Part 4 of a 4-part series Miscellaneous Products: Trends and Alternatives in Deodorants, Antiperspirants, Sunblocks, Shaving Products, Powders, and Wipes: Data from the American Contact Alternatives Group

Objective: To provide updated data on the usage of ingredients that are common potential contact allergens in several categories of topical products. To identify useful alternative products with few or no common contact allergens. Design: In November 2009, the full ingredient lists of 5,416 skin, hair, and cosmetic products marketed by the CVS pharmacy chain were copied from CVS.com into Microsoft Word format for analysis. Computer searches were made in Microsoft Word using search/replace and sorting functions to accurately identify the presence of specific allergens in each website product. Measurements: Percentages of American Contact Dermatitis Society core series allergens (and other common preservatives and sunblocks) were calculated. Results: The usage of American Contact Dermatitis Society core series allergens (and other preservatives and sunblocks) in various miscellaneous categories of topical products is reported. Conclusion: Data on allergens and alternatives for ancillary skin care products are not widely published. This article reviews some of the common potential allergens in antiperspirants, deodorants, shaving products, sunblocks, powders, and wipes. Suitable available alternative products for patients with contact allergy are listed.     

Part 3 of a 4-part series. Lip and common dental care products: trends and alternatives: data from the American Contact Alternatives Group

Objective: To provide updated data on the use of ingredients that are common potential contact allergens in several categories of lip and oral products. To identify useful alternative products with few or no common contact allergens. Design: In November 2009, the full ingredient lists of 5,416 skin, hair, and cosmetic products marketed by the CVS pharmacy chain was copied from CVS.com into Microsoft Word format for analysis. Computer searches were made in Microsoft Word using search/replace and sorting functions to accurately identify the presence of specific allergens in each website product. Measurements: Percentages of American Contact Dermatitis Society core series allergens (and other common preservatives) were calculated. Results: The use of American Contact Dermatitis Society core series allergens (and other preservatives) in various categories of lip and oral products are reported. Conclusion: Data on allergens and alternatives for lip and oral products is not widely published. This article reviews some of the common potential allergens in lip liners, lipsticks, lip moisturizers, mouthwashes, and toothpastes. Suitable available alternative products for patients with contact allergy are listed.Current data on the prevalence of known cosmetic allergens in cosmetic and skin care products is invaluable information for contact allergy specialists. Knowledge of current ingredient usage is instrumental in choosing relevant allergens for patch testing patients with suspected contact allergy to different types of topical products. In addition, knowledge of the most common potential allergens in each type of topical product allows the patch testing specialist to identify key alternative products that can be used by patients with proven contact allergy to skin, hair, and cosmetic products.In this four-part series, the American Contact Alternatives Group (ACAG) provides data on the prevalence of cosmetic allergens on the American Contact Dermatitis Society core screening tray of 80 allergens in 5,416 skin, hair, and cosmetic products listed on the CVS website. From this data, suitable potential alternative products are listed for use by patients with proven contact allergy. Part 1 discusses facial cosmetic products, part 2 covers hair care products, part 3 discusses lip and oral care products, and part 4 covers miscellaneous categories of topical products. Two additional installments on moisturizers and cleansers will follow at a later date.In November 2009, the American Contact Alternatives Group (ACAG) collected data from the CVS website,1 which contains the full ingredient lists for 5,416 skin, hair, and cosmetic products marketed by this pharmacy chain. Evaluation of this data provides a large representative sample of the products currently being marketed in one major drugstore chain in the United States and provides an excellent overview of the ingredients being used in products currently on the market. This type of data is important to help guide which allergens need to be tested in order to identify most cases of contact allergy to topical products. This data also allows easy identification of available alternative products for patients with contact allergy.Finding alternative products free of specific allergens plays a crucial role in obtaining clinical improvement in patients with contact allergy. There have been several papers published previously that discussed contact allergy alternatives.2–5 ACAG was formed in order to provide periodically updated information on contact allergy alternatives and has previously published alternatives information for all of the allergens on the 2007 North American Contact Dermatitis Group (NACDG) standard screening tray.5In 2010, the American Contact Dermatitis Society (ACDS) unveiled a recommended core screening tray of contact allergens that would identify a significant proportion of contact allergies.6 In this paper, ACAG discusses the ACDS core screening tray allergens found in various types of lip and dental care products and give updated information on available products that can serve as alternatives for patients with contact allergy to specific cosmetic ingredients. In addition, products were screened for additional preservatives not on the ACDS core series. When there was no alternative in the CVS database free of certain allergens, other suitable alternative products were located.     

