Differentiating Allergic and Irritant Contact Dermatitis Based on Histopathology: Overview
DOI:
https://doi.org/10.56570/jimgs.v3i2.175Keywords:
irritant contact dermatitis, allergic contact dermatitis, diagnosis, histology, histopathology, biopsy findings, light microscopyAbstract
Differentiating Allergic Contact Dermatitis(ACD) from Irritant Contact Dermatitis (ICD) has posed a significant challenge for dermatologists, allergists, and histopathologists. Over the years, many studies have been conducted to determine whether ACD can be differentiated from ICD based on histopathology findings. A clear-cut distinction based on histopathology will facilitate the diagnosis and appropriate management of both conditions. Abbreviations: CD, Contact Dermatitis; ACD, allergic contact dermatitis; ICD, irritant contact dermatitis Objective: This review summarizes the existing literature on whether and how ACD can be differentiated from ICD based on histopathology findings. Methods: Pubmed, Embase, Web of Science, Scopus, Cochrane Library, and Google Scholar were searched from inception to August 23, 2024, for primary literature reporting on histopathology findings in ACD and ICD. We used the search words: contact dermatitis, allergic contact dermatitis, irritant contact dermatitis, histopathology, histology, biopsy, light microscopy, diagnosis. Conclusions: Although the difference between ACD and ICD has been extensively studied over the past years, the research still needs to be more conclusive in categorically differentiating the two. Further research on the comparative histopathology of ACD vs ICD will enhance our understanding and ability to accurately distinguish. In addition, many chemicals possess both irritant and allergic properties, which might be the reason for the overlap. Moreover, the studies conducted up till now have only tested patients with one dosage of chemicals. Using a range of low, medium, and high doses might aid in eliciting better and more conclusive findings.References
Ackerman, A. B., Sanchez, J., Guo, Y. (1997). Histologic Diagnosis of Inflammatory Skin Diseases: An Algorithmic Method Based on Pattern Analysis. United Kingdom: Lippincott Williams & Wilkins.
Ale, S.I., Maibach, H.I. (2006). Irritant Contact Dermatitis Versus Allergic Contact Dermatitis. In: Chew, AL., Maibach, H.I. (eds) Irritant Dermatitis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-31294-3_2
Carr, R. D., Scarpelli, D. G., & Greider, M. H. (1968). Allergic contact dermatitis. Dermatology, 137(6), 358-368. Allergic Contact Dermatitis: Light and Electron Microscopic Study
Cockerell, C., Mihm, M.C., Hall, B.J., Chisholm, C., Jessup, C., Merola, M. (2014). Pediatric Inflammatory Dermatoses. In: Dermatopathology. Springer, London. https://doi.org/10.1007/978-1-4471-5448-8_19
Willis, C. M., Young, E., Brandon, D. R., & Wilkinson, J. D. (1986). Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis. British Journal of Dermatology, 115(3), 305-316. https://doi.org/10.1111/j.1365-2133.1986.tb05745.x
Ferguson, J., Gibbs, J. H., & Beck, J. S. (1985). Lymphocyte subsets and Langerhans cells in allergic and irritant patch test reactions: histometric studies. Contact Dermatitis, 13(3), 166-174. https://doi.org/10.1111/j.1600-0536.1985.tb02530.x
Frings VG, Böer-Auer A, Breuer K. Histomorphology and Immunophenotype of Eczematous Skin Lesions Revisited-Skin Biopsies Are Not Reliable in Differentiating Allergic Contact Dermatitis, Irritant Contact Dermatitis, and Atopic Dermatitis. Am J Dermatopathol. 2018 Jan;40(1):7-16. https://doi.org/10.1097/DAD.0000000000000842
Jovanovic, D. L., Petrovic, A., Paravina, M., Stanojevic, M., & Binic, I. (2003). Chronic contact allergic and irritant dermatitis of palms and soles: routine histopathology not suitable for differentiation. ACTA DERMATOVENEROLOGICA ALPINA PANONICA ET ADRIATICA, 12(4), 127- 130.https://api.semanticscholar.org/CorpusID:324602 27
Krawiec, D. R., & Gaafar, S. M. (1975). A comparative study of allergic and primary irritant contact dermatitis with dinitrochlorobenzene (DNCB) in dogs. Journal of Investigative Dermatology, 65(2), 248-251. https://doi.org/10.1111/1523-1747.ep12598271
Lachapelle, J. M. (1973). Comparative histopathology of allergic and irritant patch test reactions in man. Current concepts and new prospects. Archives Belges de Dermatologie et de Syphiligraphie, 29(1), 83-92.
