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Negative results of patch testing with standard and textile series in a case of annular lichenoid dermatitis of youth

2005; Elsevier BV; Volume: 53; Issue: 1 Linguagem: Inglês

10.1016/j.jaad.2004.10.887

1097-6787

Carlos de la Torre, Ángeles Flórez, Virginia Fernández‐Redondo,

Allergic Rhinitis and Sensitization

To the Editor: We evaluated a case of annular lichenoid dermatitis of youth for allergic contact dermatitis. To our knowledge, no papers have addressed this topic since the recent publication of this new entity by Annessi et al.1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google ScholarA 22-year-old man presented with a 1-year history of an asymptomatic eruption on the pelvic girdle area. Examination revealed several annular plaques (up to 8 cm × 3 cm in size) with a raised erythematous, well-defined border and depressed hypopigmented center (Fig. 1). Our initial clinical diagnosis included morphea, annular erythema, and annular lichenoid dermatitis of youth. Results of laboratory investigations, including peripheral blood cell counts, liver and renal function tests, blood glucose levels, and urinalysis were within normal limits. Antinuclear and antiborrelia antibodies were negative. A biopsy was performed, and the histopathologic examination disclosed a lichenoid dermatitis with massive apoptosis in the tips of the rete ridges supporting the diagnosis of annular lichenoid dermatitis (Fig 2). Topical corticosteroid therapy resulted in partial regression with fading of the lesions but recurrence was noted on discontinuation of treatment.Fig 2Histologic examination revealed a lichenoid dermatitis mainly affecting the tips of the rete ridges. (Hematoxylin-eosin stain; original magnification: ×200.)View Large Image Figure ViewerDownload (PPT)Annular lichenoid dermatitis of youth was recently described by Annesi et al1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar and defined as a distinctive new inflammatory condition of the skin. Their series collected 23 patients (median age, 10 years; age range, 5-22 years; 12 females and 11 male patients) with persistent annular lesions distributed in the groins, flanks, periumbilical, and axillary regions. Histology of these lesions was characterized by a peculiar lichenoid dermatitis with apoptosis limited to the tips of rete ridges. The authors investigated the nature of the infiltrate which proved to be policlonal T-cell CD4+ predominant. A differential diagnosis was established with morphea, mycosis fungoides, and annular erythemas. According to the authors, the etiology remains to be determined, as other causes of lichenoid dermatoses, such as autoimmune, infectious, drug reactions, or contact dermatitis to common allergens could not be demonstrated.1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google ScholarTextile dermatitis frequently shows a similar distribution in areas of friction on the trunk (the axillae, groin, and waistband are frequently involved in the localized type) and atypical forms with erythema multiforme–like or nummular-like lesions have been described.2Giusti F. Massone F. Bertoni L. Pellacani G. Seidenari S. Contact sensitization to disperse dyes in children.Pediatr Dermatol. 2003; 20: 393-397Crossref PubMed Scopus (43) Google Scholar, 3Lazarov A. Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study.J Eur Acad Dermatol Venereol. 2004; 18: 531-537Crossref PubMed Scopus (57) Google Scholar A number of dermatoses may have a histologic lichenoid dermatitis pattern, among them contact dermatitis related to several allergens, including rubber and certain clothing dyes.4Oliver G.F. Winkelmann R.K. Muller S.A. Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases.J Am Acad Dermatol. 1989; 21: 284-292Abstract Full Text PDF PubMed Scopus (51) Google Scholar, 5Brancaccio R.R. Cockerell C.J. Belsito D. Ostreicher R. Allergic contact dermatitis from color film developers: clinical and histologic features.J Am Acad Dermatol. 1993; 28: 827-830Abstract Full Text PDF PubMed Scopus (30) Google Scholar, 6Sharma V.K. Mandal S.K. Sethuraman G. Bakshi N.A. Para-phenylendiamine-induced lichenoid eruptions.Contact Dermatitis. 1999; 41: 40-56Crossref PubMed Scopus (26) Google Scholar, 7Weedon D. The lichenoid reaction pattern.in: Weedon D. Skin Pathology. Churchill Livingstone, Edinburgh2002: 31-74Google ScholarThe symmetrical distribution of lesions in our patient following the belt line suggested to us a localizing external factor and we theorized with the possibility of an allergic contact dermatitis. Patch testing with the components of the European Standard series (S-1000) completed with the Spanish series and the specific series of textile colors and finish (TF-1000) (Chemotechnique Diagnostics, Tygelsjö, Sweden) was negative on reading at 48 and 96 hours.Although we initially believed that the clinical features in this case pointed to textile contact allergy, the patch test results were