Allergic contact dermatitis from an electronic facial toner
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Contact Dermatitis, 2001, 45, 252–253 Copyright C Munksgaard 2001 Printed in Denmark . All rights reserved ISSN 0105-1873 Short Communication Allergic contact dermatitis from an electronic facial toner G L * C G Department of Dermatology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK Key words: allergic contact dermatitis; nickel; electronic facial toner. C Munksgaard, 2001. Case Report A 38-year-old woman presented in November 2000 after 2 episodes of upper lip and periorbital swelling requiring attention at Accident and Emergency. Each episode was associated with facial erythema, wheeze and tachycar- dia. Self-administration of antihistamine did not relieve her symptoms and she was treated with systemic cortico- Fig. 1. Electronic facial toner showing positive dimethylglyoxi- me test. * 4th-year medical student. steroids on the 1st occasion. She also displayed a scaly erythematous rash over the back of her neck, under her chin and anterior neck, and over her knees and legs. Her mixture of immediate and delayed-type hypersensitivity symptoms had no obvious trigger. She was investigated for food allergy with IgE and RAST tests for mixed foods and was patch tested to the European standard series and her own products using Finn Chambers on Scanpor tape. Her eczema responded to a moderately potent topical corticosteroid and an emollient, and she was commenced on cetirizine. Her immunopathology results showed borderline anti- nuclear factor, Ro and La, with a low C4 complement level. Patch test readings at D4 showed a ππ reaction to para-phenylenediamine and πππ to nickel. Di- methylglyoxime testing of her facial toning machine showed a strong positive to the metal applicator pad (Fig. 1), and she was given information on nickel and PPD avoidance. Discussion Both contact dermatitis and contact urticaria have been reported from patients with a history of frequent nickel contact (1, 2). Nickel is released from nickel-containing alloys by the action of sweat, blood or physiological sa- line. Although the majority of cases of nickel allergy are due to nickel-plated jewellery (3), nickel-containing alloy may have the potential to sensitize individuals (2). Other common exposures to nickel include wrist- watches, spectacle frames, coins, metal clothing, buckles and the electroplating industry (4). Medical instruments, such as infusion needles, electromyography needles (5), dental prostheses (6) and TENS electrodes (7), have also been shown to cause nickel allergy. The detection of a nickel-containing electrode on our patient’s facial toning machine by the dimethylglyoxime spot test (8) documents a new route of nickel sensitiza- tion, of which, to our knowledge, this is the 1st report. References 1. Helgessen A L O, Austad J. Contact urticaria from alumin-
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Transcript of Allergic contact dermatitis from an electronic facial toner
Contact Dermatitis, 2001, 45, 252–253 Copyright C Munksgaard 2001Printed in Denmark . All rights reserved
ISSN 0105-1873
Short Communication
Allergic contact dermatitis from an electronic facial toner
G L* C G
Department of Dermatology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
Key words: allergic contact dermatitis; nickel; electronic facial toner. C Munksgaard, 2001.
Case ReportA 38-year-old woman presented in November 2000 after2 episodes of upper lip and periorbital swelling requiringattention at Accident and Emergency. Each episode wasassociated with facial erythema, wheeze and tachycar-dia. Self-administration of antihistamine did not relieveher symptoms and she was treated with systemic cortico-
Fig. 1. Electronic facial toner showing positive dimethylglyoxi-me test.
* 4th-year medical student.
steroids on the 1st occasion. She also displayed a scalyerythematous rash over the back of her neck, under herchin and anterior neck, and over her knees and legs. Hermixture of immediate and delayed-type hypersensitivitysymptoms had no obvious trigger. She was investigatedfor food allergy with IgE and RAST tests for mixedfoods and was patch tested to the European standardseries and her own products using Finn Chambers onScanpor tape. Her eczema responded to a moderatelypotent topical corticosteroid and an emollient, and shewas commenced on cetirizine.
Her immunopathology results showed borderline anti-nuclear factor, Ro and La, with a low C4 complementlevel. Patch test readings at D4 showed a ππ reactionto para-phenylenediamine and πππ to nickel. Di-methylglyoxime testing of her facial toning machineshowed a strong positive to the metal applicator pad(Fig. 1), and she was given information on nickel andPPD avoidance.
DiscussionBoth contact dermatitis and contact urticaria have beenreported from patients with a history of frequent nickelcontact (1, 2). Nickel is released from nickel-containingalloys by the action of sweat, blood or physiological sa-line. Although the majority of cases of nickel allergy aredue to nickel-plated jewellery (3), nickel-containing alloymay have the potential to sensitize individuals (2).
Other common exposures to nickel include wrist-watches, spectacle frames, coins, metal clothing, bucklesand the electroplating industry (4). Medical instruments,such as infusion needles, electromyography needles (5),dental prostheses (6) and TENS electrodes (7), have alsobeen shown to cause nickel allergy.
The detection of a nickel-containing electrode on ourpatient’s facial toning machine by the dimethylglyoximespot test (8) documents a new route of nickel sensitiza-tion, of which, to our knowledge, this is the 1st report.
References1. Helgessen A L O, Austad J. Contact urticaria from alumin-
Contact Dermatitis 2001: 45: 253SHORT COMMUNICATION
ium and nickel in the same patient. Contact Dermatitis1997: 37: 303.
2. Liden C, Menne T, Burrows D. Nickel-containing alloysand their ability to cause dermatitis. Br J Dermatol 1996:134: 193.
3. Shah M, Lewis F M, Gawkrodger D J. Nickel as an occu-pational allergen: a survey of 368 nickel-sensitive subjects.Arch Dermatol 1998: 134: 1231.
4. Schubert H, Berova N, Czernielewski A, Hegyi L et al.Epidemiology of nickel allergy. Contact Dermatitis 1987:16: 122.
5. Bragadin G, Taraschi A, Marchini C, Mucchiut M, PatroneP. Allergic contact dermatitis from nickel following electro-myography. Contact Dermatitis 1999: 41: 353.
6. Kerosuo H, Kanerva L. Systemic contact dermatitis causedby nickel in a stainless steel orthodontic appliance. ContactDermatitis 1997: 36: 112.
7. Al’Ajlan A, Thestrup-Pedersen K, Al’Eisa A. Contact leu-koderma following nickel dermatitis elicited by TENS elec-trode plates. Contact Dermatitis 2000: 42: 172.
8. Feigl F. Spot tests in inorganic analysis, 6th edition.Amsterdam: Elsevier, 1972: 325.
