Noninvasive Evaluation of Allergic and Irritant Contact Dermatitis by In Vivo Reflectance Confocal Microscopy

Details

• Personal Author:
  Astner S ; Gonzalez E ; Gonzalez S
• Description:
  BACKGROUND: The clinical differentiation of allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) is often difficult to accomplish. Reflectance-mode confocal microscopy (RCM) is an imaging technique that has previously been used to examine ACD and ICD noninvasively in vivo. OBJECTIVE: To determine characteristic features of ACD and ICD and their kinetic evolution over time. Ethnic susceptibility to contact irritants such as sodium lauryl sulfate and Ivory dishwashing liquid was evaluated noninvasively, and the sensitivity and specificity of RCM parameters were analyzed in a clinical context and in reference to patch testing. METHODS: Subjects were patch-tested with allergens, irritants, and controls. Clinical scoring and RCM evaluation were performed at various time points, assessing stratum corneum (SC) disruption, spongiosis, exocytosis, vesicle formation, and epidermal thickness. RESULTS: RCM features of both ACD and ICD include spongiosis, exocytosis, vesicle formation, and blood vessel dilatation. SC disruption, epidermal necrosis, and hyperproliferation are hallmarks of ICD whereas ACD more typically presents with vesicle formation. Patients with ICD showed a more rapid recovery than those with ACD. When tested with Ivory soap at selected concentrations, Caucasians, when compared to African Americans, showed significantly lower clinical thresholds for ICD and features that were more severe. CONCLUSIONS: RCM may be a promising new technology for longitudinal noninvasive studies of contact dermatitis (CD). Using a diagnostic algorithm and those parameters with high sensitivity for CD, RCM may facilitate the differentiation of acute ACD and ICD. RCM can reliably visualize cutaneous changes at subclinical degrees of CD, which suggests a possible role for RCM as an adjunctive tool in CD diagnosis. The results of this pilot study also indicate ethnic differences in the response to contact irritants. However, further studies are needed to substantiate the relevance and clinical applicability of our findings. [Description provided by NIOSH]
• Subjects:
  Demography Dermatitis Environmental Monitoring Occupational Health Race Factors Safety Skin Skin Diseases
• Keywords:
  Contact-dermatitis Demographic-characteristics Dermatosis Exposure-assessment Exposure-levels Histopathology Racial-factors Skin-irritants
• ISSN:
  1710-3568
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  182-191
• Volume:
  17
• Issue:
  4
• NIOSHTIC Number:
  nn:20031754
• Citation:
  Dermatitis 2006 Dec; 17(4):182-191
• Contact Point Address:
  Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
• Federal Fiscal Year:
  2007
• Performing Organization:
  Massachusetts General Hospital
• Peer Reviewed:
  True
• Start Date:
  20000930
• Source Full Name:
  Dermatitis
• End Date:
  20030929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:15245aebf1fbe9220eb6cb214566ed42d72d8a02c56d8c0bf7e5ed92909a4e92ea858181c079d98a11be4077c0010e4d75d4071424137a00c21be98340bd9059
• Download URL:
  https://stacks.cdc.gov/view/cdc/185928/cdc_185928_DS1.pdf
• File Type:
  [PDF - 271.32 KB ]