Is it possible to improve the prognosis in nickel contact dermatitis?

A questionnaire was sent to 143 patients who had shown a positive patch test reaction to nickel sulfate more than 10 years earlier. 91 patients returned the questionnaire, revealing that after the testing, 73 had suffered from dermatitis, 61 especially from hand dermatitis, 37 of these patients were clinically examined and patch tested with standard series and in addition, 12 patients were tested with nickel sulfate and nickel chloride with different occlusion times. At the clinic visit, 23 patients had dermatitis, 16 hand dermatitis, and 11 were symptom-free, 26 of the patients had metal items close to their skin and 21 of them had current dermatitis, 14 hand dermatitis. Of the 11 patients who had no metal exposure, 9 were symptom-free. The association of dermatitis with exposure to metal objects was statistically significant (p < 0.001). Those patients who had current dermatitis had also developed multiple allergies and reacted to nickel with shorter application times in patch tests, as compared to those who were symptom-free. It seemed possible that the prognosis for nickel dermatitis could be improved if nickel-allergic patients would strictly avoid metal contact, especially in clothing and jewelry.     

Dermatitis in hairdressers

Contact dermatitis among hairdressers is common. In The Netherlands, registered sick leave for hand dermatitis among hairdressers rose from 21,050 days in 1986 to 54,293 in 1991. In a survey among 45 hairdressers in 5 different salons, 12 had a history of hand dermatitis and 16 showed moderate to severe hand dermatitis. After extensive investigations, 13 were classified as having allergic contact dermatitis and 3 cumulative irritant contact dermatitis, fn the past 4 years, 103 hairdressers were extensively patch tested and glyceryl thioglycolate (GTG), ammonium persulfate and nickel sulfate were responsible for the majority of positive reactions. Hair dyes and preservatives were responsible for a moderate % of the positive reactions. Positive reactions were also found to cocamidopropyl betaine and sodium coco hydrolyzed animal protein. These 2 allergens show a rather capricious patch test reaction pattern and irritant reactions may easily be confused with allergic. The relevance of positive patch test reactions to these chemicals should always be questioned. Atopy was not a frequent cause of hand dermatitis in this study. Chemicals with a thiol group can be demonstrated with a chemical spot test. With this test, contamination of the hairdressing salon with thioglycolates was demonstrated. It is emphasized that contamination of hairdressing salons with GTG is probably a significant factor in explaining the severe flare-ups in GTG-sensitized hairdressers who no longer use GTG permanent-waving solutions.     

No association between nickel allergy and reporting cosmetic dermatitis from mascara or eye shadow: a cross‐sectional general population study

Background In theory, all pigmented make‐up products may contain metal allergens including nickel. Eyelid dermatitis has previously been observed among nickel allergic dermatitis patients following exposure to nickel containing mascara and eye shadow. However, an association between nickel eyelid dermatitis and nickel in make‐up products remains controversial. Objective This cross‐sectional patch test study investigated whether the frequency of self‐reported cosmetic dermatitis from mascara or eye shadow use was higher among nickel allergic Danish women than women without nickel allergy. Methods In 2006, a total of 1843 18–69 year old women completed a postal questionnaire including questions on cosmetic dermatitis and were patch tested with nickel sulphate. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results The prevalence of nickel allergy was similar among women who reported cosmetic dermatitis from eye shadow or mascara and among women who did not report such symptoms. Cosmetic dermatitis was positively associated with self‐reported atopic dermatitis and age. Conclusion Overall, no association between having nickel allergy and reporting cosmetic dermatitis from mascara or eye shadow use was found in the general population. This does not exclude a causal relationship in selected cases.     

Occupational skin disease in hospital cleaning and kitchen workers

Skin disorders were reported in 33% of catering staff and 35% of women cleaners who returned a questionnaire, and were employed in a large hospital. Hand dermatitis occurred in 15% of the caterers and 12% of the cleaners. In the majority, the dermatitis was irritant in origin and related to their wet work occupations. Cleaners had a high prevalence of jewellery dermatitis. Limited patch testing revealed a majority positive to nickel, but a third were negative, indicating that jewellery reactions often but not invariably predict nickel sensitivity. Few subjects were atopic, but some psoriatic patients with hand problems were encountered. Most workers were able to carry on in their occupations despite having hand dermatitis.     

