Vigneshkarthik Natarajan, Ganguly Satyaki, Kuruvila Sheela
Junior Resident, Department of Dermatology, Venereology and Leprosy, Pondicherry Institute of Medical Sciences , Pondicherry, India .
Associate Professor, Department of Dermatology, Venereology and Leprosy, Pondicherry Institute of Medical Sciences , Pondicherry, India .
J Clin Diagn Res. 2016 Nov;10(11):WC04-WC07. doi: 10.7860/JCDR/2016/23994.8884. Epub 2016 Nov 1.
Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country.
To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing.
This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test.
Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate.
Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.
过敏性接触性皮炎是手部湿疹的一个重要病因。斑贴试验是唯一可用于确诊过敏性接触性皮炎的检查方法。接触过敏原的情况因地理、职业、经济和社会因素而异。因此，过敏性接触性皮炎的模式在世界不同地区以及同一国家的不同区域也有所不同。
借助斑贴试验研究成年手部湿疹患者过敏性接触性皮炎的病因。
这是一项横断面研究，于2013年10月至2015年6月在印度南部的一家三级医疗中心对54例手部湿疹患者进行。在详细询问包括职业暴露史在内的病史并进行详细检查后，使用印度标准系列对这些患者进行斑贴试验。48小时后去除贴片。72小时后进行再次读数。根据国际接触性皮炎研究组标准对读数进行解读并记录下来。对于连续变量，使用均值和标准差汇总数据；对于分类变量和二分变量，使用百分比汇总数据。采用Fisher精确检验进行关联性检验。
角化过度型手部湿疹是最常见的形态学类型（29%），其次是盘状湿疹。汗疱疹在有特应性病史的患者中明显更为常见。共有20例患者（37%）对总共25种过敏原斑贴试验呈阳性。镍是最常见的过敏原（11.11%），其次是对苯二胺（PPD）（7.4%）。镍（6例患者）和钴（3例患者）是女性中常见的过敏原，而重铬酸钾（3例患者）和银胶菊（2例患者）是男性中常见的过敏原。重铬酸钾过敏在泥瓦匠中明显更为常见，PPD过敏在染发剂使用者中明显更为常见。盘状手部湿疹模式在对重铬酸钾过敏的患者中较为常见。
大多数手部湿疹病例并非由过敏性接触性皮炎引起。汗疱疹患者中特应性病史较为常见。镍引起的过敏性接触性皮炎仍是手部湿疹的常见病因。
