Showing papers in "Contact Dermatitis in 2015"

European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice

Abstract: The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

North American contact dermatitis group patch test results: 2011-2012.

Abstract: Background Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective This study documents the North American Contact Dermatitis Group (NACDG) patch-testing results from January 1, 2011, to December 31, 2012. Methods At 12 centers in North America, patients were tested in a standardized manner with a series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends analyzed using χ statistics. Results Four thousand two hundred thirty-eight patients were tested; of these, 2705 patients (63.8%) had at least 1 positive reaction, and 2029 (48.0%) were ultimately determined to have a primary diagnosis of ACD. Four hundred eight patients (9.6%) had occupationally related skin disease. There were 7532 positive allergic reactions. As compared with previous reporting periods (2009-2010 and 2000-2010), positive reaction rates statistically increased for 6 allergens: methylchloroisothiazolinone/methylisothiazolinone (5.0%; risk ratios [RRs]: 2.01 [1.60-2.52], 1.87 [1.61-2.18]), lanolin alcohol (4.6%; RRs 1.83 [1.45-2.30], 2.10 [1.79-2.47]), cinnamic aldehyde (3.9%; 1.69 [1.32-2.15], 1.53 [1.28-1.82]), glutaral (1.5%; 1.67 [1.13-2.48], 1.31 [1.00-1.71]), paraben mix (1.4%; 1.77 [1.16-2.69], 1.44 [1.09-1.92]), and fragrance mix I (12.1%; RRs 1.42 [1.25-1.61], 1.24 [1.14-1.36]). Compared with the previous decade, positivity rates for all formaldehyde-releasing preservatives significantly decreased (formaldehyde 6.6%; RR, 0.82 [0.73, 0.93]; quaternium-15 6.4% RR 0.75 [0.66, 0.85]; diazolidinyl urea 2.1%; RR, 0.67 [0.54, 0.84]; imidazolidinyl urea 1.6%, 0.60 [0.47, 0.77]; bronopol 1.6%; RR, 0.60 [0.46, 0.77]; DMDM hydantoin 1.6%; RR, 0.59 [0.54, 0.84]). Approximately a quarter of patients had at least 1 relevant allergic reaction to a non-NACDG allergen. In addition, approximately one-fourth to one-third of reactions detected by NACDG allergens would have been hypothetically missed by T.R.U.E. TEST (SmartPractice Denmark, Hillerod, Denmark). Conclusions These data document the beginning of the epidemic of sensitivity to methylisothiazolinones in North America, which has been well documented in Europe. Patch testing with allergens beyond a standard screening tray is necessary for complete evaluation of occupational and nonoccupational ACD.

Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analyses of the European Surveillance System on Contact Allergy network, 2002-2010.

Abstract: SummaryBackground Occupational contact dermatitis is one of the most common occupational diseases in Europe. In order to develop effective preventive measures, detailed and up-to-date data on the incidence, main causes and professions at risk of occupational contact dermatitis are needed. Objectives To describe the pattern of patch test reactivity to allergens in the European baseline series of patients with occupational contact dermatitis in different occupations. Methods We analysed data collected by the European Surveillance System on Contact Allergy (ESSCA) network from 2002 to 2010, from 11 European countries. Results Allergens in the European baseline series associated with an at least doubled risk of occupational contact dermatitis include: thiuram rubber chemical accelerators, epoxy resin, and the antimicrobials methylchloroisothiazolinone/methylisothiazolinone, methyldibromo glutaronitrile, and formaldehyde. The highest risk of occupational contact dermatitis was found in occupations classified as ‘other personal services workers’, which includes hairdressers, nursing and other healthcare professionals, precision workers in metal and related materials, and blacksmiths, tool-makers and related trades workers. Conclusions In the planning and implementation of measures aimed at preventing occupational contact dermatitis, the focus should be on the identified high-risk occupational groups and the most common occupational allergies.

Chromium allergy and dermatitis: prevalence and main findings.

