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Massage therapists are particularly exposed to constituents of massage preparations, wet work and mechanical strain and therefore, at high risk to develop occupational dermatitis (OD).To describe the sensitization spectrum of massage therapists with OD.In a retrospective study, patch test data of patients with OD (128 massage therapists and 24 374 patients working in other professions) collected by the Network of Departments of Dermatology (IVDK, 2008-2020) were analysed.Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with OD. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) massage therapists and thus, more often than in other patients with OD. Concomitant positivity to several fragrances/essential oils was frequent. In 8 (14.8%) of the 54 massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series.Allergic contact dermatitis is common in massage therapists with OD and is mainly caused by fragrances and essential oils. Hence, massage therapists should be aware of this risk. When OD is suspected, not only the baseline series, but also special fragrance series should be patch tested in this occupational group.

Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers.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.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.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.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.

Occupational skin diseases (OSDs) are common in healthcare workers (HCWs).To investigate and compare the incidence and clinical features of OSDs among HCWs before and during the COVID-19 pandemic.Incident cases of OSDs were investigated in the cohort of HCWs at Trieste Hospitals from 1 July 2018 (3340 workers) to 31 October 2021 (137 532 person-months).The monthly incidence was ranging from 0 to 11.90 cases per 10 000 person-months in pre-COVID-19 period (cumulative incidence 4.22; 95% confidence interval [CI]: 2.9-6.0) and from 0 to 13.61 cases per 10 000 person-months in COVID-19 period (cumulative incidence 5.06; 95% CI: 3.6-6.9). The incidence rate ratio (IRR) between COVID-19 and pre-COVID-19 period was 1.22 (95% CI: 0.73-1.98). The incidence of OSDs in the COVID-19 period was 6.1 (4.2-8.6) and 2.7 (95% CI: 1.1-5.6) cases × 10 000 person-months for women and men, respectively, with an IRR of 2.25 (95% CI: 0.98-5.9). Incidence in nurses in the COVID-19 period was 6.7 (95% CI: 4.2-10.2) cases × 10 000 person-months.Incidence of OSDs was a little bit higher during the COVID-19 pandemic compared to the previous period but fluctuation of numbers were mainly related to calendar period, with higher incidence in winter and spring. Incidence data were higher than that observed in 2004-2013 in the same cohort. Face dermatitis cases doubled after the start of COVID-19 pandemic. Overall data demonstrated a non-significant increase of OSDs in HCWs during the pandemic, probably due to the preventive strategies set up in our cohort over the years.

Background: Increased hand hygiene measures during the COVID-19 pandemic have led to an increased quantum of hand eczema (HE). Objectives: To examine the effects of varying washing frequencies using current mild cleansing agents—alongside with the effect of a rehydrating cream—on the epidermal barrier function and inflammatory processes of the stratum corneum(SC). Methods: Standardized skin washings on the volar aspects of the lower arms of skinhealthy volunteers were performed using the automated cleansing device either 5 or 11 times within 4 h for 60 s each with a standard cleanser, a lipid-containing syndet, or a lipid-containing syndet followed by one-time application of a rehydrating cream. Skin bioengineering parameters (transepidermal water loss, SC hydration, erythema, and SC pH) and biochemical/immunological parameters (interleukin-1α, interleukin- 1α receptor antagonist and natural moisturizing factor) of SCsamples collected by tape stripping were assessed. Results: All applied washing procedures provided comparable, mild effects on the epidermal barrier function and skin inflammation. Conclusion: Occupational skin cleansers seem to have improved regarding skin barrier damaging effects. To further corroborate this, a study design, modified on the basis of our findings, applying longer washing periods for consecutive days seems desirable.

