Tuesday, March 03, 2015

Contact Dermatitis Rebound

A 35 year-old woman was seen for a dermatitis on her left arm. She has a history of severe reactions to poison ivy.   Five months ago, she developed an extensive contact dermatitis of her arms and torso that was felt to be secondary to poison ivy.  At the time, she was in the early third trimester of pregnancy and did not wish to use any topical steroids.  The process was mostly resolved when she gave birth around two months ago.  

It was still visible and only slightly itchy over torso and arms at parturition. The dermatitis on her arms flared up about a week after her son's birth and has been present, and symptomatic, for almost two months now.  By history, it may be slowly be resolving.

Question: Has anyone heard of a recall dermatitis associated with allergic contact dermatitis? Alternatively, this may be a rebound contact dermatitis associated with post-partum changes in the immune system. There are no pertinent references in PubMed.

Ohtaki N, et. al. Delayed flare-up reactions caused by jellyfish. Dermatologica. 1986;172(2):98-103.
Abstract: Four patients had a recurrence of cutaneous lesions 1 week after being stung by jellyfish. Three patients had flare-up lesions after only one exposure to jellyfish. All of the recurring lesions were vesicular erythema, and the histological findings of case 3 corresponded to that of allergic contact dermatitis. [This is not all that similar; but it is of interest.]


  1. from K. Sharquie, Baghdad: This is very interesting case.Some cases of bulbous pemphigoid of pregnancy appear in a mild dermatitis like picture in the 3rd trimester which gets exacerbation after delivery that might continue for months.The second explanation is that the case was poison ivy dermatitis and was recurred as exposure to new antigen that cross reacts with ivy antigen.The other possibility ,it is ordinary dermatitis that not related to poison ivy or pregnancy that might relapse any time

  2. from Fran Storrs:
    Most interesting david. Was the rebound in the same spots? Pretty sure she wasn't re-exposed? Second allergen also possible. And nope never seen that post partum. However recall reactions with patch testing r so common that I wonder about re-exposure on say clothing. Also she obviously wasn't immunosuppressed during her pregnancy.


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