Abstract: The history of chromium as an allergen goes back more than a century, and includes an interventional success with national legislation that led to significant changes in the epidemiology of chromium allergy in construction workers. The 2015 EU Leather Regulation once again put a focus on chromium allergy, emphasizing that the investigation of chromium allergy is still far from complete. Our review article on chromium focuses on the allergen's chemical properties, its potential exposure sources, and the allergen's interaction with the skin, and also provides an overview of the regulations, and analyses the epidemiological pattern between nations and across continents. We provide an update on the allergen from a dermatological point of view, and conclude that much still remains to be discovered about the allergen, and that continued surveillance of exposure sources and prevalence rates is necessary.

New concepts in cutaneous allergy

Abstract: Summary Allergic contact dermatitis affects a worrying proportion of the general population. The mechanisms underlying this chemical-triggered delayed-type hypersensitivity are still not fully understood. In recent years, basic research has shown that the immune system reacts to contact allergens by activation of signalling pathways that are usually used to fight infections. Ongoing work is aimed at the elucidation of the path that leads from the chemistry of contact allergens to the inflammatory skin disease. The cellular players and their complex interactions are being characterized. Proteins are being identified whose chemical modification by contact allergens results in the activation of signalling pathways involved in pathogenesis. Pathway identification is supported by genomic and proteomic techniques. All of these efforts will yield a cellular and molecular understanding of the orchestration of the innate and adaptive immune response to contact allergens. This knowledge will help in the identification of gene and protein signatures for improved diagnostics, the identification of novel drug targets for targeted treatments, as well the development of in vitro assays for contact allergen identification.

Methylisothiazolinone and benzisothiazolinone are widely used in paint: a multicentre study of paints from five European countries

Abstract: Summary Background In view of the current epidemic of contact allergy to methylisothiazolinone (MI), it is important to clarify the extent of use of MI and related isothiazolinones in paints currently available for the consumer and worker in Europe Objectives To elucidate the use and concentrations of MI, methylchloroisothiazolinone (MCI) and benzisothiazolinone (BIT) in paints on the European retail market Methods Wall paints (n = 71) were randomly purchased in retail outlets in five European countries The paints were quantitatively analysed for their contents of MI, MCI and BIT by high-performance liquid chromatography coupled to tandem mass spectrometry Results MI was found in 930% (n = 66) of the paints, with concentrations ranging from 07 to 1809 ppm, MCI in 239% (n = 17), ranging from 026 to 114 ppm, and BIT in 958% (n = 68), ranging from 01 to 4625 ppm High concentrations of MI were found in paints from all five countries Paints purchased in Denmark and Sweden contained especially high concentrations of BIT Conclusion The use of MI across European countries is extensive In view of the ongoing epidemic of MI contact allergy, an evaluation of the safety of MI in paints is needed

Sensitization to palladium and nickel in Europe and the relationship with oral disease and dental alloys.

Abstract: Background The role of palladium and nickel sensitization in oral disease and dermatitis is not fully understood. Objectives To investigate whether sensitization to these metals was associated with exposure to dental alloys and oral and skin complaints/symptoms in a European multicentre study. Methods In six dermatology clinics, patch tests with palladium (3% Na2PdCl4; Pd = 102.0 µmol/g) and nickel (5% NiSO4.6H2O; Ni = 190.2 µmol/g) were performed in consecutive patients, and patients' characteristics were collected with a questionnaire and a clinical investigation. Results In total, 906 patients were included, of whom 24.3% reacted to palladium and 25.2% to nickel. The rate of monosensitization was 6-7% for both metals. Palladium sensitization (as opposed to no sensitization to both metals) was associated with exposure to dental crowns [odds ratio (OR) 2.0], skin reactivity to metals (OR 2.8), oral lichenoid lesions (OR 4.7), xerostomia (OR 7.3), and metal taste (OR 20.7), but not with eczema, stomatitis, or oral burning sensation. Additionally, xerostomia (OR 8.7) and metal taste (OR 4.6) were associated with sensitization to both metals. Conclusions Clinically, it is important for palladium-sensitized patients to undergo an oral examination, with particular attention to the presence of/exposure to dental crowns. In the case of metal contact allergy, exposure to dental crowns could play a role.

Contact allergy to acrylates and methacrylates in consumers and nail artists - data of the Information Network of Departments of Dermatology, 2004-2013.

