Study on the therapeutic mechanisms of pseudolaric acid in mice with allergic contact dermatitis

Objective:To study the therapeutic mechanisms of pseudolaric acid on allergic contact dermatitis in mice.Methods:A total of 50 BALB/C mice were selected and randomly divided into control group,model group,and treatment A,B,C groups with 10 rats in each group.ACD model was established in model group,and treatment A,B,C groups but not in control group.Model group received no treatment,but treatment A,B,C groups were treated with external application of the concentration of 0.1%,0.2% and 0.4% of the pseudolaric acid for the lesions of ear skin.And the weight gain and the swelling degree of the mice' ear were recorded,weight of thymus and spleen were measured.Spleen suspension was prepared to test T lymphocyte and B lymphocyte levels of mice in five groups.Changes in serum IFN-ed through the enzyme linked immunosorbent assay(ELISAγ,IL-4 and IL-10 levels were test).Results:The weight gain of mice in model group were significant lower than those of mice in the control group and the treatment A,B,C groups(P<0.05).Weight gain of mice in treatment A,B groups were significant lower than that of control group(P<0.05),but the difference in weight gain between treatment C group and control group showed no significant difference(P>0.05).The swelling degree and the weight of mice ears in model group were significant higher than those of mice in control group and treatment A,B,C groups(P<0.05).Swelling degree and the weight of mice ears of treatment A,B,C groups were obviously higher than that of control group(P<0.05).The swelling degree and weight of mice' ears in treatment A,B,C groups were decreased with the increase of the drug dosage,but comparison between A,B and C group showed statistically differences(P<0.05).The thymus and spleen index of mice in model group were significant higher than those of the other four groups(P<0.05),among the four groups,thymus and spleen index of treatment A and B group were higher than control group and treatment C group(P<0.05).The stimulation index of T and B cells of mice in model group was significantly higher than the rest four groups(P<0.05).The serum IFN-γ level of mice in control group and treatment A,B and C group was obviously lower than that of mice in model group(P<0.05).The serum IFN-γ level of mice in treatment A,B and C group were decreased with the increasing of the drug dosage,and the level of C group was obviously lower than that of A and B group(P<0.05).Conclusion:The pseudolaric acid has anti-inflammation and immune adjustment the effects showing a remarkable therapeutic effects for the ACD mice.

Review of allergic contact dermatitis: Scratching the surface

Contact dermatitis-including allergic contact dermatitis(ACD)-n and results in over four million lost work days per year in the United States alone. ACD is a classic example of a type IV delayed hypersensitivity reaction, and represents a significant burden on the health system, economy, and patient quality of life. Thorough history taking, clinical examination, histologic evaluation, and patch testing are keys to diagnosing contact dermatitis. Patch testing, especially with comprehensive and customized panels based on the patient's exposure history, is particularly useful in identifying potential allergens inthe case of allergic contact dermatitis. ACD management requires a combination of direct medical intervention, patient education, and appropriate environmental modification to prevent exposure to offending allergens in the home or workplace. Continuing advances in the study of ACD has led to an increased understanding of the disease processes, new methods for diagnosis, and improved management. This article reviews ACD-aiming to connect recent investigational data with the current clinical understanding of disease pathophysiology, diagnostic techniques, and management strategies.

Effect of 6＇-acetylpaeoniflorin on dinitrochlorobenzene induced allergic contact dermatitis in BALB/c mice

