Hematogenic contact dermatitis L23.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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hematogenic contact allergic eczema; hematogenic contact dermatitis; Hematogenic contact dermatitis; systemically induced contact dermatitis; Systemic contact dermatitis

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  • Contact allergic eczema, which is characterized by great clinical diversity and is hematogenically (internally) triggered, in which sensitization and triggering, or only triggering, occurs through a systemic allergen supply. The responsible allergen can be absorbed through the skin, orally, by inhalation or systemically. Possible allergens are e.g. metals such as nickel, chromium, cobalt, gold; drugs, fungal antigens, food allergens. It is not uncommon for a consecutive, generalised (exanthematic) eczema reaction to occur.
  • Special forms are various forms of dyshidrotic eczema of the hands and feet (see eczema, dyshidrotic) as well as the Baboon syndrome ("baboon syndrome").

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No reliable data on incidence or prevalence are available. A large number of publications are available on the contact allergens nickel (see below nickel allergy) and Peru balsam. In most cases, proof of type IV sensitisation (see below allergy) by the contact allergen in question (see below allergen) was a prerequisite for diagnosis.

Clinical features
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Diverse exanthematic clinical picture that develops a few hours to days after allergen intake. The exanthema is usually clearly itchy, initially small spots, initially follicular, macular or papular, later also plaque-like, and the classic initial focus, as in contact allergic eczema, is usually absent. A special form is the Baboon syndrome, a frequently drug-induced contact eczema, which is localised on the inguinal and gluteal sides (baboon syndrome). Erythema exsudativum multiforme-like exanthema is found after antiphlogistic external agents (e.g. diclophenac-containing external agents). Symmetrical dyshidrotic eczema can also be induced hematogenically.

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Restricted general condition, fever, increased inflammation parameters (e.g. CRP and BSG), lymphadenopathies and eosinophilia can be observed.

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The histological picture is not diagnosis specific and shows a follicular but also non follicular spongiotic dermatitis of different acuteity. This cannot be distinguished from other clinical pictures with spongiotic dermatitis. Usually a slightly widened epidermis with orthohyperkeratosis is found. Frequent loss of the basket plexus structure. Focal epidermotropia with spongiosis. Edema of varying severity in the papillary dermis. Bulky, perivascularly oriented, but also diffuse, predominantly lymphocytic infiltrate is present.

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Anamnesis, clinic, evidence of triggers and a systemic late type reaction. Allergen detection must be carried out by means of an epicutaneous test. It should be critically noted that epicutaneous testing can lead to "false negative results". Thus, various authors call for a positive oral provocation test for diagnosis. The provocation test should be preceded by a 6-8 week allergen avoidance phase. The oral provocation test is performed with the following test substances: Peru balsam (1.0 g); nickel (2.0-5.0 g) chromium (2.0-3.0 mg); cobalt (1.0 mg).

Differential diagnosis
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  • Clinical differential diagnosis:
    • Differentiation is the scattering allergic contact eczema (see below: eczema, contact dermatitis, allergic), in which the allergen supply is external, but the contact reaction does not have a sharp edge on the healthy skin, but instead attacks the uncontacted surrounding skin with "scattering" eczema papules (for the differential diagnosis see below: eczema, contact dermatitis, toxic).
    • Dyshidrotic allergic contact eczema: Following local allergen contact, vesicular or bullous dermatitis develops on the palms of the hands and soles of the feet with clear, intraepidermal vesicles or blisters.
    • Seborrhoeic eczema: mainly located on the trunk, here in seborrhoeic zones (sweat ducts in the sternal area, along the spine, shoulder girdle) but also centrofacial. Chronic, mostly figured, little itching, scaling of varying intensity, mostly localized, sharply defined, red or red-brown spots, papules or plaques.
  • Histological differential diagnosis: The histological picture is not diagnosis specific. Therefore, all clinical pictures with spongiotic dermatitis should be considered for differential diagnosis.

External therapy
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Refatting topical steroids. S.u. Eczema.

Internal therapy
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Short-term glucocorticoids (e.g. prednisolone) in dosages of 100-150 mg/day i.v. or p.o. antihistamines such as dimetine maleate (Fenistil 2 times/day 1 amp. i.v.).

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After the therapy of the acute skin symptoms a consequent avoidance of allergens should follow (familiarize the patient with the corresponding diet plans; diet consultants are recommended).

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  1. Erdmann SM et al (2010) Food-borne hematogenic contact dermatitis. Allergo J 19: 264-271
  2. Meier H et al (1999) Occupationally-induced contact dermatitis and bronchial asthma in an unusual delayed reaction to hydroxychloroquine. dermatologist 50: 665-669
  3. Menne T et al (1984) Hematogenous contact dermatitis after oral administration of neomycin. Dermatologist 35: 319-320


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020