Part 1 of a 4-part series Facial Cosmetics: Trends and Alternatives: Data from the American Contact Alternatives Group

Objective: To provide updated data on usage of ingredients that are common potential contact allergens in several categories of facial cosmetics. To identify useful alternative products with few or no common contact allergens. Design: In November 2009, the full ingredient lists of 5,416 skin, hair, and cosmetic products marketed by the CVS pharmacy chain were copied from CVS.com into Microsoft Word format for analysis. Computer searches were made in Microsoft Word using search/replace and sorting functions to accurately identify the presence of specific allergens in each website product. Measurements: Percentages of American Contact Alternatives Group core series allergens were calculated. Results: The usage of American Contact Alternatives Group core series allergens in facial cosmetics is reported along with suitable alternative products for individuals with contact allergy. Conclusion: Data on allergen usage and alternatives for facial cosmetics is not widely published. This article reviews some of the common potential allergens in facial cosmetics, including blushers and bronzers, concealers, eyeliners, eyeshadows, foundations, loose and pressed powders, and mascaras. Suitable available alternative products for patients with contact allergy are listed.     

Contact allergens in a pediatric population: association with atopic dermatitis and comparison with other north american referral centers

Objective: The authors aimed to retrospectively identify associations between allergen sensitization frequencies and specific comorbidities in a patient population in Miami, Florida, tested between November 2004 and July 2006 with a pediatric standard series and to compare their findings to recent pediatric and adult patch testing data published by other North American referral centers. Design: The authors performed a retrospective chart review evaluating the most common, clinically relevant contact allergens against the frequency of specific comorbidities, such as atopic dermatitis. The results were compared with the patch testing data from the Ottawan Contact Dermatitis Group's 1996-2006 study, the North American Contact Dermatitis Group 2001-2004 study, and the Mayo Clinic 1998-2000 study and the 2000-2006 study. Setting: University of Miami, Miami, Florida. Participants: Sixty-nine Miami children and adolescents between age six months and 18 years, having been referred for comprehensive patch testing. Measurements: The frequency of positive patch test reactions and clinical relevance was evaluated against the frequency of comorbidities. Results: Forty-five patients met all the inclusion criteria. Of these, 95.6 percent (43 patients) had at least one positive patch test reaction, with 76.7 percent of them having a personal history of atopic dermatitis. The most common pediatric allergens were found to significantly overlap with those of other North American referral centers. Conclusions: Allergic contact dermatitis is prevalent in atopic dermatitis; however, the authors were not able to demonstrate a statistically significant association, as the majority of patients referred had atopic dermatitis, and thus the control group was inadequate. Furthermore, allergens at the Miami center paralleled those seen at different centers within North America.     

Allergic contact dermatitis: patch testing results at Mount Sinai Medical Center

Patch testing is an important diagnostic tool commonly used to identify allergens responsible for allergic contact dermatitis, especially in cases where the diagnosis is not clearly apparent. The authors report the patch test results from 2004-2008 and compare the results with the North American Contact Dermatitis Group and Mayo Clinic. Four hundred thirty-four patients with suspected allergic contact dermatitis underwent standardized patch testing with a tray consisting of 50 allergens at Mount Sinai Medical Center. Two hundred ninety patients (66.8%) had positive reactions to at least one allergen. The most frequent contact allergens included nickel sulfate (13%), fragrance mix (9.6%), propylene glycol (7.8%), neomycin sulfate (6.6%), thimerosal (6.4%), bacitracin (6.2%), and sodium gold thiosulfate (5.8%).     

