Contact dermatitis due to a new fungicide used in the tulip bulb industry

We describe an outbreak of contact dermatitis in a tulip bulb processing company Shortly after the introduction of a new pesticide, the fungicide fluazinam, employees started to complain of dermatitis of the arms and the face. 8 employees were investigated and showed positive patch tests to fluazinam. The dermatitis disappeared quickly when they stopped work, but returned as soon they restarted. Subsequent investigations showed that the fungicide had not been used according to the manufacturer's recommendations. Fluazinam was shown to be a strong; sensitizer under these circumstances.     

Allergic contact dermatitis from 1,6-diisocyanatohexane in an anti-pill finish

We report an outbreak of occupational allergic contact dermatitis from 1,6-diisocyanatohexane (old name hexamethylene diisocyanate or HDI), in the anti-pill finish Evafanol AS-1, in 2 clothing factories. The 19 operatives from 2 dressmaking mills all complained of work-related dermatitis. 5 of the subjects had positive patch tests to the fabric with which they were working, and when all 19 were patch tested to Evafanol AS-1 (1% aq.), 11 were positive. 6 of these 11 were patch tested to HDI (1% pet.) and all 6 were positive. It appears that HDI in our group of clothing workers acted as a potent sensitizer affecting around 10% of the workforce.     

Mercury allergy in a contact dermatitis clinic in Northern Ireland

441 consecutive patients (294 female, 147 male) with suspected contact dermatitis were patch tested to the European standard series, mercury metal (1% pet.). ammoniated mercury (1% pet.), and mercuric chloride (0.1% aq.), 14 patients (3.2%), 12 of whom were female, showed a positive response to 1 or more mercury compounds: none reacted to mercuric chloride alone. Primary sensitization was most likely due to either inoculation with vaccines containing merthiolate preservatives or amalgam dental restorations. Mercury allergy was of historical clinical relevance in only 2 pa I rents, both women who developed gingivostomatitis following insertion of amalgam dental fillings. 1 of these women subsequently developed allergic contact dermatitis from contact lens solutions, shampoos and cosmetics which contained mercury preservatives. On the basis of these findings, we recommend patch testing with both metallic mercury and ammoniated mercury in patients with suspected mercury allergy.     

Diluted Compositae mix versus sesquiterpene lactone mix as a screening agent for Compositae dermatitis: a multicentre study

The objective of this study was to compare diluted Compositae mix with sesquiterpene lactone mix as a marker for Compositae dermatitis. Patients undergoing diagnostic patch testing in 8 British Isles patch test centres were also patch tested to sesquiterpene lactone mix (0.1% pet.) and Compositae mix (3% pet. or 0.6% pet.). Of a total of 5574 patients tested, 71 (1.3%) reacted to Compositae mix, 57 (1.0%) reacted to sesquiterpene lactone mix, and 45 to both. Diluted Compositae mix remained a more sensitive screening marker for Compositae allergy. We recommend that patients are patch tested to both agents.     

Allergy to cocamidopropyl betaine may be due to amidoamine: a patch test and product use test study

Cocamidopropyl betaine (CAPB) is an amphoteric surfactant commonly used in personal care products and surface cleaners. Patch testing with commercially-available CAPB has yielded occasional reactions indicative of allergic contact dermatitis. To determine if subjects with previous positive patch tests would react in provocative use tests of products containing CAPB, and to study various contaminants in commercial CAPB supplies for allergenicity in these subjects. 10 subjects previously positive to CAPB on patch testing used a hair shampoo, hand soap, and body wash containing CAPB for 1–6 weeks or until a reaction developed. Later, they were patch tested to 2 different purity grades of CAPB and 3 possible manufacturing contaminants (dimethylaminopropylamine, amidoamine, and sodium monochloroacetate). 7 of the 10 subject developed dermatitis from 1 or more CAPB-containing products at some point during the study 9 of the 10 use-test subjects were then patch tested, and 6 of these subjects showed a reaction to amidoamine, (0.1% aq.). None reacted to dimethylaminopropylamine (0.1% pet.). 1 subject reacted to CAPB but not to amidoamine. In the follow-up patch testing with CAPB that was free of amidoamine, there were no positive reactions. Most subjects who were patch-test-positive showed a reaction when using CAPB-containing skin and hair care products. The chemical amidoamine, which is used in the synthesis of CAPB and which is a known contaminant of CAPB preparations, is likely to be the actual sensitizer in most cases rather than CAPB itself. The results do not rule out the possibility shin CAPB itself may be an allergen in rare cases.     

