Eyelid dermatitis: experience in 203 cases

Allergic contact dermatitis has been considered the most common of the many dermatologic conditions found with eyelid dermatitis. This is a retrospective study of 203 patients who presented with persistent or recurrent eyelid dermatitis with or without dermatitis elsewhere. Almost all underwent patch testing and, when indicated, radioallergosorbent test, skin prick and intradermal tests, and in many cases, usage tests as part of the workup. Relevant allergic contact dermatitis was found in 151 of 203 patients (74.%): 46 (23.%) had protein contact dermatitis, but only 7% had protein contact dermatitis without concurrent allergic contact dermatitis. Less than 1% had irritant dermatitis alone. Twenty-three patients had atopic eczema, of whom 16 also had allergic contact dermatitis, protein contact dermatitis, or both. Other conditions included seborrheic dermatitis (n = 11), psoriasis (n = 7), dry eyes (n = 9), and dermatomyositis or overlapping connective tissue disease (n = 7). Important sources of contact sensitivity include cosmetics, metals, topical medications including corticosteroids, eye medications, dust mites, animal dander, and artificial nails; only 5 cases were caused by nail lacquer. Eyelid dermatitis is a multifaceted clinical problem, but in this group of patients, allergic contact dermatitis was a common cause, even among those with atopic eczema.     

Patch testing in New Zealand: Barriers to evidence‐based care

Allergic contact dermatitis is a disabling condition, significantly impacting on quality of life, which can only be alleviated by identification and avoidance of a relevant allergen. Patch testing remains the gold standard diagnostic test for allergic contact dermatitis. The consistency with which patch testing is used varies throughout the world. The purpose of this study was to look at the adequacy of current patch testing practice in New Zealand. We undertook literature review of current guidance regarding patch testing and created a web‐based survey to evaluate use of patch testing in New Zealand. This was sent to all 75 vocationally registered New Zealand dermatologists. Of respondents, 46% do not perform patch testing. The most commonly cited barriers were lack of nursing support, poor remuneration, time pressure and lack of facilities. 23% noted that public patch testing services are not available in their region. The majority do not record patch test results in a database. Access to and utilisation of patch testing in New Zealand is suboptimal. Increasing services in the public sector requires investment by health boards, as there remains a dermatology workforce shortage in New Zealand. In private practice, patients often find it unsatisfactory to pay for negative tests, and adequate remuneration of patch testing by private insurers is necessary. Surveillance of patch test results at a national level is lacking, and the development of a centralised database to identify common allergens affecting our population is recommended.     

Allergic Contact Dermatitis to Gamma‐Irradiated WEBCOL Alcohol Prep Pads

Abstract: We report a case of allergic contact dermatitis to WEBCOL^® alcohol prep pads in a healthy 17‐year‐old girl who showed no reaction to the individual components of the prep pads upon provocative use testing. Although several case reports have described allergic contact dermatitis to isopropyl alcohol, there have been no reports of allergic contact dermatitis to alcohol prep pads sterilized with gamma irradiation, a common sterilization technique capable of producing volatile products in this type of alcohol prep pad.     

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.     

Occupational contact dermatitis among rubber workers

The occurrence of occupational contact dermatitis among workers in a rubber factory from 1976 to 1980 was studied. Insurance compensation was paid to 50 workers with dermatitis. 21 of the cases were allergic and 27 toxic contact dermatitis, giving a contact dermatitis frequency of 5.6/1000 workers. Paraphenylenediamine compounds were the main cause of allergic contact dermatitis and solvents the main cause of toxic contact dermatitis.     

Allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in bacteriology technicians.

Three cases of allergic contact dermatitis due to N,N-dimethyl-para-phenylenediamine in a bacteriology laboratory are presented. This chemical, a dye closely related to the common contact allergen para-phenylenediamine, is used in laboratories to screen bacterial culture plates for Neisseria gonorrhoeae. The three patients had strongly positive patch test reactions to N,N-dimethyl-para-phenylenediamine, but had negative reactions to para-phenylenediamine. A brief discussion of allergic contact cross-sensitization among compounds with the para-aminophenyl grouping is presented.     

Evaluation of nickel and cobalt release from mobile phone devices used in Brazil

Nickel and cobalt are often responsible for metal-induced allergic contact dermatitis. With the increasing use of cell phones, we observed an increase in cases reports on telephone-related allergic contact dermatitis. The present study evaluated nickel and cobalt release from mobile phones used in Brazil. We evaluated devices of 6 brands and 20 different models using nickel and cobalt allergy spot tests. Of the 20 models, 64.7% tested positive for nickel, with 41.1% positive results for the charger input and 23.5% for other tested areas. None of them was positive for cobalt. Nickel release was more common in older models.     

Allergic contact dermatitis to proparacaine with subsequent cross-sensitization to tetracaine from ophthalmic preparations.

