a case of implant failure that was evaluated by patch testing, found to be sensitized to vanadium chloride, who developed systemic contact dermatitis in response to the patch test. Methods: This is a case of 65-year- old Hispanic female who was referred to the Allergist for evaluation of possible metal allergy after failing the second knee replacement. After her second procedure, she developed a new onset of eczema and dry, scaly and severely pruritic skin on her back. Extensive evaluation did not find any other etiology. The patient underwent 1st round of patch testing with TRUE test that was positive for nickel sulfate, ethylenediamine dihyrochloride and mercapobenzothiazole. Implant failure was attributed to nickel allergy. Prior to surgery the patient underwent second round of patch testing with number of metals used in knee implants including titanium. She was found to have strong positive reaction to Vanadium Chloride. Forty- eight hours after placement of the second patch test panels, she developed generalized eczematous rash, with vanadium being the only new positive reaction. This rash was identical to the rash after primary joint failure. She was treated with oral prednisone and antihistamines with resolution of symptoms. Conclusion: To our knowledge we present a first case of systemic contact dermatitis secondary to vanadium chloride. Physician should be aware of contact hypersensitivity to metals used in orthopedic prosthesis and tailor testing to the alloy of the failing joint and perhaps suggest replacement.