Contact Dermatitis Due to Gold in Some People

[Guest guest]

Hi,

I found this interesting article in the e-Skin and Allergy Feb. 2002

online issue. It discusses and rates the different types of patch

tests available for patients.

Take care,

Matija

Gold allergy more common than realized

Contact Dermatitis: What's New and Notable

Winnie Anne Imperio

Senior Writer

NEW YORK — Gold is a more common allergen than previously recognized,

according to a recent study of more than 4,000 patients, Dr.

R. Cohen said at a dermatology symposium sponsored by Mount Sinai

School of Medicine.

Dr. Cohen, deputy chair and professor of dermatology at the school,

highlighted the following studies as new and interesting observations

in contact dermatitis:

Gold allergy. Among 4,101 patients subjected to patch testing by the

North American Contact Dermatitis Group, an unexpected 9.5% had a

positive test result to gold sodium thiosulfate (Am. J. Contact

Dermat. 12[1]:3-5, 2001). Gold ranks only sixth among the most common

allergens. Women accounted for 90.2% of patients positive to gold but

for only 62.8% of the subjects tested.

The most common sites of allergic dermatitis due to gold were the

hands (29.6%), face (19.3%), and eyelids (7.5%). Think of gold

allergy as a possible cause for an unexplained facial dermatitis, Dr.

Cohen advised.

Patch testing. Reactions to fragrances, rubber accelerators,

formaldehyde, and pesticides containing carbamates and thiurams may

be missed using the T.R.U.E. (thin-layer rapid use epicutaneous)

test, according to a study of 167 patients.

It's astonishing that despite all the advances in science and

technology, patch testing is the only objective method to validate

the diagnosis of contact dermatitis, Dr. Cohen said.

Patients were patch tested using both the T.R.U.E. test and the Finn

chamber test, which was superior in detecting clinically relevant

allergies to fragrance mix, balsam of Peru, and thiuram mix. The

T.R.U.E. test performed somewhat better than the Finn chamber test in

detecting relevant allergic reactions to nickel, neomycin,

methylchloroisothiazolinone, and methylisothiazolinone.

Both methods were inadequate in detecting relevant allergies to

formaldehyde and carbamates (J. Am. Acad. Dermatol. 45[6]:836-39,

2001).

Occupational causes. Contact dermatitis accounts for the vast

majority (about 86%) of occupational skin disorders.

In a study of 2,889 patients evaluated for contact dermatitis, 839

had an occupational skin disease. Of those, 455 had an allergic

reaction and 270 had an irritant reaction (Am. J. Contact Dermat. 12

[2]:72-76, 2001).

Occupational contact dermatitis was most commonly found in health

care workers and those in manufacturing trades.

The authors noted that nursing personnel may be overrepresented in

the study due to their proximity to patch test clinics.

The most common allergens were thiuram, carbamates, epoxy, and

ethylenediamine, Dr. Cohen said. If contact dermatitis is suspected

to be workplace related, use the following criteria from the Centers

for Disease Control and Prevention to make a report to the workers'

compensation board.

The presence of four of the seven criteria will establish

occupational causation and aggravation: clinical appearance

consistent with contact dermatitis; workplace exposure to potential

skin irritants or allergens; anatomic distribution of dermatitis

consistent with job-related exposure; temporal relationship between

exposure and onset of the dermatitis; exclusion of nonoccupational

exposures; improvement of the dermatitis away from workplace and

exacerbation in the workplace; and identification of a probable

causative agent through patch or provocation tests.