Advertisement

Clinical Reviews in Allergy & Immunology

, Volume 56, Issue 1, pp 9–18 | Cite as

Systemic Contact Dermatitis

  • Marcella AquinoEmail author
  • Greg Rosner
Article

Abstract

Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals.

Keywords

Systemic contact dermatitis Baboon syndrome Patch test Avoidance diets 

Abbreviations

ACD

Allergic contact dermatitis

ACDS

Allergic contact dermatitis syndrome

BOP

Balsam of Peru

BS

Baboon syndrome

CS

Corticosteroids

LND

Low nickel diet

PT

Patch test

MHC

Major histocompatibility complex

SCD

Systemic contact dermatitis

SDRIFE

Symmetrical drug-related intertriginous and flexural exanthema

Notes

Compliance with Ethical Standards

Conflicts of Interest

Dr. Marcella Aquino is immediate past president and a board member of the Long Island Allergy & Asthma Society; she has served as principal investigator on asthma clinical trials for Merck & Co. (SPIRO) and F. Hoffmann-La Roche (Study 1159871); has served as a sub-investigator on clinical trials for Novartis, Genentech, Shire, and Regeneron; has been paid for giving lectures by the ACAAI and WAO; has had travel expenses covered/reimbursed for travel to meetings by the ACAAI and WAO.

Dr. Gregory Rosner declares that he has no conflict of interest.

