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Contact Dermatitis
Allergic/Irritant Contact, Occupational and Plant Dermatoses
| Question | Answer |
|---|---|
| What is the most common contact allergen? | nickel |
| What is the most commonly used patch test and how many allergens does it test for? | TRUE test for 28 allergens |
| What is the most common cosmetic preservative to cause contact dermatitis? | quaternium-15 |
| What type of hypersensitivity reaction is allergic contact dermatitis? | type IV (delayed) |
| What is the maximum dose of oral prednisone that could be given if necessary while patch-testing? | 20mg daily |
| What are the most common causes of eyelid allergic contact dermatitis? | -balsam of Peru -quaternium-15 -neomycin -metals (nickel, cobalt, gold) -surfactants |
| What test can determine if a particular item contains nickel? | dimethylglyoxime test (uses a pink color indicator) |
| What are the most common ways that nickel dermatitis presents? | -earring dermatitis -dermatitis under a necklace -dermatitis on the mid-abdomen caused by a belt-buckle or snap |
| What is the 2nd most common contact allergen? | myroxylon pereirae (balsam of Peru) |
| What is the most common chemical implicated in fragrance allergy? | Myroxylon pereirae (balsam of Peru) |
| Balsam of Peru is also known as? | Myroxylon pereirae |
| Where is balsam of Peru found? | -fragrance ingredient -cloves -Jamaican peppers -cinnamon -tomatoes/citrus |
| What 8 components are tested in Fragrance mix I? | -cinnamic aldehyde -cinnamyl alcohol -hydroxycitronellal -isoeugenol -eugenol -oak moss absolute -alpha-amyl cinnamic aldehyde -geraniol |
| What chemical is thought to be the cause of allergic contact dermatitis 2/2 "wash-and-wear" or "wrinkle-resistant" clothes? | formaldehyde |
| What textile is thought to have the least amount of formaldehyde? | 100% polyester |
| What is the most common reaction to formaldehyde? Allergic or irritant contact? | IRRITANT |
| What is believed to the responsible for the allergenicity of quaternium-15? | release of formaldehyde |
| What percent of patients that are allergic to quaternium 15 are also allergic to formaldehyde? | 80% (not everyone) |
| What are the formaldehyde-releasers? | -quaternium 15 -imidazolidinyl urea -diazolidinyl urea -2 bromo 2 nitropropane 1,3, diol -DMDM hydantoin -tris nitromethane |
| Allergy to what other topical antibiotic often exists in patients allergic to neomycin? | bacitracin |
| 80% of patients with cobalt sensitivity also have sensitivity to what two other metals? | chromate and nickel |
| What is cobalt found? | metal, cosmetics, joint replacements, ceramics, enamel, paint, and cements |
| Where is p-phenyledemiamine found? | permanent hair colorant and henna tattoos |
| p-phenyledemiamine has cross-reactivity with? | azo and aniline dyes, procaine, benzocaine, PABA, sulfonamides, para-aminosalicylic acid |
| Thimerosal cross-reacts with which medication? | piroxicam |
| Where is thimerosal most commonly used as a preservative? | vaccines |
| Patients allergic to gold are also commonly allergic to which other two metals? | nickel and cobalt |
| What are the most common presentations of a gold allergy? | hand, facial, or eyelid dermatitis |
| Where is chromate found? | leather, cement, some green felts (pool tables) |
| What two agents will be able to detect over 90% of ACD to topical steroids? | tixocortol-21-pivalate and budesonide |
| What are the most common clothing dyes to cause ACD? | disperse blue dyes 106 and 124 |
| How long can positive patch-test reactions be delayed with disperse blue dyes? | 7-10 days |
| What foods can cross-react with poison ivy? | cashews and mangoes |
| What is "baboon syndrome" | symmetric, sharply demarcated erythema of the gluteal or inguinal area and other flexural sites due to ingestion of a substance that the patient was previously exposed to by contact |
| What is the scientific nomenclature of poison ivy? | Toxicodendron radicans |
| What are the members of the Anacardiaceae family? | poison ivy, poison oak, poison sumac, mango tree, cashew tree, poisonwood tree, laquer tree, Indian marking nut, black varnish tree, Brazilian pepper tree |
| What is the allergen implicated in the Anacardiaceae family of plants? | urshiol (pentadecacatechol) |
| What plants do poison ivy/oak/sumac cross-react with? | Ginkgo tree (also contains urshiol) |
