R.J.G. Rycroft T. Menne P. 1. Frosch (Eds.)

Textbook of Contact Dermatitis Second, Revised and Enlarged Edition

With 210 Illustrations, 95 in Colour, and 122 Tables

Volume I

Springer-Verlag Berlin Heidelberg GmbH

Dr. Richard J.G. Rycroft St. John's Institute of Dermatology, St. Thomas' s Hospital, London SEl 7EH, UK

Prof. Dr. med. Torkil Menne Department of Dermatology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark

ISBN 978-3-662-03106-3

Prof. Dr. med. Peter J. Frosch Hautk:linik der Stădtischen Kliniken Dortmund, Abteilung Dermatologie, Universităt Witten/Herdecke, BeurhausstraBe 40, 44123 Dortmund, Germany

Library of Congress Cataloging-in-Publication Data. Textbook of contact dermatitis/R.J.G. Rycroft, T. Menne, P.J. Frosch. - 2nd. rev. and enlarged ed. p. cm. Includes bibliographical references and index.

1. Contact dermatitis. 1. Rycroft, R.J.G. (R G.) II. Menne, Torldl. III. Frosch, Peter J. RL244.T49 1995 616.5'1-dc20 94-34409

This work is subject to copyright. AII rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag Berlin Heidelberg GmbH. Violations are liable for prosecution under the German Copyright Law.

© Springer-Verlag Berlin Heidelberg 1995 Originally published by Springer-Verlag Berlin Heidelberg New York in 1995 Softcover reprint ofthe hardcover 2nd edition 1995 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Produc! Liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.

Typesetting: Macmillan India Ltd., Bangalore-25

SPIN: 10132859 23/3130/SPS- 5 4 3 2 l O- Printed on acid-free paper

ISBN 978-3-662-03106-3 ISBN 978-3-662-03104-9 (eBook) DOI 10.1007/978-3-662-03 104-9

We honour the memory of Claude Benezra, our coeditor for the first edition of this textbook,

who was killed in a tragic accident in January 1992.

Foreword to the Second Edition

The growth of contact dermatitis as a subspecialty of dermatology has been impressive in the past couple of decades. Each new textbook that is published reflects the considerable increase in information corning from many parts of the world. An important advance was made 3 years ago with the appearance of this new comprehensive textbook, brought to fruition from the contributions of nearly all the workers active in this field throughout Europe.

In the Foreword to the previous edition, Dr. Etain Cronin described the greatest pitfalls of patch testing as the lack of knowledge in selecting the correct allergen and the difficulty encountered in interpreting the results. It is works such as this that bring together the knowledge of the past, in such a way that the reader/investigator can have readily available the information necessary to study the patients, patch test them, and interpret the results with accuracy and precision. Millions of patients worldwide experience contact dermatitis each year; not nearly enough of them are studied in detail to determine the precise cause of their affliction. In almost no other branch of medicine is it possible to pinpoint a specific, often removable, cause of a recurring, disabling disease. With the assistance of the information that is so prolifically available in this text, physicians will be able to bring help to many of these patients.

The 22 chapters of this volume cover every aspect of contact dermatitis, even including the addresses of physicians worldwide who work in this field. This work brings together dermatologists from many different countries and is an excellent example of what can be accomplished by the cooperation of those from a variety of nationalities and languages; truly a "European union" of contact dermatology!

The editors, including the late Dr. Claude Benezra, worked with devotion and care in the creation of this fine book. Dr. Rycroft, especially, deserves congratulations for bringing everyone together and organizing this textbook, which will surely remain a model of its kind for many years.

