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1/6. Allergic contact dermatitis in dental professionals: effective diagnosis and treatment.

    BACKGROUND: Like other health care workers, dental professionals are at risk of developing allergic contact dermatitis, or ACD, after exposure to allergenic chemicals. Common allergens include antimicrobials, preservatives, rubber additives and methacrylates. CASE DESCRIPTION: The authors describe an orthodontic assistant with severe skin disease, whose symptoms included redness, cracking and bleeding that persisted for 10 years. The patient had previously received an incomplete diagnosis. After performing patch testing, assessing symptoms and evaluating the patient's medical history, the authors diagnosed ACD resulting from exposure to several dental allergens. The patient received appropriate treatment and counseling to better manage her allergies; this resulted in resolution of all symptoms and averted permanent occupational disability. CLINICAL IMPLICATIONS: Not all skin reactions are related to gloves or natural rubber latex. Dental professionals should be aware of common chemical allergens, symptoms of ACD and the appropriate treatment of occupational skin disease.
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2/6. Contact dermatitis: diagnosis and management.

    Contact dermatitis accounts for 85-90% of all occupational skin diseases and, as a frequent cause of hand dermatitis, it can lead to unemployment and permanent disability. This article examines the two main types of contact dermatitis, their diagnosis and treatment.
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3/6. Pustular psoriasis and the Kobner phenomenon caused by allergic contact dermatitis from zinc pyrithione-containing shampoo.

    zinc pyrithione is a shampoo ingredient that has been shown to be safe and effective for dandruff and scalp psoriasis. It is thought to decrease the cell turnover rate in hyperproliferative dermatoses such as psoriasis, and also has fungistatic and antimicrobial activity, although its exact mode of action is unknown. In psoriasis, external factors, such as trauma, infection and drugs, may provoke aggravated manifestations of psoriatic skin lesions. Rarely, irritant or allergic mechanisms are likely causes of psoriatic flare and Kobnerization. A patient had had stable psoriasis for 25 years and no any other skin disease. Within 20 days, she developed an aggravated scaly erythematous patch on the scalp, where a shampoo had been applied, and simultaneously developed pustular psoriasis on both forearms. Patch testing showed a relevant sensitization to zinc pyrithione, and we observed symptomatic aggravation by provocation testing with zinc pyrithione shampoo. We report a rare case of psoriasis aggravated by the induction of allergic contact dermatitis from zinc pyrithione after using antidandruff shampoo.
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4/6. Occupational dermatoses in cheese makers: frequent association of irritant, allergic and protein contact dermatitis.

    BACKGROUND: Few data are available on occupational dermatoses in cheese makers. OBJECTIVE: The purpose of the present study was to investigate occupationally related skin diseases in cheese makers. METHOD: In a retrospective study we analyzed 400 patients with occupational dermatoses which presented for expert opinion evaluation at our institution (1990-1995). RESULTS: Four patients with hand eczema acquired in cheese dairies were identified. All patients had a decreased alkali resistance. Atopy was a further risk factor in 2 patients. Three out of 4 patients were patch test positive for occupationally related substances and demonstrated also immediate skin test reactions to various milk products. Therefore, these patients had concurrent allergic contact and protein contact dermatitis. CONCLUSION: The diagnosis of concurrent allergic and protein contact dermatitis has to be considered in occupational dermatoses related to cheese making.
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5/6. Skin reactions to pesticides.

    Skin disease is the second most common type of occupational illness. This chapter reviews the important concepts in pesticide-related dermatoses, first by examining two case studies and then by describing the major fungicides, insectides, herbicides, and fumigants associated with skin disease.
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6/6. Allergic contact dermatitis caused by zinc pyrithione associated with pustular psoriasis.

    A case of allergic contact dermatitis to a shampoo containing zinc pyrithione associated with an eruption of pustular psoriasis is reported. The patient had had stable psoriasis for 5 years, and never any other skin disease. Within 1 week she developed severe generalized pustular psoriasis with many lesions where the shampoo was applied. Treatment with cyclosporin, 200 to 300 mg daily, cleared the eruption within 4 weeks, except for psoriasis of the scalp. Extensive patch testing revealed a relevant sensitization to zinc pyrithione. This case illustrates that a generalized pustular psoriasis can be provoked by a substance present in a hair shampoo. Short-term treatment with cyclosporin is valuable in exacerbations of psoriasis caused by allergic contact dermatitis.
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