Pruritus ani and perianal eczema as a manifestation of systemic contact dermatitis

Systemic contact dermatitis (SCD) is a mucocutaneous reaction that results from a systemic distribution of a contact allergen. This condition has been widely reported to occur after the exposure to some drugs (known as baboon syndrome), foods or dental materials. The clinical image is diverse and some cutaneous manifestations may encompass vesicular hand eczema, symmetrical intertriginous and flexural exanthema or lichenoid mucosal eruption in the vulvar area of females. In more severe cases, there is an involvement of large body surfaces that can lead to a development of diffuse scaling dermatitis or even exfoliative erythroderma [1, 2].
The modern lifestyle and progressive industrial development lead to a growing exposure to different metals such as nickel, chromium, cobalt or zinc, what increases the prevalence of contact allergy reactions in the society. Nickel is the most widespread contact allergen in our environment and represents a common component of different alloys, jewelry, foods or kitchen utensils, what undoubtedly makes the way of exposure to this metal very distinguished [3]. It is evident that different food products, such as peanuts, oatmeal, cereals, soy, chocolate, lettuce, broccoli or giblets, contain a relatively high amount of nickel. Interestingly, drinking water also seems to be a significant source of nickel, especially if it is delivered from water tanks of poor quality [4, 5].
We present a case of perianal eczema associated with pruritus ani (PA) which occurred in a female patient, with no concomitant systemic disease or any other pathology localized in the rectal area, which resolved following allergen-free diet.
A 42-year-old female patient was admitted to the Dermatology Clinic in Katowice due to persistent anal itching with concomitant eczema in the anogenital area. The patient had suffered from pruritus for over 20 years whereas some skin lesions started to occur in the anogenital area a year before. There was an intense erythema of well-demarcated borders which affected symmetrically both buttocks and the perianal surface. Additionally, some skin maceration and serous exudate could be detected. The previous therapy with both topical steroids and antifungals was ineffective. No concomitant systemic disorders or allergies were previously reported (Figure 1).
A skin biopsy from the perianal area revealed features of a chronic inflammatory process and epidermal proliferation with hyperkeratosis and...


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