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Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
A well-defined plaque of eczema may be due to contact with an allergen such as nickel in buckles or jean studs, colophony in elastoplast or chrome in leather straps. Creams containing parabens, antibiotics, antihistamines or even a topical steroid may also cause an allergic dermatitis (see also pp. 74 & 305). The patient will need to be patch tested (see p. 15) by a dermatologist with a special interest in contact dermatitis to interpret any positive patch tests. Any allergens thought to be causing the dermatitis will need to be avoided. In theory avoidance results in a cure, although in practice this is not always the case. The dermatitis is treated with a potentUK/group 2–3USA topical steroid ointment.
Monographs of fragrance chemicals and extracts that have caused contact allergy / allergic contact dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In one center in Belgium, between 1985 and 1990, 3970 patients with dermatitis were patch tested. 462 of these reacted positively to patch tests with cosmetic allergens. The reactions were considered to be relevant in 68%, probably relevant in 25% and doubtfully relevant in 7% of the patients. In the list of ‘most common allergens’ cinnamal had rank number 9 with 31 reactions. It should be appreciated that not all patients were patch tested with individual fragrances and that the presence of the allergen in cosmetic products causing dermatitis could not always be verified (at that time, ingredient labeling in the EU was not yet mandatory) (151).
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A 20-year-old man was treated with topical photochemotherapy for alopecia areata when, after the 6th treatment, a papulovesicular itching dermatitis in the treated areas developed. Patch tests were positive to 0.15% methoxsalen solution (apparently the pure material) and its 1:10 dilution. Photopatch tests were only slightly stronger. The reactions to the excipients of the commercial methoxsalen solution were negative. Histology of the patch test showed typical signs of allergic contact dermatitis. Ten controls were negative (9).
Comparison between patch test results of natural dyes and standard allergens in batik workers with occupational contact dermatitis
Published in Cutaneous and Ocular Toxicology, 2022
Eka Devinta Novi Diana, Suci Widhiati, Moerbono Mochtar, Muhammad Eko Irawanto
The patient’s back was patch tested with two treatments, using natural dyes (Indigofera tinctoria), sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni), and standard allergens (p-phenylenediamine (PPD) 0.1%, potassium dichromate 0.5% and formaldehyde 1%). The subjects who participated in this study were batik workers who suffered from OCD on their hands, had been in contact with natural dyes and standard allergens, were aged 18–60 years, and were willing to participate in the study by signing the informed consent. Subjects taking oral corticosteroids equivalent to prednisone or prednisolone 20 mg/day for 2 weeks before the study, suffered from inflammation of the back area to be patched, and the angry back syndrome was excluded from the study. Patch test results were evaluated at 48, and 96 hour then two dermatology and venereologists validated the patch test results assessment.
Contact sensitivity to textile dyes in patients with pigmented purpuric dermatosis
Published in Cutaneous and Ocular Toxicology, 2019
Irem Ozturk Ozcan, Evren Odyakmaz Demirsoy, Nilgün Sayman, Aysun Sikar Akturk, Dilek Bayramgurler, Rebiay Kiran
According to our knowledge, there have been few studies investigating contact sensitivity in patients with pigmented purpuric dermatoses. Engin et al.8 applied European standard series to 22 pigmented purpuric dermatoses patients and found 12 of 22 patients to have a positive result with at least one allergen. These allergens were nickel sulphate in seven patients, fragrance mix in six patients, disperse blue in four patients, formaldehyde resin in four patients, cobalt chloride in one patient and epoxy resin in one patient. Subsequently, four allergens (nickel sulphate, fragrance mix, disperse blue 106, formaldehyde resin) were applied to the lesion site of the patch test positive patients. Positive reaction was detected in the lesion area with nickel sulphate in two patients, fragrance mix in four patients, disperse blue 106 in two patients and formaldehyde resin in one patient. They noted that the lesions were cleared after the elimination of the allergen in four patients in whom the patch test was positive both at the usual site and at the lesion site. The clearance was complete in three patients and partial in one. Authors thought that patch testing at both sites—the usual site and the lesion site—may reflect a direct aetiologic relationship between an allergen and pigmented purpuric dermatoses8. Two test allergens, disperse blue-106 and formaldehyde resins, which were used by Engin et al.8 were also used in our study; however, no positive reaction was observed in any of our patients.
Successful rapid oral desensitization for dual hypersensitivity to isoniazid and rifampin while treating central nervous system tuberculosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Moni Roy, Sharjeel Ahmad, Ashish Kumar Roy
With multi drug regimen for treatment of infection such as tuberculosis, identifying the ‘culprit’ drug is a challenge, as in our case. A patch test has been used for suspected drug reaction due to one drug but a negative test result cannot be completely relied on as the spectrum of allergic reaction due to the drugs remain variable and broad [9,10]. Another method, lymphocyte transformation test that measures the proliferation of T cells to a drug in vitro, can be useful but has limited availability and low sensitivity [11]. Clinical correlation with detailed history and monitoring on reintroduction of each drug gradually is most commonly used. Since our patient developed skin rash, neutropenia and elevated liver enzymes on 4-drug regimen all medications had to be stopped transiently. Gradual introduction of medication based on known side effect profile is the next best step in cases such as ours when antimicrobial treatment cannot be held.