Case history
Case history #1
A 16-year-old girl presents with a progressively worsening pruritic eruption in the periumbilical region. She reports wearing blue jeans with metal buttons and a belt with a metal buckle on an almost daily basis. She previously developed pruritic eruptions around the neck and earlobes when wearing costume jewelry. Physical exam reveals erythematous to hyperpigmented periumbilical papules and plaques with sharp demarcation, and hyperpigmented patches on the neckline and ear lobes.
Case history #2
A 45-year-old male factory worker presents with pruritic eruption of his hands, which has been present for several months. He works in a manufacturing plant where cutting oils are used. While at work, he wears protective clothing that covers his trunk, arms, and legs, but he often neglects to wear gloves. He noticed an improvement when he was on vacation for 2 weeks. Physical exam shows hyperpigmented scaly plaques and fissuring, confined to the dorsal hands and digits, with sharp demarcation at the wrist.
Other presentations
Atypical presentations of allergic contact dermatitis (ACD) and irritant contact dermatitis include folliculitis, acneiform lesions (caused by chlorinated compounds), oral lichenoid lesions (caused by mercury and gold), cellulitis-like lesions and hyperpigmentation (caused by phototoxins), hypopigmentation and purpura (caused by black rubber), granulomas (caused by silica), ulcerations or burns (caused by strong acids), and erythema multiforme (caused by some exotic woods). Some contactants, such as latex, may cause an urticarial eruption. A systemic reaction can also occur, leading to a more widespread dermatitis at sites distant from the area of contact. The distribution of lesions on the body may provide a clue as to the causative agent. ACD may also occur in areas not directly in contact with the causative agent. For example, ACD caused by tosylamide found in nail polish may occur on the eyelids but not on the hands, because the eyelid skin is thinner and more susceptible to the development of ACD. Other allergic conditions may be triggered by exposure to an allergen, such as allergic rhinitis, asthma, and anaphylaxis.
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