Chromium in leather footwear - risk assessment of chromium allergy and dermatitis

Background. Chromium‐tanned leather footwear, which releases >3 ppm hexavalent Cr(VI), may pose a risk of sensitizing and eliciting allergic dermatitis. Objectives. To determine the content and potential release of chromium in leather footwear and to discuss the prevention of chromium contact allergy and dermatitis. Methods. Sixty pairs of leather shoes, sandals and boots (20 children's, 20 men's, and 20 women's) were purchased in Copenhagen and examined with X‐ray fluorescence spectroscopy. Chromium was extracted according to the International Standard, ISO 17075. The detection level for Cr(VI) was 3 ppm. Results. Chromium was identified in 95% of leather footwear products, the median content being 1.7% (range 0–3.3%). No association with store category or footwear category was found. A tendency for there to be a higher chromium content in footwear with high prices was shown (p_trend = 0.001). Cr(VI) was extracted from 44% of 18 footwear products, and, in three items, more than 10 ppm was extracted. One shoe had 62 ppm Cr(VI) extracted. Sandals seemed to be over‐represented among footwear with detectable Cr(VI). Cr(III) extraction reached a median value of 152 ppm. Conclusions. Most leather footwear contained chromium. Cr(VI) was extracted from a high proportion of leather footwear; this poses a risk of sensitization.     

Fluctuations in the prevalence of chromate allergy in Denmark and exposure to chrome-tanned leather

Background. A recent Danish study showed a significant increase in the prevalence of chromate contact allergy after the mid‐1990s, probably as a result of exposure to leather products. Objectives. To reproduce the results by analysing data from the period 1992–2009 at Odense University Hospital, Denmark. The temporal development in the occurrence of chromate contact allergy and assumed causative exposures were investigated. Patients, Materials and Methods. A retrospective analysis of patch test data was performed (n = 8483), and medical charts from patients with chromate allergy (n = 231) were reviewed. Comparisons were made using the χ²‐test. A test of the reproducibility of the TRUE Test^® was also performed. Logistic regression analyses were used to test for associations. Results. No significant changes in the prevalence or exposure sources of chromate allergy during 1992–2009 were identified. Leather shoes (24.4%) were the most frequent exposure sources in chromate allergy, and were mainly registered in women, although the difference between men and women was not significant (P = 0.07). Cement and leather glove exposure occurred significantly more often in men than in women (P = 0.002). Foot dermatitis (40.3%) was the most frequent anatomical location, apart from hand eczema (60.6%). The reproducibility of the TRUE Test^® was 93.3%. Conclusions. Apart from hand eczema, the most frequent clinical picture of chromate allergy was foot dermatitis caused by leather shoe exposure. A tendency for an increasing prevalence of chromate contact allergy from 1997 was shown, but no significant change was detectable.     

Contact allergy to allergens of the TRUE-test (panels 1 and 2) has decreased modestly in the general population

Summary Background The prevalence of contact allergy in the general population is nearly 20%. Objectives This study aimed to monitor the development of contact allergy to allergens from the TRUE‐test (panels 1 and 2) between 1990 and 2006. Methods Two random samples of adults from the general population in Copenhagen, Denmark, were invited to participate in a general health examination including patch testing. In 1990 and 2006, we patch tested and questioned 543 and 3460 adult Danes. Patch test readings were performed on day 2 only. Results The overall prevalence decreased significantly from 15·5% in 1990 to 10·0% in 2006, mainly as a result of a decrease in thimerosal allergy from 3·4% to 0·8%. Furthermore, the prevalence of cobalt allergy and rubber‐related allergens decreased from 1·1% to 0·2% and from 1·5% to 0·2%, respectively. Stratification by sex and age group revealed decreasing prevalences of contact allergy in all male age groups and in young and middle‐aged female age groups (18–55 years) whereas increasing prevalences were observed among older women (56–69 years). The diverging trend observed in women was probably explained by a cohort effect due to a change in the prevalence of nickel allergy following the Danish regulation on nickel exposure. Conclusions Although the overall prevalence of contact allergy decreased in the general population, frequent contact allergens such as fragrance mix II and methyldibromo glutaronitrile were not tested. Thus, contact allergy remains prevalent in the general population.     

