There is increasing evidence for an intimate interaction of the skin and the nervous system. As known from animal studies, nerve growth factor (NGF) is essential for the innervation density and functional properties of sensory neurons of the skin during embryogenesis and in adulthood, and possibly during cutaneous inflammation. This study examined NGF content and sprouting of nerves during the elicitation phase of contact allergy in human skin. Skin biopsies from patients (n=14) undergoing patch-testing were taken from positive test sites and control back skin 96 h after antigen application. NGF content was measured by enzyme-linked immunofluorescence assay. Immunohistochemistry was performed for protein gene product 9.5 (PGP9.5), a marker that stains all neuronal elements, and growth-associated protein 43 (GAP43), a marker for axonal growth cones. The NGF content was significantly increased in lesional skin in comparison with normal skin (4.2+/-0.6 pg to 2.9+/-0.5 pg NGF per mg wet weight). The length of epidermal PGP9.5-immunoreactive (ir) fibers in lesional skin significantly increased from 3.4+/-0.9 mm in normal skin to 5.3+/-1.0 mm in contact eczema, whereas dermal fibers were unaltered (11.1+/-2.7 mm vs 9.5+/-2.1 mm, respectively). GAP43-ir nerve endings were significantly increased in both epidermis (1.6+/-0.3 mm to 2.6+/-0.4 mm) and dermis (0.5+/-0.1 mm to 1.8+/-0.2 mm) in contact eczema. Thus, we have provided evidence for an NGF-mediated nerve-fiber sprouting in human contact eczema. This may have a functional impact on skin-associated immune cells, in particular mast cells and Langerhans cells.