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Protein Contact Dermatitis Clinical Presentation

  • Author: Cheryl Levin, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 11, 2013
 

History

A detailed history should be performed for any individual suspected of having protein contact dermatitis. While not confirmed with formal studies, anecdotal risk factors for the development of protein contact dermatitis include a history of atopy, chronic irritant dermatitis, and an occupation or hobby involving exposure to protein allergens. Persons at particular occupational risk include kitchen workers, food vendors, gardeners, slaughterhouse workers, butchers, commercial anglers, farmers, and veterinarians.

Many agents are capable of causing protein contact dermatitis, as is elucidated in Etiology. Identification of the agent may be aided by the rapid onset of the reaction upon exposure: an acute, urticarial, or vesicular eruption may occur within minutes after contact with the causative protein. A chronic recurrent dermatitis also ensues at the site of allergen application.

Patients may report itching, burning, stinging, or pain in the affected area. Upon ingestion of the allergen, patients may rarely experience angioedema, rhinoconjunctivitis, gastrointestinal symptoms, and/or bronchial asthma.

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Physical Examination

Protein contact dermatitis is characterized by pruritic, erythematous papules and vesicles with overlying fine scale. Lichenification may occur, especially with long-term exposure. The dermatitis usually affects the hands and forearms, which are typically diffusely involved. Sometimes, only the fingertips are affected. Urticarial papules and plaques may occur within minutes following contact with the causative allergen.

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Contributor Information and Disclosures
Author

Cheryl Levin, MD Resident Physician, Department of Dermatology, University of Minnesota Medical School

Cheryl Levin, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Acknowledgements

Erin M Warshaw, MD, MS Associate Professor, Clinical Scholar Track and Co-Director of Contact Dermatitis Clinic, Department of Dermatology, University of Minnesota Medical School; Chief of Dermatology, Division of Dermatology, Minneapolis Veterans Affairs Medical Center

Erin M Warshaw, MD, MS is a member of the following medical societies: American Contact Dermatitis Society and Women's Dermatologic Society

Disclosure: Nothing to disclose.

References
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  2. Veien NK, Hattel T, Justesen O, Nørholm A. Causes of eczema in the food industry. Derm Beruf Umwelt. 1983. 31(3):84-6. [Medline].

  3. Jones HE, Reinhardt JH, Rinaldi MG. Immunologic susceptibility to chronic dermatophytosis. Arch Dermatol. 1974 Aug. 110(2):213-20. [Medline].

  4. Wang LF, Lin JY, Hsieh KH, Lin RH. Epicutaneous exposure of protein antigen induces a predominant TH2-like response with high IgE production in mice. Journal of Immunology. 1996. 156:4079-82.

  5. Lehto M, Koivuluhta M, Wang G, Amghaiab I, Majuri ML, Savolainen K. Epicutaneous natural rubber latex sensitization induces T helper 2-type dermatitis and strong prohevein-specific IgE response. J Invest Dermatol. 2003 Apr. 120(4):633-40. [Medline].

  6. Janssens V, Morren M, Dooms-Goossens A, Degreef H. Protein contact dermatitis: myth or reality?. Br J Dermatol. 1995 Jan. 132(1):1-6. [Medline].

  7. Levin C, Warshaw E. Protein contact dermatitis: allergens, pathogenesis, and management. Dermatitis. 2008 Sep-Oct. 19(5):241-51. [Medline].

  8. Hannuksela M. Protein Contact Dermatitis. Frosch PJ, Torkil M, Lepoittevin J-P. Contact Dermatitis. 4th. Berlin: Springer; 2006. 345-348.

  9. Hansen KS, Petersen HO. Protein contact dermatitis in slaughterhouse workers. Contact Dermatitis. 1989 Oct. 21(4):221-4. [Medline].

  10. Warshaw E, Lee G, Storrs FJ. Hand dermatitis: a review of clinical features therapeutic options, and long-term outcomes. American Journal of Contact Dermatitis. 2003. 14:119-37.

  11. Mercader P, de la Cuadra-Oyanguren J, Rodriguez-Serna M, Pitarch-Bort G, Fortea-Baixauli JM. Treatment of protein contact dermatitis with topical tacrolimus. Acta Derm Venereol. 2005. 85(6):555-6. [Medline].

 
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