Occupational hand eczema (HE) is common among healthcare workers (HCWs) and has-in some regions of the world-increased during the COVID-19 pandemic due to related hygiene measures.To evaluate the efficacy of an intervention for HE prevention in HCWs during the pandemic.A prospective, controlled, unblinded interventional trial was conducted in 302 HCWs. The intervention group (IG) (n = 135) received online-based health education and free access to hand cleansing and hand care products. The control group (CG) (n = 167) did not receive any intervention within the study. At baseline (T0), after 3 (T1) and 6 (T2) months, participants completed standardized questionnaires. The Osnabrueck Hand Eczema Severity Index (OHSI) was assessed at T0 and T2.During the observation period, there were no new HE cases in the IG (n = 115) and 12 cases (8.8%) in the CG (n = 136). OHSI values at T2 were lower in the IG (b = -1.44, p 0.001). Daily use of emollients was higher at work (b = 1.73, p 0.001) and at home (b = 1.62, p 0.001) in the IG at T2.The intervention was effective in HE prevention and improving skin care behaviour during the COVID-19 pandemic.

Many risk factors such as atopic dermatitis (AD) have shown to associate with hand eczema (HE). However, studies concerning other atopic diseases, parental or longitudinal risk factors of HE are scarce.To examine the association between HE and atopic diseases, parental factors, environmental factors (keeping animals, exposure to moulds) and lifestyle factors (obesity, tobacco smoking, alcohol consumption and physical activity) at population level.Subjects belonging to the Northern Finland Birth Cohort 1966 Study (NFBC1966) (n = 6830) answered a comprehensive health questionnaire. The data was completed with parental information.HE was reported in 900 (13.3%) individuals. All atopic diseases, parental allergy, female gender and obesity increased the risk of HE whereas physical activity decreased the risk of HE. A statistically significant association was not found between HE and tobacco smoking or alcohol consumption.All atopic diseases, not only AD, seem to have influence on the presence of HE. In addition, parental and environmental factors associated with HE.

Imatinib mesylate is a first-generation tyrosine kinase inhibitor. Piperamido Nitrotoluene, also known as F5, is an intermediate used in the manufacturing of imatinib. We present a case series of allergic contact dermatitis to F5 in pharmaceutical workers.Four male pharmaceutical workers were referred between 2007 and 2021 with new dermatitis predominantly affecting the periorbital region. All were involved in the production of imatinib and particularly exposed to F5. Following medical history and examination, they underwent patch testing to standard series and F5 diluted in white soft paraffin (WSP).All patients tested positive confirming a diagnosis of contact allergy to F5. The first case tested positive to F5 diluted to 1% in WSP, the second to F5 diluted to 10% in WSP and the third and fourth to F5 diluted to 1% and 10% in WSP. In all four cases, dermatitis resolved when they were removed from exposure to F5.To the best of our knowledge, these are the first cases of allergic contact dermatitis to F5 confirmed by patch testing in the literature. In February 2016, a generic formulation of imatinib entered the market. Globalized production of imatinib may result in further cases presenting to dermatology departments worldwide.

Disperse dyes (DDs) are the most prevalent causes of textile-related allergic contact dermatitis and are used for colouring synthetic textile materials based on fibres such as polyester, acrylic, acetate and polyamide. Eight DDs are included in a textile dye mix (TDM) 6.6% petrolatum (pet.) in the European baseline patch test series.The aim of this study was to patch test TDM 6.6% pet. positive individuals with the extracts of synthetic fibre clothes that do not contain any of the pure DDs present in the TDM 6.6% to study the reactivity pattern.Seventy-three TDM-positive former patients tested between 2012 and 2017 at the Department of Occupational and Environmental Dermatology in Malmö, Sweden were invited to join the study, 10 participated. Twenty-four textile items (collected in nine countries in Europe, Asia and North America in 2012) were extracted in dichloromethane. The TDM 6.6% was patch tested simultaneously with the 24 textile item preparations in petrolatum made from the extracts. Prior to patch testing the participants filled the 7-question questionnaire regarding possible symptoms from textile exposure.Ten individuals, agreed to join the study. Eight of them reacted to TDM 6.6%. Nine participants reacted to 20 of 24 extracts. One reacted to 19 extracts, another to 14, 3 to 5 extracts, 1 to 4, 1 to 3 extracts and 2 to 2 extracts. One was negative to all tested preparations including TDM 6.6%. The participants mainly reacted to six textile extracts. All controls tested negatively to tested extracts. Four individuals of the 10 TDM-allergic individuals previously had had problems after wearing clothes. Four out of the 10 participants had had atopic eczema in childhood. All women had dyed their hair with permanent hair dyes but none of the males.TDM-positive patients react to textile extracts made from synthetic garments, even if they do not contain any of the pure DDs present in TDM 6.6%. More studies are needed to pin-point the culprit haptens in these extracts.