Abstract: Summary Background Allergic contact dermatitis caused by (meth)acrylates used in artificial nails is a relevant problem in both nail artists and consumers Objective To analyse the frequency of this problem in the contact allergy surveillance network Information Network of Departments of Dermatology in 2004–2013, and address possible time trends and patterns of co-sensitization Methods A retrospective analysis of patch test results with (meth)acrylates, along with clinical and demographic data, was performed These were used to subdivide patients according to (i) a potentially exposed occupation and (ii) nail cosmetics as the suspected cause of contact dermatitis Results Among the 114 440 patients patch tested, 72 244 were female and were considered further Eighty-seven patients both worked as nail artists/cosmetologists and suspected nail cosmetics as the cause of dermatitis Among these, 471% reacted to at least one (meth)acrylate, most often to 2-hydroxyethyl methacrylate (n = 27), 2-hydroxypropyl methacrylate, and hydroxyethyl acrylate (n = 26 each), with marked coupled reactivity In other subgroups of interest, frequencies of sensitization to (meth)acrylates were less elevated but higher than in all remaining female patients (n = 69 419) Conclusions The results indicate a not entirely common, but potentially serious, problem, especially concerning occupationally exposed, and sensitized, nail artists Adequate protective measures should be taught as part of the vocational training

Azo pigments and quinacridones induce delayed hypersensitivity in red tattoos.

Abstract: Summary Background Induction of delayed hypersensitivity reactions by red tattoos has been occasionally reported. Little is known about the inks used. Azo pigments have been implicated in some instances, but there is only one reported case involving quinacridones. Objectives To describe the clinical and pathological features and outcome of skin reactions induced by red tattoo pigments. Patients, materials, and methods Six patients with a cutaneous reaction induced by a red tattoo pigment underwent biopsy and prick and patch testing with the inks supplied. Results We observed seven reactions in the 6 patients. Histology showed various patterns: three lichenoid, two eczematous, and two pseudolymphomatous. Five reactions occurred with azo pigments, and two with quinacridones, in both cases with Violet 19 and Red 122. Four inks were tested. Only one patch test gave a positive result at a late reading (day 7). Prick tests gave negative results. The reactions required various treatments, including laser treatment for 2 patients. Activation of the reaction in 1 case was transient. Conclusion Azo pigments and quinacridones both triggered reactions with similar clinical aspects but with varying histological findings. Patch and prick test results were disappointing with both. Reactions occurred following laser use in 1 case.

Chromium released from leather - I: exposure conditions that govern the release of chromium(III) and chromium(VI).

Abstract: Background. Approximately 1-3% of the adult population in Europe is allergic to chromium (Cr). Anew restriction in REACH(Registration, Evaluation, Authorization and Restriction of Chemicals) based ...

Contact sensitization to modern dressings: a multicentre study on 354 patients with chronic leg ulcers.

Abstract: SummaryBackground Modern dressings (MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers (CLUs) to evaluate this. Objectives To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. Patients and methods A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. Results Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). Conclusions Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers.

Occupational contact allergy in nurses: results from the Information Network of Departments of Dermatology 2003-2012.

Abstract: Summary Background Healthcare workers are occupationally exposed to various allergens in protective gloves, surface or instrument disinfectants, drugs, and skin care products. An increased prevalence of sensitization to thiurams, glutaraldehyde, formaldehyde and glyoxal in nurses with occupational contact dermatitis (OCD) has been known since the 1990s. Objectives To update the range of occupational allergens in healthcare professionals. Methods We retrospectively analysed patch test data from the Information Network of Departments of Dermatology (IVDK), 2003–2012. Patch test results from 2248 nurses with OCD were compared with those of 2138 nurses without OCD. Results Significantly increased sensitization rates were found for thiuram mix (6.7%), potassium dichromate (5.7%), methylchloroisothiazolinone/methylisothiazolinone (4.4%), colophonium (3.4%), 2-bromo-2-nitropropane-1,3-diol (1.7%), and zinc diethyldithiocarbamate (1.7%). Patch testing with products from the patients' workplaces gave additional clues to further allergens, for example tetrazepam. Conclusions The known range of contact sensitization in nurses with OCD has been confirmed. Formaldehyde allergy seems to be less important today. Drugs such as tetrazepam are occupational sensitizers in nurses. The increase in chromium sensitization remains unexplained.

