Cases reported "Hand Dermatoses"

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1/12. Bullous phytophotodermatitis associated with high natural concentrations of furanocoumarins in limes.

    BACKGROUND: Phytophotodermatitis is a phototoxic reaction, occurring in skin exposed to sunlight after contact with plants containing furanocoumarins. Typical reactions are mild, showing erythema with post-inflammatory hyperpigmentation. A 6-year-old boy presented with marked, symmetric, painful erythema and edema of both hands that rapidly developed into dramatic bullae covering the entire dorsum of the hands. The history revealed that the hands had been bathed in lime juice for a prolonged period in the preparation of limeade. OBJECTIVE: This report documents an unusual bullous presentation of phytophotodermatitis resulting from contact with furanocoumarins in local limes. This study was conducted to identify and measure the inciting substances from the rind and pulp of the limes. methods: Psoralen, xanthotoxin, bergapten, and isopimpinellin content were measured by gas chromatography and high-pressure liquid chromatography RESULTS: The rind contained 6- to 182-fold concentrations of all furanocoumarins measured when compared with pulp. Bergapten was the most abundant substance in the rind. CONCLUSION: Hydration of the skin during the preparation of limeade combined with increased levels of bergapten in local limes to produce a dramatic bullous reaction. We encourage clinicians to consider the possibility of phytophotodermatitis in severe bullous skin reactions.
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2/12. Occupational allergic contact dermatitis from bisphenol A in vinyl gloves.

    Allergic contact dermatitis caused by polyvinyl chloride gloves is rarely reported, and in only 2 cases was bisphenol A considered to be the responsible sensitizer. We report a patient with occupational hand dermatitis after the use of a new type of high-density vinyl (HDV) gloves. patch tests showed positive ( ) reactions to both used and new HDV gloves and to bisphenol A. Chemical analysis by gas chromatography-mass spectrometry demonstrated the presence of bisphenol A in the HDV gloves. Replacement by nitrile rubber gloves resulted in complete clearance of the hand dermatitis.
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3/12. Occupational contact dermatitis from a grease.

    BACKGROUND: Contact allergy to grease is rare and often not even suspected. We investigated such a case in which the detected allergen was the stabilizer in the grease, which is rarely found as an allergen. OBJECTIVE: Thin-layer chromatography (TLC) was used in a novel way and helped detect the allergen. methods: Patch testing with our standard series, a metal-working series, the different substances individually, the grease in serial dilution and extracts of personal objects, the TLC plate. gas chromatography-mass spectrometry was also used. RESULTS: Test results indicated contact allergy to grease containing N-phenyl-1-naphthylamine and contact allergy to Disperse Orange 1, N-cyclohexyl-N'-phenyl-4-phenylenediamine, N-isopropyl-N'-phenyl-4-phenylenediamine, and N,N'-diphenyl-4-phenylenediamine. CONCLUSION: N-phenyl-1-naphthylamine was the main cause of the patient's dermatitis. This case report underlines the importance of testing the patient's own products and also underlines the benefit of using TLC strips for patch testing and of visiting the workplace to get correct information about exposure conditions.
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4/12. Occupational allergic contact dermatitis from antioxidant amines in a dental technician.

    We describe an 18-year-old dental technician who presented with dry hyperkeratotic lesions on his left palm that were limited to an area that was in contact with a container in which he had prepared the molds for a dental prosthesis. On patch testing, he had a positive reaction to black rubber mix and its components N-cyclohexyl-N'-phenyl-4-phenylenediamine, N,N'-diphenyl-4-phenylenediamine, and N-isopropyl-N'-phenyl-4-phenylenediamine, as well as to a piece of the rubber container. Thin-layer chromatography (TLC) of a piece of the rubber container confirmed the presence of the para-phenylenediamine mix. Results of patch-testing with TLC were positive after 48 and 96 hours. The lesions resolved when the patient stopped using the container. The patient was diagnosed with occupational allergic contact dermatitis. We also review the dermatoses caused by antioxidant amines.
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5/12. Allergic contact dermatitis from methyldibromoglutaronitrile.

