Showing papers in "Contact Dermatitis in 2020"

Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: Comparing a single surgical site with a COVID-19 intensive care unit.

Abstract: Background As a result of the COVID‐19 outbreak, hygiene regulations have been revised and hand sanitation has been intensified. Objective To investigate the onset of hand eczema during the COVID‐19 pandemic in healthcare workers (HCWs) directly involved in intensive care of COVID‐19 patients and HCWs without direct contact with COVID‐19 patients. Hereby, we aim at increasing awareness about occupational hand eczema and preventive measures that can be adopted. Method A survey was distributed amongst 114 HCWs at a single surgical centre and at a COVID‐19 intensive care unit of the university hospital Ludwig Maximilian University Munich, Germany. Participants were questioned about the daily frequency of hand hygiene prior to and during the pandemic. Participants self‐reported the onset of hand eczema and associated symptoms. Results Our study revealed a significant increase in hand washing, disinfection, and use of hand cream across all participants (P‐value <.001), regardless of having direct contact with COVID‐19 patients. A high prevalence of symptoms associated with acute hand dermatitis of 90.4% was found across all HCWs, whereas hand eczema itself was underreported (14.9%). Conclusion The increase in hand sanitation during the COVID‐19 pandemic impairs the skin of the hands across all HCWs, independent of direct intensive care of affected patients.

Short-term skin reactions following use of N95 respirators and medical masks.

Abstract: Background In the context of the COVID-19 pandemic, cases of adverse skin reactions related to the wearing of masks have been observed. Objectives To analyze the short-term effects of N95 respirators and medical masks, respectively, on skin physiological properties and to report adverse skin reactions caused by the protective equipment. Methods This study used a randomized crossover design with repeated measurements. Twenty healthy Chinese volunteers were recruited. Skin parameters were measured on areas covered by the respective masks and on uncovered skin 2 and 4 hours after donning, and 0.5 and 1 hour after removing the masks, including skin hydration, transepidermal water loss (TEWL), erythema, pH, and sebum secretion. Adverse reactions were clinically assessed, and perceived discomfort and non-compliance measured. Results Skin hydration, TEWL, and pH increased significantly with wearing the protective equipment. Erythema values increased from baseline. Sebum secretion increased both on the covered and uncovered skin with equipment-wearing. There was no significant difference in physiological values between the two types of equipment. More adverse reactions were reported following a N95 mask use than the use of a medical mask, with a higher score of discomfort and non-compliance. Conclusions This study demonstrates that skin biophysical characters change as a result of wearing a mask or respirator. N95 respirators were associated with more skin reactions than medical masks.

Surgical mask dermatitis caused by formaldehyde (releasers) during the COVID-19 pandemic.

Abstract: A 38-year-old woman with a history of erythematous and telangiectatic rosacea consulted us in December 2019 because of itchy, burning facial and periocular erythema lasting 1 year. Notwithstanding a primary diagnosis of rosacea, clinical examination also revealed subtle eczematous lesions. Moreover, the patient experienced minor respiratory complaints, also related to her profession as a laboratory technician. She worked for a company producing coatings for the paper and cardboard industry, and her duties involved the quality control of water-based polymer mixtures containing formaldehyde, bromo-2-nitropropane-1,3-diol (bronopol), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), MI, and benzisothiazolinone (BIT). She wore protective gloves and (not fully occlusive) goggles, but no mask, thus still allowing airborne exposure to these chemicals; no hand dermatitis was present. Given the peculiar clinical presentation, and the exposure to well-known sensitizers, patch tests were performed, as reported previously, with the Belgian baseline series and a cosmetic series. A flare-up of her facial condition occurred during the patch test week and readings showed, on day (D) 4, positive reactions to formaldehyde 2% aq. (++), bronopol 0.5% pet. (+), MCI/MI 0.02% aq. (++), BIT 0.1% pet. (+), and thiuram mix 1% pet. (+). She was thus diagnosed with occupational airborne allergic contact dermatitis from formaldehyde (releasers) and isothiazolinones; no relevance was found for thiuram mix. Both types of (volatile) preservatives were likely also involved in

Mask-induced contact dermatitis in handling COVID-19 outbreak.