Moisturizer allergy: diagnosis and management

Background: Moisturizers are used by patients with dry skin conditions as well as those with healthy skin to enhance and preserve the smoothness of the skin and to interrupt the dry-skin cycle. Moisturizers are generally considered safe, although skin reactions, such as allergic contact dermatitis from topical preparations may occur. Cosmetic products including moisturizers are among the main culprits of allergic contact dermatitis.Methods: Utilizing a recently published database of all moisturizers available at Walgreens Pharmacies (Chicago, Illinois), which listed each product's allergens from the North American Contact Dermatitis Group (NACDG) screening panel, we evaluated the number of moisturizers containing each allergen.Results: Of the 276 moisturizers accounted for in the database, 68 percent contained fragrance making it the most common allergen found in these moisturizers. Parabens were discovered in 62 percent of moisturizers, followed by Vitamin E in 55 percent of products. Essential oils and biologic additives were found in 45 percent of products, followed by benzyl alcohol in 24 percent of moisturizers. Propylene glycol was found in 20 percent of moisturizers, followed by formaldehyde releasers in 20 percent of products. Iodopropynyl butylcarbamate was discovered in 16 percent of products, followed by lanolin in 10 percent of moisturizers. Methylisothiazolinone/methylchloroisothiazolinone was found in six percent of available products.Conclusions: Many ingredients of moisturizers have the potential to cause irritant and allergic contact dermatitis; therefore, it is necessary for clinicians to be aware of such potential allergens in order to manage and advise their patients accordingly.     

Allergic Contact Dermatitis: Patch Testing Beyond the TRUE Test

Epicutaneous patch testing is the gold standard method for the diagnosis of allergic contact dermatitis. Despite this knowledge, many clinical dermatologists do not offer patch testing in their offices or offer testing with only a limited number of allergens. Introduced in 1995, the Thin-Layer Rapid Use Epicutaneous Test originally contained 23 allergens and one control. In 2007, five additional allergens were added. This United States Food and Drug Administration-approved patch testing system made patch testing more convenient, and after its introduction, more dermatologists offered patch testing services. However, the number of allergens in the Thin-Layer Rapid Use Epicutaneous Test remains relatively low. Every two years, the North American Contact Dermatitis Group collects and reports the data from patch testing among its members to a standardized series of allergens. In 2005-2006, the Group used a series of 65 allergens. Of the top 30 allergens reported in 2005-2006, 10 were not included in the Thin-Layer Rapid Use Epicutaneous Test. Knowledge of and testing for additional allergens such as these may increase patch testing yield.     

From Road Rash to Top Allergen in a Flash: Bacitracin

Background. Bacitracin is an antibiotic that is produced by Bacillus subtilis , which is used in several types of consumer products, including cosmetics and ophthalmic and cutaneous ointments.
Objective. To call attention to the rising allergic contact dermatitis associated with bacitracin.
Results. Mass usage has resulted in an increasing number of clinically relevant allergic contact dermatitis reactions and near fatal anaphylaxis. The North American Contact Dermatitis Group has recorded its emergence as a leading allergen and continues to monitor the ever-growing allergic reaction rates.
Conclusion. The clinical impact, scientific evidence, and need for medical cost containment all advocate the discontinuation of routine usage of bacitracin in clean surgical wounds.     

欧洲标准变应原联合化妆品筛选变应原对女性面部皮炎患者的斑贴试验

目的 采用欧洲标准变应原联合化妆品筛选变应原对女性面部皮炎患者进行斑贴试验,筛查主要致敏原.方法 对门诊女性面部皮炎患者采用化妆品筛选变应原联合欧洲标准变应原进行斑贴试验,按国际接触性皮炎研究组推荐标准判读结果.结果 41例女性患者进行了38种化妆品筛选变应原和26种欧洲标准变应原的斑贴试验.其中阳性率最高的化妆品筛选变应原计有乌洛托品(12.20%)、硫柳汞(9.76%)、双咪唑烷基脲(7.32%)及DMDM海因(7.32%),阳性率最高的欧洲标准变应原计有硫酸镍(22.20%)、甲醛(14.63%)、对苯二胺(9.76%)及香料混合物(9.76%).结论 硫酸镍,甲醛、乌洛托品、硫柳汞、对苯二胺、香料混合物、双咪唑烷基脲、DMDM海因等是女性面部皮炎患者主要致敏原.     

欧洲标准变应原联合化妆品筛选变应原对女性面部皮炎患者的斑贴试验

目的采用欧洲标准变应原联合化妆品筛选变应原对女性面部皮炎患者进行斑贴试验,筛查主要致敏原。方法对门诊女性面部皮炎患者采用化妆品筛选变应原联合欧洲标准变应原进行斑贴试验,按国际接触性皮炎研究组推荐标准判读结果。结果41例女性患者进行了38种化妆品筛选变应原和26种欧洲标准变应原的斑贴试验。其中阳性率最高的化妆品筛选变应原计有乌洛托品（12．20％）、硫柳汞（9．76％）、双咪唑烷基脲（7．32％）及DMDM海因（7．32%）,阳性率最高的欧洲标准变应原计有硫酸镍（22．20％）、甲醛（14．63％）、对苯二胺（9．76％）及香料混合物（9．76％）。结论硫酸镍、甲醛、乌洛托品、硫柳汞、对苯二胺、香料混合物、双咪唑烷基脲、DMDM海因等是女性面部皮炎患者主要致敏原。     

