Showing papers in "Contact Dermatitis in 2014"

The dramatic increase in the rate of methylisothiazolinone contact allergy in Belgium: a multicentre study.

Abstract: Background: The rate of contact allergy and allergic contact dermatitis caused by methylisothiazolinone (MI) is dramatically increasing throughout Europe. Objectives: To report on methylchloroisothiazolinone (MCI)/MI and MI allergy in Belgium. Patients and methods Between January 2010 and December 2012, the medical charts of 6599 patients of the Belgian Contact and Environmental Dermatitis Group were retrospectively reviewed for MCI/MI and MI sensitization by use of a standardized questionnaire. Available data on sensitization in 2081 patients tested in 2013 were also included. Results: In 2012, the sensitization rate for MCI/MI had increased to 4.5% and that for MI to 6.0%; the latter showed a further increase to 7.2% in 2013. The people mainly affected were women with a median age of 49 years with hand and/or facial dermatitis, most often resulting from the use of cosmetics. Simultaneous reactions to octylisothiazolinone were observed. Conclusion: A dramatic increase in the rate of contact allergy caused by MI in cosmetics is occurring in Belgium. Notwithstanding the recent recommendation to discontinue the use of MI in leave-on cosmetics, safer use concentrations should also be determined for rinse-off products. Close monitoring of MI sensitization in the near future will be necessary, and the highest test concentrations reported for MI and MCI/MI should be included in the baseline series.

Allergic contact dermatitis caused by acrylates and methacrylates--a 7-year study.

Abstract: SummaryBackgound Allergic contact dermatitis (ACD) caused by (meth)acrylates is traditionally an occupational disease among dentists, printers, and fibreglass workers. With the use of artificial nails, cases have been reported both in nail technicians and in users. Objectives The aims of this study were to characterize ACD caused by (meth)acrylates, identify the responsible allergens, and assess the sensitivity of the patch test with 2-hydroxyethyl methacrylate (HEMA) for diagnosis. Methods An observational and retrospective study (January 2006–April 2013) was performed, evaluating and correlating epidemiological and clinical parameters and positive patch test results with (meth)acrylates. Results Among 2263 patch tested patients, 122 underwent aimed testing with an extended (meth)acrylate series, and 37 showed positive and relevant reactions. Twenty-five cases (67.6%) were occupational. Hand eczema with pulpitis was observed in 32 patients. Twenty-eight cases were related to artificial nails, 3 were related to dental materials, and 2 were industrial workers. Oral lesions associated with dental prostheses were observed in 4 patients. Thirty-one patients reacted to more than one (meth)acrylate. In our sample, beauty technicians working with artificial nails were the most affected group (80% of occupational cases). Conclusion HEMA detected 80.6% of our cases, and may be considered a good screening allergen. However, to perform an accurate diagnosis, it is safer to use a broader series of allergens.

Patch test study of 90 patients with tattoo reactions: negative outcome of allergy patch test to baseline batteries and culprit inks suggests allergen(s) are generated in the skin through haptenization

Abstract: SummaryBackground Tattoo reactions, especially in red tattoos, are often suggested as allergic in nature, however, systematic evaluation by patch testing has not performed in the past. Objective To report the results of patch testing in 90 patients with non-infectious chronic tattoo reactions. Materials/methods From 2009 to 2013 at the ‘Tattoo Clinic’, Department of Dermatology, Bispebjerg University Hospital, 90 patients were patch tested with batteries of baseline allergens, disperse dyes/textile allergens, and a selection of tattoo ink stock products, which, according to case observations, were problematic, supplemented with individual culprit inks when accessible. Results Patients with reactions to the tattoo colour red, the most predominant colour associated with skin reactions, showed negative patch test results with common allergens. Outcomes were also negative in patients who had experienced concomitant reactions in another hitherto tolerated tattoo of the same colour as the problematic tattoo. Discussion/conclusion The allergen or allergens responsible for tattoo reactions are not present directly in tattoo ink stock products. This is despite the fact that clinical histories suggest that the vast majority of clinical reactions, especially reactions to red and red nuances, are likely to be allergic events caused by the injected inks. We suggest that the responsible allergen results from a complicated and slow process of haptenization, which may even include photochemical cleavage of red azo pigment.