Ethical Approval and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Winnicki M, Shear NH (2011) A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginous and flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions. Am J Clin Dermatol 12(3):171–180Google Scholar
  2. 2.
    Veien NK (2011) Systemic contact dermatitis. Int J Dermatol 50(12):1445–1456Google Scholar
  3. 3.
    Kaaber K, Sjolin KE, Menne T (1983) Elbow eruptions in nickel and chromate dermatitis. Contact Dermatitis 9(3):213–216Google Scholar
  4. 4.
    Fabbro SK, Zirwas MJ (2014) Systemic contact dermatitis to foods: nickel, BOP, and more. Curr Allergy Asthma Rep 14:463Google Scholar
  5. 5.
    Menne T et al (1994) Systemic contact dermatitis. Am J Contact Dermat 5:1–12Google Scholar
  6. 6.
    Andersen KE, Hjorth N, Menne T (1984) The baboon syndrome: systemically-induced allergic contact dermatitis. Contact Dermatitis 10(2):97–100Google Scholar
  7. 7.
    Gawkrodger DJ, McVittie E, Hunter JA (1987) Immunophenotyping of the eczematous flare-up reaction in a nickel-sensitive subject. Dermatologica 175(4):171–177Google Scholar
  8. 8.
    Di Gioacchino M et al (1995) Immuno-histopathologic changes in the gastrointestinal mucosa in patients with nickel contact allergy. G Ital Med Lav 17(1–6):33–36Google Scholar
  9. 9.
    Boscolo P, Andreassi M, Sabbioni E, Reale M, Conti P, Amerio P, di Gioacchino M (1999) Systemic effects of ingested nickel on the immune system of nickel sensitised women. Life Sci 64(17):1485–1491Google Scholar
  10. 10.
    Di Gioacchino M et al (2000) Lymphocyte subset changes in blood and gastrointestinal mucosa after oral nickel challenge in nickel-sensitized women. Contact Dermatitis 43(4):206–211Google Scholar
  11. 11.
    Roychowdhury S, Svensson CK (2005) Mechanisms of drug-induced delayed-type hypersensitivity reactions in the skin. AAPS J 7(4):E834–E846Google Scholar
  12. 12.
    Jensen CS, Lisby S, Larsen JK, Veien NK, Menne T (2004) Characterization of lymphocyte subpopulations and cytokine profiles in peripheral blood of nickel-sensitive individuals with systemic contact dermatitis after oral nickel exposure. Contact Dermatitis 50(1):31–38Google Scholar
  13. 13.
    Posadas SJ, Pichler WJ (2007) Delayed drug hypersensitivity reactions - new concepts. Clin Exp Allergy 37(7):989–999Google Scholar
  14. 14.
    Lachapelle JM The Spectrum of diseases for which patch testing is recommended. In: Patch Testing & Prick Testing: A Practical Guide Official Publication of the ICDRG, springer-Verlag, editor. 2009. Springer Berlin Heidelberg, Berlin, pp 7–31Google Scholar
  15. 15.
    Hausermann P, Harr T, Bircher AJ (2004) Baboon syndrome resulting from systemic drugs: is there strife between SDRIFE and allergic contact dermatitis syndrome? Contact Dermatitis 51(5–6):297–310Google Scholar
  16. 16.
    Ozkaya E (2014) Current understanding of baboon syndrome. Expert Rev Dermatol 4(2):163–175Google Scholar
  17. 17.
    Miyahara A, Kawashima H, Okubo Y, Hoshika A (2011) A new proposal for a clinical-oriented subclassification of baboon syndrome and a review of baboon syndrome. Asian Pac J Allergy Immunol 29:150–160Google Scholar
  18. 18.
    Veien NK, Christiansen AH, Svejgaard E, Kaaber K (1979) Antibodies against nickel-albumin in rabbits and man. Contact Dermatitis 5(6):378–382Google Scholar
  19. 19.
    Polak L, Turk JL (1968) Studies on the effect of systemic administration of sensitizers in Guinea-pigs with contact sensitivity to inorganic metal compounds. I. The induction of immunological unresponsiveness in already sensitized animals. Clin Exp Immunol 3(3):245–251Google Scholar
  20. 20.
    Tan S-C, Tan JW-l (2011) Symmetrical drug related intertriginous and flexural exanthema. Curr Opin Allergy Clin Immunol 11:313–318Google Scholar
  21. 21.
    Gallo R, Parodi A (2002) Baboon syndrome from 5-aminosalicyclic acid. Contact Dermatitis 46(2):110Google Scholar
  22. 22.
    Nakada T, Matsuzawa Y, Matsuzawa Y (2012) Allergic Contact Dermatitis Syndrome From Bufexamac for Nursing Infant. Dermatitis 23(4):185–186Google Scholar
  23. 23.
    Proske S, Uter W, Schnuch A, Hartschuh W (2003) Severe allergic contact dermatitis with generalized spread due to bufexamac presenting as the "baboon" syndrome. Dtsch Med Wochenschr 128(11):545–547Google Scholar
  24. 24.
    European Medicines Agency recommends revocation of marketing authorisations for bufexamac. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2010/04/WC500089623.pdf#search=‘eu,%20bufexamac
  25. 25.
    Lakshmi C, Srinivas C (2011) Systemic (allergic) contact dermatitis to diclofenac. Indian J Dermatol Venereol Leprol 77(4):536Google Scholar
  26. 26.
    Rajan JP, Cornell R, White AA (2015) A case of systemic contact dermatitis secondary to edetate disodium. J Allergy Clin Immunol Pract 3(4):607–608Google Scholar
  27. 27.