ROBERT M. ADAMS, M.D. Department of Dermatology Stanford University Medical Center Stanford, CA 94035, USA

Foreword to the First Edition

Ideally every patient with eczema should be patch tested and the importance of this investigation is now universally accepted. The simplicity of the technique belies its many pitfalls, the greatest being to lack the knowledge required to select the correct allergens and to interpret the results. The introduction, nearly 20 years ago, of the journal Contact Dermatitis greatly stimulated the reporting of the clinical side of contact dermatitis but a vast amount of laboratory work has also been published in other journals on the mechanisms and theory of these reactions. The literature on the subject is now quite vast and a comprehensive book on the clinical and research aspects of contact dermatitis has been sorely needed. This textbook was carefully planned to gather together what is known of the subject into a cohesive whole and it has succeeded admirably. It consists of 22 chapters written by 41 contributors, each selected for their special study of particular subjects. Every feature of contact dermatitis has been covered, beginning with its history and even concluding with the names and addresses of those worldwide who have a specific interest in the subject. The text is illustrated and well laid out; it has been broken up into clearly demarcated sections making it easy to read and its information readily accessible. One's own writing concentrates the mind but editing the texts of authors from so many different countries was a task of considerable proportions. The editors are greatly to be congratulated, partic­ularly Dr Rycroft who has worked tirelessly to mould this multi-authored book into an integrated whole. This Textbook of Contact Dermatitis is an impressive achievement; it will instruct and help all who read it and stimulate many to take a greater interest in this fascinating subject.

ETAIN CRONIN St. John's Institute of Dermatology St. Thomas's Hospital London SEI 7EH, UK

Contents

1 Historical Aspects (JEAN-MARIE LACHAPELLE)

1.1 1.2 1.3

Introduction ....................................... . Historical Aspects of Patch Testing ................... . References ........................................ .

2 Basic Features

2.1 Cellular Mechanisms in Allergic Contact Dermatitis (RIK 1. SCHEPER and B. MARY E. VON BLOMBERG)

2.1.1 2.1.2 2.1.3 2.1.4 2.1.5

Delayed Hypersensitivity and Allergic Contact Dermatitis Regulatory Mechanisms in Allergic Contact Dermatitis .. . Preventive Allergen Screening ........................ . Summary and Conclusions ........................... . References ........................................ .

2.2 Cutaneous Irritation (PETER J. FROSCH)

2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 2.2.8 2.2.9 2.2.10 2.2.11

Definition ......................................... . Clinical Pictures .................................... . Epidemiology ...................................... . Pathogenesis ....................................... . Diagnostic Tests .................................... . Action of Irritants .................................. . Inflammatory Mediators ............................. . Quantification of the Irritant Response ................. . Therapy and Prevention ............................. . Subjective Reactions to Irritants ('Stinging') ........... . References ........................................ .

3 4 8

11 20 22 23 24

28 29 42 43 46 47 48 50 51 52 56

XII Contents

2.3 Immediate Contact Reactions (ARTO LAHTI)

2.3.1 2.3.2 2.3.3 2.3.4

Introduction ....................................... . IgE-Mediated Contact Reactions ...................... . Nonimmunological Immediate Contact Reactions ....... . References ........................................ .

2.4 Photo toxic and Photoallergic Reactions (IAN R. WHITE)

2.4.1 2.4.2 2.4.3 2.4.4 2.4.5 2.4.6 2.4.7

Introduction ....................................... . Mechanisms ....................................... . Clinical Features of Photosensitivity .................. . Differential Diagnosis ............................... . Investigations ...................................... . Chronic Actinic Dermatitis .......................... . References ........................................ .

3 Histopathological and Immunohistopathological Features of Irritant and Allergic Contact Dermatitis (JEAN-MARIE LACHAPELLE)

3.1 3.2

3.3

3.4

3.5

3.6 3.7

Introduction ....................................... . Histopathological Features of Positive Allergic Patch Test Reactions .............. . Histopathological Features of Positive Irritant Patch Test Reactions ............... . Histopathological Criteria for Distinguishing Between Allergic and Irritant Patch Test Reactions in Man ....... . Comparative Immunohistochemical and Immunocytochemical Characteristics of Allergic and Irritant Patch Test Reactions in Man ............... . Conclusions ....................................... . References ........................................ .