negative. This suggests that patch testing is probably not going to be important in the evaluation of patients with this disease. Further investigations are needed in investigating the nature of annular lichenoid dermatitis of youth. To the Editor: We evaluated a case of annular lichenoid dermatitis of youth for allergic contact dermatitis. To our knowledge, no papers have addressed this topic since the recent publication of this new entity by Annessi et al.1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar A 22-year-old man presented with a 1-year history of an asymptomatic eruption on the pelvic girdle area. Examination revealed several annular plaques (up to 8 cm × 3 cm in size) with a raised erythematous, well-defined border and depressed hypopigmented center (Fig. 1). Our initial clinical diagnosis included morphea, annular erythema, and annular lichenoid dermatitis of youth. Results of laboratory investigations, including peripheral blood cell counts, liver and renal function tests, blood glucose levels, and urinalysis were within normal limits. Antinuclear and antiborrelia antibodies were negative. A biopsy was performed, and the histopathologic examination disclosed a lichenoid dermatitis with massive apoptosis in the tips of the rete ridges supporting the diagnosis of annular lichenoid dermatitis (Fig 2). Topical corticosteroid therapy resulted in partial regression with fading of the lesions but recurrence was noted on discontinuation of treatment. Annular lichenoid dermatitis of youth was recently described by Annesi et al1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar and defined as a distinctive new inflammatory condition of the skin. Their series collected 23 patients (median age, 10 years; age range, 5-22 years; 12 females and 11 male patients) with persistent annular lesions distributed in the groins, flanks, periumbilical, and axillary regions. Histology of these lesions was characterized by a peculiar lichenoid dermatitis with apoptosis limited to the tips of rete ridges. The authors investigated the nature of the infiltrate which proved to be policlonal T-cell CD4+ predominant. A differential diagnosis was established with morphea, mycosis fungoides, and annular erythemas. According to the authors, the etiology remains to be determined, as other causes of lichenoid dermatoses, such as autoimmune, infectious, drug reactions, or contact dermatitis to common allergens could not be demonstrated.1Annessi G. Paradisi M. Angelo C. Perez M. Puddu P. Girolomoni G. Annular lichenoid dermatitis of youth.J Am Acad Dermatol. 2003; 49: 1029-1036Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar Textile dermatitis frequently shows a similar distribution in areas of friction on the trunk (the axillae, groin, and waistband are frequently involved in the localized type) and atypical forms with erythema multiforme–like or nummular-like lesions have been described.2Giusti F. Massone F. Bertoni L. Pellacani G. Seidenari S. Contact sensitization to disperse dyes in children.Pediatr Dermatol. 2003; 20: 393-397Crossref PubMed Scopus (43) Google Scholar, 3Lazarov A. Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study.J Eur Acad Dermatol Venereol. 2004; 18: 531-537Crossref PubMed Scopus (57) Google Scholar A number of dermatoses may have a histologic lichenoid dermatitis pattern, among them contact dermatitis related to several allergens, including rubber and certain clothing dyes.4Oliver G.F. Winkelmann R.K. Muller S.A. Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases.J Am Acad Dermatol. 1989; 21: 284-292Abstract Full Text PDF PubMed Scopus (51) Google Scholar, 5Brancaccio R.R. Cockerell C.J. Belsito D. Ostreicher R. Allergic contact dermatitis from color film developers: clinical and histologic features.J Am Acad Dermatol. 1993; 28: 827-830Abstract Full Text PDF PubMed Scopus (30) Google Scholar, 6Sharma V.K. Mandal S.K. Sethuraman G. Bakshi N.A. Para-phenylendiamine-induced lichenoid eruptions.Contact Dermatitis. 1999; 41: 40-56Crossref PubMed Scopus (26) Google Scholar, 7Weedon D. The lichenoid reaction pattern.in: Weedon D. Skin Pathology. Churchill Livingstone, Edinburgh2002: 31-74Google Scholar The symmetrical distribution of lesions in our patient following the belt line suggested to us a localizing external factor and we theorized with the possibility of an allergic contact dermatitis. Patch testing with the components of the European Standard series (S-1000) completed with the Spanish series and the specific series of textile colors and finish (TF-1000) (Chemotechnique Diagnostics, Tygelsjö, Sweden) was negative on reading at 48 and 96 hours. Although we initially believed that the clinical features in this case pointed to textile contact allergy, the patch test results were negative. This suggests that patch testing is probably not going to be important in the evaluation of patients with this disease. Further investigations are needed in investigating the nature of annular lichenoid dermatitis of youth.