This 19-year-old college student went to the Student Health Services because she had a slowly developing rash on both earlobes, hands and wrist, and around her neck. Her medical history revealed that she had eczema in childhood. During her early teens, she had facial acne, for which she was given tetracycline. Physical examination revealed a rash of erythema and small blisters, with marked excoriation because of the itching. Her hands were red, scaly, and dry. The rash on her hands was different from the eruptions on her neck and ears. A contact hypersensitivity was suspected. Follow-up patch tests included a standard battery of agents—rubber, cosmetics, plant extracts, perfumes, nickel, and makeup. Strongly positive reactions for rubber and nickel were observed. The student was advised to eliminate contact with rubber (e.g., rubber gloves) used at home or on the job. Her jewelry probably contained nickel and was believed to be the source of the irritation to her earlobes, neck, and wrists. She was advised to wear only nickel-free jewelry. A mild corticosteroid cream was prescribed for use until her symptoms disappeared. Why did the jewelry cause a rash? What is the mechanism of type IV hypersensitivity involvement in contact eczema?
This 19-year-old college student went to the Student Health Services because she had a slowly developing rash on both earlobes, hands and wrist, and around her neck.
Her medical history revealed that she had eczema in childhood. During her early teens, she had facial acne, for which she was given tetracycline. Physical examination revealed a rash of erythema and small blisters, with marked excoriation because of the itching. Her hands were red, scaly, and dry. The rash on her hands was different from the eruptions on her neck and ears. A contact hypersensitivity was suspected.
Follow-up patch tests included a standard battery of agents—rubber, cosmetics, plant extracts, perfumes, nickel, and makeup. Strongly positive reactions for rubber and nickel were observed.
The student was advised to eliminate contact with rubber (e.g., rubber gloves) used at home or on the job. Her jewelry probably contained nickel and was believed to be the source of the irritation to her earlobes, neck, and wrists. She was advised to wear only nickel-free jewelry. A mild corticosteroid cream was prescribed for use until her symptoms disappeared.
- Why did the jewelry cause a rash?
- What is the mechanism of type IV hypersensitivity involvement in contact eczema?
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