Occupational allergic contact dermatitis in beauticians

We patch tested 13 beauticians with hand dermatitis between 1982 and 1986. They were all young female novice beauticians or those in training. The onset of their allergic dermatitis was noticed within 1 month to 1 year of their starting this occupation. Definite positive reactions to products were seen from hair dyes (as is, open test) (6/12), cold permanent wave primary solutions (as is, open test) (7/13) and a shampoo (1% aq., closed test) (1/13). Positive reactions to allergens were seen with para-phenylenediamine (1% pet) (12/13), ammonium thioglycolate (5% aq., open test) (3/7), para-toluylenediamine (1% pet) (7/9), para-aminophenol (1% pet) (1/4), ortho-aminophenol (1% pet) (1/4), Quinoline yellow SS (0.5% pet) (1/4), nickel sulfate (2.5% pet) (1/12), cobalt sulfate (2.3% pet) (1/12), thimerosal (0.05% pet) (1/12) and procaine hydrochloride (1% pet) (1/12). Study of the prognosis showed that 5 out of 12 cases could continue their occupation, but 4 cases had persistent hand dermatitis despite protecting their hands from hair dyes with gloves, 7 cases quitted their jobs, and in 5 their hands healed while 2 cases continued to have atopic hand dermatitis. A personal or family history of atopy was frequent among the cases, so we recommend that those who have such a history should not become beauticians.     

Sensitization to patch test acrylates

Data on allergic contact dermatitis from acrylates and 4 patients sensitized during routine patch testing are reported. During 1982-1985, we used 7 different acrylates for tests. 1 patient out of 22 (= 4.5%) was sensitized to ethyl acrylate and butyl acrylate (1% pet.). Since September 1985, we have used a commercial (meth)acrylate series containing 28 substances. 3 of 24 patients tested became sensitized to ethyl acrylate, 2-hydroxyethyl acrylate and 2-hydroxypropyl acrylate (0.5% pet.). Because active sensitization with acrylates can be very harmful, it may be necessary to use lower concentrations than recommended. Currently, we test ethyl acrylate, 2-hydroxyethyl acrylate and 2-hydroxypropyl acrylate at 0.167% pet.     

Skin acceptance of transcutaneous nitroglycerin patches: a prospective study of 33 patients

Transdermal nitroglycerin is commonly used and may induce contact dermatitis. The frequency of adverse skin reactions is controversial and may vary from 10% to 75%, according to various authors. 33 patients using transdermal nitroglycerin for more than 7 days were examined and patch tested (nitroglycerin 0.5% aq., 2% pet. and TTS in toto). 5 patients (15%) had adverse reactions. The patch tests were all negative in the 33 patients. Contact dermatitis occurs in many cases, about 15% of the cases with the newly available TTS, and even if patients respect the conditions for using TTS. These contact dermatitides are mainly irritant reactions and do not require transdermal nitroglycerin treatment to be stopped. Nevertheless, since some cases of allergic contact dermatitis have been reported, a contact dermatitis from transdermal nitroglycerin should lead to patch testing.     

Diagnostic patch test concentration for Kathon CG

Patch test studies, 21-day cumulative irritancy assays and Draize repeat insult patch tests with Kathon CG, were used to ascertain an appropriate diagnostic patch test concentration. A dilution of 100 ppm a.i. (aq. or pet.) appears to have low irritancy potential. Further observations are required to verify if this concentration is high enough to detect most cases of sensitization.     

Occupational allergic contact dermatitis and airborne contact dermatitis from 5 fungicides in a vineyard worker. Cross-reactions between fungicides of the dithiocarbamate group? *

We report a patient with occupational contact dermatitis due to sensitization to mancozeb and perhaps metiram used in a vineyard. Patch testing showed strong allergic patch test reactions to 2 of the commercially available preparations used (Dithane Ultra® and Polyram WG®). Further patch tests showed allergic patch test reactions to mancozeb (0.5 and 1% pet.) as weak reaction to metiram (1% pet.) as well as to 4 other fungicides of the dithiocarbamate group (maneb, nabam, propineb and zineb), which had never een used in the vineyard.     

Sulfite contact allergy

In the last 2 years, 2,894 consecutive eczematous patients were patch tested with sodium metabisulfite 1% pet. Positive reactions were elicited in 50 subjects (1.7%). All 50 patients were also positive to potassium metabisulfite 1% pet. and sodium bisulfite 1% and 5% pet., while only 2 of them were positive to sodium sulfite 1% pet. Prick tests and intradermal tests with a sodium metabisulfite solution (10 mg/ml) were negative. No flare-ups of dermatitis or patch test were provoked by oral challenge with 30 mg and 50 mg of sodium metabisulfite. The dermatitis was taken to be occupational in 7 cases. In only 5 out of 43 non-occupational cases was the positive reaction considered relevant.     