4 Molecular Aspects of Allergic Contact Dermatitis (JEAN-PIERRE LEPOITTEVIN, CLAUDE BENEZRA t, CAROLINE C. SIGMAN, DONYA BAGHERI,

4.1 4.2

ROSSANA FRAGINALS t and HOWARD I. MAIBACH)

Molecular Approach to Allergic Contact Dermatitis ..... . Use of a Data Base of Skin Allergens: Example of Arninophenols ........................... .

62 64 68 72

75 76 80 82 83 85 86

91

92

94

98

99 101 101

105

108

Contents XIII

4.3 4.4

Skin Allergens that are also Carcinogens ............... . References ........................................ .

5 Individual Predisposition to Contact Dermatitis (TORKIL MENNE and JOHN D. WILKINSON)

5.1 5.2 5.3 5.4

Introduction ....................................... . Contact Sensitization ................................ . Individual Susceptibility to Irritants ................... . References ........................................ .

6 Epidemiology

6.1 6.2 6.3 6.4 6.5 6.6

6.7

(PIETER-JAN COENRAADS and JET SMIT)

Introduction ....................................... . Basic Concepts ..................................... . Sources of Data .................................... . Prevalence in the General Population .................. . Incidence in the Working Population .................. . Methodological Considerations in the Design of Epidemiological Studies on Contact Dennatitis ....... . References ........................................ .

7 Clinical Features (NIELS K. VEIEN)

7.1 7.2 7.3 7.4

7.5 7.6 7.7

Introduction ....................................... . The Medical History of the Patient .................... . Clinical Features of Eczematous Reactions ............. . Identifying the Cause of Contact Dennatitis from the Clinical Pattern ............................ . Regional Contact Dermatitis ......................... . Differential Diagnosis ............................... . References ........................................ .

8 Hand Eczema (ETAIN CRONIN)

8.1 8.2 8.3 8.4

Introduction ....................................... . Incidence .......................................... . Patterns of Hand Eczema ............................ . Endogenous Hand Eczema ........................... .

114 117

123 123 127 128

133 134 139 141 146

147 149

154 155 159

168 182 196 198

207 207 208 213

XIV Contents

8.5 8.6 8.7 8.8 8.9

Contact Dermatitis Post-Traumatic Eczema ............................. . Lymphangitis and Lymphoedema ..................... . Differential Diagnosis ............................... . References ........................................ .

9 Noneczematous Contact Reactions (CHEE LEOK GOR)

214 216 216 217 217

9.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 9.2 Erythema-Multiforme-like Eruption

or Urticarial Papular and Plaque Eruption ............... 222 9.3 Pigmented Purpuric Eruption. . . . . . . . . . . . . . . . . . . . . . . . . . 226 9.4 Lichen-Planus-like and Lichenoid Eruption .............. 227 9.5 Bullous Eruption .................................... 230 9.6 Nodular and Papular Eruption ......................... 230 9.7 Granulomatous Eruption .............................. 230 9.8 Pustular Eruption .................................... 231 9.9 Erythematous and Exfoliative Eruption ................. 232 9.10 Scleroderma-like Eruption ............................ 233 9.11 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

10 Diagnostic Tests

10.1 Patch Testing (JAN E. WAHLBERG)

10.1.1 Introduction ........................................ 241 10.1.2 Test Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 10.1.3 Allergens........................................... 246 10.1.4 Standard Series ..................................... 248 10.1.5 Deciding What to Include in the Standard Series ......... 248 10.1.6 Reading: When and How ............................. 249 10.1.7 Recording of Results ................................. 250 10.1.8 Interpretation of Results .............................. 252 10.1.9 Relevance .......................................... 255 10.1.1 0 False-Positive Test Reactions .......................... 256 10.1.11 False-Negative Test Reactions ......................... 257 10.1.12 Effect of Medicaments and Irradiation on Patch Tests. . . . . 258 10.1.13 Complications ...................................... 259 10.1.14 Open Tests ......................................... 260 10.1.15 Use Tests.. . .. . .. . ... . ... .. . .. . .. . . .. . . .. .. . . . . .. . . . 261 10.1.16 Noninvasive Techniques .............................. 262