| What specific part of the mango contains urshiol? | the peel |
| What is the most likely plant to cause a generalized contact urticarial or anaphylactoid reaction? | celery |
| What is "contact urticaria syndrome"? | IgE mediated reaction that causes urticaria with systemic symptoms (most common plant cause is celery) |
| What is "protein contact dermatitis"? | chronic dermatitis that develops from repeat contact urticaria in which patch tests are negative but prick tests to large protein allergens are positive |
| What is "oral allergy syndrome"? | mucosal contact urticaria to antigens in fruits |
| What family of plants are the most common causes of toxin-mediated contact urticaria? | Urticaceae (nettles) |
| What is the most common stinging nettle in the US? | Urtica dioica |
| Stinging nettle hairs contain what substances that mediate toxin-induced urticaria? | histamine, acetylcholine, and serotonin |
| "Sabra dermatitis" is caused by what plant? | Prickly pear (Opuntia spp) |
| What is the name of the short, barbed or hooked hairs that arise from pincushion-like structures and penetrate the skin from the prickly pear cactus? | glochids |
| What substances have been most commonly implicated in baboon syndrome? | gold, nickel, ampicillin |
| What plants are the in the family Alliaceae? | garlic |
| What chemical in garlic causes irritant dermatitis? | thiocyanates |
| What plants are in the family Amaryllidaceae? | daffodil, narcissus, hyacinth |
| What do daffodil, narcissus, and hyacinth bulbs contain that cause ICD? | calcium oxalate |
| What plants are in the family Araceae? | dumb cane plant (very common houseplant) |
| What chemical in the dumb cane plant causes ICD? | calcium oxalate |
| What plants are in the family Euphorbiaceae? | croton plant, spurges, poinsettas |
| What chemical in the stems, leaves, and fruits of croton plants, spurges, and poinsettas causes ICD? | phorbol esters (latex) |
| What plants are in the family Ranunculaceae? | buttercups and marigolds |
| What substance in buttercups and marigolds causes ICD? | protoanemonin (specifically from damaged plant parts) |
| What common plant is in the family Solanaceae? | Hot peppers (capsaicin) |
| What can neutralize capsaicin? | vinegar |
| What type of dermatitis does capsaicin produce? | No dermatitis- just erythema, burning, and stinging |
| What substances may pineapple workers have develop irritant contact dermatitis to? | Bromelain (found in the fruit and stems) Calcium oxalate (found in all parts) |
| What plant is the source of the most common irritant dermatitis in florists? | daffodils (calcium oxalate) |
| What is the photosensitizing chemical found in plants that causes phytophotodermatitis? | furocoumarins (psoralens and angelicins) |
| What two plant families are responsible for the large majority of phytophotodermatitis? | Apiaceae and Rutaceae |
| What common plants are implicated in phytophotodermatitis? | -celery -parsley -fennel -Persian lime -Sweet orange -Lemon -Grapefruit -Rue -Key lime |
| What is "strimmer dermatitis"? | a spray of weeds caused by weed-whackers that contain psoralens (such as hogweed) and cause phytophotodermatitis |
| What induces phytophotodermatitis- UVA or UVB? | UVA |
| What are the clinical features of phytophotodermatitis? | bizarre configurations of erythema, edema, and vesicles that occur abour 24-48 hours after exposure and leave hyperpigmentation that can last months to years |
| What specific fucocoumarin is found in limes? | 8-MOP (xanthotoxin)- found in higher concentrations in the rind |
| What are the two species of poison ivy? | Toxicodendron radicans and Toxicodendron rydbergii |
| What is the species of poison sumac? | Toxicodendron vernix |
| What are the two species of poison oak? | Toxicodendron toxicarium and T. diversilobum |
| What is the main allergen in Toxicodendron plants? | catechols (urushiol) |
| What is the main allergen in the cashew nut tree, mango, and Brazillian pepper tree? | resorcinol |
| What other plants in the family Anacardiaceae cause cross-reaction to poison ivy/oak/sumac? | Mango (rinds), Brazilian pepper trees (found in Florida), and Cashew nut |
| What chemicals cause the cross reaction b/w poison ivy/oak/sumac and mangos/brazilian pepper trees and Cashew nuts? | catechols (poison ivy) and resorcinol are similar and cross-react |
