Artigos - Dermatite de Contato
1. Fernandez Vozmediano JM, Armario Hita JC.
Allergic contact dermatitis in children.
J Eur Acad Dermatol Venereol. 2005 Jan;19(1):42-6.
INTRODUCTION: Allergic contact dermatitis (ACD) is equally as likely in infancy as in adulthood, and represents 20% of all cases of dermatitis in children. Its true prevalence and incidence are, however, unknown. MATERIALS AND METHODS: We have conducted a retrospective study over 10 years of a group of patients aged 15 years or less, with clinical suspicion of ACD. Patch tests were performed in accordance with the standards of the GEIDC. RESULTS: The study covered 96 patients with a mean age of 10.57+/-0.67 years. The zones most frequently affected by eczemas were those of diffuse distribution (28% of patients) and of the hands (27%). We found at least one positive response in 52% of the cases. The most frequent allergens were thiomersal (21%), mercury (19%) and nickel (18%). We have found a statistically significant association between age of less than 15 years and positive response to thiomersal [P<0.01; OR: 8.5 with confidence interval (CI) 95%: 5.08< odds ratio (OR)<14.20] and mercury (P<0.01; OR: 4.38 with CI 95%: 3.02< OR<6.33). CONCLUSIONS: With increasing age, nickel takes the place of the mercurials as the principal allergen.
2. Kist JM, el-Azhary RA, Hentz JG, Yiannias JA.
The contact allergen replacement database and treatment of allergic contact dermatitis.Arch Dermatol. 2004 Dec;140(12):1448-50.
OBJECTIVE: To determine whether the Contact Allergen Replacement Database would improve clinical outcomes for patients with allergic contact dermatitis associated with topical skin care products by helping patients avoid known allergens. DESIGN: This study was a randomized, single-blind, controlled trial. SETTING: The study was conducted at the outpatient facilities at Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn. PARTICIPANTS: Of the 29 patients enrolled, 21 completed the study. INTERVENTION: All patients were randomly assigned to either a Contact Allergen Replacement Database group or a traditional therapy group. Patients in the database group received an individualized list of topical skin care products free of the antigens identified by the results of their individual patch tests. Otherwise, the 2 groups received identical therapy. MAIN OUTCOME MEASURES: To evaluate erythema, scale, and pruritus at 3-month follow-up, each variable was given a severity score from 0 to 3. A 1-point change was considered clinically notable. We also evaluated total physician-patient counseling time and patient satisfaction. RESULTS: We found no statistically significant differences (P>.05) between the 2 treatment groups on measures of disease activity and counseling time. However, 91% of the database group reported the allergen-free product list to be either somewhat helpful or very helpful in managing contact dermatitis. All the patients without access to the database said it would have been helpful. CONCLUSIONS: Although this small study, with its limited follow-up, did not yield objective evidence supporting the use of the Contact Allergen Replacement Database, the database-generated product lists were favorably received by patients. We anticipate an expanded clinical role for this database as an Internet-based resource.
3. Krob HA, Fleischer AB Jr, D'Agostino R Jr, Haverstock CL, Feldman S.
Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of published T.R.U.E. test data.
J Am Acad Dermatol. 2004 Sep;51(3):349-53.
BACKGROUND: The patch test procedure is frequently employed to help determine or confirm the cause of allergic contact dermatitis (ACD). The T.R.U.E. Test has become a global standard and is the commercially available patch test system currently used within the United States. Although many studies report T.R.U.E. Test data, none has measured the overall prevalence and relevance of reactions to the allergens tested by the T.R.U.E. Test. Our objective is to describe the prevalence and relevance of contact dermatitis allergens as tested by the T.R.U.E. Test. METHODS: We conducted a search of the MEDLINE database from 1966 to June 2000 for all publications on the use of the T.R.U.E. Test in the clinical evaluation of ACD in human subjects. Inclusion and exclusion criteria were applied. For each study, we identified and recorded the number of subjects tested, the number of patients with positive reactions, and the number with relevant reactions. Data were analyzed using the SAS system (Cary, NC). RESULTS: Ours is the first study to compile the entire corpus of published T.R.U.E. Test data and to examine these data using meta-analytic techniques. The meta-analysis shows that nickel (14.7% of tested patients), thimerosal (5.0%), cobalt (4.8%), fragrance mix (3.4%), and balsam of Peru (3.0%) are the most prevalent allergens. The 5 least prevalent allergens are paraben mix (0.5%), black rubber mix (0.6%), quaternium-15 (0.6%), quinoline mix (0.7%), and caine mix (0.7%). By contrast, North American Contact Dermatitis Data Group (NACDG) data show that the 5 most prevalent allergens are nickel (14.3%), fragrance mix (14%), neomycin (11.6%), balsam of Peru (10.4%), and thimerosal (10.4%). NACDG data indicate that the prevalence of allergy to cobalt is 9.2%. In order to assess the clinical importance of T.R.U.E. Test allergens, we employ the Significance-Prevalence Index Number (SPIN). Based on SPIN, the most clinically important allergens tested by the T.R.U.E. Test are nickel (SPIN=894), cobalt (266), fragrance mix (158), colophony (141), and thiuram mix (138). CONCLUSIONS: Our results identify the prevalence of common contact dermatitis allergens as tested by the T.R.U.E. Test and are in general agreement with previously published reports using other patch test methods. Over 3700 allergens have been identified as causing ACD, of which the T.R.U.E. Test tests only 23. Thus, the T.R.U.E. Test is a screening test at best. Comparison with NACDG data suggests that clinically important allergens may be missed by the T.R.U.E. Test.
4. Saint-Mezard P, Rosieres A, Krasteva M, Berard F, Dubois B, Kaiserlian D, Nicolas JF.
Allergic contact dermatitis.