We report 2 cases of allergic contact dermatitis (ACD) to proparacaine and tetracaine. Patient 1 is an ophthalmologist with chronic finger pad dermatitis sensitized to the topical anesthetic proparacaine. Despite discontinuance of proparacaine and substitution with a patch test negative agent, tetracaine, his hand dermatitis persisted. Follow up patch testing documented that acquisition of contact allergy to tetracaine as well as thiuram had taken place. Patient 2 had a periocular eczematous dermatitis with ACD to both proparacaine and tetracaine. Cross sensitization between related topical ophthalmologic anesthetics has been suggested to be a rare occurrence. We suggest that allergic sensitization and possible cross-reaction to topical anesthetics in ophthalmologists and ophthalmologic technicians is an occupational hazard. Chronically eczematized skin might result in increased exposure to contact allergens and result in concomitant allergic sensitization. ACD to topical anesthetic agents among ophthalmologists should be recognized as a potential hazard.     

A preliminary report of the occupation of patients evaluated in patch test clinics.

BACKGROUND: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.     

Dermatitis alérgica de contacto por cosméticos

IntroductionContact dermatitis to cosmetics is a common problem in the general population, although its prevalence appears to be underestimated. We reviewed cases of allergic contact dermatitis to cosmetics diagnosed in our dermatology department over a 7-year period with a view to identifying the allergens responsible, the frequency of occurrence of these allergens, and the cosmetic products implicated.MethodsUsing the database of the skin allergy department, we undertook a search of all cases of allergic contact dermatitis to cosmetics diagnosed in our department from January 2000 through October 2007.ResultsIn this period, patch tests were carried out on 2,485 patients, of whom 740 were diagnosed with allergic contact dermatitis and the cause was cosmetics in 202 of these patients (170 women and 32 men), who accounted for 27.3 % of all cases. A total of 315 positive results were found for 46 different allergens. Allergens most often responsible for contact dermatitis in a cosmetics user were methylisothiazolinone (19 %), paraphenylenediamine (15.2 %), and fragrance mixtures (7.8 %). Acrylates were the most common allergens in cases of occupational disease. Half of the positive results were obtained with the standard battery of the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC). The cosmetic products most often implicated among cosmetics users were hair dyes (18.5 %), gels/soaps (15.7 %), and moisturizers (12.7 %).ConclusionMost patients affected were women. Preservatives, paraphenylenediamine, and fragrances were the most frequently detected cosmetic allergens, in line with previous reports in the literature. Finally, in order to detect new cosmetic allergens, cooperation between physicians and cosmetics producers is needed.     

Atypical and unusual clinical manifestations of contact dermatitis to clothing (textile contact dermatitis): case presentation and review of the literature

Although the exact incidence of textile contact dermatitis is unknown, recent studies demonstrate that contact dermatitis produced by allergic or irritant reactions to clothing not only is more frequent than previously thought but also increasing. The clinical features of contact dermatitis (CD) caused by clothing may resemble common allergic contact dermatitis or may have atypical presentations. We report on several cases of clothing-induced contact dermatitis with atypical clinical presentations.     

呼和浩特地区1036例可疑皮肤过敏者斑贴试验分析

目的探讨呼和浩特地区常见化学过敏原的种类及其与变应性接触性皮炎之间的关系。方法对内蒙古医科大学附属医院皮肤科2013年3月—2016年3月1 036例过敏性皮肤病患者进行斑贴试验,并对性别、年龄和患病情况进行分析。结果斑贴试验总阳性率为54.8%,变应原阳性率列前5位的过敏原分别为硫酸镍、硫柳汞、异噻唑、溴硝丙醇、氯化钴。结论斑贴试验能帮助大多数变应性接触性皮炎患者查找到过敏原,为了解呼和浩特地区常见过敏原提供相关参考。     

Nickel allergy: localized, id, and systemic manifestations in children

Nickel is the most common allergen causing allergic contact dermatitis in patch-tested children, especially in female children. Allergy to this metal can manifest in a variety of ways. In this case series, we present four children to illustrate the different presentations of nickel allergy confirmed by patch testing. Localized, id, and systemic nickel reactions are reviewed, as well as the diagnosis and management of nickel allergic contact dermatitis. While localized dermatitis in areas of direct contact to the allergen is the most common and easiest form of nickel allergy to identify, recognition of varying presentations is critical as these can result in more chronic and severe symptoms, and can be misdiagnosed as atopic dermatitis.     

Reactions to Aquaphor®: Is Bisabolol the Culprit?

Abstract:  Bisabolol is a sesquiterpene alcohol compound derived from the German chamomile plant, a member of the Compositae family. Only two case reports of adults with allergic contact dermatitis to this chemical exist in the literature, and we describe three more cases of children with recalcitrant atopic dermatitis found to have potential allergic contact dermatitis to bisabolol- a component of the Aquaphor^® emollient they were using to treat their atopic dermatitis. Of note, Compositae dermatitis has been shown to have a higher prevalence in children with atopic dermatitis, so it is important for physicians to be aware of the potential allergens (like bisabolol) in products they are recommending as first line treatments.     