Abstract: CASE REPORT An otherwise healthy 23-year-old woman presented with facial symmetrical erythema and slight itching lasting 4 days. Symptoms developed after wearing a KN95 (FFP2 equivalent) mask for 2 days to prevent contracting SARS-CoV-2. One day before, the patient had consulted the emergency department and a presumptive diagnosis of acute cutaneous lupus erythematosus by the general emergency doctors was made because of her gender and facial symmetrical erythema. However, the physical examination and medical history of the patient and her family were unremarkable. Blood and urine routine tests and the erythrocyte sedimentation rate were negative and normal, respectively. The specific autoantibodies and complement were also negative. In our dermatology clinic, given the use of the mask and the shape of the lesion resembling that of the sponge strip on the contact surface inside the mask (Figure 1), the patient was provisionally diagnosed with mask-induced allergic contact dermatitis (ACD). After 3 days of anti-allergic treatment (oral desloratadine and topical desonide cream), the lesions almost completely disappeared. The patient switched to other masks without sponge strips which were tolerated. No recurrence was found after 3-month follow-up. Patch tests were applied on the upper back and occluded for 2 days with the TRUE Test (Mekos Laboratories, Hillerød, Denmark), and readings were made on day (D)2, D4, and D7 with negative results. Additional patch tests using IQ chambers (Chemotechnique Diagnostics, Vellinge, Sweden) were performed with pieces of sponge taken from this mask. Tests were read on D2 and D4 according to ESCD guidelines and showed a positive reaction to the sponge (++) at D4, while no reaction was seen in three self-controls (D4) (Figure 2A). Ten control volunteers were patchtested the same way with all negative results. The patient was then tested with the isocyanate series (Chemotechnique Diagnostics) and showed a positive reaction to toluene-2,4-diisocyanate (TDI) 2.0% pet., 4,4'-diaminodiphenylmethane (MDA) 0.5% pet., and hexamethylene diisocyanate (HDI) 0.1% pet. on day D2 (++) and D4 (++) (Figure 2B). DISCUSSION Polyurethanes, which are being used increasingly in the production of various products, including the sponge strip inside the mask, are produced by the reaction of diisocyanates and may cause ACD or precipitate asthma attacks. Polyurethane as the fully cured polymer is thought not to be a sensitizer. However, residual cross-linkers have been reported to cause allergic reactions, such as TDI, HDI, MDA, or MDI, which are particularly responsible for respiratory symptoms, and less frequently for ACD. To our knowledge, this is the first case report of ACD to a polyurethane sponge inside a mask.

Identification of pigments related to allergic tattoo reactions in 104 human skin biopsies.

Abstract: Background Red tattoos are prone to allergic reactions. The identity of the allergen(s) is mostly unknown. Objectives Chemical analysis of human skin biopsies from chronic allergic reactions in red tattoos to identify culprit pigment(s) and metals. Material and methods One hundred four dermatome biopsies were analyzed by matrix-assisted laser desorption/ionization tandem mass spectrometry (MALDI-MS/MS) for identification of commonly used organic pigments. Metal concentrations were assessed by inductively coupled plasma (ICP)-MS and x-ray fluorescence (XRF). Fourteen patients had cross-reactions in other red tattoos. Results In total, the identified pigments were mainly azo Pigment Red (P.R.) 22 (35%), P.R. 210 (24%), P.R. 170 (12%), P.R. 5 (0.9%), P.R. 112 (0.9%), and Pigment Orange (P.O.) 13 (11%). P.R. 122 (0.9%) and Pigment Violet (P.V.) 23 (8%) were also common. P.R. 22, P.R. 170, and P.R. 210 also dominated in patients with cross-reactions. In 22% of the biopsies, no red pigment was detected. Element analysis indicated the presence of the sensitizers nickel and chromium. Conclusions P.R. 22, P.R. 170, and P.R. 210 were identified as the prevailing pigments behind chronic allergic reactions in red tattoos. The epitope causing the reaction might be a pigment-degradation product. Metal contamination may derive from different sources, and its role in red tattoo allergy cannot be ascertained.

The risk of hand eczema in healthcare workers during the COVID-19 pandemic: Do we need specific attention or prevention strategies?

Abstract: Coronavirus disease-2019 (COVID-19) causes a global pandemic following the first identified case in China in late 2019. Apart from respiratory droplets, contact transmission was stated to play an important role in the spreading of the disease. Therefore, hand hygiene became an important measure for prevention; the World Health Organization has recommended washing of hands with water and soap, or alcoholbased hand disinfectant before and after the contact with COVID-19 patients and/or their body fluids. Independent of COVID-19, healthcare workers (HCW) generally have an increased risk of hand eczema (HE). Skin damage due to intensive hand hygiene measures during the COVID-19 pandemic in HCW has recently been reported, as well as HE among HCW during the pandemic. Therefore, we aimed to investigate the frequency, risk factors, and clinical features of HE among healthcare workers during the COVID-19 pandemic.