Contents XV

10.1.17 Quality Control of Test Materials ...................... 262 10.1.18 Tests with Unknown Substances ....................... 263 10.1.19 The Future ......................................... 265 10.1.20 References ......................................... 265

10.2 Organization of Patch Testing in Office Practice (NIELS K. VEIEN)

10.2.1 Introduction ........................................ 269 10.2.2 Equipment Needed .................................. 270 10.2.3 Substances for Patch Testing .......................... 270 10.2.4 Test Procedure ...................................... 271 10.2.5 Recording Test Results ............................... 272 10.2.6 Informing the Patient ................................ 273 10.2.7 Should Dermatologists in Private Practice

Hesitate to Patch Test for Legal Reasons? (Is a Patch Test Ever Too Risky?) ..................... 273

10.2.8 Literature .......................................... 274 10.2.9 References ......................................... 274

10.3 Spot Tests and Chemical Analyses for Allergen Evaluation (LEON M. WALL)

10.3.1 Introduction ........................................ 277 10.3.2 Dimethylglyoxime Test for Nickel ..................... 278 10.3.3 Dipheny1carbazide Test for Chromate .................. 280 10.3.4 Tests for Formaldehyde .............................. 280 10.3.5 Tests for Epoxy Resins ............................... 282 10.3.6 Spot Testing for Atranorin in Lichens and Perfumes ...... 284 10.3.7 Detection of Textile Dyes ............................. 284 10.3.8 References ......................................... 284

10.4 Skin Tests for Immediate Hypersensitivity (MATTI HANNUKSELA)

10.4.1 Introduction ........................................ 287 10.4.2 Skin Prick Test ...................................... 287 10.4.3 Scratch Test ........................................ 288 10.4.4 Scratch-Chamber Test ................................ 288 10.4.5 Chamber Test ....................................... 289 10.4.6 Open Application Test ............................... 289 10.4.7 Rub Test ........................................... 290 10.4.8 Factors Suppressing Immediate Skin Test Reactivity ...... 290

XVI Contents

10.4.9 Control Tests ....................................... 291 10.4.10 References ......................................... 291

10.5 Photopatch Testing (IAN R. WHITE)

10.5.1 Types of Reaction ................................... 293 10.5.2 Contact Photoallergens ............................... 294 10.5.3 Diagnostic Difficulties ............................... 297 10.5.4 Photopatch Testing .................................. 298 10.5.5 References ......................................... 303

10.6 In Vitro Testing in Contact Hypersensitivity (CLIFFORD McMILLAN and DESMOND BURROWS)

10.6.1 Introduction ........................................ 306 10.6.2 Immunology ........................................ 307 10.6.3 In Vitro Tests ....................................... 308 10.6.4 Discussion.......................................... 316 10.6.5 References ......................................... 318

10.7 Noninvasive Techniques for Quantification of Contact Dermatitis (J0RGEN SERUP)

10.7.1 Introduction ........................................ 323 10.7.2 Prerequisites and Planning of Study

by Noninvasive Techniques ........................... 324 10.7.3 Review of Noninvasive Techniques Relevant to the Study

of Contact Dermatitis ................................ 325 10.7.4 Allergic Contact Dermatitis ........................... 330 10.7.5 Irritant Contact Dermatitis ............................ 331 10.7.6 Urticarial Wheals .................................... 334 10.7.7 References ......................................... 336

11 Occupational Contact Dermatitis (RICHARD J. G. RYCROFT)

11.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 11.2 Definition and Setting ................................ 343 11.3 History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 11.4 Frequency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 11.5 Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347

Contents XVII

11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18

Occupations ....................................... . Period of Exposure ................................. . Aetiology ......................................... . Pathology ......................................... . Clinical Features ................................... . Prognosis Diagnosis Treatment Prevention ......................................... . Medical Report .................................... . Examples of Occupational Contact Dermatitis .......... . Specific Occupational Harzards ....................... . References ........................................ .

