Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Original Article
2005:71:6;406-408
doi: 10.4103/0378-6323.18945
PMID: 16394482

Relevance of patch testing in patients with nummular dermatitis

DS Krupa Shankar, Shristi Shrestha
 Department of Dermatology, Manipal Hospital, Bangalore, Karnataka, India

Correspondence Address:
D S Krupa Shankar
Department of Dermatology, Manipal Hospital, 98 Rustom Bagh, Airport Road, Bangalore - 560 017, Karnataka
India
How to cite this article:
Krupa Shankar D S, Shrestha S. Relevance of patch testing in patients with nummular dermatitis. Indian J Dermatol Venereol Leprol 2005;71:406-408
Copyright: (C)2005 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Background: A chronic dermatosis like nummular dermatitis may be complicated by contact dermatitis due to an impaired cutaneous barrier. This study is aimed at evaluating secondary contact dermatitis in patients with nummular dermatitis. Methods: Patch testing with the Indian Standard Series was performed in 50 of 78 patients with a clinical diagnosis of nummular eczema. Significant reactions were graded as per ICDRG criteria. Results: Significant reactions were noted in 23 of 50 tested patients. The most frequent sensitizers were colophony, nitrofurazone, neomycin sulfate and nickel sulfate (7.14% each) Reactions to antigens in topical medications, cosmetics and toiletries constituted 64.28% of all the reactions. Conclusions: Patients with nummular dermatitis are at significant risk of developing secondary allergic contact dermatitis, which contributes to the severity and chronicity of their dermatitis. Patch testing has the potential to improve the quality of life in these patients. Hence, patients with chronic recalcitrant nummular dermatitis must be patch tested.
Keywords: Nummular dermatitis, Patch testing, Allergic contact dermatitis

Introduction

Nummular dermatitis, also known as discoid eczema, is a common type of endogenous eczema. It was first described by Rayer in 1845 but the term was introduced by Devergie in 1857.[1] It is characterized by coin shaped or oval plaques with a clearly defined border. The etiology is obscure and a number of factors have been proposed as causative agents. Contact sensitivity to a number of substances is one of the etiological factors.[1] This study aims at finding the incidence of allergic contact dermatitis in patients with nummular eczema.

Methods

Seventy-eight patients with the clinical diagnosis of nummular dermatitis were included in the study, which was conducted from January 2003 to March 2004. Fifty of these patients were patch tested with the Indian Standard Series consisting of 29 antigens.[2] The criteria for patch testing were unremitting nummular dermatitis, anatomical distribution suggestive of allergic contact dermatitis, steadily shorter remissions, or nummular dermatitis worsened by topical treatment. Exclusion criteria for patch testing were extensive intervening areas of erythema, and pregnancy.

Readings were taken on Day 2 (48 hr) and Day 4 (96 hr) and interpreted according to ICDRG criteria.[3] Reactions on Day 4 were taken as significant. The relevance of positive reactions was explained to patients as being relevant to the present dermatitis, due to past exposure, or as significant reactions yet to prove their relevance and a source of caution against future exposure.

Results

Of the 78 patients who participated in the study, 39 each were male and female. The youngest patient was 2 years old and the oldest was aged 84 years (mean age, 38.04 years). Most patients were in the age group of 21-50 years. Dermatitis was present in almost all the sites, with the lower and upper limbs being the commonest affected sites [Table - 1]. Forty-five patients had involvement of more than one site while 31 patients had only one site involved.

Of the 50 patients who were patch tested, a reaction was seen in 23 patients. In all, 56 reactions were seen, the most common allergens being nickel sulfate, neomycin, nitrofurazone and colophony [Table - 2]. Nine patients reacted to one antigen while 14 patients reacted to more than one [Table - 3]. Reactions to topical medications, cosmetics and toiletries constituted about 64% of the reactions (cosmetic antigens, 17.85%; toiletry antigens; 10.7%; and topical medications, 35.7%).

Discussion

Allergic contact dermatitis has been found to be very common in nummular dermatitis.[14] Oral challenge with metal salts is known to aggravate various types of eczema, including nummular eczema.[4] Ethyl cyanoacrylate-containing glue, as well as ethylenediamine hydrochloride, have been reported to cause a nummular eczema-like eruption.[5],[6] In atopic children, thiomerosal is known to cause nummular eczema.[7] Mercury leaching out of dental amalgams,[8],[9] and depilating creams containing potassium thioglycolate[10] can cause nummular eczema. Hypersensitivity to aloe can also manifest as eczematous lesions of nummular eczema.[11] Xerotic skin permits various aeroallergens to enter and induce nummular eczema.[12]

