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Background: Rubber gloves contain rubber accelerators that may cause contact allergy. The content of sensitising rubber accelerators in contemporary rubber gloves is not well known., Objectives: Identify and quantify the content of rubber accelerators in disposable rubber gloves., Methods: Fifty-one gloves of 49 different brands were collected. Forty-eight of the gloves were disposable and three re-usable. The gloves were analysed for their content of sensitising rubber accelerators, that is, zinc dithiocarbamates, thiurams, thiazoles/benzothiazoles, diphenylguanidine, and thioureas by high-performance liquid chromatography., Results: Rubber accelerators were identified in 43/48 (90%) of the disposable gloves. In total, 39 gloves contained zinc dibutyldithiocarbamate (ZDBC) (0.18-1.96 mg/g), 34 zinc diethyldithiocarbamate (ZDEC) (0.032-2.78 mg/g), three zinc dibenzyldithiocarbamate (0.65-1.4 mg/g), one zinc dimethyldithiocarbamate (0.23 mg/g), and one 1,3-diphenylguanidine (0.21 mg/g). 2-cyanoethyl dimethyldithiocarbamate (CEDMC) was identified in three gloves (<0.052 mg/g). The one glove labelled as accelerator free contained ZDBC (1.07 mg/g). Only few glove packages had the specific content of rubber accelerators labelled., Conclusions: The most frequent rubber accelerators in rubber gloves are ZDEC and ZDBC. Accelerator-free gloves may contain rubber accelerators. Full labelling of rubber gloves is needed and producers should be sure not to falsely claim that the rubber gloves are free of rubber accelerators., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Rubber accelerators are used in the vulcanization of rubber. However, rubber accelerators for example tetraethylthiuram disulfide (TETD) and zinc diethyldithiocarbamate (ZDEC) may cause contact allergy. Concomitant reactions between ZDEC and TETD have been observed in patients which could be explained by co- or cross-reactivity., Objectives: To investigate cross-reactivity between TETD and ZDEC and vice versa., Methods: Groups of mice were sensitized with TETD or ZDEC based on reported EC3-values. Proliferation of lymphocytes were measured on day 5. To test cross-reactivity, mice were sensitized and challenged 3 weeks later with TETD or ZDEC. The inflammatory response was measured by changes in ear thickness and the proliferative response in CD4 + and CD8 + T cells in the submandibular and cervical draining lymph nodes., Results: Sensitization of mice with doses of ZDEC 3%, TETD 5.6% or TETD 16.2% induced significant increased ear thickness and proliferation of CD4 + and CD8 + T cells. Challenge with ZDEC or TETD in these groups induced significant increased ear thickness. Challenge with ZDEC in mice sensitized to TETD 5.6% or TETD 16.2% induced significant increased proliferation of CD4 + and CD8 + T cells., Conclusions: We show cross-reactivity between TETD and ZDEC. Patients sensitized to TETD or ZDEC should avoid exposure to both ZDEC and TETD., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Gold contact allergy is diagnosed by patch testing using gold chloride or gold sodium thiosulfate. These tests often show high positivity rates, but a direct correlation with dermatitis from everyday gold exposure is rare. The aim of this study was to investigate and estimate the current prevalence of gold contact allergy in dermatitis patients. We performed a systematic literature search in PubMed, Embase and Web of Science for studies reporting the prevalence of gold contact allergy in dermatitis patients and published between January 2010 and May 2024. Data extraction and quality assessment were performed, and pooled proportions were calculated using random effects models. Sixteen studies with 14 887 dermatitis patients were included. The pooled prevalence of gold contact allergy was 14.1% (95% confidence intervals: 9.5%-19.4%) with significant heterogeneity (I 2  = 98.3%). High positivity rates with limited clinical relevance highlight the need for cautious interpretation. Even within the same country, studies find different prevalence rates. Standardized testing protocols and further research are needed to better understand and manage this allergy., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Nickel is the leading cause of contact allergy in Europe, with 14.5% of the adult population being sensitized. Despite regulations limiting nickel release from consumer items, the incidence and prevalence of nickel allergy remain high., Objective: To investigate the clinical and subclinical immune response to low-dose nickel exposure on nickel pre-exposed skin to assess the adequacy of current regulatory limits., Method: Nickel-allergic and healthy controls were patch tested with nickel twice with a 3-4 weeks interval. The first exposure used the diagnostic concentration of 2000 μg/cm 2 nickel sulphate, and the same skin areas were then re-exposed to 0.2, 0.5, 12.8 and 370 μg/cm 2 nickel sulphate. After 48 h, the patch reactions were examined for clinical signs of eczema, and skin biopsies were collected. The transcriptomic immune profile was analysed with Nanostring nCounter and quantitative polymerase chain reaction., Results: Two nickel-allergic participants (15%) had clinical reactions to the regulatory limiting doses for nickel (0.2/0.5 μg/cm 2 ) following re-exposure. There was immune activation in all skin areas following re-exposure to nickel, predominantly mediated by up-regulation of cytokines and chemokines. In all nickel re-exposed skin areas, 81 genes were up-regulated independent from the clinical response. In skin areas exposed to 0.2 μg/cm 2 , 101 immune-related genes were differentially expressed, even when no clinical response was observed. Healthy controls showed up-regulation of three genes in response to nickel re-exposures without any clinical reactions., Conclusion: Immune activation can be induced in skin with local memory to nickel upon challenge with nickel doses within the regulatory limits. Our findings suggest that the regulatory limits in the European nickel regulation may not provide sufficient protection for consumers against low-dose exposures., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: p-Phenylenediamine (PPD) is a potent contact allergen found in many hair colour products. However, not all individuals develop allergic contact dermatitis (ACD) although they are regularly exposed to PPD. It is unclear whether these asymptomatic individuals are true non-responders to PPD or whether they mount a response to PPD without showing any symptoms., Methods: Skin biopsies were collected from 11 asymptomatic hairdressers regularly exposed to PPD and from 10 individuals with known ACD on day 4 after patch testing with 1% PPD in petrolatum and petrolatum exclusively as control. RNA sequencing and confocal microscopy were performed., Results: T cell activation, inflammation and apoptosis pathways were up-regulated by PPD in both asymptomatic and allergic individuals. Compared to asymptomatic individuals with a negative patch test, individuals with a strong reaction to PPD strongly up-regulated both pro- and anti-inflammatory cytokines genes. Interestingly, PPD treatment induced significant up-regulation of several genes for chemokines, classical type 2 dendritic cell markers and regulatory T cell markers in both asymptomatic and allergic individuals. In addition, apoptosis signalling pathway was activated in both non-responders and allergic individuals., Conclusion: This study demonstrates that there are no true non-responders to PPD but that the immune response elicited by PPD differs between individuals and can lead to either