Irritant contact dermatitis: is there an immunologic component?

Irritant contact dermatitis (ICD) describes a multifactorial disease resulting from exposure to occupational irritants. Though often characterized as a localized reaction, there are at least 10 forms of ICD, several of which possess systemic involvement. The exact mode of irritant action in ICD is not completely understood, but recent literature suggests that an immunologic-like component may be present. The correlation between the morphology, clinical manifestations and chemokines involved in allergic contact dermatitis and irritant contact dermatitis will be discussed and studies indicating an irritant "immunologic-like" response will be reviewed and analyzed.     

Hair highlights and severe acute irritant dermatitis (“burn”) of the scalp

Context: These days, most celebrities—young and old—have their hair highlighted. That is why it is not surprising that even the youth have their hair highlighted as they emulate their favorite actors, unaware of the harmful consequences of this unsafe procedure. Hair highlighting involves decolorizing melanin pigments of select hair strands through an oxidation reaction under alkaline conditions by the active ingredients of the highlighting mixture—hydrogen peroxide, persulfates, and metasilicate. Hydrogen peroxide and the persulfates are flammable, necessitating that regulatory bodies (namely, the U.S. Food and Drug Administration [FDA] and the Cosmetic Ingredient Review [CIR] Expert Panel, the European Union’s (EU), European Economic Community [EEC] directives, the Australian government’s National Industrial Chemicals Notification and Assessment Scheme [NICNAS], and the Association of Southeast Asian Nations [ASEAN]) to regulate the permissible amounts of these chemicals in hair highlighting products.

Objectives: To review published case reports of resulting in severe acute irritant dermatitis (“burns”) of the scalp caused by hair highlighting, to explain why these scalp burns happen, to identify preventive measures to avoid such occurrences, and to discuss the implications for society.

Materials and methods: We searched medical and scientific search engines and used keywords such as hair highlights, scalp burn, and other related terms..

Results: Six articles were obtained, yielding 8 reported cases (2 of the 6 articles had 2 cases each) of hair highlighting resulting in scalp burns; these 8 cases were reviewed and analyzed. Five of the 8 patients belonged to the pediatric age group.

Discussion: The causes of scalp burn were classified into 2 categories: chemical (caustic nature of the highlighting mixture, spillage of the hot mixture, toxic reaction to the dyes) and thermal (by contact of the scalp with overheated aluminum foil and by the blow dryer). The 5 pediatric patients in the group unnecessarily suffered pain and embarrassment caused by this procedure, as well as the risk of developing malignancy in the future.

Conclusions: Hairstylists play a large role in the occurrence of scalp burns. Thus, they need to be careful and knowledgeable of the caustic nature of the highlighting mixture and the potential harm these chemicals may cause. The authors strongly propose that the relevant regulatory bodies review the permissible levels of the caustic chemicals, and that this unsafe procedure should be performed only on adults.     

Pustular irritant contact dermatitis caused by dexpanthenol in a child

Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.     

Systemic allergic contact dermatitis to fiberglass in a factory worker of wind turbine blades

Fiberglass is extensively used due to its properties of thermal, acoustic and electrical insulation, and also to reinforce other materials such as plastics. Irritant contact dermatitis to fiberglass is a well established occupational dermatose and is due to penetration of small fragments in the cornified layer of the skin. On the other hand, allergic contact dermatitis (ACD) is rare and is more often triggered by sensitivity to the additives and resins used in the manufacture of fiberglass products.

We report a case of ACD to fiberglass in a factory worker of fiberglass reinforced products.     

Irritant contact dermatitis: effect of age

Knowledge on age-relationship to irritant contact dermatitis (ICD) remains of interest. We searched for articles and textbooks on age-relationship to ICD and evaluated relevant data. Irritant response may be enhanced in children and decline with increasing age. In general, older skin reacts more slowly and with less intensity to irritants when compared with young skin. Such age-related changes may depend: (i) on differences in percutaneous penetration in old and young skin, and/or on (ii) differences in the microcirculatory efficiency, which serves as the route by which inflammatory cells make their way to the site of inflammation. Additionally, stratum corneum turnover time increases with age which means that an irritant remains longer on the skin; a compromised cutaneous blood vessel network with ageing may lead to a decreased inflammatory response, decreased absorption and decreased clearance. In conclusion, age-related differences of ICD are present despite some conflicting data. Investigations elucidating this interesting subject may benefit in prevention and intervention strategies.     

