Another Great Imitator: Allergic Contact Dermatitis Differential Diagnosis, Clues to Diagnosis, Histopathology, and Treatment

So, Jessica Kim; Hamstra, Ashley; Calame, Antoanella; Hamann, Carsten R.; Jacob, Sharon E.

doi:10.1007/s40521-015-0064-y

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…Allergic contact cheilitis shows inflammatory infiltrates mainly consisting of lymphocytes, Langerhans cells, macrophages, and eosinophils rather than plasma cells. 19 Our case showed a consistent infiltrate of mature plasma cells and the patient did not report allergies or sensitivities to a specific substance. The histopathological features of syphilis are inflammatory infiltrates containing plasma cells, lymphocytes, and macrophages, usually with a perivascular distribution.…”

Section: Discussionsupporting

confidence: 46%

“…These lesions may be excluded depending on the histomorphology. Allergic contact cheilitis shows inflammatory infiltrates mainly consisting of lymphocytes, Langerhans cells, macrophages, and eosinophils rather than plasma cells 19. Our case showed a consistent infiltrate of mature plasma cells and the patient did not report allergies or sensitivities to a specific substance.…”

Section: Discussionmentioning

confidence: 46%

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Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Santos

Cunha²,

Santana

et al. 2019

Autops. Case Rep.

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Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown etiology that affects the lip. It is characterized histologically by a dense infiltrate of plasma cells with a variety of clinical features. The response to different therapeutic modalities is controversial, especially regarding the effectiveness of corticosteroids. We present a case of a 56-year-old Caucasian man with a painful ulcerated and crusted area in the lower lip, resembling a squamous cell carcinoma or actinic cheilitis. Topical corticosteroid was used for one week, which resulted in partial regression and motivated a biopsy. The histological examination provided the diagnosis of PCC. The patient has been disease-free for six months. We also provide a discussion on the criteria of differential diagnosis and management of this rare condition.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 46%

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Santos

Cunha²,

Santana

et al. 2019

Autops. Case Rep.

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“…Patch testing for ACD was performed in three patients during dupilumab treatment, but only one patient showed positive patch tests, to lanolin and cocamidopropyl betaine. However, avoidance of the allergens did not improve this erythema and the histopathological findings were not suggestive of ACD …”

Section: Discussionmentioning

confidence: 84%

“…However, avoidance of the allergens did not improve this erythema and the histopathological findings were not suggestive of ACD. 8 It has been suggested that (co)sensitization to the human and/or fungal (including Malassezia spp.) enzyme superoxide dismutase might play an important role in the pathogenesis of AD and associated head and neck dermatitis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series

et al. 2019

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Dupilumab is the first biologic registered for the treatment of atopic dermatitis (AD). We report on seven patients with AD presenting with a paradoxical head and neck erythema that appeared 10-39 weeks after the start of dupilumab treatment. The patients presented with a relatively sharply demarcated, patchy erythema in the head and neck area that showed no or less scaling compared with their usual eczema. Only one patient experienced symptoms of itch and burning, although this was notably different from his pre-existent facial AD. Except for a notable 'red face', eczema on other body parts had greatly improved in six of the seven patients, with a mean numerical rating scale for treatment satisfaction of 9 out of 10 at the time of biopsy. Treatment of the erythema with topical and systemic drugs was unsuccessful. Despite the presence of this erythema, none of our patients discontinued dupilumab treatment. Lesional skin biopsies showed an increased number of ectatic capillaries, and a perivascular lymphohistiocytic infiltration in all patients. In addition, epidermal hyperplasia with elongation of the rete ridges was observed in four patients, resembling a psoriasiform dermatitis. Additional immunohistochemical stainings revealed increased numbers of plasma cells, histiocytes and T lymphocytes. Interestingly, spongiosis was largely absent in all biopsies. We report on patients with AD treated with dupilumab developing a paradoxical erythema in a head and neck distribution. Both clinically and histopathologically we found a heterogeneous response, which was most suggestive of a drug-induced skin reaction. What's already known about this topic? • Dupilumab has proven to be an efficacious and effective treatment for atopic dermatitis with an acceptable safety profile. • The most frequently observed side-effects in patients with atopic dermatitis treated with dupilumab are conjunctivitis, herpes infections and injection-site reactions. What does this study add? • For the first time, we report on patients with atopic dermatitis treated with dupilumab who developed a paradoxical, mainly asymptomatic erythema in a head and neck distribution. • Histological examination of skin biopsies revealed a psoriasiform reaction pattern suggestive of a drug-induced skin reaction.

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“…Contact allergy on skin is typically manifested as eczema, but other lesions may also represent skin allergy (64). Oral contact allergy can manifest itself in many different ways, e.g.…”

Section: Manifestations Of Oral Contact Allergymentioning

confidence: 99%

Oral contact allergy to carvone : with a focus on oral lichen

Kroona¹

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This thesis examines carvone (l-carvone), a mint flavour, and contact allergy to carvone with a focus on oral lichen. Carvone is a constituent of spearmint oil and is used to flavour toothpaste and food. Like many flavours and fragrances, carvone may cause contact allergy, but the prevalence is low, between 1.6 and 2.8%. Affected patients often have perioral or oral signs. A couple of studies have shown that patients with oral lichen planus or oral lichenoid lesions often have contact allergy to carvone but it is not known if these lichenoid lesions are a manifestation of contact allergy or part of the auto-immune disease, oral lichen planus. In paper I, the amount of carvone was measured in 66 toothpastes and the ingredient lists were studied. Carvone was detected in all toothpastes with flavour, even fruit flavoured toothpaste, in up to 0.35%. The measured concentrations were all within the safe use level estimated to not induce contact allergy, but carvone concentrations over 0.1% are high enough to elicit a reaction in already allergic individuals. The regulation of carvone as a constituent in toothpaste was discussed. Registry data (age, sex, referring information and patch tests results) on patients with a positive patch test reaction to carvone was studied in paper II. Data was retrieved from 1996 to 2016 and was compared with other patch tested groups not allergic to carvone. A matched comparison was also made between carvone-positive and carvone-negative patients tested with the same test series. Patients with contact allergy to carvone had a high mean age and were often women. According to the referrals, they often had oral signs and

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Another Great Imitator: Allergic Contact Dermatitis Differential Diagnosis, Clues to Diagnosis, Histopathology, and Treatment

Cited by 12 publications

References 13 publications

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Clinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series

Oral contact allergy to carvone : with a focus on oral lichen

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