tolerance, subclinical inflammation or allergy., (© 2024 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi-step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success., Objectives: To examine the effectiveness of a Danish-adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3-month follow-up., Methods: Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish-adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3-month follow-up using self-reported questionnaires., Results: A statistically significant decrease in the severity of eczema was found at 3-month follow-up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3-month follow-up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences., Conclusions: These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Rubber accelerators are used in the production of rubber gloves and may cause contact allergy., Objectives: To estimate long-term trend and prevalence of contact allergy to rubber accelerators for a 30-year period in Denmark, high-risk occupations, and exposures., Methods: Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch-tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted., Results: The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12-years, followed by a stable frequency in the past 18-years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet-work occupations were most often affected and gloves the most frequent exposure., Conclusions: Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Occupational contact dermatitis (OCD) is a common occupational disease. Atopic dermatitis (AD) is a known risk factor for OCD., Objectives: To determine the prevalence of previously diagnosed AD among young workers with recognized OCD and assess its impact on OCD prognosis., Methods: A retrospective cohort study. A questionnaire was sent to 6251 workers with recognized OCD who were under 35 years at notification (response rate: 47%). Of the respondents, 2392 answered a question about previous doctor-diagnosed AD and were included in the study. Eczema severity, occupational consequences and quality of life were examined using statistical analyses comparing workers with and without previously diagnosed AD., Results: The prevalence of previously diagnosed AD was 41.8% (95% CI: 39.8-43.8). Women had a higher AD prevalence, and workers with AD reported OCD at a younger age. Workers with AD reported more frequent and severe eczema symptoms and had a higher risk of OCD negatively affecting job and occupation choices. Health-related quality of life was more adversely affected in workers with AD., Conclusions: AD significantly impacts severity and has long-term consequences for young people with OCD. Targeted prevention strategies need to be developed., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Hand eczema (HE) is a prevalent skin disease. However, the classification of HE into different subtypes remains challenging. A limited number of previous studies have employed invasive biopsy-based strategies; yet, studies of the HE proteome using noninvasive tape-stripping methodology have not been reported. In this study, we wanted to assess whether global proteomic analysis of skin tape strip samples can be used for subclassification of patients with HE. Tape strips were collected from patients with HE and healthy skin. Liquid chromatography-mass spectrometry proteomics was performed, and the global protein expression was analyzed. We identified 2,919 proteins in stratum corneum-derived skin cells from tape strip samples. Compared with healthy skin, the lesional samples from patients with HE exhibited increased expression of immune-related markers and a decreased expression of structural barrier proteins. The difference between HE subtypes was restricted to the lesional skin areas and included an increased expression of skin barrier-related proteins independently of the concurrent AD. In conclusion, we found that the noninvasive tape strip method used in combination with liquid chromatography-mass spectrometry proteomics can be used for analysis of skin protein expression in patients with HE. Thus, the method shows potential for assessing the proteomic differences between subtypes of HE and biomarker discovery., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Although chronic hand eczema (CHE) is a highly prevalent and disabling skin disease, it is currently unknown if CHE is associated with systemic inflammation., Objectives: To characterize the plasma inflammatory signature of CHE., Methods: Using Proximity Extension Assay technology, we assessed 266 inflammatory and cardiovascular disease risk proteins in the plasma of 40 healthy controls, 57 patients with atopic dermatitis (AD) with active lesions, 11 with CHE and a history of AD (CHEPREVIOUS&#95;AD), and 40 with CHE and no history of AD (CHENO&#95;AD). Filaggrin gene mutation status was also assessed. Protein expression was compared between groups and according to disease severity. Correlation analyses for biomarkers, and clinical- and self-reported variables, were performed., Results: Very severe CHENO&#95;AD was associated with systemic inflammation when compared with controls. Levels of T helper (Th)2- and Th1-, general inflammation and eosinophil activation markers increased with severity of CHENO&#95;AD, primarily being significantly increased in very severe disease. Significant, positive correlations were found between markers from these pathways and severity of CHENO&#95;AD. Moderate-to-severe but not mild AD displayed systemic inflammation. The Th2 markers C-C motif chemokine (CCL)17 and CCL13 (also known as monocyte chemotactic protein 4) were the top differentially expressed proteins in both very severe CHENO&#95;AD and moderate-to-severe AD, showing a higher fold change and significance in AD. CCL17 and CCL13 levels further correlated positively with disease severity in both CHENO&#95;AD and AD., Conclusions: Systemic Th2-driven inflammation is shared between very severe CHE with no history of AD, and moderate-to-severe AD, suggesting that Th2 cell targeting could be effective in several CHE subtypes., Competing Interests: Conflicts of interest C.B. is a consultant for Thorne HealthTech. J.P.T. is an advisor for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, ASLAN Pharmaceuticals, UNION Therapeutics, Eli Lilly & Co., LEO Pharma, Pfizer, Regeneron and Sanofi-Genzyme, a speaker for AbbVie, Almirall, Eli Lilly & Co., LEO Pharma, Pfizer, Regeneron and Sanofi-Genzyme, and received research grants from Pfizer, Regeneron and Sanofi-Genzyme. The remaining authors declare they have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Purpose of Review: This study aims to provide an overview on current knowledge on occupational allergic diseases in hairdressers and up-to-date perspectives of prevention., Recent Findings: Hand eczema (dermatitis) is common in hairdressers, often caused by contact allergy to one or multiple small molecules (haptens) used, e.g., for dyeing, bleaching, and waving/relaxing or by ancillary substances such as preservatives. Hairdressers, compared to other patch-tested patients, have an up to fivefold increased risk to be found sensitized, e.g., against p-phenylenediamine, ammonium persulfate, and glyceryl thioglycolate. Some of these small molecules may induce respiratory sensitization causing allergic rhinitis and/or asthma, notably persulfate salts. Occupational hazards in hairdressing are well described. This knowledge needs to be put into use for risk reduction, mainly by substitution of allergenic ingredients by less allergenic ones, education, and use of ventilation and suitable single-use gloves., (© 2023. The Author(s).)