Shenoi et al found that the common sensitizers in patients with allergic contact dermatitis were gentamicin, potassium dichromate, colophony and fragrance.[13] In a study by Fleming et al, 50% of 48 patients with nummular dermatitis showed positive patch test reactions and 33% of these were considered clinically relevant. The commonest allergens were rubber chemicals, formaldehyde, neomycin, chrome and nickel.[14] Khurana et al found that 50% of 56 patients with nummular dermatitis showed positive reactions on patch testing, the commonest allergens being potassium dichromate, nickel, cobalt chloride and fragrance mix in decreasing order.[15] In our study, two-thirds of patients with nummular dermatitis required patch testing and about half of them showed significant reactions. Two-thirds of these reactions were to antigens in cosmetics, toiletries and medications that would remain in prolonged contact with the skin. The antigens include the following:

l Wool alcohol found in cosmetics, moisturizers

l Balsam of Peru used as fixative and fragrance in perfume, topical medications

l 4-chloro- 3 cresol found in creams, topical antiseptics, shampoos

l Benzocaine, a local anaesthetic which cross reacts with parabens

l Formaldehyde used as a preservative in cosmetics, shampoos, etc.

l Polyethylene glycol 400 found in cosmetics, topical medicaments, detergents, toothpaste, etc.

l Gentamycin sulphate, a medicine

l 4-paraphenylenediamine found in hair dyes which cross react with parabens

l Fragrance mix found in cosmetics, toothpaste, soap, etc.

l Chinoform commonly found in topical pharmaceutical preparations

l Colophony found in transparent soaps and cosmetics

l Nitrofurazone, a topical antibiotic which indicates past exposure

l Neomycin sulphate, a broad spectrum antibiotic in topical creams, powders, ointment, eye & ear drops

l Quaternium 15, a preservative in many cosmetics, topical medicines

l Propylene glycol, used in therapeutics (topical steroids, antibiotic preparations, lubricant jelly, ECG gels, injectables) and cosmetics

Patients with nummular dermatitis are at increased risk of developing secondary contact dermatitis due to impaired barrier function that contributes to the chronicity and severity of dermatitis. Patch testing has the potential to increase the quality of life in these patients. Therefore, it is recommended that patients with chronic, recalcitrant nummular dermatitis be patch tested.

References
1.
Soter NA. Nummular eczema and lichen simplex chronicus/prurigo nodularis. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's Dermatology in general medicine. 6th ed. New York: Mc Graw-Hill; 2003. p. 1194-6.
[Google Scholar]
2.
Narendra G, Srinivas CR. Patch testing with Indian Standard Series. Indian J Dermatol Venereol Leprol 2002;68:281-2.
[Google Scholar]
3.
Wilkinson JD, Shaw S. Contact Dermatitis: Allergic. In : Burns Tony, Breathnach Stephen, Cox Neil, Griffiths Christopher, editors. Rook's Textbook of dermatology. 7th ed. Oxford: Blackwell; 2004. p. 20.
[Google Scholar]
4.
Veien NK, Hattel T, Justesen O, Norholm A. Oral challenge with metal salts. (II). Various types of eczema. Cont Dermat 1983;9:407-10.
[Google Scholar]
5.
Belsito DV. Contact Dermatitis to ethyl-cyanoacrylate containing glue. Cont Dermat 1987;17:234-6.
[Google Scholar]
6.
Caraffini S, Lisi P. Nummular dermatitis-like eruption from ethylenediamine hydrochloride in 2 children. Cont Dermat 1987;17:313-4.
[Google Scholar]
7.
Patrizi A, Rizzoli L, Vincenzi C, Trevisi P, Tosti A. Sensitization to thiomerosal in atopic children. Cont Dermat 1999;40:94-7.
[Google Scholar]
8.
Pigatto PD, Guzzi G, Persichini P. Nummular lichenoid dermatitis from mercury dental amalgam. Cont Dermat 2002;46:355-6.
[Google Scholar]
9.
Adachi A, Horikawa T, Takashima T, Ichihashi M. Mercury-induced nummular dermatitis. J Am Acad Dermatol 2000;43:383-5.
[Google Scholar]
10.
Le Coz CJ. Contact nummular (discoid) eczema from depilating cream. Cont Dermat 2002;46:111-2.
[Google Scholar]
11.
Morrow DM, Rapaport MJ, Strick RA. Hypersensitivity to aloe. Arch Dermatol 1980;116:1064-5.
[Google Scholar]
12.
Aoyama H, Tanaka M, Hara M, Tabata N, Tagami H. Nummular eczema: An addition of senile xerosis and unique cutaneous reactivities to environmental aeroallergens. Dermatology 1999;199:135-9.
[Google Scholar]
13.
Shenoi DS, Srinivas CR, Balachandran C. Results of patch testing with a standard series of allergens at Manipal. Indian J Dermatol Venereol Leprol 1994;60:133-5.
[Google Scholar]
14.
Fleming C, Parry E, Forsyth A, Kemmett D. Patch testing in discoid eczema. Cont Dermat 1997;36:261-4.
[Google Scholar]
15.
Khurana S, Jain VK, Aggarwal K, Gupta S. Patch testing in discoid eczema. J Dermatol 2002;29:763-7.
[Google Scholar]

Fulltext Views
223

PDF downloads
114
Show Sections