A survey of exposures related to recognized occupational contact dermatitis in Denmark in 2010

Abstract: Summary Background Skin diseases are the most commonly recognized occupational diseases in Denmark, and occupational contact dermatitis (OCD) comprises ∼95% of all cases. Objectives To prevent occupational contact dermatitis, it is important to specifically identify exposures and work routines related to outbreak of the disease. The aim of this study was to give an overview of exposures for patients with occupational contact dermatitis in Denmark in 2010, and relate this to line of work and disease severity. Material and methods The study was a descriptive, register-based study including patients with recognized occupational contact dermatitis in Denmark in 2010. Data were obtained from the National Board of Industrial Injuries in Denmark, and comprised information about the skin disease as well as the occupation/industry of employment and exposures. Results One thousand five hundred and four patients, 1020 women and 484 men, were included in the study. Irritant contact dermatitis accounted for 70% of all cases; 68% of these were caused by wet work. Forty-six per cent of all patients were employed either in the healthcare sector, in cleaning, or as kitchen workers. Among contact allergies, the most common were to rubber additives from gloves and epoxy in patients employed in the windmill industry. Conclusion The data are important for planning preventive efforts in the future. The workers in the healthcare sector, kitchen workers and cleaners constitute almost half of all cases, and future preventive efforts should be directed at these occupations.

Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study

Abstract: Summary Background /objectives Environmental exposure and personal susceptibility both contribute to the development of hand eczema. Here, we report an investigation on wet work exposure and its influence on the risk of developing hand eczema in apprentice nurses. Methods A prospective cohort study was performed among 721 Dutch apprentice nurses. Participants recorded wet work exposure and symptoms of hand eczema using specially designed diary cards. Results For 533 apprentice nurses, a follow-up time of 1–3 years was completed. Diary cards were supplied by 383 students. The 1-year period prevalence of hand eczema was 23% in the first year, 25% in the second year and 31% in the third year of follow-up. Eighty-one new cases of hand eczema developed, most of which occurred during the first year of follow-up. In approximately one-third of the participants, wet work exposure exceeded the national guidelines. Frequent hand washing during traineeships [odds ratio (OR) 1.5; 90% confidence interval (CI) 1.0–2.3], frequent hand washing at home (OR 2.3; 90% CI 1.5–3.7) and having a side job involving wet work (OR 1.6; 90% CI 1.0–2.4) were independent risk factors for hand eczema. Conclusion As a considerable number of apprentice nurses had already developed hand eczema during traineeships, more attention should be paid to skin protection in vocational education.

Contact and photocontact allergy to octocrylene: a review

Abstract: Summary Octocrylene is an ultraviolet (UV)B and UVAII absorber that was introduced some15yearsago,andisnowwidelyusedinsunscreenagentsandskincarecosmetics.Since2003, several studies, notably from France, Belgium, Spain, and Italy, have reported anincreasing number of patients with photocontact allergy to octocrylene. This reaction isseen mainly in adult patients who have previously used topical products containing thenon-steroidalanti-inflammatorydrugketoprofen.Photosensitizationtoketoprofenleads,in many cases, to photocontact allergy to octocrylene; the mechanism of this reaction isunknown.Contactallergytooctocrylenealsooccurs,butisfarlessfrequent,andisseen,in most cases, in children, resulting from the use of octocrylene-containing sunscreenproducts.Inthisarticle,(photo)contactallergytooctocryleneisfullyreviewed. Keywords: benzophenone-3;contactallergy;ketoprofen;octocrylene;photocontactallergy;photopatchtests;photo-cross-reactivity;sunscreen;UVA-absorber;UVB-absorber.The rise in public awareness of the harmful effects ofthe sun’s ultraviolet (UV) radiation, such as sunburn,skin cancer, and photoaging, has led to an increase inthe use of sunscreen products. Octocrylene is a relativelynew UV-filter that was introduced in sunscreens anddaily care cosmetic products in the late 1990s. Since2003,severalstudieshaveindicatedthatoctocrylenenotinfrequently causes photocontact allergy/photoallergiccontact dermatitis, notably in adult patients previouslyphotosensitized to ketoprofen in topical medications.Allergic contact dermatitis is seen to a lesser degree,usually in children, and is caused by sensitization tooctocryleneinsunscreenproducts.

p‐Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study

Abstract: Summary Background Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers. Objectives To evaluate the presence of potent contact sensitizers in oxidative hair dye products intended for home use on the US market. Methods Ingredient labels of 107 hair dyes from 10 major brands were examined and used to assess the prevalence of hair dye substances known to be potent contact sensitizers. Results One hundred and six of 107 (99%) products contained at least one potent sensitizer, and the average product contained six (range 0–11). p-Phenylenediamine (PPD) was found in 83 products (78%), but resorcinol (89%), m-aminophenol (75%), p-aminophenol (60%) and toluene-2,5-diamine (21%) were also frequently identified. Conclusions Potent contact sensitizers were almost universally included in the hair dyes investigated in the United States. Although PPD is a common allergen, resorcinol and m-aminophenol were found more frequently. In total, 30 potent sensitizers were found. Clinicians should consider other allergens in addition to PPD when evaluating patients with suspected hair dye allergy.

Contact allergy to ingredients of hair cosmetics - a comparison of female hairdressers and clients based on IVDK 2007-2012 data.

