Systemic Nickel Allergy Presenting as Papuloerythroderma-like Eruptions

Abstract

Letters to the Editor 655 328-332. 4. Rogawski MA, Loscher W. The neurobiology of antiepileptic drugs for the treatment of nonepileptic conditions. Nat Med 2004; 10: 685-692. 5. Caterina MJ, Leffler A, Malmberg AB, Martin WJ, Trafton J, Petersen-Zeitz KR, et al. Impaired nociception and pain sensation in mice lacking the capsaiein receptor. Science 2000:288:306-313. 6. Hölzer P. Capsaiein: cellular targets, mechanisms of action. and selectivity for thin sensory neurons. Pharmacol Rev 1991; 43: 143-201. 7. Senba E, Katanosaka K, Yajima H, Mizumura K. The immunosuppressant FK506 activates capsaiein-and bradykinin-sensitive DRG neurons and cutaneous C-fibers.Papuloerythroderma is characterized by erythroderma with widespread coalescent solid or lichenoid papules, and eruptions often spare skin folds. Below is reported an old women experiencing pmntic pupules for a long period.CASE REPORT An 82-year-old woman had had pruritic papules on her entire body for 4 years. Her medical history included hypertension eontrolled with cilnidipine. On examination, there were numerous red-brown lichenoid papules on her trunk and extremities. The papules tended to aggregate or coalesce to form diffuse erythematous plaques with sparing flexors, mimicking papuloerythroderma (Fig. 1 ). Laboratory data revealed elevated levels of blood eosinophils (1204/(il) and lactate dehydrogenase (354 U/1), but no other abnormal findings. Histologically, lichenoid papules showed irregular acanthosis with hyperkeratosis. There was a cellular inftltrate comprising lymphocytes and eosinophils in the upper dermis (Fig. 2). Extensive examinations, including serum tumour markers, eomputed tomography and fiberscope Fig. I Clinical features of skin lesions. (A) Numerous lichenoid papules were dislributed on the trunk. (B) Eruptions spared popliteal fossa.Fig. 2. Clinical and histological manifestations of lichenoid papules. (A) Polygonal, red, solid papules on the arms. (B) Papules showed parakeratotic hyperkeratosis and aeanthosis with dermal cellular infiltrates. (Haematoxylin and eosin staining, original magnification x 100).examination of the gastrointestinal tract, did not reveal any evidence of internal malignancy. The condition had been resistant to topical corticosteroids prior to adtnission, but the skin lesions improved after external application of petrolatum and without cessation of cilnidipine. Lymphocyte stimulation test and patch-testing for cilnidipine (10% and 20% in petrolatum) were negative. She did not have a history of allergic reactions to metals. However, patch-testing for metals revealed positive Acta Derm Venereol 90

Nickel Sensitization and Dietary Nickel are a Substantial Cause of Symptoms Provocation in Patients with Chronic Allergic-Like Dermatitis Syndromes

“…12 – 15 The flare-up of healing or quiescent contact dermatitis is the most frequent reaction, but pompholix, dyshidrosic or vescicular eczema, toxicoderma-like rash, chronic pruritus, maculo-papular rash, vasculitis-like lesions, flexural dermatitis, papuloerythroderma-like eruptions, chronic urticaria, pseudo-atopic dermatitis, generalized rash, and baboon syndrome are several clinical variants within the spectrum of systemically induced allergic contact dermatitis (ACD). 1 – 21 SCD should be considered as an “umbrella term,” which includes a broad spectrum of clinical manifestations that can occur when a person sensitized to a contact allergen is exposed to the same allergen through a systemic route.…”