Irritant bullous contact dermatitis caused by a rove beetle: an illustrated clinical course

Bullous impetigo-like irritant contact dermatitis caused by perfume

Contact dermatitis usually presents as erythematous macules, papules, and vesicles. Sometimes, unusual clinical presentations of contact dermatitis are reported, including pustular, lymphomatoid, lichenoid, and pigmented variants. We describe the first patient with bullous irritant contact dermatitis caused by perfume, mimicking impetigo lesions. We report this case to raise awareness concerning the possibility of serious cutaneous reactions, such as bullous impetigo-like irritant contact dermatitis due to perfumes which are ubiquitous, especially after direct contact with the solution. Perfume ingredients, such as fragrance, solvents, and preservatives all may cause or contribute to irritant contact dermatitis.

Paederus Dermatitis Outbreak in Addis Ababa, Ethiopia: A Case-Control Study

Background

Paederus dermatitis is an irritant contact dermatitis caused by crushing insects of the genus Paederus, which releases a vesicant toxin called pederin. On July 28, 2018, the district health office received a report of cases with erythema, itching, and burning after contact with the Paederus insect. In response, we investigated the outbreak intending to describe, confirm, and identify the risk factors associated with the country's first reported outbreak.

Methods

A community-based unmatched case-control study was conducted from August 10 to 22, 2018. Two hundred twenty-five (75 cases and 150 controls) study participants were involved in the study. Cases were defined as Bole subcity residents who had acute contact dermatitis after contact with the insect, while controls were persons who did not have contact with the insect. Cases were recruited consecutively as they present, whereas controls were selected by the neighborhood sampling method. An interviewer-administered questionnaire was used for the data collection, and multiple logistic regression was applied to determine the independent risk factors. The results were expressed as adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

Results

A total of 122 cases were reported from the three districts of the subcity. The mean age of cases and controls was 23.6 (SD ± 16.4) and 29.4 (SD ± 10.9) years, respectively. Multivariate analysis showed that the presence of outdoor light (AOR = 5.1; 95% CI (2.5, 10.9), presence of rotten leaves (AOR = 6.4; 95% CI (2.9, 15.7)), sleeping on the floor (AOR = 6.1; 95% CI (2.5, 15.7)), wearing protective clothing (AOR = 0.2; 95% CI (0.1, 0.4)), and use of insect repellant (AOR = 0.1; 95% CI (0.0, 0.4)) were significantly associated with Paederus dermatitis outbreak.

Conclusion

The investigation identified exposure to artificial light and the presence of rotten leaves around the residential area as important factors leading to an increase in the odds of Paederus dermatitis. In contrast, the use of insect repellant and wearing protective clothing were shown to provide protection. The investigation determined that reducing burning outdoor lights, cleaning excess vegetation, avoiding sleeping on the floor, using insect repellants, and wearing protective clothing can reduce the risk of contracting Paederus dermatitis.

Contact dermatitis to cobalt chloride with an unusual mechanism

BACKGROUND

Contact dermatitis is a frequent inflammatory skin disease. A suspected diagnosis is based on clinical symptoms, a plausible contact to allergens and a suitable history of dermatitis. Therefore, careful diagnosis by patch testing is of great importance because the patch testing is important to find out which allergen/material causes the complaints. Metallic allergens such as cobalt are among the most common causes of allergic contact dermatitis, but frequencies of contact dermatitis to these allergens may vary in different skin areas. Here, we report an unusual case of cobalt allergy on the skin contact with the prosthetic leg of a 30-year-old female patient.

CASE DESCRIPTION AND METHODS

The patient developed maculopapular and vesicular lesions on her contact region of residual limb to prosthetic leg.

FINDINGS AND OUTCOME

She underwent standard patch testing, which resulted in a strong positive reaction to cobalt chloride.

CONCLUSION

This case report may serve to remind doctors to be aware of potential allergic reactions to prostheses and to enable them to recognize a metal allergy if it appears. Prosthetists should also be reminded of potential allergic reactions.

CLINICAL RELEVANCE

Cobalt can be used as an accelerator in making a prosthetic socket. Several cases have been reported concerning allergies to components of the prosthetic socket. This is the first report of sensitization to cobalt which is used in making a prosthetic leg.