Allergic contact dermatitis to proparacaine with subsequent cross-sensitization to tetracaine from ophthalmic preparations.

We report 2 cases of allergic contact dermatitis (ACD) to proparacaine and tetracaine. Patient 1 is an ophthalmologist with chronic finger pad dermatitis sensitized to the topical anesthetic proparacaine. Despite discontinuance of proparacaine and substitution with a patch test negative agent, tetracaine, his hand dermatitis persisted. Follow up patch testing documented that acquisition of contact allergy to tetracaine as well as thiuram had taken place. Patient 2 had a periocular eczematous dermatitis with ACD to both proparacaine and tetracaine. Cross sensitization between related topical ophthalmologic anesthetics has been suggested to be a rare occurrence. We suggest that allergic sensitization and possible cross-reaction to topical anesthetics in ophthalmologists and ophthalmologic technicians is an occupational hazard. Chronically eczematized skin might result in increased exposure to contact allergens and result in concomitant allergic sensitization. ACD to topical anesthetic agents among ophthalmologists should be recognized as a potential hazard.

Contact urticaria and anaphylaxis to the fungicide chlorothalonil.

Chlorothalonil, a common fungicide used for agricultural and horticultural purposes is capable of eliciting contact urticaria. In our patient, an anaphylactoid reaction resulted from intact skin contact to diluted chlorothalonil (0.01 percent aqueous). Our patient also experienced immediate respiratory reactions such as a tight chest and throat after entering the nursery greenhouse, without direct skin contact with chlorothalonil.

Contact dermatitis: prognosis, risk factors, and rehabilitation.

This article reviews the prognosis for irritant and allergic contact dermatitis and occupational and nonoccupational contact dermatitis. Factors adversely affecting prognosis are discussed. Rehabilitation of the patient with disabling contact dermatitis is considered. The importance of the various risk factors for contact dermatitis are reviewed.

An international survey on the prognosis of occupational contact dermatitis of the hands.

Prognosis is a crucial topic in contact dermatitis. We recently reviewed the extensive literature on the prognosis of contact dermatitis. The majority of patients in these studies had persistent dermatitis. Job changes usually did not lead to a significant improvement for most patients with occupational contact dermatitis. We performed a worldwide survey of colleagues with expertise in treating patients suffering from occupational contact dermatitis of the hands. Of 65 experts, 51 returned questionnaires for analysis. 67% of European and 29% of respondents from Sweden, Denmark, Finland, United States of America, Canada, and Mexico stated that more than 75% of workers with severe hand dermatitis required a job change. 78% of the respondents found that chromate and 57% found that nickel allergy were associated with the worst possible prognosis. 98% felt that barrier creams were no more effective than bland emollients in the prevention of hand dermatitis.

The prognosis of contact dermatitis.

This article reviews the prognosis of contact dermatitis, particularly of occupational contact dermatitis. Most studies document a poor prognosis for occupational and nonoccupational contact dermatitis. The prognoses of occupational and nonoccupational contact dermatitis, irritant contact dermatitis, and allergic contact dermatitis are similar. Only a minority of studies on the prognosis of occupational contact dermatitis have found that a job change by the affected worker leads to clearing of the dermatitis. Dermatologic and nondermatologic factors associated with a poor prognosis are discussed.

Allergic sensitization to a non-bisphenol A epoxy of the cycloaliphatic class.

This is the first report of sensitization to a cycloaliphatic epoxy. Allergic contact dermatitis occurred in an electron microscopist after exposure to the cycloaliphatic epoxy, vinyl cyclohexene diepoxide. Cycloaliphatic epoxies are not based on the diglycidyl ether of bisphenol A (DGEBA), presently the epoxy of greatest commercial usage. However, non-DGEBA epoxies are finding new applications in the semiconductor and aerospace industries and will likely gain in importance as a cause of occupational allergic dermatitis. Latex or polyvinyl chloride gloves did not protect the reported patient from percutaneous absorption and elicitation of allergic dermatitis.

Cutaneous allergy to mustard in a salad maker.

A case of allergic contact dermatitis to mustard (Brassica nigra) in a salad maker is reported. The sources of skin contact included a commercial salad cream, a vinegrette, and various members of the mustard family, Cruciferae. The Cruciferae family includes many salad vegetables and condiments which contain allergenic isothiocyanates. The extent of skin contact among salad makers and other food handlers may be significant, and sensitization to isothiocyanates from this large family of vegetables may be an important cause of food contact allergy in these individuals.