Kontaktallergie und Fußekzem

Frequent elicitors of contact allergy are metals like nickel, fragrances, preservatives and rubber chemicals. Contact eczema of the feet may additionally be triggered by chromium released from leather – as chromium may be present from leather tanning – and by glues used during shoe fabrication. In addition adhesives on the basis of colophony or acrylates can cause allergic contact dermatitis. Foot eczema may also be part of atopic eczema, which however is recognizable due to other manifestations like eczema in the folds and signs of atopy. Differential diagnoses include irritative eczema, psoriasis and tinea pedum. The patch test is used to identify allergic contact sensitization and mycological diagnostics will exclude tinea. If the clinical picture is unclear, a biopsy is recommended. Topical and sometimes systemic anti-inflammatory substances are used to treat acute eczema, whereas avoidance of allergens or irritants together with basic treatment helps to maintain the disease free status.     

Contact dermatitis to white petrolatum

A 31-year-old Caucasian woman presented with a 20-year history of presumed atopic dermatitis. She complained of severe pruritus and the presence of extensive patches of erythema and scale. Her previous treatments included: multiple topical corticosteroids, tacrolimus 0.1% ointment, pimecrolimus 1% cream, and cyclosporine with no improvement of her symptoms. Her past medical history was unremarkable and she was on no other oral medications, including over-the-counter products. On physical examination, multiple erythematous, scaly patches were present on the chest, abdomen,back, and upper extremities. Lichenification of both antecubital fossa was present. Extensive excoriations on her arms and abdomen were also noted. Although the patient had a long-standing history of presumed atopic dermatitis, she had never undergone a skin biopsy. A skin biopsy was performed which demonstrated a perivascular lymphocytic infiltrate with eosinophils and dermal edema (Figures 1, 2). The biopsy was suggestive of possible hypersensitivity dermatitis. The patient then underwent patch testing. The following patch tests were applied to normal back skin using IQ chambers:North American Contact Dermatitis Group (NACDG) expanded standard, textile, fragrance trays, and ingredients found in her products (Chemotechnique, Malmo, Sweden). A total of 89 patches were applied, removed at 48 hours, and read both at 48 and 96 hours. At 48 hours, a total of 70 allergens were positive, 69 of those allergens were in a petrolatum vehicle. There were 50, 3+ reactions to sites of allergens in petrolatum (Figure 3). There were only two sites with petrolatum that were negative: budesonide (a corticosteroid) and melamine formaldehyde. In contrast, all of the sites where there were allergens in liquid vehicles were negative, with the exception of a 1+ reaction to cocamidopropyl betaine. At 48 hours,four additional patch tests were applied to plain petrolatum. Two of these patches were in plastic IQ chambers and two in aluminum Finn Chambers. At 48 hours, all four of the sites showed 3+ reactions (Figure 4). By 96 hours, all of the patch test sites that were positive at 48 hours, and much of the surrounding skin, showed a diffuse "angry back" reaction, which made an accurate 96-hour reading impossible.     

141例化妆品接触性皮炎患者斑贴试验结果分析

目的：检测分析化妆品接触性皮炎患者常见的致敏原种类,为其防治提供依据。方法：2009年10月～2011年2月,对临床诊断的141例化妆品接触性皮炎病例采用患者自用可疑化妆品和欧洲标准27种系列抗原进行斑贴测试;对测试数据进行统计学分析和比较。结果：患者对可疑化妆品斑贴阳性率48.22%（68/141）,阳性反应化妆品为45.69%（90/197）,导致患者阳性率高的化妆品依次是：香体喷雾（80,%44/55,）祛斑霜（56,%14/25）,水剂产品（38.89,%7/18）,清洁用品（31.58,%6/19）和护肤面霜（乳）（25.62,%31/121）。141例患者对欧洲标准27种系列抗原中至少1种过敏者123例,总阳性率87.2%;引起阳性率高的过敏源是：重铬酸钾（43.97%）、硫酸镍（43.26%）、氯化钴（36.17%）、对羟基苯甲酸类混合物（23.40%）、香料混合物（20.57%）、甲基二溴戊二腈（16.31%）、4-苯二胺碱基（15.60%）、苯唑卡因（14.90%）、甲醛（14.89%）、5-氯-2-甲基-4-异噻唑啉（13.48%）、芳香混合物Ⅱ（10.64%）。结论：化妆品原料中精炼不良带入的重金属、混合防腐剂、混和香料等是化妆品接触性皮炎的可能过敏源。     

