Updates in Contact Dermatitis

Transcription

1 Updates in Contact Dermatitis Brian P. Peppers, DO, PhD 1/22/16 Osteopathic Adult & Pediatric Allergy and Immunology Fellowship University Hospitals Regional Hospitals/LECOMT Allergy and Immunology Associates

2 Outline Definition Difficulties in Proper Identification Forms of Contact Dermatitis Diagnosis Treatments Summary

3 Definition Any skin disorder caused by contact with an exogenous substance that elicits an allergic and/or irritant response.

4 Definition Any skin disorder caused by contact with an exogenous substance that elicits an allergic and/or irritant response. Irritant is responsible for vast majority of cases Fonacier, Luz, et al. "Contact Dermatitis: A Practice Parameter Update 2015." The Journal of Allergy and Clinical Immunology: In Practice 3.3 (2015): S1-S39.

5 Difficulties in Identifying the Trigger of Contact Dermatitis Delayed onset of symptoms from exposure to the substances May have more than one substances causing CD Empirical treatments for mild dermatitis may cause overlapping dermatitis. Not all substances are listed on products trade secrets Standardized tests and research papers lack positive controls Extreme number of commercial products with complex mixtures of chemicals Quantities of offending substance needed to cause reaction varies Fonacier, Luz, et al. "Contact Dermatitis: A Practice Parameter Update 2015." The Journal of Allergy and Clinical Immunology: In Practice 3.3 (2015): S1-S39.

6 Avogadro's number Units of anything = 1 mole 35μg of Levothyroxine = 2.71 x molecules

7 Avogadro's number Units of anything = 1 mole 35μg of Levothyroxine = 2.71 x molecules Human Body has ~ Trillion cells or 1.00 X 10 13

8 Main Forms of Contact Dermatitis Irritant Allergic Occupationa l

9 Local or Systemic CD Irritant Allergic Occupationa l

10 ICD Glazed, patched, or scalded appearance Sharply circumscribed dermatitis Healing begins promptly on withdrawal of the offending agent Patch testing negative Most common region: Hands * Irritants can disrupt the skin barrier and allow for allergen penetration * Fonacier, Luz, et al. "Contact Dermatitis: A Practice Parameter Update 2015." The Journal of Allergy and Clinical Immunology: In Practice 3.3 (2015): S1-S39.

11 ACD Acute: Erythematous papules, pruritus, vesicles, and crusted lesions. Chronic: Pruritus and lichenification 3 most common distributions Face, Hands and scattered/generalized Often mixed with ICD Medical History alone has a 76% sensitivity and specificity in establishing the diagnosis

12 OCD Work related: ICD and/or ACD Mathias Criteria: 4 of 7 must be met Clinical Appearance of CD Potential for suspected agent present at work Anatomic distribution consistent with work place Temporal relationship Non-occupational exposures excluded Improves when not at work Patch Testing (PT) according to guidelines are positive

13 Highest Risk Vocations Food Services and Food Processing Cosmetology Health care Agriculture, Forestry, and Fishing Cleaning Painting Mechanics, metal working, and vehicle assembly Electronic industry Printing and/or lithography Construction

14 Diagnosis History Patch testing for ACD: Gold Standard Thin-Layer Rapid Use Epicutaneous (T.R.U.E.)Test Has 35 possible Allergens North American Contact Dermatitis Group (NACDG) Has possible Allergens Core Allergen Series 80 possible Allergens Usage test Actual suspected agent Repeated open application test (ROAT) More for Irritation, but can be used for Allergens too Most common Allergens: Metals (Nickel, Fragrance Mix, Balsam of Peru) Johansen, Jeanne D., et al. "European Society of Contact Dermatitis guideline for diagnostic patch testing recommendations on best practice. " Contact dermatitis 73.4 (2015):

15 Treatments Identification Avoidance and safe lists Protection: gloves, uniforms, goggles, etc Medications: 1 st line Topical Steroids 2 nd line Phototherapy, oral retinoid, and immunosuppression Oral steroids maybe needed for SCD: eg. Toxicodendron

16 Summary ICD, ACD and OCD can be difficult to diagnose and manage based on history alone Attention to body distribution and vocation can help identify possible agents Often there is more than one offending agent and ICD can increase reactivity to Allergens Easier to use safe products then to try and decipher ingredients in products as many have multiple names.

17 Acknowledgements University Hospitals Regional Hospitals/LECOMT Mentors: Allergy and Immunology Associates Dr. Hostoffer, DO (Program Director) Dr. Tcheurekdjian, MD Dr. Sher, MD Dr. Jhevari, DO Colleagues in the Fellowship

18 Acknowledgements University Hospitals Regional Hospitals/LECOMT Mentors: Allergy and Immunology Associates Dr. Hostoffer, DO (Program Director) Dr. Tcheurekdjian, MD Dr. Sher, MD Dr. Jhevari, DO Colleagues in the Fellowship All of you!!!

19 Resources Fonacier, Luz, et al. "Contact Dermatitis: A Practice Parameter Update 2015." The Journal of Allergy and Clinical Immunology: In Practice 3.3 (2015): S1-S39.] Johansen, Jeanne D., et al. "European Society of Contact Dermatitis guideline for diagnostic patch testing recommendations on best practice. " Contact dermatitis 73.4 (2015):