Aim The present study aimed to investigate anti-inflammatory activity of 6-AP on murine model of aller- gic contact dermatitis （ACD）. Methods 6＇-acetylpaeoniflorin （6-AP） was synthesized from paeoniflorin （Pae） via acetylation and the structure was characterized by 1H-NMR, 13C-NMR and EI-MS. ACD model was established by repeated application of dinitrochlorobenzene （DNCB） to induce skin immune inflammation. The mice were oral- ly administered 6-AP （35, 70, 140 mg. kg-1 ·d^-l）, Pae （70 rag. kg-1·d^-1） and prednisone （Pre, 5 rag. kg^- 1· d^-1 ） from day 1 to day 7 after Cutaneous inflammation was evaluated by ear swelling and histological exami- nation. Splenocyte proliferation was assayed by the 3-（4, 5-dimethylthiazol-2-yl）-2, 5-diphenyl-2H tetrazolium bromide assay. The cytokine production in the splenocytes was measured by enzyme-linked immunosorbent assay. Results Topical application of DNCB to the skin provoked obvious swelling and inflammatory cell infiltration. 6- AP significantly inhibited ear swelling, decreased inflammatory cell infiltration and epidermal keratinization. Ad- dtionally, 6-AP obviously alleviated the hyperplasia of red pulp and germinal center （GC） appearance, decreased spleen index, decreased spleen index, and inhibited splenocyte proliferation in ACD model, compared to that of Pae. Further, the study indicated that 6-AP treatment could increase IL-10 level, while reduce IL-17 level in splenocytes simultaneously. The correlation analysis displayed significantly positive correlations between IL-17 level and the severity of skin inflammation, while negative correlations between IL-10 level and skin inflammation. Con- clusion 6-AP has a significantly higher anti-inflammatory effect than Pae, and it may be a useful treatment for ACD.

Occupational Allergic Contact Dermatitis in Tunisia: Epidemiology and Occupational Outcome

Background: Occupational allergic contact dermatitis (ACD) is one of the most frequent diseases on the workplace worldwide. Its national incidence and prevalence were not previously studied in Tunisia. Objective: To assess incidence of occupational allergic contact dermatitis and its occupational outcome in Tunisia. Methods: Descriptive epidemiological study of all cases of occupational allergic contact dermatitis reported from 2002 to 2012 in Tunisia and recognized by the medical commissions of the National Health Insurance Fund. Results: 315 cases of occupational ACD were collected representing an annual incidence of 31.65 cases/100.000 workers in the private sector in Tunisia. The mean age of our population was 42.70 ± 9.02 years with a male predominance (sex ratio 3.03). The most affected sectors were the clothing sector (14.3% of cases) and the cement industry (13.7% of cases). Patch tests were positive in 188 patients (59.67%). The most frequently positive allergen was potassium dichromate in 27.3% of the cases. Overall, 25.4% of patients had lost their jobs. After multiple binary logistic regression, job loss had a statistically significant relationship with localization of lesions on the face and on dominant hand. Conclusion: Occupational ACD is frequent in Tunisia and is responsible for an important rate of job loss. Preventive measures must be reinforced, especially the wearing of protective gloves.

Preprocessing and Efficacy Analysis of Comprehensive Anti-Inflammatory Treatment for Lymphedema in Patients with Irritating Contact Dermatitis

Objective: To explore the pre-treatment and efficacy analysis of comprehensive anti-inflammatory treatment for lymphedema in patients with irritating contact dermatitis. Method: Convenience sampling method was used to observe the skin of 160 patients with upper limb lymphedema admitted to the lymphedema outpatient department of our hospital. They were divided into an observation group (80 cases) and a control group (80 cases), and both groups received a course of comprehensive anti-inflammatory treatment (20 treatments). The control group received routine skin care;On the basis of the control group, the observation group received pre-treatment of the affected limb skin: Laofuzi herbal ointment was applied externally to the prone areas of irritating contact dermatitis (such as the upper arm, inner forearm, and cubital fossa). Result: The incidence of irritating contact dermatitis in the observation group was significantly lower than that in the control group (P 0.05). Patients in the observation group felt significantly better in terms of comfort, skin moisture, and itching relief after being wrapped with low elasticity bandages than those in the control group (P Conclusion: Preventive treatment can effectively reduce the incidence of irritating contact dermatitis, prolong the time of stress treatment, thereby increasing efficacy and improving patient compliance.

Allergic Contact Dermatitis from Diethyl Sebacate in a Topical Antimycotic Medicament

Diethyl sebacate is used in topical medicaments in United States and Japan. We described a case of allergic contact dermatitis from diethyl sebacate in a topical antimycotic medicament. Allergic reaction to diethyl sebacate is likely more common because our group has found three of eight sensitized cases. We believe that an investigation regarding the sensitized frequency to diethyl sebacate would conduct to improve the safety of products in United States and Japan.

