title: Malar rash caused by metal allergy in a patient with systemic lupus erythematosus.
abstract: BACKGROUND
  A 61-year-old woman with an 8-year history of systemic lupus erythematosus presented with a non-pruritic, erythematous, malar rash. Previously, she had tested positive for antinuclear antibody and autoantibodies to double-stranded DNA and Ro/SSA, and had an elevated erythrocyte sedimentation rate. She wore eyeglasses with metal frames and had recently gained weight, which caused the eyeglasses to have increased contact area with her face.
  
  
  METHODS
  Physical examination, autoantibody testing, measurement of complement C3 and C4 levels, measurement of erythrocyte sedimentation rate, hypersensitivity patch testing, dimethylglyoxime test of the patient's eyeglass frames.
  
  
  METHODS
  Delayed-type hypersensitivity reaction to nickel and possibly to cobalt dichloride in the patient's eyeglass frames, which caused a malar rash that mimicked acute cutaneous lupus erythematosus.
  
  
  RESULTS
  The rash resolved completely with contact avoidance with the eyeglass frames.
authors: Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610-0221, USA.
authors: Meghavi
authors: M
authors: Kosboth
authors: Anthony
authors: A
authors: Chin-Loy
authors: Robert
authors: R
authors: Lyons
authors: Stanton K
authors: SK
authors: Wesson
authors: Westley H
authors: WH
authors: Reeves
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000209:etiology; D005076:Exanthema / Q000175:diagnosis / Q000209:etiology*; D005139:Eyeglasses / Q000009:adverse effects; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications*; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects
chemical_list: D000974:Antibodies, Antinuclear; D003176:Complement C3; D003181:Complement C4; D008670:Metals; D009532:Nickel