Sensitizing potential of triclosan and triclosan-based skin care products in patients with chronic eczema

Triclosan is a lypophilic chlorophenol biocide with broad-spectrum antibacterial and antifungal activity. Triclosan-based topical products have been shown to be tolerated and beneficial in atopic dermatitis. The aim of this study was to evaluate the sensitizing potential of triclosan and triclosan-based creams in patients affected by eczematous dermatitis. Two hundred and seventy-five patients affected by chronic eczema (allergic contact dermatitis, irritant contact dermatitis, atopic eczema, nummular eczema, stasis dermatitis) were patch tested with standard patch test series as well as triclosan and triclosan-based products. Standard patch test series resulted positive in 164 patients (61%), with nickel sulfate, house dust mites, fragrance mix, propolis, thimerosal, myroxylon pereira, potassium dichromate, wool alcohols, and p-phenylenediamine the most common sensitizing haptens. Only two patients developed positive reactions to triclosan (0.7%) and four (1.4%) to triclosan-based products. The present study's results confirm that triclosan is well tolerated and has a very low sensitizing potential even in high-risk patients affected by eczema.     

Occupational allergic contact dermatitis caused by thiourea compounds

Thiourea compounds are mainly used as accelerators in the rubber industry, but also in other industries, e.g., as antioxidants in the graphics industry. Thiourea compounds may provoke allergic contact dermatitis, although the number of reported cases is relatively low. During 1985–1991, we had 5 patients with allergic patch test reactions caused by thiourea compounds. 1 of our patients had to use a knee brace after an occupational accident. He developed allergic contact dermatitis caused by the knee brace, probably because he had become sensitized to diethylthiourea. 2 patients were probably sensitized by diphenylthiourea in neoprene gloves. A florist had an allergic patch test reaction to diphenylthiourea and might have been sensitized by fungicides or pesticides, which break down into thioureas. It is often difficult, however, to detect the source of thiourea compound sensitization. If the patient has contact dermatitis and has been exposed to products that may contain thiourea compounds (or compounds that break down into thiourea compounds), such as rubber, PVC plastic or adhesive, diazo paper, paints or glue remover, anticorrosive agents, fungicides or pesticides, patch testing with a series of thiourea compounds needs to be performed. If patch testing with thiourea compounds is not performed, allergic contact dermatitis caused by thiourea compounds is not likely to be diagnosed.     

Allergic contact dermatitis from para-tertiary-butylphenol-formaldehyde resin (PTBP-FR) in athletic tape and leather adhesive

4 girls with severe allergic contact dermatitis from a brand of athletic tape and a cobbler with allergic contact dermatitis from leather adhesive are presented. Alkylphenol resin with unknown chemical structure had been compounded in both products. One of the girls developed foot dermatitis later from the adhesive used on the inside of new sneakers. By patch testing and chemical analysis of alkylphenol resin and the products, the 5 patients were given a specific diagnosis of allergic contact dermatitis from PTBP-FR.     

Case of allergic contact dermatitis due to 1,3‐butylene glycol

1,3‐Butylene glycol (1,3‐BG) is widely used in cosmetics, including low‐irritant skin care products and topical medicaments, as an excellent and low‐irritation humectant. We report a case of allergic contact dermatitis caused by 1,3‐BG. A 28‐year‐old woman suffered from an itchy erythematous eruption on her face. By 2 days of closed patch testing, her own cosmetics and many of the hypo‐irritant skin care products showed positive results. A second patch testing showed positive reaction to 1,3‐BG (1% and 5%). 1,3‐BG was a common component in most of the products that had elicited a positive reaction in the first patch testing. Although allergic contact dermatitis due to 1,3‐BG is not so common, we have to consider 1,3‐BG as a possible contact allergen in the patients presenting with allergic contact dermatitis due to various cosmetics.     

