The term connubial or consort allergic contact dermatitis defines a peculiar dermatitis caused by sensitization to substances used by people in close contact with the patient. A case of connubial allergic contact dermatitis in a tango dancer is reported.
CASE REPORTA 53-year-old man presented a 3-year history of a monolateral, pruritic, erythematous lesion on his right temple ( Figure 1). He denied having atopy or other dermatological diseases. Patch testing was performed with the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) baseline series (Lofarma, Milano, Italy) on Van der Bend chambers (Van der Bend, Brielle, The Netherlands). Patch tests were applied under occlusion on the patient's back for 2 days; readings were performed on day (D) 2 and D4 according to ESCD guidelines. 1Strong positive reactions to p-phenylenediamine (PPD) 1% (++/+++ on D2/D4) and weak reactions to textile dye mix 6.6% (?+ on D2/D4) and sorbitan sesquioleate 20% (?+ on D2/D4) were observed. This result seemed unrelated to patient's history. Careful investigation of the patient's habits showed a passion for tango, which he had been practising assiduously for the previous 4 years. He reported close contact of the area affected by dermatitis with the hair and face of his usual dancing partner, who used make-up and perfumes, and had dyed red hair. The presence of the sensitizers PPD and azo dyes was confirmed in the product data sheet of the hair dye used by his tango partner. The repeated skin contact, friction and perspiration while he was dancing favoured elicitation of the eczema. Suspension of the dance activity for some weeks and avoidance of the close cheek-to-cheek contact with his partner improved the dermatitis.
DISCUSSIONConnubial dermatitis is a term used for dermatitis that occurs because of contact with substances transferred to patients' skin by spouses 2,3 or by other people in close contact in daily life. In the literature, some 30 cases of connubial dermatitis and photodermatitis have been reported; the most frequently involved allergens are fragrances, preservatives, and topical medicaments. 2-10 In our case, the source of sensitization was the patient's tango partner. A case of connubial photodermatitis in a tango dancer caused by ketoprofen has been reported. 4 PPD, which is a major component of hair dyes, is a strong sensitizer and a common allergen. It is well known to cause contact dermatitis in hairdressers and in those who dye their hair; it has been reported as a cause of connubial dermatitis in a few articles. 5,6 Cross-sensitization between PPD and azo dyes has also been described. 11 The diagnosis of connubial dermatitis should be considered in cases of probable allergic contact eczema when patch test results are apparently inconsistent with the patient's clinical history. In these situations, it may be necessary to extend medical investigation not only to the professional and recreational activities of the patient, but also to family members and cohabitants. Our case hig...