Contact dermatitis
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Metallic gold has long been regarded as a relatively safe material when in contact with the skin and mucosal membranes, with only sporadic reports of allergic contact dermatitis or stomatitis. This is probably due to its stability and low tendency to ionization. ⋯ Histologically, these lesions presented a lymphomatoid appearance, with a T-cell diffuse infiltrate. The patch test demonstrated a strong reaction to 1% gold sodium thiosulfate.
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Two cases of sarcoidal-type allergic contact granuloma due to metals in ear piercing are presented, the first to palladium (Pd) only, and the second to Pd and possibly also to other metals. Both the patients developed papulonodular lesions at the helices following ear piercing, which after 3-4 weeks, became more granulomatous and very resistant to treatment. Indeed, repeated intralesional injections with corticosteroids produced only a temporary regression of the lesions. ⋯ Patch testing showed a strong positive reaction to Pd only in case 1 and to Pd and nickel in case 2. Chemical analysis of the earring of patient 1 confirmed the presence of Pd; however, analysis of the earrings of the second patient did not show the presence of Pd, but showed the presence of nickel and copper. Both the clinical and histological findings concur with some rarely reported similar observations in the literature.
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There are numerous reports of anaphylaxis from chlorhexidine in surgical operations and other medical procedures, usually due to its application to wounds or mucous membranes. We wanted to analyse the clinical data of patients with a positive chlorhexidine prick test and perform some additional testing. We studied the case records of the patients with a positive chlorhexidine prick test and performed an open application test and tests for specific IgE. ⋯ Besides severe attacks, patients with a positive prick test often have milder local symptoms, such as exacerbation of dermatitis. Local symptoms from chlorhexidine-containing products may precede severe attacks. We recommend a prick test to be performed routinely when symptoms during medical interventional procedures, e.g. local and general anaesthesia, are investigated.