Exacerbation of allergic contact dermatitis during immunosuppression with cyclosporine A.

Allergic contact dermatitis (ACD) is one of the commonest occupational diseases in industrialized countries, where it comprises 20-70% of all occupational diseases. Recent studies found out the top ten allergens, but there are some differences in their frequency in relation to gender and age of patients: Myroxylon pereirae and Carba mix resulted the most prevalent allergens in men, while in women the most common sensitizers were nickel sulfate, PPD, fragrance mix and cobalt chloride. ACD is an inflammatory skin disease caused by repeated skin exposure to contact allergens, in which the lesions are due to T CD8+ cells in a type IV, delayed or cell-mediated, immune reaction. The typical skin lesions of ACD in general outburst in contact areas with the specific allergens and they are erythematosus-squamous lesions with other little differences in relation to localization, for example edema, vesicular-exuding lesions or onychodystrophy. Different treatment options exist and are applied according to the severity of the lesions. Topical treatments consist of bland emollients, corticosteroids ointments, topical immunomodulators such as tacrolimus and pimecrolimus ointments, coal tar and derivatives and irradiation with ultraviolet lights or X-rays; while azathioprine, methotrexate, cyclosporine A, oral retinoids or oral corticosteroids represent systemic options of therapy. Nevertheless, the control of chronic ACD is often difficult, overall in patients with chronic ACD.