African American Women,Hair Care,and Health Barriers

Objectives: The objective of this study was to elucidate the prevalence of hair loss among African American women; explore the psychosocial impact of hair grooming difficulties; and examine both perceptions related to physician encounters in this group and the relationship between hair grooming, physical activity, and weight maintenance. Design: An anonymous retrospective and qualitative survey, the Hair Care Assessment Survey, is an 18-question novel survey instrument designed at the Henry Ford Hospital Department of Dermatology Multicultural Dermatology Center. Setting: The Hair Care Assessment Survey was distributed at church-related functions at predominantly African American metropolitan Detroit churches. Participants: Two hundred African American women from metropolitan Detroit, Michigan, aged 21 to 83. Measurements: The Hair Care Assessment Survey collected data relating to hair loss and hair care, psychosocial experiences relating to hair loss, and hair care as it relates to exercise and body weight management. Data was collected on doctor-patient hair-related medical visits and experiences with commercially available ethnic hair care products. Results: More than 50 percent reported excessive hair loss. Twenty-eight percent had visited a physician to discuss hair issues, but only 32 percent felt their physician understood African American hair. Forty-five percent reported avoiding exercise because of hair concerns, and 22 percent felt that their hair impeded maintaining healthy body weight. Conclusion: Hair loss affects a compelling number of African American women, and a significant number express dissatisfaction in hair-related physician encounters. Additionally, hair styling problems present a serious impediment to physical activity and weight management among this already high-risk population.While hair loss among African American women is exceedingly common,1 there is limited epidemiological data. Alexis et al2 reported alopecia as the fourth most common diagnosis of African Americans presenting to the dermatologist, accounting for 8.3 percent of visits.The most common hair and scalp complaints among African Americans include hair breakage, scalp itching, excessive dandruff and flaking, and hair loss at the crown and temples.3 Hair care products popular among African American women, including emollients, colloquially referred to as “hair grease,” gels, spritzes, and relaxers have been implicated in hair fragility and loss.1The goal of this project was to further characterize hair loss among African American women, including the psychosocial and physical impact of hair grooming difficulties. Further, the authors explored the penetrance of chemical hair services among African American women and their subjective experiences with both physicians and the hair care industry in relation to hair and scalp concerns and the perceived viability of currently available hair grooming products, respectively.     

Contact sensitisation in patients with chronic leg ulcers

The aim of our study is to identify the allergens in patients with leg ulcers who have contact dermatitis surrounding the skin of the ulcer and compare them with a control group consisting of patients with lower extremity contact dermatitis. A total of 40 patients with chronic leg ulcers (CLU) and contact dermatitis around the skin of ulcer were included in the study. As a control group, 20 patients with contact dermatitis of lower extremity without leg ulcers were included. The patient and control groups were patch tested with 37 allergens of the European Standard Series. Of the 40 patients, 31 (77·5%) had positivity to one or more allergens, and 10 (50%) of the control group patients had positivity to one or more allergens. The number of patients who had positivity to at least one allergen was significantly higher in the patient group (P < 0·05). Positivity to the balsam of Peru and benzocaine was significantly higher in the patient group than that in the control group (P < 0·05). Contact sensitisation to benzocaine and balsam of Peru was found to be associated with the presence of CLU. The efficacy of therapy in patients with leg ulcers might be increased by avoiding these allergens.     

Dermatologic Surgical Implications of Allergic Contact Dermatitis

Background. Dermatologic surgery is a common practice among dermatologists; consequently, there is an increased number of exposures to potential contact allergens in the surgical setting.
Objective. The purpose of this article is to alert the clinician to the most common allergens associated with the use of surgical products.
Conclusions. Increased awareness will lead to early diagnosis and allergen avoidance.     