| What seed outside of the family Anacardiaceae cross-reacts with poison ivy? | Ginkgo biloba |
| What substance in Gingko biloba causes cross-reactivity with poison ivy? | ginkgolic acid |
| What common anti-parasitic cream is derived from chrysanthemums? | Permethrin |
| What substance in the plant Family Asteraceae is responsible for allergic contact dermatitis? | sesquiterpene lactone |
| What common plants are in the family Asteraceae? | -artichokes -chamomile -chyrsanthemums -daisy -dandelion -marigolds -sunflowers -tarragon -ragweed |
| What chemicals make up urushiol? | catechols and resorcinols (resorcinol is less allergeneic) |
| What is an underreported cutaneous reaction of severe poison ivy, occurring about 2 weeks after the onset of the dermatitis? | erythema multiforme |
| What is "black spot" poison ivy dermatitis? | urshiol can act as an irritant as well as allergic contact- oxidized resin turns black on the skin |
| What is the most common cause of Asteraceae dermatitis? | chrysanthemums |
| How does Asteraceae family dermatitis most commonly present? | airborne dermatitis that flares in the summer |
| How does ragweed hypersensitivity typically present? | ocular and airway reactions (seasonal allergies) and less commonly causes contact dermatitis |
| Does garlic act as an irritant or allergic contact? | both |
| What is the substance thought to cause ACD and ICD from garlic? | diallyl disulfide |
| What plant is included in the family Moraceae and causes phytophotodermatitis? | the fig tree |
| What plants are included in the Rutaceae family that cause phytophotodermatitis? | -lime -sweet orange -lemon -rue -grapefruit -key lime |
| Myroxylon pereirae is also known as? | Balsam of Peru |
| What is the allergen found in tulips that causes both ACD and ICD? | Tulipalin A (metabolized product of tuliposide A)- aka alpha-methylene-gamma-butyrolactone |
| Tulipalin A is found in which common plants? | Tulips and the Peruvian lily |
| What is the allergen found in spearmint? | carvone |
| What is the allergen found in peppermint? | menthol |
| What herbs/spices are found in the family Lamiaceae? | lavender, thyme, spearmint, peppermint |
| What is the allergen in primrose? | primin (2-methoxy-6-pentyl-benzoquinone) |
| MCC eyelid ACD? | rubber, nail products (methyl methacrylate), eye products |
| MCC forehead ACD? | hat band (rubber), leather |
| MCC scalp/retroauricular ACD? | hair dye/perms |
| MCC perioral ACD? | gum, foods |
| MCC neck ACD? | fragrance |
| MCC earlobe ACD? | nickel |
| MCC abdomen ACD? | nickel |
| MCC trunk ACD? | formaldehyde |
| MCC axillary vault ACD? | deodorant |
| MCC axillary fold ACD? | clothing dyes, formaldehyde |
| MCC back of women ACD? | bra strap (rubber), nickel |
| MCC wrist ACD? | chromates (leather) |
| MCC hand ACD? | gloves (latex, rubber), ethyl methacrylate in dentists/surgeons |
| MCC waist ACD? | rubber |
| MCC perianal ACD? | suppositories (from caine anesthetics) |
| MCC shin ACD? | socks (rubber) |
| MCC feet ACD? | shoes (rubber- mercaptobenzothiazole and chromates in leather) |
| MCC of ACD seen around ulcers? | bacitracin, neosporin, lanolin |
| MCC of penile ACD? | poison ivy, rubber (latex condoms) |
| What is the best clothing textile for patients with allergies to formaldehyde? | 100% polyester |
| What is the allergen found in Spandex? | mercaptobenzathiazole (in rubber) |
| Does the TRUE test detect gold allergy? | NO |
| What is the allergen in permanent waves? | glyceryl thioglycolate |
| What is the allergen in nail polish/acrylic nails? | tosylamide formaldehyde resin and acrylates |
| What are allergens found in rubber products? | carba mix, mercaptobenzothiazole, thiuram, mixed dialkyl thioureas |
| What is the allergen found in henna tattoos? | paraphenylenediamine |
| What is the contact allergen found in baby wipes and toilet paper? | methylchlorosiothiazolinone |
| What is the allergen in beeswax-containing lip balm? | propolis |
| Latex cross-reacts with which foods? | bananas, avocadoes, kiwi, chesnuts |
| Fiberglass dermatitis can be prevented by what? | talcum powder |
| Is contact urticaria immune-mediated or non-immune mediated? | It can be both |
| What does the term "latex" mean? | an aqueous dispersion of a rubber |
| What is a common cause of contact urticaria in healthcare workers? | latex |
| What are two tests for latex allergy? | IgE blood test and prick test |