Photoepilation with a diode laser vs. intense pulsed light: a randomized,intrapatient left‐to‐right trial

Background Safe and efficient options for removing unwanted hair are in great demand. Laser devices and intense pulsed light (IPL) sources are the most commonly used treatment modalities. Yet, only a few randomized controlled trials (RCTs) comparing laser and IPL devices are available, and RCTs with long‐term results are missing from the literature. Objectives To compare the safety and long‐term efficacy of diode lasers (DL) and IPL sources for axillary hair removal, we conducted an intrapatient, left‐to‐right, assessor‐blinded and controlled trial. Methods IPL (Ellipse Flex PPT; Danish Dermatological Development, Hoersholm, Denmark; λ_em = 600–950 nm) and DL (LightSheer XC system; Lumenis Inc., Santa Clara, CA, U.S.A.; λ_em = 800 nm) treatments were evaluated in 30 study participants (skin type II–III) with unwanted axillary hair growth. Six treatments with each device were carried out at 4‐week intervals. Final assessment was conducted 12 months after the last treatment by means of hair counts using close‐up photographs. The primary endpoint was reduction in hair growth, analysed on an intention‐to‐treat and last‐observation‐carried‐forward basis (n = 30), and secondary endpoints were patient‐rated efficacy, treatment‐related pain, adverse effects and treatment duration. Results Both devices significantly reduced hair counts. Mean reductions from baseline (3 and 12 months after the last treatment) were 59·7% and 69·2% for DL and 42·4% and 52·7% for IPL treatment (P < 0·01), respectively. DL treatment induced significantly more pain [3·7 ± 2·1 (DL) vs. 1·6 ± 1·4 (IPL); P < 0·01; visual analogue scale] but could be conducted faster [33·1 ± 3·8 s (DL) vs. 40·1 ± 5·0 s (IPL); P < 0·01]. No severe side‐effects were observed for either therapy. Conclusions Both DL and IPL treatments are highly effective, long lasting and safe. DL was found to be more effective than IPL treatment. DL treatment was more painful but less time‐consuming than IPL therapy.     

Maternal employment and atopic dermatitis in children: a prospective cohort study

Background Considering the early onset of atopic dermatitis (AD), which most often arises in the first year of life, risk factors occurring very early in life must be considered. Little is known about the effects of maternal occupational exposure on the development of atopic disorders in children. Objectives The aim of this study was to evaluate associations between maternal employment and childhood AD. Methods We used multistage stratified systematic sampling to recruit 24 200 mother–newborn pairs from the Taiwan national birth register. Information on maternal occupation categories, work stress, working time, shift work and potential confounders during pregnancy was gathered by questionnaires after birth. At 3 years of age, information on the development of AD was assessed by home interviews. Multiple logistic regression analysis was performed to estimate the association of maternal employment and AD. Results Overall, 11 962 out of 19 381 mothers (61·7%) worked during pregnancy. The children of mothers who worked during pregnancy had an increased risk of AD compared with those whose mothers did not work [odds ratio (OR) 1·38, 95% confidence interval (CI) 1·25–1·53]. The children of mothers with a professional or technical occupation had a higher risk of AD (OR 1·64, 95% CI 1·44–1·87). The risk of AD was found to increase with maternal work stress during pregnancy in a dose–response manner (P_trend < 0·01). The mothers of children with AD had a longer working time than those without AD (P < 0·0001). However, no significant association between AD and maternal shift work was found. Conclusions Working in professional or technical occupations increased the risk of childhood AD in addition to work stress during pregnancy.     