Occupational dermatoses in farmers growing okra (Hibiscus esculentus L.)

By questionnaire survey, 32 out of 52 workers (61.5%) reported previous or current skin diseases from okra cultivation. The sites of skin lesions were mainly the arms, fingers and fingertips. Positive patch test reactions with preparations of okra leaves or immature pods in 111 workers, compared to 63 control subjects, were significantly higher in okra workers than in controls (p less than 0.01), ranging from 9.8 to 30.0%. 37 out of 111 workers (33.3%) were diagnosed as having allergic contact dermatitis (n = 17; 15.3%) and irritant contact dermatitis (n = 18; 16.2%) from okra cultivation.     

652例过敏性皮肤病斑贴试验变应原分析

目的:分析我院过敏性皮肤病患者常见的接触性变应原.方法:回顾性分析我院门诊652例行斑贴试验的过敏性皮肤病患者资料,包括接触性皮炎249例、面部皮炎158例、湿疹87例、激素依赖性皮炎64例、特应性皮炎51例、唇炎43例,并对斑贴试验结果及不同年龄、性别阳性率进行比较分析.结果:斑贴试验总阳性448例(68.71％)....     

Erythema multiforme associated with contact dermatitis

A garment worker developed erythema multiforme concurrently with allergic contact dermatitis of the hands. Patch testing revealed sensitivity to nickel (which was present in her scissors) and to paraphenylenediamine (a commercial dye). During the course of the patch-test evaluation, both the hand dermatitis and the erythema multiforme became exacerbated. Later, patch testing to only nickel sulfate resulted in the development of erythema multiforme on the face and hands. The allergic pathogenesis, involving the absorption of an allergen through the skin and resulting in a type III allergic reaction from nickel, is discussed.     

Hand eczema in car mechanics

To estimate the prevalence of hand eczema, a questionnaire was distributed to 901 male car mechanics. Of the 801 persons who responded, 15% reported hand eczema on some occasion in the previous 12 months, and 57% admitted dry skin on the hands. In a 2nd part of the study, those who reported hand eczema were examined and patch tested with a standard series and a special "car mechanics' series". The most common diagnosis was irritant contact dermatitis, 55%, and 2nd was allergic contact dermatitis, 19%. 35/105 (33%) had a total of 51 positive patch test reactions, all to substances in the standard series, except for 2 persons who reacted to oxidized d -limonene. The most frequent reactions were to thimerosal (9%), nickel (8%) and colophony (5%). One plausible explanation for the high prevalence of nickel allergy was the common use of nickel-plated tools. 5 individuals had a history of contact urticaria, but scratch tests were negative. It was concluded that car mechanics are at high risk for contact dermatitis on the hands, irritant as well as allergic.     

A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals

Chelating agents in protective barrier creams have often been used in the prevention of allergic contact dermatitis to nickel. In a pilot study, we demonstrated the preventive effect of 10% diethylenetriaminepentaacetic acid (DTPA) in an oil-in-water emulsion in nickel-sensitized patients. Now we reproduced these results in a randomized, double-blind study. Additionally, we investigated the efficacy of the barrier cream in other clinically relevant metal allergies. Individuals sensitized to various metals had a significant decrease in positive patch test reactions after pre-treatment with the DTPA-cream: 2.5% nickel sulfate (24/28 positive without pre-treatment versus 1/28 with pre-treatment; p<0.0001), 5% nickel sulfate (30/32 versus 15/32; p=0.0003), 1% cobalt chloride (19/20 versus 6/20; p=0.001) and 5% copper sulfate (13/14 versus 5/14; p=0.02). However, the cream had no protective effect with 1% palladium chloride (17/23 versus 16/23) and with 0.5% potassium dichromate (9/13 versus 7/13). We conclude that the DTPA-cream clearly abrogates positive patch test reactions in nickel-, cobalt- and copper-sensitized subjects and that it may therefore be helpful in the management of allergic contact dermatitis.     