Decrease in the rate of sensitization and clinical allergy to natural rubber latex

Abstract: SummaryBackground In the 1980s, a striking increase in natural rubber latex (NRL) allergy was seen. Since then, many measures have been taken to prevent NRL allergy. Objectives To investigate changes in the prevalence of NRL sensitization/clinical NRL allergy over time from 2002 to 2013. Methods All patients prick tested for NRL at the Department of Dermatology and Allergy Centre, Odense University Hospital were included in this study (n = 8580). In NRL-sensitized patients, the clinical relevance was evaluated for NRL. Furthermore, concomitant positive prick test results for birch pollen were recorded, together with food-related symptoms and sensitization in a subgroup of patients. Results The prevalence of NRL sensitization declined from 6.1% in 2002–2005 to 1.9% in 2006–2009, and then to 1.2% in 2010–2013 (p < 0.0001). The prevalence of clinical NRL allergy declined from 1.3% in 2002–2005 to 0.5–0.6% in 2006–2013 (p < 0.004). Among the NRL-sensitized patients, 64% had a concomitant positive prick test reaction to birch pollen, and 52% had a history of reaction to oral intake of related fruits or vegetables. Conclusion Our study showed a statistically significant decline in the number of patients sensitized/clinically allergic to NRL. Many of the NRL-sensitized patients without clinical allergy to NRL had concomitant birch pollen sensitization, and reported food-related symptoms.

Occupational allergic contact dermatitis caused by epoxy chemicals: occupations, sensitizing products, and diagnosis.

Abstract: Summary Background Epoxy products are among the most common causes of occupational allergic contact dermatitis. Diglycidyl ether of bisphenol A resin (DGEBA-R) is the most important sensitizer in epoxy systems. Objectives To describe patients with occupational allergic contact dermatitis caused by epoxy products. Methods Patients with allergic reactions to epoxy chemicals were chosen from test files (January 1991 to June 2014). Only patients with occupational contact allergy to some component of epoxy resin systems were included. We analysed patch test results, occupation, symptoms, and exposure data. Results We found a total of 209 cases with occupational contact allergy to epoxy chemicals. The largest occupational groups were painters (n = 41), floor layers (n = 19), electrical industry workers (n = 19), tile setters (n = 16), and aircraft industry workers (n = 15). A total of 82% of the patients reacted to DGEBA-R. Diagnosis of the DGEBA-R-negative patients required testing with m-xylylenediamine, N,N′-tetraglycidyl-4,4′-methylenedianiline, 1,4-butanediol diglycidyl ether, 2,4,6-tris-(dimethylaminomethyl)phenol, diglycidyl ether of bisphenol F resin, N,N′-diglycidyl-4-glycidyloxyaniline, isophoronediamine, 4,4′-diaminodiphenylmethane, diethylenetriamine, and cresyl glycidyl ether. The hands/upper extremities were most commonly affected (69%), but facial symptoms were also frequent (60%). Conclusions Allergic contact dermatitis caused by to epoxy products cannot always be diagnosed by the use of commercial test substances. Workplace products need to be tested.

Methylisothiazolinone in selected consumer products in Belgium: Adding fuel to the fire?

Abstract: SummaryBackground Methylisothiazolinone (MI) contact allergy is severely affecting consumers with allergic contact dermatitis, owing to its presence in cosmetics, household detergents, and water-based paints, in particular. Data on the true isothiazolinone concentrations in these products are scarce, and labelling may be incorrect. Objectives To report on the MI concentrations in such products marketed in Belgium, in order to verify the accuracy of labelling (when applicable) and compliance with EU regulations. Materials and methods Thirty cosmetics (18 leave-on and 12 rinse-off), eight detergents and four paints were analysed for MI by the use of high-performance liquid chromatography with ultraviolet detection. Results The analysed leave-on, and to a lesser extent the rinse-off, cosmetics, contained MI at concentrations far exceeding the permitted 100 ppm use concentration. Household detergents contained high concentrations of MI, and mislabelling occurred for both cosmetics and detergents. The (limited) data on paints are in line with the existing literature. Conclusion Cosmetics and detergents may facilitate contact sensitization because of a (too) high MI concentration, and mislabelling may make its avoidance extremely difficult. Safer use concentrations and correct labelling should be ensured by adequate quality control.