The widespread use of skin sensitizing preservatives is well-known. Contact allergy to preservatives is often caused by their presence in cosmetic products. Preservative use in non-cosmetic products is less well-known. We have reviewed European Union (EU) legislations on classification and labelling, biocides and cosmetics, concerning conditions for use of the most used sensitizing preservatives (including formaldehyde-releasing substances, isothiazolinones and parabens). We have analysed temporal trends in their use in non-cosmetic products (tonnes, number of products, concentrations), based on annual reports to the Swedish Products Register 1995-2018; and we discuss implications for stakeholders. Major changes over time are that the use of most of the preservatives has increased by tonnes and/or by number of products, and that several use concentrations have declined following harmonized classification as a skin sensitizer with low concentration limits for this classification. We conclude that the massive increase in use of preservatives is alarming, and that urgent action is needed for protection of health. Their use in non-cosmetic products is broad, increasing and often undisclosed. In the EU, legislations concerning chemicals can provide relevant restrictions to reduce their use and associated health risks, monitored by efficient surveillance. Prevention would be benefited by better coordination between legislations.

Healthcare workers (HCWs) wash their hands with tap water (TW) and soap. However, hard TW causes dermatitis.The present study aimed to compare the effects of ultra-pure soft water (UPSW) with those of TW on the hands of HWCs.The present study was a prospective randomized trial with a crossover design. All the nurses in the neonatal intensive care unit (NICU) at the study centre were divided into Sequence 1 (UPSW to TW) or 2 (TW to UPSW) and washed their hands with TW or UPSW in alternating 4-week periods with a 4-week washout period. Trans-epidermal water loss (TEWL) and stratum corneum hydration (SCH) were evaluated. Skin condition was self-assessed.Twenty-one and 22 nurses were assigned to Sequence 1 and Sequence 2, respectively. USPW increased SCH to a significantly greater degree than TW (mean: 26.3 μS ± 12.3 SD; 95% confidence interval: 1.12-51.54; p = 0.041) although it did not affect TEWL. UPSW use significantly improved the subjects' skin condition, as reflected in an overall increase in the assessment scores.UPSW improved SCH and the condition of hand skin. Prolonged USPW use may increase nurses' comfort during work and hand hygiene compliance.

BACKGROUND: Insulin pumps and glucose monitoring devices improve diabetes mellitus control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices have been reported.OBJECTIVE: To investigate the culprits of localized contact dermatitis in paediatric patients with diabetes caused by insulin pumps and glucose monitoring devices.METHODS: Retrospective analysis of 15 paediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pumps and glucose monitoring devices.RESULTS: Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster.CONCLUSION: A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to BP. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices.

Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and the absence of cutaneous testing. Many false-negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method.The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy.A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed.Of the 36 patients identified, half tested positive for brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). Three patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. The absence of eyelid pruritus was associated with negative testing.In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT.

Hand eczema (HE) is the most frequently occurring occupational skin disease. However, studies on non-occupational wet exposure, occupations not considered as high-risk, and socioeconomic factors regarding HE are scarce.To investigate the association between HE and occupational and non-occupational wet exposure and work-related factors in the Dutch general population.Within the Lifelines Cohort Study, participants with HE were identified by a digital, add-on questionnaire that included questions regarding exposure. Data on work-related and socioeconomic factors were collected from baseline.Overall, 57 046 participants (42.0%) were included. Occupational and non-occupational wet exposure were positively associated with HE in the past year (odds ratios (ORs) 1.35, [95% confidence interval (CI): 1.22-1.49] and 1.34, [95%CI: 1.17-1.53], respectively). Positive associations for high-risk occupations (OR 1.20, [95%CI: 1.06-1.36] for personal care workers in health services and OR 1.25, [95%CI: 1.06-1.48] for nursing and midwifery professionals), occupations not considered as high-risk (OR 1.19, [95%CI: 1.03-1.39] for legal, social and religious associate professionals) and higher levels of education were found (OR 1.17, [95%CI: 1.04-1.32] and OR 1.18, [95%CI: 1.04-1.34] for middle and high level, respectively).Preventive strategies for HE should focus on avoidance of all wet exposure, regardless of origin. In addition, job tasks instead of job title should be taken into account. As previous results on the association between HE and socioeconomic factors differ, future research should focus on a uniform definition of socioeconomic status.

Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses.To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight.A total of 199 patients with work-related symmetrical hand dermatoses were asked to wear a cotton glove (COT) on one hand and a Sympatex glove underneath a cotton glove (SYM/COT) on the other hand for 19 consecutive nights. The severity of skin lesions was regularly examined. A questionnaire on acceptance and tolerability was used in a subset of 126 patients.Data on skin lesions were available for 183 participating patients (92%). The severity did not differ substantially between hands covered with SYM/COT or COT over time. Questionnaire data were available for 120 patients (95%). SYM/COT received better ratings regarding climate conditions while COT showed superiority in wearing comfort, practicality and appearance.Both SYM/COT and COT were well tolerated and accepted in patients with hand dermatoses. Hence, SYM/COT may serve as suitable alternative for COT as comfort gloves supporting therapeutic efforts. The observed slight differences may influence the decision when selecting the glove type.

Hand eczema is a common inflammatory condition of the skin that has been linked to hand hygiene. This systematic review and meta-analysis aims to determine the risks of hand eczema associated with hand hygiene, including frequency of hand washing, wet work and use of alcohol hand rub. A comprehensive search of MEDLINE, EMBASE and Cochrane Library was performed for cohort, case-control or cross-sectional studies that analysed the association between hand hygiene and risk of hand eczema. Results of individual studies were presented in respective forest plots and pooled summary relative risks were estimated using a random-effects model. Forty-five studies were included in the analysis. Hand washing at least 8-10 times daily significantly increased risk of hand eczema (relative risk [RR] 1.51; 95% confidence interval [CI]: 1.35-1.68; p

BACKGROUND Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. OBJECTIVES To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. METHOD The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. RESULTS Consensus was achieved for several statements and management strategies. CONCLUSION The updated guideline should improve management of hand eczema.

Background: The hands are a common predilection site of atopic dermatitis (AD). Dupilumab is licensed for the treatment of AD but not for chronic hand eczema (CHE), while CHE is challenging to treat.Objectives: To evaluate the long-term effect of dupilumab on hand eczema (HE) in patients with AD from the BioDay Registry.Methods: A prospective observational study of adult patients with HE, treated for AD with dupilumab. Patients with a HE severity of at least moderate at baseline were considered for analysis. Patients with other concomitantly systemic immunosuppressive treatments were excluded. Clinical effectiveness on HE severity, using the Hand Eczema Severity Index (HECSI) and photographic guide, and health-related quality of life, using the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), were evaluated.Results: A total of 72 patients were included. HECSI-75 was achieved by 54/62 patients (87.1%) and HECSI-90 by 39/72 (62.9%) at 52 weeks. Based on the photographic guide, 56/62 patients (90.3%) achieved the endpoint of ‘clear’ or ‘almost clear’. Mean QOLHEQ reduction was −63.5% (95% confidence interval −38.23 to −27.41). There was no difference in response between HE subtypes.Conclusions: The results from this study hold promise for dupilumab to be a suitable treatment option for isolated CHE.

The practical importance of two recently described epoxy hardener allergens-1,3-benzenedimethanamine, N-(2-phenylethyl) derivatives (1,3-BDMA-D) and hydrogenated formaldehyde benzenamine polymer (FBAP)-as occupational allergens remains to be defined.To describe patients diagnosed at the Finnish Institute of Occupational Health (FIOH) with positive reactions to 1,3-BDMA-D or FBAP.We searched FIOH's patch-test files from January 2017 to December 2020 for patients examined due to suspected occupational contact allergy to epoxy compounds. We analyzed the patch-test results and sources of exposure to various epoxy hardeners and focused on occupations, symptoms, and the sources of exposure to 1,3-BDMA-D and FBAP.During the study period, 102 patients were examined at FIOH for suspected occupational contact allergy to epoxy compounds. Of these, 19 (19%) were diagnosed with contact allergy to 1,3-BDMA-D (n = 10) or FBAP (n = 12). The largest occupational group was sewage pipe reliners (n = 8). Seven different hardener products contained FBAP, whereas 1,3-BDMA-D was present in only one hardener used by spray painters.A substantial number of patients with suspected occupational epoxy resin system allergy tested positive to in-house test substances of 1,3-BDMA-D and/or FBAP.