Eur J Dermatol. 2004 Sep-Oct;14(5):284-95. Review.
Contact dermatitis is an inflammatory skin condition induced by exposure to an environmental agent. Eczema and dermatitis are used synonymously to denote a polymorphous pattern of skin inflammation characterized at least in its acute phase by erythema, vesiculation and pruritus. Substances responsible for contact dermatitis after single or multiple exposures are non protein chemicals, i.e. haptens, that induce skin inflammation through activation of innate skin immunity (irritant contact dermatitis) or both innate and acquired specific immunity (allergic contact dermatitis). The present review will focus on allergic contact dermatitis, a delayed-type hypersensitivity reaction, which is mediated by hapten-specific T cells. Recent advances in the pathophysiology of ACD have shown that the occurrence of ACD, as well as its magnitude and duration, is controlled by the opposite functions of CD8 effector T cells and CD4 regulatory T cells. From these studies ACD can be considered as a breakdown of cutaneous immune tolerance to haptens.
5. Kadyk DL, Hall S, Belsito DV.
Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation.
Dermatitis. 2004 Sep;15(3):117-24.
BACKGROUND: Little has been published regarding the impact of gender, ethnicity, age, and occupation on the quality of life (QoL) of patients with allergic contact dermatitis (ACD). OBJECTIVES: This study investigated the relationship between QoL scores for patients with ACD and variables such as gender, ethnicity, age, and occupation. METHODS: Four hundred twenty-eight patients with ACD were mailed a QoL questionnaire modified from Skindex-16 to include an additional five items pertaining to occupational impact. The QoL scores were analyzed to ascertain factors that affect QoL in patients with ACD. RESULTS: The response rate was 35%. Non-Caucasians reported lower QoL scores than did Caucasians within the functioning scale. There were no statistically significant gender-related differences in QoL scores although females reported a higher degree of emotional distress. Younger subjects were more likely to have lower QoL scores within the functioning and occupational scales. Industrial workers reported the worst occupational QoL, followed by office workers. Occupation was the variable that significantly affected the greatest number of survey subjects, followed by age, ethnicity, and gender. CONCLUSIONS: Three of the four variables examined had a significant association with QoL. Non-Caucasians, younger subjects, and industrial workers reported a significantly worse QoL due to ACD. There were no statistically significant gender-related differences in QoL scores.
6. Cohen DE, Heidary N.
Treatment of irritant and allergic contact dermatitis.
Dermatol Ther. 2004;17(4):334-40. Review.
The treatment of contact dermatitis lies principally in the avoidance of the offending agent. In certain circumstances, avoidance protocols are insurmountable, and therapy is rendered to assuage the inflammatory component and its consequent objective and subjective findings. However, the options thereafter vary, as some patients will require continuous symptomatic therapy despite avoidance of the purported offending agent. This manuscript will review established treatment options for contact dermatitis, such as corticosteroids and dietary manipulation, as well as discuss some promising new therapies from the last decade, such as the immunomodulatory and anti-inflammatory agents.
7. Cohen DE.
Contact dermatitis: a quarter century perspective.
J Am Acad Dermatol. 2004 Jul;51(1 Suppl):S60-3. Review. No abstract available.
8. Saint-Mezard P, Berard F, Dubois B, Kaiserlian D, Nicolas JF.
The role of CD4+ and CD8+ T cells in contact hypersensitivity and allergic contact dermatitis.
Eur J Dermatol. 2004 May-Jun;14(3):131-8. Review.
Allergic contact dermatitis (ACD) and contact hypersensitivity (CHS) are delayed-type hypersensitivity reactions which are mediated by hapten specific T cells. During the sensitisation phases, both CD4+ and CD8+ T cell precursors are activated in the draining lymph nodes by presentation of haptenated peptides by skin dendritic cells. Subsequent hapten skin painting induces the recruitment of T cells at the site of challenge which induces inflammatory signals and apoptosis of epidermal cells, leading to the development of a skin inflammatory infiltrate and of clinical symptoms. There have been major controversies on the respective roles of CD4+ and CD8+ T cells in the development of the CHS inflammatory reaction. Experimental studies from the last 10 years have demonstrated that, in normal CHS responses to strong haptens, CD8+ type 1 T cells are effector cells of CHS while CD4+ T cells are endowed with down-regulatory functions. The latter may correspond to the recently described CD4+ CD25+ regulatory T cell population. However, in some instances, especially those where there is a deficient CD8 T cell pool, CD4+ T cells can be effector cells of CHS. Ongoing studies will have to confirm that the pathophysiology of human ACD is similar to the mouse CHS and that the CHS response to weak haptens, the most frequently involved in human ACD, is similar to that reported for strong haptens.
9. Resendiz Gomez F, Orea Solano M.
Immunological mechanisms in contact dermatitis
Rev Alerg Mex. 2004 May-Jun;51(3):116-8. Review. Spanish.
Contact dermatitis is an altered state of skin reactivity induced by the exposure to an external antigen which begins a series of mechanisms where Langerhans cells and keratinocytes play an important role in antigen presentation and have an effective response by chemokines, interleukins and lymphocytes T.
10. Girolomoni G, Gisondi P, Ottaviani C, Cavani A.
Immunoregulation of allergic contact dermatitis.
J Dermatol. 2004 Apr;31(4):264-70. Review.