12 Contact Dermatitis in Children (CARLO LUIGI MENEGHINI)

348 349 351 355 355 357 359 365 366 371 371 377 386

12.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 12.2 Irritant Contact Dermatitis ............................ 403 12.3 Allergic Contact Dermatitis ........................... 406 12.4 Personal Observations ................................ 408 12.5 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 12.6 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

13 Allergens from the Standard Series (KLAUS E. ANDERSEN, DESMOND BURROWS and IAN R. WHITE)

l3.1 l3.2 l3.3 13.4 l3.5 13.6 13.7 13.8 l3.9 13.10 l3.11 l3.12 13.13 13.14 13.15

Introduction ....................................... . Nickel ............................................ . Chromium ......................................... . Cobalt ............................................ . Fragrance Mix ..................................... . Balsam of Peru .................................... . Colophony ........................................ . Neomycin ......................................... . Benzocaine ........................................ . Clioquinol ......................................... . Wool Alcohols ..................................... . Ethylenediamine Dihydrochloride ..................... . Parabens .......................................... . Formaldehyde ...................................... . Quaternium 15 ..................................... .

416 418 421 424 425 427 429 430 432 433 434 436 437 438 440

XVIII Contents

13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24

Cl- + Me-Isothiazolinone ............................ . p-Phenylenediamine ................................ . Thiuram Mix ...................................... . Mercapto Mix ..................................... . N-Isopropyl-N'-phenyl-p-phenylenediamine (lPPD) ..... . Epoxy Resin ....................................... . p-tert-Butylphenol-Formaldehyde Resin ............... . Primin ............................................ . Sesquiterpene Lactone Mix .......................... .

14 Allergens Related to Specific Exposures

14.1 Cosmetics and Skin Care Products (ANTON C. DE GROOT and IAN R. WHITE)

442 444 445 447 449 451 453 456 457

14.1.1 What Are Cosmetics? ................................ 461 14.1.2 The Allergens ....................................... 464 14.1.3 Diagnosis .......................................... 471 14.1.4 Cosmetic Ingredient Labelling: The Gap in EC Legislation 473 14.1.5 References ......................................... 474

14.2 Topical Drugs (GIANNI ANGELINI)

14.2.1 Incidence........................................... 477 14.2.2 Factors Favouring Development of Contact Dermatitis .... 478 14.2.3 Clinical Patterns ..................................... 478 14.2.4 Sites and Dermatoses at Risk ......................... 482 14.2.5 Cross-Sensitization .................................. 485 14.2.6 Systemic Contact Dermatitis .......................... 485 14.2.7 Sensitizers .......................................... 489 14.2.8 Patch Tests ......................................... 494 14.2.9 Prognosis and Prevention ............................. 494 14.2.10 Appendix: Topical Drugs

Capable of Inducing Allergic Contact Dermatitis ......... 494 14.2.11 References ......................................... 498

14.3 Clothing (JEAN FOUSSEREAU)

14.3.1 Introduction ........................................ 504 14.3.2 Examination ........................................ 505 14.3.3 The Allergens ....................................... 507 14.3.4 Patch Tests ......................................... 511

Contents XIX

14.3.5 Cross-reactions...................................... 511 14.3.6 Chemical Analyses .................................. 513 14.3.7 Diagnosis .......................................... 514 14.3.8 References ......................................... 514

14.4 Shoes

14.4.1 14.4.2 14.4.3 14.4.4 14.4.5 14.4.6 14.4.7 14.4.8

(PATRICIA PODMORE)

Introduction ....................................... . Shoe Uppers ....................................... . Shoe Soles ........................................ . Shoe Insoles ....................................... . Adhesives ......................................... . Heel and Toe Counters .............................. . Conclusion References ........................................ .