Abstract: Summary Background Cosmetics for bleaching, waving/relaxing and dyeing hair contain well-known allergens, leading to a substantial number of cases of allergic contact dermatitis. Objective To compare the frequency of important contact allergens (i) between two distinct groups of exposed patients, and (ii) with previous surveillance data. Methods On the basis of data collected by the Information Network of Departments of Dermatology (IVDK; www.ivkd.org) between 2007 and 2012 in 824 female hairdressers and 2067 female clients, the current spectrum of contact sensitization to ingredients of hair cosmetics, as contained in different pertinent series, is described. Results A similar burden of sensitization as in previous analyses was observed, but with some increase in sensitization to oxidative hair dye components in clients. Some allergens mainly affected hairdressers, such as ammonium persulfate (18.7% positive) and glyceryl monothioglycolate (GMTG; still 4.7% positive, with a few cases also in young hairdressers, despite removal from the German market). Conclusions Hair dyes remain important contact allergens, despite various attempts by the cosmetic industry to introduce hair dyes with lower allergenic potential. The re-emergence of GMTG as an occupational allergen should be considered as a warning signal (‘sentinel event’) prompting close monitoring.

Allergic contact dermatitis in Danish children referred for patch testing - a nationwide multicentre study.

Abstract: SummaryBackground Although contact allergy among children was previously considered to be rare, data from the past decade have shown that it is common among children and that the prevalence may be increasing. Objectives To describe the demographics of all children referred for patch testing in Denmark during 2003–2011, to examine the frequency and relevance of positive patch test reactions, and to assess the most common allergens. Methods A retrospective analysis of the patch test data from the Danish National Database of Contact Allergy was performed. Results Of 2594 children and adolescents aged 1–17 years, 25.1% had one or more positive patch test reactions. The associated relevance was 66.4%. The most common sensitizers were metals, fragrances, and hair dyes. The frequency of positive patch test reactions and allergic contact dermatitis was significantly higher among girls. Conclusions Allergic contact dermatitis in children is a significant clinical problem. Contact allergy should always be considered when children with recalcitrant eczema are encountered, and special attention should be paid to girls. Patch testing is important, and children may be tested with the same patch test concentrations as adults.

Baseline series fragrance markers fail to predict contact allergy.

Abstract: SummaryBackground Negative patch test results with fragrance allergy markers in the European baseline series do not always predict a negative reaction to individual fragrance substances. Objectives To determine the frequencies of positive test reactions to the 26 fragrance substances for which labelling is mandatory in the EU, and how effectively reactions to fragrance markers in the baseline series predict positive reactions to the fragrance substances that are labelled. Methods The records of 1951 eczema patients, routinely tested with the labelled fragrance substances and with an extended European baseline series in 2011 and 2012, were retrospectively reviewed. Results Two hundred and eighty-one (14.4%) (71.2% females) reacted to one or more allergens from the labelled-fragrance substance series and/or a fragrance marker from the European baseline series. The allergens that were positive with the greatest frequencies were cinnamyl alcohol (48; 2.46%), Evernia furfuracea (44; 2.26%), and isoeugenol (40; 2.05%). Of the 203 patients who reacted to any of the 26 fragrances in the labelled-fragrance substance series, only 117 (57.6%) also reacted to a fragrance marker in the baseline series. One hundred and seven (52.7%) reacted to either fragrance mix I or fragrance mix II, 28 (13.8%) reacted to Myroxylon pereirae, and 13 (6.4%) reacted to hydroxyisohexyl 3-cyclohexene carboxaldehyde. Conclusions These findings confirm that the standard fragrance markers fail to identify patients with contact allergies to the 26 fragrances.

Occupational contact dermatitis in hairdressers: an analysis of patch test data from the Danish Contact Dermatitis Group, 2002 - 2011

Abstract: SummaryBackground Occupational contact dermatitis among hairdressers is frequent, owing to daily exposure to irritants and allergens. Objectives To identify sensitization to the most common allergens associated with the occupation of hairdressing. Methods Patch test results of 399 hairdressers and 1995 matched controls with contact dermatitis, registered by the Danish Contact Dermatitis Group between January 2002 and December 2011, were analysed. All patients were patch tested with the European baseline series, and hairdressers were additionally tested with the hairdressing series. Results Occupational contact dermatitis (p < 0.001) and hand eczema (p < 0.001) were observed significantly more often among hairdressers than among controls. Atopic dermatitis was less commonly observed among hairdressers (21.3%) than among controls (29.4%) (p < 0.01). Allergens from the European baseline series with a statistically significant association with the occupation of hairdressing were p-phenylenediamine, thiuram mix, and benzocaine. Frequent sensitizers from the hairdressing series were ammonium persulfate, toluene-2,5-diamine, 3-aminophenol, and 4-aminophenol. Cysteamine hydrochloride and chloroacetamide emerged as new sensitizers. Conclusions These results indicate a healthy worker effect among hairdressers diagnosed with eczema. Ammonium persulfate and p-phenylenediamine remain frequent sensitizers in hairdressers with contact dermatitis. Cysteamine hydrochloride and chloroacetamide should be included in future surveillance studies.