Allergic contact dermatitis (ACD) to haptens can serve as a valuable paradigm for understanding the physiopathology of T cell mediated immune responses. In sensitized individuals, exposure to the relevant hapten initiates clinical expression of ACD, which depends on the rapid activation of specific T cells. Mechanisms of tissue damage include direct cytotoxicity against keratinocytes, mostly mediated by CD8+ T cells, and T cell release of cytokines, which amplify the inflammatory response by targeting resident skin cells. The expression of ACD is actively regulated by specialized subsets of T lymphocytes with suppressive functions. In particular, T regulatory cells producing high levels of IL-10 suppress ACD by blocking the functions of dendritic cells. In contrast CD4+CD25+ regulatory T cells prevent immunopathological reactions and maintain peripheral tolerance to haptens by acting via a cell-to-cell contact mechanism. Understanding the role of suppressor T cells and the requirements for their in vivo and in vitro expansion are critical steps for the development of specific desensitization protocols in hapten-allergic individuals. This information may also provide the basis for novel interventions in other immune-mediated diseases.
11. Kutting B, Brehler R, Traupe H.
Allergic contact dermatitis in children: strategies of prevention and risk management.
Eur J Dermatol. 2004 Mar-Apr;14(2):80-5. Review.
Over recent years, allergic contact dermatitis in children has repeatedly been reported as a significant clinical problem. It is generally accepted that allergic contact dermatitis is rare in the first years of life, and with increasing age (by the age of 10 years) reaches the incidence seen in adults. As in adults, metals are one of the most common sensitizers in children, along with rubber chemicals and fragrances. The influence of fashion trends and lifestyle such as piercing, decorative skin paintings, the hype of natural remedies and cosmetics (e.g. tea tree oil) or the use of cosmetical products with fragrances or herbal ingredients play an important role in developing allergic contact dermatitis. This review aims to give an overview on allergic contact dermatitis in childhood by focussing on strategies for prevention, potential risk factors and recommendations for parents as well as for physicians. By reporting typical cases of our outpatients clinic we point out several characteristics of allergic contact dermatitis. Prevention of allergic contact dermatitis in children is a current problem of interdisciplinary concern not only for dermatologists and paediatricians, but also for midwives. Frequently, children are already exposed at an early age to well-known allergens, and therefore, strategies of avoidance have to gain or regain importance and should start as early as possible.
12. Rietschel RL.
Clues to an accurate diagnosis of contact dermatitis.
Dermatol Ther. 2004;17(3):224-30. Review.
An accurate diagnosis of allergic contact dermatitis can be achieved by a combination of historical, morphologic, and diagnostic steps. Clues in the history and physical examination can point to an irritant as the source of contact dermatitis. While irritants and allergens share many common features both immunologically and clinically, there are grounds for the distinction. Knowledge of occupational factors is necessary to assess the source of contact dermatitis. A common pitfall is the failure to appreciate the role of endogenous factors in the clinical presentation and overall care of the dermatitis patient. A comprehensive assessment of the patient's environment will lead to appropriate patch tests being applied and a correct diagnosis being reached.
13. Garner LA.
Contact dermatitis to metals.
Dermatol Ther. 2004;17(4):321-7. Review.
Metals are in close contact with skin and mucous membranes on a repeated, if not constant, basis. Nickel and mercury, well-recognized causes of contact dermatitis; gold and palladium, recently gaining acceptance as patch test allergens on standard screening trays; and cobalt are reviewed in this article. Sensitization to nickel, the most frequently identified allergen on patch testing, is associated with ear piercing. Contact with this potential allergen is ubiquitous. Mercury may be encountered as organic mercury in thimerosal, used as an antiseptic and a preservative in topical medications and vaccines, and metallic mercury found in dental amalgam and thermometers. Both forms may cause contact dermatitis. Gold, recognized as a frequent sensitizer, has been implicated in some cases of eyelid, patchy diffuse and oral lichenoid dermatitis. Cobalt allergy, found frequently in patients who are nickel allergic, also has been associated with ear piercing. Palladium sensitivity is often associated with nickel allergy. However, the incidence of clinical relevance is yet to be established.
14. Li LY, Cruz PD Jr.
Allergic contact dermatitis: pathophysiology applied to future therapy.
Dermatol Ther. 2004;17(3):219-23. Review.
Contact dermatitis is a common reason for patient visits to primary-care clinics and represents up to 7% of all dermatologic consultations in the US. Substantial progress has been made in elucidating the pathophysiology of contact dermatitis, particularly the allergic form. A better understanding of pathologic mechanisms has led to improved management of cases and will continue to advance treatment modalities. The present paper reviews the pathogenesis and current treatment of allergic contact dermatitis and speculates on the prospects for improved future therapy.
15. Zeller S, Warshaw E.
Allergic contact dermatitis.
Minn Med. 2004 Mar;87(3):38-42.
Allergic contact dermatitis is a common skin condition that can be difficult to diagnose without the aid of a specific diagnostic tool called patch testing. The pathophysiology, clinical features, diagnosis, and treatment of allergic contact dermatitis are summarized in this review. The process of patch testing, the gold standard for diagnosing allergic contact dermatitis, is discussed in detail.
16. Duarte I, Lazzarini R, Kobata CM.
Contact dermatitis in adolescents.
Am J Contact Dermat. 2003 Dec;14(4):200-2.
BACKGROUND: Adolescents between the ages of 10 and 19 are exposed to a series of substances capable of causing contact dermatitis. OBJECTIVES: (1) To study the frequency and characteristics of allergic contact dermatitis in adolescents, (2) to characterize the group being studied, and (3) to verify the main sensitizing substances among this age group. METHODS: From 1996 to 2001, 1,027 patients with a suspicion of contact dermatitis were analyzed, and patients between 10 and 19 years of age were selected. These patients were submitted to contact tests. RESULTS: Among the 102 adolescents, 93 (91%) were female and 9 (9%) were male. The face was the area most affected by dermatosis. The contact tests were positive in 64 patients (56%), whereas in 45 (44%) they were negative. The main location of the contact dermatitis was the face (36%). The substances with higher frequencies of sensitization were nickel sulfate in 33 (31%) patients and tosylamide-formaldehyde resin in 13 (12%) patients. CONCLUSION: Contact dermatitis in adolescents was more frequent in white girls and on the face. The substances with greater frequency of sensitization were nickel sulfate and tosylamide-formaldehyde resin. These two substances are related to adolescent habits and behavior.
