Dermatite da contatto

Protein contact dermatitis (PCD) is a rare and underdiagnosed condition, caused by high-molecular-weight proteins, that many clinicians fail to recognize. PCD affects occupations involving food handling, such as bakers, fishmongers, cooks, greengrocers, and veterinary. Clinically, PCD is characterized by chronic and recurrent dermatitis of the hands and forearms occurring few minutes after contact with allergens. The lesions are at first urticarial; then they develop eczematous-type, with erythema, scaling, and fissures. We report a case of an 38-year-old atopic baker who presented recurrent chronic dermatitis of hands, forearms and trunk, associated with urticaria; the lesions were related to the patient's job. Patch tests with flours used by patient during his job were negative when performed on healthy skin, positive when performed on affected skin. Prick by prick tests with the same flours gave positive results; ImmunoCAP test showed specific IgE antibodies for wheat (9.76 kUA/L).