0
ALLERGIC
CONTACT DERMATITIS (ACD)
INTRODUCTION
• Von Pirquet (1906) - Gk: ‘Allos’ = Other ; ‘Ergon’ – Work
• 1840 - Dakin  Dermatitis Venenata / Rhus derma...
DEFINITION
• type of contact dermatitis
• Delayed cell-mediated HSN

• manifestation of an allergic response
• contact wit...
EPIDEMIOLOGY
• 3700 documented allergens
• Children > Adults
• Females > Males ? Ni ? Fragnance Mix

• Males : 10-19 % Occ...
ETIOPATHOGENESIS
• Type IV HSN
• T-cell mediated Inflammation to Haptens
• Genetic Susceptibility  HLA alleles to Co / Ni...
PATHOGENESIS
• AA
CLINICAL FEATURES
• A
• ACUTE : pruritic papules and vesicles on an
erythematous base Erosions , crusting
• Edema in areas of higher absorption...
REGIONAL DISTRIBUTION
ACUTE ACD

10
ACUTE ACD

11
CHR ACD

12
VARIANTS
• Mucosae - Contact Aphthae / Lingual erosions /
Peri-anal dermatitis ; more in Geriatric group 
Poor hygeine , ...
• Eythroderma / Exfoliative Dermatitis
• EM – Ni / Poison Ivy / Hair dye / Neomycin
• Non-Eczematous : Contact Purpura / C...
• Systemic Eczematization (Immunological
Memory + Secondary Systemic Exposure)
• ACD SYNDROME
DDx
• aa
DDx
• a
DIAGNOSIS
• DETAILED HISTORY
• CLINICAL EXAM / REGIONAL ALGORITHM

• PATCH TESTING +/- ROAT
• SPOT TESTS (DIMETHYLGLOXAMIN...
PATCH TESTING (IN-VIVO)
• ISS (Indian Standard Series)

• TRUE (Thin-layer Rapid Use ; Epicutaneous)
• Other Series (Plant...
INTERPRETATION
• − (0) Negative reaction
• ?+ Doubtful reaction; erythema only
• + (1+) Weak (nonvesicular) positive aller...
PATCH TESTING (IN-VITRO)
• LEUKOCYTE TRANSFORMATION INHIBITION
• MACROPHAGE MIGRATION INHIBITION

• LYMPH NODE ASSAY
HPE
• Spongiosis
• Eosinophillic Folliculitis

• Microvesicle formation
• Perivascular infiltrate in
Dermis ; granuloma fo...
MANAGEMENT
• PHARMACOTHERAPY
– Aluminium Sulfate / Calcium Acetate
– Emollients
– Topical Antipruritic agents
– Antihistam...
PHOTOTHERAPY
P-UVA
NBUVB
PREVENTION

?? HYPOSENSITIZATION / TOLERANCE INDUCTION
THANK YOU
Acd by aseem
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Transcript of "Acd by aseem"

  1. 1. ALLERGIC CONTACT DERMATITIS (ACD)
  2. 2. INTRODUCTION • Von Pirquet (1906) - Gk: ‘Allos’ = Other ; ‘Ergon’ – Work • 1840 - Dakin  Dermatitis Venenata / Rhus dermatitis • Bloch / Steiner-Worlich  Allergic Sensitization of skin (Primula sp) • Haxthausen (1942)  ‘Allergy stems from within’ • Landsteiner / Chase (1949)  hypersensitivity reaction to HAPTENS Cell-mediated • Staedler (1847) – Blotting paper patch test ; modified by Jadassohn – Dermatitis Medicamentosa
  3. 3. DEFINITION • type of contact dermatitis • Delayed cell-mediated HSN • manifestation of an allergic response • contact with an exogenous substance • previous sensitization
  4. 4. EPIDEMIOLOGY • 3700 documented allergens • Children > Adults • Females > Males ? Ni ? Fragnance Mix • Males : 10-19 % Occupational (44% - Hand Dermatitis)
  5. 5. ETIOPATHOGENESIS • Type IV HSN • T-cell mediated Inflammation to Haptens • Genetic Susceptibility  HLA alleles to Co / Ni / Cr • Sensitization (Induction) – Elicitation – Resolution • Hapten + Epidermal Carrier Protein (LC) = Contact Allergen • Contact Allergen conjugate recognized by LC  Presented to T-cells • Internalized to LNs  LCs differentiate into DCs
  6. 6. PATHOGENESIS • AA
  7. 7. CLINICAL FEATURES • A
  8. 8. • ACUTE : pruritic papules and vesicles on an erythematous base Erosions , crusting • Edema in areas of higher absorption coefficient – Mucosae / Eyelids / Genitals • CHRONIC : Lichenified pruritic plaques , scaling • Initial Site localization – causal
  9. 9. REGIONAL DISTRIBUTION
  10. 10. ACUTE ACD 10
  11. 11. ACUTE ACD 11
  12. 12. CHR ACD 12
  13. 13. VARIANTS • Mucosae - Contact Aphthae / Lingual erosions / Peri-anal dermatitis ; more in Geriatric group  Poor hygeine , incontinence , mucosal dryness • PARADOXICAL ACD Weak allergens Contact / Damaged Epidermis Gold on Metal Oxides Paraben / Lanolin Eczema Topical Corticosteroids
  14. 14. • Eythroderma / Exfoliative Dermatitis • EM – Ni / Poison Ivy / Hair dye / Neomycin • Non-Eczematous : Contact Purpura / Contact Leucoderma / Lichenoid AC Reactions / Erythema Dyschromia Perstans • Allergic Contact Urticaria (ACU) – IgE ; Latex Rubber / Colophony / Bacitracin
  15. 15. • Systemic Eczematization (Immunological Memory + Secondary Systemic Exposure) • ACD SYNDROME
  16. 16. DDx • aa
  17. 17. DDx • a
  18. 18. DIAGNOSIS • DETAILED HISTORY • CLINICAL EXAM / REGIONAL ALGORITHM • PATCH TESTING +/- ROAT • SPOT TESTS (DIMETHYLGLOXAMINE TEST) • HISTOPATHOLOGY
  19. 19. PATCH TESTING (IN-VIVO) • ISS (Indian Standard Series) • TRUE (Thin-layer Rapid Use ; Epicutaneous) • Other Series (Plant / Food / Vegetable / Fragnance / Cosmetic / Textile) ‘Gold Standard’
  20. 20. INTERPRETATION • − (0) Negative reaction • ?+ Doubtful reaction; erythema only • + (1+) Weak (nonvesicular) positive allergic reaction; erythema, infiltration and possibly papules • ++ (2+) Strong (vesicular) positive allergic reaction; erythema, infiltration, papules and vesicles • +++ (3+) Extreme positive allergic reaction; bullous reaction • IR Irritant reaction
  21. 21. PATCH TESTING (IN-VITRO) • LEUKOCYTE TRANSFORMATION INHIBITION • MACROPHAGE MIGRATION INHIBITION • LYMPH NODE ASSAY
  22. 22. HPE • Spongiosis • Eosinophillic Folliculitis • Microvesicle formation • Perivascular infiltrate in Dermis ; granuloma formation noted
  23. 23. MANAGEMENT • PHARMACOTHERAPY – Aluminium Sulfate / Calcium Acetate – Emollients – Topical Antipruritic agents – Antihistaminics – Corticosteroids (topical / Oral) – Calcineurin Inhibitors (topical / Oral)
  24. 24. PHOTOTHERAPY P-UVA NBUVB PREVENTION ?? HYPOSENSITIZATION / TOLERANCE INDUCTION
  25. 25. THANK YOU
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