Allergic Contact Dermatitis Syndrome Due to Tocopherol Acetate, in Addition to Glycyrrhetinic Acid

Natural vitamin E is suggested to have an antioxidant function. However, the synthetic form of vitamin E, DL-tocopherol, which has been widely used in topical ointments, may cause allergic contact dermatitis. Here, we report a case of allergic contact dermatitis with erythema multiforme-like eruption caused by a topical ointment. Patch testing indicated a positive allergic reaction to an anti-inflammatory ointment the patient had been using and its ingredient, DL-alpha-tocopheryl acetate (vitamin E). In addition, a positive reaction to glycyrrhetinic acid was observed. Both vitamin E and glycyrrhetinic acid are useful ingredients of topical applications. However, the possibility that both can cause contact dermatitis, albeit rarely, should be considered.

Deficiency of Autophagy-Related Gene 5 in Keratinocytes Leads to Aggravation of Epidermal Damage in 2,4-Dinitrochlorobenzene-Induced Allergic Contact Dermatitis

Objective:The interrelationship between apoptosis and autophagy plays an important role in many pathophysiological processes,however,whether their interplay is involved in allergic contact dermatitis(ACD)has not yet been elucidated.So,we conducted this study to determine whether keratinocyte-specific autophagy-related gene 5(ATG5)deficiency can regulate apoptosis to inhibit skin damage in mice with 2,4-dinitrochlorobenzene(DNCB)-induced ACD.Methods:This study involved keratinocyte-specificAtg5 conditional knockout(cKO)mice(Krt14cre/+-Atg5flox/flox)and control mice(Krt14+/+-Atg5flox/flox).We painted DNCB on the right ear of each mouse to induce ACD.Dermatitis scoring and measurements of ear weight and thickness were performed to evaluate inflammation levels.An immunohistochemical assay was performed to analyze immune cell infiltration.Histological study and TUNEL staining were performed to compare the differences in skin lesions betweenAtg5 cKO mice and control mice.Immunofluorescence and western blotting were used to examine the levels of ATG5 and apoptosis-related protein.The results were statistically analyzed byt test.Results:After DNCB stimulation of mice ears,we observed a more severe phenotype inAtg5 cKO mice than in control mice(dermatitis score:7.500±2.588vs.3.250±0.822,P=0.003).Further analysis of ATG5 protein confirmed keratinocyte-specific ablation ofAtg5 in cKO mice and showed that DNCB did not influence ATG5 expression.Immunohistochemistry assay revealed that the infiltrated immune cells were not involved in aggravation of the phenotype of DNCB-stimulatedAtg5 cKO mice.However,the histological study(P=0.024),TUNEL staining(P=0.024),immunofluorescence(P=0.036),and western blotting showed that the increase in keratinocyte death,especially apoptosis,contributed to aggravation of the phenotype of DNCB-stimulatedAtg5 cKO mice.Conclusion:Deficiency ofAtg5 in keratinocytes increases apoptosis,aggravating skin damage in DNCB-induced ACD mice.This has no relationship with the involvement of immune cells.

Analysis of nickel distribution by synchrotron radiation X-ray fluorescence in nickel-induced early- and late-phase allergic contact dermatitis in Hartley guinea pigs

Background: Nickel-induced allergic contact dermatitis (Ni-ACD) is a global health problem. More detailed knowledge on the skin uptake of haptens is required. This study aimed to investigate the penetration process and distribution of nickel in skin tissues with late phase and early phase of Ni-ACD to understand the mechanisms of metal allergy. Methods: Forty Hartley guinea pigs were divided into four groups according to the NiSO4 sensitizing concentration and the NiSO4 challenged concentration: the 5% NiSO4-group, 5% to 10%(sensitization-challenge;late phase group);10% NiSO4-group, 10% to 10%(sensitization-challenge;early-phase group);and the positive and negative controls. Pathological biopsies were performed on each group. The depth profile of nickel element concentration in the skin of guinea pigs was detected by synchrotron radiation micro X-ray fluorescence spectroscopy (SR-μ-XRF) and micro X-ray absorption near-edge spectroscopy (μ-XANES). Results: In each section, the nickel element concentration in both the 5% NiSO4-group and 10% NiSO4-group was significantly higher than that in the negative control group. In the upper 300-μm section of skin for the early phase group, the nickel element concentration was significantly higher than that in the lower section of skin. In deeper sections (>200 μm) of skin, the concentration of nickel in the early phase group was approximately equal to that in the late phase group. The curve of the late phase group was flat, which means that the nickel element concentration was distributed uniformly by SR-μ-XRF. According to the XANES data for the 10% NiSO4 metal salt solution, structural changes occurred in the skin model sample, indicating that nickel was not present in the Ni^2+ aqueous ionic state but in the nickel-binding protein. Conclusions: This study showed that the distribution of the nickel element concentration in ACD skin tissue was different between the early phase and late phase groups. The nickel element was not present in the Ni^2+ aqueous ionic state but bound with certain proteins to form a complex in the stratum corneum in ACD model tissue.

