Chandler W. Rundle

Contact dermatitis considerations in atopic dermatitis

Complex immunologic pathways, influenced by both genetic and environment triggers, contribute to the development of atopic dermatitis and allergic contact dermatitis. Suppressing mechanisms between the Th1-driven allergic contact dermatitis and the Th2-driven atopic dermatitis conditions were thought to reduce the simultaneous expression of both; however, recent evidence indicates that pediatric patients with atopic dermatitis are likely to develop clinically relevant positive patch tests and more likely to react to specific allergens, such as lanolin. We review the potential role of skin barrier defects, such as filaggrin mutations and impaired barrier function, including aberrancies in epidermal pH buffering capabilities, which may promote bacterial biofilms and create an environment favoring sensitization.

Metal Allergy in Children

Metals are significant provocateurs of allergic contact dermatitis in children. Skin barrier defects due to filaggrin gene mutations confer an increased risk of expression of atopic dermatitis, a potential for increased absorption of metals across a defective barrier, and a risk for contact sensitization to metals, particularly nickel. This chapter discusses the complex interplay of environmental and intrinsic factors with respect to metal contact sensitization in children.

Chelation Therapy for Nickel Allergy

ABSTRACT By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this column is to focus on some of the more common drugs used in dermatology, specifically their mechanism of action, how they are utilized, and routine alternatives (if available). This article revisits the history of chelation therapy for nickel allergy; discusses its role in dermatology with an emphasis on the mechanism of action, adverse effects, and how it compares with alternative treatment options; and highlights the future implications in medical therapy.

Nickel release and surveying in surgical clip alopecia

We read with interest the article by Ono et al. in which a woman experienced onset of redness, itching, and focal hair loss 3 weeks after clipping surgery of her cerebral aneurysm.[3] It was noted that the four metal pins of the Sugita head holder contain allergens such as cobalt, nickel, chromium, and mercury. It was later determined that the woman had a history of contact dermatitis to metal jewelry, supporting the nickel in the etiology.

Low Nickel Diet: A Patient-Centered Review

Nickel allergic contact dermatitis (ACD) has become a more widely recognized disease process over the last three decades in the United States. A subpopulation of ACD patients will manifest with systemic contact dermatitis (SCD). Specifically, those cases of widespread recalcitrant nickel ACD with only partial clinical relief after strict nickel avoidance, suggest SCD. Evidence indicates that application of the low nickel diet has the highest efficacy in patients with SCD, and that a targeted, points-based approach is most meaningful. Furthermore, as the immunologic pathways of how oral nickel provokes cutaneous dermatitis are complex, involving interplay between the Th2 and Th1 response, more specific investigative work in this area is much needed.