    BACKGROUND: Arriving at a diagnosis of allergic contact dermatitis is a multistep procedure including the establishing of contact allergy, demonstration of current exposure to the sensitizer, and assessment of clinical relevance. Sometimes, these steps are easy to get through; at other times, there may be problems with every step. OBJECTIVE: To demonstrate the possible difficulties and pitfalls in establishing the presence of contact allergy and diagnosing allergic contact dermatitis from exposure to the preservative methyldibromoglutaronitrile (MDBGN). methods: Simultaneous patch-testing with petrolatum preparations of MDBGN at various concentrations, use testing, and chemical analysis with high-performance liquid chromatography (HPLC). RESULTS: Contact allergy to MDBGN was established in two cases, with MDBGN in petrolatum at 0.5%. Results of HPLC investigation of moisturizers used by the patients and yielding positive results on patch and use tests disagreed with the information about preservatives on the labels of the moisturizers and with the material safety data sheets (MSDSs). CONCLUSIONS: Patch testing with MDBGN in petrolatum at a concentration of less than 0.5% may fail to diagnose a clinically relevant contact allergy. The information on labels of products, on MSDSs, and from manufacturers may not be reliable, which indicates the need for chemical analyses.
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6/12. Contact allergy to the UV-absorber Tinuvin P in plastics.

    Contact allergy to the UV-absorber 2-(2-hydroxy-5-methylphenyl)benzotriazole (Tinuvin P) was revealed in a patient with wrist dermatitis caused by a plastic watch strap. A high-performance liquid chromatography method was developed and subsequent chemical analysis showed the presence of Tinuvin P in the watch strap. The possibility of cross-reactions between Tinuvin P and various substituted benzotriazole compounds was investigated. No cross-reactions were found.
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7/12. Occupational dermatitis due to an epoxy acrylate.

    A dental assistant developed sensitivity to dental restorative materials within 3 months of starting to use them. They contained the epoxy acrylate BIS-GMA, which is the most commonly used dimethacrylate monomer in dental composite restorations. She was positive to a patch test with BIS-GMA, which was the probable allergen, and epoxy resin, but this substance was not present in the materials used, as shown by high performance liquid chromatography. The patient was also allergic to the disinfectant Desimex i containing dodecyl diaminoethyl glycine.
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8/12. Allergic contact dermatitis to quinones in Paphiopedilum haynaldianum (orchidaceae).

    An eczematous eruption developed on the hands and forearms of a 68-year-old man after frequent contact with homebred specimens of the lady slipper Paphiopedilum haynaldianum. patch tests with leaves, petals, and stems, as well as with two quinones isolated from the plant by thin-layer chromatography, gave strongly positive reactions. The results demonstrated that the recurrent skin lesions were the expression of an allergic contact dermatitis due to the quinoid constitutnets, which are the main contact allergens in this orchid species.
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9/12. Occupational allergic contact dermatitis from alkanolamineborates in metalworking fluids.

    Alkanolamineborates are extensively used in coolants as corrosion inhibitors. In this paper, 3 machinists with contact allergy to alkanolamineborates are reported. To avoid false-positive test reactions due to the alkalinity of the alkanolamineborates, they should be tested when dissolved in an acidic buffer. When various alkanolamineborates were tested in dilution series in the 3 patients, 2 types of reactivity patterns emerged, indicating the existence of at least 2 separate sensitizers in alkanolamineborates. The raw materials, ethanolamines and boric acid, did not yield any positive patch test reactions. Thin-layer chromatography investigations demonstrated that each alkanolamineborate consists of many substances, which differed in part between different alkanolamineborates. The present study shows that it is not possible to use 1 particular alkanolamineborate for tracing contact allergy to alkanolamineborates in general.
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10/12. Identification of causative chemicals of allergic contact dermatitis using a combination of patch testing in patients and chemical analysis. Application to cases from rubber gloves.

    5 cases of allergic contact dermatitis from rubber gloves were investigated by our recommended procedures using a combination of patch testing in patients and chemical analysis of causative rubber products by gas chromatography (GC) and high-performance liquid chromatography (HPLC). We previously confirmed that zinc ethylphenyldithiocarbamate (ZEPC), a dithiocarbamae-type accelerator (DTC), was causative in a case of allergic contact dermatitis from rubber work gloves. Subsequently, we have clarified that DTCs such as zinc dimethyldithiocarbamate (ZDMC), zinc diethyldithiocarbamate (ZDEC) and zinc dibutyldithiocarbamate (ZDBC) and amines such as dimethylamine (DMA), diethylamine (DEA) and piperidine (PIP) were also causative in cases from surgical rubber gloves. Thus, our investigative studies revealed that, although thiurams have been taken much more notice of as allergenic compounds than their corresponding DTCs and amines, not only DTCs such as ZDMC, ZDEC, ZDBC and ZEPC, but also amines such as DMA, DEA and PIP were noteworthy causative candidates of allergic contact dermatitis from rubber gloves.
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