Allergen Activity Pattern in Patch Test on Allergic Contact

Dermatitis Patient at Dermato-Venereology Clinic, Dr. Sardjito

Central General Hospital, Yogyakarta 2012-2016

Budi Satria, Fajar Waskito, Niken Indrastuti, Duma Mauliyasari, Sri Awalia Febriana

Dermato–Venereology Department Sardjito Central General Hospital, Gadjah Mada Medical Faculty, Yogyakarta,

Indonesia.

Keywords: Allergic Contact Dermatitis, allergen activity pattern, sensitizer, irritant, ascending pattern, descending

pattern.

Abstract: Allergic Contact Dermatitis (ACD) was caused by some group of substances which was called allergen.

Groups of those substances have their own characteristic as a sensitizer or irritant. Clinical manifestation as a

visible symptom is a balancing result between sensitizer and irritant that will be describe on pattern of allergen

activity from patch test result. This research was performed to describe allergen activity pattern for five of

most common founded allergen in patch test for ACD patient performed at Dermato-Venereology Clinic, dr.

Sardjito Central General Hospital, Yogyakarta from 2012-2016. The most common allergen was Nickel

Sulphate, Potassium dichromate, Cobalt chloride, Fragrance mix I and Fragrance mix II. Literally found that

primarily all of them are irritant, and secondary are sensitizer. Activity pattern dominantly as sensitizer were

showed by Nickel Sulphate, Potassium dichromate, Cobalt chloride for interpretation at 48-72 and 48-96

hours, where for Fragrance mix I and Fragrance mix II dominantly as a sensitizer was described for

interpretation at 48-72 hours and dominantly as irritant for 48-96 hours. Interpretation at 48-72-96 hours

continuously showed no specific allergen pattern.

1 INTRODUCTION

Contact allergies are complex diseases, and one of the

important challenges for public health and

immunology. It was still a challenge for medical

sciences to perform optimum management for the

patient. Contact dermatitis was divided to Allergic

Contact Dermatitis (ACD) and Irritant Contact

Dermatitis (ICD). 15–20% of the general population

was estimated suffered from contact allergy.

Workplace exposure, age, sex, use of consumer

products and genetic predispositions were identified

as the most important risk factors. (Peiser,2012). The

basic pathophysiology for this disease is

hypersensitivity mechanism especially type IV/ slow

onset type for the person who has experiencing

sensitization and elicitation previously and finally

show clinical manifestation, while ICD could be

suffered by any individual. ( Diepgen, 1999) ACD

was founded mostly on developing country where the

incidence rate is believed to be around 0.5±1.9 cases

per 1000 full-time workers per year.( English, 2004).

Each allergen has their own characteristic and differ

from each other and it was one of the factor which

caused variation on clinical manifestation for the

person who has been contacted to those allergen. The

characteristic / activity for chemical substance were

sensitizer and irritant, and each of them showed

different activity pattern where it was ascending for

sensitizer and descending for irritant on the patch test

interpretation result. Although contact dermatitis

uncommonly leads to hospitalization, and minor

degrees of contact dermatitis are often accepted as a

normal hazard of life, the occupational, domestic,

social and psychological implications may be

considerable. It must be assumed that the total

economic impact of ACD is very high. The research

was performed to describe allergen activity pattern

visible on interpretation of patch test result on ACD

patient at Dermato-Venereology clinic, dr. Sardjito

central general hospital, Yogyakarta from 2012-2016.

Satria, B., Waskito, F., Indrastuti, N., Mauliyasari, D. and Febriana, S.

Allergen Activity Pattern in Patch Test on Allergic Contact Dermatitis Patient at Dermato-Venereology Clinic, Dr. Sardjito Central General Hospital, Yogyakarta 2012-2016.

DOI: 10.5220/0008153801950198

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 195-198

ISBN: 978-989-758-494-7

195

2 METHODS

This is a descriptive retrospective research using

medical record data from patients that have been

diagnosed as an ACD and have been performed patch

test in Dermato-Venereology clinic dr. sardjito

central general hospital Yogyakarta from 2012-2016

using standard serial patch test and listed for five of

the most common founded allergen. The listed

allergen was analyzed for its activity pattern showed

on patch test interpretation from 48, 72, 96 hours.