ESSCA results with the baseline series, 2009-2012: rubber allergens

Abstract: Summary Background Allergic contact dermatitis caused by rubber allergens is common, and causes significant patient morbidity. Contemporary data are important to allow appropriate preventive measures and identification of contact allergy trends. Objectives To describe the pattern of patch test reactivity to rubber allergens, including those in the European baseline series. Methods Data collected by the European Surveillance System on Contact Allergies (ESSCA) network between 2009 and 2012 from 12 European countries were analysed. Results Contact allergy to thiuram mix declined over the studied time period, with an overall prevalence of 1.87%. The prevalence of allergy to carba mix was 2.29%, and was significantly increasing. Prevalence rates of sensitization to other rubber allergens were largely unchanged. Statistical analysis with the MOAHLFA index confirmed the strong links between rubber allergy and occupational hand dermatitis. Conclusions Changing patterns of allergy to rubber additives have been identified. Inclusion of carba mix in the European baseline series may be appropriate.

Concomitant reactivity to methylisothiazolinone, benzisothiazolinone, and octylisothiazolinone. International Network of Departments of Dermatology data, 2009-2013.

Abstract: Europe has been facing an epidemic of contact allergy to methylisothiazolinone (MI; CAS no. 2682-20-4) in recent years (1, 2), mostly driven by leave-on cosmetics (3, 4). Additionally, water-based paints, other industrial fluids and household products are preserved with MI, often in combination with benzisothiazolinone (BIT; CAS no. 2634-33-5). Octylisothiazolinone (OIT; CAS no. 26530-20-1) is a preservative used industrially, for example in paints, lacquers, and water-based metalworking fluids (5–8). The chemical structures of these three isothiazolinones are shown in Fig. 1. BIT and OIT are not currently allowed in cosmetics (3). On the basis of case reports from Belgium, the question has been raised of whether cross-reactivity between MI and OIT exists (9). Against this background, we analysed concomitant reactions to MI, BIT and OIT in the Information Network of Departments of Dermatology (IVDK). The IVDK is a network of departments of dermatology dedicated to the clinical epidemiology of contact allergy (10). In 2009–2013, 64 039 patients in 55 departments of dermatology were patch tested. Generally, test reactions on D3 were selected for this data analysis. In few exceptional cases, the D4 reaction was chosen, if no reading was performed on D3. In the study period, the three isothiazolinones were patch tested for different indications, resulting in a heterogeneous test population for each substance. They were part of the following DKG test series:

Short and frequent skin contact with nickel

Abstract: Summary Background The existing EU nickel restriction does not sufficiently protect the population from skin exposure to nickel. Better understanding is needed of the extent to which short and frequent contact with nickel-releasing items contributes to nickel deposition on skin. Objectives To quantify nickel skin exposure from short and frequent contact with nickel-releasing materials. Materials/methods Sequences of short contact events were assessed in (i) touch tests for measurement of nickel skin dose, (ii) wipe tests to similarly quantify the nickel release during a touch, and (iii) immersion tests in artificial sweat, for nickel-containing alloys and pure nickel. Results Nickel skin doses from a single touch were 0.024–4.7 µg/cm2 for all materials. Touching or wiping five untouched surfaces resulted in more accumulated nickel than five repeated touches of the same surface. The released amounts of nickel were generally lower at immersion, but increased with the number of repeated immersion periods. Conclusions Nickel skin doses were quantified after one single touch for all study materials. Touch tests, and potentially wipe tests as a proxy for skin dose measurements, are preferred to immersion tests for the assessment of short and frequent skin contact with nickel.

Chromium(VI) release from leather and metals can be detected with a diphenylcarbazide spot test

Abstract: SummaryBackground Along with chromium, nickel and cobalt are the clinically most important metal allergens. However, unlike for nickel and cobalt, there is no validated colorimetric spot test that detects chromium. Such a test could help both clinicians and their patients with chromium dermatitis to identify culprit exposures. Objectives To evaluate the use of diphenylcarbazide (DPC) as a spot test reagent for the identification of chromium(VI) release. Methods A colorimetric chromium(VI) spot test based on DPC was prepared and used on different items from small market surveys. Results The DPC spot test was able to identify chromium(VI) release at 0.5 ppm without interference from other pure metals, alloys, or leather. A market survey using the test showed no chromium(VI) release from work tools (0/100). However, chromium(VI) release from metal screws (7/60), one earring (1/50), leather shoes (4/100) and leather gloves (6/11) was observed. We found no false-positive test reactions. Confirmatory testing was performed with X-ray fluorescence (XRF) and spectrophotometrically on extraction fluids. Conclusions The use of DPC as a colorimetric spot test reagent appears to be a good and valid test method for detecting the release of chromium(VI) ions from leather and metal articles. The spot test has the potential to become a valuable screening tool.

