Hand dermatitis and allergic patch test reactions caused by nickel in electroplaters

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers ( n =163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE Test^TM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women ( n = 8) and 4% ( n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.     

The effect of topically applied corticosteroid on irritant and allergic patch test reactions

The purpose of the study was to assess the effect of topical corticosteroid on the patch test response in patients with known positive allergens and also to study any effect on the irritant response. In Study 1, 10 patients with known positive allergens had their backs pre-treated 2× daily for 3 days with either betamethasone dipropionate 0.5% or the equivalent ointment base. On day 4, previous known allergens and dilutions of sodium lauryl sulfate (5% and 10%) as an irritant were applied to each side of the back. In Study 2 (4 patients), a 1:4 dilution of betamethasone dipropionate was substituted for the full-strength preparation. Betamethasone dipropionate 0.05% caused total or partial suppression of the allergic reaction in 8 of in eases. The 1:4 dilution caused partial suppression in 3 cases. The irritant reaction was totally suppressed by betamethasone dipropionate in 1 of 10 cases and partially suppressed in 7 of 10. The 1:4 dilution decreased the intensity of the irritant reaction in 3 of 4 cases. The relevance of these results to clinical practice is discussed.     

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.     

Dynamic patterns of allergic patch test reactions to 10 European standard allergens

In an epidemiological study of occupational dermatitis in 5 different show factories, 246 workers were interviewed, examined and patch tested using standard and occupational patch test series. The prevalence of occupational contact dermatitis was 14.6% (36/246): 8.1% (20/246) irritant contact dermatitis (OACD). Among the latter, the most common occupational allergens were p-tert-butylphenol-formaldehyde resin and mercaptobenzothiazole. 6% (15/246) presented with hyperkeratosis of the fingertips, while 3.2% (8/246) reported prutitus sine materia (PSM) present only during working hours. 2 workers presented with vitiligo-like leukodermic patches on the backs of their hands and on their forearms. Some jobs were more frequently associated with skin complaints. In the assembly department, OACD was most frequent (11.4%), attributed to contact with adhesives and, to a lesser degree, with rubber and leather, OICD caused by contact with the solvents contained in adhesives and varnishes was probably caused by the dust present in the working environment was reported by 33.3% of the workers in the sole-cutting and scraping departments. Hyperkeratosis of the fingertips, as a reaction to the continuous trauma of leather on the skin, was observed most frequently (41.6%) in the sole-cutting department.     

Thoughts on sensitizers in a standard patch test series

Patch testing is the predominant method of establishing contact allergy. The present patch test technique is the result of a continuous process of development and improvement since its first application in the late 19th century. The perfect patch test should give no false-positive and no false-negative reactions. The ideal patch test should also cause as few adverse reactions as possible, particularly no patch test sensitization. Even though the history and examination of a patient with suspected allergic contact dermatitis will give clues to possible sensitizers, it is not sufficient to patch test only with initially suspected sensitizers; unsuspected sensitizers used for patch testing frequently turn out to be the real cause of the dermatitis. Fortunately, a small number of substances are considered to account for the majority of delayed hypersensitivity reactions. Therefore, generally 20-25 test preparations consisting of chemically defined compounds, mixes of allergens, and natural and synthetic compounds, are grouped into a standard test series. The requirements to be fulfilled by a sensitizer in a standard patch test series are discussed in this article. A procedure of investigations is proposed before a sensitizer is included in a standard series.     

Analysis of patch testing results in patients with contact dermatitis in Istanbul,Turkey, from 2012 to 2022

Background

Allergens responsible for allergic contact dermatitis (ACD) differ between populations. They can even change over the years with the effect of environmental factors.

Aims

To evaluate the results of patch testing performed in our center.

Methods

In this study, the thin-layer rapid-use epicutaneous (T.R.U.E.) test results of patients with a diagnosis of ACD between 2012 and 2022 were retrospectively evaluated.

Results

In 431 (42.5%) of the total 1012 patients, a positive reaction to at least one allergen was detected in the patch test. Allergen positivity was most detected for nickel sulphate (16.8%), gold sodium thiosulfate (GST) (6.9%), thimerosal (4.2%), fragrance mix (3.4%), carba mix (3.2%), and cobalt dichloride (2.9%). Nickel sulfate and GST sensitivity was found to be significantly higher in women, fragrance mix sensitivity in men, thimerosal sensitivity in individuals aged under 40 years, colophony and balsam of Peru sensitivity in head and neck dermatitis, and carba mix and thiuram mix sensitivity in atopic individuals.

Conclusions

This study presents comprehensive data from Turkey concerning the sensitivity frequencies for allergens included in the T.R.U.E. test.     

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％)....     