17. Kimber I, Dearman RJ.
Allergic contact dermatitis: the cellular effectors.
Contact Dermatitis. 2002 Jan;46(1):1-5. Review.
Contact hypersensitivity reactions are mediated by lymphocytic effector cells. Until recently it was believed that the most important of these were CD4+ T lymphocytes. However, there is growing evidence that in many instances the predominant effector cell may be a CD8+ T lymphocyte, with in some instances CD4+ cells performing a counter-regulatory function. Here we review the roles of CD4+ T helper (Th) cells and CD8+ T cytotoxic (Tc) cells, and their main functional subpopulations (respectively, Th1 and Th2 cells and Tc1 and Tc2 cells) in the elicitation of contact hypersensitivity reactions and consider the implications of effector cell selectivity for the biology of allergic contact dermatitis.
18. Kimbe I, Basketter DA, Gerberick GF, Dearman RJ.
Allergic contact dermatitis.
Int Immunopharmacol. 2002 Feb;2(2-3):201-11. Review.
Allergic contact dermatitis (ACD) is a common occupational and environmental health issue. In common with other forms of allergy the disease progresses in two stages; an initial phase during which sensitization is acquired, followed later (after subsequent exposure to the same chemical allergen) by elicitation of a cutaneous inflammatory reaction. The development of skin sensitization is associated with, and requires, the activation and clonal expansion of allergen responsive T lymphocytes and it is these cells that orchestrate the cutaneous allergic reaction. In recent years, much has been learned of the characteristics of immune responses to skin sensitizing chemicals and of the roles played by dendritic cells, cytokines and chemokines. Some of the more interesting cellular and molecular mechanisms are reviewed briefly in this article. A more detailed appreciation of responses induced by chemical allergens has in turn facilitated the design of novel approaches to the toxicological evaluation of skin sensitization. Real progress has been made, not only in the development of improved methods for hazard identification and characterization, but also in the application of new paradigms for risk assessment. The newer methods now available and the opportunities that exist for further advances are considered. Finally, progress has been made in the characterization of skin sensitization in humans and in the clinical management of ACD. This article seeks to consider skin sensitization and ACD in holistic fashion, bridging experimental observations with clinical disease and basic mechanisms with practical toxicology.
19. Swerlick R.
A review of cellular and molecular events of contact allergic dermatitis.
Cutis. 2001 May;67(5 Suppl):25-6. Review.
Swerlick R.
This biochemical review is presented for the first time in a dermatophytosis conference. The intent is to challenge biochemists to explain the formation of these lesions to clinicians.
20. Weston WL, Bruckner A.
Allergic contact dermatitis.
Pediatr Clin North Am. 2000 Aug;47(4):897-907, vii. Review.
Allergic contact dermatitis (ACD) in children is underrecognized. It is often confused with antibody-mediated allergies such as urticaria or allergic rhinitis, but the mechanism in ACD involves T lymphocytes and not antibody. Surprisingly, sensitization to common allergens is likely to occur in infancy. All contact allergens are weak allergens requiring repeated exposure over long periods of time. Detection of specific allergens is by epicutaneous (patch) testing and will provide the basis for allergen avoidance therapeutic strategies.
21. Mortz CG, Andersen KE.
Allergic contact dermatitis in children and adolescents.
Contact Dermatitis. 1999 Sep;41(3):121-30. Review.
Mortz CG, Andersen KE.
From a clinical point of view, the prevalence of allergic contact dermatitis (ACD) among children and adolescents seems to be low. However, many children have dermatitis, most often atopic dermatitis. In selected cases, ACD is suspected, and the child is tested. The question remains, whether the prevalence of ACD in children really is low or whether the possibility of ACD is not sufficiently considered. During the last decade, reports have appeared on series of children and adolescents with contact allergy and ACD. Few cases have been reported in infants, but the development of contact allergy and ACD increases with age. Most studies include selected groups of children and adolescents with suspected ACD. Few studies have examined unselected populations, and most consider only the prevalence of contact allergy without evaluating the clinical relevance, e.g., the prevalence of ACD. Furthermore, no follow-up studies exist. Therefore, the incidence and prevalence of contact allergy and ACD in children and adolescents is largely unknown.
22. Bergstresser PR.
Immune mechanisms in contact allergic dermatitis.
Dermatol Clin. 1990 Jan;8(1):3-11. Review.
The problem of contact allergic dermatitis in humans and contact hypersensitivity in animals begins with the observation that certain reactive compounds, when placed on skin, lead to a reproducible and characteristic inflammatory reaction. The immunologic processes that conspire to produce this damaging tissue reaction are derived from the normal immunologic balance between the protection of self and the destruction of nonself. Experimental work in the last decade has focused on the role of antigen-presenting cells, and specifically Langerhans cells, in the initiation of contact hypersensitivity, as well as on the competing roles of subsets of T lymphocytes in its regulation. For humans, an important goal has been the development of techniques by which tolerization and desensitization may be achieved, and for those who work with laboratory animals, contact hypersensitivity has provided methods to examine immune regulation in general. In the coming decade, we anticipate that new techniques from molecular biology, molecular genetics, tissue culture, and, above all, shrewd clinical observation will provide a new array of ideas and possibilities.