Allergic contact dermatitis from topical doxepin: Food and Drug Administration's postmarketing surveillance experience

A total of 26 postmarketing cases of allergic contact dermatitis to doxepin 5% cream were reported to the Food and Drug Administration. Our findings suggest that allergic contact dermatitis was more common when treatment duration exceeded the recommended 8 days. Allergic contact dermatitis to doxepin cream should be considered in patients whose condition fails to improve or worsens with doxepin use.     

Allergic contact dermatitis to cosmetics: retrospective analysis of a population subjected to patch tests between 2004 and 2017

BackgroundCosmetics are part of the daily life of the population, and their use can lead to allergic contact dermatitis.ObjectivesTo assess the profile of patients diagnosed with allergic contact dermatitis to cosmetics treated at a referral center for 13 years, as well as the characteristics of the clinical picture and allergens involved.MethodsThis was a retrospective study, with analysis of medical records of patients attended at this service. The individuals included had a diagnostic hypothesis of allergic contact dermatitis to cosmetics and had previously been submitted to epicutaneous tests.ResultsA total of 1405 medical records were analyzed, 403 (28.7%) with suspected allergic contact dermatitis to cosmetics and 232 (16.5%) with confirmed diagnosis. Of these, 208 (89.7%) were women, and the age group most affected was 31 − 60 years. The most common locations were face in 195 cases (25.8%), cervical region in 116 (15.3%), and trunk in 96 (12.6%). The main allergens in the contact tests were toluene-sulfonamide-formaldehyde resin in 69 cases (29.7%), paraphenylenediamine in 54 (26.3%), Kathon CG® in 41 (20.7%), and fragrance-mix 1 in 29 (16.4%). In 154 (66.4%) of the 232 patients with a confirmed diagnosis of allergic contact dermatitis to cosmetics it was possible to specify the cosmetic product responsible for the lesions.Study limitationsThe absence of some allergens considered important in the world as causes of allergic contact dermatitis, which are not readily accessible among us.ConclusionsThe data of the analyzed population (predominance of young women), as well as the location of the lesions (face and cervical area) and the main allergens involved were consistent with those from the world literature.     

Contact dermatitis in printing tradesmen

During a 2-year period in Toronto, Canada, 21 printing tradesmen with contact dermatitis were evaluated. 67% had allergic contact dermatitis; 29% due to ultraviolet-Cured ink components Irritant contact dermatitis accounted for 37% of the cases. The prognosis in printing tradesmen with contact dermatitis is guarded, except for those wish allergic contact dermatitis due to UV-cured components, as the tradesmen who were sensitized to other contactants eventually left the trade. Offset lithography was associated with the problem in 18 of the 21 eases.
A brief outline is given of the printing processes in common use.     

Allergic contact dermatitis from latex rubber

Summary Previously we have found occasional patients with delayed hypersensitivity to latex (in rubber gloves) in the absence of allergy to any chemicals in the rubber chemical screen. There are many reports of contact urticaria to latex and isolated reports of delayed hypersensitivity to latex, usually in the presence of contact urticaria. To establish if latex rubber is a more common cause of delayed hypersensitivity than is currently recognized, we patch tested all patients attending our contact dermatitis clinic, over a 6-month period, with latex. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six exhibited contact urticaria to latex, five contact urticaria and allergic contact dermatitis, and five allergic contact dermatitis alone. Of the five with delayed hypersensitivity to latex in the absence of contact urticaria, only one was atopic and the sensitivity was thought to be relevant or possibly relevant in four. Of our patients, 1.2% exhibited positive patch-test reactions to latex. Patch testing with latex should be considered where contact dermatitis to a latex rubber-containing product is suspected, e.g. gloves and footwear.     

Allergic contact dermatitis from carmine in cosmetic blush

Although there are many reported cases of immediate allergy after ingestion of foods containing cochineal, there are few reports of allergic contact dermatitis from carmine. We present a rare case of allergic contact dermatitis due to carmine. A 52-year-old female presented with an itchy erythema on her cheeks at the site where blush had been applied. Patch-tested with her cosmetics, she showed a positive reaction to the blush (30% in petrolatum) and to 0.2% (but not 0.1%) carmine in petrolatum. In this case, the optimum patch-test concentration of carmine was 0.2% in petrolatum.     

Allergic contact dermatitis to white petrolatum

White petrolatum is known for its nonsensitizing and nonirritating properties. Only a few cases of allergic contact dermatitis to white petrolatum have been reported. Although it is a rare event, the finding of contact sensitization to white petrolatum raises the potential problem of its usage of common topical agents or vehicles for patch testing. We herein report a case of allergic contact dermatitis to white petrolatum.