Original article Allergic contact dermatitis is accompanied by severe abnormal changes in antioxidativity of blood Maigi Eisen a,b, *, Sirje Kaur a , Aune Rehema b , Tiiu Kullisaar b , Tiiu Vihalemm b , Kersti Zilmer b ,C ˇ eslava Kairane b , Mihkel Zilmer b a Clinic of Dermatology, The University of Tartu, Raja Street 31, 50417 Tartu, Estonia b Institute of Biochemistry, The University of Tartu, Ravila Street 19, 50411 Tartu, Estonia Received 27 October 2003; accepted 24 February 2004 Abstract We investigated whether the oxidative stress (OS) caused by skin inflammation could reflect in the blood, in a 21-year-old female student sensitized to nickel, colophony and abitole with often relapsing allergic contact dermatitis (ACD). As glutathione redox ratio was increased in the blood not only during the relapse but also in the beginning of remission phase, we prescribed natural medical preparations of D-a-tocopherol (in the first week 100 mg three times a day followed by 100 mg/day) and ascorbic acid (200 mg/day) for 25 days to her. After using antioxidants in the remission period, one of the principal OS markers—the glutathione redox ratio reached the normal physiological level. In this report, we showed that during acute extensive ACD OS is expressed in the blood and simultaneous supplementation of D-a-tocopherol and ascorbic acid might reduce systemic OS. © 2004 Elsevier SAS. All rights reserved. Keywords: Allergic contact dermatitis; Glutathione redox ratio; D-a-tocopherol; Ascorbic acid; Oxidative stress 1. Introduction In many pathological circumstances, including irritant and allergic contact dermatitis (ACD), an excessive produc- tion of reactive oxygen species (ROS) occurs causing an imbalance in the oxidative stressors—antioxidants system [1,2]. The principal ROS are free radicals like superoxide and hydroxyl radicals that despite a very short existence. Besides damaging lipids, proteins and nucleic acids [3], some of ROS (e.g. superoxide anion, etc.) are capable of reducing transi- tion metal ions, and release iron from storage proteins, e.g. ferritin [4–6]. Iron ions significantly promote the formation of free radicals. For systemic control of action of ROS, human body has an integrated antioxidant defense system. These include both non-enzymatic antioxidants like reduced glutathione (GSH) and vitamins E and C and enzymatic antioxidants like cata- lase, superoxide dismutase, and etc. [3]. Reduced glutathione (GSH) is of particular importance, as a central one among intracellular non-enzymatic antioxi- dants [7]. It directly scavenges a variety of ROS including hydroxyl radicals [8], it also serves as a co-factor for enzyme glutathione peroxidase [3]. Its oxidation product—oxidized glutathione (GSSG) is toxic at elevated levels and is rapidly converted back to GSH by enzyme glutathione reductase [7]. The involvement of ROS in the pathogenesis of contact dermatitis (CD) is described in literature [8,9]. We have recently demonstrated that chronic CD in a restricted area (hands) is accompanied by substantial changes in free iron level and glutathione redox status not only in diseased area, but also clinically uninvolved skin [2]. The changes in clini- cally undamaged skin pointing to the severity and general- ized nature of oxidative stress (OS) prompted us to investi- gate whether the severe skin inflammation is accompanied by high-grade OS in the blood. 2. Subject A 21-year-old female art student had experienced the symptoms of nickel sensitization since ear piercing at the age of 11; afterwards relapses occurred because of wristwatches, jewelry and clothes with metal accessories. At the age of * Corresponding author. E-mail address: Maigi.Eisen@kliinikum.ee (M. Eisen). Biomedicine & Pharmacotherapy 58 (2004) 260–263 www.elsevier.com/locate/biopha © 2004 Elsevier SAS. All rights reserved. doi:10.1016/j.biopha.2004.02.005