| How does UV radiation induce DNA damage? | forms thymine dimer |
| What is the most common cause of preservative dermatitis in the US? | Quaternium-15 |
| What chemicals cause chloracne? | halogenated polycyclic hydrocarbons (polychlorinated dibenzodioxins and dibenzofurans) |
| Where is chloracne classically located? | open comedones on the malar crescent, behind the ears, buttocks, scrotum and thighs |
| What is vibration white finger? | -development of white finger(s) in response to cold in people who are exposed to tools with vibration of 30-300 hz with tingling and pain -attack ceases with rewarming -symptoms stop if exposure to cold is avoided |
| What popular emollients contain lanolin? | Aquaphor and Eucerin |
| Where are epoxy resins found? | cement and glue |
| What allergen is typically responsible for contact allergy from photodeveloping chemicals? | paraphenylenediamine (also found in hair dye, inks, henna tattoos) |
| What is methylchloroisothiazinolone (Kathon CG)? | a preservative found in cosmetics, skin/hair products, perms, soaps, toilet paper, mascara |
| What is the main allergen in Lily of the Valley? | hydroxycitronellal |
| What is imidazolidinyl urea (Germall 115)? | a formaldehyde-releasing preservative in cosmetics/creams/lotions/shampoo/deodorant/soaps |
| If a patient has a reaction to a tincture of benzoin, they are also likely to be allergic to what? | Balsam of Peru |
| Where is thimerosal found? | vaccines and otic/optic drops |
| Ethylenediamine dihydrochloride is an allergen found where? | topical antihistamines/creams |
| What are the formaldehyde releasers? | -quaternium 15 -imidazolidinyl urea (Germall 115 or Tristat) -diazolidinyl urea -DMDM hydantoin -Bronopol -tris nitromethane |
| What tests for class A cortisosteroid allergy? | Tixocortol pivalate |
| What tests for class B and D steroid allergy? | Budesonide |
| What are the Class A steroids? | Hydrocortisone, Methylprednisone, prednisone, prednisolone, Tixocortol pivalate |
| What are the Class B steroids? | -TAC, flucinonide, flucinolone, desonide, budesonide, halcinonide, amcinonide |
| What are the Class C steroids? | betamethasone, dexamethasone, flucortisone, desoximetasone |
| What are the Class D steroids? | betamethasone diproprionate/valerate, clobetasol, mometasone, aclomethasone |
| Quaternium-15 has biocide activity against which organisms? | Pseudomonas |
| What is the #1 OCCUPATIONAL irritant contact dermatitis? | SOAP |
| What is the #1 OCCUPATIONAL allergic contact dermatitis? | RUBBER |
| What is the most common topical steroid to cause ACD? | hydrocortisone |
| What is the taxonomic name of the rubber tree? | Havea brasiliensis |
| What is the most common cause of ACD from shampoos and body washes? | Cocamidopropyl betaine |
| What chemical used in leather products is a common cause of ACD? | potassium dichromate |
| What is Melaleuca alternifolia commonly referred to as? | Tea tree oil |
| What 3 plants can cause erythema multiforme after several allergic contact dermatitis? | -Toxicodendron spp -Tea tree oil -Wild feverfew |
| Oil of Bergamot causes what kind of reaction? | phytophotodermatitis- contains 5-MOPP |
| Alstroemeria is also known as? | Peruvian Lily |
| Where is dimethyl fumarate found? | -present in satchets to prevent mold formation on shipper furniture (2011 contact allergen of the year) |
| Dowicil-200 is also known as? | Quaternium-15 |
| Ethylenediamine cross reacts with what? | Hydroxyzine |
| What is the allergen found in tea tree oil? | d-limonene |
| What is the allergen found in castor bean? | ricin |
| Tea tree oil comes from which plant? | Melaleuca plant |
| What topical medication can often be found in rubber products? | Hydroquinone |
| Where are glutaraladehyde and benzalkonium chloride found? | Baby wipes (are cold sterilizers) |
| Thiuram mix (rubber) is found in what medication? | Antabuse (disulfuram) |
| Lanolin is derived from what? | sheep fleece |
| Imidazolidinyl Urea is also known as? | Germall 115 and Tristat |
| Lanolin allergy is commonly seen in patients with what condition? | chronic leg ulcers |
| Where is lanolin found? | -wool alcohol/wax/fat -adhesives -cosmetics -topical medications (creams/lotions/ointments) |
| Alpha-methylene-gamma-butyrolactone is also known as? | Tulipalin A |
Created by:
criddel
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