Protein contact dermatitis - Case report
A 37-year-old female, with a personal history of intrinsic asthma, treated with\nsalbutamol, and who worked as a cook, was referred to our Center for evaluation of skin\nlesions on the dorsum of the hands and forearms, which had started 2 years before. On\nphysical examination eczematous plaques were observed on the dorsal aspect of both\nforearms and hands, including fingers and interdigital surfaces, with the presence of\nfissures (). She had previously been\ntreated with moderate potency topical corticosteroids without improvement.\nThe patient worked as a cook at a Japanese restaurant, and daily handled food based on\nfish and vegetables (). She used\nprotective latex gloves during her daily routine and reported that during vacations or\nrest days she experienced major improvement, as well as worsening when she returned to\nwork.\nGiven the clinical aspect, location of the lesions and the patient's occupation, we\ndecided to conduct patch testing with the baseline series of the Spanish Group for\nResearch of Allergy and Contact Dermatitis and the rubber series (True Test and\nChemotechnique Diagnostics), in addition to prick-by-prick tests with all the raw food\nthat the patient handled daily at her workplace. All patch tests were negative.\nRegarding the prickby-prick tests, positive results were observed to crab, tuna fish,\nsalmon, scallop, eel, shrimp and butterfish (). Additionally IgE levels were measured in serum, with high levels of total\nIgE (326 IU / ml), shrimp IgE (0.52 KU / L) and crab IgE (0.52 KU / L).\nWith the diagnostic test results and the patient's clinical and occupational history,\nthe diagnosis of protein contact dermatitis was established. The patient was advised to\navoid contact with prawns, shrimp and crab, both handling and ingestion, and to wear\nprotective plastic gloves. Prompt improvement was observed.