Follicular contact dermatitis revisited: A review emphasizing neomycin-associated follicular contact dermatitis

Follicular contact dermatitis clinically presents as individual papules that include a central hair follicle. Pathologic features involve the follicle and the surrounding dermis: spongiosis and vesicle formation of the follicular epithelium associated with perifollicular and perivascular lymphocytic inflammation. Using the Pub Med database, an extensive literature search was performed on follicular contact dermatitis and neomycin. Relevant papers were reviewed and the clinical and pathologic features, the associated chemicals(including a more detailed description of neomycin), the hypothesized pathogenesis, and the management of follicular contact dermatitis were described. Several agentseither as allergens or irritants-have been reported to elicit follicular contact dermatitis. Several hypotheses have been suggested for the selective involvement of the follicles in follicular contact dermatitis: patient allergenicity, characteristics of the agent, vehicle containing the agent, application of the agent, and external factors. The differential diagnosis of follicular contact dermatitis includes not only recurrent infundibulofolliculitis, but also drug eruption, mite infestation, viral infection, and dermatoses that affect hair follicles. The primary therapeutic intervention for follicular contact dermatitis is withdrawal of the causative agent; treatment with a topical corticosteroid preparation may also promote resolution of the dermatitis. In conclusion, follicular contact dermatitis may be secondary to allergens or irritants; topical antibiotics, including neomycin, may cause this condition. Several factors may account for the selective involvement of the hair follicle in this condition. Treatment of the dermatitis requires withdrawal of the associated topical agent; in addition, topical corticosteroids may be helpful to promote resolution of lesions.

Pathogenesis and diagnosis of contact dermatitis:Applications of reflectance confocal microscopy

Contact dermatitis(CD) is the most common professional skin disease, with frequencies ranging from 24 to 170 every 100000 individuals. Approximately 20% of the United States population suffers from CD. CD can be classified according to its origin and severity. ICD stands for irritant CD, whereas ACD means allergic CD. Their clinical presentation includes acute, sub-acute and chronic eczema. Despite their different origin, ICD and ACD often present similar clinical and histologic findings. The current gold standard for diagnosis is patchtesting. However, patch-testing is being questioned in terms of validity and reproducibility, as it relies heavily on the skill of the observer. Real-time reflectance confocal microscopy is a non-invasive imaging technique that bears strong promise for the study of CD, and it enables the evaluation of cellular and subcellular changes over time with similar resolution compared to that of conventional histology.

Nurses: Workers Particularly Concerned by Contact Dermatitis in Public Hospital

Background: Contact dermatitis is common disease and represents a significant problem in healthcare sector, mainly among nurses. Many studies reported the prevalence of contact dermatitis from different parts of the world. Nevertheless, data about its frequency in Tunisia especially in public hospital seems to be insufficient. This study aims to assess the prevalence of contact dermatitis among nurses working in public hospital and identify risk factors. Patient and Methods: A cross sectional study was conducted among a representative sample of 1278 health professionals working in a public hospital matched by professional status and department. The survey was based on a questionnaire, a specialized examination and patch tests. Results: The prevalence of occupational contact dermatitis was 22% (17.5 - 27.2). The worker profile at risk of contact dermatitis was a female nurse aged 37 years working in a surgical department during 12.7 ± 9.36 years. Hands were damaged in 92.4% of cases and rhythmicity with occupational exposure was reported by 86% of affected individuals. Patch tests using European Standard Battery were performed among 33 workers and revealed a sensitization to an allergen among 26 workers. Patch test using rubber battery (if suspicion of allergic contact dermatitis to gloves) was performed among 29 agents and positive among 12. The analytical study revealed that history of atopy, job tenure, the mean daily number of hand washing, the mean daily number of worn gloves and mean duration of glove wearing were significantly higher in the affected population. Conclusion: Contact dermatitis affects particularly nurses in public hospitals. Its prevention requires a diagnostic approach based on a detailed professional investigation and patch tests.