Nickel,cobalt and chromate sensitization and occupation*

Background: Exposure to nickel, cobalt and chromate are important causes of occupational contact dermatitis. Objectives: To estimate the prevalence of nickel, cobalt and chromate allergy in a population of consecutive patients and to investigate the possible association with individual and occupational risk factors. Patients/Methods: A total of 14 464 patients (67.6% women and 32.4% men) with suspected allergic dermatitis underwent patch tests. The associations between patch test results and occupations were studied by multivariate logistic regression analysis. Results: About 24.6% of the patients reacted positively to nickel sulphate, 10.2% to cobalt chloride and 8.7% to potassium dichromate. Nickel sensitization was higher in women aged 26–35 years in comparison with the youngest group (15–25 years) and the older group (> 45 years). In women, the prevalence of positive reactions to nickel was positively associated with metal and mechanical work (OR 1.54; 95%, CI 1.16–2.05). Chromate sensitization was more prevalent in building trade workers for both women (OR 1.58; 95% CI 1.00–2.49) and men (OR 2.24; 95% CI 1.55–3.22). Cobalt sensitization was associated with textile and leather work in women (OR 1.52; 95% CI 1.09–2.12) and with cleaning work in men (OR 1.86; 95% CI 1.18–2.93). Conclusions: Our study showed interesting associations between some occupations and nickel, chromate and cobalt allergy.     

Nickel sensitivity in atopics, psoriatics and healthy subjects

A prospective study of 552 persons was performed lo study nickel allergy in atopics, with and without dermatitis, psoriatics and healthy adults. We found no statistically-significant difference in the frequency of nickel allergy between persons with atopic dermatitis, atopics without dermatitis and healthy controls. More females than men gave a history of metal intolerance and gave allergic patch test reactions. A poor correlation between history and patch lest reaction was not specific for atopics. Psoriatics had a significantly lower frequency of allergic patch test reactions lo nickel than healthy controls or atopics with and without dermatitis. Psoriatics should not be used as controls for atopics in studies of contact dermatitis.     

Addition of ferrous sulfate to cement and risk of chromium dermatitis among construction workers

Lowering the water-soluble chromium content of cement to < 2 ppm has been suggested to diminish tile risk of allergic hand dermatitis caused by chromium among construction workers. The prevalence of chromium dermatitis was determined for a representative sample of 913 house construction workers and 707 concrete element prefabrications workers, with a questionnaire and clinical examination, before the use of cement with such H low content of water-soluble chromium was Lined on Finnish construction sites in 1987. The prevalence of allergic contact dermatitis caused by water-soluble chromium, diagnoses confirmed with patch tests among the workers with hand dermatitis, was 9/ 117 (7.7%). 4 of them were new 4/105 (4%) and 5 had been diagnosed earlier. In 1997, the prevalence of work-related hand dermatitis (allergic and irritant together) was 6.8% among the construction workers and 8.9% among the concrete element prefabrication workers. The Finnish Register of Occupational Diseases was checked for reports of chromium dermatitis and other forms of hand dermatitis from 1978 to 1992. The results indicated that, after 1987, the occurrence of allergic contact dermatitis caused by chromium decreased to less than 1/3 the previous level, whereas the occurrence of irritant contact dermatitis remained stable throughout the observation period. Regardless of some potential confounders, the addition of ferrous sulfate to cement during the production process may have reduced the number of cases of allergic contact dermatitis among construction and concrete element prefabrication workers. Our results agree with the results of Danish studies and Swedish observations.     

Is the European standard series suitable for patch testing in Riyadh,Saudi Arabia?