Systemic allergic contact dermatitis to fiberglass in a factory worker of wind turbine blades

Fiberglass is extensively used due to its properties of thermal, acoustic and electrical insulation, and also to reinforce other materials such as plastics. Irritant contact dermatitis to fiberglass is a well established occupational dermatose and is due to penetration of small fragments in the cornified layer of the skin. On the other hand, allergic contact dermatitis (ACD) is rare and is more often triggered by sensitivity to the additives and resins used in the manufacture of fiberglass products. We report a case of ACD to fiberglass in a factory worker of fiberglass reinforced products.     

A discussion of natural rubber latex allergy with special reference to children: clinical considerations

Latex allergy is an increasingly common condition, because the use of latex products is widespread. Three types of reactions can occur in persons using natural latex rubber products: 1) Irritant contact dermatitis, 2) Allergic contact dermatitis, 3) and Type I hypersensitivity. Children's subpopulations at particular risk include: atopics, individuals with spina bifida, or individuals who required frequent surgical instrumentations. An association between allergy to latex and allergy to various fruits and vegetables has been reported. Recently, an homology between latex allergens and mold allergens has been reported leading to postulate a possible existence of a "latex-mold syndrome". Diagnosis of allergy is based initially on history, skin prick test and search for specific serum IgE. Provocation tests may confirm the suspicion, although these are seldom performed on children because they are not easy to bear with. The most effective strategy to decrease the incidence of NRL (natural rubber latex) sensitization is avoidance; however, this is virtually impossible, given the large number of latex products we encounter since childhood. Studies of secondary prophylaxis among children demonstrate that notwithstanding recommendations, children could manifest yet adverse reactions to latex products and have detectable levels of anti latex IgE.     

Delayed type hypersensitivity to benzoyl peroxide

Benzoyl peroxide (BP) has been a standard and effective topical treatment for acne vulgaris for the past 35 years. Previous studies and case reports have documented benzoyl peroxide to be a strong irritant and a weak allergen, with many cases of tolerance induced with repeat use of this irritant. While less common, numerous cases of BP-induced allergic contact dermatitis (delayed type hypersensitivity reaction) have been reported in the literature. We report here an individual with an incipient edematous reaction to topical BP used for acne therapy. This under-recognized presentation is discussed in the context of published literature on BP-induced hypersensitivity and irritation.     

Occupational skin diseases in automotive industry workers

Context: Studies on occupational skin diseases in workers of the automotive industry are few.

Aim: To investigate the prevalence of occupational skin diseases in workers of the automotive industry.

Materials and methods: Between September and December 2011, a total of 405 workers from the automotive repair industry in Diyarbak?r were interviewed. They were active workers in the repair industry who had been employed for at least six months. Business owners, sellers of spare parts and accounting officers were not included. The employees were examined at their workplaces and the working conditions were observed. Detailed dermatological examination was performed.

Results: The mean age of the 405 workers who participated in the study was 27.7?±?10.3. The mean working time of employees was 13.3?±?10.4 years. All of the employees were male. Dermatological diseases were not detected in 144 out of 405 workers (35.6%) and at least one condition was diagnosed in 261 (64.4%). The most frequent diagnosis was callus, hyperkeratosis, clavus (27.7%), followed by nail changes (16.8%) and superficial mycoses (12.1%). Contact dermatitis was seen at a rate of 5.9%.

Discussion: Traumatic lesions such as hyperkeratotic lesions and nail changes were found most frequently. Traumatic lesions were common among individuals who did not use gloves. Most nail changes were localized leuconychia, a finding not reported in the studies on automotive industry workers. In accordance with the literature, irritant contact dermatitis was observed in patients with a history of atopy and who had been working for a long time.

Conclusion: Occupational skin diseases comprise an important field in dermatology, deserving much attention. Further studies on occupational dermatology are necessary.     

A literature review of dermatotoxicity.

Dermatotoxicity is the skin's response to chemical substances that produce damage. Penetration of the chemical to the various skin layers is important and may result in irritation, allergic contact dermatitis, contact urticaria, one of various forms of photosensitization, or other cutaneous reactions. The testing of new products or industrial chemicals for potential dermatotoxicity is an important process in protecting the public's health.     

Chemicals with weak skin sensitizing properties can be identified using low-density microarrays on immature dendritic cells

A critical step in the induction of allergic contact dermatitis is the interaction of haptens with immature dendritic cells (iDC) leading to their activation. Therefore iDC appear as suitable targets for the evaluation of the sensitizing properties of haptens with the aim of developing in vitro toxicologic methods. Here, using a low-density cDNA-array, we analyzed the expression of 165 genes related to dendritic cell biology in human iDC following a 24h incubation with four haptens representative of strong (DNBS), moderate (isoeugenol) and weak (eugenol, hydroxycitronellal) contact sensitizers and with one irritant sodium dodecyl sulphate (SDS). Results show that 21/165 iDC genes were significantly modulated by hapten treatment. Some genes were preferentially modulated by a given chemical. Thus, DNBS, isoeugenol, eugenol and hydroxycitronellal consistently modulated CCR5, CCL27, CCL2 and CCR7, respectively, whereas the CXCL10 gene was regulated by SDS. When subjected to principal component analysis, the 21 target genes fell into four groups associated with a particular type of chemical endowed with distinct sensitizing or irritant properties. Thus, gene profiling of iDC using low-density microarray allows, for screening of chemicals, the indentification of weak haptens with potential skin sensitizing properties. These results suggest that gene profiling of iDC using low-density microarrays may be useful to identify chemicals with weak skin sensitizing properties.     