The methylisothiazolinone epidemic goes along with changing patients' characteristics – After cosmetics industrial applications are the focus

Abstract: Background Sensitization to methylisothiazolinone (MI) has seen an exceptional epidemic, mainly attributed to its use in cosmetics. Objectives To trace the epidemic of MI allergy (2009-2018), and to analyze a possible change of patients' characteristics. Methods Informationsverbund Dermatologischer Kliniken-data of patients patch tested between 2009 and 2018 with MI (0.05% aq.) were analyzed concerning anamnestic items and sensitization frequencies. Results Overall, 4.9% reacted positive to MI. Comparing sensitization to MI in three periods (2009, 2013/14, and 2017/18), there was an increase to 7% in 2013 and a decrease to 3.4% in 2018. The MOAHLFA Index (M=Men, O=Occupational Dermatitis, A=Atopic Dermatitis, L=Leg Dermatitis, F=Face Dermatitis, A= Age > 40) for the period 2013/14 is characterized by a lower proportion of occupational dermatitis and a higher proportion of face dermatitis. The period 2017/18 is characterized by increases of occupational dermatitis and hand dermatitis, and a decrease of face dermatitis. Painters, personal care workers, and hairdressers were particularly affected. Sensitization in hairdressers and personal care workers (mostly cosmeticians) decreased after the peak in 2013/14, whereas sensitization to MI in painters continued to increase. Conclusions After an unprecedented epidemic of MI allergy, mainly caused by its use in cosmetics, the continuous use of MI in industrial applications, for example, paints, and subsequent sensitization remain a matter of concern.

The role of occupational dermatology in the COVID-19 outbreak.

Abstract: To the Editor: The current coronavirus disease 2019 (COVID-19) emergency is highlighting the importance of occupational dermatology. It is known that in emergency medicine and disaster management, skin diseases may be frequent not only in victims, but also in rescuers. The current COVID-19 pandemic demonstrates that health-care workers (HCWs) are particularly affected by skin problems. Although not a severe disease, skin problems often have a significant impact on emergency management, as they are potentially able to reduce the effective workforce. HCWs caring for COVID-19 patients have to wear for many hours, on a daily basis, specific personal protective equipment (PPE) and are therefore susceptible to PPE-related adverse skin reactions. It has been reported that up to 97% of HCWs showed skin lesions related to the enhanced protection measures, mainly affecting the nasal bridge, cheek, forehead, and hands. The facial lesions are secondary not only to the prolonged use of N95 FFP3 masks, but mainly to goggles, which were implicated in most injuries. Hand hygiene with alcohol-based hand rubs is widely used as one of the most effective, simple, and low-cost procedures against COVID-19 cross-transmission. By denaturing proteins, alcohol inactivates enveloped viruses, including coronaviruses, and thus alcohol-based formulations with at least 60% ethanol have been proven effective for hand hygiene. Moreover, HCWs may perform frequent handwashing with water and soap more than 10 times per day. Because coronavirus was found to survive for several hours on used PPE, double gloving can reduce the risks of viral contamination during PPE removal and is therefore recommended. These procedures may lead to hand dermatitis with symptoms that can vary from quite mild to debilitating, including dryness, irritation, itching, and even fissuring and bleeding. The problem of hand dermatitis is very important for many aspects. First, hand dermatitis due to frequent washing may create a route of entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); indeed, angiotensin-converting enzyme 2, the receptor for the virus, is richly expressed in the skin on blood vessels, basal cells, hair follicles, eccrine glands. Second, dryness, skin irritation, and itching can be debilitating and cause absence from work and impair work productivity, with important consequences during the pandemic. Therefore, basic skin care measures should be taken after hand washing to address these aspects. To this end, several measures to avoid hand dermatitis, maceration, and erosion due to PPE and handwashing during the pandemic have been proposed. Although the application of hand cream/moisturizers on intact skin after hand washing is recommended, only 22.1% applied hand creams after washing. Education of HCWs regarding proper skin care management may be effective in preventing occupational skin disorders. For HCWs at risk of hand dermatitis to hygiene products, additional skin moisturizing may be needed. Hand lotions and creams often contain humectants, fats, and oils that increase skin hydration and replace altered or depleted skin lipids that contribute to the barrier function of the skin. No product, however, is free of potential risk, especially contact allergy. Hence, it is usually necessary to provide an alternative for use by individuals with sensitivity or reactions to the hand hygiene product available in the institution. Finally, to safeguard hygiene rules, disposable packaging is recommended.