Allergic contact dermatitis in children.
J Eur Acad Dermatol Venereol. 2005 Jan;19(1):42-6.
INTRODUCTION: Allergic contact dermatitis (ACD) is equally as likely in infancy as in adulthood, and represents 20% of all cases of dermatitis in children. Its true prevalence and incidence are, however, unknown. MATERIALS AND METHODS: We have conducted a retrospective study over 10 years of a group of patients aged 15 years or less, with clinical suspicion of ACD. Patch tests were performed in accordance with the standards of the GEIDC. RESULTS: The study covered 96 patients with a mean age of 10.57+/-0.67 years. The zones most frequently affected by eczemas were those of diffuse distribution (28% of patients) and of the hands (27%). We found at least one positive response in 52% of the cases. The most frequent allergens were thiomersal (21%), mercury (19%) and nickel (18%). We have found a statistically significant association between age of less than 15 years and positive response to thiomersal [P<0.01; OR: 8.5 with confidence interval (CI) 95%: 5.08< odds ratio (OR)<14.20] and mercury (P<0.01; OR: 4.38 with CI 95%: 3.02< OR<6.33). CONCLUSIONS: With increasing age, nickel takes the place of the mercurials as the principal allergen.
2. Kist JM, el-Azhary RA, Hentz JG, Yiannias JA.
The contact allergen replacement database and treatment of allergic contact dermatitis.Arch Dermatol. 2004 Dec;140(12):1448-50.
OBJECTIVE: To determine whether the Contact Allergen Replacement Database would improve clinical outcomes for patients with allergic contact dermatitis associated with topical skin care products by helping patients avoid known allergens. DESIGN: This study was a randomized, single-blind, controlled trial. SETTING: The study was conducted at the outpatient facilities at Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn. PARTICIPANTS: Of the 29 patients enrolled, 21 completed the study. INTERVENTION: All patients were randomly assigned to either a Contact Allergen Replacement Database group or a traditional therapy group. Patients in the database group received an individualized list of topical skin care products free of the antigens identified by the results of their individual patch tests. Otherwise, the 2 groups received identical therapy. MAIN OUTCOME MEASURES: To evaluate erythema, scale, and pruritus at 3-month follow-up, each variable was given a severity score from 0 to 3. A 1-point change was considered clinically notable. We also evaluated total physician-patient counseling time and patient satisfaction. RESULTS: We found no statistically significant differences (P>.05) between the 2 treatment groups on measures of disease activity and counseling time. However, 91% of the database group reported the allergen-free product list to be either somewhat helpful or very helpful in managing contact dermatitis. All the patients without access to the database said it would have been helpful. CONCLUSIONS: Although this small study, with its limited follow-up, did not yield objective evidence supporting the use of the Contact Allergen Replacement Database, the database-generated product lists were favorably received by patients. We anticipate an expanded clinical role for this database as an Internet-based resource.
3. Krob HA, Fleischer AB Jr, D'Agostino R Jr, Haverstock CL, Feldman S.
Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of published T.R.U.E. test data.
J Am Acad Dermatol. 2004 Sep;51(3):349-53.
BACKGROUND: The patch test procedure is frequently employed to help determine or confirm the cause of allergic contact dermatitis (ACD). The T.R.U.E. Test has become a global standard and is the commercially available patch test system currently used within the United States. Although many studies report T.R.U.E. Test data, none has measured the overall prevalence and relevance of reactions to the allergens tested by the T.R.U.E. Test. Our objective is to describe the prevalence and relevance of contact dermatitis allergens as tested by the T.R.U.E. Test. METHODS: We conducted a search of the MEDLINE database from 1966 to June 2000 for all publications on the use of the T.R.U.E. Test in the clinical evaluation of ACD in human subjects. Inclusion and exclusion criteria were applied. For each study, we identified and recorded the number of subjects tested, the number of patients with positive reactions, and the number with relevant reactions. Data were analyzed using the SAS system (Cary, NC). RESULTS: Ours is the first study to compile the entire corpus of published T.R.U.E. Test data and to examine these data using meta-analytic techniques. The meta-analysis shows that nickel (14.7% of tested patients), thimerosal (5.0%), cobalt (4.8%), fragrance mix (3.4%), and balsam of Peru (3.0%) are the most prevalent allergens. The 5 least prevalent allergens are paraben mix (0.5%), black rubber mix (0.6%), quaternium-15 (0.6%), quinoline mix (0.7%), and caine mix (0.7%). By contrast, North American Contact Dermatitis Data Group (NACDG) data show that the 5 most prevalent allergens are nickel (14.3%), fragrance mix (14%), neomycin (11.6%), balsam of Peru (10.4%), and thimerosal (10.4%). NACDG data indicate that the prevalence of allergy to cobalt is 9.2%. In order to assess the clinical importance of T.R.U.E. Test allergens, we employ the Significance-Prevalence Index Number (SPIN). Based on SPIN, the most clinically important allergens tested by the T.R.U.E. Test are nickel (SPIN=894), cobalt (266), fragrance mix (158), colophony (141), and thiuram mix (138). CONCLUSIONS: Our results identify the prevalence of common contact dermatitis allergens as tested by the T.R.U.E. Test and are in general agreement with previously published reports using other patch test methods. Over 3700 allergens have been identified as causing ACD, of which the T.R.U.E. Test tests only 23. Thus, the T.R.U.E. Test is a screening test at best. Comparison with NACDG data suggests that clinically important allergens may be missed by the T.R.U.E. Test.
4. Saint-Mezard P, Rosieres A, Krasteva M, Berard F, Dubois B, Kaiserlian D, Nicolas JF.
Allergic contact dermatitis.