Cobalt, nickel and chromium release from dental tools and alloys

Abstract: Summary Background. Cobalt – chromium alloys are used as casting alloys by dental technicians when producing dental prostheses and implants. Skin exposure and metal release from alloys and tools used by the dental technicians have not been studied previously. Objectives. To study the release of cobalt, nickel and chromium from alloys and tools that come into contact with the skin of dental technicians. Methods. Cobalt and nickel release from tools and alloys was tested with the cobalt spot test and the dimethylglyoxime test for nickel. Also, the release of cobalt, nickel and chromium in artificial sweat (EN1811) at different time-points was assessed. Analysis was performed with inductively coupled plasma-mass spectrometry. Results. Sixty-one tools were spot tested; 20% released nickel and 23% released cobalt. Twenty-one tools and five dental alloys were immersed in artificial sweat. All tools released cobalt, nickel and chromium. The ranges were 0.0047 – 820, 0.0051 – 10 and 0.010 – 160 μg/cm 2 /week for cobalt, nickel and chromium, respectively. All dental alloys released cobalt in artificial sweat, with a range of 0.0010 – 17 μg/cm 2 /week, and they

Isothiazolinones in commercial products at Danish workplaces.

Abstract: Summary Background In recent years, a steep increase in the frequency of occupational contact allergy to isothiazolinones has been reported from several European countries. Objective To examine the extent and occurrence of isothiazolinones in different types of product at Danish workplaces. Methods Seven different isothiazolinones were identified in the Dictionary of Contact Allergens: Chemical Structures, Sources, and References from Kanerva's Occupational Dermatitis. By use of the chemical names and Chemical Abstracts Service numbers for these chemicals, information on products registered in the Danish Product Register Database (PROBAS) was obtained. Results All seven isothiazolinones were registered in PROBAS. The top three isothiazolinones registered were: benzisothiazolinone (BIT), registered in 985 products, methylisothiazolinone (MI), registered in 884 products, and methylchloroisothiazolinone (MCI)/MI, registered in 611 products. The concentration ranges were 0.01 ppm to 45% for BIT, 0.01 ppm to 10% for MI, and 0.01 ppm to 14.1% for MCI/MI. The most common product type was ‘paint and varnish’; five of the seven isothiazolinones were registered in this type of product. Conclusion Isothiazolinones are present in multiple products registered for use at workplaces, and may occur in high concentrations.

Filaggrin loss-of-function mutations and atopic dermatitis as risk factors for hand eczema in apprentice nurses: part II of a prospective cohort study

Abstract: Summary Background/objectives. Environmental exposure and personal susceptibility both contribute to the development of hand eczema. In this study, we investigated the effect of loss-of-function mutations in the filaggrin gene (FLG), atopic dermatitis and wet work exposure on the development of hand eczema in apprentice nurses. Methods. Dutch apprentice nurses were genotyped for the four most common FLG mutations; atopic dermatitis and hand eczema history were assessed by questionnaire. Exposure and hand eczema during traineeships were assessed with diary cards. Results. Theprevalenceofhandeczemaduringtraineeshipswashigheramongsubjects with a history of hand eczema reported at inclusion. Hand washing during traineeships andathomeincreasedtheriskofhandeczema.Afteradjustmentfortheeffectsofexposure andFLGmutations,anoddsratioof2.5(90%confidenceinterval1.7‐3.7)wasfoundfor ahistoryofatopicdermatitis.Inthisstudy,anincreasedriskofhandeczemaconferredby FLG mutations could not be shown, but subjects with concomitant FLG mutations and atopic dermatitis showed the highest risk of hand eczema during traineeships. Conclusion. A history of atopic dermatitis, a history of hand eczema and wet work exposure were the most important factors increasing the risk of hand eczema during

Topical botanically derived products: use, skin reactions, and usefulness of patch tests. A multicentre Italian study

