Contact dermatitis is produced by external skin exposure to an allergen, but sometimes a systemically administered allergen may reach the skin and remain concentrated there with the aid of the circulatory system, leading to the production of systemic contact dermatitis (SCD). Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. Metal allergy may result in allergic contact dermatitis and also SCD. Systemic reactions, such as hand dermatitis or generalized eczematous reactions, can occur due to dietary nickel or cobalt ingestion. Zinc-containing dental fillings can induce oral lichen planus, palmoplantar pustulosis, and maculopapular rash. A diagnosis of sensitivity to metal is established by epicutaneous patch testing and oral metal challenge with metals such as nickel, cobalt, chromium, and zinc. In vitro tests, such as the lymphocyte stimulating test (LST), have some advantages over patch testing to diagnose allergic contact dermatitis. Additionally, the determination of the production of several cytokines by primary peripheral blood mononuclear cell cultures is a potentially promising in vitro method for the discrimination of metal allergies, including SCD, as compared with the LST. 1. Introduction Contact dermatitis is usually produced by external exposure of the skin to an allergen; however, sometimes a systemically administered allergen may reach the skin through the circulatory system and thereby produce systemic contact dermatitis. Systemic contact dermatitis (SCD) is an inflammatory skin disease that is known to occur with exposure to drugs, foods, and dental metals. A variety of types of skin eruptions have been reported, including flares of previous patch test sites, symmetrical intertriginous and flexural exanthema, exfoliative erythroderma, and widespread dermatitis [1]. Metals such as nickel, cobalt, chromium, and zinc are ubiquitous in our environment. During the 20th century, industrialization and modern living resulted in increased cutaneous exposure to these metals and hence an increased incidence of metal allergies [2]. Metal allergies may result in allergic contact dermatitis. Metals that are electrophilic have the ability to ionize and react with proteins, thus forming complexes that can be recognized by dendritic cells, which allows for sensitization to occur [3]. Cases of contact dermatitis caused by cutaneous exposure to cosmetics products and jewelry that contain nickel have been reported in the literature. The thinness of the stratum corneum and intermittent exposure to sweat on the eyelids have
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