Contact Urticaria and Protein Contact Dermatitis in the Finnish Register of Occupational Diseases in a Period of 12 Years

Abstract: Background Although occupational contact urticaria (CU) and protein contact dermatitis (PCD) are considered frequent among workers with exposure to proteinaceous materials, data on occupations at risk and the main causes of these occupational skin diseases are relatively limited. Objectives To report the causative agents and risk occupations for CU and PCD in the Finnish Register of Occupational Diseases (FROD). Methods We retrieved from the FROD all recognized cases of CU/PCD in the years 2005-2016. Results With 570 cases, CU and PCD constituted 11% of all recognized cases of occupational skin diseases in the study period. Occupations with the highest incidence of CU/PCD included bakers, chefs and cooks, farmers and farm workers, veterinarians, gardeners, and hairdressers. The most common causative agents were cow dander and flour and grain, followed by natural rubber latex (NRL) and other food. In food-related occupations, wheat and other flours were by far the most common cause of CU/PCD, with 76 cases, whereas fish and other animal-derived food caused 33 and other plant-derived food caused 23 cases. Conclusions Apart from the Finnish peculiarity of cow dander allergy, a striking finding was a large share of CU/PCD caused by flours in food handlers as compared to other food.

Allergic contact dermatitis caused by elastic bands from FFP2 mask

Abstract: Keywords: allergic contact dermatitis;carbamates;case report;elastic bands;FFP2 mask;thiuram EN allergic contact dermatitis carbamates case report elastic bands FFP2 mask thiuram 168 169 2 07/27/20 20200801 NES 200801 CASE REPORT A 43-year-old nonatopic woman, working as a hospital cleaner, was referred to our contact eczema department with face and neck dermatitis developing since 20 days ago Skin barrier dysfunction and potential skin microbiota dysbalance on the face might make patients more vulnerable to side effects from the masks 2 Acne and rosacea patients are the most vulnerable to developing skin reactions to protective equipment [Extracted from the article] Copyright of Contact Dermatitis (01051873) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Contact dermatitis caused by glucose sensors-15 adult patients tested with a medical device patch test series.

Abstract: Background: Several cases of allergic contact dermatitis (ACD) to the glucose sensor FreeStyle Libre have been reported Isobornyl acrylate (IBOA) and N,N-dimethylacrylamide (DMAA) are known culprit allergens Objectives: To evaluate patients with suspected ACD to FreeStyle Libre in a standardized manner, present causative allergens, and assess patient-reported implications Methods: A total of 15 patients with suspected ACD to FreeStyle Libre were patch tested with the Swedish baseline series and a new medical device series IBOA and DMAA were tested at 01% and 03% in petrolatum (pet) Readings were performed on day (D) 3 and D7 Background data, details on skin reactions, and associated implications were assessed using a questionnaire Results: Thirteen patients were sensitized to IBOA and four to DMAA Two positive reactions to IBOA and one to DMAA were seen only at 03% concentration on D7 Median duration of sensor use before dermatitis onset was 6 months Half the number of the patients took precautions in everyday life due to sensor-related skin reactions Six patients discontinued sensor usage Conclusions: Patients with suspected ACD to glucose sensors should be evaluated with a relevant patch test series containing IBOA and DMAA Adding the 03% pet concentration is recommended The reading on D7 is necessary (Less)

Health education decreases incidence of hand eczema in metal work apprentices: Results of a controlled intervention study.

Abstract: BACKGROUND Metal work apprentices (MWAs) frequently develop work-related hand eczema (HE). OBJECTIVES To evaluate the effect of health education on incidence of work-related HE in MWAs and to assess confounding factors. MATERIALS/METHODS In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow-ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome-wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples. RESULTS The 2-year and 3-year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P < .01 and OR 3.47, 95% CI 1.88 to 6.40, P < .0001). The knowledge score was higher in unaffected MWAs (P < .05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P < .01) and FLG mutations (P < .001). No significant associations were found regarding epidermal cytokine levels and GWAS. CONCLUSIONS Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling.

Contact dermatitis caused by glucose sensors in diabetic children.

Abstract: Background Allergic contact dermatitis caused by glucose sensors has been recently described in diabetics, mostly in adult patients. Isobornyl acrylate and N-N dimethylacrylamide are the potent causative agents. Objectives To describe a child population with contact dermatitis caused by glucose sensors, determine the causative allergen, and assess the prevalence of isobornyl acrylate (IBOA) sensitization. Patients and methods Overall, 12 children with a reaction to medical devices, either glucose sensors or insulin sets, were patch tested with the European baseline series, glues and rubber, (meth) acrylates series, and with piece of the adhesive part of the glucose sensor FreeStyle Libre. Isobornyl acrylate 0.1% pet. was patch tested in 11 patients, and N-N dimethylacrylamide in two. Some patients were tested with adhesive parts of the infusion set. Results Overall, 10 children reacted to the adhesive part of the sensor FreeStyle Libre, and 10 children were sensitized to IBOA. One patient turned out to be negative in all patch tests. Conclusion Allergic contact dermatitis caused by glucose sensors is common in the pediatric diabetic patient population. Like in the adult patient population, IBOA was the culprit allergen, with 83.3% sensitization prevalence in children exhibiting adverse cutaneous reactions caused by FreeStyle Libre.