Lachapelle, JM., Marot, L. (2021). Histopathological and Immunohistopathological Features of Irritant and Allergic Contact Dermatitis. In: Johansen, J.D., Mahler, V., Lepoittevin, JP., Frosch, P.J. (eds) Contact Dermatitis. Springer, Cham. https://doi.org/10.1007/978-3-030-36335-2_9
Le, T. M., Schalkwijk, J., van de Kerkhof, P. C., van Haelst, U., & van der Valk, P. G. (1998). A histological and immunohistochemical study on chronic irritant contact dermatitis. American Journal of Contact Dermatitis, 9(1), 23-28. https://doi.org/10.1016/S1046-199X(98)90141-5
Marzullo, A., Cazzato, G., Rossi, R. (2021). Histological, Immunohistochemical, and Ultrastructural Aspects of Contact Dermatitis. In: Angelini, G., Bonamonte, D., Foti, C. (eds) Clinical Contact Dermatitis. Springer, Cham. https://doi.org/10.1007/978-3-030-49332-5_5
Medenica, M., & Rostenberg Jr, A. (1971). A comparative light and electron microscopic study of primary irritant contact dermatitis and allergic contact dermatitis. Journal of Investigative Dermatology, 56(4), 259-271. https://doi.org/10.1111/1523-1747.ep12260992
Nater, J. P., & Hoedemaeker, P. J. (1976). Histological differences between irritant and allergic patch test reactions in man. Contact Dermatitis, 2(5), 247-253. https://doi.org/10.1111/j.1600-0536.1976.tb03042.x
Rantuccio, F., Sinisi, D., Scardigno, A. and Conte, A. (1978), Histologic aspects of patch test reactions in allergic contact dermatitis. Contact Dermatitis, 4: 338-342. https://doi.org/10.1111/j.1600-0536.1978.tb03846.x
So, J.K., Hamstra, A., Calame, A. et al. Another Great Imitator: Allergic Contact Dermatitis Differential Diagnosis, Clues to Diagnosis, Histopathology, and Treatment. Curr Treat Options Allergy 2, 333–348 (2015). https://doi.org/10.1007/s40521-015-0064-y
Taylor, R. M. (1986). Histopathology of contact dermatitis. Clinics in Dermatology, 4(2), 18-22. https://doi.org/10.1016/0738-081X(86)90059-3
Vestergaard, L., Clemmensen, O.J., Sørensen, F.B. and Andersen, K.E. (1999), Histological distinction between early allergic and irritant patch test reactions: follicular spongiosis may be characteristic of early allergic contact dermatitis. Contact Dermatitis, 41: 207-210. https://doi.org/10.1111/j.1600-0536.1999.tb06131.x
Wildemore JK, Junkins-Hopkins JM, James WD. Evaluation of the histologic characteristics of patch test confirmed allergic contact dermatitis. J Am Acad Dermatol. 2003 Aug;49(2):243-8. https://doi.org/10.1067/s0190-9622(03)00865-x
Willis, C. M., Stephens, C. J., & Wilkinson, J. D. (1989). Epidermal damage induced by irritants in man: A light and electron microscopic study. Journal of Investigative Dermatology, 93(5), 695-699. https://doi.org/10.1111/1523-1747.ep12319895
Ziemer, M. (2012). Skin Biopsy and Dermatopathology. In: Rustemeyer, T., Elsner, P., John, SM., Maibach, H.I. (eds) Kanerva's Occupational Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02035-3_87
