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Dermatology Board Prep > DERM (02) Eczematous Disease > Allergic contact dermatitis > Flashcards

Allergic contact dermatitis Flashcards

1
Q

Most common causes of allergic dermatitis on the lips?

A

gallates, dyes, flavorings, sunscreens, propolis

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2
Q

Common cause of allergic contact derm on the wrist?

A

Chromates (in leather)

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3
Q

What areas are spared in clothing dermatitis?

A

Spares folds (axillary vault) and is accentuated where clothes fit tightly

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4
Q

Number one cause of cosmetics dermatitis?

A

Fragrances, preservatives are second most common

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5
Q

What is the most common cause of airborne ACD?

A

Compositae

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6
Q

What type of reactions are most tape reactions?

A

Irritant contact dermatitis

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7
Q

What causes more allergy, pure metals or metal salts?

A

Metal salts

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8
Q

What test do you do to see if something has nickel?

A

Dimethylglyoxime test (turns pink in the presence of pink)

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9
Q

Sources of chromate?

A

dyes (green felt fabric on pool table), yellow green pigment (tattoos/cosmetics), leather, cement, matches and crude oils.

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10
Q

What is the indicator test for Chromates?

A

diphenylcarbazide spot test

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11
Q

The molecule used for the cobalt release spot test?

A

disodium-1-nitroso-2-napthol-3,6-disulfonate

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12
Q

What irritant dermatitis do you get with cobalt?

A

Irritant reaction w/ purpuric pores (not a true rxn really)

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13
Q

What does cobalt commonly cross react with?

A

nickel and chromate

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14
Q

What type of reaction can mercury cause?

A

Oral lichenoid reaction

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15
Q

What things does latex cross react with?

A

bananas, avocado, chestnut, kiwi, passion fruit

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16
Q

Most common glove allergy?

A

Thiuram (tetramethylthiuram disulfide)

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17
Q

what does thiuram cross react with?

A

disulfiram

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18
Q

What is the number one cause of allergic shoe dermatitis?

A

Mercaptobenzothiazole (MBT)

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19
Q

what is the indicator test for formaldehyde?

A

Lutidine (acetylacetate)

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20
Q

What type of textile has the least amount of formaldehyde?

A

polyester

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21
Q

What is the number prservative sensitizer in the USA?

A

Quanternium-15 (it releases formaldehyde over time)

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22
Q

What products are in Kathon CG (methychloroisothiazolinone/methylisothiazolin one MCI/MI)

A

found in wet wipes

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23
Q

Can you give a child a vaccine with a positive patch test to thimerosal?

A

Yes! This + result is almost never relevent

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24
Q

What is the difference between fragrance-free and unscented?

A

The gragrance free is the only one that doesn’t have any fragrance (unscented may have masking fragrances)

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25
Q

What transdermal patch causes the most allergic contact dermatiis

A

Clonidine

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26
Q

Which corticosteriod group is least likely to cause allergy?

A

Class C, screening agent is Betamethasone

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27
Q

What allergens are in the PPPASTE family?

A

PPD, PABA, Para-aminosaliciylic acid, azo dyes, sulfonamides, thiazides, and ethyl anesthetics

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28
Q

Which is more common, irritant or allergic contact dermatitis?

A

Irritant is more common, 80% of cases vs 20% being allergic contact

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29
Q

How long does sensitization take for allergic contact dermatitis?

A

Can vary from a few exposures or after years of exposure

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30
Q

How often do you need an exposure to maintain the allergic reaction in allergic contact dermatitis?

A

Only need an exposure once q3weeks to keep allergic reaction going.

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31
Q

What is the difference between cross reaction and co-reaction for allergic contact dermatitis?

A

Cross reaction: sensitization to one compound results in sensitization to compounds w/ similar chemical structure (eg: poison ivy and mago peel; neomycin and gentamycin Co-reaction: Sensitization to two chemicals simultaneously bc they are contacted/used together, but otherwise allergy to one wouldn’t result in allergy to the other (ex: nekcel and cobalt; neomycin and bacitracin

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32
Q

What is the #1 flower associated with fingertip allergic contact derm in florists?

A

Tulips

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33
Q

What type of pattern might you see for allergic contact derm w/ hair products?

A

Since the scalp is thick and resistant to allergy it will often presetn on the ears and hairline/face

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34
Q

What nail products may contribute to periocular/eyelid dermatitis?

A

tosylamide>acrylates, formaldehyde, resin, glutaraldehyde, benzalkonium chloride

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35
Q

1 cause of allergic contact dermatitis on the face/neck?

A

Fragrances, preservatives are 2nd

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36
Q

Most common cause of perianal dermatitis

A

Lidocaine (hemorrhoid gel) and preservatives (MCI/MI, in wipes).

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37
Q

Most common causes of oral stomatitis (allergic contact)

A

dental fillings (mercury/gold/amalgam) which give you a lichenoid reaction, eposxy resins and flavorings like mind and cinnamon.

