CI and Dermatology Manifestation

Bullous Skin Disease 
Dermatitis (Contact or Allergic)
Uritcaria / Angiodema 


Atopic Dermatitis
  • Predisposed for skin Infection 
  • Increased risk of lymphoma associated with disease itself and not medications 
  • Dilute bleach bath may work (on an individual basis; strong evidence; only one study) 
  • Have predisposed skin condition including
    • Barrier abnormality: Hence, fluticasone cream (2/ week) unto 12 month has better outcome 
    • Immune abnormality
  • Identification and Elimination of Triggers 
  • Wet dressing (protect skin from persistent scratch, promotes rapid healing) 
    • DO not overuse wet wrap 
  • Now, idea is to be more proactive than is such a use of barrier treatment 
    • JACI 2013, 131, 295
Contact Dermatitis  (HAS NOT BEEN DOWNLOADED YET) 
  • Dermatitis with Scattered generalized dermatitis
    • Even though most likely it can be due to Atopic Dermatitis, can also be Contact Dermatitis 
  • Allergic Contact Dermatitis with Diffuse Contact 
    • Irritant CD
    • Allergic CD
    • Note: Moisture releases textile dyes.
  • Systemic Contact Dermatitis 
    • Baboon Syndrome (most recognizable form of SCD
    • Upper inner thigh, and axilla may be involved
    • Nickel, and Balsam of Peru are common cause
      • Various foods, and utensils are rich has nickel and balsam of Peru 
  • Hand Dermatitis 
    • Both Irritant and Allergic Contact Dermatitis 
      • Allergic: 
        • Has more vesicles; dorsum of hand, finger tips, Nails of hand 
        • Less commonly involves palm 
  • Eyelid Dermatitis
    • 72 % allergic  CD
    • I5 % Irritant CD
    • Atopic Dermatitis is < 5 % 
  • Face and Neck
    • Periphery Face involvement 
      • Sampoo etc that drips down in the neck 
    • Central Face Involvement 
      • Jweelery, Make up 
  • Lip Dermatitis 
    • Irrtant 36 %
    • Allergic CD 25 %
    • AD 19 % 
  • When doing Patch Test for Eyelid, Face and Neck or Lip Dermatitis, personal home products should be used. Often dissolved with Normal Saline 
  • Shoe Induced Dermatitis 
    • Neomycin somehow in the shoe, can cause persistent contact Dermatitis. Changing shoes can fix it. 
    • Steroid use can cause false negative test 
    • Topical Calcineurion inhibitor and topical steroids : stope 5-7 days before. 
    • Routine Patch Test does not include roughly total of 40 % of materials that may cause contact dermatitis 
    • If you read only one reading at 48 hr , 1/3 rd of patch test positive will be missed 
    • Dealyed patch test reactnatns > 5 days: Gold, Metal, Abx (neomycin, bacitracin)
      • Can send the photo of the back 
    • Likewise, some allergen will be absent after 5 days. eg. Fragrance Mix, and Basalam of Peru 
    • 0.5 - 5 % of patient can have allergy to topical steroids 
  • Topical Steroids
    • Group 1 - 7. 
      • Low potency steroids have highest incidence 
      • Dexamenthasone has the least incidence of steroids allergy . Hence, this is perhaps the best way to go
      • Rim test, while is negative for other allergens may be positive for steroids as high steroid dose in central may inhibit the high concentration area 
    • True test for patch tests also includes steroids 
      • Budesonide, 
      • Hydrocortisone 
      • Tixocortocl Pivalate 
Food For thoughts: 
Patch testing in a patient with eiosinophilic esophagitis and other food allergies 


  • Autoimmune Blistering Disease
    • pemphigus vulgaris
    • bullous pemphigoid 

  • Epidermolysis bullosa