Allergy Cases.org: 01/2009

Cellular and Molecular Immunology by Abbas et al: Video Lectures and Q&A

Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology

The textbook Cellular and Molecular Immunology by Abbas et al. explains the experimental observations that form the basis for the science of immunology.

Some links that may help you to get more out of the textbook are listed below:

Video Lectures, Conferences On-Line Allergy (COLA) by Children's Mercy Hospital

Immunology - Abbas Chapter 5: MHC

Immunology - Abbas Chapter 7: Antigen Receptors and Accessory Molecules

Imuunology - Abbas Chapter 8 - Lymphocyte Development

Immunology: Abbas Chapter 9 - T-cell Activation

Immunology: Abbas Chapter 10 - B-cell Activation

Immunology: Abbas Chapter 11 - Immunologic Tolerance

Immunology: Abbas Chapter 13 - Effector Mechanisms of Cell-Mediated Immunity

Cytokines and Their Receptors

Anticytokine Treatments for Asthma and Rhinitis

Immunology Jeopardy

Principles of Flow Cytometry

The Conferences On-Line Allergy (COLA) is a collaborative venture between the Children's Mercy Hospitals & Clinics section of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology (ACAAI).

Questions and Answers

Abbas MCQ from FIT Corner by ACAAI, 2004.

The questions are posted in a reverse chronological order and you have to scroll to the bottom of the web page in order to see the first chapter.

Image source: Nutrophil, Wikipedia, GNU Free Documentation License.

Published: 02/01/2009
Updated: 03/04/2009

Labels: Education, Fellowship, Podcast, Review, Video

Irritant contact dermatitis to acne medication that contains benzoyl peroxide

Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology

A 25-year-old Caucasian female developed worsening symptoms of facial dermatitis during the last 3 months. She started using over-the-counter hydrocortisone cream yesterday and her symptoms are better now. This is the third episode of similar complaints in the last 3 months. She reports long term use of the acne cream Proactiv, which contains benzyl peroxide, and she also uses Eucerin lotion on her face.

Medications

Her medications include Allegra (fexofenadine), Flonase (fluticasone nasal) and levothyroxine. Proactiv and Eucerin.

Past medical history

She has a long history of allergic rhinitis and conjunctivitis.

Physical examination

The physical examination is positive for facial erythema with some eyelid eczema.

What is the most likely diagnosis?

Facial dermatitis related to Proactiv, containing benzoyl peroxide. The etiology of the dermatitis is either irritant or allergic contact dermatitis to benzoyl

peroxide. Considering that she had two prior episodes that resolved and the rash is not worsening now, the most likely explanation for her condition is irritant contact dermatitis to benzoyl peroxide.

What treatment would you suggest?

The patient was advised to use hydrocortisone at the lowest of concentration of 1%, daily, on the face, for a week. She had to stop using Proactiv immediately. She could still use Eucerin daily.

Final diagnosis

Irritant contact dermatitis to acne medication that contains benzoyl peroxide.

Benzoyl peroxide (BP) is shown to be a weak allergen. In a study of 25 guinea pigs, only 5 were sensitized in the TINA test. BP is a skin irritant. However, only 11 of 155 acne patients had clinical signs of intolerance, which settled despite continued use in 10 cases.

References

Purpuric contact dermatitis to benzoyl peroxide. van Joost T, van Ulsen J, Vuzevski VD, Naafs B, Tank B. J Am Acad Dermatol. 1990 Feb;22(2 Pt 2):359-61.

Allergic contact angioedema to benzoyl peroxide. Minciullo PL, Patafi M, Giannetto L, Ferlazzo B, Trombetta D, Saija A, Gangemi S. J Clin Pharm Ther. 2006 Aug;31(4):385-7.

Allergic and irritant potential of benzoyl peroxide. Haustein UF, Tegetmeyer L, Ziegler V. Contact Dermatitis. 1985 Oct;13(4):252-7.

Contact dermatitis due to benzoyl peroxide. Morelli R, Lanzarini M, Vincenzi C, Reggiani M. Contact Dermatitis. 1989 Mar;20(3):238-9.

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