Dermatotoxicologic clinical solutions: hair dying in hair dye allergic patients?

This article describes how to identify allergic contact dermatitis resulting from hair dye, and outlines interventions and prevention principles for those who wish to continue dyeing their hair despite being allergic. Hair dye chemicals thought to be the most frequent sensitizers are discussed with instructions for health care providers on how to counsel patients about techniques to minimize exposure to allergenic substances. This framework should allow many patients to continue dyeing their hair without experiencing adverse side effects.     

Dual Characteristics of Skin Care Creams Evaluated by Two In-Vivo Human Experimental Models

The use of skin care creams is a well documented protection measure to reduce the risk of barrier damage and contact dermatitis from exogenous contact with skin irritants. Before choosing a skin care cream two aspects should be considered: a) Is the product able to reduce irritant reactions caused by the irritant, and b) is the product well tolerated, also on damaged skin. Both aspects can be evaluated by experimental models in human volunteers. We used two standard experimental designs to compare six commercially available skin care products: a) the chamber scarification test, designed to assess the irritancy potential, and b) the repeated short-time occlusive irritation test (ROIT), developed to evaluate the efficacy of skin care creams. The results showed that a high score in the chamber scarification test for skin irritation was not necessarily correlated to the products' ability to impede sodium lauryl sulfate (SLS)-induced irritant skin reactions. Three products were shown to both have a low irritancy potential and be capable of reducing skin barrier damage induced by SLS, and one product had both an irritant potential on scarified skin and also a modest capability to reduce skin irritation induced by SLS. The use of both test methods, chamber scarification and ROIT, gives valuable information on skin compatibility and efficacy of skin care creams. The clinical relevance of the test results can only be determined by comparing products with high and low scores in both tests in controlled clinical experiments with subjects at risk of developing irritant contact dermatitis.     

Fundamental Concepts in Photoimmunology and Photoallergy

Abstract

Exposure to sunlight, particularly ultraviolet light (UV), can produce changes in the status of the immune system. Photoimmunology is the study of the distortions in “normal” immune responses that may be produced by UV and/or visible light exposure. Photoallergy, on the other hand, is an acquired im-munologically mediated reactivity to a chemical or drug precipitated by the formation of photoproducts. This article reviews the key principles with supporting evidence from both photoimmunology and photoallergy. Reviews of the fundamental concepts of cutaneous structure and function, inflammation, immunology, and allergic contact dermatitis are presented as introduction. Subsequent sections discuss the capacity of UV to alter allergic contact dermatitis. The second part of the article presents an overview of past clinical observations and important laboratory animal studies relevant to photoallergy, including new techniques for predictive testing for photoallergic contact dermatitis in animals and helpful suggestions for handling problems when assessing consumer products for photoallergenicity. The article concludes by presenting approaches to diagnosing patients with suspected photoallergic contact dermatitis and photosensitivity to chemicals and drugs.     

Epidermal cytokines in experimental contact dermatitis

Topical exposure to a variety of xenobiotics may result in irritant as well as allergic contact dermatitis both in rodents and in humans. Despite their induction by different mechanisms, they cannot be differentiated by macroscopic appearance and, by histological examination they are both generally characterized by a perivascular mononuclear cell infiltrate and capillary hyperpermeability. Recently, cytokines, a family of inducible glycoproteins that play a pivotal role in immune and inflammatory reactions, have been identified as useful tools for differentiation of irritant and allergic contact dermatitis. In this article the role of cytokines in the development and differentiation of irritant and allergic contact dermatitis is discussed.     

Prevalence of potent skin sensitizers in oxidative hair dye products in Korea

Objectives: The objective of the present study was to elucidate the prevalence of potent skin sensitizers in oxidative hair dye products manufactured by Korean domestic companies.

Methods: A database on hair dye products made by domestic companies and selling in the Korean market in 2013 was used to obtain information on company name, brand name, quantity of production, and ingredients. The prevalence of substances categorized as potent skin sensitizers was calculated using the hair dye ingredient database, and the pattern of concomitant presence of hair dye ingredients was analyzed using network analysis software.