Introduction: Hairdressers are exposed to wet work and manifold allergens at work, rendering exposure complex and the aetiology of occupational hand eczema (OHE) often multifactorial in this occupational group., Objectives: To identify exposure patterns associated with increased risk of hand eczema in hairdressers., Methods: All hairdressers graduating from 2004 to 2007 and 2015 to 2018 received a questionnaire in 2009 and 2020, respectively. Current exposures (with or without regular glove use) and OHE were self-reported, and their association examined. Patterns of exposure were identified by latent class analysis (LCA)., Results: A total response of 39.9% (668/1675) was obtained. Six exposure profiles (#1-6) were identified by LCA across 11 tasks performed with or without gloves as well as deep conditioning, that is, 23 task items. Compared to profile #1 with the lowest OHE risk (reference) an increased risk of current OHE were seen in profile #4 [adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.5-44.8 and #6 (aOR 39.4, 95%CI 6.1-362.8)] in logistic regression analysis. Profile #1 and #6 had performed the same tasks, but in profile #6 regular glove use was performed in 9.1% (1/ 11) of tasks compared to 72.7% (8/11) of tasks in profile #1 (p = 0.002)., Conclusion: Although occupational exposures in hairdressing are complex, meaningful patterns associated with a wide range of OHE risk can be identified by LCA. The increase of OHE risk seems predominantly to be due to poor compliance with protective gloves. LCA could be applied to further fields of complex (skin) exposures., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use., Objectives: To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p-phenylenediamine (PPD), toluene-2,5-diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non-hairdressers., Methods: Following a PROSPERO-registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias., Results: Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8-4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate-type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized., Conclusions: An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

This systematic review, conducted according to the PRISMA guidelines, focuses on genotoxicity of oxidative hair dye precursors. The search for original papers published from 2000 to 2021 was performed in Medline, Web of Science, Cochrane registry, Scientific Committee on Consumer Safety of the European Commission and German MAK Commission opinions. Nine publications on genotoxicity of p -phenylenediamine (PPD) and toluene-2,5-diamine ( p -toluylenediamine; PTD) were included, reporting results of 17 assays covering main genotoxicity endpoints. PPD and PTD were positive in bacterial mutation in vitro assay, and PPD tested positive also for somatic cell mutations in the Rodent Pig-a assay in vivo . Clastogenicity of PPD and PTD was revealed by in vitro chromosomal aberration assay. The alkaline comet assay in vitro showed DNA damage after PPD exposure, which was not confirmed in vivo , where PTD exhibited positive results. PPD induced micronucleus formation in vitro , and increased micronucleus frequencies in mice erythrocytes following high dose oral exposure in vivo . Based on the results of a limited number of data from the classical genotoxicity assay battery, this systematic review indicates genotoxic potential of hair dye precursors PPD and PTD, which may present an important health concern for consumers and in particular for professional hairdressers.

