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Fitz 9th > 24 - Allergic Contact Dermatitis > Flashcards

24 - Allergic Contact Dermatitis Flashcards

1
Q

ACD accounts for _____% of new incident cases of contact dermatitis

A

20

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2
Q

Most prevalent contact allergens (retrospective study between 1996 and 2007

A

Nickel
Thimerosal
Fragrance mix

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3
Q

Y/N: Adults are more likely to develop ACD than children

A

No - equally likely

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4
Q

Increase in _____ (2) allergies with increasing age

A

Fragrance

Preservative

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5
Q

_____ sensitivity much higher among women

A

Nickel

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6
Q

Significant risk factor for the development of nickel allergy

A

Pierced ears

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7
Q

Sensitizing substance in poison ivy, poison oak, or poison sumac

A

Uroshiol

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8
Q

Key symptom for ACD

A

Pruritus

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9
Q

Type of ACD that occurs at the periphery of allergen application; linked primarily to exotic woods and topical medicaments

A

Erythema multiforme-like ACD

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10
Q

Type of ACD mainly described in Asian-ethnicity populations

A

Pigmented ACD

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11
Q

Type of ACD mainly observed on the lower legs and/or feet; associated with rubber and textile dyes

A

Purpuric ACD

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12
Q

Type of ACD based only on histopathologic criteria

A

Lymphomatoid ACD

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13
Q

Lymphomatoid ACD: presence of significant dermal infiltrate displaying features of

A

Pseudolymphoma

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14
Q

ACD hypersensitivity reaction

A

Cell-mediated (type IV) delayed hypersensitivity

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15
Q

Phases in the development of ACD

A
  1. Sensitization

2. Elicitation

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16
Q

Pigmented ACD also known as

A

Riehl melanosis

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17
Q

Unprocessed allergens which are typically small, lipophilic molecules with a low molecular weight (<500 daltons)

A

Haptens

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18
Q

Complete antigen is made up of

A

Hapten-protein complex

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19
Q

Hapten penetrates the skin and binds with

A

Epidermal carrier proteins

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20
Q

Sensitization phase generally lasts

A

10-15 days

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21
Q

Primary cells responsible for contact sensitization

A

CD1a+/CD141+ dermal dendritic cells

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22
Q

Most important population of cells in allergic sensitization

A

Th1/Tc1 subset

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23
Q

ACD phase that corresponds to clinical disease

A

Elicitation phase

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24
Q

Antigen-specific effector T cells containing their target antigen interact with antigen-presenting cells and cluster around postcapillary venukes

A

Inducible skin-associated lymphoid tissue

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25
Q

Diagnostic algorithm for ACD (2)

A
  1. Topographic approach

2. Allergen-specific approach

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26
Q

Single most important clue to the diagnosis of ACD

A

Dermatitis distribution

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27
Q

Topographic approach does not hold in (2)

A

Ectopic ACD

Airborne ACD

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28
Q

One of the most potent sensitizers known and widely used as an ingredient in hair dyes

A

Para-phenylenediamine

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29
Q

Chemical substance used in permanent wave solutions

A

Glyceryl monothioglycolate

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30
Q

Most women allergen accounting for isolated eye dermatitis (2007 NACDG analysis)

A

Gold

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31
Q

_____ of patients with isolated cheilitis - without other areas of dermatitis - are typically found to have an allergen as a contributing factor

A

1/3

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32
Q

Most common cause of contact allergy in patch-tested patients with cheilitis

A

Fragrance mix

Balsam of Peru

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33
Q

Repeated application of fragrances to the anterior neck may result in the appearance of a dermatitic plaque on the neck which has been coined the

A

Atomizer sign

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34
Q

Y/N: ACD of the axillae does not spare the axillary vault

A

No - relative sparing of axillary vault

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35
Q

80% of occupational skin disease

A

Hand dermatitis

36
Q

Scattered generalized distribution is defined as (2)

A

Involvement of more than 3 body sites or

Involvement of 3 body sites if the sites are the trunk, arms, and legs

37
Q

Higher incidence of scattered generalized distribution in (2)

A

Males

History of atopic dermatitis

38
Q

Systemic contact dermatitis in which erythema of the buttocks and upper thighs are seen

A

Baboon syndrome

39
Q

Dietary _____ (2) are associated with dyshidrosiform hand eczema

A

Nickel

Balsam of Peru

40
Q

Potential cross-reactors with balsam of Peru

A

Tomatoes, citrus peel/zest, chocolate, ice cream, wine, beer, dark-colored sodas, spices such as cinnamon, cloves, curry and vanilla

