A hairdresser develops chronic eczema predominantly on the dorsal hands and fingertips that worsens at work and improves on holidays. She has a history of childhood atopic eczema. Patch testing shows positive reactions to para-phenylenediamine (PPD), thiuram mix, and nickel sulphate. This presentation represents:

• A Irritant contact dermatitis from repeated water and shampoo exposure
• B Allergic contact dermatitis (type IV hypersensitivity) superimposed on atopic background (polysensitisation) ✓
• C Pompholyx (dyshidrotic eczema) triggered by sweat
• D Protein contact dermatitis — immediate reaction to hair dye proteins

Explanation

Occupational contact dermatitis in hairdressers can be irritant (from water, shampoos, bleach) or allergic. Positive patch tests to PPD (hair dye), thiuram (gloves), and nickel confirm allergic contact dermatitis (type IV, T-cell mediated delayed hypersensitivity). The improvement on holidays and worsening at work confirms occupational causation. Polysensitisation is common in atopics who develop contact allergy. Protein contact dermatitis (IgE-mediated) causes immediate urticarial rather than eczematous reactions to proteins (e.g., natural rubber latex, hydrolysed wheat). Pompholyx is a distinct vesicular pattern.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.