Abstract: Summary Background The evidence on the safety of topical preparations containing botanical extracts is limited. Objectives To assess (i) the use of botanically derived compounds in a large population, (ii) the incidence of cutaneous side-effects, and (iii) the diagnostic usefulness of patch testing. Methods A questionnaire was used in 2661 patients to assess both the prevalence and type of topical botanical preparations used, and the occurrence of adverse skin reactions. Patients declaring adverse reactions were patch tested with (i) the Italian (SIDAPA) baseline series, (ii) an additional botanical series, and (iii) the patients' own products. Results Of the patients, 1274 (48%) reported the use of topical botanical products; 139 patients (11%) commented on adverse cutaneous reactions; 75 (54%) showed positive reactions with the Italian baseline series. Among the 122 patients tested with the botanical series, 19 (16%) showed positive reactions, in many cases with concomitant relevant positivity to at least one allergen of the Italian series connected with cosmetics. The commonest botanically derived allergens were propolis, Compositae extracts, and Melaleuca alternifolia (tea tree) oil. Conclusions Contact allergy is a possible adverse effect of natural products. Baseline series supplemented with the commonest botanical allergens may be adequate for detecting most of the cases of contact allergy to natural topical products.

Recommendation to increase the test concentration of methylchloroisothiazolinone/methylisothiazolinone in the European baseline patch test series – on behalf of the European Society of Contact Dermatitis and the European Environmental and Contact Dermatitis Research Group

Abstract: Methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) in aqua is present in the European baseline patch test series at 100 ppm, whereas 200 ppm has been used in Sweden since 1986, in Spain in the late 1980s, and, in recent years, also in the United Kingdom and Ireland.

Outbreak of contact sensitization to methylisothiazolinone: an analysis of French data from the REVIDAL-GERDA network.

Abstract: Background The preservative methylisothiazolinone (MI) is used in combination with methylchloroisothiazolinone (MCI), but the MCI/MI mixture has been identified as highly allergenic. MI is considered to be less allergenic, and since the mid-2000s has been widely used alone, but is now clearly identified as a contact allergen. The French Vigilance Network for Dermatology and Allergy of the Study and Research Group on Contact Dermatitis (REVIDAL-GERDA) added MI to its baseline patch testing series in 2010. Objective To evaluate the change in the proportion of MI-positive tests in France between 2010 and 2012. Patients/materials/methods We conducted a nationwide, multicentre, retrospective study of all MI-tested patients between 2010 and 2012. Results Sixteen centres participated in the study (7874 patients were tested). Patch tests were performed mainly at a concentration of MI 200 ppm aq. We observed a significant increase in the proportion of MI-positive tests in 2012 and 2011 as compared with 2010 (5.6%, 3.3%, and 1.5%, respectively; p Conclusions We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.

Occupations at risk of developing contact allergy to isothiazolinones in Danish contact dermatitis patients: results from a Danish multicentre study (2009-2012).

Abstract: Summary Background In recent years, the prevalence of contact allergy to isothiazolinones has reached epidemic levels. Few studies have presented data on occupations at risk of developing contact allergy to isothiazolinones. Objectives To present demographics and examine risk factors for sensitization to methylisothiazolinone (MI), methylchloroisothiazolinone (MCI) in combination with MI and benzisothiazolinone (BIT) in Danish dermatitis patients. Materials and methods A retrospective epidemiological analysis of data from three Danish hospitals departments was conducted. All patients consecutively patch tested with MI, MCI/MI and BIT between 2009 and 2013 were included. Results MI contact allergy showed a significantly increased trend in prevalence from 1.8% in 2009 to 4.2% in 2012 (p 40 years, and the occupational groups of tile setters/terrazzo workers, machine operators, and painters. MCI/MI contact allergy was significantly associated with the following high-risk occupations: painting, welding (blacksmiths), machine operating, and cosmetology. The occupational group of painting was frequent in the group of patients with BIT contact allergy. Conclusion Several high-risk occupations for sensitization to isothiazolinones exist. Regulation on the allowed concentration of isothiazolinones, and especially MI, in both consumer products and industrial products is needed.

Preventing irritant contact dermatitis with protective creams: influence of the application dose

Abstract: Summary Background Skin protection creams (PC)s are used in the occupational setting to help prevent irritant hand dermatitis. The actual amounts of PC applied and the resulting dose per unit area on hands at work are lower than recommended. Objectives To assess the influence of the applied dose on the efficacy of PCs in the prevention of irritant contact dermatitis. Methods Experimental cumulative irritant contact dermatitis was induced by twice daily application of 0.5% NaOH or sodium lauryl sulfate (SLS) for 4 days on the backs of 20 healthy volunteers. Test areas were left unprotected or were pretreated with three different PCs applied at a low dose (2 mg/cm2) or a high dose (20 mg/cm2) before irritation. Irritant responses were assessed by visual scoring and measurement of transepidermal water loss, chromametry, and corneometry. Results Although cumulative irritant dermatitis developed in all unprotected test sites, irritation was significantly reduced in a dose-dependent manner on PC-protected sites. The higher doses of all PCs provided significant protection against irritation. However, the lower dose of one product did not significantly protect against SLS-induced irritation. Conclusions The protective efficacy of PCs depends on the amount of product applied per unit skin surface area. Some products may show no protective efficacy when used at doses close to those practically applied at workplaces. Future efficacy studies of PCs should be performed with doses not higher than 2 mg/cm2, to avoid overestimation of their protective efficacy.