Results: A total of 19 potent skin sensitizers were identified from a database that included 99 hair dye products manufactured by Korean domestic companies. Among 19 potent skin sensitizers, the four most frequent were resorcinol, m-aminophenol, p-phenylenediamine (PPD), and p-aminophenol; these four skin-sensitizing ingredients were found in more than 50% of the products studied. Network analysis showed that resorcinol, m-aminophenol, and PPD existed together in many hair dye products. In 99 products examined, the average product contained 4.4 potent sensitizers, and 82% of the products contained four or more skin sensitizers.

Conclusion: The present results demonstrate that oxidative hair dye products made by Korean domestic manufacturers contain various numbers and types of potent skin sensitizers. Furthermore, these results suggest that some hair dye products should be used with caution to prevent adverse effects on the skin, including allergic contact dermatitis.     

Amended final report on the safety assessment of ethyl methacrylate

Ethyl Methacrylate is a methacrylate ester used as a chemical additive in artificial fingernail enhancement products. These products may be applied by trained professionals or be provided directly to consumers with instructions for use. Ethyl Methacrylate readily polymerizes and rapidly reacts with multifunction methacrylates to form a highly cross-linked polymer. The oral LD(50) of Ethyl Methacrylate for rats ranged from 12.7 to 18.14 g/kg. In acute studies with rats, hemoglobinuria and respiratory tract lesions were observed. Animal studies indicate that Ethyl Methacrylate is a skin irritant and sensitizer. In some cases the results were dependent on the vehicle. Evidence of embryotoxicity and teratogenicity were observed in rats injected intraperitoneally with 0.1223 to 0.4076 ml/kg Ethyl Methacrylate. Positive evidence of mutagenicity was observed in the L5178Y mouse lymphoma cell assay, but not in two Ames tests. Case reports cite examples of individuals suffering allergic contact dermatitis from exposure to Ethyl Methacrylate and related methacrylates, and some degree of cross-reactivity appears to exist between widely used acrylates and methacrylates. Information from several clinical registries of sensitization reactions to various agents reported that Ethyl Methacrylate is a sensitizer, but not a potent one. Because Ethyl Methacrylate monomer is short-lived in the normal course of using artificial fingernail-enhancement products, the primary hazard is expected to be inadvertant skin contact. In order to avoid sensitization, it is necessary to avoid skin contact. It is recommended that fingernail-enhancement products containing Ethyl Methacrylate include directions to avoid skin contact because of the sensitizing potential. Based on the available data on the formulation of nail products containing this ingredient, it is concluded that Ethyl Methacrylate is safe as used, when application is accompanied by directions for use as above.     

Epidermal cytokines in murine cutaneous irritant responses

Investigations on cytokines in skin irritancy or non-immunological irritant contact dermatitis (ICD) should improve our understanding of their complex mechanism. Numerous studies showed, however, that similar epidermal cytokines have been detected in irritant and allergic reactions, suggesting a lack of specific cytokines that clearly differentiate allergic from irritant reactions even though the pathomechanisms between allergic contact dermatitis (ACD) and ICD are distinguished. Recent data, however, indicate that some mediators may be restricted to allergic responses (contact hypersensitivity). This could provide the impetus to study their implication on irritant reactions. We overview the epidermal cytokines involved in irritant responses compared to those in contact hypersensitivity based on published results of studies using in vitro cell-cultured murine keratinocytes and in vivo murine models.     

Use of differential display-polymerase chain reaction to identify genes selectively modulated by chemical allergens in reconstituted human epidermis.

In the screening of topical drugs, cosmetics and other chemicals for human use, it is very important, both from a safety and an economic point of view, to have biological markers to discriminate irritant and allergic contact dermatitis that have different impacts on human health. Owing to their anatomical location, keratinocytes are among the first cells to be exposed to various antigens and the use of these cells as a simplified in vitro model to evaluate the potential toxicity of chemicals destined for cutaneous application is amply justified. The purpose of this work was to identify new genes selectively modulated by skin toxicants. Commercially available reconstituted human epidermis (Epiderm) was treated for 18 h with sodium dodecyl sulfate (SDS) 0.4 mg/ml, as reference irritant, or with dinitrochlorobenzene (DNCB) 0.2 mg/ml, as reference allergen, or with vehicle control. Differential display PCR (DD-PCR) was performed. Results identified adipose differentiation-related protein (ADRP) as up-regulated by both irritant and allergen, and KIAA0368 as selectively up-regulated by contact allergen. These data indicate the enormous potential of functional genomic techniques, which allow the identification of genes not immediately connected with the immune response, or even novel genes with unknown functions, which nevertheless may be potential markers of skin irritation and allergy.