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1/32. Laboratory assistant's occupational allergic airborne contact dermatitis from nickel presenting as rosacea.

    A male laboratory assistant working in a metallurgical laboratory with airborne exposure to nickel dust developed highly pruritic, rosacea-like symptoms. The symptoms cleared within eight days without treatment when the patient was off work. Patch testing confirmed nickel allergy. Based on the patient's work and clinical history it was evident that occupational exposure to airborne nickel induced the highly abnormal rosacea-like symptoms, not previously reported from nickel.
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ranking = 1
keywords = metal
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2/32. lichen planus with involvement of all twenty nails and the oral mucous membrane.

    A 57-year-old man had had deformities of all ten fingernails for one and a half years before presentation and deformities of all ten toenails for the previous six months. The surfaces of the nails were rough, with excessive longitudinal striations. The bases of the nails were slightly hypertrophic, and the tips were atrophic and itchy. A longitudinal nail biopsy including the nail matrix revealed the typical histology of lichen planus. Reticulated pigmentation, maceration, and erosion on the buccal mucous membrane were also discovered. Histological analysis of the buccal mucous membrane revealed lichen planus intermingled with eosinophils. Immunological blood analysis revealed elevated CD4 T cells and CD4/CD8 ratio. He worked as a tinsmith and had dental metal. The metal series patch test revealed positive reactions to chromate and tin. Treatment with systemic steroids was quite effective in treating the nail lesions.
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ranking = 2
keywords = metal
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3/32. Degradation of triglycidyl isocyanurate as a cause of false-negative patch test reaction.

    Triglycidyl isocyanurate (TGIC) is mainly used in polyester-based powder paints, but also in laminates, insulating varnishes, coatings and adhesives. Several cases of contact allergy to TGIC have been reported during the last 10 years. Contact allergy to TGIC has developed in a factory producing the chemical, in a factory producing powder paints containing TGIC, and in industries using powder coating. In this paper, we report a man who developed a work-related dermatitis when working on the painting of metal frames. He was exposed to polyester powder pigments containing TGIC. When patch tested, he was negative to TGIC (prepared in 1988) 3x and positive to polyester powder pigment. Only when a new test preparation of fresh TGIC powder was tested, was a positive reaction obtained. Chemical analyses showed that there was no TGIC in the test preparation from 1988, and that in the TGIC powder from 1988, there was only 30% of the expected amount of TGIC. The investigations, clinical and chemical, strongly indicate degradation of TGIC in the test preparation and powder. Both substances and the test preparations made from them may change over time. Therefore, if a false-negative reaction due to a test preparation is strongly suspected, we recommend a re-test of the patient with a new test preparation of fresh material. As a general rule, patch testing should be performed with fresh substances and test preparations made from them, unless their stability and durability are known.
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ranking = 1
keywords = metal
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4/32. Contact dermatitis due to printer's ink in a milk industry employee: case report and review of the allergen paraphenylenediamine.

    Paraphenylenediamine is a common cause of occupational dermatoses in hairdressers, metallurgy workers, and others. hand dermatitis developed in an employee of a milk packaging facility. The employee's hands were exposed to milk cartons embossed with wet printer's ink on a daily basis for 2 years. The worker was evaluated through a history, physical examination, and patch testing with 50 standard allergens. Patch testing revealed a positive reaction to paraphenylenediamine. The hand dermatitis resolved once the patient instituted protective measures. The worker's reaction might represent a delayed-type hypersensitivity reaction to printer's ink that contained this agent. More likely, the inciting agent was some other ingredient of the printer's ink that cross-reacts with paraphenylenediamine.
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ranking = 1
keywords = metal
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5/32. Occupational allergic contact dermatitis to silver and colophonium in a jeweler.

    The aim of this study was to determine any occupationally relevant allergic contact sensitizations in hand dermatitis in a jeweler. Patch test with European Standard, vehicle, medicaments, and metal series (Finn chambers on Scanpor) was performed. Readings were taken on day 2 and day 4. Allergic positive reaction to colophonium 20% pet and silver nitrate 0.5% aq was detected. The contact sensitivities to silver and colophonium seem to be occupationally relevant in this case.
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ranking = 1
keywords = metal
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6/32. Two cases of occupational allergic contact dermatitis from a cycloaliphatic epoxy resin in a neat oil: case report.