Positive patch test reactions to oxidized limonene: exposure and relevance

Abstract: Background. R-Limonene is a common fragrance terpene found in domestic and industrial products. R-Limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a recent multicentre study, 5.2% (range 2.3-12.1%) of 2900 patients showed a positive patch test reaction to oxidized R-limonene. Objective. To study the exposure to limonene among consecutive dermatitis patients reacting to oxidized R-limonene in an international setting, and to assess the relevance of the exposure for the patients' dermatitis. Methods. Oxidized R-limonene 3.0% (containing limonene hydroperoxides at 0.33%) in petrolatum was tested in 2900 consecutive dermatitis patients in Australia, Denmark, the United Kingdom, Singapore, Spain, and Sweden. A questionnaire assessing exposure to limonene-containing products was completed. Results. Overall, exposure to products containing limonene was found and assessed as being probably relevant for the patients' dermatitis in 36% of the limonene-allergic patients. In Barcelona and Copenhagen, >70% of the patients were judged to have had an exposure to limonene assessed as relevant. Conclusions. Oxidized R-limonene is a common fragrance allergen, and limonene was frequently found in the labelling on the patients' products, and assessed as relevant for the patients' dermatitis. A large number of domestic and occupational sources for contact with R-limonene were identified.

Reaction profile in patch testing with allergens formed during vulcanization of rubber

Abstract: Summary Background Vulcanization of rubber changes its allergen pattern. Objectives To estimate the contact allergic reactivity profile of users of finished rubber products. Methods Twenty-four patients with known contact allergy to rubber accelerators were patch tested with 21 compounds found in chemical analyses of vulcanized rubber products. No diphenylguanidine, p-phenylenediamine antioxidants or thioureas were included in the study. Results Thiuram monosulfides formed during vulcanization showed generally stronger test reactions than the corresponding thiuram disulfides. We also obtained more positive thiuram reactions to the monosulfides than to the disulfides. A positive reaction to a dithiocarbamate was accompanied by a positive reaction to the corresponding thiuram, except for 1 patient. The nitrogen substituents showed only minor differences between the methyl, ethyl and pentamethylene groups, but the butyl derivatives gave, in most cases, a negative response. Dialkylthiocarbamyl benzothiazole sulfides, formed between thiurams and mercaptobenzothiazoles during vulcanization, showed strong test reactions in almost all patients who were sensitive to dithiocarbamates, thiurams, or mercaptobenzothiazoles. Conclusions We found thiuram monosulfides to be better markers of thiuram sensitivity than the corresponding disulfides or dithiocarbamates. Surprisingly, the dialkylthiocarbamyl benzothiazole sulfides were good markers of both thiuram and mercaptobenzothiazole sensitivity. This is an unexpected finding that needs to be confirmed in a larger study.

Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids.

Abstract: Summary Background Little is known about the socio-economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids. Objectives To estimate the socio-economic burden of severe chronic hand eczema refractory to potent topical corticosteroids, and to establish an algorithm for the estimation of the health-related quality of life EuroQol five-dimensional (EQ-5D) utility index from the Dermatology Life Quality Index (DLQI) summary score. Methods A multicentre cost of illness study was conducted, adopting the societal perspective. Adult patients with severe and refractory chronic hand eczema were enrolled. Direct (e.g. drug treatment and travel) and indirect (i.e. loss of productivity) mean costs/patient-month were estimated. Health-related quality of life was assessed with the EQ-5D and DLQI questionnaires. An ordinary least square regression model was used to investigate relationships between health-related quality of life scores. Results One hundred and four valid patients (mean age 44.5 years, 39.4% male) participated. Overall mean costs were €418.3/patient-month: loss of productivity contributed 43.7%, followed by hospitalization (16.1%) and travel (10.3%). Health-related quality of life scores were, on average, 0.50 (EQ-5D utility) and 11.3 (DLQI). Utility and DLQI summary were significantly related to each other. Conclusions Wellbeing and loss of productivity are the most important consequences in these patients. Appropriate treatment is necessary to improve patient health and productivity, which will contribute to reducing societal costs.

Coupled exposure to ingredients of cosmetic products: II. Preservatives.