Allergic contact dermatitis due to hexamethylenetetramine in core molding

Hexamethylenetetramine is an odorless powder and slowly liberates formaldehyde in an acid medium or when heated. It is usually used in the manufacture of formaldehyde resins, rubber and the explosive, cyclonite. It is also used as a hardener in core molding processes. It was reported as one of the formaldehyde releasers and as a cause of formaldehyde contact dermatitis. We report an allergic contact dermatitis due to hexamethylenetetramine, with a positive patch test reaction to hexamethylenetetramine (1% pet.) but not to formaldehyde (2% aq.). We concluded that this case was an allergic contact dermatitis from hexamethylenetetramine itself.     

FC04.3Allergy to phthalic anhydride/trimellitic anhydride/glycols copolymer in nail varnishes

Introduction:  Nail varnishes are well‐known sensitizers, and the most frequent allergen is nowadays tosylamide/formaldehyde resin (TFR). We present 3 cases of allergic contact dermatitis (ACD) due an unusual ingredient.
Case reports:  The 1st patient presented with atopic dermatitis that progressively worsened, involving face and neck for several months. The 2nd patient had history of occupational allergy to glutaraldehyde, and presented with head and neck dermatitis. The 3rd patient had severe onycholysis and dermatitis of perionychium, face, neck and décolleté. European standard series was negative in all patients, as was TFR, (meth‐) acrylates and cosmetic series when tested. Patch tests with patient's own varnish(es) were ++, and breakdown identified phthalic anhydride/trimellitic anhydride/glycols copolymer (PTG) as the allergen (tested 1 to 5% pet.).
Discussion:  PTG results of condensation of phthalic anhydride, trimellitic anhydride, ethylene glycol, and neopentyl glycol monomers. It belongs to the copolymer class, and is used in confection of nail polish and enamels, like TFR or phthalic anhydride/glycerine/glycidyl decanoate copolymer. Our patients had long lasting dermatitis, common in ACD to nail varnishes. Sensitivity was proved by patch testing with patient's own cosmetics. Allergic contact dermatitis to PTG seems to be rare, but has to be considered particularly in patients with negative standard patch tests. An alternative is the use of tosylamide/formaldehyde‐based nail polish.     

Allergic contact dermatitis from phenylephrine in eyedrops.

Phenylephrine is widely used as an ophthalmic drug. However, there are only very few reports on allergic contact dermatitis induced by phenylephrine. In addition, little is known on cross reactivity patterns between the sympathomimetics phenylephrine, epinephrine and ephedrine which share a similar chemical structure. We report on a man who developed allergic contact dermatitis to Neosynerphin POS eyedrops containing phenylephrine hydrochloride. Cross reactivity between phenylephrine, epinephrine and ephedrine was studied by patch testing. Patch tests were performed with the European standard, an ophthalmics and preservatives series, Neosynerphin POS eyedrops, phenylephrine hydrochloride 10% aq., epinephrine and ephedrine (both 1.0 % aq.). Test sites were read after 48, 72 and 168 hours according to the recommendations of the ICDRG. Neosynerphin POS and phenylephrine hydrochloride 10 % aq. gave positive reactions, whereas epinephrine and ephedrine tested negative. Although phenylephrine is an epinephrine analog delayed type hypersensitivity to phenylephrine did not result in cross reactivity with chemically related epinephrine and ephedrine.     

Type III and type IV hypersensitivity reactions due to mitomycin C

A 71-year-old man developed an exfoliative dermatitis of the palms of the hands and soles of the feet, and a generalized itch, during treatment with intravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. Patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated that this reaction was an immune-complex-mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histopathological and immunofluorescence investigations, and these showed the reaction to be consistent with Henoch-Schonlein-type purpura. We therefore conclude that this patient developed systemic reactions to mitomycin C, characterized by an eczematous dermatitis as well as purpuric reactions. The intravesical installations with mitomycin C have been stopped. The patient's skin problems (the purpura as well as the eczema) have completely resolved and have not recurred.     