14.5 Pesticides (HANS J. SCHUBERT)

516 518 522 522 523 524 524 526

14.5.1 Introduction ........................................ 527 14.5.2 Specific Groups of Pesticides ......................... 529 14.5.3 Patch Testing with Pesticides .......................... 533 14.5.3 References ......................................... 537

14.6 Plastic Materials (BERT BJORKNER)

14.6.1 Introduction ........................................ 540 14.6.2 Acrylic Resins ...................................... 541 14.6.3 Epoxy Resin Systems ................................ 550 14.6.4 Phenol-Formaldehyde Resins .......................... 554 14.6.5 Polyurethane Resins ................................. 557 14.6.6 Amino Plastics ...................................... 559 14.6.7 Polyester Resins ..................................... 560 14.6.8 Polyvinyl Resins .................................... 561 14.6.9 Polystyrene Resins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562 14.6.10 Polyolefins ......................................... 563 14.6.11 Polyamides ......................................... 564 14.6.12 Polycarbonates ...................................... 564 14.6.13 Other Plastic Materials ............................... 564 14.6.14 Additives in Synthetic Polymers ....................... 565 14.6.15 References ......................................... 567

XX Contents

14.7 Health Personnel (JOSE G. CAMARASA)

14.7.1 Introduction ........................................ 573 14.7.2 Dental Personnel .................................... 575 14.7.3 Nurses, Clinical Assistants and Cleaners ................ 578 14.7.4 Surgeons ........................................... 580 14.7.5 Laboratory Personnel ................................ 582 14.7.6 Veterinarians ........................................ 583 14.7.7 References ......................................... 585

14.8 Plants and Plant Products (GEORGES DUCOMBS and RICHARD J. SCHMIDT)

14.8.1 Introduction ........................................ 589 14.8.2 Clinical Aspects ..................................... 590 14.8.3 Dermatologically Important Plants ..................... 597 14.8.4 Diagnosis .......................................... 617 14.8.5 Therapy ............................................ 620 14.8.6 Appendix: Correct Names and Synonyms

of Some Dermatologically Hazardous Members of the Anacardiaceae and Compositae .................. 621

14.8.7 References ......................................... 624

15 Pigmented Contact Dermatitis and Chemical Depigmentation (HIDEO NAKAYAMA)

15.1 Hyperpigmentation Associated with Contact Dermatitis 637 15.2 Depigmentation from Contact with Chemicals ........... 651 15.3 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 654

16 The Management of Contact Dermatitis (JOHN D. WILKINSON)

16.1 16.2

Suspicion and Recognition of Contact Dermatitis Identification of the Factors

660

Involved in Contact Dermatitis ........................ 661 16.3 Interpretation of Patch Test Results .................... 662 16.4 Advice and Counselling .............................. 663 16.5 Creation of a Low-Risk Environment ................ , . . 663 16.6 Treatment of Acute Contact Dermatitis ................. 664 16.7 Treatment of Subacute Contact Dermatitis .............. 664 16.8 Treatment of Chronic and Chronic-Relapsing Dermatitis .. 667

Contents XXI

16.9 16.10 16.11

16.12 16.13 16.14 16.15

16.16 16.17 16.18 16.19

Information Sheets and Test Kits Causes of Persistence ............................... . Theoretical Aspects and Mechanisms of Action in Respect of Treatment of Contact Dermatitis .............. , .... . Other Specific Forms of Treatment .................... . Management of Specific Types of Contact Dermatitis .... . Prognosis ......................................... . Prevention of Allergic Contact Dermatitis: Theoretical Considerations ........................... . Prevention of Contact Dermatitis: Practical Aspects ..... . General Preventive Measures ......................... . Appendices ........................................ . References ........................................ .