Abstract: SummaryBackground The use of cosmetics exposes consumers to mixtures of ingredients, many of which are potential allergens. Many cosmetics contain one or several preservatives, some being important contact allergens. Objective To examine the pattern of co-exposure to preservatives in different categories of cosmetics. Methods A survey of products marketed in Germany, conducted in 2006–2009 by the Chemical and Veterinary Investigation Office in Karlsruhe, identified 4680 products categorizable according to Annex I to the Cosmetics Directive with information on the presence of preservatives. The occurrence and co-occurrence of preservatives were analysed and presented in tabular and graphical format. Results Thirty per cent of all products were not declared to contain any preservatives; for 8%, no INCI labelling was present. For the remainder, the number of preservatives used tended to be higher in leave-on than in rinse-off products. Most often, combinations of (up to all five) parabens were used (39% of all products). Combinations with phenoxyethanol were also frequent. Formaldehyde releasers were found in 8% of products overall. Conclusions The pattern of co-exposure to preservatives in important categories of cosmetic products illustrates the ‘cocktail’ of allergens that may facilitate sensitization, although, conversely, the combination of preservatives allows individual use levels to be kept lower, thereby possibly reducing sensitization risk.

Allergic contact dermatitis caused by alkyl glucosides

Abstract: Background Alkyl glucosides were not expected to have a sensitizing potential at the concentrations to be used in finished consumer products; however, several contact allergy cases have been published. Objectives To report on the patients suffering from allergic contact dermatitis caused by alkyl glucosides observed in our department. Patients/methods During a 19-year period (1993-2012), 11 842 patients with suspected contact dermatitis were patch tested with the European baseline series and, if relevant, also with other series and individual allergens. For this study, the clinical data and the sensitization sources in the alkyl glucoside-positive patients were analysed. Results In total, 30 patients (24 women and 6 men) presented with a positive reaction to one or more alkyl glucosides. The causal products were shampoos (in 12), skin-cleansing products (in 12, among which were wipes for intimate hygiene), sunscreen products (in 5), skin-care products (in 4), and a deodorant (in 1). Sixteen patients showed multiple sensitivities (defined as three or more contact allergies), not only to other glucosides, but also to non-related chemicals. Conclusions Allergic contact dermatitis caused by alkyl glucosides in cosmetics does occur, and might be more frequent than suspected. In view of their common use, their identification as allergenic culprits is important.

An epidemic of contact allergy to methylisothiazolinone in Finland.

Abstract: Kaija Lammintausta1, Kristiina Aalto-Korte2, Leena Ackerman3, Kristiina Alanko3, Päivikki Berry4, Taina Hasan5, Renata Kaminska6, Laura Korhonen5, Arja Laukkanen7, Jussi Liippo1, Maria Pesonen2, Tapio Rantanen8, Riita Riekki9 and Katri Suuronen2 1Department of Dermatology, Turku University Hospital, 20521 Turku, Finland, 2Department of Dermatology, Finnish Institute of Occupational Health, Control of Hypersensitivity Diseases, 00250 Helsinki, Finland, 3Department of Dermatology, Skin and Allergy Hospital, 00290 Helsinki University Central Hospital, Helsinki, Finland, 4Department of Dermatology, Allergy Centre, North Carelia Central Hospital, 80210, Joensuu, Finland, 5Department of Dermatology, Tampere University Hospital, 33521 Tampere, Finland, 6Department of Dermatology, Central Hospital of Keski-Pohjanmaa, 67200 Kokkola, UK, 7Department of Dermatology, Kuopio Unievrsity Hospital, 70211 Kuopio, Finland, 8Department of Dermatology, Central Hospital, Päijät-Häme Social and Health Care Group, 15850 Lahti, Finland, and 9Department of Dermatology, Oulu University Hospital, 90029 Helsinki, Finland

An analysis of gender differences in patients with hand eczema - everyday exposures, severity, and consequences

Abstract: Summary Background Hand eczema is often related to high-risk occupations and aggravating exposures in everyday life. The disease is twice as frequent in women as in men, partly because of diverse exposure patterns. Other gender differences may be relevant for treatment and prevention. Objectives To gain insights into the common features and differences between men and women with hand eczema. Methods The clinical disease severity of patients (n = 306) attending for dermatological treatment at two settings was assessed with the Hand Eczema Severity Index (HECSI). Self-reported medication adherence, aggravating factors, hand eczema-related consequences and quality of life were obtained from a questionnaire. Results Men and women had equal clinical severities of disease, with an overall median HECSI of 43. Self-reported medication adherence was equal between the genders, but, among patients aged > 40 years, more reported higher adherence. The impact of disease was larger in women than in men. Women reported significantly more aggravating factors and sick leave. Also, women had a more impaired quality of life than men at equal levels of disease severity, and this could be associated with the higher number of aggravating factors. Conclusion Gender differences in hand eczema need to be considered in the dermatological treatment and counselling of patients.

Methylisothiazolinone: second 'epidemic' of isothiazolinone sensitization.

