Systemic contact dermatitis caused by cobalt chloride and palladium in a 26-year-old woman with allergic type I reactions, non-steroidal anti-inflammatory drug hypersensitivity and autoimmune thyroiditis

Skin reactions are different in pathogenesis, types and symptoms. They include contact dermatitis (CD), which could be caused by contact allergens, haptens mostly. They are a class of antigens of molecular weight below 500 Da [1]. Especially, many metals have the potential to trigger type IV of allergic reactions: nickel [2, 3], cobalt [4] or chrome [5] mainly. Furthermore, haptens are present in various chemical agents for example cosmetics [6]. In minority of cases some kinds of haptens are able to cause generalized skin reactions typical for CD after systemic administration, for example by oral route, inhalation or intramuscular injection [7]. Haptens responsible for causing systemic contact dermatitis (SCD) could be derived from the animal and vegetable world as a part of the human diet. Certain universally consumed types of food contain potent allergens like nickel, balsam of Peru, urushiol, and sesquiterpene lactones [8].
We describe a case of SCD in a patient presenting also an immediate type of allergic hypersensitivity, hypothyroidism in the course of autoimmune inflammation of the thyroid gland with hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs).
A 26-year-old woman was admitted to the Department of Internal Diseases, Geriatrics and Allergology in 2014 because of suspected drug hypersensitivity. The clinical picture had a number of complicating features which, we felt, deserved broader explanation. First alarming symptoms appeared in the young woman 8 years prior to her referral to our clinic. There were eczematous skin lesions around eyes (Figure 1), temples and the neck, usually with accompanying severe headaches. Four years later, after she took ibuprofen, urticaria and angioedema occurred. It was manifested by swelling of lips, eyelids, and hives on the abdominal wall and on the back. Moreover, there was an allergic eczema on her face. At the emergency room the appropriate treatment was implemented and all signs subsided. Since that time, various types of recurrent skin lesions typical for eczema on different parts of the body have occurred in the patient. They usually appeared on the hands and face, and less frequently on legs, arms, around knees, on elbows, but also on the abdominal wall, back and neck after consuming a meal containing cobalt and/or palladium (Figures 2, 3). Eczematous skin lesions in the neck were also associated with the use of synthetic jewelry by the patient. Furthermore, she...


View full text...