Contact dermatitis from textile dyes

6 female patients with allergic contact dermatitis from textile dyes are described. Lesions were confined to areas in direct contact with the offending garment, mainly where friction and/or pressure occurred. Patch tests were positive to 2 or more disperse dyes. Thin-layer chromatography was carried out on the dyes extracted from fabrics of 3 patients, for the identification of textile dyes.     

Purpuric allergic contact dermatitis to paraphenylenediamine *

A 59-year-old saleswoman of black hats presented with a severe purpuric eruption of the exposed areas of the face, neck and arms. Patch testing to paraphenylenediamine produced a purpuric test reaction. Similar eruptions have been reported due to N-isopropyl-N-phenylparaphenylenediamine (IPPD), a rubber antioxidant. The patient had previous dermatitis underneath the elastic portions of her undergarments. It was determined that IPPD is added to elastic material used in some elastic trim on undergarments in the United States. This relationship is discussed.     

Textile dye allergic contact dermatitis prevalence

This article summarizes textile dye prevalence studies and makes recommendations for advancing knowledge about textile-dye sensitization. Prevalence data is provided by study and by dye. Dermatology teams are encouraged to conduct textile-dye prevalence studies in countries other than Italy, include dyes for which the least prevalence data has been collected, to standardize method of application and reading, and to verify purity and identity of dyes used for patch testing. Testing with pure dyes and other chemicals in dye formulations should provide insights in choosing dye systems that will decrease sensitization.     

The purpuric patch test in patients with allergic contact dermatitis from azo dyes

The histopathological features of the purpuric patch test have been described in individual cases only. We report a series of patients with allergic contact dermatitis, who developed purpuric patch tests at the sites of allergens from the azo dye group. 105 patients were clinically evaluated and tested with the TRUE Test and the textile color & finish series (Chemotechnique Diagnostics) because of suspected clothing dermatitis. Positive results to the latter were found in 31 patients (29.5%). In 9 of these, purpuric patch tests were observed at the sites of the allergens Disperse Blue 124, 106 and 85. 10 biopsies were performed and studied. The histopathological changes of the purpuric patch test included: spongiosis (in 90% of cases), exocytosis (70%), and dilated blood vessels (100%) without signs of vasculitis, surrounded by an inflammatory infiltrate composed mainly of T lymphocytes. Extravasated erythrocytes were seen perivascularly, but also in the interstitium, surrounding the acrosyringium, at the dermoepidermal junction, and in the epidermis. Increased number of mast cells were found in 22.2% of cases. Disperse Blue 124, 106, and 85 are potent allergens that can elicit purpuric patch test reactions. The purpuric patch test in our cases was a manifestation of an allergic reaction, based not only on histopathological changes, but also on evolution and relevance of the patch tests.     

Sensitization to reactive textile dyes in patients with contact dermatitis

Reactive dyes are used especially for colouring natural fibres (cotton, silk and wool) that arc widely used in Western countries, particularly Italy, in the production of clothes. The aim of our study was to investigate sensitization to the most commonly used reactive textile dyes in patients undergoing patch tests, and to assess the clinical relevance of contact sensitization of these dyes. 1813 consecutive patients underwent patch tests with the GIRDCA standard series and an additional textile series of 12 reactive dyes. 18 of these patients were sensitized to reactive dyes (0.99) (4 only to reactive dyes). The dyes most frequently responsible for positive patch tests were Red Cibacron CR and Violet Remazol 5R (respectively, 8 and 5 positivities). In 5 cases only was a history of intolerance to particular garments given; of 4 patch tests performed with pieces of garment, 2 were positive. In 1 occupationally-exposed patient, airborne contact dermatitis was suspected. Owing to the lack of up-to-date patch test series, some cases of allergic contact dermatitis from textile dyes are probably misdiagnosed: new colouring agents are continuously introduced to the market, so that a close relationship with textile industry is necessary to improve our diagnostic tools.     

Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study

BACKGROUND: The exact incidence of textile dermatitis is unknown because of the lack of controlled epidemiological studies. Nevertheless, the increasing frequency of contact dermatitis to clothing has been demonstrated, thus indicating the importance of further investigations in this field. OBJECTIVE: To analyse the results from a 4-year prospective study of the clinical and aetiological features of contact dermatitis to textiles in Israel. We also aimed to assess the frequency and relevance of sensitization to textile dyes and resins in these patients. METHODS: Six hundred and forty-four patients (441 female and 203 male), referred for the investigation of contact dermatitis, and suspected of having textile allergic contact dermatitis (ACD), were studied. All patients were patch tested with the standard series (TRUE Tests), textile colour and finish series (TCFS) clothing extracts and pieces of garment in some cases. Readings were performed on days 2, 3 and in many patients also on day 7. RESULTS: Eighty-three patients (12.9%) had an allergic reactions to a dye and/or resin allergen. Of them, 43 (51.8%) had positive patch tests to the textile dye allergens, 28 (33.7%) to the formaldehyde and textile finish resins and 12 (14.4%) to allergens from both groups. The highest incidence of sensitization from the dye group allergens was due to Disperse Blue (DB) 124 (30.6%), DB 106 (27.0%) and DB 85 (8.1%) and from the resin group to melamine formaldehyde and ethyleneurea melamine formaldehyde (20.7% each) and urea formaldehyde (18.3%). Present relevance of the patch tests was found in 81.4% of the cases. Concomitant sensitization with allergens from the standard series included nickel sulphate, potassium dichromate, formaldehyde, rubber additives and others. Although chronic dermatitis was the typical clinical presentation, less frequent forms such as purpuric, hyperpigmented and papulopustular lesions and atypical forms such as erythema multiforme-like, nummular-like lesions, lichenification and erythrodermia were observed in 24.4% of the cases. The atypical manifestations were provoked by sensitization to dye allergens and never to resins. Along with the typical distribution in areas of friction on the trunk and extremities, less frequent areas including the hands, face, genital area and the soles were affected too. CONCLUSIONS: In view of the increasing frequency of contact dermatitis to clothing, the clinical assessment should include awareness of the classical as well as the unusual and atypical clinical forms and locations of ACD to textiles, for they are not infrequent. Although dyes and among them DB 106 and DB 124 are the most frequent allergens inducing textile dermatitis, concomitant testing with allergens from the textile dyes and resin groups is recommended when investigating patients with textile dermatitis.     

Patch testing for permanent-press allergic contact dermatitis

During the decade of the 90s, 24 cases of permanent-press textile-resin contact dermatitis were identified. The most common allergen associated with these cases was dimethylol propylene urea (DMPU). Although previous reports had suggested ethylene urea melamine formaldehyde resin (EUMF) or dimethylol dihydroxy ethylene urea (DMDHEU) as the most appropriate test materials for this type of contact dermatitis, we could not confirm EUMF as appropriate but, with some limitations, can support DMDHEU due to its widespread and continued use. DMPU has been withdrawn from the marketplace and replaced with what may be less reactive materials. In this study, we also observed discordance between EUMF patch tests in the range of 30%, which is consistent with previous reports about the biovariability of patch test results.     

Contact sensitization to textile dyes: description of 100 subjects

We have described 100 subjects sensitized to textile dyes. Of these, 16 had clinically been suspected of having a textile dermatitis from among 1145 patients referred for patch testing. 41 patients were identified from among 861 consecutive subjects tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series supplemented with 4 disperse dyes (Disperse Blue 124, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3). The remaining 43 patients were identified from among 746 subjects tested with the GIRDCA standard series, supplemented with the 4 disperse dyes mentioned above and a further series of 12 other textile dyes. The clinical picture was extremely variable: most patients had a typical eczematous dermatitis, but we also observed persistent erythematous-wheal-type reactions, a transient urticarial dermatitis and an erythema-multiforme-like eruption. Among these textile dyes, Disperse Blue 124 caused most reactions. With the addition of the 4 disperse dyes to the GIRDCA standard series, we identified 4.8% sensitized to textile dyes, a much higher figure than the 1.4% observed among patients being patch tested on the basis of their history and the clinical findings; the addition of a further 12 textile dyes to the series further increased the detection rate to 5.8%. We stress the importance of routinely patch testing with textile dyes, which can help to elucidate the cause of certain kinds of atypical dermatitis.