Possible Role of Regional Variation in Allergic Contact Dermatitis: Case Report

Details

• Personal Author:
  Harrison JC ; Jiang A ; Maibach H ; Siegel, Paul D.
• Description:
  A 27-year-old male presented to our dermatitis clinic with 6 months' duration of red oedematous lesions on his ankles. He was previously treated for this suspected allergic contact dermatitis with prednisone (30 mg daily) for 2weeks, during which time these lesions cleared. However, upon prednisone discontinuation the lesions recurred within several days. Physical examination showed symmetrical red, oedematous and scaling lesions on the patient's anterior and lateral ankles bilaterally. The dorsa of his feet and his soles were clear, and no psoriatic stigmata were observed. Working diagnoses considered at this point were atypical tinea and possible allergic contact dermatitis. KOH scraping for fungi gave a negative result. Patch testing was performed with the baseline series of the ICDRG. Finn Chambers were placed on the upper back, and read on day (D) 2 and D4; the ICDRG scoring system was used (maximum of +++). All patch tests gave negative results on D4, except for potassium dichromate 0.5% pet. (++) and cobalt chloride 1% pet. (++). Repeat patch testing was performed with potassium dichromate 2% pet., and gave a positive result (++). The National Institute for Occupational Safety and Health (NIOSH) was consulted, and samples of the patient's leather footwear were sent to the NIOSH for evaluation of total chromium (Cr) content in the ankle and dorsal foot area. Cr contents of a leather boot were analysed with inductively coupled plasma mass spectrometry (ICP-MS) (NexION 300D; Perkin-Elmer, Waltham, MA, USA) after acid digestion. All glassware was cleaned with 10% (vol/vol) HNO3 solution, and rinsed with deionized ultrapure water. Five hundred milligrams of each sample was digested with 10 ml of trace metal grade HNO3, and heated for 4 h at 90 degrees C. Samples were cooled overnight, and non-solubilized residue was allowed to settle. One millilitre of each sample supernatant was diluted to 50 ml with deionized ultrapure water. This solution was used for elemental Cr analysis, performed with an ICP-MS device equipped with a concentric nebulizer, a quartz torch with a quartz injector tube, and a cyclonic spray chamber. All sample quantification was performed with the 52Cr isotope in triplicate against known standards. The leather of the boot at the ankle had a total Cr content of 377 ng/mm2 (225 mg/kg); the leather at the foot had a total Cr content of 428 ng/mm2 (268 mg/kg). The patient's lesions cleared completely when he switched to wearing electronically welded plastic shoes. [Description provided by NIOSH]
• Subjects:
  Chromium Dermatitis Hypersensitivity Immune System Men Occupational Health Safety Skin Skin Diseases
• Keywords:
  Allergic Dermatitis Allergic Reactions Allergies Analytical Processes Author Keywords: Allergic Contact Dermatitis Body Regions Case Reports Chromium Compounds Contact Dermatitis Dermal Exposures Footwear Humans Immune Reaction Mass Spectrometry Materials Testing Medical Examinations Medical Treatment Patch Tests Physical Examination Regional Variation Sampling Skin Disorders Skin Exposure Skin Lesions Skin Tests

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• ISSN:
  0105-1873
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  California ; Ohio ; OSHA Region 3 ; OSHA Region 5 ; OSHA Region 9 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  HELD - Health Effects Laboratory Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  228-229
• Volume:
  78
• Issue:
  3
• NIOSHTIC Number:
  nn:20051025
• Citation:
  Contact Dermatitis 2018 Mar; 78(3):228-229
• Contact Point Address:
  Mr Austin Jiang, University of Cincinnati College of Medicine, 2342 Dana Avenue, Cincinnati, OH 45208, USA
• Email:
  austinjiang13@gmail.com
• CAS Registry Number:
  Chromium (CAS RN 7440-47-3) ; Cobalt chloride (CAS RN 1332-82-7) ; Potassium dichromate (CAS RN 7778-50-9)
• Federal Fiscal Year:
  2018
• Peer Reviewed:
  True
• Source Full Name:
  Contact Dermatitis
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fe6e72192e327536527f36bccd9bc6424837022b1dc52e20fb16401192249639dd92175857382b1cb96fc461d428a56daf3d3d5d6ebf41ac96c6e00ac7a54483
• Download URL:
  https://stacks.cdc.gov/view/cdc/211165/cdc_211165_DS1.pdf
• File Type:
  [PDF - 82.34 KB ]