android barcode scanner api java CLINICAL PICTURE OF ALLERGIC CONTACT DERMATITIS in .NET

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CLINICAL PICTURE OF ALLERGIC CONTACT DERMATITIS
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While in ACD the primary clinical dermatitis usually occurs in the distribution of the contact with the instigating allergen, there are inherent differences in the area of the involved epidermis, the potency of the allergen, and the duration of the dermatitis that may alter the presentation4 Classic localizations for cosmetic contact allergy are the face, neck, hands, and axillae relating to the use of fragrance-based products in these areas5 (Fig 18-3) Flavorings such as peppermint or cinnamon can lead to skin reactions as well and often present as a dermatitis around the mouth known as perioral dermatitis (Fig 18-4) In some cases, consort or connubial contact dermatitis occurs when the contact dermatitis is caused by contact with products used by partners or coworkers ACD can be classified into three main categories: subacute, acute, and chronic subtypes6 In subacute presentations, clinically the skin exhibits macular erythema and scaling The acute presentation typically displays pruritic erythematous, edematous, and papulovesicular changes in the skin When the dermatitis is chronic, however, the clinical presentation involves lichenification and fissuring and may not be distin-
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FIGURE 18-2 Sensitivity to hair dye
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guishable from other chronic dermatoses
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COSMETIC IMPLICATIONS OF CONTACT DERMATITIS
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Cosmetic procedure outcomes may be compromised by an ensuing irritant
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or allergic-based contact dermatitis Furthermore, failure to effectively detect and avoid subsequent exposures to the allergen may result in unmitigating dermatitis, which may have a seemingly poor correlation with the current personal regimen of the patient For example, a patient exquisitely sensitized to fragrances containing balsam of Peru,
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FIGURE 18-3 Contact dermatitis to fragrance presenting on eyelids
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It should be noted that irritant-based reactions may also be seen at the 48-hour reading However, unlike the ACD-type reactions, these tend to be resolving at the delayed reading The sodium lauryl sulfate (SLS) test may be a useful adjuvant patch test, especially in the sensitive skin patient, as it may facilitate the differentiation between allergic and irritant reactions9 A reaction in the SLS application patch during patch testing indicates that macular erythema in the patch test sample on that patient more likely reflects an irritant etiology Conversely, if the SLS test fails to demonstrate a reaction upon patch testing, it is more likely that macular erythematous reactions may be allergic in nature While the SLS testing may be useful, it is important to note that clinical correlation of the presentation and exposure history are crucial for the correct diagnosis of allergic versus irritant contact dermatitis FIGURE 18-4 Contact dermatitis to avorings such as peppermint and cinnamon can lead to perioral dermatitis, which is a variant of contact dermatitis In this gure, the patient s dermatitis was caused by peppermint avoring in her toothpaste
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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TOP SENSITIZERS IN COSMETIC PRODUCTS
A full discussion of the wide range of sensitizing chemicals found in cosmeticbased products is beyond the scope of this chapter, but a list of the most common allergens is found in Table 18-1 Two categories deserve special attention, however, with regard to cosmetic-based contact allergies, most notably fragrances and preservatives
such as cinnamic alcohol and aldehyde, may no longer be able to tolerate the fragrance-preservative chemical benzyl alcohol because of cross-reactivity The fragrance -allergic patient may then, in an attempt to avoid fragrances, turn to fragrance-free products, which notably may contain the fragrance benzyl alcohol Indeed, fragrance-based chemicals may be added to products labeled as fragrance-free if they are included for an indication other than as a fragrance Benzyl alcohol has a preservative function as well as a fragrance function and can therefore be found in fragrancefree products In this example, the patient using a benzyl alcohol-containing fragrance-free product could end up with recall-type reactions in the distributions of other fragrance sensitivity responses This may occur in addition to or without a subsequent dermatitis in the area of the new fragrance-free product Obviously, a diagnosis in this case would be difficult to achieve As with any ACD, factors to consider in attempting to correlate exposure with reactions and control future outbreaks are (1) the number and duration of exposures to the same chemical (even if it is in a different product composition); (2) status of the skin barrier; (3) occlusion; and (4) the amount (dose) per unit area of skin exposed2
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