17 Principles of Prevention and Protection in Contact Dermatitis (JEAN-MARIE LACHAPELLE)

667 668

669 670 671 675

675 676 677 677 683

17.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695 17.2 General Measures of Prevention ....................... 696 17.3 Individual Measures of Prevention ..................... 698 17.4 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 701

18 Predictive Assays: Animal and Man, and In Vitro and In Vivo (ESTHER PATRICK and HOWARD I. MAIBACH)

18.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 706 18.2 Dermatopharmacokinetics: Relation to Predictive Assays .. 706 18.3 Allergic Contact Dermatitis ........................... 710 18.4 Irritant Contact Dermatitis ............................ 726 18.5 Contact Urticaria .................................... 734 18.6 Subjective Irritation and Paraesthesia ................... 737 18.7 References. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 740

19 International Legal Aspects of Contact Dermatitis (PETER J. FROSCH and RICHARD J. G. RYCROFf)

19.1 Introduction ................... , . .. . .. . . .. . .. . . ... . . 751 19.2 Occupational Dermatitis in Germany ................... 752 19.3 Occupational Contact Dermatitis

in Other European Countries and the USA .............. 756 19.4 Conclusions and Comment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 766 19.5 Further Reading ..................................... 768

XXII Contents

20 Computers and Patient Information Systems (AN DOOMS-GOOSSENS, M. DOOMS and J. DRIEGHE)

20.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 771 20.2 Useful Data Bases ................................... 772 20.3 Data Processing ..................................... 777 20.4 Artificial Intelligence ................................. 782 20.5 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783 20.6 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

21 Contact Dermatitis Research Groups (DESMOND BURROWS) .............................. 787

22 Patch Test Concentrations and Vehicles for Testing Contact Allergens (ANTON C. DE GROOT and PETER J. FROSCH) .......... 797

22.1 References 805

Subjectlndex ........................................... 807

List of Contributors

KLAUS E. ANDERSEN Algade 33, 4000 Roskilde, Denmark Dermatology Department I, Odense Hospital, 5000 Odense C, Denmark

GIANNI ANGELINI 2nd Department of Dermatology, University of Bari, 70100 Bari, Italy

DONYA BAGHERI CCS Associates, 1285 Hamilton Drive, Palo Alto, Ca, USA

CLAUDE BENEZRA t Laboratoire de Dermatochimie, Universite Louis Pasteur, Clinique Dermatologique, I Place de I'H6pital, 67091 Strasbourg Cedex, France

BERT BJORKNER Department of Occupational Dermatology, General Hospital, 21401 Malmo, Sweden

B. MARY E. VON BLOMBERG Department of Pathology, Free University Hospital, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

DESMOND BURROWS Dermatology Department, Royal Victoria Hospital, Grosvenor Road, Belfast BT 12 6BA, UK

JOSE G. CAMARASA Department of Dermatology, Hospital de N. S. del Mar, Paseo Maritimo Sin, 08003 Barcelona, Spain

PIETER-JAN COENRAADS Occupational and Environmental Dermatology Unit, State University, Academic Hospital, P.O. Box 30001,9700 RB Groningen, The Netherlands

XXIV List of Contributors

ETAIN CRONIN Contact Dermatitis Clinic, St. John's Dermatology Centre, St. Thomas's Hospital, London SEI 7EH, UK

M.DoOMS Contact Dermatitis Unit, University Hospital, Kapucijnenvoer 33, 3000 Leuven, Belgium

AN DOOMS-GOOSSENS Contact Dermatitis Unit, University Hospital, Kapucijnenvoer 33, 3000 Leuven, Belgium

J. DRIEGHE Contact Dermatitis Unit, University Hospital, Kapucijnenvoer 33, 3000 Leuven, Belgium

GEORGES DUCOMBS Clinique Dermatologique, H6pital Saint Andre, Universite de Bordeaux, Rue Jean Burguet 1, 33075 Bordeaux, France