12-year data on dermatologic cases in the Finnish Register of Occupational Diseases I: Distribution of different diagnoses and main causes of allergic contact dermatitis.

Abstract: BACKGROUND Skin diseases are among the most common occupational diseases, but detailed analyses on their epidemiology, diagnoses, and causes are relatively scarce. OBJECTIVES To analyze data on skin disease in the Finnish Register of Occupational Diseases (FROD) for (1) different diagnoses and (2) main causes of allergic contact dermatitis (ACD). METHODS We retrieved data on recognized cases with occupational skin disease (OSD) in the FROD from a 12-year-period 2005-2016 and used national official labor force data of the year 2012. RESULTS We analyzed a total of 5265 cases, of which 42% had irritant contact dermatitis (ICD), 35% ACD, 11% contact urticaria/protein contact dermatitis (CU/PCD), and 9% skin infections. The incidence rate of OSD in the total labor force was 18.8 cases/100 000 person years. Skin infections concerned mainly scabies in health care personnel. Twenty-nine per cent of the ACD cases were caused by plastics/resins-related allergens, mainly epoxy chemicals. Other important causes for ACD were rubber, preservatives, metals, acrylates, and hairdressing chemicals. Cases of occupational ACD due to isothiazolinones reached a peak in 2014. CONCLUSION Our analysis confirms that epoxy products are gaining importance as causes of OSD and the isothiazolinone contact allergy epidemic has started to wane.

Prevalence of contact allergy to metals: nickel, palladium, and cobalt in Southern Sweden from 1995–2016

Abstract: Background: In 2001, the EU nickel directive was introduced to prevent contact allergy to nickel. Contact allergy to palladium and/or cobalt is often seen together with contact allergy to nickel. Objectives: To compare the contact allergy prevalence of nickel, palladium, and cobalt allergy before and after the introduction of the EU nickel directive in consecutive patients with dermatitis. Methods: A retrospective analysis of patch test results from 1995–2016 was performed (n = 18 264). Chi-square tests were used to examine trends for nickel, palladium, and cobalt across test years. Logistic regression was used for associations. Results: The prevalence of nickel allergy decreased significantly in the youngest age group (6–30 years) for both female and male patients from 1995–1999 to 2012–2016: females: 33.4% to 19.1% (P <.001); males: 5.9% to 2.1% (P <.05). The concomitant reactions between nickel and palladium and nickel and cobalt among young females, respectively, also decreased significantly. Isolated palladium and cobalt allergy remained stable (1.4% and 2.3%, respectively) during the same time period for both men and women. Conclusions: The prevalence of nickel has decreased among young females and males suspected of contact allergy in Southern Sweden after the introduction of the EU nickel directive. There has been no change in isolated palladium or cobalt allergy. (Less)

The implanted glucose monitoring system Eversense: An alternative for diabetes patients with isobornyl acrylate allergy.

Abstract: Background Some patients with diabetes develop skin reactions when using systems for continuous glucose monitoring (CGM) or insulin pumps. Regular usage and long wearing periods lead not only to skin irritation, but also to allergic contact dermatitis. It has been shown that allergens such as isobornyl acrylate (IBOA) are present in the plastic housing and also in the adhesives of medical devices used for diabetes treatment. Objectives To evaluate the IBOA content of all parts of a newly introduced, implanted CGM system (Eversense) to check whether this can be an alternative for IBOA-sensitized patients. Methods The IBOA content of the implanted sensor itself (n = 3), the transmitter (n = 3), and two different types of adhesive (white adhesive [n = 4] and clear adhesive [n = 4]) was measured by gas chromatography/mass spectrometry. Results No IBOA was found in any part of this CGM system. Conclusions Patients with an IBOA allergy may be able to use this implanted CGM system.

Teledermatology and hygiene practices during the COVID-19 pandemic.