Occupational hand eczema is frequent in metalworkers. The contribution of metal allergies is poorly elucidated even though such exposures are common at the workplace. To estimate the prevalence of metal allergy to cobalt (Co), chromium (Cr) and nickel (Ni) in metalworkers and compare these to estimates from the European Surveillance System on Contact Allergies (ESSCA). Two authors independently searched PubMed for studies reporting on the prevalence of metal allergy in metalworkers. Proportion meta-analyses were performed to calculate the pooled proportions of metal allergy in metalworkers. In total, 29 studies (22 from Europe) were included yielding 5691 subjects for quantitative analysis. The pooled proportion (95% confidence interval) of Co, Cr and Ni in European metalworkers with dermatitis referred to patch test clinics was 8.2% (5.3%-11.7%), 8.0% (5.1%-11.4%), and 11.0% (7.3%-15.4%), respectively. The corresponding estimates for unselected metalworkers from workplace studies were 4.9% (2.4%-8.1%), 5.2% (1.0%-12.6%), and 7.6% (3.8%-12.6%), respectively. In comparison, the prevalence of metal allergy in 13 382 consecutive European males with dermatitis was 3.9% (3.6%-4.2%), 4.4% (4.1%-4.8%) and 6.7% (6.3%-7.0%) for Co, Cr and Ni, respectively. Data on sex, age, body piercings and atopic dermatitis in metalworkers with metal allergy was mostly lacking. Metal allergy to all three metals was significantly more common in European metalworkers with dermatitis attending patch test clinics as compared to ESSCA data, indicating a relationship to occupational exposures, however, confounders could not be accounted for., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers., Objective: To assess the risk OHE and compliance with skin protective measures in hairdressers trained before and after implementation of a nationwide skin protection program in Danish hairdressing vocational schools in 2011., Methods: A repeated cross-sectional study was performed. A questionnaire was sent in 2009 and 2020. The Danish Labour Market Supplementary Pension Scheme provided information on yearly payments from the hairdressing profession., Results: A response rate of 66.6% (305/460) was obtained in the 2009 survey and of 29.9% (363/1215) in the 2020 survey. The career time prevalence of OHE decreased from 42.8% to 29.0% (adjusted odds ratio 0.55 95% confidence interval [CI] 0.40-0.77) and the incidence rate of OHE decreased from 57.5 (95%CI 48.4-68.4) to 42.0 (95%CI 34.6-50.9) per 1000 person years (incidence rate ratio 0.73 [95%CI 0.56-0.95] between the two surveys). A statistically significant (P < .05) increase in glove use when doing wet-work and when handling hair dyes, permanent wave solutions and bleaching products was observed in the 2020 compared to the 2009 survey., Conclusion: Our data suggest that skin protection training during apprenticeship reduces the risk of OHE in hairdressers. The lack of primary prevention of OHE in hairdressing vocational schools may be a missed opportunity in the prevention of the disease., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Artificial nail modelling systems (ANMS), encompassing artificial nails and long-lasting nail polish, are sources of acrylate exposure in beauticians and users of ANMS. Hairdressers' exposure to ANMS from self-use and occupational exposure is currently unknown. In 2020 a questionnaire was sent to all hairdressers graduating during 2008 to 2018 in Denmark (n = 4,830). Self-use of ANMS was reported by 87.6% of respondents (1,251/1,428), and application of ANMS to others was reported by 22.1% (316/1,428). Of these, application to others was performed in a salon by 37.1% (109/294), privately by 51.0% (150/294) and in both settings by 11.9% (35/294). Compliance with glove use was seen in 23.0% (67/291) among those applying ANMS to others. Among hairdressers exposed to ANMS, 4.3% (52/1,218) reported ANMS-related hand eczema. Being a trained beautician (adjusted odds ratio 3.26, 95% confidence interval 1.06-9.99) and having had a positive patch-test to acrylates (adjusted odds ratio 7.70, 95% confidence interval 1.44-41.13) were associated with ANMS-related hand dermatitis. In conclusion, hairdressers have a high prevalence of exposure to ANMS and ANMS-related hand dermatitis. Compliance with glove use when applying ANMS to others is poor. Patch-testing with acrylates is valuable in the diagnostic work-up of hand eczema in hairdressers.

Objective: To review the literature on respiratory effects of persulfate salts (PS) or hair bleaches in hairdressers and animal models exploring mechanisms behind PS-induced asthma., Methods: A systematic review according to the PRISMA guidelines was performed. Studies published from 2000 to July 2021 that fulfilled predefined eligibility criteria were retrieved. Data were not quantitatively synthesized due to the heterogeneity of study designs, outcomes and methods., Results: Forty-two articles were included. PS are indicated as the main cause of occupational rhinitis and asthma in hairdressers, and one of the leading causes of occupational asthma in some European countries. Bleaching products are indicated as the most important factor for development of respiratory symptoms, lung function decline, and leaving the hairdressing profession. Risk estimates from a good quality prospective study showed up to 3.9 times higher risk for wheezing and breathlessness in hairdressers aged ≥ 40 years than in matched controls, and 20 times higher risk in hairdressers to develop respiratory symptoms from exposure to bleaching powder than controls. Pathophysiological mechanisms of the respiratory response to PS are not yet fully elucidated, but may include non-specific and specific immune responses., Conclusions: Hairdressing is associated with a wide spectrum of respiratory adverse effects, of which bleaching products were indicated as the most hazardous. Preventive measures for reducing inhalatory exposure to PS in hair salons should be re-evaluated, including adopting occupational exposure limits at EU level, and encouraging use of safer bleach formulations., Prospero Registration Number: CRD42021238118., (© 2022. The Author(s).)

