Title Dijagnostički pristup i liječenje kontaktnog alergijskog dermatitisa Title (english) Diagnostic approach and treatment of contact allergic dermatitis Author Anja Perković Mentor Suzana Ljubojević Hadžavdić (mentor)Committee member Zrinka Bukvić Mokos (predsjednik povjerenstva)Committee member Romana Čeović (član povjerenstva)Committee member Suzana Ljubojević Hadžavdić (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Kontaktni alergijski dermatitis (KAD) je upalna eritematozna bolest kože koja se manifestira kožnim promjenama na mjestu kontakta s vanjskim alergenom u prethodno senzibiliziranog pojedinca i posljedica je reakcije odgođene preosjetljivosti. Prevalencija KAD-a u europskoj općoj populaciji iznosi između 10 i 27%. Žene obolijevaju češće od muškaraca i rizik nastanka KAD-a je veći u nekim profesionalnim zanimanjima. U najčešće alergene ubrajaju se nikal i kobalt iz nakita, mirisi u kozmetici, kemikalije gume, kromatske soli u kožnoj odjeći i obući te boje za kosu. U patogenetski mehanizam nastanka KAD-a uključeni su složeni imunološki putevi i upalni medijatori na koje utječu genetski i okolišni čimbenici. U kliničkoj slici kožne promjene nalazimo najčešće na izloženim dijelovima tijela praćene osjećajem svrbeža. Za postavljanje dijagnoze važno je uzeti detaljnu anamnezu izloženosti, prepoznati i posumnjati na kontaktni dermatitis temeljem kliničke slike i učiniti odgovarajuće dijagnostičke testove. Epikutano testiranje je zlatni standard dijagnostike KAD-a. Provodi se aplikacijom alergena osnovne i, po indikaciji, proširene serije alergena pod okluzijom tijekom 48 sati na očišćenu kožu leđa pacijenta. Reakcije se očitavaju najmanje dva puta, a optimalno je to učiniti drugog, trećeg ili četvrtog i sedmog dana od aplikacije. Reakcije se interpretiraju prema kriterijima Međunarodne grupe za istraživanje kontaktnog dermatitisa (ICDRG), a konačna interpretacija rezultata uzima u obzir i relevantnost alergena. Nakon što se identificiraju alergeni uzročnici, edukacija pacijenta je ključna za pravilno liječenje i zbrinjavanje. Potrebna je kvalitetna edukacija o prisutnosti alergena u pacijentovoj okolini i načinima kako ga izbjeći. Farmakološko liječenje lokaliziranog oblika KAD-a uključuje primjenu lokalnih pripravaka srednje i visoko potentnih kortikosteroida te lokalnih inhibitora kalcineurina. U slučajevima kada mjere izbjegavanja i lokalne terapije nisu uspješne, u obzir dolazi terapija ultraljubičastom svjetlošću ili sistemska imunosupresija. U teškom obliku KAD-a primjenjuje se sistemska imunosupresija kortikosteroidima, oralnim retinoidima, azatioprinom, metotreksatom, ciklosporinom ili mikofenolat mofetilom. Mjere prevencije su univerzalne i uključuju izbjegavanje daljnjeg kontakta s alergenom, zaštitu kožne barijere korištenjem hidratantnih krema i prikladne zaštitne opreme.
Abstract (english) Contact allergic dermatitis (CAD) is an inflammatory eczematous skin disease that manifests by skin lesions at the site of contact with an external allergen in a previously sensitized individual and it is the result of a delayed hypersensitivity reaction. The prevalence of CAD in the European general population is between 10 and 27%. Women are affected more often than men and the risk of developing CAD is higher in some occupations. The most common allergens appear to be nickel and cobalt from jewelry, fragrances in cosmetics, rubber chemicals, chromate in leather clothing and footwear and hair dye. The pathogenetic mechanism of CAD includes complex immune pathways and inflammatory mediators, influenced by both genetic and environmental factors. In the clinical presentation, skin lesions are often found on exposed parts of the body accompanied by pruritus. The diagnosis is made on by taking a detailed history of exposure, by suspecting and recognizing CAD based on clinical presentation and by preforming appropriate diagnostic tests. Epicutaneous patch testing is the gold standard for diagnosing CAD. It is performed by applying allergens of the baseline and, if indicated, extended series of allergens under occlusion for 48 hours on the cleansed skin of the patient's back. Reactions are read at least twice, and it is optimal to do so on second, third or fourth and seventh day after application. Reactions are interpreted according to the criteria of the International Contact Dermatitis Research Group (ICDRG), and the final interpretation of the results takes into account the relevance of the allergen. Once the causative allergens have been identified, patient education is crucial to proper treatment and management of the patient. Quality education on presence of allergens in patient's environment and different ways to avoid it is needed. Pharmacological treatment of localized form of CAD includes the usage of topical corticosteroids with mild and high potency and local calcineurin inhibitors. In cases where avoidance measures and local therapy are not successful, ultraviolet therapy and systemic immunosuppression may be considered. In severe form of CAD, systemic immunosuppression with corticosteroids, oral retinoids, azathioprine, methotrexate, cyclosporine, or mycophenolate mofetil is used. Measures of prevention are universal and include avoiding further contact with the allergen, protecting the skin barrier by using moisturizers and appropriate protective equipment.
Keywords
kontaktni alergijski dermatitis
epikutani test
imunosupresivi
UV terapija
Keywords (english)
contact allergic dermatitis
patch test
immunosuppression therapy
UV therapy
Language croatian URN:NBN urn:nbn:hr:105:050344 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-07-18 11:12:22
