Tammaro Antonella, Magri Francesca, Pigliacelli Flavia, Gelormini Enza, Parisella Francesca Romana, Chello Camilla, Persechino Severino
Prof. Antonella Tammaro, MD, Sant'Andrea Hospital Sanienza University of Rome, via di Grottarossa 1089, 00100 Roma, Italy;
Acta Dermatovenerol Croat. 2018 Dec;26(4):339-340.
Dear Editor, Nickel is a ubiquitous allergen and an important cause of allergic contact dermatitis (ACD). Sensitized patients generally develop a localized eruption after cutaneous exposure to nickel, characterized by erythema, vesicles, eczematous plaques, and itching. Nickel is frequently found in several everyday objects. It is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life (1). This metal may be found in a wide variety of items, such as jewelry, belt buckles, buttons, glasses, coins, and keys. More recently, items such as mobile phones, laptop computers, video game controllers, and other technological accessories have also been identified as a source of nickel. The use of mobile phones has risen exponentially in recent decades. Nickel has been detected in cell phones, and reports of contact dermatitis due to metals contained in cell phones are present in the literature (2,3). Allergic contact dermatitis to a mobile phone was first described in 2000, when Pazzaglia et al. reported two cases of nickel allergy due to mobile phone use (4). In addition to nickel, cobalt, which is frequently used in hard metal alloys and observed to be present in mobile phones, is a frequent cause of allergic contact dermatitis (5). Herein we present a case of allergic contact dermatitis, possibly caused by the use of a mobile phone. A 38-year-old woman was admitted to our Department of Dermatology for the presence of a pruritic eczematous solitary lesion on the face. At physical investigation, we observed the presence of confluent erythematous and squamous plaques localized at the pre-auricular and auricular region of the left ear. These lesions varied in size from 1 to 4 cm (Figure 1). As reported by the patient, the symptoms had been present for 6 months. No other cutaneous diseases or photodermatoses were reported. As reported by the patient during the anamnestic interview, she worked as a manager for a big commercial company and used to spend many hours per day using her cell phone. She had a familiar history of atopic dermatitis and a personal history of metal allergy. A patch test SIDAPA series was performed (Table 1). After 48 hours, the patch was removed and a preliminary reading of the skin was done. The final reading was performed after 72 hours from the patch application. The test was positive for nickel sulfate (++ after 48 hours and +++ after 72 hours) and for cobalt chloride (+ after 48 hours and ++ after 72 hours). We also performed a patch test Metal series (Table 2), which was negative at 48 and 72 hours. Based on the patch test results and the information revealed by the patient, we hypothesized a triggering role of the cell phone to the onset of the pre-auricular dermatitis. This hypothesis stems from the literature regarding cases of dermatitis due to allergenic metals contained in cell phones. Oral antihistamines and topical steroids were prescribed to treat the eczematous plaques. After one week of therapy, a partial improvement of the skin condition was observed. In line with our hypothesis of a causal role of the cell phone, our patient's dermatitis completely disappeared when her usual auricular contact with her mobile phone was avoided. Following our suggestion, the patient started to use the speakerphone when needed. Six months later, she had a complete remission of the cutaneous lesions and did not present recurrences of the auricular dermatitis. Dermatologists should be aware that mobile phone dermatitis is an emerging phenomenon, especially among young adults and adolescents. Despite efforts to control the presence of allergen metals in phones, many phones present levels of metals such as nickel and cobalt, known to induce allergic contact dermatitis. In conclusion, it is important to suspect this diagnosis in case of patients with dermatitis of the face, neck, hands, or auricular region, especially when the lesions are unilateral. Patch test for common metal allergens may be helpful for diagnosis.
尊敬的编辑，镍是一种普遍存在的过敏原，是过敏性接触性皮炎（ACD）的重要病因。致敏患者在皮肤接触镍后通常会出现局部皮疹，其特征为红斑、水疱、湿疹样斑块和瘙痒。镍常见于多种日常用品中。它被用于众多工业和消费品，包括不锈钢、磁铁、金属镀层、硬币和特殊合金，因此在日常生活中几乎不可能完全避免接触（1）。这种金属可能存在于各种各样的物品中，如珠宝、皮带扣、纽扣、眼镜、硬币和钥匙。最近，手机、笔记本电脑、视频游戏控制器和其他科技配件等物品也被确定为镍的来源。近几十年来，手机的使用呈指数级增长。已在手机中检测到镍，文献中也有因手机所含金属导致接触性皮炎的报道（2,3）。2000年首次描述了因手机导致的过敏性接触性皮炎，当时帕扎利亚等人报告了两例因使用手机导致镍过敏的病例（4）。除镍外，常用于硬质合金且在手机中也有发现的钴，也是过敏性接触性皮炎的常见病因（5）。在此，我们报告一例可能由使用手机引起的过敏性接触性皮炎病例。一名38岁女性因面部出现瘙痒性湿疹样孤立性皮损入住我们皮肤科。体格检查时，我们观察到左耳耳前和耳部区域存在融合性红斑和鳞屑性斑块。这些皮损大小从1厘米到4厘米不等（图1）。据患者报告，症状已出现6个月。未报告其他皮肤疾病或光皮肤病。据患者在病史询问中所述，她是一家大型商业公司的经理，每天通常会花很多时间使用手机。她有特应性皮炎家族史和金属过敏个人史。进行了SIDAPA系列斑贴试验（表1）。48小时后取下贴片，并对皮肤进行初步读数。在贴片应用72小时后进行最终读数。硫酸镍试验呈阳性（48小时后为++，72小时后为+++），氯化钴试验也呈阳性（48小时后为+，72小时后为++）。我们还进行了金属系列斑贴试验（表2），在48小时和72小时时均为阴性。根据斑贴试验结果和患者提供的信息，我们推测手机对耳前皮炎的发生起到了触发作用。这一假设源于关于手机中含致敏金属导致皮炎病例的文献。开具了口服抗组胺药和外用类固醇药物来治疗湿疹样斑块。治疗一周后，观察到皮肤状况有部分改善。与我们关于手机起因果作用的假设一致，当患者避免左耳与手机的日常接触时，其皮炎完全消失。按照我们的建议，患者在需要时开始使用免提功能。六个月后，她的皮肤损害完全缓解，耳部皮炎未再复发。皮肤科医生应意识到手机性皮炎是一种新兴现象，尤其是在年轻人和青少年中。尽管已努力控制手机中过敏原金属的含量，但许多手机中仍存在已知会诱发过敏性接触性皮炎的镍和钴等金属。总之，对于面部、颈部、手部或耳部区域出现皮炎的患者，尤其是皮损为单侧时，怀疑这一诊断很重要。对常见金属过敏原进行斑贴试验可能有助于诊断。
