Nail varnish is a potential allergen in nickel allergic subjects
Nail varnish is a potential allergen in nickel allergic subjects
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指甲油是镍过敏受试者的潜在过敏原
DOI：
10.1111/j.1365-2230.2004.01563.x
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发表时间：
2004
影响因子：
4.1
通讯作者：
P. Goldsmith
中科院分区：
文献类型：
--
作者：
B. Shergill;P. Goldsmith
确定阳性斑贴反应的临床相关性至关重要，也可能是一项挑战。我们的病人是一位26岁的家庭主妇，患有严重的特应性皮炎，她有2年的面部湿疹恶化史。她接受了标准的欧洲、面部和光敏剂系列过敏原斑贴试验。第2天，她对镍和甲苯磺酰胺甲醛树脂（指甲油的一种成分）呈强阳性反应。10多年来，她一直对镍过敏，避免佩戴18 K金以外的珠宝;然而，她强烈否认曾经涂过指甲油。第4天，没有进一步的阳性斑贴试验反应，但她的脸两侧与眼镜框臂相对应的地方出现了新的对称性流泪性皮炎斑（图1）。在进一步检查她的眼镜（图2）时，我们注意到她眼镜的金属臂上有一个苍白的残留物。在面对她的这一点，她承认，她用了6个月的透明指甲油涂层的武器框架是旧的和缺口，并已造成刺激。眼镜架两臂的丁二酮肟试验（镍斑试验）呈阳性。诊断为特应性皮炎伴变应性接触性皮炎，对镍和甲苯磺酰胺甲醛树脂有再活化反应。当她买了塑料框架的镜片后，她脸上的湿疹大大改善了。这个案例说明了补丁测试中的三个要点。首先，指甲油是镍过敏受试者的潜在过敏原。镍过敏是非常普遍的，用透明指甲油覆盖金属的做法很普遍。然而，尽管如此，还没有发表文献认为两种接触性过敏原的存在因果关系。其次，斑贴试验在治疗慢性和复发性体质性湿疹患者中具有重要作用。在特应性患者中，重要的是不要将明显的耀斑视为内源性疾病的一部分。我们的病人的面部湿疹部分是过敏性的，当她戴上新眼镜后就好了。第三，在斑贴试验期间接触性皮炎的再激活是众所周知的，并且可能对患者造成痛苦，应警告患者可能发生这种情况。最常见的罪魁祸首之一是对染发剂过敏原对苯胺二胺的阳性斑贴试验反应，这可能会引起头皮或暂时性纹身皮炎。图1涂有透明指甲油的眼镜臂，用于预防镍过敏性接触性皮炎。
Determining the clinical relevance of positive patch reactions is of fundamental importance and can be a challenge. Our patient is a 26-year-old housewife with severe atopic dermatitis, who presented with a 2-year-history of worsening eczema on her face. She underwent patch testing to the standard European, face and photosensitiser series of allergens. On day 2 she had strongly positive reactions to nickel and toluene sulphonamide formaldehyde resin, a component of nail varnish. She had suffered with her nickel allergy for more than 10 years and avoided wearing jewellery that was not 18 carat gold; however, she denied vehemently ever wearing nail polish. On day 4 there were no further positive patch test reactions but she had developed new symmetrical weeping patches of dermatitis on the sides of her face corresponding to the arms of her spectacle frames (Fig. 1). On further inspection of her glasses (Fig. 2), we noticed a pale residue on the metal arms of her glasses. On confronting her with this, she admitted that she had used clear nail varnish for 6 months to coat the arms of the frames which were old and chipped and been causing irritation. The dimethylglyoxime test (nickel spot test) was positive for both arms of the spectacle frames. A diagnosis of atopic dermatitis with allergic contact dermatitis and a reactivation reaction to nickel and toluene sulphonamide formaldehyde resin was made. When she bought plastic-framed lenses, her facial eczema greatly improved. This case illustrates three important points in patch testing. Firstly nail varnish is a potential allergen in nickel allergic subjects. Nickel allergy is extremely common and the practice of covering metal with clear nail varnish widespread. However despite this there has been no literature published where the presence of both contact allergens was thought to be causally linked. Secondly patch testing has an important role in managing patients with chronic and recurrent constitutional eczema. In atopic patients it is important not to dismiss apparent flares as being part of the endogenous condition. Our patient’s facial eczema was in part allergic in origin and settled when she got new spectacles. Thirdly reactivation of contact dermatitis during patch testing is well recognized and can be distressing to patients who should be warned that it may occur. One of the most common culprits is a positive patch test reaction to the hair dye allergen paraphenylamine diamine, which may flare a scalp or temporary tattoo dermatitis. Figure 1 Arm of spectacle with clear nail varnish applied to prevent allergic contact dermatitis to nickel.