Allergic contact dermatitis is classically eczematous in nature since the antigen-antibody cell reaction takes place in the epidermis. At times, however, an allergen may be deposited in the dermis with a resultant dermal locale for the antigen-antibody cell reaction. Typical of this dual response site is the case of the delayed reaction to tuberculin. Applied as a patch test, tuberculin induces a vesicular reaction in the sensitive individual. This same allergen (reacting with the same lymphoid antibody system) produces a papular dermal tuberculin response when injected intradermally. Thus, the clinical characteristics of the delayed hypersensitivity state reflect the site at which the allergen actually meets the lymphoid cellular defenses of the body. At times the pattern is a mixed epidermal and dermal one. However, we wish here to present a clear example of contact dermatitis presenting as a papular eruption involving the dermis. The fact that the allergen was a
SHELLEY WB, EPSTEIN E. Contact-Sensitivity to Gold as a Chronic Papular Eruption. Arch Dermatol. 1963;87(3):388–391. doi:10.1001/archderm.1963.01590150104021
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