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Cutaneous disease and religious practice: case of allergic contact dermatitis to tefillin and review of the literature

Case Report A 69-year-old male rabbi presented with an eruption on thescalp, face, neck and left arm and on scattered areas of thebody. He had previously been diagnosed with psoriasis, seb-orrheic dermatitis, and generalized eczema. He was referredfor the evaluation of potential allergic contact dermatitis. Onphysical examination, there were erythematous scaly patchesand plaques located on the forehead, scalp, neck, left wrist,and waistband. The patient reported regular use of tefillin(Fig. 1). The wearing of tefillin (phylacteries) is a daily religiouspractice followed by observant Jewish men. The objects areworn every morning of the week except on Saturday and holydays during daily prayer services. The distribution of the lesionssuggested an allergic contact dermatitis caused by allergens inthe leather components of his tefillin and other small leathergoods such as his watchband and belts. He was initially treatedwith mid-potency topical corticosteroids and oral cetirizine.Patch testing was performed using the North AmericanContact Dermatitis Group series. Patches were applied,removed at 48 h, and readings were performed at 48 and96 h, utilizing the previously described system.