In Germany, a stepwise multidisciplinary approach has been established to prevent occupational skin diseases (OSDs), primarily occupational contact dermatitis. This review aims to perform a systematic evaluation of the short- and long-term effects of the German secondary and tertiary individual prevention programmes (SIP and TIP, respectively) for OSDs. Primary outcomes were continuation of employment, severity of hand dermatitis, and quality of life (QoL). The PubMed and Embase databases were searched for studies reporting the effects of the SIP and TIP. A total of 19 studies encompassing 5527 patients with OSDs were included: 11 studies evaluated the SIP and 8 evaluated the TIP. Following the SIP, approximately 70% to 90% and 60% to 70% of patients remained in their occupation after 1 and 5 years, respectively. At 3 years after the TIP, 82.7% of patients remained in their occupation and exhibited a significant decrease in hand dermatitis severity, as well as an increase in QoL. Most of these studies were uncontrolled and the interventions, outcomes, and measurement instruments used were heterogeneous. The SIP and TIP lead to decreased disease severity, improved QoL, and enabled most patients to continue working in their chosen professions. Implementing a similar multidisciplinary approach across Europe may be beneficial., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, this systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) 2020 recommendations for reporting systematic reviews and meta-analysis. In total, six publications from six countries were eligible for this systematic review. A meta-analysis revealed that hairdressers and beauticians have a ninefold increased risk of developing contact allergy to HEMA compared with controls who are not hairdressers and beauticians. Results for ECA are lacking. The results of this systematic review clearly show that-regarding contact allergy to acrylates-it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Hairdressers are at high risk of developing occupational hand eczema. Opinions on the health and safety concerns of nonfood consumer products, such as cosmetics and their ingredients, consider the exposure of a "common consumer," which may not account for occupational exposure of hairdressers. As a result, there is a parlous scenario in which serious safety concerns about occupational exposures are present. The purpose of this review is to compare the frequency of exposure to various types of hair cosmetic products among hairdressers and consumers. Database searches for this review yielded a total of 229 articles; 7 publications were ultimately included. The analysis showed that-dependent on the task-hairdressers were exposed 4 to 78 times more than consumers to a wide spectrum of hair cosmetic products used in their daily working life, ranging from shampoos, conditioners, oxidative and nonoxidative hair colors, to bleaching agents. The highest frequency was found for coloring hair with oxidative hair color. Consumer use frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk-assessment procedures to be reconsidered., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Studies on the causes and consequences of occupational contact dermatitis (OCD) among young workers are non-existent., Objectives: Determine causes and consequences of OCD among workers younger than 35 years of age., Methods: A questionnaire was sent to 6251 workers younger than 35 years at notification with recognized OCD (response rate 47%)., Results: The most prevalent occupations were health care workers, kitchen workers, nursery teachers, and hairdressers and beauticians. Seventy-six percent still had eczema, and 77% of these had eczema half to all the time over the last 3 months, with 61% evaluating their eczema as moderate to very severe. Fifty-three percent had changed their occupation since notification, and 42.5% had lost their job because of OCD. Allergic OCD increased the odds ratio (OR) for facial or foot eczema, job loss, change in work tasks, difficulties finding work, decrease in income, and sick leave. Age at notification of 25 years of age or younger increased the risk of job loss and feeling restricted in choice of job. Workers in the food industry had a higher OR for job loss, whereas hairdressers and beauticians had a higher risk of job loss and a decrease in income., Conclusions: The severe, long-term consequences of OCD notification signify the need for further preventive strategies among young workers., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Hairdressers are commonly affected by hand eczema (HE) due to skin hazardous exposure such as irritants and allergens in the work environment., Objective: To give an overview of the current prevalence, incidence, and severity, as well as the pattern of debut and the contribution of atopic dermatitis on HE in hairdressers., Methods: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed. Studies published from 2000 to April 2021 that fulfilled predefined eligibility criteria were retrieved., Results: A pooled lifetime prevalence of 38.2% (95% confidence interval [CI] 32.6-43.8), a pooled 1-year prevalence of 20.3% (95% CI 18.0-22.6), and a pooled point prevalence of 7.7% (95% CI 5.8-9.6) of HE was observed in hairdressers. The lifetime prevalence in fully trained hairdressers and hairdressing apprentices was almost identical. The pooled incidence rate of HE was 51.8 cases/1000 person-years (95% CI 42.6-61.0) and the pooled prevalence of atopic dermatitis was 18.1% (95% CI 13.6-22.5)., Conclusion: HE is common in hairdressers and most hairdressers have debut during apprenticeship. The prevalence of atopic dermatitis in hairdressers is comparable with estimates in the general population, indicating that occupational exposures are the main factor in the increased prevalence of HE in hairdressers. This warrants a strategic and collective effort to prevent HE in hairdressers., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Exposure to hazardous chemicals released during hairdressing activities from hair care products puts hairdressers at risk of adverse health effects. Safety assessments of hair products are mainly focused on consumers, but exposure for professional hairdressers might be substantially higher., Objective: To identify and assess available research data on inhalation exposures of professional hairdressers., Methods: A systematic search of studies between 1 January 2000 and 30 April 2021 was performed in Medline, Embase, Web of Science and in Cochrane registry, toxicological dossiers of the Scientific Committee on Consumer Safety (SCCS) of the European Commission as well as the German MAK Commission. Studies reporting quantitative data on airborne concentrations of chemicals in the hairdresser's workplace were considered. The outcome was an airborne concentration of chemicals in the working environment, which was compared, when possible, with current occupational exposure limits (OEL) or guidance levels., Results: In total, 23 studies performed in 14 countries were included. The average number of hairdressing salons per study was 22 (range 1-62). Chemicals most frequently measured were formaldehyde ( n = 8), ammonia ( n = 5), total volatile organic compounds (TVOC) ( n = 5), and toluene ( n = 4). More than fifty other chemicals were measured in one to three studies, including various aromatic and aliphatic organic solvents, hydrogen peroxide, persulfate, and particulate matter. Most studies reported environmental air concentrations, while personal exposure was measured only in seven studies. The measured air concentrations of formaldehyde, ammonia, and TVOC exceeded OEL or guidance values in some studies. There was large variability in measuring conditions and reported air concentrations differed strongly within and between studies., Conclusion: Hairdressers are exposed to a wide spectrum of hazardous chemicals, often simultaneously. Airborne concentrations of pollutants depend on salon characteristics such as ventilation and the number of customers but also on used products that are often country- or client-specific. For exposure to formaldehyde, ammonia, and TVOC exceeding OELs or guidance values for indoor air was observed. Therefore, occupational exposure should be taken into account by safety regulations for hair care products.