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38
Q

Most common occupational exposures for allergic contact demratitis?

A

Rubber > nickel > epoxy and other resins >aromatic amines

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39
Q

What type of dermatitis is caused from most tape reactions?

A

irritant rather than allergic.

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40
Q

In patch testing which compounds can cause a delayed postive patch test (arises after 7 days)?

A

gold, neomycin, dodecyl gallate, palladium, p-phenyedediamine, and corticosteroids.

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41
Q

Which metal can cause a persisitant psoitive reaction at the site of patch testing?

A

Gold

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42
Q

What are some key differences between irritant contact dermatitis vs allergic contact dermatitis on histology?

A

Allergic has more spongiosis, dermal inflammation and eos and also lacks the necrotic keratinocytes.

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43
Q

Which foods have nickel in them that people with nickel allergy should be aware of?

A

cocoa, licorice, margarine, peanuts, borwn lentils, walnuts, almonst, hazelnuts, beans.

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44
Q

What is the indicator compound for nickel and what color does it turn?

A

Dimethyglyoxime, turns pink.

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45
Q

What is the indicator compound for chromates?

A

diphenylcarbazide spot test

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46
Q

What things have chromates?

A

dyes (green felt fabric on pool table), yellow/green pigment (tattoos/cosmetics), cement, matches, and crude oils (engine aircraft workers and photographers.

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47
Q

What do the chromates cross react with?

A

nickel and cobalt

48
Q

What is the spot test for cobalt?

A

disodium-1-nitroso-2naphthol-3,6-disulfonate

49
Q

What things have cobalt in them?

A

metal products, cosmetics, dyes (blue-green dyes, paint, tattoos), glass/pottery, cement, vit B12 inejctions (can cause intractable hand dermatitis), and artificial joints.

50
Q

What is the Poral Reaction associated with cobalt?

A

This is irritant reaction w/ purpuric sores associated with cobalt exposure.

51
Q

What does cobalt cross react with?

A

Nickel and chromate

52
Q

What products are mercury in that cause allergic contact dermatitis?

A

amalgams, insecticides, industry glues and starch pastes, felt hat workers, etching/artwork and furs

53
Q

What is the most common reaction to latex?

A

Immunologic contact urticaria (type I hypersensitivity) rather than type IV delayed-type hypersensitivity reaction.

54
Q

What things does latex cross-react with?

A

BACK Passion Bananas Avocados Chestnut Kiwi Passion fruit

55
Q

What is the most common glove allergen?

A

Thiuram

56
Q

What is the most common allergen in healthcare workers?

A

Thiuram

57
Q

What does Thiuram cross react with?

A

disulfiram

58
Q

What allergen is released from bleached elastic?

A

Carba mix/carbamates

59
Q

What are the main sensitizers associated with rubber?

A

So it is the accelerants that get you not the rubber: thiurams and benzothiazole derivatives and antioxidants.

60
Q

What is the #1 cause of shoe allergic contact derm?

A

Mercaptobenzothiazole (MBT)

61
Q

What is the sensitizer in neoprene?

A

Dialkyl thioureas

62
Q

What products does the allergen P-phenalenediamine (PPD) come from?

A

Hair dye, black henna, black rubber, photograph development, photocopies, printer ink, other darkly colored cosmetics

63
Q

What things is the allergen Rosin found in?

A

de-epilation waxes, adhesives, painting, chewing gum, violin and other musical instruments

64
Q

What products is the allergen P-tert-butylphenol formaldehyde resin (PTBP) found in?

A

Is used for glueing together leather products (watchbands, leather handbags, shoes

65
Q

What specific clinical finding can PTBP cause?

A

hypopigmentation

66
Q

What products are the allergen Epoxy resin (bisphenol A) found in?

A

PVC and plastic materials, electrical insulation, pain, glues

67
Q

In what form do the epoxy resin’s cause allergic contact derm?

A

Only in their liquid form, when they have cured and turned into a fully polymerized product they are non-sensitizing.

68
Q

What allergen is in Krazy Glue that you would find for glueig artificial nails?

A

Ethyl cyanoacrylate

69
Q

What allergen is in GluStitch, sutureles skin closures?

A

Butyl cyanoacrylate

70
Q

What allergen is in Dermabond, sutureles skin closures?

A

Octyl cyanoacrylate

71
Q

What type of products are methacrylates in?

A

very hard rigid plastic. artifical nail plates, hard contact lenses, adhesive bone cement for artifical joints, dental prostheses, dental sealant.

72
Q

What allergen chemical can pass through rubber and polyvinyl gloves?

A

Methacrylate

73
Q

What clinical finding that is unique can methacrylate cause?

A

paresthesias

74
Q

What is the indicator test for formaldehyde?

A

Lutidine (acetylacetate)

75
Q

What allergen is common in wrinkle-free clothing?

