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Protein Contact Dermatitis Workup

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

Approach Considerations

The most sensitive methods for detecting protein contact dermatitis include prick and scratch tests, although open application testing may also be performed. Patch-test results are usually negative.

Systemic symptoms, including anaphylaxis, have been reported with prick and scratch tests. Therefore, these tests should be performed only in settings where appropriate resuscitation equipment is available.

Go to Irritant Contact Dermatitis, Allergic Contact Dermatitis, and Pediatric Contact Dermatitis for complete information on these topics.

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Fungal Testing

Testing should be performed to exclude a tinea infection. This may consist of potassium hydroxide (KOH) testing, fungal culture, or periodic acid-Schiff staining

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Open Application Testing

Open application testing involves placing or rubbing the allergen on intact skin and/or damaged, eczematous skin.

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Prick Testing

Prick testing involves placing one drop of diluted test allergen, vehicle (negative control), and histamine (positive control) onto the volar forearm of the patient. The test sites are pierced with lancets to introduce the allergen into the dermis. The results are read at 15-minute intervals over 1 hour. A positive reaction is a wheal of at least 3 mm in diameter that is also at least half the size of the histamine control in the absence of a reaction in the vehicle control.

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Scratch Testing

Scratch testing involves placing one drop of diluted test allergen, vehicle, and histamine onto the volar forearm and scratching the skin lightly with a needle. The test sites are read at 15-minute intervals over 1 hour. A positive reaction is a wheal that is at least half the diameter of the histamine control in the absence of a reaction in the vehicle control.

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Radioallergosorbent Testing

A radioallergosorbent test (RAST) with a particular allergen may be performed to measure allergen-specific IgE in the patient's serum, although a negative test result does not rule out protein contact dermatitis. RAST testing measures only circulating antibodies and does not assess tissue-bound antibodies.

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Imaging Studies

If the patient is experiencing extracutaneous symptoms, appropriate imaging studies may be performed. No specific imaging study is required in the evaluation of protein contact dermatitis.

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Histologic Findings

Histology findings are relatively nonspecific. Biopsy may reveal perivascular lymphocytic infiltrate with eosinophils or spongiosis with lymphocytic exocytosis.

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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
  1. Hjorth N, Roed-Petersen J. Occupational protein contact dermatitis in food handlers. Contact Dermatitis. 1976 Feb. 2(1):28-42. [Medline].

  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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