Oxford medial unicompartmental knees display contact‐loss during step‐cycle motion and bicycle motion: A dynamic radiostereometric study

The Oxford medial unicompartmental knee is designed fully congruent, with the purpose of maintaining a large contact‐area throughout motion and minimize wear. No other study has investigated this design feature in‐vivo. We aimed to evaluate if contact‐loss was introduced between the articulating surfaces of the Oxford medial unicompartmental knee during bicycle‐ and step‐cycle motion, and whether this correlated with essential implant parameters, such as polyethylene (PE) wear, knee‐loadings, and clinical outcome. To study contact‐loss, 15 patients (12 males, mean age 69 years) with an Oxford medial unicompartmental knee (7 cemented, mean follow‐up 4.4 years) were examined with use of dynamic radiostereometry (RSA) (10 frames/s). PE wear was measured from static RSA and clinical outcome was evaluated with American Knee Society Score (AKSS) and Oxford Knee Score (OKS). Data on knee‐loadings were acquired from the literature. Contact‐loss was deteced in all patients during both exercises, and the trend of contact‐loss correlated with the knee‐loadings. Median contact‐loss was 0.8 mm (95%PI: 0.3; 1.5) for bicycle motion and 0.3 mm (95%PI: 0.24; 0.35) for step‐cycle motion, and did not correlate with the PE wear rate of mean 0.06 mm/year. Possible in‐congruency was seen in three patients. Clinical outcome scores correlated with contact‐loss during step‐cycle motion. In conclusion, contact‐loss was seen in all patients indicating a clinical tolerance during load. Contact‐loss followed the knee‐loadings, which could explain why no correlation was seen with PE wear, as an increase in load was acommadated by an increase in contact‐area (contact‐loss reduction). The size of contact‐loss may reflect clinical outcome. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:357–364, 2018.     

Contact allergens in persons with leg ulcers: a Canadian study in contact sensitization

Individuals with chronic leg ulcers often develop contact allergic reactions to topical preparations used to treat their wounds and the surrounding skin. The objective of this study was to determine the frequency of positive patch test responses to common allergens in patients with leg ulcers or venous disease. A case series of 100 consecutive, consenting patients with chronic venous disease and other causes of leg ulcers that were available for patch testing were enrolled. The patients were tested with 38 common allergens, including those most relevant to leg ulcers. A total of 46% of the patients had at least 1 positive patch test response. Multiple reactions in the same patient were common. The most frequent groups of sensitizers were fragrances, lanolin, antibacterial agents, and rubber-related allergens. Though the prevalence of positive patch test reactions is high in this population, it is lower than commonly reported. This may be the result of clinical practice that considered the avoidance of common sensitizers in the management of patients with leg ulcers.     

What is the role of sensitization in uremic pruritus? An allergologic study

Patch tests were carried out to evaluate the presence of a sensitization to some components of dialytic circuits in 17 uremic patients complaining of pruritus of unknown origin. Fragments of different dialyzer membranes, of tubing sets, of dialyzer membranes recently resterilized with ethylene oxide and the International Contact Dermatitis Research Group standard series substances were tested. Neither patients nor healthy subjects reacted positively to patch tests, which leads us to question the role of contact allergy in the determination of uremic pruritus.     

Analysis of early complications after radical cystectomy: results of a collaborative care pathway

PURPOSE: We examined our recent series of patients who underwent radical cystectomy to determine and analyze the early perioperative morbidity of the procedure in a contemporary series treated with the guidance of a clinical pathway. MATERIALS AND METHODS: We reviewed the records of 304 consecutive patients who underwent radical cystectomy from December 1995 to July 2000. We specifically evaluated complications that developed within 30 days of the procedure. Potential variables predictive of early morbidity were analyzed, including patient age, gender, race, American Society of Anesthesiologists score, type of urinary diversion, smoking history, estimated blood loss, transfusion requirement, pathological stage and operative time. RESULTS: The overall minor complication rate was 30.9% (94 of 304 patients). Postoperative ileus was the most common minor complication, affecting 54 patients (18%). Increased blood loss and major complications predicted a significantly higher likelihood of ileus on multivariate analysis (p = 0.02 and 0.001, respectively). Major complications in 15 patients (4.9%) correlated with higher American Society of Anesthesiologists score, surgical intensive care unit admission and transfusion requirement (p = 0.01, <0.001 and 0.001, respectively). The early mortality rate was 0.3% (1 patient). CONCLUSIONS: Within the framework of a clinical pathway, radical cystectomy can be performed safely with an acceptable rate of early minor and major complications. Delay in the return of bowel function is the most common minor complication. Increased estimated blood loss, transfusion requirement and a major complication predicted a higher likelihood of postoperative ileus. The acceptable rate of early morbidity in this series in a 5-year period validates its use in patients undergoing radical cystectomy.