Occupational allergic contact dermatitis and contact urticaria caused by polyfunctional aziridine hardener

Polyfunctional aziridine (PFA) is increasingly used as a water-based cross-linker in 2-component paints, paint primers, lacquers, topcoats and other protective coatings. The cross-linker (PFA hardener) is made by reacting multifunctional acrylic monomer with a highly reactive aziridine compound. During 1992–1993, we came across 2 patients with allergic patch test reactions provoked by PFA hardener. One of the patients was a parquet layer, and the other a printer. Allergic-contact dermatitis (ACD) was diagnosed by positive allergic patch test reactions to PFA hardener in a dilution series in pet.: 0.3%-1% gave ++ to +++ allergic reactions in both patients, whereas 0.1% gave a weak (+) or questionable reaction (?+), respectively. The methacrylate patch test series was negative in both patients, although gas chromatography mass spectrometry analysis showed that PFA hardener contained 0.3% of trimethylolpropane triacrylate (TMPTA), a multifunctional acrylic monomer. One of the patients also had symptoms of contact urticaria, and a prick test with PFA hardener (1% aq.) induced a histamine-sized prick test reaction. The positive reactions with the PFA hardener and the negative reactions with the starting chemicals and additives in PFA, namely acrylates, propyleneimine and dimethylethanolamine, indicate that PFA caused ACD. This is in accordance with our previous observations, but differs from the reports of others, whose patients had been sensitized to acrylates present as remnants in the PFA hardener. As test substance, 0.5% PFA hardener in pet, is recommended for patch testing. Testing should be performed in patients with contact dermatitis if exposure to PFA has occurred. Skin prick tests may be of help to detect contact urticaria.     

Active sensitization and contact allergy to methyl 2‐octynoate

Background: Methyl 2‐octynoate is a synthetic fragrance which was first described to have sensitizing properties in 1935. It is one of the 26 fragrances to be labelled on the ingredient list according to current European cosmetics regulation. Objectives: To report the experience with patch testing with methyl 2‐octynoate 1% and 2% in pet. Methods: 230 eczema patients were consecutively patch tested with 1% methyl 2‐octynoate at department of Dermato‐allergology Gentofte Hospital, Denmark and 120 eczema patients were consecutively patch tested with 2% M2O in Finn Chambers® at the Départment de Dermatologie, CHU Saint Jacques, France. Results: Three cases of active sensitization were observed. 2 (0.87%) of the 230 Danish subjects tested with 1% in pet. and of the 120 French subjects patch tested with 2% in pet. 1 (0.83%). There was no statistical difference in active sensitization between the two groups (P = 0.72). Allergic contact dermatitis was observed in two patients (1.67%) in the French group and none in the Danish group. Conclusion: Contact allergy to methyl 2‐octynoate was frequently seen when patch testing with 2% in pet. However, active sensitization was also observed, when patch testing with concentrations of 1% and 2% methyl 2‐octynoate. The patch test concentration should be below 1% in pet., but a safe concentration remains to be defined.     

The vehicle tray revisited: The use of the vehicle tray in assessing allergic contact dermatitis by a 24-hour application method

Over 700 patients were screened by patch testing for sensitivity to the components of a vehicle from July 1974 through June 1976 the Mayo Clinic. A modified version of the vehicle tray originally suggested by Fisher et al. (1971) was used, containing 14 substance commonly found in vehicles. Patches were applied for 24 rather than the usual 48 hours. Our percentage of reactivity compares favorably with the 48-h application method, thus demonstrating the efficacy of this time-saving technique. The method and usefulness of determining a percentage of irritancy are discussed. This was found to be a valuable tool in assessing false-positive reactions among our percentage of reactivity. Four irritants were demonstrated: phenylmercuric acetate (0,05 % pet.), sodium lauryl sulfate 1 % aq), thimerosal (0.1 % aq) and hexachlorophene (1 % pet.).     

4 cases of photocontact dermatitis due to ketoprofen

We report 4 cases of photocontact dermatitis due to ketoprofen, a non-steroidal anti-inflammatory drug derived from propionic acid. We carried out a skin biopsy to examine the amount of ketoprofen in the eruptive skin. We investigated the cross-reactions between tiaprofenic acid, suprofen and ketoprofen by patch and photopatch testing. In case no. 1, 17 days after the discontinuance of Mohrus poultice (containing ketoprofen as an active ingredient), we detected ketoprofen 312.5 ng/g in the area of skin where the poultice was applied. All 4 cases reacted positively to the causative medicaments containing ketoprofen and ketoprofen 1% pet. 3 out of 4 cases reacted positively to tiaprofenic acid 1% pet. Only 1 case out of the ketoprofen and tiaprofenic acid positive cases reacted positively to suprofen 1% pet. Vehicles of patients' medicaments were negative in all 4 cases. We suspected that the key structure of the cross-reaction between ketoprofen and tiaprofenic acid and suprofen was the benzoyl radical.