Allergic and irritant patch test reactions and atopic disease

This study presents a profile of patients with chronic recalcitrant eczematous disease referred by dermatologists for contact allergy evaluation. Allergic contact dermatitis (ACD) and irritant responses were carefully defined, as was the presence or absence of atopy obtained by history. Of 410 patients studied, 44% had no history of atopic disease and 46% were classed as definitely atopic. Among relevant ACD patch lest reactors ( n = 198). 51.5% had atopy, compared with 40.9% with no atopy but this difference was not significant. Likewise, among atopics ( n = 189). 54% had definite, relevant ACD patch test responses while 33.9% had negative ACD (again not significant). Significance was seen in the higher mean number of positive allergic patch tests in the atopic group (2.7 versus 2.0. p =0.0223). Irritant patch tests were highest among patients with both ACD and atopy ( p = U.0308) and the proportion of irritant responses correlated with increasing numbers of positive ACD tests. We conclude that atopics are at least as likely to have ACD as are non-u topics. Irritancy is increased in these patients with chronic dermatitis and the frequency of irritant reactions correlates with both greater numbers of ACD responses and with presence of atopy.     

Hypersensitivity reactions to metallic implants - diagnostic algorithm and suggested patch test series for clinical use

Cutaneous and systemic hypersensitivity reactions to implanted metals are challenging to evaluate and treat. Although they are uncommon, they do exist, and require appropriate and complete evaluation. This review summarizes the evidence regarding evaluation tools, especially patch and lymphocyte transformation tests, for hypersensitivity reactions to implanted metal devices. Patch test evaluation is the gold standard for metal hypersensitivity, although the results may be subjective. Regarding pre-implant testing, those patients with a reported history of metal dermatitis should be evaluated by patch testing. Those without a history of dermatitis should not be tested unless considerable concern exists. Regarding post-implant testing, a subset of patients with metal hypersensitivity may develop cutaneous or systemic reactions to implanted metals following implant. For symptomatic patients, a diagnostic algorithm to guide the selection of screening allergen series for patch testing is provided. At a minimum, an extended baseline screening series and metal screening is necessary. Static and dynamic orthopaedic implants, intravascular stent devices, implanted defibrillators and dental and gynaecological devices are considered. Basic management suggestions are provided. Our goal is to provide a comprehensive reference for use by those evaluating suspected cutaneous and systemic metal hypersensitivity reactions.     

Results of routine patch testing with corticosteroid series in 2073 patients

The patch test results of 61 patients allergic to at least 1 corticosteroid molecule are presented. These contact allergies were detected by testing with several corticosteroids included in our standard patch test series between February 1988 and December 1990. Whenever possible, further investigations were conducted by means of a more complete corticosteroid series. We found corticosteroids to be the 7th most frequent allergen, positive results being obtained in 2.9% of all patients referred to our contact dermatitis unit. In this series, budesonide was the most common allergen and often gave simultaneous reactions with other corticosteroids.     

Audit of primary and secondary care as a source of patch test clinic referrals

BACKGROUND: Referral for patch testing is important in managing patients with eczema/dermatitis. These referrals come from many different sources. OBJECTIVES: To assess the appropriateness of referrals from general practitioners (GPs) to a dedicated patch test clinic. METHODS: Referral sources were recorded for patch testing in a dedicated contact dermatitis unit for a 4-month period between November 2002 and February 2003. RESULTS: Of 217 referrals reviewed, 45 (21%) were received from GPs. There was no significant difference in the percentages of positive patch test results and of relevant positive patch test results obtained from GP referrals compared with those received from other sources, including dermatology departmental referrals. CONCLUSIONS: Referrals from GPs, if selected appropriately, can be seen directly in the patch test clinic without prior assessment in a general dermatology clinic.     

重庆地区193例化妆品变应性接触性皮炎患者斑贴试验结果分析

 目的:分析重庆地区化妆品变应性接触性皮炎患者主要化妆品成分变应原,以便指导患者合理选择和使用化妆品,降低皮炎的发生率。方法:选取我院皮肤科门诊确诊为化妆品变应性接触性皮炎的193例患者进行化妆品成分斑贴试验,并对结果作统计学分析。结果:斑贴试验总阳性率为69.43%,合并2种及2种以上变应原的患者占50.26%,阳性率前5位的变应原分别为硫柳汞、十二烷基硫酸钠、尼泊金酯、三乙醇胺和乙二胺;女性斑贴试验阳性率为73.33%,明显高于男性,差异有统计学意义(X²=9.67,P<0.05）;青年组明显高于其他年龄组,差异有统计学意义（ X²=36.79,P<0.05）。结论：硫柳汞、十二烷基硫酸钠、尼泊金酯、三乙醇胺和乙二胺5种物质是重庆地区化妆品变应性接触性皮炎患者主要的致敏成分。化妆品变应性接触性皮炎患者以女性为主,中青年多见。