title: Low-cobalt diet for dyshidrotic eczema patients.
abstract: BACKGROUND
  Dyshidrotic eczema is a type of chronic intermittent dermatitis characterized by vesicles, dystrophic fingernail changes, and rarely bullae that affects the hands and feet. Many exogenous factors may trigger a flare including dermatophyte infections, contact irritants, and metal hypersensitivity. Although metal hypersensitivity does not play a role in all cases of dyshidrotic eczema, high oral ingestion of nickel and/or cobalt should be considered, regardless of patch test results.
  
  
  OBJECTIVE
  We updated and simplified existing published guidelines for low-cobalt diets. A recent review of the literature showed that dietary cobalt restriction, a safe yet burdensome treatment option for dyshidrosis, is referenced to dated sources.
  
  
  METHODS
  We have analysed current data for the cobalt content in common food items.
  
  
  CONCLUSIONS
  We propose a revised, point-based diet that will eliminate much of the dietary cobalt (and nickel) and reduce dyshidrotic eczema flares.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Stuckert
authors.forename: Susan
authors.initials: S
authors.lastname: Nedorost
mesh_terms: D003035:Cobalt / Q000633:toxicity*; D004032:Diet; D011146:Eczema, Dyshidrotic / Q000178:diet therapy* / Q000209:etiology*; D005512:Food Hypersensitivity / Q000178:diet therapy* / Q000209:etiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009532:Nickel / Q000633:toxicity; D009747:Nutritional Physiological Phenomena; D017410:Practice Guidelines as Topic; D014481:United States
chemical_list: D003035:Cobalt; D009532:Nickel