Quantitative aspects of contact allergy to chromium and exposure to chrome-tanned leather

The potential of trivalent and hexavalent chromium to induce and elicit allergic contact dermatitis and the degree of chromium exposure from leather products are reviewed. Chromium dermatitis is often due to exposure in the occupational environment, with cement being one of the most common chromium sources. However, consumer products such as chromium(III)-tanned leather products are also an important source of chromium exposure. Apart from Cr(III), which is used for tanning, leather often also contains trace amounts of Cr(VI), which is formed by oxidation of Cr(III) during the tanning process. In a recent study of the Cr(VI) content of leather products bought on the Danish market, 35% of such articles had a Cr(VI) content above the detection limit of 3 p.p.m., ranging from 3.6 p.p.m. to 14.7 p.p.m. Leachable Cr(III) was detected at levels of 430-980 p.p.m. An examination of available dose-response studies showed that exposure to occluded patch test concentrations of 7-45 p.p.m. Cr(VI) elicits a reaction in 10% of the chromium-sensitive patients. When reviewing repeated open exposure studies, it is seen that either exposure to 5 p.p.m. Cr(VI) in the presence of 1% sodium lauryl sulfate (SLS) or exposure to 10 p.p.m. Cr(VI) alone both elicit eczema in chromium-sensitive patients. The eliciting capacity of Cr(III) has not been systematically investigated but, compared to Cr(VI), much higher concentrations are needed to elicit eczema.     

The association between hand eczema and nickel allergy has weakened among young women in the general population following the Danish nickel regulation: results from two cross‐sectional studies

Background: An association between nickel contact allergy and hand eczema has previously been demonstrated. In 1990, Denmark regulated the extent of nickel release in the ear‐piercing process as well as nickel release from consumer products. Objectives: This study aimed to evaluate the effect of the Danish nickel regulation by comparing the prevalence of concomitant nickel allergy and hand eczema observed in two repeated cross‐sectional studies performed in the same general population in Copenhagen. Materials: In 1990 and 2006, 3881 18–69 year olds completed a postal questionnaire and were patch tested with nickel. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The prevalence of concomitant nickel contact allergy and a history of hand eczema decreased among 18–35‐year‐old women from 9.0% in 1990 to 2.1% in 2006 (P < 0.01). The association between nickel contact allergy and a history of hand eczema decreased in this age group between 1990 (OR = 3.63; CI = 1.33–9.96) and 2006 (OR = 0.65; CI = 0.29–1.46). Among older women, no significant changes were observed in the association between nickel contact allergy and hand eczema. Conclusions: Regulatory control of nickel exposure may have reduced the effect of nickel on hand eczema in the young female population.     

Fluctuations in the prevalence of nickel and cobalt allergy in eczema patients patch tested after implementation of the nickel regulation in Denmark

Background. A recent Danish study showed that the prevalence of nickel allergy decreased among young female patients and increased among older female patients with dermatitis patch tested between 1985 and 2007 at Gentofte Hospital, Denmark. The prevalence of cobalt allergy remained unchanged. Objectives. To examine fluctuations in the prevalence of nickel and cobalt allergy after implementation of the nickel regulation, by analysing patch test results from male and female patients with dermatitis tested between 1992 and 2009 at Odense University Hospital, Denmark. Methods. A retrospective analysis of patch test data was performed (female, n = 5821; male, n = 3317). Comparisons were made using the chi‐square test for trend. Logistic regression analyses were used to test for associations. Results. The prevalence of nickel allergy decreased significantly among the 2–30‐year‐old female patients, from 29.8% in 1992–1997 to 19.6% in 2004–2009 (p < 0.001), whereas it increased significantly, from 6.9% in 1992–1997 to 11.1% in 2004–2009 (p = 0.04), among the >60‐year‐old female patients. The overall prevalence of cobalt allergy increased significantly, from 3.7% in 1992–1997 to 5.1% in 2004–2009 (p = 0.03). The overall prevalence of nickel and cobalt allergy among male patients during the test period was 5.2% and 2.2%, respectively, and no significant change across the test years was detected. Conclusions. The prevalence of nickel allergy decreased among young female patients and increased among older female patients with dermatitis, probably because of a cohort effect. The overall prevalence of cobalt allergy increased from 1992 to 2009. No significant trend in the prevalence of nickel and cobalt allergy among male patients was found.     