In Vivo Observation of Allergic Dermatitis of the Genuine Pig by Optical Coherence Tomography

In order to understand pathogenic mechanism of allergic dermatitis, it is important to find morphological changes of the internal structure of the skin by non-invasive imaging. Optical coherence tomography (OCT) is powerful tool for in vivo tomographic imaging of the internal microstructure in biological tissue. In this study, we prepared the animal model of genuine pig with allergic dermatitis developed by chemical administration to examining their skin inflammation by microscopic observations with OCT images captured continuously, aiming at tracking the morphological changes in the skin structure induced by the chronological inflammation. As a result, epidermis thickening became evident as the days passed since Day 7, and the capillary vessel expansion was confirmed since Day 14;the process of inflammation development was successfully observed.

Allergic dermatitis after knee arthroscopy with repeated exposure to Dermabond Prineo^(TM) in pediatric patients:Two case reports

BACKGROUND Allergic contact dermatitis(ACD)secondary to Dermabond Prineo^(TM) is rare,but documented.To our knowledge,there are no described reports of this ACD reaction within the pediatric population following arthroscopic surgery.CASE SUMMARY We report two cases of pediatric ACD upon second exposure to Dermabond Prineo^(TM) after knee arthroscopy.Both cases presented within two weeks of the inciting second exposure.The cases resolved with differing described combinations of sterile cleaning,diphenhydramine,and antibiotic administration.No long-term sequelae were found.CONCLUSION This case report elucidates the rare complication of allergic dermatitis secondary to Dermabond Prineo^(TM) repeat exposure use in pediatric arthroscopy.

Research progress in traditional Chinese medicine treatment of contact dermatitis

Contact dermatitis is one of the common diseases in dermatology in clinical practice. In recent years, the incidence of the disease has been increasing year by year. Clinically, antihistamines and hormones are often taken for symptomatic treatment. However, long-term repeated use will cause more serious symptoms, such as redness, swelling, and itching in the affected part of the patient. Traditional Chinese medicine (TCM) treats this disease with Chinese medicine decoction, Chinese patent medicine, hydropathic compress, acupuncture, etc., which have significant curative effect, and not only can relieve the patient's symptoms, but also not easy to relapse. Now, the progress of TCM treatment of this disease is reviewed in detail from two aspects: the internal treatment of TCM and the external treatment of TCM.

Vulvar Contact Dermatitis: Effect of a Treatment with a Anti-Inflammatory, Moisturizing and Healing Product on the Course of the Disease

Background: Vulvar contact dermatitis is inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab&#174 system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, as a treatment of vulvar contact dermatitis. Method: 36 patients with the diagnosis of vulvar contact dermatitis received an 10-days treatment, during which the subjects applied TF, complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid on the affected vulvar surfaces, used once a day. Clinical symptoms (itching and burning) and signs (vulvar surface disruption) were documented at baseline and after 1 months of follow-up. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints 1 months of follow-up. Moreover a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that application of TF can be an effective agents for the reduction of symptom and sign of vulvar contact dermatitis, and the medical device can be used as a preventive agent in predisposing condition of vulvar discomfort.

Chromium and leather:a review on the chemistry of relevance for allergic contact dermatitis to chromium

As other causes decline in importance,chromium-tanned leather has become a more important source for chromium allergy,which affects around 1%of the general population.The aim of this review is to give suggestions on how to minimize the risk of leather-related allergic contact dermatitis,which can be elicited in chromiumallergic persons by hexavalent and trivalent chromium released from leather.Hexavalent chromium is the more potent chromium form and requires a lower skin dose to elicit allergic reactions.It is formed on the surface of some,antioxidant-free,leathers at dry conditions(<35% relative humidity)and is influenced by the tanning process and other conditions,such as UV irradiation,contact with alkaline solutions,and leather age.Trivalent chromium is the dominant form released from chromium-tanned leather and its released amount is sufficient to elicit allergic reactions in some chromium-allergic individuals when they are exposed repetitively and over longer time(days-months).A low initial test result(<3 mg/kg)for hexavalent chromium with the current standard test(ISO 17075)does not guarantee a low release of chromium from the leather or a low release of hexavalent chromium under typical exposure conditions during the service life of the leather.Information,labels,and certificates regarding leather products are often insufficient to protect chromium-allergic individuals.Correct labelling and information on the possible content of different allergens,as well as different tanning alternatives for certain leather products,are crucial.

