SUBMITTED 2 DEC 21 1 REVISION REQ. 23 JAN 22; REVISION RECD. 26 JAN 22 2 ACCEPTED 15 FEB 22 3 ONLINE-FIRST: MAY 2022 4 DOI: https://doi.org/10.18295/squmj.5.2022.037 5 6 Bullous Allergic Contact Dermatitis caused by Potassium Dichromate 7 *Francisco J. Navarro-Triviño,1 Álvaro Prados-Carmona,2 Juan Pablo 8 Velasco-Amador,2 Ricardo Ruiz-Villaverde,2 9 10 1Department of Contact Eczema and Immunoallergic Diseases, Dermatology and 11 2Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain. 12 *Corresponding Author’s e-mail: fntmed@gmail.com 13 14 Introduction 15 Contact dermatitis comprises eczematous and non-eczematous reactions. Certain 16 allergens can trigger very intense reactions, which can be confused with other dermatoses. 17 18 A 66-year-old man presented with rapidly progressive pruritic erythematous-oedematous 19 eruption with blistering on his abdomen (Fig. 1). The patient was attended in the 20 emergency department. A diagnosis of second-degree burn was made, indicating 21 treatment with silver sulfadiazine cream. The evolution was unfavourable, with the 22 formation of new blisters and more intense itching. The patient returned to the emergency 23 department. He was assessed by a dermatologist. The directed anamnesis detected contact 24 with cement sacks 48 hours before the onset of the cutaneous blistering eruption. Bullous 25 allergic contact dermatitis to potassium dichromate was suspected. He worked as an 26 aeronautical engineer. Contact with multiple metals, including chromium, was confirmed. 27 He also reported dermatitis on wrists with leather bracelets, as well as eczematous lesions 28 on the back of the feet with leather shoes. Treatment with oral corticosteroids was 29 prescribed for 10 days, with complete improvement of the rash. The patch test showed 30 positivity to potassium dichromate +++ at 48 and 96 hours. Bullous allergic contact 31 dermatitis to potassium dichromate was confirmed. Patient consent was obtained for 32 publication purposes. 33 34 Comment 35 The most frequent source of contact to potassium dichromate in men is through cement1. 36 Other sources2 are stainless steel objects, orthopaedic prostheses, dental implants, 37 orthodontic appliances, green dyes from textiles and tattoos, matches, paints and 38 varnishes, anti-corrosion agents, cutting oils, degreasing solvents, electrolysis baths, 39 electric batteries, waterproof fabrics, TV manufacturing, photocopy paper, solder, floor 40 waxes, shoe polish, paints, glues, eye shadow and eye mask pigments, detergents, 41 analytical reagents, chrome catgut. 42 43 The application of barrier creams with glutathione and iron sulphate could inhibit the 44 elicitation phase of patients predisposed to develop allergic contact dermatitis to 45 hexavalent chromium3. Hand dermatitis is the most frequent location when the source of 46 contact is cement. Other locations such as the feet are related to leather footwear4. 47 Eczematous and blistering rash on the back of the foot is suggestive of allergic contact 48 dermatitis caused by potassium dichromate5. The anamnesis is crucial to correctly 49 approach the diagnosis of the patient. Other allergens associated with the development of 50 bullous allergic contact dermatitis include diethylthiourea6, and colophonium7, among 51 others. 52 53 Contact dermatitis can manifest itself in various clinical forms. Bullous lesions can be 54 observed in both irritant and allergic forms. Anamnesis is crucial in order to correctly 55 approach the diagnosis as well as the scheduling of the patch test. 56 57 Authors’ Contribution 58 All authors contributed equally to conception and design, data collection, data analysis 59 and interpretation, drafting and editing the manuscript. All authors approved the final 60 version of this manuscript. 61 62 References 63 1. Mowitz M, Zimerson E, Hauksson I, Pontén A. Chromate and amine contact 64 allergies in workers manufacturing precast concrete elements. Contact Dermatitis. 65 2016;75(6):363-369. 66 2. Bregnbak D, Johansen JD, Jellesen MS, Zachariae C, Menné T, Thyssen JP. 67 Chromium allergy and dermatitis: prevalence and main findings. Contact 68 Dermatitis. 2015;73(5):261-80. 69 3. Lejding T, Engfeldt M, Bruze M, Isaksson M, Svedman C, Zimerson E, Verma 70 K, Mowitz M. Skin application of glutathione and iron sulfate can inhibit 71 elicitation of allergic contact dermatitis from hexavalent chromium. Contact 72 Dermatitis. 2020;82(1):45-53. 73 4. Adams DW, Marshall-Battle MR. Shoe contact dermatitis: a case report of an 74 acute severe reaction to potassium dichromate. Foot (Edinb). 2012;22(3):141-5. 75 5. Thyssen JP, Strandesen M, Poulsen PB, Menné T, Johansen JD. Chromium in 76 leather footwear - risk assessment of chromium allergy and dermatitis. Contact 77 Dermatitis. 2012;66(5):279-85. 78 6. Bregnhøj A, Sommerlund M. Severe bullous allergic contact dermatitis caused by 79 diethylthiourea 20 years after sensitization to neoprene. Contact Dermatitis. 80 2017;76(4):236-237. 81 7. Christoffers WA, Coenraads PJ, Schuttelaar ML. Bullous allergic reaction caused 82 by colophonium in medical adhesives. Contact Dermatitis. 2014;70(4):256-7. 83 84 85 Figure 1. Eczematous and bullous rash on the abdomen. 86