The association between null mutations in the filaggrin gene and contact sensitization to nickel and other chemicals in the general population

Background It was recently shown that filaggrin gene (FLG) null mutations are positively associated with nickel sensitization. We have hypothesized that histidine‐rich filaggrin proteins in the epidermis chelate nickel ions and prevent their skin penetration and exposure to Langerhans cells. Furthermore, we have proposed that the low degree of genetic predisposition to nickel sensitization found by a Danish twin study was explained by a high prevalence of ear piercing among participants resulting in ‘bypassing’ of the filaggrin proteins. Objectives To investigate the association between FLG null mutations and (nickel) contact sensitization. Methods A random sample of 3335 adults from the general population in Denmark was patch tested and genotyped for R501X and 2282del4 in the FLG gene. Results The combined carrier frequency of FLG null mutations was 8·1%. Nickel, fragrance and contact sensitization to at least one allergen were not associated with FLG null mutations. A crude analysis on women who did not have ear piercings revealed a positive association between FLG null mutations and nickel sensitization [8·3% vs. 2·4%; odds ratio (OR) 3·71, 95% confidence interval (CI) 0·73–18·96] as well as between FLG null mutations and allergic nickel dermatitis (8·3% vs. 1·3%; OR 6·75, 95% CI 1·17–38·91). FLG mutation status and atopic dermatitis were positively associated with neomycin or ethylenediamine sensitization. Conclusions This study suggests that FLG null mutations may be a risk factor for the development of nickel sensitization. However, ear piercing was a much stronger risk factor in our general population and we could therefore identify a positive association only in women without ear piercings. Contact sensitization to specific chemicals is related to treatment exposure.     

Temporal trends of preservative allergy in Denmark (1985–2008)

Background: Most cosmetics and industrial products contain preservatives. Preservative allergy is common and, historically, changing contact allergy epidemics caused by preservatives have been observed. In 1997, Alan Dillarstone predicted a stable development of preservative allergy following mandatory ingredient labelling on cosmetic products. Objectives: To investigate the development in the prevalence of preservative allergy in Denmark over a 24‐year period (1985–2008) and to challenge the prediction made by Dillarstone. Patients/Methods: A retrospective analysis of patch test data was performed (n = 18179). Comparisons were made using a χ² test. Logistic regression analyses were used to test for associations. Results: The development of preservative allergy mirrored those of other European patch test centres. The development was not dependent on sex or age group. The prevalence was higher among women and those aged 41–60 years. Formaldehyde allergy was persistently prevalent over the study years. The overall prevalence of preservative allergy increased significantly (P_trend = 0.001), mainly because of patch testing with additional preservatives in recent years. Conclusions: Dillarstone's prediction was confirmed as the prevalence of contact allergy to individual preservatives remained relatively stable. However, the overall burden of preservative allergy seemed to increase. Introduction of new preservatives may add to the burden of contact allergy.     

Parental sun-protective regimens and prevalence of common melanocytic naevi among 7-year-old children in Sweden: changes over a 5-year period

Background Common melanocytic naevi and cutaneous malignant melanoma share a common risk profile, influenced by ultraviolet radiation exposure. A high density of common melanocytic naevi correlates with an increased lifetime risk of developing cutaneous malignant melanoma. Effective strategies for sun protection, starting in early childhood, are considered of great importance to reduce the steadily rising melanoma trend. Objectives To investigate the 5‐year changes in sun tanning habits, sun‐protective regimens and density of common melanocytic naevi between two age‐standardized populations of children. Methods Population‐based cross‐sectional study performed among 7‐year‐old children in southern Sweden in 2002 and 2007. The parents answered a questionnaire and all children were examined by the same, trained research nurse. Results In total, 1190 children were enrolled: 681 in 2002 and 509 in 2007. The results showed that sun‐protective regimens, such as use of sunscreen (+29%), clothing (+30%), staying in the shade (+123%) or indoors (+136%) during peak sun hours, had all increased significantly (P < 0·0001). Travelling to sunny seaside holiday resorts abroad before the age of 2 years had almost doubled (P < 0·0001). The adjusted mean number of naevi per square metre body surface was significantly (P < 0·0001) lower in 2007: 6·6 [95% confidence interval (CI) 5·6–7·6], compared with 11·0 (95% CI 10·0–12·0) in 2002. Conclusions This study demonstrates increased self‐reported parental actions for sun protection of young Swedish children in recent years; in consistency, lower numbers of common melanocytic naevi were observed. Results support the use of common melanocytic naevi as an objective measure of sun exposure in children.     