Due to the lack of a regional patch test series in our geographical area, the suitability of the European standard series was evaluated by patch testing dermatitis patients in Riyadh, Saudi Arabia. Of 240 consecutive patients with various forms of dermatitis, 136 (57%) showed 1 or more positive patch tests, women, 74 (54%), slightly outnumbering men, 62 (46%), Positive reactions were found to 21 of the 22 items in the test series. Sensitization was most common to nickel sulfate (51=37.5%), potassium dichromate (48=35%) and cobalt chloride (43 = 32%). The frequency of sensitization to nickel was higher in women (41=30%) while that to dichromate was higher in men (39=29%). Less reactions were found to fragrance mix (21 = 15%). formaldehyde (15=11%) and neomycin sulfate (15=11%). Sensitization to other allergens ranged between 10 and 1%. Less than 1% of patients (0.7%) reacted to benzocaine and none to primin. The frequency of occurrence of multiple sensitivities is also presented. We conclude that the European standard series is suitable for patch testing dermatitis patients in our region, with the exception of benzocaine and primin. The addition of 3 allergens that could be of local relevance is discussed.     

Nickel reactivity and filaggrin null mutations--evaluation of the filaggrin bypass theory in a general population

Background. It was recently shown that filaggrin null mutation carrier status was associated with nickel allergy and self‐reported intolerance to costume jewellery. Because of the biochemical characteristics of filaggrin, it may show nickel barrier properties in the stratum corneum. Objectives. To investigate whether subjects with filaggrin null mutations report nickel dermatitis at an earlier age than wild‐type individuals, and to analyse whether null mutation carriers have stronger patch test reactivity to nickel sulfate than do wild‐type individuals. Materials. A total of 3471 Danes (18–69 years of age) answered a questionnaire about general health, and underwent patch testing and filaggrin genotyping. Results. The mean number of years at risk of developing nickel dermatitis was significantly lower for the filaggrin null genotype than for the wild‐type genotype when ear piercing status was considered. In positive patch test readings, the proportion of null mutants increased with increasing reaction strength. Conclusions. Filaggrin null mutations may lower the age of onset of nickel dermatitis. The hypothesis that ear piercings obscure the effect of filaggrin null mutations on the development of nickel allergy in statistical analyses was supported. An association between the null genotype and increased nickel sensitivity was indicated by patch test reading and questionnaire data.     

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

Contact dermatitis in Korean dental technicians

The high risk of occupational contact dermatitis in dental personnel are well accepted throughout the world. There are few reports concerning occupational skin disease in dental personnel in Korea. The purposes of this study were to investigate the frequency, characteristics and causative factors of contact dermatitis in Korean dental technicians. Recording of personal history, physical examination and patch tests with the Korean standard series and dental screening series were performed in 49 dental technicians. Most of the subjects were exposed to a variety of compounds, including acrylics, metals, plaster, alginate, etc. 22 (44.9%) subjects had contact dermatitis, present or past, and the site involved was the hand in all 22. The most common clinical feature of hand dermatitis was itching (77.3%); scaling, fissuring and erythema were other common clinical features. Metals, including potassium dichromate (24.5%), nickel sulfate (18.4%), mercury ammonium chloride (16.3%), cobalt chloride (12.2%) and palladium chloride (10.2%), showed high positive rates in patch test results of 49 dental technicians. 7 positive reactions to the various acrylics were found in 3 subjects. In our study, the frequency and clinical features of the contact dermatitis showed a similarity to other reports, though the patch test results were somewhat different; a higher patch-positive reaction to metals and a relatively lower patch-positive reaction to acrylics than the patch test results reported in Europe.     

Changing frequency of thiuram allergy in healthcare workers with hand dermatitis

BACKGROUND: Healthcare workers (clinical, allied/paramedical professions and ancillary workers) may have prolonged contact with natural rubber latex devices, particularly in the form of natural rubber latex gloves. OBJECTIVES: To examine the changing frequency of type IV thiuram allergy in healthcare workers with hand dermatitis over a 16-year period. METHODS: During the study period, 450 healthcare workers (352 women and 98 men) with hand dermatitis were investigated, and their patch test results were analysed retrospectively. RESULTS: On average, a thiuram-positive patch test was noted in 12% of individuals, with a peak incidence of 27% of the patients patch tested in 1994. Comparison of results between 1983--88 and 1989--93 showed a statistically significant increase in the incidence of thiuram-positive patch tests (odds ratio 2.55, 95% confidence interval 1.25--5.20, P = 0.01). CONCLUSIONS: We have documented a changing frequency of thiuram-positive patch tests in healthcare workers with hand dermatitis since 1983. This may reflect changes in degree of exposure to thiurams in medical gloves during this period.     