JEAN FOUSSEREAU Clinique Dermatologique, Universite Louis-Pasteur, 1 Place de l'H6pital, 67091 Strasbourg Cedex, France

ROSSANA FRAGINALS t Laboratoire de Dermatochimie, Universite Louis Pasteur, Clinique Dermatologique, 1 Place de l'Hopital, 67091 Strasbourg Cedex, France

PETER J. FROSCH Hautklinik, Stadtische Kliniken Dortmund, BeurhausstraBe 40, 44123 Dortmund, Germany

CHEE LEOK GOH Contact and Occupational Dermatoses Clinic, National Skin Centre, 1 Mandalay Road, Singapore 1130, Republic of Singapore

ANTON C. DE GROOT Department of Dermatology, Carolus Hospital, P.O. Box 1101, 5200 BD's-Hertogenbosch, The Netherlands

MATTI HANNUKSELA Department of Dermatology, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland

List of Contributors XXV

JEAN-MARIE LACHAPELLE Unit of Occupational and Environmental Dermatology, Catholic University of Louvain, 30 Clos Chapelle-aux-Champs, UCL 3033, 1200 Brussels, Belgium

ARTO LAHTI Department of Dermatology, University of Oulu, 90220 Oulu, Finland

JEAN-PIERRE LEPOITTEVIN

Laboratoire de Dermatochimie, Universite Louis Pasteur, Clinique Dermatologique, 1 Place de I'H6pital, 67091 Strasbourg Cedex, France

HOWARD I. MAIBACH Department of Dermatology, University of California, School of Medicine, Box 0989, Surge 110, San Francisco, CA 94143-0989, USA

CLIFFORD McMILLAN Dermatology Department, City Hospital, Belfast, UK

CARLO LUIGI MENEGHINI Department of Dermatology, Post-Graduate Medical School, University of Bari, Via Abate Gimma 99, 70100 Bari, Italy

TORKIL MENNE Department of Dermatology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark

HIDEO NAKAYAMA Department of Dermatology, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108, Japan

ESTHER PATRICK Department of Dermatology, University of California, School of Medicine, San Francisco, CA 94143-0989, USA

PATRICIA PODMORE Department of Dermatology, Altnagelvin Hospital, Waterside, Londonderry BT47 ISB, UK

RICHARD J.G. RYCROFT Contact Dermatitis Clinic, St. John's Institute of Dermatology, St. Thomas's Hospital, London SEI 7EH, UK

XXVI List of Contributors

RIK J. SCHEPER Department of Pathology, Free University Hospital, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

RICHARD 1. SCHMIDT Welsh School of Pharmacy, UWCC, PO Box 13, Cardiff CFl 3XF, UK

HANS J. SCHUBERT Klinik und Poliklinik fOr Hautkrankheiten der Medizinischen Akademie, Postfach 434, Erfurt, Germany

J0RGEN SERUP Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

CAROLINE C. SIGMAN CCS Associates, 1285 Hamilton Drive, Palo Alto, Ca, USA

JET SMIT TNO-Institute of Preventive Health Care, Leiden, The Netherlands

NIELS K. VEIEN Dermatology Clinic, Vesterbro 99, 9000 Aalborg, Denmark

JAN E. WAHLBERG Karolinska Sjukhuset, Box 60500, 10401 Stockholm, Sweden

LEON M. WALL Sir Charles Gairdner Hospital, 5th Floor, G Block, Nedlands, Western Australia 6009, Australia

IAN R. WHITE Contact Dermatitis Clinic, St. John's Institute of Dermatology, St. Thomas's Hospital, London SEI 7EH, UK

JOHN D. WILKINSON Department of Dermatology, Amersham General Hospital, Amersham, Bucks, HP7 OJD, UK