Quantitative aspects of contact allergy to chromium and exposure to chrome-tanned leather

The potential of trivalent and hexavalent chromium to induce and elicit allergic contact dermatitis and the degree of chromium exposure from leather products are reviewed. Chromium dermatitis is often due to exposure in the occupational environment, with cement being one of the most common chromium sources. However, consumer products such as chromium(III)-tanned leather products are also an important source of chromium exposure. Apart from Cr(III), which is used for tanning, leather often also contains trace amounts of Cr(VI), which is formed by oxidation of Cr(III) during the tanning process. In a recent study of the Cr(VI) content of leather products bought on the Danish market, 35% of such articles had a Cr(VI) content above the detection limit of 3 p.p.m., ranging from 3.6 p.p.m. to 14.7 p.p.m. Leachable Cr(III) was detected at levels of 430-980 p.p.m. An examination of available dose-response studies showed that exposure to occluded patch test concentrations of 7-45 p.p.m. Cr(VI) elicits a reaction in 10% of the chromium-sensitive patients. When reviewing repeated open exposure studies, it is seen that either exposure to 5 p.p.m. Cr(VI) in the presence of 1% sodium lauryl sulfate (SLS) or exposure to 10 p.p.m. Cr(VI) alone both elicit eczema in chromium-sensitive patients. The eliciting capacity of Cr(III) has not been systematically investigated but, compared to Cr(VI), much higher concentrations are needed to elicit eczema.     

Antimicrobial allergy from polyvinyl chloride gloves

BACKGROUND: Contact allergy to plastic gloves is rare. Benzisothiazolinone is a biocide that is mainly used in industrial settings. We first suspected delayed-type contact allergy to benzisothiazolinone from polyvinyl chloride (PVC) gloves in 2004. We looked through our medical records from 1991 to 2005 to find similar cases. OBSERVATIONS: We found a total of 8 patients who are allergic to benzisothiazolinone and who had had exacerbations of their hand dermatitis while using PVC gloves. Patch testing revealed that 3 of them had weak allergic or doubtful reactions to the glove materials. Six of them had used Evercare Soft, Medi-Point, or Derma Grip PVC gloves, which in chemical analysis were shown to contain 9 to 32 ppm of benzisothiazolinone. Seven of the patients worked in dentistry or health care and 1 in farming. All of them had had hand dermatitis for many years. CONCLUSIONS: To our knowledge, there have been no previous reports of contact allergy to antimicrobial agents in plastic gloves. Benzisothiazolinone is widely used as a biocide in the manufacture of disposable PVC gloves. Small amounts of benzisothiazolinone in the gloves may sensitize those who already have hand dermatitis. We recommend that all patients with hand dermatitis while using PVC gloves should be patch tested with benzisothiazolinone.     

Allergic contact dermatitis induced by zinc pyrithione in shampoo: a case report

Shampoo-induced allergic contact dermatitis is difficult to diagnose clinically because it can involve multiple and variable areas where the shampoo flows. Zinc pyrithione is a common active agent in medicated shampoo that is known to have good anti-dandruff and antifungal effects. Despite its low risk of sensitization, cases of allergic contact dermatitis still occur because of the popularity of such products. We report a 33-year-old man who developed pruritic rash on his scalp, face, neck, and hands after using a new shampoo containing zinc pyrithione. A patch test revealed a positive reaction to zinc pyrithione and personal shampoo containing zinc pyrithione.     

A Case of Chromium Contact Dermatitis due to Exposure from a Golf Glove

Chromium is a transition metal and has been shown to elicit contact dermatitis. Although leather products have been known to be the most significant source of chromium exposure these days, the majority of reports have been related to exposure from shoe products. We herein report a professional golfer who became allergic to golf gloves made of chromium-tanned leather. A 27-year-old woman golfer presented with recurrent, pruritic, erythematous plaques that had been occurring on both hands for several years. The lesions developed whenever she had worn golf gloves for an extended period of time, especially during tournament season. To identify the causative agent, patch tests were performed and the results demonstrated a strong positive reaction to potassium dichromate 0.5% and to her own glove. The amount of chromium in her golf glove was analyzed to be 308.91 ppm and based on this, a diagnosis of allergic contact dermatitis due to a chromium-tanned leather glove was made. She was treated with oral antihistamines combined with topical steroids and advised to wear chromium-free leather gloves. There has been no evidence of recurrence during a six month follow-up period.     

