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Related Experiment Videos

Contact dermatitis to white petrolatum.

Roopal V Kundu1, Andrew J Scheman, Artem Gutmanovich

  • 1Department of Dermatology, University of Illinois College of Medicine, Chicago, Illinois, USA.

Skinmed
|September 15, 2004
PubMed
Summary

This study highlights a patient with chronic dermatitis misdiagnosed as atopic dermatitis. Patch testing revealed widespread hypersensitivity to numerous allergens in a petrolatum vehicle, indicating a delayed-type hypersensitivity reaction.

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Area of Science:

  • Dermatology
  • Allergology
  • Contact Dermatitis Research

Background:

  • A 31-year-old woman with a 20-year history of presumed atopic dermatitis presented with severe pruritus, erythema, and scaling.
  • Previous treatments including topical corticosteroids, tacrolimus, pimecrolimus, and cyclosporine were ineffective.

Observation:

  • Physical examination revealed erythematous, scaly patches, lichenification, and excoriations.
  • A skin biopsy showed a perivascular lymphocytic infiltrate with eosinophils and dermal edema, suggestive of hypersensitivity dermatitis.
  • Extensive patch testing with 89 allergens revealed 70 positive reactions, predominantly to allergens in a petrolatum vehicle.

Findings:

  • Sixty-nine of 70 positive patch tests were in a petrolatum vehicle, with 50 showing 3+ reactions.

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  • Allergen sites in liquid vehicles were largely negative, except for cocamidopropyl betaine.
  • A diffuse 'angry back' reaction occurred by 96 hours, complicating interpretation.

    • Implications:

    • The findings suggest a significant delayed-type hypersensitivity to multiple allergens delivered via a petrolatum base.
    • This case underscores the importance of comprehensive patch testing in refractory dermatitis cases.
    • Further investigation into allergen vehicles in patch testing may be warranted.