RESUMO
BACKGROUND: Dyshidrotic eczema is a type of chronic intermittent dermatitis characterized by vesicles, dystrophic fingernail changes, and rarely bullae that affects the hands and feet. Many exogenous factors may trigger a flare including dermatophyte infections, contact irritants, and metal hypersensitivity. Although metal hypersensitivity does not play a role in all cases of dyshidrotic eczema, high oral ingestion of nickel and/or cobalt should be considered, regardless of patch test results. OBJECTIVE: We updated and simplified existing published guidelines for low-cobalt diets. A recent review of the literature showed that dietary cobalt restriction, a safe yet burdensome treatment option for dyshidrosis, is referenced to dated sources. METHODS: We have analysed current data for the cobalt content in common food items. CONCLUSION: We propose a revised, point-based diet that will eliminate much of the dietary cobalt (and nickel) and reduce dyshidrotic eczema flares.
Assuntos
Cobalto/toxicidade , Eczema Disidrótico/dietoterapia , Eczema Disidrótico/etiologia , Hipersensibilidade Alimentar/dietoterapia , Hipersensibilidade Alimentar/etiologia , Guias de Prática Clínica como Assunto , Dieta , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Níquel/toxicidade , Fenômenos Fisiológicos da Nutrição , Estados UnidosAssuntos
Humanos , Adulto , Dermatite Atópica/etiologia , Dermatite de Contato/etiologia , Eczema Disidrótico , Ceratodermia Palmar e Plantar , Níquel/efeitos adversos , Prurido/etiologia , Eczema Disidrótico/classificação , Eczema Disidrótico/dietoterapia , Eczema Disidrótico/etiologia , Eczema Disidrótico/fisiopatologia , Glândulas Sudoríparas/fisiologia , Hiperidrose/fisiopatologia , Penfigoide Bolhoso/patologia , Piroxicam/efeitos adversos , Estresse Psicológico , Estações do AnoRESUMO
In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low-nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low-nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous "pores". This phenomenon was greatest after DSCG. We suggest that DSCG can help selected cases of pompholyx.
