Differential Diagnosis of Irritant Versus Allergic Contact Dermatitis Based on Noninvasive Methods

Differential Diagnosis of Irritant Versus Allergic Contact Dermatitis Based on Noninvasive Methods

Authors

  • Panagiota Gkagkari Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
  • Anna Tagka First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Syggros Hospital, Athens, Greece
  • Alexandros Stratigos First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Syggros Hospital, Athens, Greece
  • Vangelis Karalis Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
  • Aikaterini Kyritsi Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
  • Andreas Vitsos Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
  • Michail Christou Rallis Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece

Keywords:

irritant contact dermatitis, Allergic Contact Dermatitis, imaging techniques, transepidermal water loss (TEWL), oxidative stress

Abstract

Introduction: Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms underpinning each condition, the differentiation between them presents a significant diagnostic challenge.

Objective: This study aims to determine whether a combination of clinical evaluation and noninvasive measurements—encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume—can distinguish ICD from ACD.

Methods: Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments.

Results: ICD prompts an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incites a delayed response (72 hours). Noninvasive evaluated parameters as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (p < 0.05).  The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress.

Conclusions: The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis  from allergic contact dermatitis (ACD). Nevertheless, the study is constrained by a limited sample size.

References

Thyssen JP, Johansen JD, Linneberg A, Menné T. The epidemiology of hand eczema in the general population--prevalence and main findings. Contact Dermatitis. 2010 Feb;62(2):75-87. doi: 10.1111/j.1600-0536.2009.01669.x. PMID: 20136890.

Alinaghi F, Bennike NH, Egeberg A, Thyssen JP, Johansen JD. Prevalence of contact allergy in the general population: A systematic review and meta-analysis. Contact Dermatitis. 2019 Feb;80(2):77-85. doi: 10.1111/cod.13119. Epub 2018 Oct 29. PMID: 30370565.

Gittler JK, Krueger JG, Guttman-Yassky E. Atopic dermatitis results in intrinsic barrier and immune abnormalities: implications for contact dermatitis. J Allergy Clin Immunol. 2013 Feb;131(2):300-13. doi: 10.1016/j.jaci.2012.06.048. Epub 2012 Aug 28. PMID: 22939651; PMCID: PMC4281264.

Clark SC, Zirwas MJ. Management of occupational dermatitis. Dermatol Clin. 2009 Jul;27(3):365-83, vii-viii. doi: 10.1016/j.det.2009.05.002. PMID: 19580930.

Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF. Allergic and irritant contact dermatitis. Eur J Dermatol. 2009 Jul-Aug;19(4):325-32. doi: 10.1684/ejd.2009.0686. PMID: 19447733.

Bonneville M, Chavagnac C, Vocanson M, Rozieres A, Benetiere J, Pernet I, Denis A, Nicolas JF, Hennino A. Skin contact irritation conditions the development and severity of allergic contact dermatitis. J Invest Dermatol. 2007 Jun;127(6):1430-5. doi: 10.1038/sj.jid.5700726. Epub 2007 Feb 1. PMID: 17273160.

Vocanson M, Hennino A, Rozières A, Poyet G, Nicolas JF. Effector and regulatory mechanisms in allergic contact dermatitis. Allergy. 2009 Dec;64(12):1699-714. doi: 10.1111/j.1398-9995.2009.02082.x. Epub 2009 Oct 12. PMID: 19839974.

DaSilva SC, Sahu RP, Konger RL, Perkins SM, Kaplan MH, Travers JB. Increased skin barrier disruption by sodium lauryl sulfate in mice expressing a constitutively active STAT6 in T cells. Arch Dermatol Res. 2012 Jan;304(1):65-71. doi: 10.1007/s00403-011-1168-2. Epub 2011 Sep 30. PMID: 21959772; PMCID: PMC3249512.

Fu K, Qu L, Shimada SG, Nie H, LaMotte RH. Enhanced scratching elicited by a pruritogen and an algogen in a mouse model of contact hypersensitivity. Neurosci Lett. 2014 Sep 5;579:190-4. doi: 10.1016/j.neulet.2014.03.062. Epub 2014 Apr 3. PMID: 24704378; PMCID: PMC4138274.