    Mussani F, Poon D, Skotnicki-Grant S (2013) Systemic contact dermatitis to topical clioquinol/hydrocortisone combination cream. Dermatitis 24(4):196–197Google Scholar
  28. 28.
    Oliveira A, Rosmaninho A, Lobo I, Selores M (2011) Intertriginous and flexural exanthema after application of a topical anesthetic cream: a case of baboon syndrome. Dermatitis 22(6):360–362Google Scholar
  29. 29.
    Erdmann S, Sachs B, Merk H (2001) Systemic contact dermatitis from cinchocaine. Contact Dermatitis 44(4):260261Google Scholar
  30. 30.
    Malinauskiene L, Isaksson M, Bruze M (2013) Systemic contact dermatitis in a gold-allergic patient after treatment with an oral homeopathic drug. J Am Acad Dermatol 68(2):e58Google Scholar
  31. 31.
    Moller H et al (1996) Flare up at contact allergy sites in a gold treated rheumatic patient. Acta Derm Venerol 76(1):55–58Google Scholar
  32. 32.
    Klein-Gitelman MS, Pachman LM (1998) Intravenous corticosteroids: adverse reactions are more variable than expected in children. J Rheumatol 25(10):1995–2002Google Scholar
  33. 33.
    Baeck M, Goossens A (2012) Systemic contact dermatitis to corticosteroids. Allergy 67(12):1580–1585Google Scholar
  34. 34.
    Barbaud A, Waton J (2016) Systemic allergy to corticosteroids: clinical features and cross reactivity. Curr Pharm Des 22(45):6825–6831Google Scholar
  35. 35.
    Garcia-Bravo B, Repiso JB, Camacho F (2000) Systemic Contact Dermatitis to Deflazacort. Contact Derm 43:359–360Google Scholar
  36. 36.
    Bianchi L, Hansel K, Antonelli E, Bellini V, Rigano L, Stingeni L (2016) Deflazacort hypersensitivity: a difficult-to-manage case of systemic allergic dermatitis and literature review. Contact Dermatitis 75(1):54–56Google Scholar
  37. 37.
    Treudler R, Simon J (2006) Symmetric, drug-related, intertriginous, and flexural exanthema in a patient with polyvalent intolerance to corticosteroids. J Allergy Clin Immunol 118:965–967Google Scholar
  38. 38.
    DeKoven JG, Warshaw EM, Belsito DV, Sasseville D, Maibach HI, Taylor JS, Marks JG, Fowler JF Jr, Mathias CGT, DeLeo VA, Pratt MD, Zirwas MJ, Zug KA (2017) North American contact dermatitis group patch test results 2013-2014. Dermatitis 28(1):33–46Google Scholar
  39. 39.
    Guin JD, Phillips D (1989) Erythroderma from systemic contact dermatitis: a complication of systemic gentamicin in a patient with contact allergy to neomycin. Cutis 43(6):564–567Google Scholar
  40. 40.
    Haeberle M, Wittner B (2009) Is gentamicin-loaded bone cement a risk factor for developing systemic allergic dermatitis? Contact Dermatitis 60:176–177Google Scholar
  41. 41.
    Wolf R, Orion E, Matz H (2003) The baboon syndrome or intertriginous drug eruption: a report of eleven cases and a second look at its pathomechanism. Dermatol Online J 9(3):2Google Scholar
  42. 42.
    Goossens C, Sass U, Song M (1997) Baboon syndrome. Dermatology 194:421–422Google Scholar
  43. 43.
    Wolf R, Elman M, Brenner S (1993) Drug-induced "intertrigo". Int J Dermatol 32(7):515–516Google Scholar
  44. 44.
    Ash S, Scheman AJ (1997) Systemic contact dermatitis to hydroxyzine. Am J Contact Dermat 8(1):2–5Google Scholar
  45. 45.
    Cusano F, Ferrara G, Crisman G, Sarracco G, Zalaudek I, Argenziano G (2006) Clinicopathologic features of systemic contact dermatitis from ethylenediamine in cetrizine and levocetrizine. Dermatology 213(4):353–355Google Scholar
  46. 46.
    Isaksson M, Ljunggren B (2003) Systemic contact dermatitis from ethylenediamine in an aminophylline preparation presenting as the baboon syndrome. Acta Derm Venereol 83(1):69–70Google Scholar
  47. 47.
    Walker S, Ferguson S (2004) Systemic allergic contact dermatitis due to ethylenediamine following administration of oral aminophylline. Br J Dermatol 150(3):594Google Scholar
  48. 48.
    Sharma AD (2007) Relationship between nickel allergy and diet. Indian J Dermatol Venereol Leprol 73(5):307–312Google Scholar
  49. 49.
    Brandao MH et al (2010) Ear piercing as a risk factor for contact allergy to nickel. J Pediatr 86(2):149–154Google Scholar
  50. 50.
    Thyssen JP (2011) Nickel and cobalt allergy before and after nickel regulation--evaluation of a public health intervention. Contact Dermatitis 65(Suppl 1):1–68Google Scholar
  51. 51.
    Kulberg A, Schliemann S, Elsner P (2014) Contact dermatitis as a systemic disease. Clin Dermatol 32:414–419Google Scholar
  52. 52.
    Lerch M, Bircher AJ (2004) Systemically induced allergic exanthem from mercury. Contact Dermatitis 50(6):349–353Google Scholar
  53. 53.
    Audicana M, Bernedo N, Gonzalez I, Munoz D, Fernandez E, Gastaminza G (2001) An unusual case of baboon syndrome due to mercury present in a homeopathic medicine. Contact Dermatitis 45(3):185Google Scholar
  54. 54.
    Shimizu T, Kobayashi S, Tanaka M (2003) Systemic contact dermatitis to zinc in dental fillings. Clin Exp Dermatol 28(676):675Google Scholar
  55. 55.
