Nickel Allergy of the Skin and Beyond.

BACKGROUND: Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema. OBJECTIVE: The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented. METHODS: Electronic databases on this topic was carried out using PubMed-Medline. RESULTS: The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared. CONCLUSION: The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.

Hyperhidrosis, bromhidrosis, and chromhidrosis: Fold (intertriginous) dermatoses.

Human sweat glands disorders are common and can have a significant impact on the quality of life and on professional, social, and emotional burdens. It is of paramount importance to diagnose and treat them properly to ensure optimal patient care. Hyperhidrosis is characterized by increased sweat secretion, which can be idiopathic or secondary to other systemic conditions. Numerous therapeutic options have been introduced with variable success. Novel methods with microwave-based and ultrasound devices have been developed and are currently tested in comparison to the conventional approaches. All treatment options for hyperhidrosis require frequent monitoring by a dermatologist for evaluation of the therapeutic progress. Bromhidrosis and chromhidrosis are rare disorders but are still equally disabling as hyperhidrosis. Bromhidrosis occurs secondary to excessive secretion from either apocrine or eccrine glands that become malodorous on bacterial breakdown. The condition is further aggravated by poor hygiene or underlying disorders promoting bacterial overgrowth, including diabetes, intertrigo, erythrasma, and obesity. Chromhidrosis is a rare dermatologic disorder characterized by secretion of colored sweat with a predilection for the axillary area and the face. Treatment is challenging in that the condition usually recurs after discontinuation of therapy and persists until the age-related regression of the sweat glands.

Contact dermatitis in a child from methlychloroisothiazolinone and methylisothiazolinone in moist wipes.

Contact allergic reactions to methlychloroisothiazolinone/methylisothiazolinone also widely known as Kathon CG have been reported extensively reported. It is one of the most commonly used preservatives in rinse-off products, cosmetics, and others. Herein, a case of a 50-year-old girl is presented with chronic dermatitis in the anogenital area. The patient was patch tested and had positive reaction to Kathon CG. The detailed history taking revealed that the allergen was present in the moist cleaning wipes used instead of dry toilet paper. The presented case serves as a basis for a appraisal of the use of this preservative in wet wipes. In addition, the duration of the patch test protocol in children has also been discussed.

Recall dermatitis after systemic treatment with paclitaxel.

BACKGROUND: Recall phenomena of the skin at the site of prior radiation treatment are well established after systemic anti-neoplastic therapy. The aim of this report is to describe a rare clinical entity of recall dermatitis after systemic treatment with paclitaxel without a history of previous radiation at the site of reaction. MATERIAL AND METHODS: A 63-year-old Caucasian female patient treated with paclitaxel because of breast cancer (T3 N1 M0) is presented. RESULTS: Five days after the fifth-in-a-row infusion swelling and redness occurred on the left arm, where the drug has been administered. The skin changes were interpreted as erysipelas and the patient was treated with systemic antibiotic. One month later, when a new cycle of chemotherapy with paclitaxel was performed, the medication was administered on the opposite (right) arm. Several days after the procedure, the same changes occurred again on the left arm, as in the previous hospitalization. Based on the clinical features and the laboratory findings, diagnosis of "recall dermatitis" was coined. The presented case serves as a basis for discussion on the etiopathogenetic mechanism of the skin recall phenomenon. The drugs associated with the onset of such a reaction are debated. CONCLUSION: The specificity of this rare dermatological entity is important for setting up the exact diagnosis and therapeutic approach.

Erythema annulare centrifugum in a patient operated on for breast carcinoma.

A 73-year-old Caucasian female patient presented for three annular erythematous lesions on the left leg and buttock, persisting for two months, clinically interpreted as erythema annulare centrifugum. Routine laboratory findings were within the normal ranges, Borrelia serology and wet mount microscopy for mycosis were negative. Histologic examination confirmed the diagnosis of superficial erythema annulare centrifugum. Since no association of erythema annulare centrifugum with concomitant bacterial or viral infections, or active systemic disease was found in our patient, we considered the possible activation of her previous breast cancer operated on in October 2000.