Patch test results with fragrance markers of the baseline series - analysis of the European Surveillance System on Contact Allergies (ESSCA) network 2009-2012

Abstract: Background. Contact allergy to fragrances is common, and impairs quality of life, particularly in young women. Objective. To provide current results on the prevalences of sensitization to fragrance allergens used as markers in the baseline series of most European countries. Methods. Data of patients consecutively patch tested between 2009 and 2012 in 12 European countries with fragrance allergens contained in the baseline series were collected by the European Surveillance System on Contact Allergies network and descriptively analysed. Four departments used the TRUE Test (R) system. Results. The 'basic markers' were tested on 51 477 [fragrance mix II (FM II)] to 57 123 [Myroxylon pereirae, balsam of Peru] patients, and yielded positive reactions as follows: fragrance mix I 6.9%, Myroxylon pereirae 5.4%, FM II 3.8%, colophonium 2.6%, and hydroxyisohexyl 3-cyclohexene carboxaldehyde 1.7%, with some regional differences. Prevalences with TRUE Test (R) allergens were lower. Additional fragrances were tested on 3643 (trimethylbenzenepropanol) to 14 071 (oil of turpentine) patients, and yielded between 2.6% (Cananga odorata) and 0.7% (trimethylbenzenepropanol) positive reactions. Conclusions. Contact allergy to fragrances is common throughout Europe, with regional variation probably being explained by patch test technique, and differences in exposure and referral patterns. The current basic markers of fragrance sensitivity in the baseline series should be supplemented with additional fragrance allergens.

Recommendation to include a textile dye mix in the European baseline series.

Abstract: Disperse dyes are common sensitizers, but are not currently included in the European baseline series.

Self-reported adverse tattoo reactions: a New York City Central Park study.

Abstract: SummaryBackground Although permanent tattoos are becoming increasingly commonplace, there is a paucity of epidemiological data on adverse tattoo reactions. Several European studies have indicated that tattoo reactions may be relatively common, although the extent of this phenomenon in the United States is largely unknown. Objectives To provide insights into the prevalence and nature of adverse tattoo reactions. Patients/materials/methods We administered a survey about adverse tattoo reactions to 300 randomly selected tattooed people in Central Park, New York City. Results Of 300 participants, 31 (10.3%) reported experiencing an adverse tattoo reaction, 13 (4.3%) reported acute reactions, and 18 (6.0%) suffered from a chronic reaction involving a specific colour lasting for >4 months. Forty-four per cent of colour-specific reactions were to red ink, which was only slightly higher than the frequency of red ink in the sampled population (36%). Twenty-five per cent of chronic reactions were to black ink, which was less than expected based on the number of respondents with black tattoos (90.3%). Study participants with chronic, colour-specific reactions had more tattoo colours than those without reactions. Conclusions This study shows that tattoo reactions are relatively common, and that further investigation into the underlying causes is merited.

Contact allergy trends in Sweden – a retrospective comparison of patch test data from 1992, 2000, and 2009

Abstract: Background. Contact allergy prevalence rates change over time as a result of variations in allergen exposure. Data from patch test clinics are often used as markers for allergy trends.Objectives. T ...

Failures in risk assessment and risk management for cosmetic preservatives in Europe and the impact on public health.