The role of glutathione S‐transferase and claudin‐1 gene polymorphisms in contact sensitization: a cross‐sectional study

Background Contact sensitization is frequent in the general population and arises from excessive or repeated skin exposure to chemicals and metals. However, little is known about its genetic susceptibility. Objectives To determine the role of polymorphisms of glutathione S‐transferase (GST) genes and the claudin‐1 gene (CLDN1) on the risk of contact sensitization, taking common filaggrin gene (FLG) mutations into account. Methods In total, 3471 adult Danes from the general population were standard patch tested and filled out a questionnaire on their general health. They were genotyped for the following polymorphisms: GSTM1 and GSTT1 deletion, GSTP1 single nucleotide polymorphism (SNP) rs1695, four CLDN1 SNPs (rs893051, rs9290927, rs9290929 and rs17501010) and the FLG null mutations R501X and 2282del4. Results In individuals without ear piercings, a higher prevalence of nickel sensitization was found in those with the minor allele of CLDN1 SNP rs9290927 (P_trend = 0·013). For CLDN1 rs17501010, contact sensitization to organic compounds was associated with the major allele (P_trend = 0·031). The risk pattern was also identified for self‐reported nickel dermatitis (P_trend = 0·011). The fragrance sensitization prevalence differed in a pairwise comparison of the CLDN1 rs893051 SNP genotypes (P = 0·022), with the minor allele being associated with a higher prevalence. The associations were confirmed in logistic regression analyses. Conclusions The CLDN1 polymorphisms rs9290927, rs893051 and rs17501010 were associated, respectively, with nickel contact sensitization in individuals without ear piercings, contact sensitization to fragrances, and with both organic compounds and nickel contact dermatitis. We could not find associations between GST gene polymorphisms and contact sensitization. FLG mutations did not affect the observed associations.     

Serum insulin‐like growth factor 1 and facial ageing: high levels associate with reduced skin wrinkling in a cross‐sectional study

Background Insulin‐like growth factor (IGF)‐1 is a growth factor that can influence fibroblast functioning, with effects including the inhibition of collagenases and the induction of collagen expression. Objectives To assess whether serum IGF‐1, IGF‐binding protein (IGFBP)3 and the ratio between IGF‐1 and IGFBP3, as a measure of IGF‐1 bioavailability, are associated with facial ageing and skin wrinkling. Methods From a random sample comprising 617 subjects from the Leiden Longevity Study, perceived age and skin wrinkling were assessed from facial photographs, and IGF‐1 and IGFBP3 were measured in serum. The associations were assessed using linear regression models, adjusted for chronological age, sex, body mass index, smoking and sun exposure. Results Across tertiles of the ratio of IGF‐1 to IGFBP3, and after adjusting for all potential confounding factors, the mean perceived age decreased from 60·6 years in the lowest tertile to 59·5 years in the highest (P_trend = 0·045). Similarly, the mean skin wrinkling grade decreased from 4·8 in the lowest tertile to 4·5 in the highest (P_trend = 0·011). Adding skin wrinkling as a covariate in the analysis between IGF‐1 and perceived age diminished this association. Conclusions This study demonstrates that a higher ratio of IGF‐1 to IGFBP3 associates with a lower perceived age, via its association with reduced skin wrinkling. Whether high IGF‐1 levels actually delay the accumulation of skin wrinkling now needs investigating.     

