CD14 ‘Alien mask’ allergic contact dermatitis: a case of multisensitization highlighting the importance of a comprehensive hobby history

Abstract It is well recognized that exploring a patient’s hobbies and interests is an essential component of the patch test history. It can ensure the relevant batteries are tested and explain otherwise atypical distributions or flares of rashes. We present a case of severe allergic contact dermatitis (ACD) with numerous positive patch test reactions, explained by the patient’s eclectic mix of hobbies and interests. A 53-year-old man was referred to the patch testing clinic after developing two episodes of dramatic facial swelling, followed by dry and scaly skin. He was well other than a history of psoriasis and had no known allergies. He had a desk job in a printing firm but spent his spare time creating model masks from his favourite sci-fi films, most notably ‘Alien’. Having discussed the glues and polyurethane foams used in the model-making process, he was patch tested to the British Society for Cutaneous Allergy standard, medicaments, facial, epoxy resins and isocyanates series in accordance with the International Contact Dermatitis Research Group and European Society of Contact Dermatitis guidelines. Patch test readings were performed on day 2 and day 4 and he had multiple positive patch test reactions as outlined in the Table. Diaminodiphenylmethane and hexamethylene­tetramine were both felt to be relevant to the mask-making process. Hexamethylenetetramine is used in the manufacture of formaldehyde resins and rubber, and diamino­diphenylmethane is a diamine used in the manufacture of rubber, plastics, dyes and adhesives. The Abitol and colophony reactions were initially of unknown relevance, but on further questioning the patient revealed a second hobby: reupholstering wooden record players, involving sanding of pine wood and use of polish and varnish. The propolis and fragrance allergies could have been related to personal care products, but uncovering a third pastime – caring for his pet gecko – better explained this. Bee pollen granules are advertised as ‘ideal natural supplements’ for reptiles and are commonly used as a food supplement for geckos, which are picky eaters. He was feeding his pet gecko propolis pellets and putting tree moss in its cage to create a humid environment. Reassuringly his facial rash settled and has not flared since. This case highlights the importance of taking a detailed history of interests and hobbies prior to patch testing as this information may not be volunteered by patients who are unaware of their relevance.TablePositive patch test reactionsAllergenDay 2 reactionDay 4 reactionRelevance4,4′-diaminodiphenylmethane−+CurrentHexamethylenetetramine−+CurrentColophony++++CurrentAbitol++CurrentPropolis−+CurrentTree moss++CurrentFragrance mix I++CurrentSorbitan sesquioleate−+CurrentClindamycin−+Don’t know