Abstract: Summary Background In view of the current and unprecedented increase in contact allergy to methylisothiazolinone (MI), we characterized and evaluated two recent epidemics of contact allergy to preservatives used in cosmetic products to address failures in risk assessment and risk management. Objective To evaluate temporal trends of preservative contact allergy. Methods The study population included consecutive patch tested eczema patients seen at a university hospital between 1985 and 2013. A total of 23 138 patients were investigated for a contact allergy. Results The overall prevalence of contact allergy to at least one preservative increased significantly over the study period, from 6.7% in 1985 to 11.8% in 2013 (p < 0.001). Importantly, the preservatives methyldibromo glutaronitrile and MI rapidly resulted in high sensitization prevalence rates, which reached epidemic proportions. Although the proportion of patients with current clinical disease attributable to methyldibromo glutaronitrile contact allergy decreased significantly following the ban on its use in cosmetic products (p < 0.001), the sudden and high proportion of current sensitization to MI requires immediate attention (p < 0.001). Conclusions The introduction of new preservatives in Europe with inadequate pre-market risk assessment has rapidly increased the overall burden of cutaneous disease caused by preservatives. We suggest that the cosmetic industry has a responsibility to react faster and replace troublesome preservatives when a preservative contact allergy epidemic is recognized, but the European Commission has the ultimate responsibility for failures in risk management after new, major sensitizing preservatives are introduced onto the market.

Nickel hypersensitivity and orthodontic treatment: a systematic review and meta‐analysis

Abstract: Nickel-containing alloys are widely used in orthodontic appliances, even though nickel is by far the most common contact allergen. However, the scientific evidence concerning allergic reactions to nickel in orthodontic patients has not been evaluated systematically. The objective of this study was to investigate whether the prevalence of nickel hypersensitivity is affected by orthodontic treatment. Unrestricted electronic and manual searches were performed until July 2013 for human clinical studies assessing orthodontic treatment and nickel hypersensitivity. Methodological limitations were evaluated with the Downs and Black tool. Crude and adjusted odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated from random-effects meta-analyses, followed by subgroup and sensitivity analyses. Thirty studies were included in the review, and 24 datasets with 10 184 patients in the meta-analyses. Orthodontic treatment had no significant effect on nickel hypersensitivity (n = 11; crude OR 0.99; 95%CI: 0.78-1.25; p = 0.914). However, when confounding from factors such as sex and piercings was taken into account, orthodontic treatment was associated with a lower risk of hypersensitivity (n = 1; adjusted OR 0.60; 95%CI: 0.40-0.80; p < 0.001). This was even more pronounced when orthodontic treatment was performed prior to piercing (n = 7; crude OR 0.35; 95%CI: 0.24-0.50; p < 0.001). Orthodontic treatment seems to have a protective role against nickel hypersensitivity, especially when it precedes piercings.

Tobacco smoking and hand eczema - is there an association?

Abstract: Summary Background Numerous risk factors have been suggested for hand eczema. This systematic review evaluates the association between tobacco smoking and hand eczema. Objective To review the literature systematically on the association between smoking and hand eczema. Methods The PubMed and EMBASE databases were searched up to 27 January 2015 for articles on the association between tobacco smoking and hand eczema, including human studies in English and German only. Experimental studies, studies on tobacco allergy, case reports, reviews and studies on second-hand smoking were excluded. Results Twenty articles were included. Among studies in occupational settings, three of seven found a statistically significant positive association between tobacco smoking and hand eczema prevalence rate, as did four of eight population-based studies. The association was stronger for studies in occupational settings than for population-based studies. No studies reported tobacco to be a clear protective factor for hand eczema. Two of five studies regarding severity found a positive association between smoking and hand eczema severity. Conclusion Overall, the data indicate that smoking may cause an increased frequency of hand eczema, particularly in high-risk occupations. However, data from studies controlling for other risk factors are conflicting, and few prospective studies are available. Studies controlling for other risk factors are needed, and information regarding the diagnosis of subclasses of hand eczema, as well as severity, may be important.

Jewellery: alloy composition and release of nickel, cobalt and lead assessed with the EU synthetic sweat method.

Abstract: Summary Background Several studies have shown nickel and cobalt release from jewellery by using spot tests, but the metal composition of jewellery is largely unknown. Objectives To evaluate the metal composition of a large worldwide sample of mainly inexpensive jewellery items, and investigate the release of nickel, cobalt and lead from a subsample by using EN 1811:1998-required methods. Methods A total of 956 metallic jewellery components were examined with X-ray fluorescence spectroscopy. A subsample of 96 jewellery items purchased in the United States were investigated for nickel, cobalt and lead release by the use of artificial sweat immersion and plasma optical emission spectroscopy. Results Eighteen elements were detected. The 10 most frequently occurring were, in order of frequency, copper, iron, zinc, nickel, silver, chromium, tin, manganese, lead, and cobalt. Release of nickel was noted from 79 of the 96 US samples (0.01–98 µg/cm2/week), release of cobalt from 35 samples (0.02–0.5 µg/cm2/week), and release of lead from 37 samples (0.03–2718 µg/cm2/week). Conclusions We present here a comprehensive list of the most frequently encountered metals in jewellery and fashion accessories. Different allergenic and non-allergenic metals are utilized. We also report the frequent release of nickel, cobalt and lead from these objects, despite legislative restrictions.