Martin SF, Esser PR, Schmucker S, Dietz L, Naisbitt DJ, Park BK, Vocanson M, Nicolas JF, Keller M, Pichler WJ, Peiser M, Luch A, Wanner R, Maggi E, Cavani A, Rustemeyer T, Richter A, Thierse HJ, Sallusto F. T-cell recognition of chemicals, protein allergens and drugs: towards the development of in vitro assays. Cell Mol Life Sci. 2010 Dec;67(24):4171-84. doi: 10.1007/s00018-010-0495-3. Epub 2010 Aug 18. PMID: 20717835.

Kaplan DH, Igyártó BZ, Gaspari AA. Early immune events in the induction of allergic contact dermatitis. Nat Rev Immunol. 2012 Jan 13;12(2):114-24. doi: 10.1038/nri3150. PMID: 22240625; PMCID: PMC3578582.

Martin SF. Contact dermatitis: from pathomechanisms to immunotoxicology. Exp Dermatol. 2012 May;21(5):382-9. doi: 10.1111/j.1600-0625.2012.01471.x. PMID: 22509837.

Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher A, Bruze M, Cannavó A, Giménez-Arnau A, Gonçalo M, Goossens A, John SM, Lidén C, Lindberg M, Mahler V, Matura M, Rustemeyer T, Serup J, Spiewak R, Thyssen JP, Vigan M, White IR, Wilkinson M, Uter W. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis. 2015 Oct;73(4):195-221. doi: 10.1111/cod.12432. Epub 2015 Jul 14. PMID: 26179009.

Rustemeyer, T., Van Hoogstraten, I. M. W., Von Blomberg, B. M. E., Gibbs, S., & Scheper, R. J. (2011). Mechanisms of irritant and allergic contact dermatitis. In Contact Dermatitis (Fifth Edition) (pp. 43-90). Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-03827-3_3

Nijhawan RI, Matiz C, Jacob SE. Contact dermatitis: from basics to allergodromes. Pediatr Ann. 2009 Feb;38(2):99-108. doi: 10.3928/00904481-20090201-07. PMID: 19263785.

Riemann H, Schwarz T, Grabbe S. Pathomechanismen der Auslösephase der allergischen Kontaktdermatitis [Pathomechanisms of the elicitation phase of allergic contact dermatitis]. J Dtsch Dermatol Ges. 2003 Aug;1(8):613-9. German. PMID: 16296151.

DeKoven JG, Warshaw EM, Zug KA, Maibach HI, Belsito DV, Sasseville D, Taylor JS, Fowler JF Jr, Mathias CGT, Marks JG, Pratt MD, Zirwas MJ, DeLeo VA. North American Contact Dermatitis Group Patch Test Results: 2015-2016. Dermatitis. 2018 Nov/Dec;29(6):297-309. doi: 10.1097/DER.0000000000000417. PMID: 30422882.

Nassau S, Fonacier L. Allergic Contact Dermatitis. Med Clin North Am. 2020 Jan;104(1):61-76. doi: 10.1016/j.mcna.2019.08.012. Epub 2019 Oct 28. PMID: 31757238.

Tagka A, Stratigos A, Lambrou GI, Nicolaidou E, Katsarou A, Chatziioannou A. Prevalence of contact dermatitis in the Greek population: A retrospective observational study. Contact Dermatitis. 2019 Dec;81(6):460-462. doi: 10.1111/cod.13364. Epub 2019 Aug 8. PMID: 31347179.

Uter W, de Pádua CM, Pfahlberg A, Nink K, Schnuch A, Lessmann H. Contact allergy to topical corticosteroids--results from the IVDK and epidemiological risk assessment. J Dtsch Dermatol Ges. 2009 Jan;7(1):34-41, 34-42. English, German. doi: 10.1111/j.1610-0387.2008.06844.x. Epub 2008 Aug 28. PMID: 18761609.

Arslan S, Aksan S, Ucar R, Caliskaner AZ. Contact dermatitis to cobalt chloride with an unusual mechanism. Prosthet Orthot Int. 2015 Oct;39(5):419-21. doi: 10.1177/0309364614534293. Epub 2014 May 29. PMID: 24876170.