    BACKGROUND: Metal-working fluids contain complex mixtures of chemicals and metal workers constitute a potential risk group for the development of allergic contact dermatitis. CASE PRESENTATION: Two metal workers developed allergic contact dermatitis on the hands and lower arms from exposure to a neat oil used in metal processing. Patch testing revealed that the relevant contact allergen was a cycloaliphatic epoxy resin, 1,2-cyclohexanedicarboxylic acid, bis(oxiranylmethyl) ester, added to the oil as a stabilizer. None of the patients had positive reactions to the bisphenol A-based epoxy resin in the standard series. CONCLUSIONS: These cases emphasize that well-known contact allergens may show up from unexpected sources of exposure. Further, it can be a long-lasting, laborious process to detect an occupational contact allergen and cooperation from the patient and the manufacturer of the sensitizing product is essential.
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ranking = 3
keywords = metal
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7/32. Allergic contact dermatitis from 1-[2-(2,4-dichlorophenyl)-2-(2-propenyloxy) ethyl]-1H-imidazole in a water-based metalworking fluid.

    water-based metalworking fluids (MWF) frequently cause irritant contact dermatitis (1, 2), and some of their constituents, especially biocides, may induce allergic contact dermatitis (3).
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ranking = 5
keywords = metal
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8/32. Acute mercury intoxication with lichenoid drug eruption followed by mercury contact allergy and development of antinuclear antibodies.

    A 31-year-old black man was examined for evaluation of a suspected occupational disease. Three years earlier he had been suffering from acute mercury intoxication during work in a mercury recycling factory. skin symptoms then had been a lichenoid drug eruption, patchy alopecia and stomatitis, which had all disappeared rapidly after systemic glucocorticosteroid treatment. The examination revealed positive patch test reactions to metallic mercury and inorganic mercury compounds, an elevated titre of serum antinuclear antibodies and normal IgE levels. The induction of antinuclear antibodies by mercury has been shown in animal experiments. It can be hypothesized that this patient, who may have had an increased individual susceptibility, became allergic to mercury by the mercury intoxication.
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ranking = 1
keywords = metal
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9/32. Contact orofacial granulomatosis caused by delayed hypersensitivity to gold and mercury.

    Orofacial granulomatosis, an entity with characteristic clinicopathologic features, is thought to be a reactive process. The authors describe orofacial granulomatosis associated with contact allergy to gold in dental crowns in one patient and a possible allergic contact reaction to mercury from dental fillings in another one. Thus allergic contact dermatitis to the metals gold and mercury should be considered as a possible etiologic agent of orofacial granulomatosis.
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keywords = metal
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10/32. dermatitis artefacta?

    A 35-year-old man presented with a 2-month history of intensely pruritic excoriated and crusted linear lesions on the dorsa of the left hand and left forearm (Fig 1). The patient had worked in construction for 2 years, and his job consisted mainly in covering the facades of buildings with cement. The patient was right-handed and used a black rubber glove as a protective measure only on his left hand (Fig 2). He reported that the lesions resolved partially during holidays and weekends and clearly flared in association with his work. There was no history of atopic dermatitis, drug use, or intolerance to metals, rubber, or fruits. On physical examination, linear excoriations with crusts were observed on the dorsa of the left hand, extending to the ventral and dorsal aspects of the forearm, involving the whole area that was in contact with the glove. Lichenified erythematous plaques and excoriations on the dorsal surface of the metacarpophalangeal joints and scaly lesions on the dorsal surfaces of the fingers were also present. On the palm, only discrete hyperkeratosis was seen. The right hand and forearm were free of lesions. He complained of intense pruritus when wearing the rubber glove and admitted to continuous scratching to relieve his discomfort, inducing the linear and excoriated lesions. Treatment with topical corticosteroids was initiated, with progressive resolution of the lesions.
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keywords = metal
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