Evidence regarding the association between lifestyle factors and hand eczema is limited.To extensively investigate the association between lifestyle factors (smoking, alcohol consumption, stress, physical activity, body mass index, diet, and sleep) and the prevalence, incidence, subtype, severity, and prognosis of hand eczema, a systematic review and meta-analysis were conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology consensus statement. MEDLINE, Embase, and Web of Science were searched up to October 2021. The (modified) Newcastle-Ottawa Scale was used to judge risk of bias. Quality of the evidence was rated using the Grades of Recommendation, Assessment, Development and Evaluation approach. Eligibility and quality were blindly assessed by two independent investigators; disagreements were resolved by a third investigator. Data were pooled using a random-effects model, and when insufficient for a meta-analysis, evidence was narratively summarized. Fifty-five studies were included. The meta-analysis (17 studies) found very low quality evidence that smoking is associated with a higher prevalence of hand eczema (odds ratio 1.18, 95% confidence interval 1.09-1.26). No convincing evidence of associations for the other lifestyle factors with hand eczema were found, mostly due to heterogeneity, conflicting results, and/or the limited number of studies per outcome.

Relevant nickel and cobalt release from hairdressing tools has recently been evidenced. Comparable data are not available for tools used in beauty salons.Screening of beauty tools for nickel and cobalt release.Three hundred eight beauty tools were tested in seven beauty salons located in two North-German states. A nickel spot test and a cobalt spot test were used to test the tools for nickel release and cobalt release, respectively.One hundred forty-three of 308 beauty tools overall (46.4%; 95% confidence interval [CI]: 40.8%-52.2%) released nickel and 18 of 308 beauty tools overall (5.8%; 95%CI: 3.5%-9.1%) released cobalt. Nickel release was found in 22 of 99 metal tools (22.2%; 95%CI: 14.5%-31.7%) and 121 of 209 tools with metallic parts (57.9%; 95%CI: 50.9%-64.7%); cobalt release was detected in 3 of 99 metal tools (3.0%; 95%CI: 0.63%-8.6%) and 15 of 209 tools with metallic parts (7.2%; 95%CI: 4.1%-11.6%).Nickel and cobalt are emitted at allergologically relevant levels by a wide range of beauty tools (i.e., metal tools and tools with metallic parts) utilized in the German cosmetics trade. Beauty tools should thus be considered occupational sources of nickel and cobalt exposure.

The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n = 145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing.

An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL-GERDA) has collected many cases in the last few years.To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB.We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB.A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components.CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children.

Sensitization to acrylates is a concern in the occupational/environmental dermatology field.To describe an occupational allergic contact dermatitis (ACD) outbreak from a smartphone screen protector glue.Thirteen affected workers of a chain store selling phone screen protectors were investigated in five Spanish dermatology departments. The glue datasheet and label were assessed. A chemical analysis of the glue was performed. Based on this, some patients underwent additional testing.All patients (all female, mean age: 25) had severe fingertip dermatitis. The datasheet/label indicated that the glue contained isobornyl acrylate (IBOA), a "photoinitiator" and polyurethane oligomer. The company informed us that the ingredients were polyurethane acrylate, "methacrylate" (unspecified), acrylic acid, hydroxyethyl methacrylate, propylmethoxy siloxane, and photoinitiator 184. Isobornyl acrylate (or IBOA) and N,N-dimethylacrylamide (DMAA) were patch tested in eight and two cases, respectively, with negative results. A chemical analysis revealed 4-acryloylmorpholine (ACMO); isobornyl methacrylate (IBMA), and lauryl acrylate in one glue sample. Seven patients were patch tested with dilutions of the identified substances and six of seven were positive for ACMO 0.5% pet.An outbreak of occupational ACD, likely from ACMO in a glue is described. Further investigations are needed to corroborate the role played by each compound identified in the chemical analyses.