Abstract: To the Editor, Coronavirus disease 2019 (COVID-19) is an acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First isolated in 2019 in China, the virus rapidly spread globally and was declared a global pandemic in March 2020. Italy is one of the countries with the highest number of positive patients, hospitalizations, and deaths and, on March 12th, was been declared “red zone” with the application of severe disease containment measures. Although San Gallicano Dermatological Institute, a primary referral hospital for dermatological diseases, has not been declared COVID center, Medical Hospital Direction decided to maintain services for patients who cannot avoid having therapy during the COVID-19 emergency or need urgent visits. In order to continue to assist non-urgent dermatological patients, a telemedicine service has been set up. To date we have screened the requests from 461 patients, received between March and April 2020, highlighting that 28 of 461 consultations revealed the presence of bilateral hand dermatitis. Among these, 64.3% (18 patients) were female and 7.1% (2 patients) had a known history of atopic dermatitis. When grading the disease severity utilizing the Physician Global Assessment (PGA) scale, which consists of four levels (1 = almost clear, 2 = mild, 3 = moderate, and 4 = severe), we observed 13 patients with mild disease, 12 patients with moderate disease, and 3 patients with severe disease. Teledermatology is now a way of improving the management of cutaneous diseases and it may increase the number of diagnoses of several skin conditions, even during this pandemic when patients cannot easily access the healthcare system because of contact restrictions. In conclusion, during the COVID-19 pandemic, a higher incidence of irritant contact dermatitis (ICD) has been observed. This is due to increased hand hygiene to prevent the direct spread of SARS-CoV-2 both through the use of soap and water and/or alcohol-based sanitizers. Given the importance of reducing nonemergency visits in dermatology, it is crucial to recommend the use of skin products that can help to maintain a healthy skin barrier and prevent the development of ICD. Teledermatology may represent a useful diagnostic tool, since clinical images together with anamnestic data, in the majority of cases, allow the formulation of a correct diagnostic hypothesis as well as proper treatment recommendations. AUTHOR CONTRIBUTIONS

Isothiazolinones in cleaning products: Analysis with liquid chromatography tandem mass spectrometry of samples from sensitized patients and market.

Abstract: Background Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) contact dermatitis is a severe problem. The high concentrations of these substances and other isothiazolinones such as benzisothiazolinone (BIT) and octylisothiazolinone (OIT) contained in cleaning products may cause allergic contact dermatitis in sensitized patients. Objectives To evaluate the exposure to isothiazolinones contained in cleaning products on the market and from sensitized patients, and to verify the accuracy of labeling. Methods A total of 34 cleaning products were collected (17 supplied by sensitized patients and 17 bought randomly). Analysis was made of the concentrations of MI, MCI, BIT, and OIT using liquid chromatography tandem mass spectrometry (LC-MS/MS). Results MI and BIT were the components most frequently detected. Of all the products analyzed, 76.5% contained at least one isothiazolinone. Twelve products had an MI concentration above the permitted level for rinse-off cosmetics. Most of them were coming into direct contact with the skin in daily use. Mislabeling occurred in eight products. Conclusions Some cleaning products with high concentrations of isothiazolinones may cause cutaneous symptoms in sensitized patients, especially in spray form. The labeling should be correct, also regarding the use of each article.

Natural ingredients in cosmetic products-A suggestion for a screening series for skin allergy.

Abstract: Background Naturally derived cosmetic product ingredients of both plant and animal origin are being included increasingly in product formulations in order to cater to consumer preferences. They may be an overlooked cause of reactions to cosmetic products in some patients with dermatitis. Objectives To identify naturally derived cosmetic product ingredients with allergenic potential (type I and type IV) and propose a cosmetic screening test series. Methods The study was conducted in two steps. The first step was a market survey using a nonprofit application helping consumers avoid problematic substances in cosmetic products. The application contained 10 067 cosmetic products that were label checked for naturally derived cosmetic product ingredients. The second step was a literature search to examine how frequently the naturally derived ingredients were described and related to allergic reactions in cosmetics or other topically administered products. Results We identified 121 different naturally derived cosmetic product ingredients that were included in at least 30 cosmetic products. In total, 22 ingredients were selected for a screening test series. Conclusions We propose a supplemental patch test and a prick test screening series with naturally derived cosmetic product ingredients for patients with skin reactions to cosmetic products, aiming to identify a cause in more patients than is currently possible.

Contact allergy to isothiazolinones epidemic: Current situation.