A

Formaldehyde

76
Q

What products is the allergen quanternium-15 (Dowicil 200) found in?

A

soaps, shampoos, moisturizers.

77
Q

What allergens are found in wet wipes?

A

Kathon CG (methychloroisothiazolinone/methylisothiazolin one) (MCI/MI)

78
Q

What things do parabens cross react with?

A

PPPASTE family Para-aminosalicyclic acid PABA PPD Azo dyes Sulfonamides Thiazides Ester anesthetics

79
Q

What products are the allergen propylene glycol in?

A

ECG and lubricant jelly, antifreeze, brake fluid, food dyes/ flavorings

80
Q

What allergen is derived from coconut oil?

A

cocoamidopropyl betaine

81
Q

What produces is cocoamidopropyl betaine found in?

A

shampoo, soaps

82
Q

What products is lanolin in?

A

aquaphor, wax-wool alcohol, eucerin

83
Q

What allergen is derived from bees and is notable for causing allergic contact of the lips?

A

Propolis

84
Q

What chemicals will pick of 90% of fragrance allergies?

A

balsam of peru and fragrance mix

85
Q

What tree does balsam of peru come from?

A

Myroxylon Pereirea

86
Q

What 8 fragrances are in the Fragrance mix that you test on patch testing?

A

Cinnamic alcohol, cinnamic aldehyde, amyl cinnamic alcohol, eugenol, isoeugenol, geraniol, hydroxycitronellal, oak moss absolute

87
Q

What is the rare sensitizer found in home hair perms

A

ammonium thioglycolate (more offten causes irritant)

88
Q

What is the sensitizer found in acid/professional/salon perms?

A

glyeryl monothiogycolate

89
Q

What is in nail lacquer/polish which causes eyelid, neck and finger-periungal dermitits?

A

Tosylamide (toluene-sulfonamide)

90
Q

What is the screening agent for Class A corticosteroids?

A

Tixocortol pivalate

91
Q

What are the most frequent allergenic Class A corticosteroids?

A

hydrocortisone, prednisone, prednisolone, and methylprednisolone

92
Q

What is the screening agent for Class B steroids?

A

Budesonide

93
Q

What are the most common allergenic of the Class B steroids?

A

triamcinolone, desonide, gluocinolone, fluocinonide, halocinomnide and hydrocrotisone butyrate

94
Q

What is the screening agent for Class C steroids?

A

Betamethasone

95
Q

What is special about the class C steroids?

A

Least allergenic: betamethasone, desoximetasone, dexamethasone

96
Q

Screening agent for Class D steroids?

A

Hydrocortisone - 17-Butyrate

97
Q

What steroids are included in Class D?

A

mometasone, aclomethasone, betamethasone valerate, and clobetasol

98
Q

Delayed reading is important for what class of steroid?

A

Class D

99
Q

What two steroid classess cross-react with each other?

A

B and D

100
Q

What is the most common sunscreen allergen?

A

Oxybenzone

101
Q

What things does poison ivy cross react with?

A

Japanese laquer tree, cashew nut, mango, ridnd leaves sap, indian marking nut, ginkgo, brazilian pepper tree

102
Q

Where does the sensitizer pinaceae come from?

A

Pinus palustris (pine tree)

103
Q

What does pinaceae cross react with?

A

balsam of peru, turpentine, colophony, benzoin, wood tars, spices

104
Q

What is the sensitizer sesquiterpen lactone (of the asteraceae compositae group) from?

A

ragweek, dandelion, pyrethrum, mugwort, chrysanthemum, wees, feverfew, artichoke, daisy, sunflower, endive, arnica, marigold, chammomile

105
Q

What do the asteraceae compositae cross react with?

A

permethrin

106
Q

What is the sensitizer for the plant aliaceae?

A

Diallyl disulfide

107
Q

What things are diallyl disulfide in?

A

Onions, garlic, chive

108
Q

What is the sentizer in the plant primulaceae?

A

Primin

109
Q

What plants is primin in?

A

primrose

110
Q

What is the sensitizer for the myrtaceae plants?

A

D-limonene

111
Q

What things is D-limonene in?

A

tea tree oil/malaeuca oil

112
Q

What is the senitizer for the anacardiacea family, toxicodendron species?

A

Urushiol (an oleoresin)

113
Q

What plants have urushiol?

A

poison ivy/poison oak/ poison sumac (in the leaves, stems and roots

114
Q

What type of dermatitis does the asteraceae (compositae) plants cause?

A

usually airborn allergic contact dermatitis. This involves eyelids, melolabial folds, submental/retroaricular sulci/ anecubital fossae

115
Q

How long after re-exposure to an allergen does it take to get rash?

A

Within 48 hrs

116
Q

How frequently do you have to be exposed to an allergen to maintain an allergic contact dermatitis?

A

As little as once every 3 weeks

DERM (02) Eczematous Disease (6 decks)

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