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Cold panniculitis – an unusual differential diagnosis from aluminium allergy in a patient hyposensitized with aluminium‐precipitated antigen extract

Case Report A 23-year-old woman, with a past history of dermatitis from costume jewellery, was referred with subacute eczema, which had begun 4 weeks earlier on her neck and décolleté and spread to the upper limbs. She reported the onset as a few days after she had worn a new blue woollen pullover. Patch tests with the European standard series, additional allergens, disperse blue dyes (ChemotechniqueA), her nail lacquer and a piece of her pullover showed a π reaction to nickel sulfate only. As the patient had often worn another pullover with a zip likely to contain nickel, she was advised to avoid wearing this garment, and lesions cleared with topical corticosteroids. Dermatitis relapsed acutely 2 months later, however, within 4 h of the patient wearing a strongly-coloured cotton scarf (black with a teddy bear motif) made in India, which had also been worn before the preceding episodes. Further patch tests with the garment and textile dyes and finishes series (ChemotechniqueA and TrolabA), showed at D2 a πππ reaction to both the scarf and Naphthol AS 1% pet. (TrolabA). The presence of Naphthol AS in the scarf was confirmed by comparative thin-layer chromatography followed by high-performance liquid chromatography, after extraction with chloroform.