    Saito N, Yamane N, Matsumura W, Fujita Y, Inokuma D, Kuroshima SI, Hamasaka K, Shimizu H (2010) Generalized exacerbation of systemic allergic dermatitis due to zinc patch test and dental treatments. Contact Dermatitis 62(6):372–373Google Scholar
  56. 56.
    Pigatto PD, Guzzi G (2004) Systemic contact dermatitis from nickel associated with orthodontic appliances. Contact Dermatitis 50(2):100–101Google Scholar
  57. 57.
    Hausen BM et al (1995) Identification of new allergenic constituents and proof of evidence for coniferyl benzoate in balsam of Peru. Am J Contact Dermatitis 6(4):199–208Google Scholar
  58. 58.
    Belsito DV (2001) Surviving on a balsam-restricted diet: cruel and unusual punishment or medically necessary therapy? J Am Acad Dermatol 45(3):470–472Google Scholar
  59. 59.
    Hill AM, Belsito DV (2003) Systemic contact dermatitis of the eyelids caused by formaldehyde derived from aspartame? Contact Dermatitis 49(5):258–259Google Scholar
  60. 60.
    Nijhawan RI et al (2009) Systemic contact dermatitis. Dermatol Clin 27(3):355–364 viiGoogle Scholar
  61. 61.
    Matiz C, Jacob SE (2011) Systemic contact dermatitis in children: how an avoidance diet can make a difference. Pediatr Dermatol 28(4):368–374Google Scholar
  62. 62.
    Dejobert Y, Delaporte E, Piette F, Thomas P (2001) Vesicular eczema and systemic contact dermatitis from sorbic acid. Contact Dermatitis 45(5):291Google Scholar
  63. 63.
    Giordano-Labadie F, Pech-Ormieres C, Bazex J (1996) Systemic contact dermatitis from sorbic acid. Contact Dermatitis 34(1):61–62Google Scholar
  64. 64.
    Scheman A, Cha C, Jacob SE, Nedorost S (2012) Food avoidance diets for systemic, lip, and oral contact allergy: an american contact alternatives group article. Dermatitis 23(6):248–257Google Scholar
  65. 65.
    Burden AD, Wilkinson SM, Beck MH, Chalmers RJG (1994) Garlic-induced systemic contact dermatitis. Contact Dermatitis 30(5):299–300Google Scholar
  66. 66.
    Veien NK (1997) Ingested food in systemic allergic contact dermatitis. Clin Dermatol 15(4):547–555Google Scholar
  67. 67.
    Cho E, Lee JD, Cho SH (2011) Systemic contact dermatitis from propolis ingestion. Ann Dermatol 23(1):85–88Google Scholar
  68. 68.
    Jacob SE, Scheman A, McGowan MA (2017) Allergen of the year: propylene glycol. Dermatitis 29(1):3–5Google Scholar
  69. 69.
    Warshaw EM, Botto NC, Zug KA, Belsito DV, Maibach HI, Sasseville D, Fowler JF Jr, Storrs FJ, Taylor JS, DeLeo V, Marks JG Jr, Mathias CG, Pratt MD, Rietschel RL (2008) Contact dermatitis associated with food: retrospective cross-sectional analysis of north American contact dermatitis group data, 2001-2004. Dermatitis 19(5):252–260Google Scholar
  70. 70.
    Lowther A, McCormick T, Nedorost S (2008) Systemic contact dermatitis from propylene glycol. Dermatitis 19(2):105–108Google Scholar
  71. 71.
    Pereira F, Santos R, Pereira A (1997) Contact dermatitis from chamomile tea. Contact Dermatitis 36(6):307Google Scholar
  72. 72.
    Rodriguez-Serna M, Sanchez-Motilla JM, Ramon R, Aliaga A (1998) Allergic and systemic contact dermatitis from Matricaria chamomilla tea. Contact Dermatitis 39(4):192–193Google Scholar
  73. 73.
    Rycroft RJ (2003) Recurrent facial dermatitis from chamomile tea. Contact Dermatitis 48(4):229Google Scholar
  74. 74.
    Barbaud A, Gonçalo M, Bruynzeel D, Bircher A, European Society of Contact Dermatitis (2001) Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermatitis 45(6):321–328Google Scholar
  75. 75.
    Brockow K et al (2002) General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 57(1):45–51Google Scholar
  76. 76.
    Sharma AD (2006) Disulfiram and low nickel diet in the management of hand eczema: a clinical study. Indian J Dermatol Venereol Leprol 72(2):113–118Google Scholar
  77. 77.
    Christensen OB, Kristensen M (1982) Treatment with disulfiram in chronic nickel hand dermatitis. Contact Dermatitis 8(1):59–63Google Scholar
  78. 78.
    Veien NK, Hattel T, Laurberg G (1993) Low nickel diet: an open, prospective trial. J Am Acad Dermatol 29(6):1002–1007Google Scholar
  79. 79.
    Mislankar M, Zirwas MJ (2013) Low-nickel diet scoring system for systemic nickel allergy. Dermatitis 24(4):190–195Google Scholar
  80. 80.
    Joneja JM (1995) Specific food restrictions nickel allergy. In: Managing food allergy & intolerance: a practical guide. J.A. Hall Publications, Port Coquitlam (BC), pp 247–262Google Scholar
  81. 81.
    Salam TN, Fowler JF Jr (2001) Balsam-related systemic contact dermatitis. J Am Acad Dermatol 45(3):377–381Google Scholar
  82. 82.
    Sharma AD (2009) Low chromate diet in dermatology. Indian J Dermatol 54(3):293–295Google Scholar
  83. 83.
    Stuckert J, Nedorost S (2008) Low-cobalt diet for dyshidrotic eczema patients. Contact Dermatitis 59(6):361–365Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.SUNY at Stony BrookStony BrookUSA
  2. 2.Division of Rheumatology, Allergy & ImmunologyNYU Winthrop University HospitalMineolaUSA

Personalised recommendations