Abstract: Isothiazolinones are used as biocides in a wide variety of products, such as cosmetics, detergents, and industrial products. In the 1980s, a formulation with methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) was responsible for an allergic contact dermatitis ‘epidemic’. To control this phenomenon, a maximum allowed dose was set. However in 2005, MI alone was introduced in cosmetics, and this was followed by a new ‘epidemic’ of sensitization to MI and MCI/MI (1). We performed a retrospective study, consulting the medical files of patch tested patients reactive to ISs, from 2005 to 2013. MCI/MI was tested at 100 ppm in water (TROLAB® patch test allergens, Almirall Hermal

Air-oxidized linalool elicits eczema in allergic patients - a repeated open application test study.

Abstract: Summary Background Linalool is a commonly used fragrance terpene that forms potent sensitizers upon oxidation. In a recent multicentre study, we found that 7% of 2900 patients showed positive patch test reactions to oxidized linalool at 6.0%. No elicitation studies have been performed. Objective To identify threshold concentrations for elicitation of allergic contact dermatitis caused by oxidized linalool in allergic individuals with repeated exposures. Methods Repeated open application tests were performed in 6 participants previously diagnosed with contact allergy to oxidized linalool. Creams containing 3.0%, 1.0% and 0.30% oxidized linalool (corresponding to 0.56%, 0.19% and 0.056% linalool hydroperoxides, respectively) and ‘fine fragrance’ containing 1.0%, 0.30% and 0.10% oxidized linalool (corresponding to 0.19%, 0.056% and 0.019% linalool hydroperoxides, respectively) were used twice daily for up to 3 weeks. Patch testing with a dilution series of oxidized linalool was performed. Results Five of 6 participants reacted to the cream containing 3% oxidized linalool. With 1% oxidized linalool, a reaction was seen in 3 (cream) and 4 (fine fragrance) participants, respectively. With 0.3% oxidized linalool, 2 (cream) and 1 (fine fragrance) participants reacted. Conclusion Repeated exposure to low concentrations of oxidized linalool can elicit allergic contact dermatitis in previously sensitized individuals.

The rise in prevalence of contact allergy to methylisothiazolinone in the British Isles.

Abstract: Since 2005, in the EU, the use of methylisothiazolinone (MI) as a single-agent preservative has been permitted in both leave-on and rinse-off cosmetic products at concentrations of up to 100 ppm. Like others, we have observed a recent large increase in the number of patients with contact allergy to MI. Fourteen dermatology centres from across the British Isles (10 in England, one in Scotland, two in Wales, and one in Ireland) provided their patch test data on MI and methylchloroisothiazolinone (MCI)/MI contact allergy. Nine centres contributed data on both MI and MCI/MI, two centres [number 4 (Cork) and number 14 (Canterbury)] contributed data on MCI/MI alone, and three centres [number 12 (St John’s, London), number 13 (St Mary’s, London), and number 8 (Manchester)] contributed data on MI alone. In 2010, five centres were testing with MI. This number increased over the study period to 12 centres. Analysis was performed on data from January 2010 to June 2013. In all centres, test agents were applied in Finn Chambers® according to International Contact Dermatitis Research Group guidelines. Readings were performed on D2 and D4. Of the 11 centres contributing data on MCI/MI, nine centres tested with MCI/MI 0.02% aq. (Chemotechnique

Limonene hydroperoxide analogues show specific patch test reactions.

Abstract: Summary Background The fragrance terpene R-limonene is a very weak sensitizer, but forms allergenic oxidation products upon contact with air. The primary oxidation products of oxidized limonene, the hydroperoxides, have an important impact on the sensitizing potency of the oxidation mixture. One analogue, limonene-1-hydroperoxide, was experimentally shown to be a significantly more potent sensitizer than limonene-2-hydroperoxide in the local lymph node assay with non-pooled lymph nodes. Objectives To investigate the pattern of reactivity among consecutive dermatitis patients to two structurally closely related limonene hydroperoxides, limonene-1-hydroperoxide and limonene-2-hydroperoxide. Methods Limonene-1-hydroperoxide, limonene-2-hydroperoxide, at 0.5% in petrolatum, and oxidized limonene 3.0% pet. were tested in 763 consecutive dermatitis patients. Results Of the tested materials, limonene-1-hydroperoxide gave most reactions, with 2.4% of the patients showing positive patch test reactions. Limonene-2-hydroperoxide and oxidized R-limonene gave 1.7% and 1.2% positive patch test reactions, respectively. Concomitant positive patch test reactions to other fragrance markers in the baseline series were frequently noted. Conclusions The results are in accordance with the experimental studies, as limonene-1-hydroperoxide gave more positive patch test reactions in the tested patients than limonene-2-hydroperoxide. Furthermore, the results support the specificity of the allergenic activity of the limonene hydroperoxide analogues and the importance of oxidized limonene as a cause of contact allergy.