Copy number variations of the human histamine H4 receptor gene are associated with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a complex genetic disease; the histamine H4 receptor (HRH4) has been shown to be related to different kinds of autoimmune disorders; and copy number variations (CNVs) have been found to be associated with various types of diseases. Objectives To explore a possible association between HRH4 (formerly H4R) CNVs and the risk of SLE. Methods Genomic DNA and RNA from 340 patients with SLE and 392 healthy controls were extracted, and CNVs and mRNA levels of HRH4 were examined. Results The expression of HRH4 mRNA was significantly increased in patients with SLE compared with controls. Amplification of HRH4 copy numbers significantly increased the risk of SLE [P < 0·001, odds ratio (OR) 2·26, 95% confidence interval (CI) 1·50–3·40]. HRH4 amplifications also positively correlated with the incidence of arthritis (P = 0·019, OR 1·96, 95% CI 1·11–3·47), and proteinuria (P < 0·001, OR 2·95, 95% CI 1·73–5·00) and antinuclear antibody abnormalities (P < 0·001, OR 2·97, 95% CI 1·66–5·33). Deletions of HRH4 copy numbers were protective against proteinuria (P = 0·03, OR 0·50, 95% CI 0·26–0·94). Conclusion CNVs of the HRH4 gene are associated with SLE.     

Trends in incidence of nonmelanoma skin cancers in Alberta,Canada, 1988–2007

Background Nonmelanoma skin cancer (NMSC) is the most common malignancy affecting caucasian populations and has been seeing global increases in incidence for decades. Objectives The objective of this study was to determine trends in incidence of NMSC in Alberta, Canada from 1988 to 2007. Methods A retrospective analysis of patients from Alberta diagnosed with NMSC from 1988 to 2007 inclusive was conducted with data retrieved from the Alberta Cancer Registry (ACR). Sex‐, age‐ and anatomical location‐specific incidence rates and trends were examined. Results From 1988 to 2007, there were 66 192 basal cell carcinomas, 19 959 invasive squamous cell carcinomas (SCC) and 12 494 in situ SCC. ACR coding for the 2007 data was not completed at the time of this study; hence, data from this year were not included in the trend analyses. Incidence of NMSC in women has been stable since 2000 [annual percentage change (APC) 0·08, P = 0·88] and has declined in men since 2001 (APC −1·28, P = 0·026). BCC incidence has been stable since 2000 (APC −0·80, P = 0·09). In situ and invasive SCC also showed a trend towards stabilization in 2000 (APC 0·36, P = 0·77) and 1995 (APC 0·01, P = 0·98), respectively. NMSC primarily affects the elderly and is rarely seen in individuals before the age of 40 years. Although the head and neck region was the location most often involved with NMSC (71·1%), it revealed a stabilizing trend, whereas most other anatomical regions demonstrated an increasing NMSC incidence rate. Conclusions NMSC incidence in Alberta has stabilized in women and declined in men. As 95–99% of NMSC occurs in patients aged 40 years or older, and with its increased frequency in traditionally clothed areas, the authors recommend regular complete skin examinations starting at 40 years of age.     

The impact of photosensitivity disorders on aspects of lifestyle

Background Photosensitivity disorders involve an abnormal skin reaction to sunlight exposure and affect a substantial percentage of the population. No previous studies have directly compared lifestyle attributes between photosensitive and healthy individuals. Objectives To assess the impact of photosensitivity on time spent outdoors in the U.K., holiday behaviour, use of sunscreens and vitamin D supplements, and employment status. Methods Questionnaires were completed by ambulant photosensitive and healthy adults aged 18–60 years residing in Greater Manchester. Results Forty‐five adults with moderate–severe photosensitivity and 124 healthy adults completed the questionnaire. This revealed that photosensitive subjects spent significantly less time outdoors in the U.K. on both summer weekdays (P < 0·01) and summer weekends (P < 0·0001) than healthy subjects, took fewer holidays per year (P < 0·05), and spent less time outdoors on a sunny holiday (P < 0·0001). They wore clothing that covered a wider skin area (P < 0·0001), and use of sunscreen was greater (both frequency of application and area covered) in the photosensitive group outside of holiday time (P < 0·0001), but not when on a sunny holiday, as healthy people increased their sunscreen use at this time. Despite the reduced sun exposure, photosensitive subjects were no more likely to take vitamin D supplements than healthy subjects were; they also exhibited a significantly higher rate of unemployment (P < 0·05). Conclusions Photosensitivity disorders negatively influence lifestyle including employment status; more attention is required to the socioeconomic impact of these conditions.     

