Chromate-Induced Allergic Contact Dermatitis Treated With Dupilumab

December 2021 | Volume 20 | Issue 12 | Case Reports | 6246 | Copyright © December 2021


Published online November 18, 2021

Britney N. Wilson MBSa, Esther A. Balogh MDa, David J. Rayhan MDb, Paul K. Shitabata MDc, Daniel J. Yousefzadeh BAd, Steven R. Feldman MD PhDa,e

aWake Forest School of Medicine, Winston-Salem, NC
bPrivate Practice, Huntington Beach, CA
cHarbor-UCLA Medical Center, Torrance, CA
dSaba University School of Medicine, Saba, Dutch Caribbean
eUniversity of Southern Denmark, Odense, Denmark

Abstract
Chromate causes persistent, difficult to treat irritant and allergic contact dermatitis in cement-handling occupational workers. When therapeutics such as topical corticosteroids, topical calcineurin inhibitors, phototherapy and immune-modulating treatments like methotrexate fail, many patients are advised that avoidance may be the only remaining option – an option that may be particularly challenging if the patient’s occupation necessitates chromate exposure. We report a case of severe chromate-induced allergic contact dermatitis in a 55-year-old cement mason that presented to the outpatient dermatology clinic with multiple scaly, erythematous, >5 cm plaques scattered over the skin of his hands, head and neck. After a prior failed course of treatment with high potency topical corticosteroid, this patient was successfully treated with dupilumab. Given the success of dupilumab in our patient, we propose the consideration of dupilumab as an alternative treatment option for those suffering from chromate-induced allergic contact dermatitis that is refractory to ultra-high potency topical corticosteroids.

J Drugs Dermatol. 2021;20(12): doi:10.36849/JDD.6246

INTRODUCTION

Chromate, an anion of chromium and oxygen discovered by Vaquelin in 1798, is a common cause of occupational skin disease.1 The prevalence of chromium sensitivity in the general U.S. population ranges from 0.08 to 7%.2 Chromium can cause both irritant contact dermatitis and, more frequently, allergic contact dermatitis (ACD).3 Nickel(II) ion is the most frequent cause of type IV hypersensitivity reactions, accounting for 23% of all cases diagnosed by patch testing, followed by cobalt(II) ion (9.3%) and hexavalent chromium (chromium[VI]) (5.6%).4 Chromate is frequently used in plating, leather tanning, pigmentation, dye production, and chemical industries, and is found in cement as a byproduct of the cement manufacturing process.5 Approximately one-third of bricklayers and stonemasons who are in frequent contact with cement, as well as one in ten metal operators who have an occupational disorder, received a diagnosis of contact dermatitis due to hexavalent chromium exposure.4,6,7

CASE

A 55-year-old Hispanic male patient presented to the outpatient dermatology clinic in October 2018 with intractable dermatitis. Scaly, erythematous, >5 cm plaques were present on the exposed skin of his hands, head and neck (Figure 1). Areas covered by clothing generally showed no lesions. History revealed that the patient worked as a cement mason, and the areas with the aforementioned skin findings were present only at the areas exposed to cement dust. The patient reported little to no improvement in the past with ultra-high potency topical corticosteroids

.