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Treatment of giant vulvar syringomas with topical adelmidrol: The role of mast cells

Sweden) showed a positive reaction to resin base (bisphenol F) and several diluents (Fig. 2). On a visit to the facility, we observed a large amount of epoxy paint waste, including bases, diluents and hardeners at the incinerator. It was suspected that epoxy resin in vapour, especially diluents, in view of their volatile properties, was the cause. His symptoms were resolved after he was relocated. Epoxy resin systems, consisting of resin bases, diluents and hardeners, are used in many industrial fields. It is known that epoxy resin can cause characteristic dermatoses: firstly, through contact dermatitis not only on exposed but also on covered areas, because tiny molecules can penetrate protection except for thick and chemical-resistant materials and secondly, through airborne contact dermatitis on areas exposed to vapour. However, our patient had two unique features. Firstly, the symptoms were seen only when he worked without a gas mask. Secondly, the eruptions arose on areas covered by thick chemical-resistant materials, not on his exposed face. Therefore, we considered that the eruptions were elicited by exhaling epoxy resin in vapour, resulting in systemic contact dermatitis. Systemic contact dermatitis has various manifestations, including hand eczema, generalised maculopapular eruptions, erythema multiforme and baboon syndrome. There are various routes of exposure, such as s.c., i.v., inhalation and transmucosal routes and oral ingestion. Haptens are thought to reach the skin through haematogenous transport. Several metals, chemicals and plants have been reported to cause systemic contact dermatitis via inhaling the vapour. Allergens in the vapour may be absorbed through mucosa of the nose and mouth or bronchi. It is likely that our patient was previously sensitised to epoxy resins through contact and that the eruptions were elicited by the absorption of these resins in vapour. In conclusion, clinicians should consider the possibility of systemic contact dermatitis caused by absorption of an allergen in vapour.