Case Studies
Case 11.3 Nickel dermatitis
A 47-year-old woman presented with a 3-week history of an acute rash which started beneath her watch. Two weeks later, a further patch appeared at the umbilicus. She had previously noted that she could not wear cheap earrings without triggering a rash on her ear lobes. There was no past medical history of note and no personal or family history of atopy. On examination, two patches of dermatitis were seen over the presenting areas. The appearances were suggestive of nickel-induced contact dermatitis corresponding to nickel in the watch and on a jeans stud. She was patch-tested to a battery of commonly implicated agents (Table C11.1): strongly positive results were induced by nickel sulphate and cobalt chloride only. The final diagnosis was nickel dermatitis, which cleared spontaneously following avoidance of nickel-containing articles.
Table C.11.1 Some agents responsible for allergic contact dermatitis.
|
Agent |
Examples of exposure |
| Metals |
Nickel |
Clasps, necklaces, watch-straps |
|
Chromate |
Cement (building site workers) |
|
Cobalt* |
|
| Medications |
'Para'-group chemicals |
Benzocaine-type anaesthetics, sulphonamide antibiotics, PABA-containing substances (e.g. sunscreens) and oral hypoglycaemic agents (sulphonylureas)
|
|
Phenothiazines |
Phenothiazine-based antihistamines |
|
Neomycin |
Topical antibiotics |
| Plastics |
Epoxyresins, acrylates |
Construction industry, glues |
| Rubber |
Accelerators |
Tyre industry, rubber gloves, shoes, clothing, household 'grips', etc. |
| Plants |
Poison ivy (USA only)
Primula
Chrysanthemum
Geranium |
|
| Cosmetics |
Perfumes
Preservatives
Lanolin |
|
*Source of cobalt sensitivity is usually obscure but it may exist as a co-sensitivity with nickel (metal) or chromate (cement).
PABA, para-amino benzoic acid.
|