Eur J Dermatol. 2004 Sep-Oct;14(5):284-95. Review.
Contact dermatitis is an inflammatory skin condition induced by exposure to an environmental agent. Eczema and dermatitis are used synonymously to denote a polymorphous pattern of skin inflammation characterized at least in its acute phase by erythema, vesiculation and pruritus. Substances responsible for contact dermatitis after single or multiple exposures are non protein chemicals, i.e. haptens, that induce skin inflammation through activation of innate skin immunity (irritant contact dermatitis) or both innate and acquired specific immunity (allergic contact dermatitis). The present review will focus on allergic contact dermatitis, a delayed-type hypersensitivity reaction, which is mediated by hapten-specific T cells. Recent advances in the pathophysiology of ACD have shown that the occurrence of ACD, as well as its magnitude and duration, is controlled by the opposite functions of CD8 effector T cells and CD4 regulatory T cells. From these studies ACD can be considered as a breakdown of cutaneous immune tolerance to haptens.
5. Kadyk DL, Hall S, Belsito DV.
Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation.
Dermatitis. 2004 Sep;15(3):117-24.
BACKGROUND: Little has been published regarding the impact of gender, ethnicity, age, and occupation on the quality of life (QoL) of patients with allergic contact dermatitis (ACD). OBJECTIVES: This study investigated the relationship between QoL scores for patients with ACD and variables such as gender, ethnicity, age, and occupation. METHODS: Four hundred twenty-eight patients with ACD were mailed a QoL questionnaire modified from Skindex-16 to include an additional five items pertaining to occupational impact. The QoL scores were analyzed to ascertain factors that affect QoL in patients with ACD. RESULTS: The response rate was 35%. Non-Caucasians reported lower QoL scores than did Caucasians within the functioning scale. There were no statistically significant gender-related differences in QoL scores although females reported a higher degree of emotional distress. Younger subjects were more likely to have lower QoL scores within the functioning and occupational scales. Industrial workers reported the worst occupational QoL, followed by office workers. Occupation was the variable that significantly affected the greatest number of survey subjects, followed by age, ethnicity, and gender. CONCLUSIONS: Three of the four variables examined had a significant association with QoL. Non-Caucasians, younger subjects, and industrial workers reported a significantly worse QoL due to ACD. There were no statistically significant gender-related differences in QoL scores.
6. Cohen DE, Heidary N.
Treatment of irritant and allergic contact dermatitis.
Dermatol Ther. 2004;17(4):334-40. Review.
The treatment of contact dermatitis lies principally in the avoidance of the offending agent. In certain circumstances, avoidance protocols are insurmountable, and therapy is rendered to assuage the inflammatory component and its consequent objective and subjective findings. However, the options thereafter vary, as some patients will require continuous symptomatic therapy despite avoidance of the purported offending agent. This manuscript will review established treatment options for contact dermatitis, such as corticosteroids and dietary manipulation, as well as discuss some promising new therapies from the last decade, such as the immunomodulatory and anti-inflammatory agents.
7. Cohen DE.
Contact dermatitis: a quarter century perspective.
J Am Acad Dermatol. 2004 Jul;51(1 Suppl):S60-3. Review. No abstract available.
8. Saint-Mezard P, Berard F, Dubois B, Kaiserlian D, Nicolas JF.
The role of CD4+ and CD8+ T cells in contact hypersensitivity and allergic contact dermatitis.
Eur J Dermatol. 2004 May-Jun;14(3):131-8. Review.
Allergic contact dermatitis (ACD) and contact hypersensitivity (CHS) are delayed-type hypersensitivity reactions which are mediated by hapten specific T cells. During the sensitisation phases, both CD4+ and CD8+ T cell precursors are activated in the draining lymph nodes by presentation of haptenated peptides by skin dendritic cells. Subsequent hapten skin painting induces the recruitment of T cells at the site of challenge which induces inflammatory signals and apoptosis of epidermal cells, leading to the development of a skin inflammatory infiltrate and of clinical symptoms. There have been major controversies on the respective roles of CD4+ and CD8+ T cells in the development of the CHS inflammatory reaction. Experimental studies from the last 10 years have demonstrated that, in normal CHS responses to strong haptens, CD8+ type 1 T cells are effector cells of CHS while CD4+ T cells are endowed with down-regulatory functions. The latter may correspond to the recently described CD4+ CD25+ regulatory T cell population. However, in some instances, especially those where there is a deficient CD8 T cell pool, CD4+ T cells can be effector cells of CHS. Ongoing studies will have to confirm that the pathophysiology of human ACD is similar to the mouse CHS and that the CHS response to weak haptens, the most frequently involved in human ACD, is similar to that reported for strong haptens.
9. Resendiz Gomez F, Orea Solano M.
Immunological mechanisms in contact dermatitis
Rev Alerg Mex. 2004 May-Jun;51(3):116-8. Review. Spanish.
Contact dermatitis is an altered state of skin reactivity induced by the exposure to an external antigen which begins a series of mechanisms where Langerhans cells and keratinocytes play an important role in antigen presentation and have an effective response by chemokines, interleukins and lymphocytes T.
10. Girolomoni G, Gisondi P, Ottaviani C, Cavani A.
Immunoregulation of allergic contact dermatitis.
J Dermatol. 2004 Apr;31(4):264-70. Review.