Each allergen was compared for its activity from 48

to 72 hours, 48 to 96 hours, and 48-72-96 hours then

calculated for percentage.

3 RESULTS

Five of most common founded positive allergen listed

were Nickel sulphate, Potassium dichromate, Cobalt

chloride, Fragrance mix I, and Fragrance mix II.

Interpretation on patch test result for Nickel sulphate,

Potassium dichromate, Cobalt chloride at 48-72 hours

and 48-96 hours showed dominantly sensitizer

pattern (ascended). Interpretation for Fragrance mix

I, and Fragrance mix II showed sensitizer pattern on

interpretation at 48-72 hours, while for interpretation

at 48-96 hours showed dominantly irritant pattern. No

specific dominant pattern was showed on

interpretation at 48-72-96 hours, as minimal

limitation score as sensitizer and irritant showed on

table 2.

4 DISCUSSION

The prevalence of contact allergy is rising worldwide.

This results in high costs for health care systems and

the economy as well as in an impairment of the

quality of life for the patients.(Nguyen, 2008),(

Kohl,2002), (Lunder, 2000). Contact dermatitis is

often localized on the hands, a highly visible area of

the body, thus drawing attention and causing

difficulties in social interaction. Jowett and Ryan

found that, in general, 38% of patients with eczema

noticed interference with social life ( Jowett,1985). In

a follow-up study of 954 patients with contact

dermatitis, 61% reported that they had lost time from

work due to their skin disease ( Mälkönen, 2009).

About 6% of all patients had been off work for longer

than 12 months continuously.

Each allergen or chemical substance has been

studied and analyzed then listed on some literation,

but visible clinical manifestation caused by those

allergen or chemical substance could be varied, and

not always as a result of its main characteristic. (

Thyssen,2007) In Europe about 20% of the general

population suffers from contact allergy to at least one

contact allergen. Most common are allergies to

nickel, fragrances and preservatives. Allergic

reactions to chromate and p-phenylenediamine (PPD)

are generally less common but occur frequently in

occupationally exposed subgroups of the population.

Contact dermatitis occurs twice as frequently in

women as in men and often starts at a young age, with

a prevalence of 15% in 12–16 year olds. (

Nosbaum,2009). Literally said that all of those

allergen most common founded positive on patch test

for ACD patient at Dermato-venereology clinic

central general hospital Yogyakarta 2012-2016 which

are Nickel sulphate, Potassium dichromate, Cobalt

chloride, Fragrance mix I and Fragrance mix II were

mainly irritant and sensitizer secondarily (ASTM,

2005), (Sciencelab, 2013), (Sheet,2009). Dominant

activity pattern as sensitizer showed on interpretation

on patch test result for Nickel sulphate, Potassium

dichromate, Cobalt chloride at 48-72 and 48-96

hours. Dominant activity pattern as sensitizer showed

on interpretation on patch test result for Fragrance

mix I and Fragrance mix II at 48-72 hours while

dominant activity pattern as irritant showed on

interpretation at 48-96 hours. Interpretation at 48-72-

96 hours continuously showed no specific allergen

pattern. Contact dermatitis is a pattern of

inflammatory response of the skin that may occur as

a result of contact with external factors (allergens,

irritants). The clinical picture is a polymorphic

pattern of inflammation of the skin characterized by a

wide range of clinical features like itching, redness,

scaling, erythema, vesiculation, and clustered

papulovesicles. In chronic cases, assuring,

hyperkeratosis, and lichenification occur. The variety

of morphologies and natural histories makes it

difficult to define a widely accepted, standardized

definition of the disease, which is needed to compare

epidemiological studies. (Diepgen,1999)

The difference on clinical manifestation could be

caused by combination of endogenous factor (atopic)

and exogenous factor (allergen concentration), and

the balance of sensitize and irritant activity. Skin

contact with irritants and/or allergens is a necessary

condition of contact

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

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Table 1 Allergen activity pattern for interpretation on 2 timing comparation

No Allergen Case

number

48 and 72 hours pattern 48 and 96 hours pattern

Ascending

(case/

percent)

Descending

(case/

percent)

Ascending

(case/

percent)