Qualitative and quantitative analysis of Arnebiae Radix and Dictamni Cortex and efficacy study of herbal extracts on allergic contact dermatitis using 3D human reconstructed epidermis

Objective:To evaluate the quality of Arnebiae Radix(AR)and Dictamni Cortex(DC)and study the efficacy of herbal extracts of these two herbs on the treatment of allergic contact dermatitis(ACD).Methods:Qualitative and quantitative analysis of effective components was performed using High Performance Thin Layer Chromatography(HPTLC),High Performance Liquid Chromatography(HPLC),and HPLC-Quadrupole Time of Flight-Mass Spectrometry(HPLC-QTOF-MS).In vitro allergic ACD 3D model was established by incubating 3D reconstructed human epidermis(RHE)with skin sensitizer,potassium dichromate.A total of 65 gene expression that were associated with ACD,which included 24 antioxidant responsive element(ARE)and 41 SENS-IS genes were quantified by q RT-PCR.More than or equal to 10 ARE genes and 18 SENN-IS genes were induced by 1.3-fold,demonstrating the successful establishment of in vitro ACD model.Oil extracts of AR and DC were applied on the in vitro ACD model to study the efficacy.Results:Batch 3 of AR and batch 2 of DC showed presence of all active ingredients with the highest concentrations.Active ingredients of the herbs were extracted using a special oil and formulated into herbal oil extracts.The herbal oil extracts were able to down regulate the induced genes in the in-vitro ACD skin model,bringing the tissue back to homeostatic status.Conclusion:The oil extracts showed the potent efficacy of using AR and DC in ACD treatment.The combination study will be done to optimize the formulation ratio which will be developed into a topical cream.

Allergen immunotherapy in patients with atopic dermatitis allergic to house dust mite:A systematic review and meta-analysis

To the Editor:Atopic dermatitis(AD)is the most common chronic allergic skin disease worldwide.House dust mite(HDM)is the most prevalent aeroallergen and pathogenic cause,which triggers skin barrier disruption and polysensitization.Allergen immunotherapy(AIT)may be the only etiologic treatment to improve the natural history of AD by applying a dose of specific allergens to stimulate adaptive immunity in the body.[1,2]However,the effects of HDM AIT showed controversial results recently.This study aimed to investigate the effectiveness and safety of AIT for HDM.

Contact Dermatitis With the Homoeopathic Medicine Calendula officinalis:A Rare Case Report

Introduction:Herbal medicines and other traditional medicines are well accepted in India and are readily available as over-the-counter preparations.With their increased use,the safety and quality of homoeopathic medicines have become a major concern for health authorities,pharmaceutical industries,and consumers.It is difficult to assess the adverse effects of homoeopathic medicines due to a lack of scientific evidence regarding their safety and efficacy in clinical trials or post-marketing surveillance.Here,we reported a patient with contact dermatitis due to the homoeopathic medicine Calendula officinalis.Case presentation:A 33-year-old previously healthy woman presented with pruritus,redness,and swelling over the entire face and upper neck.The symptoms developed within about 1 hour after the use of a homoeopathic skin ointment containing 2%Calendula officinalis as the major ingredient in an aqueous base.Cutaneous examination revealed periorbital edema and facial swelling with multiple vesicular eruptions over erythematous edematous plaques on the face.A clinical diagnosis of contact dermatitis was considered.Discussion:Many herbal preparations in India are available without safety data.Calendula officinalis extract(oil expressed from seeds)is used in various skin products.The exact allergens present in Calendula officinalis are unknown,but the flowers reportedly contain a variety of phenolic acids and phenylpropanoids that have elicited contact dermatitis.Conclusion:Anecdotal case reports of accidental exposure/sensitization and experimental studies provide sufficient evidence to confirm the causal relationship between contact dermatitis with Calendula Officinalis.Postmarketing surveillance of all homoeopathic medicines should be mandatory,and the availability of such preparations as over-the-counter drugs must be restricted.