Background: No biomarkers have been identified that can classify subtypes of hand eczema (HE). Although skin biopsies represent the gold standard for investigations of the skin, the invasive technique is not favorable when investigating skin from sensitive areas. Recent advances in the use of skin-tape strips for molecular investigations enable noninvasive investigations of HE., Objective: By using whole transcriptome sequencing (WTS), the molecular profile of HE according to different localizations on the hands, etiologies, and clinical/morphological subtypes was investigated., Methods: Thirty adult, Danish HE patients, 12 with and 18 without concurrent atopic dermatitis (AD), as well as 16 controls were included. Tape strip samples were collected from lesional, nonlesional, and healthy skin. Total RNA was extracted and WTS was performed., Results: The largest molecular difference of HE patients with and without AD was found in nonlesional skin areas and included a downregulation of CXCL8 for HE patients without AD. Differences between allergic and irritant contact dermatitis included epidermal biomarkers such as EPHA1., Conclusion: Skin tape strip samples could be used to assess the gene expression profile of HE on different localizations of the hands. The skin tape strip method identified new molecular markers that showed promising result for the identification of HE subtypes., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Allergic contact dermatitis (ACD) is classically described as a delayed-type hypersensitivity reaction. However, patients often experience flare-ups characterized by itching erythema, edema, and often vesicles occurring within hours after re-exposure of previously sensitized skin to the specific contact allergen. Recent studies have indicated that skin-resident memory T (T RM ) cells play a central role in ACD. However, the pathogenic role of T RM cells in allergen-induced flare-ups is not known., Methods: By the use of various mouse models and cell depletion protocols, we investigated the role of epidermal T RM cells in flare-up reactions to the experimental contact allergen 1-fluoro-2,4-dinitrobenzene. The inflammatory response was measured by changes in ear thickness, and the cellular composition in epidermis was determined by flow cytometry and confocal microscopy. Finally, adaptive transfer and inhibitors were used to determine the role of T RM cells, neutrophils, and CXCL1/CXCL2 in the response., Results: We show that CD8 + T RM cells initiate massive infiltration of neutrophils in the epidermis within 12 h after re-exposure to the contact allergen. Depletion of neutrophils before re-exposure to the allergen abrogated the flare-up reactions. Furthermore, we demonstrate that CD8 + T RM cells mediate neutrophil recruitment by inducing CXCL1 and CXCL2 production in the skin, and that blockage of the C-X-C chemokine receptor type 1 and 2 inhibits flare-up reactions and neutrophil infiltration., Conclusion: As the first, we show that epidermal CD8 + T RM cells cause ACD flare-ups by rapid recruitment of neutrophils to the epidermis., (© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Objectives: To review recent epidemiological studies investigating carcinogenic or reprotoxic effects among hairdressers who seem to be at greater risk for systemic adverse effects of chemicals released from hair care products than consumers., Methods: A systematic review according to the PRISMA-P guidelines was performed and included studies published from 2000 to August 2021, in which cancer or adverse reproductive effects were diagnosed in 1995 and onward. Data were synthetized qualitatively due to the small number of studies, heterogeneity of study designs, outcomes, and methods., Results: Four studies investigating cancer frequencies and six studies investigating effects on reproduction among hairdressers were identified. All were of good quality and with low risk of bias. Only one of the four studies found an increased risk of cancer reporting nine times higher odds for bladder cancer in hairdressers than the population-based controls. Three other studies investigating bladder and lung cancer, and non-Hodgins lymphoma did not find an increased risk in hairdressers. Regarding reprotoxic effects, numerous outcomes were investigated including menstrual disorders, congenital malformations, fetal loss, small-for-gestational age newborns, preterm delivery, and infertility. Increased risk was found for ventricular septal defect in newborns of fathers working as hairdressers. Furthermore, several indices of poor neonatal or maternal health were significantly associated with mothers working as hairdresser., Conclusions: Despite the scarce evidence that hairdressers are at increased risk of carcinogenic or reprotoxic effects related to their trade, such health risks cannot be ruled out. Therefore, preventive efforts to diminish occupational exposures to hairdressing chemicals should be targeted., (© 2022 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Background: Parents report that children with aluminium contact allergy and vaccination granulomas may react to aluminium-containing sunscreen following application., Objectives: To evaluate whether contact dermatitis develops following repeated application of aluminium-containing sunscreens in children with aluminium sensitization and vaccination granulomas., Methods: Sixteen children aged 2-9 years (mean age 5 years) with vaccination granulomas and a positive patch test reaction to aluminium chloride hexahydrate 2%/10% petrolatum completed a blinded repeated open application test (ROAT) with two daily applications of two sunscreens for 14 days. One cream contained aluminium and the other did not. The children served as their own controls., Results: Sixteen children completed the study. Only one child (6%) had a positive skin reaction during ROAT on day 2 to the sunscreen with aluminium. None reacted to the sunscreen without aluminium., Conclusions: Use of aluminium-containing sunscreens may on a case basis lead to allergic contact dermatitis in aluminium allergic children., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Hairdressers constitute a major subgroup in the service sector. They are exposed to various substances hazardous for skin, airways or systemically. Accordingly, skin and other occupational diseases are common. The present systematic review will compile and appraise evidence regarding skin, systemic and airways toxicity of an indicative set of specific, important product ingredients. Additionally, evidence concerning hand eczema morbidity among hairdressers will be reviewed., Methods and Analysis: Systematic searches will be performed in two electronic literature databases (Medline, Web of Science-Core Collection), the Cochrane register and two collections of toxicological dossiers (Scientific Committee on Consumer Safety of the European Commission and the MAK Commission of the German Research Council). Additional literature sources will be retrieved using hand search of reference lists of included studies and snowballing methods. We will include studies with all types of quantitative study designs, including results from in vitro and in vivo experiments, chemical analysis, epidemiological findings and clinical results. We will assess the risk of bias within studies amalgamating an abbreviated version of the Mixed Methods Appraisal Tool, basic Cochrane criteria and US Environmental Protection Agency assessment factors for scientific information. As we expect large heterogeneity in methods and outcomes, we will conduct a narrative synthesis of results instead of a meta-analysis, except where quantitative pooling is feasible., Ethics and Dissemination: Ethical approval and patient consent are not required as this is a systematic review based on published