Goldenberg A, Matiz C, Eichenfield LF. Religious Allergic Contact Dermatitis. Pediatr Dermatol. 2015 Jul-Aug;32(4):e191-2. doi: 10.1111/pde.12613. Epub 2015 May 13. PMID: 25968562.

Tang B, Williams PL, Xue KS, Wang JS, Tang L. Detoxification mechanisms of nickel sulfate in nematode Caenorhabditis elegans. Chemosphere. 2020 Dec;260:127627. doi: 10.1016/j.chemosphere.2020.127627. Epub 2020 Jul 10. PMID: 32673864.

Schnuch A, Lessmann H, Frosch PJ, Uter W. para-Phenylenediamine: the profile of an important allergen. Results of the IVDK. Br J Dermatol. 2008 Aug;159(2):379-86. doi: 10.1111/j.1365-2133.2008.08644.x. Epub 2008 May 28. Erratum in: Br J Dermatol. 2008 Sep;159(3):772. PMID: 18510664.

Zapolanski T, Jacob SE. para-Phenylenediamine. Dermatitis. 2008 May-Jun;19(3):E20-1. PMID: 18627681.

Zanoni TB, Hudari F, Munnia A, Peluso M, Godschalk RW, Zanoni MV, den Hartog GJ, Bast A, Barros SB, Maria-Engler SS, Hageman GJ, de Oliveira DP. The oxidation of p-phenylenediamine, an ingredient used for permanent hair dyeing purposes, leads to the formation of hydroxyl radicals: Oxidative stress and DNA damage in human immortalized keratinocytes. Toxicol Lett. 2015 Dec 15;239(3):194-204. doi: 10.1016/j.toxlet.2015.09.026. Epub 2015 Oct 9. PMID: 26456176.

Coogan TP, Latta DM, Snow ET, Costa M. Toxicity and carcinogenicity of nickel compounds. Crit Rev Toxicol. 1989;19(4):341-84. doi: 10.3109/10408448909029327. Erratum in: Crit Rev Toxicol 1989;20(2):135. PMID: 2663022.

Stinson TJ, Jaw S, Jeffery EH, Plewa MJ. The relationship between nickel chloride-induced peroxidation and DNA strand breakage in rat liver. Toxicol Appl Pharmacol. 1992 Nov;117(1):98-103. doi: 10.1016/0041-008x(92)90222-e. PMID: 1440619.

Das KK, Dasgupta S. Effect of nickel on testicular nucleic acid concentrations of rats on protein restriction. Biol Trace Elem Res. 2000 Feb;73(2):175-80. doi: 10.1385/BTER:73:2:175. PMID: 11049209.

Kyritsi A, Kikionis S, Tagka A, Koliarakis N, Evangelatou A, Papagiannis P, Stratigos A, Karalis V, Dallas P, Vitsos A, Ioannou E, Roussis V, Rallis M. Management of Acute Radiodermatitis in Non-Melanoma Skin Cancer Patients Using Electrospun Nanofibrous Patches Loaded with Pinus halepensis Bark Extract. Cancers (Basel). 2021 May 26;13(11):2596. doi: 10.3390/cancers13112596. PMID: 34073193; PMCID: PMC8199239.

Kotroni E, Simirioti E, Kikionis S, Sfiniadakis I, Siamidi A, Karalis V, Vitsos A, Vlachou M, Ioannou E, Roussis V, Rallis M. In Vivo Evaluation of the Anti-Inflammatory Activity of Electrospun Micro/Nanofibrous Patches Loaded with Pinus halepensis Bark Extract on Hairless Mice Skin. Materials (Basel). 2019 Aug 15;12(16):2596. doi: 10.3390/ma12162596. PMID: 31443178; PMCID: PMC6720688.

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Published

2024-10-30

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1.
Differential Diagnosis of Irritant Versus Allergic Contact Dermatitis Based on Noninvasive Methods . Dermatol Pract Concept [Internet]. 2024 Oct. 30 [cited 2024 Nov. 7];14(4):e2024231. Available from: https://dpcj.org/index.php/dpc/article/view/4338

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