Abstract: Background Since 2009, an increasing number of published cases of allergic contact dermatitis (ACD) from isothiazolinones in Europe was observed, amounting to an epidemic. However, only few studies have assessed the current situation after changes in European regulation. Objectives To analyze the incidence of isothiazolinone-related ACD in our area in the last decade. Methods A retrospective study analyzed all patients patch tested in the allergy unit in a tertiary hospital in Spain between January 2010 and June 2019. Positive patch-test reactions to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and/or MI alone were recorded. Results A total of 243 patients (9.55%) with positive patch-test reactions to MCI/MI and/or MI alone among 2544 consecutively patch-tested patients were recorded. An initial increase in the prevalence of MCI/MI allergy was observed, from 4.5% in 2010 reaching a peak in 2015, which was followed by a significant decrease until July 2019 with 3.1% prevalence in 2019. Conclusions As shown in our data, regulatory interventions have resulted in a dramatic decrease in the prevalence of MCI and MI ACD, reaching a pre-epidemic level of 3.1% in 2019.

Freestyle libre 2: The new isobornyl acrylate free generation.

Abstract: well as the effect of pressure and rubbing on the skin of the top band, is more common. To our knowledge this is the first report of ACD with ECS caused by platinum siloxane complex. Because after 4 days of not wearing the ECS, the patient's skin lesions still persisted with obvious itching, further patch tests confirmed that it was indeed contact allergy. As the use of ECS seems be increasing, the garment industry should strive to develop materials or textile manufacturing methods that reduce the risk of allergies and further improve the quality of ECS.

Occupational and non‐occupational allergic contact dermatitis to hair dyes in Greece. A ten‐year retrospective study

Abstract: BACKGROUND Oxidative hair dyes are an important source of chemical exposure and a major risk factor for the development of occupational and non-occupational allergic contact dermatitis (ACD) worldwide. OBJECTIVE To identify the frequency of common allergens associated with occupational and non-occupational ACD to hair dyes during the last 10 years, in Greece. METHODS We retrospectively reviewed the medical records of patients with suspected ACD to hair dyes from 2010-2019. All patients with patch-test-confirmed ACD to hair dyes were evaluated. RESULTS Out of 501 patients with suspected ACD to hair dyes, 362 had at least one positive reaction to hair dye allergens (62.4% were customers and 37.6% were hairdressers). The mean age of customers and hairdressers was 43.8 years and 30.8 years, respectively. Of the customers, 58.9% were exposed to dyes for >10 years and 61% of hairdressers for <5 years. The most common site of ACD among customers was the scalp (85%) and among hairdressers the hands (90%). p-Phenylenediamine (PPD) was the most common contact allergen (52.2%), followed by toluene-2,5-diamine, p-aminophenol, m-aminophenol, and ammonium persulfate. CONCLUSIONS Sensitization prevalences for PPD and cross-reacting allergens have increased in Greece during the last decade, regardless of occupational or non-occupational exposure to hair dyes.

Intense skin reaction to a new glucose monitoring and insulin pump system

Abstract: DISCUSSION ACD results in a considerable burden in professional musicians. Several case reports described ICD (“fiddler's neck” type 1) while others reported sensitization to colophonium used on the bow. To our knowledge, this is the first case reporting concomitant sensitization to nickel (“fiddler's neck” type 2) and colophonium in a professional musician. This case illustrates the need to consider more than one sensitization when one allergen does not explain all the symptoms. Many allergens may be present in the metals and woods of instruments; however, recent studies indicate that ACD, as an occupational skin disease, is a rare diagnosis in musicians. Large scale epidemiological studies are required to learn if multiple sensitizations are frequent among musicians and which allergens pose the highest risks and in which instruments. Musicians, instrument manufacturers, and physicians may consider measures to identify and avoid frequent allergens.

Filaggrin gene mutations in relation to contact allergy and hand eczema in adolescence.

Abstract: Background Filaggrin is an important protein for structure and function of the skin barrier. Filaggrin gene (FLG) mutations are known to result in dry skin, impaired skin barrier, and increased risk for atopic dermatitis. However, it is not clear whether these mutations are associated with contact allergy or hand eczema in adolescence. Objectives The purpose of this study was to investigate whether FLG mutations are associated with contact allergy, self-reported hand eczema, or dry skin in adolescence. Methods We used data from the 16-year follow-up in the BAMSE cohort, information obtained from a Web-based questionnaire including questions on hand eczema and dry skin, from FLG mutation analysis (R501X, R2447X, 2282del4), and patch testing (n = 1822). Results Logistic regression analyses showed no statistically significant associations between FLG mutations and contact allergy (any contact allergy, nickel allergy, or fragrance allergy) according to patch test, or self-reported hand eczema at 16 years, or hand eczema ever. However, FLG mutations were associated with self-reported dry skin at 16 years. Conclusions FLG mutations are associated with self-reported dry skin at 16 years. However, in this study no consistent associations were found between FLG mutations and contact allergy or hand eczema at 16.