Cutaneous reactions to surgical preparations and dressings

A prospective study of 100 surgical patients was undertaken to identify causes of contact dermatitis. Patch testing with the North American Contact Dermatitis Standard Series and additional agents used in the surgical preparation and dressing was performed in 11 patients with post-operative dermatitis or a history of tape allergy. 12 patients were diagnosed as having irritant (mechanical) contact dermatitis. One patient had allergic contact dermatitis to benzoin postoperatively; another patient with a history of an adhesive tape reaction had a positive patch test to thiuram mix, rubber accelerators formerly present in adhesive tapes. Our findings indicate that irritant contact dermatitis is a common problem in the surgical patient. Allergic contact dermatitis is less common, occurring in 2 of the 100 patients.     

Contact allergy caused by isothiazolinone derivatives: an overview of non-cosmetic and unusual cosmetic sources

The isothiazolinone derivatives, methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), benzisothiazolinone (BIT), and octylisothiazolinone (OIT), owing to their strong bactericide, fungicide and algicide properties, are widely used in non-cosmetic products, such as chemical (industrial) products, household detergents, and water-based paints, and the former two derivatives are also used in cosmetic products. However, given their inherent sensitization potential (with MCI >MI >BIT >OIT), allergic contact dermatitis is frequently observed, both in consumers as well asworkers in various industries. In this review, we provide an update on the use of MCI/MI and MI in cosmetics, highlighting certain aspects of MI; the use of excessive concentrations, the presence in some less familiar cosmetic products, and the association with unusual clinical manifestations. Furthermore, the use of isothiazolinones in dishwashing and washing-machine liquids, cleaning agents for dental care, and their general presence in multi-purpose household detergents, which may elicit (airborne) allergic contact dermatitis, is discussed. Finally, we provide a brief overview of the use of isothiazolinone derivatives in the paint and textile industry, and of OIT in the leather industry in particular.     

Allergic contact dermatitis

Allergic contact dermatitis is a frequent inflammatory skin disease. The suspected diagnosis is based on clinical symptoms, a plausible contact to allergens and a suitable history of dermatitis. Differential diagnoses should be considered only after careful exclusion of any causal contact sensitization. Hence, careful diagnosis by patch testing is of great importance. Modifications of the standardized test procedure are the strip patch test and the repeated open application test. The interpretation of the SLS (sodium lauryl sulfate) patch test as well as testing with the patients' own products and working materials are potential sources of error. Accurate patch test reading is affected in particular by the experience and individual factors of the examiner. Therefore, a high degree of standardization and continuous quality control is necessary and may be supported by use of an online patch test reading course made available by the German Contact Dermatitis Research Group. A critical relevance assessment of allergic patch test reactions helps to avoid relapses and the consideration of differential diagnoses. Any allergic test reaction should be documented in an allergy ID card including the INCI name, if appropriate. The diagnostics of allergic contact dermatitis is endangered by a seriously reduced financing of patch testing by the German statutory health insurances. Restrictive regulations by the German Drug Law block the approval of new contact allergens for routine patch testing. Beside the consistent avoidance of allergen contact, temporary use of systemic and topical corticosteroids is the therapy of first choice.     

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.     

Contact Hypersensitivity to Topical Antibacterial Agents

Three hundred ninety patients with suspected contact dermatitis to topical medicaments were patch tested with various commercially available antibacterial agents to evaluate the incidence of contact hypersensitivity. The common sensitizers were nitrofurazone, neomycin, oxytetracycline, cetrimide, and framycetin. The least common sensitizers were sodium fusidate, chlorhexidine hydrochloride, and gentian violet. Cross-sensitivity was observed between neomycin, framycetin, and gentamicin.     

Recalcitrant atopic dermatitis due to allergy to Compositae

Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.     

The repeated open application test (ROAT)

Repeated open application tests (ROATs) were performed with common ingredients of vehicles in 86 patients with contact dermatitis. The substances were applied twice daily for 7 days to the flexor aspect of the forearm near the cubital fossa, unless dermatitis appeared earlier. Of the patients with a questionable (?+) patch test result, 44% were positive in ROATs. The corresponding figure was 80% in the patients with B positive (+ or ++) response in the patch lest, when the results of ROAT with propylene glycol were excluded. Only 5 of 14 patients reacting lo 30% or to 10% propylene glycol but not in 15 in water in patch testing, showed a positive result to a cream containing 5% propylene glycol in ROAT. All 5 patients with a positive patch test reaction to 1% propylene glycol reacted to 5% propylene glycol in ROAT. The results suggest that ROATs should be performed more often, especially in patients in whom little known or new allergens are suspected as being the cause of allergic contact dermatitis.     

