Ole B. Christensen

External and internal exposure to the antigen in the hand eczema of nickel allergy

A provocation study was performed in twelve female patients with contact allergy to nickel and hand eczema of the pompholyx type. Intense handling of nickel‐contaminated metal objects did not induce any visible eczematous activity. Oral administration of nickel in a double‐blind test provoked an aggravation of the hand eczema in nine of the twelve patients, and in seven of the patients this was accompanied by secondary eruptions including outbreaks of earlier, healed eczema. The nickel dose given is probably in the upper limit of the presently known daily intake of the metal, but should be considered to be within the physiologic range. It is concluded that ingestion of small amounts of nickel may be of greater importance in maintaining the hand eczema than external contacts with the metal.

Individual variation in nickel patch test reactivity

BACKGROUND AND OBJECTIVE Various factors such as hormones, drugs, and ultraviolet (UV) radiation may influence patch test reactions. The aim was to study the individual variation in nickel reactivity, also in relation to the menstrual cycle. METHODS Thirty women allergic to nickel were studied for 7 months with patch tests with a serial dilution of nickel sulfate in water on four different test occasions. The patients belonged to two different eczema groups, one with nickel allergy, atopy, and pompholyx (12 patients); and the other with nickel allergy, but without both atopy and hand eczema. RESULTS None of the patients showed the same patch test reactivity on all four occasions, and the highest individual difference noticed was 250 times for the four test occasions. Furthermore, two of the patients had completely negative test reactions on at least one test occasion. CONCLUSION The variation in nickel reactivity as shown in this article is of great importance and should be kept in mind when a patient has a positive history of allergic contact dermatitis but negative patch test results to nickel.

Nickel allergy and hand eczema

A clinical study was performed in 66 female patients with hand eczema and contact allergy to nickel. They were drawn from a basic material of 165 patients with nickel allergy in which hand eczema occurred in 86 cases (52 %). The hand eczema started at an average age of 32 years and ii had been preceded by a metal hypersensitivity for an average of 6 years. The eczema was found to the chronic with a mean duration up to the time of examination of 8 years. It was associated with secondary eruptions in half of the cases. The hand eczema showed a low degree of relevance with regard to dependance of occupation or vacation, as well as to exacerbation of the dermatitis after a direct contact with nickel‐coated objects. The clinical examination disclosed in 77 % a pompholyx, i.e. a symmetric vesicular eruption mainly located on the palms and volar aspects of fingers, and sides of fingers. The eczema often showed a periodic activity, with about 15 annual eruptions in the pompholyx cases. It is concluded that simple external contact with the metal can hardly explain the most common clinical pattern of the hand eczema in nickel allergy.

The significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel

Several factors, such as amount of allergen, vehicle, anatomic site, immunologic status and previous eczema, may influence delayed hypersensitivity reactions. In an extended model, we have studied the significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel in 25 nickel‐allergic females. On 3 occasions, 8, 4 and 1 months before the final challenge patch testing, an experimental allergic contact dermatitis from nickel was induced on the lower back. At the challenge patch testing, 4 identical dilution series of nickel were tested on 4 areas on the lower back 3 with previous but healed dermatitis and I control area. The tests were read in a blind way. A significantly higher test reactivity was found at the areas with a previous allergic contact dermatitis, the shorter the time interval between the previous provocation and the challenge, the stronger the reaction. These results may be of importance for the understanding of factors contributing to chronicity of allergic contact dermatitis.

Prognosis in nickel allergy and hand eczema

63 female patients with nickel allergy and hand eczema were reinvestigated 6 years after the primary investigation. 30% of the patients were healed. Patients with the pompholyx‐type eczema had the worst prognosis. The start of hand eczema was not correlated to any particular occupation. There was a strong correlation between a history of metal sensitivity and a positive patch test reaction. High frequencies of personal and family atopy were found, and atopy made the prognosis worse. Determination of serum IgE was not found to be of any use in predicting the prognosis in patients with nickel allergy and hand eczema.

Fixed drug eruption: an immunohistochemical investigation of the acute and healing phase

Five patients were each challenged orally with a drug which had previously induced a fixed drug eruption. A positive reaction occurred in all the patients. Punch biopsies were taken 6–12 h, 24h and 3 weeks after challenge. The specimens were tested with different mouse anti‐human monoclonal antibodies to identify T lymphocytes and phenotypic subsets, natural killer cells, B lymphocytes, OKT‐6 and HLA‐DR‐positive cells. T suppressor/cytotoxic cells seemed to play a major role in initiating the flare‐up reaction and preserving the cutaneous memory function of the fixed drug eruption.

Release of nickel from cooking utensils

The release of nickel to boiling water from new and used saucepans of different material was measured. No nickel was released from aluminium, teflon and enamel. Certain amounts of nickel were released from stainless steel, but only al acid pH.

Treatment with disulfiram in chronic nickel hand dermatitis

Eleven patients with nickel allergy and hand eczema of the pompholyx type were treated with disulfiram 200 mg daily for 8 weeks. 2 patients healed and 8 improved considerably. Mild relapses were observed in all patients within 2–16 weeks after discontinuation of treatment. Liver enzymes should be carefully monitored during disulfiram therapy.

Natural history of dermatitis herpetiformis in southern Sweden.

A retrospective clinical survey of 96 patients with dermatitis herpetiformis (DH) was performed in two defined populations of 425,000 in southern Sweden. The incidence of DH was 1.05-1.13/100,000 inhabitants/year and the prevalence was approximately 20-25/100,000 inhabitants. In one-third of DH patients the age at onset was greater than 60 years. In women with DH a strong connection to thyroid dysfunction was observed, but also other conditions of probable autoimmune pathogenesis were found in both sexes. No connection to malignant disease was observed. DH seems to be less active the later in life it starts. Several patients with DH manage without dapsone or need dapsone just occasionally in connection with bouts. This is the case even without a gluten-free diet. Many mild cases of DH were observed without a gluten-free diet; therefore, this restricting regimen should be prescribed only in more active cases of DH.

Treatment of chronic hand eczema with UV-B Handylux® in the clinic and at home

The efficacy of UV‐B irradiation, administered by a new unit, Handylux®, in patients with chronic hand eczema was investigated. 15 patients were treated in the clinic and 11 patients at home. Treatments were performed 4–5 × weekly for approximately 10 weeks. According to the strict criteria used for clearing, none of the patients cleared during the study, but 18 of the 26 patients were defined as much improved by the investigator, while 17 of the patients considered themselves as > 80% improved. The compliance in both groups was very good and side‐effects limited and dose‐related. According to our experience, the effect of high dose UV‐B in chronic hand eczema is almost comparable to PUVA, and offers an opportunity for patients to treat themselves at home.