41
Q

ACD syndrome stage 1

A

Localized ACD

42
Q

ACD syndrome stage 2

A

Regional dissemination of ACD

43
Q

ACD syndrome stage 3A

A

Generalized or distant involvement of ACD

44
Q

ACD syndrome stage 3B

A

Systemic exposure resulting in systemic contact dermatitis

45
Q

Most common cause of ACD

A

Metals

46
Q

Most frequently patch test-positive allergen worldwide

A

Nickel

47
Q

Spot test for nickel

A

Dimethylgloxime

48
Q

Added to other metals to increase the overall strength of an alloy; used in ceramics, paints, and tattoos to impart a blue color

A

Cobalt

49
Q

Irritant effect from a deposition of cobalt within eccrine glands

A

Pseudopurpuric appearance

50
Q

Sport test for cobalt

A

2-nitroso-1-naphthol-4-sulfonic acid

51
Q

Has long been considered the classic marker for allergy to leather goods and wet cement

A

Chromium (potassium dichromate)

52
Q

Aside from chromium, also a relevant marker for allergy to both leather and cement

A

Cobalt

53
Q

Controversial allergen as it can often give a positive patch test but fail to meet standards for relevance; frequently manifests extremely delayed hypersensitivity

A

Gold

54
Q

Colorless gas with preservative and disinfectant properties; found in glues, biocides, and photographic development agents

A

Formaldehyde

55
Q

Among the preservatives, the most common cosmetic allergen is

A

Quaternium-15

56
Q

Liked to two forms of ACD:

1) involves glues
2) involve wrinkle-free our permanent-press fabrics and clothing

A

Formaldehyde-containing resins

57
Q

Two major non-formaldehyde releasing preservatives

A

Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE)

Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI)

58
Q

Most allergic reactions to nonreleasers of formaldehyde originate from

A

Personal care products such as creams, lotions, wet wipes, liquid soaps, and medicated tissue and toilet paper

59
Q

Up to _____% of the general population are allergic to fragrances

A

4

60
Q

Main substances used by most patch test groups for screening for fragrance allergy

A

M. pereirae
Fragrance mix I
Fragrance mix II

61
Q

2 antibiotics most commonly implicated in ACD

A

Neomycin

Bacitracin

62
Q

Persists in its ability to cause ACD: died or permed hair

A

Permed hair

63
Q

Adulterant added to natural henna; darkened the henna tattoo

A

Para-phenylinediamine

64
Q

Individuals allergic to either the rubber accelerator/vulcanizer chemicals (or to latex itself) can safely use _____ gloves

A

Vicryl

65
Q

Carbamates, mercaptobenzothiazole and thiuram are classified as

A

Rubber accelerator/vulcanizer chemicals

66
Q

Safest steroid from an allergic standpoint

A

Desoximethasone ointment

67
Q

Least-allergenic steroids belong to class

A

C

68
Q

Thin-layer rapid-use epicutaneous (TRUE) test consists of

A

3 panels with a total of
35 allergens plus
1 blank control

69
Q

Substance is applied to the cubital fossa twice a day for 1 to 3 weeks to simulate real life use

A

Repeat open application test or use test

70
Q

Useful if testing liquid products with irritant potential; substance or dilutions of test substance applied to skin surface covering 1 cm2, allowed to evaporate and dry, then covered with hypoallergenic tape

A

Semiopen patch test

71
Q

Represents a weak nonvesicular reaction but with palpable erythema

A

+

72
Q

Represents a strong (edemstous or vesicular) reaction

A

++

73
Q

Represents an extreme (bullous or ulcerative) reaction

A

+++

74
Q

Represenrs macular (nonpalpable) erythema

A

Doubtful

75
Q

Irritant patch test reactions can be classified into: (3)

A

Erythematous reactions
Purpuric reactions
Pustular reactions

76
Q

Purpuric reactions with petechial hemorrhage seen in approximately 5% of patients tested to

A

Cobalt chloride (punctate purpura of cobalt)

77
Q

Pustular reactions are most commonly encountered with

A

Metalic salts

78
Q

Early appearing: allergic vs irritant pattern

A

Irritant

79
Q

Usually spreads, slowly disappearing: allergic vs irritant pattern

A

Allergic

80
Q

Mercuric preservative that commonly causes positive patch test reactions but very seldom accounts for the patient’s dermatitis; present in vaccines

A

Thimerosal

81
Q

Clinical relevance assessment classification

A

Current: possible or probable
Past
Doubtful

82
Q

Most common side effects of patch testing

A

Itching at the site of a positive test reaction

Irritation or pruritus from tape application

83
Q

Persistent patch test reactions are defined as patch test reactions that persist for

A

More than 1 month

84
Q

Persistent patch test reactions occur most commonly from

A

Gold salts

85
Q

Anaphylasix most often reported with

A

Ammonium persulfate

Fitz 9th (108 decks)

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