Descending

(case/

percent)

1 Nickel sulphate 137 81 / 59,12 15 / 10,9 91 / 66,42 12 / 8,75

2 Potassium

dichromate

123 69 / 56,09 12 / 9,25 83 / 67,47 13 / 10,56

3 Cobalt chloride 98 48 / 48,9 10 / 10,2 32 / 32,65 21 / 21,42

4 Fragrance Mix I 88 42 / 47,72 15 / 17,05 13 / 14,77 41 / 46,59

5 Fragrance Mix II 87 43 / 49,42 3 / 3,44 14 / 16,09 39 / 44,82

Table 2 Allergen activity pattern for interpretation on 3 timing comparation (48-72-96)

No Allergen Ascending (case/

percent)

Descending (case/

percent)

Non Pattern (case/

percent)

1 Nickel sulphate 41 (29,92) 9 (6,56) 87 (63,50)

2 Potassium dichromate 37 (30,08) 4 (3,25) 82 (66,67)

3 Cobalt chloride 11 (11,22) 8 (8,16) 79 (80,61)

4 Fragrance Mix I 13(14,77) 9 (10,22) 66 (76,13)

5 Fragrance Mix II 21 (24,13) 2 (2,29) 64 (73,56)

dermatitis and the probability and severity of a

reaction depend on the type and intensity of exposure.

Additionally, apart from exposure to hazardous

substances, there are many endogenous factors that

may influence the development of contact dermatitis

other than atopic condition such as the condition of

the epidermal barrier, sensitization, psychological

factors, age, and gender. Environmental factors may

play a role in this process by influencing the

individual susceptibility and the characteristics of

exposure. A wide spread application of a weak

allergen or irritant is more likely to result in a high

proportion of cases than the use of a particularly

strong but rare agent. It should be noted that exposure

is characterized by concentration and duration. (

Diepgen,1999), (COENRAADS,1983) It should be

noticed that basically pathogenesis of ICD and ACD

start simultaneously. (Diepgen,1999)

Strategies for prevention of ACD include

identifying allergens and irritants, substituting

chemicals that are less irritating or allergenic,

establishing engineering controls to reduce exposure,

and organizing the work in a way that all employees

are exposed to the same degree. Personal protection,

such as gloves or barrier cream, has to be the last

choice, but is often resorted to in the first place. (Rea,

1967) Allergen activity pattern aid to describe the

characteristic of each allergen and to create the

prevention system and management. Further research

needed with attention on availability of atopic factor

and exact allergen concentration needed to caused

skin reaction on patch test to normal population

especially.

5 CONCLUSIONS

Data has showed that five of the most common

founded positive allergen on ACD patient that has

performed patch test in Dermato-venereology clinic

dr. sardjito central general hospital Yogyakarta from

2012-2016 were Nickel sulphate, Potassium

dichromate, Cobalt chloride, Fragrance mix I and

Fragrance mix II. Activity pattern dominantly as a

sensitizer was showed for Nickel sulphate, Potassium

dichromate, Cobalt chloride at 48-72 hours and 48-96

hours’ interpretation. Activity pattern dominantly as

sensitizer for Fragrance mix I and Fragrance mix II

was showed at 48-72 hours’ interpretation while for

48-96 hours show dominantly irritant pattern.

Interpretation for 48-72-96 hours continuously

Allergen Activity Pattern in Patch Test on Allergic Contact Dermatitis Patient at Dermato-Venereology Clinic, Dr. Sardjito Central General

Hospital, Yogyakarta 2012-2016

197

showed no specific dominant activity pattern. Further

research needed for assessment the atopic risk

factor’s influence and exact allergen concentration

needed for skin reaction on patch test for normal

population

ACKNOWLEDGEMENTS

Special thanks to Dr. Fajar

Waskito,Sp.KK(K),M.Kes for his idea and assistance

during the research, and also for DR.Dr. Niken

Indrastuti,Sp.KK(K), and Dr. Sri Awalia

Febriana,M.Kes, SP.KK, Ph.D, for their contribution

during this research. Hopefully that the result of this

research could be as a guidance for optimum

management of ACD through patch test

interpretation. None of the authors had a conflict of

interest

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