studies. The results of this study will be published in international peer-reviewed journals., Prospero Registration Number: CRD42021238118., Competing Interests: Competing interests: WU has received a honorarium for a lecture on contact allergy from mixed dermatopharmaceutical sponsors (GEIDAC, Toledo, September 2018) and travel reimbursement for participation in study meetings of the IDEA project (IFRA). WU is external expert for the SCCS. Other authors: none to declare. Provenance and peer review: not commissioned; externally peer reviewed., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge., Objectives: To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic-related allergens and a new test series with cosmetic-relevant natural ingredients (CRNIs)., Methods: This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic-relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life)., Results: Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic-induced FD. The most common cosmetic-related allergens were fragrances and preservatives. The most common patch test-positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test-positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life., Conclusions: Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Chromium and cobalt are important skin sensitizers. It has, however, been difficult to identify causative exposures. Studies on nickel allergy have demonstrated piercing as critical for both sensitization and elicitation. It may be speculated that the same applies for chromium and cobalt., Objective: To examine the content and release of chromium and cobalt from earrings randomly purchased in Denmark., Methods: Three hundred four earrings were examined with x-ray fluorescence (XRF) spectrometry. Earrings with measured content of chromium or cobalt were spot tested with diphenylcarbazide spot test (n = 166) or Nitroso-R spot-test (n = 99), respectively. Chromium and cobalt release were quantified in a selected subsample (n = 100) with the artificial sweat test (EN 1811)., Results: Chromium was present in 54.6% (166/304) of earrings and cobalt was present in 72.0% (219/304),- measured by XRF. All chromium spot tests for chromium VI were negative. The cobalt spot test was positive for one component. Chromium release was found from 59/100 (median concentration = -0.06 μg/cm 2 /week) and cobalt release from 29/100 (median concentration = -0.06 μg/cm 2 /week) of earrings in tested subsample., Conclusion: Earrings for piercing release chromium and cobalt and may on a case basis be a source of chromium and cobalt allergy., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In March 2014, the European Commission issued a new regulation restricting the content of hexavalent chromium (Cr) in leather to no more than 3 mg/kg. We previously performed a questionnaire study in January 2014 to characterize our patients with Cr contact allergy prior to regulatory intervention., Objectives: To assess whether clinical characteristics, self-reported sources of Cr exposure, and burden of disease changed in patients with Cr allergy over time., Methods: A questionnaire study was performed among 172 adult dermatitis patients with Cr allergy and 587 age- and sex-matched dermatitis patients without Cr allergy. A questionnaire was sent to all dermatitis patients patch tested from 2003 to 2018 in August 2019., Results: The overall response rate was 61.2% (759/1241). Patients with Cr allergy were still more commonly affected by current foot dermatitis (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.07-7.08) and hand dermatitis (OR 1.98, 95% CI 1.13-3.49) compared with controls diagnosed during 2013 to 2018. The proportion of patients with Cr allergy reporting dermatitis caused by leather exposure did not change during 2003 to 2012 vs 2013 to 2018 (71.0% vs 66.2%, P = .5). Furthermore, estimates on occupational performance and disease severity (eg, current dermatitis), number of anatomical locations with dermatitis, worst-case dermatitis, and effect on work were similar in patients with Cr allergy for 2003 to 2012 vs 2013 to 2018., Conclusion: No immediate sign of improvement was found in patients with Cr allergy concerning severity of disease and dermatitis from leather exposures 5 years after adoption of the regulation against hexavalent Cr in leather. The regulation may have to be revised for better protection of those already sensitized., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Recent population-based studies on the incidence rates (IRs) of occupational contact dermatitis (OCD) are sparse., Objectives: To determine the IRs of OCD and development thereof between 2007 and 2018 in known risk occupations., Methods: Data on all recognized cases of OCD were used to calculate IRs as the number of recognized OCD cases per 10 000 workers per year. Asymptotic chi-square test was used to compare the IRs between 2007-2012 and 2013-2018., Results: The median age at notification of OCD was below 30 years for several of the examined occupations. Hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills had the highest overall IRs of OCD. We found a statistically significant increase in the IRs of OCD for child/nursery care workers., Conclusions: The median age at notification of OCD was low for several of the occupations, signifying the need for further preventive strategies among young people. Based on the IRs of OCD, future preventive efforts should be directed at hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills. Furthermore, the statistically significant increase in IRs of OCD among child/nursery care workers highlights the need for further preventive strategies in this field., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Patch testing is the gold standard for identifying culprit allergens in allergic contact dermatitis; however, it is laborious and positive reactions are difficult to quantitate. Development of complementary in vitro tests is, therefore, of great importance., Objectives: This study aimed to improve the in vitro lymphocyte proliferation test (LPT) to detect allergic responses to nickel (Ni), cobalt (Co), and chromium (Cr)., Methods: Twenty-one metal allergic patients with a positive patch test to Ni (n=16), Co (n=8), and Cr (n=3) and 13 controls were included. All were tested by a flow cytometric LPT., Results: Metal-reactive cells were identified as T helper (Th) cells with high expression of the memory marker CD45RO. Skin-homing (cutaneous lymphocyte-associated antigen positive [CLA+]) Ni-reactive memory Th (Th mem hi ) cells identified individuals with a positive patch test for Ni with 100% sensitivity (95% confidence interval [CI] 81%-100%) and 92% specificity (95% CI 67%-100%). Moreover, Co-specific Th mem hi cells expressing CCR6 identified patients with a positive patch test for Co with 63% sensitivity (95% CI 31%-86%) and 100% specificity (95% CI 77%-100%). In Cr allergic individuals, Cr-reactive Th mem hi cells tended to increased CLA and CCR6 expression., Conclusion: Metal-reactive Th cells with high expression of CD45RO and coexpression of CLA and CCR6 improved the LPT, making it an attractive supplement to the patch test., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) has been the most reported fragrance chemical for two decades and will be prohibited in cosmetic products from August 2021., Objectives: To describe the time trend of HICC contact allergy in European patients with dermatitis in 2009 to 2019, and the added value of testing HICC separately in the baseline series., Methods: Data were reviewed for 124 472 patients with dermatitis who were patch tested with HICC 5% pet. in the baseline series in the European Surveillance System on Contact Allergy (ESSCA) network (2009 to 2018) and at the Herlev-Gentofte Hospital Department of