Contact dermatitis is produced by external skin exposure to an allergen, but sometimes a systemically administered allergen may\r\nreach the skin and remain concentrated there with the aid of the circulatory system, leading to the production of systemic contact\r\ndermatitis (SCD). Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. Metal allergy may result\r\nin allergic contact dermatitis and also SCD. Systemic reactions, such as hand dermatitis or generalized eczematous reactions,\r\ncan occur due to dietary nickel or cobalt ingestion. Zinc-containing dental fillings can induce oral lichen planus, palmoplantar\r\npustulosis, and maculopapular rash. A diagnosis of sensitivity to metal is established by epicutaneous patch testing and oral metal\r\nchallenge with metals such as nickel, cobalt, chromium, and zinc. In vitro tests, such as the lymphocyte stimulating test (LST),\r\nhave some advantages over patch testing to diagnose allergic contact dermatitis. Additionally, the determination of the production\r\nof several cytokines by primary peripheral blood mononuclear cell cultures is a potentially promising in vitro method for the\r\ndiscrimination of metal allergies, including SCD, as compared with the LST.
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