Contact allergy has been reported as a side effect of topical antifungals (TAFs), although most evidence has come from small case series.To investigate the frequency and associated factors of contact allergy to TAFs.We performed a retrospective analysis of the data of the Contact Allergy Unit of a University Dermatology Department between January 2009 and April 2021. From a cohort of 3788 patients tested in our unit, aimed testing was performed in 482 patients using TAFs from Chemotechnique Diagnostics (Vellinge, Sweden), allergEAZE, and, in some cases, commercial preparations 'as is'.Contact allergy to antifungals was found in 27 patients (0.71% of consecutively tested patients and 5.6% of those who had aimed testing). Foot and leg eczema were the clinical presentation in 12 (44.4%) and 10 (37.0%) patients, respectively. Positive reactions were observed mostly with econazole nitrate 1% alcohol (51.9%), miconazole 1% alcohol (48.9%), tioconazole 28% solution (40.7%), and clotrimazole 5% pet. (18.5%). Fifteen patients (55.6%) had sensitization to more than one antifungal.Contact allergy to antifungals was uncommon and occurred mostly associated with foot dermatitis. Most patients were sensitized to more than one chemical, particularly to azoles, which may limit future choices of TAF treatment.

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.

The skin is frequently exposed to chemical stress by organic chemicals or metal ions that can directly or indirectly challenge its immune components and may lead to T-cell-mediated delayed-type hypersensitivity reactions. The disruption of the skin's homeostasis by exposure to contact sensitizers (CSs) can trigger an inflammatory immune response that results in eczema and allergic contact dermatitis. The recognition of these chemicals depends on the expression of pattern recognition receptors on sentinel skin cells, mainly the innate resident immune cells orchestrating the skin's immune response and involving both oxidative and inflammatory pathways. The main driver of these both pathways is the Nrf2/Keap1 pathway, a major ubiquitous regulator of cellular oxidative and electrophilic stress, activated in various innate immune cells of the skin, including keratinocytes and epidermal Langerhans cells in the epidermis and dermal dendritic cells in the dermis. Nrf2 also shows a strong protective capacity by downregulating inflammatory pathways. In this review, the important role of Nrf2 in the regulation of the immune response to CSs will be discussed and highlighted.

BACKGROUND: Hand eczema (HE) has a significant impact on quality of life and work related activities. Little is known about the patients' perspectives on quality of care for HE.OBJECTIVES: To evaluate the patient perspective of the HE care process in a tertiary referral center.METHODS: Qualitative, semi-structured focus groups were carried out and recorded, transcribed and analysed by an inductive-deductive thematic approach.RESULTS: Fifteen patients participated in four focus groups. Time and attention, together with being listened to and understood by the health care professional, were the most important aspects of care for HE mentioned by participants. Other important insights included: Diagnoses, causes and follow-up of HE were not always clear to the participant; more psychosocial support was needed; participants experienced frequent changes in doctors. Information provided by nurses was valuable, but more individualized advice was needed.CONCLUSIONS: In order to better meet the needs of patients, more explanation should be given about the causes of HE and final diagnosis. Besides focusing on the treatment, it is also important to focus on its impact on the patient and options for psychosocial and peer support should be discussed. Furthermore, the specialized nurse as part of integrated care was emphasized. This article is protected by copyright. All rights reserved.