Positive change in hand care habits using therapeutic patient education in chronic hand eczema

Abstract: Background Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. Objective To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. Methods A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). Results Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. Conclusions TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.

Hypersensitivity to antibiotics in Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) from other culprits

Abstract: BACKGROUND Antibiotics have been implicated in the reactivation of exanthema and systemic involvement in drug reaction with eosinophilia and systemic symptoms (DRESS); however, it is not clear whether these patients become sensitized to the antibiotic. OBJECTIVE To evaluate if, after DRESS, patients become sensitized to antibiotics. METHODS We retrospectively reviewed the patch test (PT) data and clinical files of DRESS patients who were administered antibiotics during DRESS from other culprits. RESULTS Nine patients out of 17 (53%) were positive to antibiotics in PT: six to the penicillin group and three to cephalosporins (including one patient with additional positivity to vancomycin). Considering the eight patients who were negative to antibiotics in PT, seven were exposed to a fluoroquinolone. Four cases were patch tested again and three remained positive to antibiotics 2 to 5 years thereafter. Two patients with positive PT results had an accidental re-exposure to antibiotics and developed a maculopapular exanthema without systemic symptoms. CONCLUSION Exposure to antibiotics during DRESS or its prodromal phase could enhance sensitization to antibiotics, as confirmed by a positive PT. Reproducibility of positive PTs to antibiotics after several years and reactivation after re-exposure support that T-cell-mediated hypersensitivity to antibiotics in the setting of DRESS is a specific reaction.

Characteristics and incidence of contact dermatitis among hairdressers in north-eastern Italy.

Abstract: BACKGROUND Hairdressers are at high risk of contact dermatitis (CD) due to skin exposure to numerous irritants and haptens in hair products in combination with frequent wet work. OBJECTIVES To investigate the characteristics and incidence of CD among hairdressers in north-eastern Italy. METHODS A total of 324 hairdressers who had been examined and patch tested in north-eastern Italy from 1996 to 2016 were retrospectively identified, and compared with 9669 matched controls. Sensitization to allergens of the hairdressing series was analysed among hairdressers attending an occupational medicine clinic in Trieste, Italy. Incidence data were calculated from 1999 to 2016. RESULTS Sensitization to p-phenylenediamine, thiuram mix, and N-isopropyl-N'-phenyl-p-phenylenediamine was significantly associated with hairdressing and with hand/forearms dermatitis. Frequent sensitizers from hairdressing series were ammonium persulfate, toluene-2,5-diamine, and p-aminobenzene. The overall incidence of CD declined from 2003 (31.7 cases/10 000 workers) to 2016 (20.8 cases/10 000 workers). CONCLUSIONS Sensitization to several haptens was significantly associated with hairdressing. The incidence of CD among hairdressers in north-eastern Italy has declined in recent years, but is still high. Preventive efforts are needed to reduce the burden of CD in this professional group.

Adverse cutaneous reaction to diabetic glucose sensors and insulin pumps: Irritant contact dermatitis or allergic contact dermatitis?

Abstract: Background Adverse cutaneous reactions to diabetes medical devices (glucose sensors and insulin pumps) are described, notably allergic contact dermatitis (ACD) with isobornyl acrylate (IBOA) and N,N dimethylacrylamide (DMAA) as the main allergen. Objectives To determine if all cases of adverse cutaneous reactions observed with diabetes medical devices (ie FreeStyle Libre, Enlite sensors or insulin pumps), referred to our department with suspected allergies are confirmed as ACD. Patients and methods Fifty-two patients who presented skin reactions to diabetes medical devices were patch tested with the European baseline series, a plastic and glues series, a (meth) acrylates series, a piece of the adhesive part of the device, as well as IBOA 0.1% and DMAA 0.1% pet. Results Seventeen patients had no positive reaction to IBOA nor to the adhesive part of the device; 11 of these also tested with DMAA with negative result. No other relevant allergen was identified. Conclusion Some cutaneous reactions, otherwise very similar to those of patients sensitized to IBOA, can be explained either by the presence of an untested allergen not yet discovered, or by irritant contact dermatitis. Therefore, European legislation on the full labelling of ingredients by manufacturers, in order to facilitate the identification of allergens and irritants, is imperative.

Contact sensitization in metalworkers: Data from the information network of departments of dermatology (IVDK), 2010-2018.

Abstract: Background Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large‐scale reports on contact allergy due to MWFs are more than 10‐years‐old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. Objectives To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). Patients and Methods Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010–2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. Results Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. Conclusions The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.