Effect of allergic contact dermatitis on wound healing

feet, being worst on the left hand. Treatment with betamethasone valerate 0.1% cream had produced temporary improvement. The patient was known to be allergic to chromate, having been patch tested by another dermatologist. His father had suffered from hand dermatitis attributed to cement allergy. On examination, there was a vesicular erythematous scaly rash of the left palm, base of the thumb and palmar aspects of the index to little fingers. A less florid dermatitis was present on the right central palm and on the soles and lateral aspects of the feet. There was a localized area of lichenification, erythema, pigmentation and papules below the angle of the mandible on the left side, consistent with 'fiddler's neck'. The patient had played the same violin for many years. He carried the leather violin case in his left hand. In view of his known chromate allergy, the handle of the case and his shoes were initially suspected as the cause of his dermatitis. Clobetasol propionate 0.05% cream produced some improvement in his rash, but the left palm and thumb responded poorly. Patch testing with the European standard and shoe series gave positive reactions to potassium dichromate (D2 + +, D4 + + +) and cobalt (D2+, D4+ ++).During patch testing, the rash on the left palm flared. Despite changing the handle of his violin case, our musician's rash failed to improve over the next 3 months. We were considering patch testing him to varnishes, when he told us that he had received information from the German manufacturers of his violin strings, in response to his enquiries. The usual composition of Estrings is of gold plate or rolled gold, surrounding a stainless steel or aluminium core. In this case, the core was of chromated steel. Changing the string to a standard type resulted in rapid clearing of the dermatitis. Contact Dermatitis 1995: 32: 47