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Nickel, cobalt and chromium sensitivity in patients with pompholyx (dyshidrotic eczema)
Abstract:
Sixteen patients with negative routine patch tests were challenged orally in a controlled trial with 2.5 mg nickel, 1 mg cobalt, and 2.5 mg chromium given as salts of the respective metals. All of the patients had symmetrical, vesicular hand dermatitis and in some cases also foot involvement. The dermatitis of two patients flared after challenge with cobalt; in two patients flare occurred following chromate ingestion. Prior to the oral challenge all the patients were patch tested with nickel sulphate, cobalt chloride and potassium dichromate after adhesive tape stripping. Solutions of the same metal salts were used for intradermal testing. The intradermal test sites were read after 20 minutes and 48 hours, the patch tests after 48 h. Skin test reactivity correlated poorly to the results of the oral challenge, possibly due to nonspecific skin test reactivity. It is concluded that oral challenge is a valuable adjunctive diagnostic procedure in patients with pompholyx who have negative routine patch tests.
Insights
Oral challenge with nickel, cobalt, and chromium can help diagnose hand dermatitis in patients with negative skin tests. This method aids in identifying metal sensitivities contributing to pompholyx (a type of eczema).
Area of Science:
- Dermatology
- Allergology
- Toxicology
Background:
- Routine patch testing is often insufficient for diagnosing metal-induced hand dermatitis.
- Pompholyx, a form of vesicular hand eczema, can be triggered by systemic metal exposure.
- Identifying specific metal triggers is crucial for effective patient management.
Purpose of the Study:
- To evaluate the efficacy of oral metal challenge as an adjunctive diagnostic tool.
- To assess the correlation between skin test reactivity and oral challenge results in patients with hand dermatitis.
- To determine the diagnostic value of oral challenge in cases with negative routine patch tests.
Main Methods:
- A controlled trial involving sixteen patients with negative routine patch tests for nickel, cobalt, and chromium.
- Oral challenge administered with specific doses of nickel, cobalt, and chromium salts.
- Simultaneous patch testing and intradermal testing with the same metal salts prior to oral challenge.
Main Results:
- Two patients experienced dermatitis flare-ups after oral cobalt challenge.
- Two patients showed dermatitis exacerbation following oral chromate ingestion.
- Skin test reactivity (patch and intradermal) showed poor correlation with oral challenge outcomes, suggesting non-specific reactivity.
Conclusions:
- Oral metal challenge is a valuable supplementary diagnostic procedure for pompholyx.
- It is particularly useful in patients with negative routine patch tests.
- This method helps identify systemic metal hypersensitivity contributing to hand dermatitis.