Preservatives are usually added to a wide array of consumer products to prevent growth of microbes and to prevent product destabilization and degradation. However, many of these preservatives are common skin sensitizers and may cause allergic contact dermatitis. The amount of preservatives may vary per country or region according to their respective legislation and may be reported in differences in prevalence rates of contact dermatitis.To examine and identify preservatives in consumer products in accordance with Philippine legislation. To verify the accuracy of the list of ingredients of Philippine cosmetic products as legislated by the Philippine Bureau of Food and Drug Administration.A total of 65 commonly used Philippine consumer products ranging from liquid facial and body washes, bar soaps, laundry detergents, feminine hygiene washes and wipes, shampoos and conditioners, sunblock, and moisturizers were selected. Ingredients noted on labels were documented. Products were subsequently investigated chemically for the presence of methylchloroisothiazolinone, methylisothiazolinone, or formaldehyde.The preservatives most commonly used in cosmetic products in the Philippine market are methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), and/or formaldehyde. In accordance with Philippine legislation, almost all products provided a detailed ingredient list as printed on the packaging. Measurements of MCI/MI ranged from less than 1 ppm to 16 ppm, and MI ranged from only less than 1 ppm to 66 ppm, whereas formaldehyde was noted to range from less than 2.5 ppm to greater than 40 ppm in the products tested. Most products are manufactured by international brands, with a few products being manufactured locally.The preservatives found in cosmetic products were MCI, MI, and formaldehyde. Discrepancies were found in the preservatives and labeling of these products, with a majority of investigated Philippine products labeled inaccurately with varying concentrations of preservatives.

Although the Mas-related G-protein-coupled receptors (Mrgprs) play essential roles in itch detection, their contribution to allergic contact dermatitis (ACD)-associated itch remains unclear.To investigate whether Mrgprs are involved in ACD and whether Mrgprs can be identified as potential therapeutic targets.Mrgpr-clusterΔUtilizing an ACD model, we found that Mrgpr-clusterΔOur study provides the first evidence that Mrgprs are involved in ACD-induced chronic itch, which provides new avenues for itch management in ACD.

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.

Health care workers (HCWs) report frequent adverse skin reactions (ASRs) due to face personal protective equipment (F-PPE) use during the coronavirus disease 2019 (COVID-19) pandemic.To describe self-reported ASRs among HCWs using F-PPE; investigate background factors, such as chronic skin diseases and skin types (dry, oily, combination, sensitive), and determine whether HCWs took preventive methods against ASRs.An online questionnaire was distributed to 22 993 HCWs at hospitals.The prevalence of ASRs was 61.9% based on 10 287 responders. Different types of F-PPE caused different reactions. The most common ASRs from surgical masks were spots and pimples (37.2%) and from FFP3 masks was red and irritated skin (27.3%). A significantly higher proportion of HCWs with chronic skin diseases had ASRs (71.6%) than those without chronic skin diseases (59.7%) (P .001). Some skin types were more prone to ASRs (sensitive skin [78.8%] vs dry skin [54.3%]; P = .001). HCWs using F-PPE for6 hours versus3 hours per day had a four times higher ASR risk (P = .001). Nearly all HCWs used preventive and/or counteractive methods (94.2%).It is important to consider background factors, such as chronic skin diseases and skin types, to prevent and counteract ASRs due to F-PPE use.

Social media platforms are increasingly used by patients to research and discuss medical problems.The aim of this study was to identify by whom, how frequently, and in what manner allergic contact dermatitis (ACD) is discussed on social media sites.Search terms "allergic contact dermatitis" and "contact dermatitis" were queried across Twitter, Instagram, Reddit, Facebook, YouTube, and Google search metrics. The frequency, content, and creators of the content were assessed.ACD content was identified on all platforms, generated by by patients, physicians, professional organizations, and companies. When comparing the volume of posts, more content was on Instagram than Twitter, particularly among patients. Patient support groups were identified on Facebook but not on Reddit. A formal analysis of YouTube videos found that the medical information presented in these videos was often of poor quality.Patch testing physicians should be aware that information on ACD exists across social media sites. While some content is generated by physicians, patients and industry groups also post and share material. Patch testing physicians should know that there is an opportunity to share ACD information, but they should also be aware that patients are posting and creating online support communities independent of physicians.Online support communities exist for patients with ACD on Facebook. Online information is of lower quality, with a mean QUEST quality score of 7.4/28 on reviewed YouTube videos. Of the five social media sites reviewed, patients are most active on Instagram, Reddit, and Facebook. Approximately 9000 Google searches per month are conducted using contact dermatitis-related search terms. Differences in terminology exist between physicians and non-physicians. While the most popular hashtag term was "contact dermatitis", physicians disproportionately authored posts tagged with "allergic contact dermatitis."