Allergic contact dermatitis (ACD) to haptens can serve as a valuable paradigm for understanding the physiopathology of T cell mediated immune responses. In sensitized individuals, exposure to the relevant hapten initiates clinical expression of ACD, which depends on the rapid activation of specific T cells. Mechanisms of tissue damage include direct cytotoxicity against keratinocytes, mostly mediated by CD8+ T cells, and T cell release of cytokines, which amplify the inflammatory response by targeting resident skin cells. The expression of ACD is actively regulated by specialized subsets of T lymphocytes with suppressive functions. In particular, T regulatory cells producing high levels of IL-10 suppress ACD by blocking the functions of dendritic cells. In contrast CD4+CD25+ regulatory T cells prevent immunopathological reactions and maintain peripheral tolerance to haptens by acting via a cell-to-cell contact mechanism. Understanding the role of suppressor T cells and the requirements for their in vivo and in vitro expansion are critical steps for the development of specific desensitization protocols in hapten-allergic individuals. This information may also provide the basis for novel interventions in other immune-mediated diseases.
11. Kutting B, Brehler R, Traupe H.
Allergic contact dermatitis in children: strategies of prevention and risk management.
Eur J Dermatol. 2004 Mar-Apr;14(2):80-5. Review.
Over recent years, allergic contact dermatitis in children has repeatedly been reported as a significant clinical problem. It is generally accepted that allergic contact dermatitis is rare in the first years of life, and with increasing age (by the age of 10 years) reaches the incidence seen in adults. As in adults, metals are one of the most common sensitizers in children, along with rubber chemicals and fragrances. The influence of fashion trends and lifestyle such as piercing, decorative skin paintings, the hype of natural remedies and cosmetics (e.g. tea tree oil) or the use of cosmetical products with fragrances or herbal ingredients play an important role in developing allergic contact dermatitis. This review aims to give an overview on allergic contact dermatitis in childhood by focussing on strategies for prevention, potential risk factors and recommendations for parents as well as for physicians. By reporting typical cases of our outpatients clinic we point out several characteristics of allergic contact dermatitis. Prevention of allergic contact dermatitis in children is a current problem of interdisciplinary concern not only for dermatologists and paediatricians, but also for midwives. Frequently, children are already exposed at an early age to well-known allergens, and therefore, strategies of avoidance have to gain or regain importance and should start as early as possible.
12. Rietschel RL.
Clues to an accurate diagnosis of contact dermatitis.
Dermatol Ther. 2004;17(3):224-30. Review.
An accurate diagnosis of allergic contact dermatitis can be achieved by a combination of historical, morphologic, and diagnostic steps. Clues in the history and physical examination can point to an irritant as the source of contact dermatitis. While irritants and allergens share many common features both immunologically and clinically, there are grounds for the distinction. Knowledge of occupational factors is necessary to assess the source of contact dermatitis. A common pitfall is the failure to appreciate the role of endogenous factors in the clinical presentation and overall care of the dermatitis patient. A comprehensive assessment of the patient's environment will lead to appropriate patch tests being applied and a correct diagnosis being reached.
13. Garner LA.
Contact dermatitis to metals.
Dermatol Ther. 2004;17(4):321-7. Review.
Metals are in close contact with skin and mucous membranes on a repeated, if not constant, basis. Nickel and mercury, well-recognized causes of contact dermatitis; gold and palladium, recently gaining acceptance as patch test allergens on standard screening trays; and cobalt are reviewed in this article. Sensitization to nickel, the most frequently identified allergen on patch testing, is associated with ear piercing. Contact with this potential allergen is ubiquitous. Mercury may be encountered as organic mercury in thimerosal, used as an antiseptic and a preservative in topical medications and vaccines, and metallic mercury found in dental amalgam and thermometers. Both forms may cause contact dermatitis. Gold, recognized as a frequent sensitizer, has been implicated in some cases of eyelid, patchy diffuse and oral lichenoid dermatitis. Cobalt allergy, found frequently in patients who are nickel allergic, also has been associated with ear piercing. Palladium sensitivity is often associated with nickel allergy. However, the incidence of clinical relevance is yet to be established.
14. Li LY, Cruz PD Jr.
Allergic contact dermatitis: pathophysiology applied to future therapy.
Dermatol Ther. 2004;17(3):219-23. Review.
Contact dermatitis is a common reason for patient visits to primary-care clinics and represents up to 7% of all dermatologic consultations in the US. Substantial progress has been made in elucidating the pathophysiology of contact dermatitis, particularly the allergic form. A better understanding of pathologic mechanisms has led to improved management of cases and will continue to advance treatment modalities. The present paper reviews the pathogenesis and current treatment of allergic contact dermatitis and speculates on the prospects for improved future therapy.
15. Zeller S, Warshaw E.
Allergic contact dermatitis.
Minn Med. 2004 Mar;87(3):38-42.
Allergic contact dermatitis is a common skin condition that can be difficult to diagnose without the aid of a specific diagnostic tool called patch testing. The pathophysiology, clinical features, diagnosis, and treatment of allergic contact dermatitis are summarized in this review. The process of patch testing, the gold standard for diagnosing allergic contact dermatitis, is discussed in detail.
16. Duarte I, Lazzarini R, Kobata CM.
Contact dermatitis in adolescents.
Am J Contact Dermat. 2003 Dec;14(4):200-2.
BACKGROUND: Adolescents between the ages of 10 and 19 are exposed to a series of substances capable of causing contact dermatitis. OBJECTIVES: (1) To study the frequency and characteristics of allergic contact dermatitis in adolescents, (2) to characterize the group being studied, and (3) to verify the main sensitizing substances among this age group. METHODS: From 1996 to 2001, 1,027 patients with a suspicion of contact dermatitis were analyzed, and patients between 10 and 19 years of age were selected. These patients were submitted to contact tests. RESULTS: Among the 102 adolescents, 93 (91%) were female and 9 (9%) were male. The face was the area most affected by dermatosis. The contact tests were positive in 64 patients (56%), whereas in 45 (44%) they were negative. The main location of the contact dermatitis was the face (36%). The substances with higher frequencies of sensitization were nickel sulfate in 33 (31%) patients and tosylamide-formaldehyde resin in 13 (12%) patients. CONCLUSION: Contact dermatitis in adolescents was more frequent in white girls and on the face. The substances with greater frequency of sensitization were nickel sulfate and tosylamide-formaldehyde resin. These two substances are related to adolescent habits and behavior.