Common allergens in shoe dermatitis: our experience in Lahore,Pakistan

BACKGROUND: Shoe dermatitis is a form of contact dermatitis resulting from exposure to shoes. Different chemicals, in conjunction with a hot and humid environment within the shoe, give rise to allergic or irritant dermatitis. Allergic shoe dermatitis is commonly caused by constituents of rubber, leather, adhesives, and rarely by linings and dyes. AIM: To determine the frequency of various allergens in shoe dermatitis in our patients. METHODS: One hundred and nine patients suspected of having contact dermatitis due to shoe allergens were included. All patients were patch tested with the Shoe series and European Standard series. Patches were applied on the upper back and removed after 48 h. Results were read at 48, 72, and 120 h and interpreted according to International Contact Dermatitis Research Group (ICDRG) criteria. RESULTS: Of the 119 patients, 87 (73%) reacted positively to various allergens, 48% of whom showed polysensitivity. Glues (33.6%), particularly para-tert-butylphenol formaldehyde resin (PTBP-FR) (26.9%), were the leading cause of shoe dermatitis. Other allergens were leather chemicals (26.4%), potassium dichromate (16.18%), rubber allergens (7.6%), and dyes (7.6%). Shoe scrapings tested positive in 26.3% of patients. Other common allergens were nickel sulfate (22.7%), neomycin sulfate (10.1%), and cobalt chloride (8.4%). CONCLUSIONS: Considering the diversity of allergens, all patients presenting with shoe dermatitis should be patch tested with the Shoe series and a standard series to determine the etiologic allergens.     

Deodorants: an experimental provocation study with isoeugenol

Axillary dermatitis is common and overrepresented in people with contact allergy to fragrances. Many people suspect their deodorants to be the incriminating products. In order to investigate the significance of isoeugenol in deodorants for the development of axillary dermatitis when used by people with and without contact allergy to isoeugenol, patch tests with deodorants and ethanol solutions with isoeugenol, as well as repeated open application tests (ROAT) with roll-on deodorants with and without isoeugenol at various concentrations, were performed in 35 dermatitis patients, 10 without and 25 with contact allergy to isoeugenol. A positive ROAT was observed only in patients hypersensitive to isoeugenol (P<0.001) and only in the axilla to which the deodorants containing isoeugenol had been applied (P<0.001). Deodorants containing isoeugenol in the concentration range of 0.0063-0.2% used 2 times daily on healthy skin can thus elicit axillary dermatitis within a few weeks in people with contact allergy to isoeugenol.     

Frequency of postoperative allergic contact dermatitis to topical antibiotics.

BACKGROUND AND DESIGN--Topical antibiotics are one of the most common causes of allergic contact dermatitis and are frequently used in postoperative wound care. We prospectively followed up patients having cutaneous surgery to determine the frequency of allergic contact dermatitis to topical antibiotics used on postoperative wound care. RESULTS--Nine (4.2%) of 215 patients who had undergone surgery who were using a topical antibiotic had an eruption develop postoperatively that was consistent with an allergic contact dermatitis from the topical antibiotic. Seven of the nine patients agreed to patch testing with the standard tray and selected topical antibiotics. Five patients had a positive patch test to neomycin sulfate and four had a positive patch test to bacitracin. The frequency of allergic contact dermatitis proved by patch testing to neomycin and bacitracin is five (5.3%) of 94 and four (2%) of 198, respectively, in the patients who used these antibiotics. All proved sensitivities to bacitracin occurred in patients using a topical antibiotic that also contained neomycin and were patch tested positive to the neomycin. No patients using only pure bacitracin had allergic contact dermatitis. CONCLUSIONS--Allergic contact dermatitis to a topical antibiotic, especially neomycin, should be considered in any patient who has development of a dermatitis after cutaneous surgery. Because of the frequency of allergic contact dermatitis, neomycin-containing antibiotics should be avoided in postoperative wound care.