Srinivasan N*, Desai G**, Hatkar P***.
(* Junior resident, ** Assistant Professor, *** Associate Professor, Department of Obstetrics & Gynecology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, India).
Allergic contact dermatitis is a variety of dermatitis or eczematous reaction caused by an allergen when it comes in contact with skin. The allergen otherwise does not cause any harm to people who are not allergic to it. We present a case of a young post operative woman developing allergic contact dermatitis to adhesive surgical dressing.
Allergic contact dermatitis is common skin condition amongst general population. Women are more likely to suffer from allergic contact dermatitis. Most common ones are due to nickel and acrylate allergy. Allergic contact dermatitis is a common occupational disease especially seen in metal workers, hair dressers, beauticians, health care workers, painters and flower decorators. Patients with improper first line defence of immunity like leg ulcers, perianal dermatitis, chronic irritant contact dermatitis, systemic illnesses like diabetes, autoimmune diseases are more prone to develop allergic contact dermatitis.
Allergic contact dermatitis is also seen in people suffering from atopic dermatitis as they lack filaggrin, a structural protein in stratum corneum.
A 22 year old primipara on day 3 of emergency cesarean delivery presented with multiple, well demarcated, reddish maculo-papular vesicles filled with clear transparent fluid and plaques with skin excoriations and fine scaling on the dorsum of her left hand and similar lesions in the lower abdomen, which were the sites of application of adhesive surgical dressings of intravenous access and cesarean wound respectively. The shape of areas of distribution of such lesions corresponded exactly to the shape of the adhesive dressing used. The lesions were intensely pruritic. Multiple such skin excoriations were found on the face and elbows. She gives past history of generalized reddish skin eruptions that cropped up suddenly 2 years back, but there was no history of any treatment or medications taken for the same.
Dermatology opinion was sort. A diagnosis of allergic contact dermatitis to adhesive surgical dressing was made. Aseptic puncturing and aspiration of fluid from the bigger vesicles was advised. She was started on topical fluocinolone acetonide and mupirocin ointments, tablet levocetrizine OD, and augmented betamethasone dipropionate scalp solution. Avoidance of adhesive surgical dressing was advised. She was encouraged to wear loose fitting clothes of 100% natural fabrics, and to wash her clothes multiple times prior to use.
Allergic contact dermatitis is a type 4 hypersensitivity reaction or delayed hypersensitivity that is caused by an allergen when it comes in contact with skin. It manifests 48-72 hours after exposure to the allergen. It is mediated by CD4+ T lymphocytes which recognize the antigen on skin surface and respond by releasing cytokines that stimulate the immune system and cause allergic reaction. Allergic contact dermatitis on histopathology shows psoriasiform epidermal hyperplasia with spongiosis and parakeratosis with perivasular lymphocytic infiltration. Microscopic evaluation of the lesions in our case was not necessary as a confirmatory diagnosis was made on its gross appearance itself.
Allergic contact dermatitis is treated usually by glucocorticoids, avoidance of offending allergen sources. Prognosis is dependent on patient education, compliance in avoiding allergens and appropriate skin care.
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Srinivasan N, Desai G, Hatkar P. Surgical Adhesive Dressing induced Allergic Contact Dermatitis. JPGO 2019. Vol 6 No. 5. Available from: https://www.jpgo.org/2019/05/remembering-past-greats-ingemar.html