17. Kimber I, Dearman RJ.
Allergic contact dermatitis: the cellular effectors.
Contact Dermatitis. 2002 Jan;46(1):1-5. Review.
Contact hypersensitivity reactions are mediated by lymphocytic effector cells. Until recently it was believed that the most important of these were CD4+ T lymphocytes. However, there is growing evidence that in many instances the predominant effector cell may be a CD8+ T lymphocyte, with in some instances CD4+ cells performing a counter-regulatory function. Here we review the roles of CD4+ T helper (Th) cells and CD8+ T cytotoxic (Tc) cells, and their main functional subpopulations (respectively, Th1 and Th2 cells and Tc1 and Tc2 cells) in the elicitation of contact hypersensitivity reactions and consider the implications of effector cell selectivity for the biology of allergic contact dermatitis.
18. Kimbe I, Basketter DA, Gerberick GF, Dearman RJ.
Allergic contact dermatitis.
Int Immunopharmacol. 2002 Feb;2(2-3):201-11. Review.
Allergic contact dermatitis (ACD) is a common occupational and environmental health issue. In common with other forms of allergy the disease progresses in two stages; an initial phase during which sensitization is acquired, followed later (after subsequent exposure to the same chemical allergen) by elicitation of a cutaneous inflammatory reaction. The development of skin sensitization is associated with, and requires, the activation and clonal expansion of allergen responsive T lymphocytes and it is these cells that orchestrate the cutaneous allergic reaction. In recent years, much has been learned of the characteristics of immune responses to skin sensitizing chemicals and of the roles played by dendritic cells, cytokines and chemokines. Some of the more interesting cellular and molecular mechanisms are reviewed briefly in this article. A more detailed appreciation of responses induced by chemical allergens has in turn facilitated the design of novel approaches to the toxicological evaluation of skin sensitization. Real progress has been made, not only in the development of improved methods for hazard identification and characterization, but also in the application of new paradigms for risk assessment. The newer methods now available and the opportunities that exist for further advances are considered. Finally, progress has been made in the characterization of skin sensitization in humans and in the clinical management of ACD. This article seeks to consider skin sensitization and ACD in holistic fashion, bridging experimental observations with clinical disease and basic mechanisms with practical toxicology.
19. Swerlick R.
A review of cellular and molecular events of contact allergic dermatitis.
Cutis. 2001 May;67(5 Suppl):25-6. Review.
Swerlick R.
This biochemical review is presented for the first time in a dermatophytosis conference. The intent is to challenge biochemists to explain the formation of these lesions to clinicians.
20. Weston WL, Bruckner A.
Allergic contact dermatitis.
Pediatr Clin North Am. 2000 Aug;47(4):897-907, vii. Review.
Allergic contact dermatitis (ACD) in children is underrecognized. It is often confused with antibody-mediated allergies such as urticaria or allergic rhinitis, but the mechanism in ACD involves T lymphocytes and not antibody. Surprisingly, sensitization to common allergens is likely to occur in infancy. All contact allergens are weak allergens requiring repeated exposure over long periods of time. Detection of specific allergens is by epicutaneous (patch) testing and will provide the basis for allergen avoidance therapeutic strategies.
21. Mortz CG, Andersen KE.
Allergic contact dermatitis in children and adolescents.
Contact Dermatitis. 1999 Sep;41(3):121-30. Review.
Mortz CG, Andersen KE.
From a clinical point of view, the prevalence of allergic contact dermatitis (ACD) among children and adolescents seems to be low. However, many children have dermatitis, most often atopic dermatitis. In selected cases, ACD is suspected, and the child is tested. The question remains, whether the prevalence of ACD in children really is low or whether the possibility of ACD is not sufficiently considered. During the last decade, reports have appeared on series of children and adolescents with contact allergy and ACD. Few cases have been reported in infants, but the development of contact allergy and ACD increases with age. Most studies include selected groups of children and adolescents with suspected ACD. Few studies have examined unselected populations, and most consider only the prevalence of contact allergy without evaluating the clinical relevance, e.g., the prevalence of ACD. Furthermore, no follow-up studies exist. Therefore, the incidence and prevalence of contact allergy and ACD in children and adolescents is largely unknown.
22. Bergstresser PR.
Immune mechanisms in contact allergic dermatitis.
Dermatol Clin. 1990 Jan;8(1):3-11. Review.
The problem of contact allergic dermatitis in humans and contact hypersensitivity in animals begins with the observation that certain reactive compounds, when placed on skin, lead to a reproducible and characteristic inflammatory reaction. The immunologic processes that conspire to produce this damaging tissue reaction are derived from the normal immunologic balance between the protection of self and the destruction of nonself. Experimental work in the last decade has focused on the role of antigen-presenting cells, and specifically Langerhans cells, in the initiation of contact hypersensitivity, as well as on the competing roles of subsets of T lymphocytes in its regulation. For humans, an important goal has been the development of techniques by which tolerization and desensitization may be achieved, and for those who work with laboratory animals, contact hypersensitivity has provided methods to examine immune regulation in general. In the coming decade, we anticipate that new techniques from molecular biology, molecular genetics, tissue culture, and, above all, shrewd clinical observation will provide a new array of ideas and possibilities.