Allergic patch test reactions to palladium chloride in schoolchildren

A study of the prevalence of allergic patch test reactions to palladium chloride compared to nickel sulfate was performed in a group of Finnish schoolchildren. All adolescents 14–18 years of age in a Finnish town with 40 000 inhabitants, who had received orthodontic treatment with metallic appliances at a municipal dental clinic, were included in the study. The selection of patients was based on patient records. A non-treatment control group was randomly selected from the same age groups of the town population. A total of 700 subjects (77% of those invited), 417 (60%) girls and 283 (40%) boys, participated. The majority (91%) of the girls had pieced ears. Orthodontic treatment was equally common (67–70%) in the boys and the girls. The girls had a much higher frequency of allergic patch test reactions to both nickel sulfate and palladium chloride. Of the 700 adolescents tested 48 (7%) had an allergic patch test reaction to palladium chloride. Of the 417 girls, 44 (11%) were palladium-chloride-positive, whereas only 4 of the 283 boys tested (1%) had an allergic patch test reaction to palladium chloride 3 patients reacted to palladium chloride only, whereas all other patients with allergic patch test reactions to palladium chloride also had an allergic patch test reaction to nickel sulfate. The results support the concept of cross-reactivity between nickel sulfate and palladium chloride. The clinical significance of the allergic patch test reactions caused by palladium chloride remains unclear.     

Hand eczema: causes, course, and prognosis I

Background:  Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described.
Objective:  To describe in detail a consecutive cohort of hand eczema patients with regard to aetiology and morphology as well as the dynamics of the hand eczema.
Patients and Methods:  This prospective study included 522 consecutive patients (175 men and 347 women with hand eczema) seen in 1 year in a private practice of dermatology. 425 (81%) of the patients were patch tested in relation to the current study. Most of the remainder had been previously patch tested.
Results:  38% had mild dermatitis, 49% had dermatitis of moderate severity, and 11% had severe dermatitis. 23% had had dermatitis for more than 10 years. 33% had irritant contact dermatitis, 13% of the men and 20% of the women had allergic contact dermatitis, and 15% of the men and 16% of the women had atopic dermatitis. For 34% of the men and 29% of the women, the dermatitis was certainly or possibly occupational. There was no relationship to smoking.
Conclusions:  The majority of this cohort of hand eczema patients had long-standing disease. Irritant contact dermatitis was the most common aetiological diagnosis.     

Retrospective survey of patch testing at department of dermatology and venerology, zagreb university hospital center in zagreb, croatia

Epicutaneous (patch) test is a standard test to confirm contact allergy. During a six-year period (1998-2003), contact allergic dermatitis was diagnosed in 4132 (65%) of 6341 patients using standard patch test with a Croatian series of allergens according to the International Contact Dermatitis Research Group (ICDRG). The most common clinical diagnoses related to contact allergy (male; female) were contact allergic dermatitis (65.4%; 72.2%); atopic dermatitis (15.9%; 11.7%); contact irritant dermatitis (7.0%; 6.6%) and nummular eczematoid dermatitis (4.2%; 2.4%). According to occupation, positive patch test reaction was most commonly observed in workers, whereas 65% of patients showed positive reactions to one or more substances. There was an increased frequency of positive patch test reactions to potassium dichromate, nickel sulfate, thimerosal and neomycine sulfate, along with a significant decrease in the frequency of positive patch test reactions to cobalt chloride, carba mix, wood tars, detergents, parabens mixture, urushiol and rubber mixture. We strongly recommend keeping up-to-date with the epidemiology of contact allergy in Croatia.