Dermatology and Allergy (2009 to 2019)., Results: Contact allergy to HICC was found in 1.98% of 9865 patients in Gentofte and 1.62% of 114 607 patients in the ESSCA network. Overall, the prevalence decreased annually, with 0.156 percentage points (P = .001) in Gentofte and 0.051 percentage points (P = .0002) in ESSCA. The frequency of missed contact allergy to HICC when testing only with fragrance mix II (FMII) was 0.17% (17/9865) and 0.35% (405/114607) of the whole test population in the Gentofte and ESSCA populations, respectively., Conclusions: This is the first study to demonstrate a significant decline in HICC allergy in European patients with dermatitis, most likely attributed to the upcoming European ban., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Accurate assessments of the burden of hand eczema (HE) in the general population are important for public awareness and intervention. The aim of this systematic review and meta-analysis was to provide updated estimates of prevalence and incidence, alongside additional epidemiological endpoints on HE in the general population. PubMed, Embase and Web of Science were searched for studies reporting the prevalence and/or incidence of HE in the general population. Proportion meta-analyses were performed to calculate pooled estimates of prevalence, incidence, severity, and the proportion of individuals with HE and a history of atopic dermatitis. Sixty-six studies were included in the quantitative analysis encompassing 568 100 individuals. The pooled estimates for lifetime, 1-year, and point prevalence were 14.5% (95% confidence interval [CI]: 12.6-16.5), 9.1% (95% CI: 8.4-9.8) and 4.0% (95% CI: 2.6-5.7), respectively. The pooled incidence rate of HE was 7.3 cases/1000 person-years (95% CI: 5.4-9.5). The occurrence of HE was 1.5-2 times higher in females than males. More than one third suffered from moderate/severe disease and around one third had a history of atopic dermatitis. HE was a recurrent, long-lasting disease with an average age at onset of the early- to mid-twenties. In conclusion; HE is a highly prevalent disease in the general population and carries a significant risk of long-term or chronic disease., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In 2005, methylisothiazolinone (MI) was allowed as a stand-alone preservative in cosmetics. This resulted in an epidemic of allergic contact dermatitis to MI, mainly affecting women exposed to leave-on cosmetics. Consequently, a regulation of Annex V in the European Union in 2017 banned the use of MI in leave-on cosmetics and reduced the allowed concentration in rinse-off products., Objective: To analyze the temporal trends in contact allergy to MI in Danish patients in relation to key events including European regulations over time., Methods: A retrospective study of consecutive patients patch tested with methylisothiazolinone from 2005 to 2019. Demographics and clinical characteristics in terms of MOAHLFA (male, occupational, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis and age >40 years), sources of exposure, and clinical relevance were analyzed in relation to key historical events., Results: Three hundred eighty of 12 494 patients (3.0%, 95CI: 2.7-3.4%) tested from 2005 to 2019 were sensitized to MI. An increasing trend in the prevalence of MI contact allergy from 2005 to 2019 (P < .01) was observed, although a decline in the absolute number of patch-test positive patients was seen from 2013 and onward. A reduction in leave-on cosmetics as a source of exposure was observed following the legislative ban in 2017, from 24.8% from in 2010 to 2013 to 6.2% in 2017 to 2019 (P < .01)., Conclusion: The epidemic of MI contact allergy is declining in absolute terms, although the prevalence in the patch-tested population has not returned to its pre-epidemic levels. The legislative regulation of MI in 2017 has been effective in terms of leave-on cosmetics as a source of exposure in MI allergic patients. The process of post-marketing risk assessment of contact allergens in the European Union needs improvement., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Background: Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark., Objectives: To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change., Methods: Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification., Results: The degree of employment decreased on average 8.9 work-hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long-term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case-processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave., Conclusions: OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Existing criteria for inclusion in the European baseline series are summarized. Additional criteria are developed to aid decision making where the current criteria do not yield an unequivocal result. These include a consideration of whether an allergen (hapten) is better placed in a special series and the frequency with which an allergen cross-reacts with existing markers in the baseline series., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Background: Exposure to nickel-releasing ear-piercing jewellery may explain the persistently high prevalence of nickel allergy in Europe. While nickel release from earrings is regulated, field studies show that the regulation is not always respected. More knowledge is needed regarding the risk of piercing exposure including suitable screening methods., Objective: To examine the proportion of earrings on the Danish market that release more nickel than allowed, and to validate the use of the dimethylglyoxime (DMG) test as a screening tool., Methods: A total of 304 earrings were purchased and tested with the DMG test and X-ray fluorescence spectrometry. The level of nickel release was quantified in a selected subsample of 100 earrings by the European reference test EN 1811. The DMG spot test was validated against EN 1811 at different thresholds., Results: Excessive nickel release according to the European regulation was found in 45 (14.8%) tested earrings. The sensitivity of the DMG test decreased with reduced levels of nickel release (sensitivity of 45.2% at ≥0.2 μg/cm 2 /week vs 61.1% at >0.5 μg/cm 2 /week)., Conclusion: Excessive nickel release is common in earrings on the Danish market. Because of low sensitivity, the DMG test has limited use in screening of earrings for research but may still be used clinically., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Background: During the first wave of the COVID-19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen., Objectives: To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare., Methods: The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center., Results: Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing., Conclusion: Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well-established prophylactic skin care might have spared a proportion of the children from developing hand eczema., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate-type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA-based COVID-19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under-diagnosis and under-reporting of allergy to PEGs, putting patients at risk of repeated severe reactions., Objectives: To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019., Method: Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0-10) before and after diagnosis., Results: Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot-steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2-6). Median time from first reaction to diagnosis was 20 months (range 2-120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis., Conclusion and Clinical Relevance: The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients' lives., (© 2021 John Wiley & Sons Ltd.)