The role of acrylic acid impurity as a sensitizing component in electrocardiogram electrodes.

Abstract: Summary Background Allergic contact dermatitis caused by (meth)acrylates is well known, both in occupational and in non-occupational settings. Contact hypersensitivity to electrocardiogram (ECG) electrodes containing (meth)acrylates is rarely reported. Objective To report the first case of contact dermatitis caused by acrylic acid impurity in ECG electrodes. Materials and methods Patch tests were performed with separate components of electrodes and some (meth)acrylates. This was followed by high-performance liquid chromatography of electrode hydrogel. Results The patient was contact-allergic to electrode hydrogel but not to its separate constituents. Positive reactions were observed to 2-hydroxyethyl methacrylate (2-HEMA), 2-hydroxypropyl methacrylate (2-HPMA) and ethyleneglycol dimethacrylate (EGDMA). Subsequent analysis showed that the electrode hydrogel contained acrylic acid as an impurity. The latter was subsequently patch tested, with a positive result. Conclusion The sensitization resulting from direct contact with ECG electrodes was caused by acrylic acid, present as an impurity in ECG electrodes. Positive reactions to 2-HEMA, 2-HPMA and EGDMA are considered to be cross-reactions.

Patch testing with hair cosmetic series in Europe: a critical review and recommendation

Abstract: Summary Many key ingredients of hair cosmetics (in particular, dyes, bleaches, and hair-styling agents) are potent (strong to extreme) contact allergens. Some heterogeneity is apparent from published results concerning the range of allergens for which patch testing is important. The objective of the present review was to collect information on the current practice of using ‘hair cosmetic series’, and discuss this against the background of evidence concerning consumer/professional exposure and regulatory aspects to finally derive a recommendation for a ‘European hair cosmetic series’. The methods involved (i) a survey targeting all members of the COST action ‘StanDerm’ (TD1206) consortium, (ii) analysis of data in the database of the European Surveillance System on Contact Allergies (ESSCA), and (iii) literature review. Information from 19 European countries was available, partly from national networks, and partly from one or several departments of dermatology or, occasionally, occupational medicine. Apart from some substances being tested only in single departments, a broad overlap regarding ‘important’ allergens was evident. Some of the substances are no longer permitted for use in cosmetics (Annex II of the Cosmetics Regulation). An up-to-date ‘European hair cosmetics series’, as recommended in the present article, should (i) include broadly used and/or potent contact allergens, (ii) eliminate substances of only historical concern, and (iii) be continually updated as new evidence emerges.

Occupational skin diseases in hairdressing apprentices - has anything changed?

Abstract: Summary Background Hairdressers are at risk for occupational skin diseases. Since 2008, an educational programme has been conducted in Danish hairdressing schools to prevent occupational skin diseases. Its effect is unknown. Objective To examine the current frequency of self-reported hand eczema and contact urticaria in Danish hairdressing apprentices as compared with controls, and to determine the occurrence of hand eczema and contact urticaria in hairdressing apprentices with different durations of exposure to the trade. Methods This was a cross-sectional, web-based questionnaire study conducted among 504 hairdressing apprentices and a control group of 1400 adolescents from the general population. Results Hand eczema was significantly more prevalent in the hairdressing apprentices than in controls (34.5% versus 18.8%, p < 0.001). The incidence rate of hand eczema among hairdressing apprentices was 98 cases/1000 person-years. Contact urticaria was also more prevalent in the hairdressing apprentices (7.3% versus 4.2%, p = 0.006). Both diseases increased with increasing duration of exposure to the trade. Conclusion Despite educational efforts to prevent occupational skin diseases in the hairdressing schools, Danish apprentices are still at increased risk for hand eczema and contact urticaria. Both diseases develop after only a few years of work in hairdressing. Further preventive strategies are warranted.