Cr(III) reactivity and foot dermatitis in Cr(VI) positive patients

Chromium allergy has become synonymous with Cr(VI) allergy. However, real exposure to chromium from leather products may include both Cr(III) and Cr(VI). In this study, we investigate the reactivity to both Cr(VI) and Cr(III) in consecutive patients to analyse the relation between foot eczema/leather exposure and reactivity to Cr(III). From March 2002 to December 2004, 2211 consecutive patients with suspected allergic contact dermatitis were patch tested with 0.5% potassium dichromate (Cr(VI)) and 13% chromium trichloride (Cr(III)). A total of 71 (3.2%) patients had a positive reaction to Cr(VI), of which 31 also had a positive Cr(III) reaction. No Cr(VI) negative patients had a positive reaction to Cr(III). An increased risk of foot dermatitis was found in Cr(VI) positive patients with a concomitant positive or doubtful reaction to Cr(III) compared with Cr(VI) positive patients with no reactions to Cr(III). The increased risk was not due to a higher degree of sensitivity to Cr(VI). Leather was reported most frequently as the suspected cause of chromium dermatitis (54%). However, Cr(VI) allergics having foot eczema and positive or doubtful Cr(III) reactions often had positive reactions to other shoe allergens. Thus, Cr(III) allergy is part of a multiple shoe allergy pattern.     

Ultraviolet exposure patterns of Irish and Danish gardeners during work and leisure

Background Skin cancer, caused by solar ultraviolet (UV) radiation, is a growing problem in Europe. Reliable data on occupational exposure of outdoor workers are needed to develop protective strategies. Objectives To compare UV radiation exposure patterns between outdoor workers in two European populations. Methods Fifty‐three gardeners, 31 Irish and 22 Danish (age range 24–69 years) wore personal UV dosimeters, measuring time‐stamped UV doses continuously during a 4‐month summer period. The current and historical sun exposure pattern was recorded by means of a diary and questionnaire. Assessment of pigmentation, naevi, freckles and solar lentigines was performed. The relationship between UV dose and sun exposure pattern was analysed. Results Regarding work days, the Irish had a significantly lower percentage of ambient UV exposure than the Danes, 4·5% vs. 8·1%; a lower UV dose per day, 0·97 standard erythema dose (SED) vs. 1·6 SED; a lower UV dose between 12.00 and 15.00 h, 0·43 SED vs. 0·75 SED; and fewer hours with positive dosimeter measurements, 3·2 h vs. 4·8 h (all values are medians, P < 0·01). Regarding days off work, the same patterns emerged for both UV doses and exposure hours. The Irish had significantly fewer days off than the Danes, median 21 days vs. 49 days, and fewer days with risk behaviour (sunbathing/exposing upper body), median 0 days vs. 8 days (P < 0·01). Conclusions The lower UV exposure received by the Irish gardeners may have been due to indoor breaks during peak ambient UV. Other contributing factors may include differences in natural shade between the parks. Our data suggest that consideration of such factors in scheduling of outdoor work can significantly reduce the occupational UV exposure.     

Allergic contact dermatitis in children: should pattern of dermatitis determine referral? A retrospective study of 500 children tested between 1995 and 2004 in one U.K. centre

Background Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13·3% and 24·5% has been reported. Patch testing infants may be particularly difficult, and false‐positive reactions may occur. Objectives The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified. Methods Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child. Results Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant (P < 0·001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0·62 (95% confidence interval 0·41–0·95; P = 0·029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p‐phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result. Conclusions The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing.     

Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study

Summary Background Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives To investigate the association between FLG null mutations and hand eczema. Methods A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27–7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41–1·67). Conclusions FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence.