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Background: Due to an increasing occupational usage of isothiazolinone (IT)-containing preservatives, and their potential to cause skin sensitization and allergic contact dermatitis, that is, chronic disease, there is a need for more knowledge on how highly exposed workers are affected., Objectives: The overall objective was to explore dermatological symptoms of potentially long-lasting or chronic character in Swedish painters., Methods: Building painters from western and southern Sweden were initially invited to perform a questionnaire on occurrence of skin symptoms. Participants with affirmative responses, and the right inclusion criteria, were further invited to patch testing with four different ITs: benzisothiazolinone (BIT), methylisothiazolinone, methylchloroisothiazolinone and octylisothiazolinone., Results: There was a tendency towards higher occurrence of positive patch test reactions among the painters compared with occupationally unexposed registry patients; however, not statistically significant differences. BIT was the substance most frequently causing positive test results in both groups. The occurrence of adult-onset eczema was higher in painters than in the control group of electricians, and just shy of statistical significance concerning any of several skin locations (face/legs/arms/hands)., Conclusion: Building painters present with positive patch test reactions to common paint preservatives (ITs), and they report adult-onset eczema more often than do less occupationally exposed groups., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Educating pediatric eczema patients and caregivers on appropriate product selection and avoidance of common irritants or allergens is a crucial aspect of eczema management. This study surveyed 80 pediatric caregivers in an academic pediatric dermatology clinic to assess influential factors in caregivers' selection of pediatric eczema-care products and identify ways to improve patient counseling on appropriate product selection and avoidance of common irritants or allergens. Caregivers frequently reported positive perceptions of commonly recommended ingredients for eczema but had inconsistent perceptions of fragrant plant oils and extracts, regardless of previous counseling on fragrance avoidance. These findings demonstrate uncertainty and misperceptions perpetuated by product labeling and a need for improved counseling strategies for avoiding fragrance and excessive product costs., (© 2023 Wiley Periodicals LLC.)

Background: Hair cosmetic products contain several, partly potent contact allergens, including excipients like preservatives. Hand dermatitis in hairdressers is common, scalp and face dermatitis in clients or self-users (summarised here as 'consumers') may be severe., Objective: To compare frequencies of sensitization to hair cosmetic ingredients and other selected allergens between female patch tested patients working as hairdressers and consumers without professional background, respectively, who were tested for suspected allergic contact dermatitis to such products., Methods: Patch test and clinical data collected by the IVDK (https://www.ivdk.org) between 01/2013 and 12/2020 were descriptively analysed, focusing on age-adjusted sensitization prevalences in the two subgroups., Results: Amongst the 920 hairdressers (median age: 28 years, 84% hand dermatitis) and 2321 consumers (median age: 49 years, 71.8% head/face dermatitis), sensitization to p-phenylenediamine (age-standardised prevalence: 19.7% and 31.6%, respectively) and toluene-2,5-diamine (20 and 30.8%) were most common. Contact allergy to other oxidative hair dye ingredients was also more commonly diagnosed in consumers, whereas ammonium persulphate (14.4% vs. 2.3%) and glyceryl thioglycolate (3.9 vs. 1.2%) as well as most notably methylisothiazolinone (10.5% vs. 3.1%) were more frequent allergens in hairdressers., Conclusions: Hair dyes were the most frequent sensitizers both in hairdressers and in consumers; however, as indication for patch testing may differ, prevalences cannot directly be compared. The importance of hair dye allergy is evident, often with marked coupled reactivity. Workplace and product safety need to be further improved., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Allergic contact dermatitis to gloves is mostly induced by rubber accelerators. The European baseline series (EBS) appears insufficient to detect glove allergy. Since 2017, it is recommended to use the European rubber series (ERS) and to test the patients' own gloves., Objectives: To investigate the clinical profile of glove-wearing patients with hand eczema (HE) and to evaluate their sensitisation profile to glove allergens and the value of testing the patients' own gloves., Methods: We conducted a French multicentre study of patients evaluated for HE between 2018 and 2020 and tested with the EBS, the ERS and their own gloves in patch tests and semi-open (SO) tests., Results: A total of 279 patients were included; 32.6% of patients had positive tests to their own gloves or to glove allergens. Almost 45% of the sensitisations to glove allergens were detected only by the ERS. Among the patients tested both in patch tests and SO tests with their own gloves with positive results, 28% had positive SO tests only. Polyvinylchloride (PVC) gloves were positive in four patients., Conclusion: Our series confirms the need to test the ERS. All the patients' gloves must also be tested including PVC gloves. SO tests with gloves are useful as a complement to patch tests., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease., Objectives: To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology., Methods: A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020., Results: A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%)., Study Limitations: The number of treated cases and socioeconomic profile was limited to a vulnerable population group., Conclusion: HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Competing Interests: Conflicts of interest Dr Shi is on the board of directors for the Hidradenitis Suppurativa Foundation; is a stock shareholder of Learn Health; and has served as an advisory board member, investigator, speaker, and/or received research funding from Sanofi Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Incyte, Boehringer Ingelheim, Aristea Therapeutics, Menlo Therapeutics, Dermira, Burt’s Bees, Galderma, Kiniksa, UCB, Target-PharmaSolutions, Altus Lab/cQuell, MYOR, Polyfins Technology, GpSkin, Skin Actives Scientific, and the National Eczema Association. Dr Hsiao is on the board of directors for the Hidradenitis Suppurativa Foundation and is a consultant for Novartis and speaker for AbbVie. Drs Rick and Morgan and Author De have no conflicts of interest to declare.

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions., (Copyright © 2022 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Few studies explored the relationship between stasis dermatitis (SD) and allergic contact dermatitis (ACD)., Objective: To examine trends, associations, and clinical relevance of ACD in patients referred for patch testing who had a final SD diagnosis., Methods: Retrospective analysis from 2001 to 2016 of 38,723 patients from the North American Contact Dermatitis Group., Results: After patch testing, 303 (0.7%) patients were diagnosed with SD; 46.7% had a concomitant diagnosis of ACD. Patients with vs. without a final SD diagnosis had similar proportions of ≥ 1 positive allergic reaction (59.7% vs. 64.7%; Chi-square, P = 0.0724) but higher odds of allergic reactions to fragrance mix I, bacitracin, quaternium-15, Myroxylon pereirae, benzalkonium chloride, ethyleneurea melamine formaldehyde, diazolidinyl urea, and propylene glycol. The most commonly relevant allergens in patients with final SD diagnosis were fragrance mix I, Myroxylon pereirae, bacitracin, quaternium-15, and formaldehyde. The most common allergen sources were personal care products, topical medications and other health aid products., Conclusion: Nearly half of patients with a final SD diagnosis were also diagnosed with ACD, supporting the role of patch testing in select SD patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions, including allergic contact dermatitis., Objective: To characterize positive patch test reactions to APS (2.5% petrolatum)., Methods: Retrospective analysis of patients tested to the North American Contact Dermatitis Group screening series from 2015 to 2018., Results: Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared with APS-negative patients, APS-positive patients were significantly more likely to be male (43.2% vs 28.0%; P < .0001); have primary hand dermatitis (30.2% vs 22.0%; P = .0064), scattered generalized dermatitis (25.5% vs 17.9%; P = .0064), or trunk dermatitis (8.9% vs 4.9%; P = .0123); and have dermatitis that is occupationally related (22.2% vs 10.9%; P < .0001). More than half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially hairdressers (68.4%). Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common sources of APS., Limitations: Immediate reactions and follow-up testing were not captured., Conclusion: The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals were important sources of APS exposure., Competing Interests: Conflicts of interest Dr Atwater received a Pfizer Independent Grant for Learning & Change and has consulted for Henkel. Dr Warshaw has received research funding from Wen by Chaz Dean and served as a consultant for Noven Pharmaceuticals and Wen by Chaz Dean. Dr Taylor owns shares of stock in Astra Zeneca, Cigna, Merck, Johnson & Johnson, and Opko Health; has consulted for Kao Brands and Monsanto (Bayer); is a member of the Cosmetic Ingredient Review Steering Committee; and has a nondependent child employed by Pfizer. Dr Sasseville receives royalties from UpToDate (Wolters Kluwer Health). Drs DeKoven, Pratt, Silverberg, Maibach, Zug, Reeder, Fowler, Fransway, Belsito, DeLeo, Houle, and Dunnick and Ms Ruggiero have no conflicts of interest to declare., (Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

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., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings., Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD., Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain., Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P<.001)., Conclusions: AD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different., (Copyright © 2021 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Apprentice nurses are considered at high risk to developing occupational skin diseases., Objectives: This study assessed the frequency and origin of hand eczema, and work-related risk factors in apprentice nurses., Methods: The study involved 240 final-year apprentice nurses (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test with the basic series of allergens, and disinfectants, were performed in 42 apprentice nurses with hand eczema that lasted more than 3 months., Results: Clinically observed and self-reported hand eczema were found in 49% and 46% of apprentice nurses, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (P = .001). Median OHSI was 4 (interquartile range 2-6). There were no positive SPTs to latex, and 11 (26%) apprentice nurses had positive patch test reactions to one or more tested allergens, mostly nickel., Conclusions: Hand eczema was common in final-year apprentice nurses during the COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Patch testing is the gold standard diagnostic tool for cell-mediated type IV hypersensitivity reactions like allergic contact dermatitis. Sensitized individuals have primed antigen-specific T lymphocytes that cause a reaction when antigens are applied to the skin owing to prior sensitization. Patch testing can be used in the adult and pediatric populations, but it is contraindicated in patients with a known history of severe allergic reactions to suspected allergens, generalized active dermatitis, or extensive eczema. Patch test systems can be a comprehensive panel (70-80 allergens), but they can also be targeted and limited to a more common allergen series (35 allergens). The decision for allergen selection should be based on an accurate patient history, physical examination, and availability of allergens. Measurement and interpretation of the test results requires training and experience, as well as consideration of relevance and clinical history. Patch testing is generally considered safe with just a few known complications: excited skin syndrome, active sensitization, and rarely anaphylaxis or other cutaneous complications. Appropriately pretesting patient education can help to mitigate some of these complications. Based on patch testing results, patients should be educated regarding proper allergen avoidance measures to resolve symptoms of allergic contact dermatitis., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE)., Objectives: To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing., Methods: A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed., Results: Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ 2 -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone., Conclusions: Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens., (© 2021 British Association of Dermatologists.)

Background: Few studies have examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD)., Objective: To examine trends, associations, and clinical relevance of ACD in patients with NE who were referred for patch testing., Methods: Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group., Results: Overall, 748 patients (1.9%) were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001 and 2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE increased steadily with age and was associated with male sex and Asian and other race/ethnicity, and inversely associated with a history of atopic dermatitis (AD) and hay fever. Patients with NE had lower proportions of one or more positive allergic reactions and lower odds of a positive reaction in multiple individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium 15, fragrance mix I, and propylene glycol., Conclusion: NE is a heterogeneous disorder with distinct subsets of lesional distributions and a profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly one in four patients with NE had ACD, supporting the role of patch testing in patients with NE., (© 2021 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Hand dermatitis is a widespread problem among cleaners. In most cases, it is caused by a combination of wet work and contact with irritants, which can result in irritant (toxic) contact dermatitis. In some cases, the irritant contact eczema then evolves into allergic contact dermatitis, although not all cases of allergic contact dermatitis are preceded by irritant contact dermatitis. This mini-review proposes a two-step diagnostic algorithm based on patch testing, which can be used if allergic contact dermatitis is suspected in cleaning workers. As a first step, we recommend performing the DKG standard series (German Contact allergy research group, DKG), the DKG rubber series, both DKG "further fragrances" series as well as the DKG preservative and disinfectant series. If there are clear hints of an occupational contact dermatitis, the first step can also involve testing patients' own products alongside the standardized tests. In a second step (at the latest), if standardized tests do not suffice to identify the culprit allergen and there is well-founded suspicion, we recommend testing the patients' own products. If necessary, the second step can also include testing the individual contact allergens contained in the screening mixes that are part of the standard series., (© 2021 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Understanding the etiological factors, stress and quality of life have important implications in the management. There is dearth of the literature in this subject, assessing the stress levels in hand eczema and disparities exist in results of the available literature. Primary objective of this study is to assess the clinico-etiological factors in cases of hand eczema. The secondary objectives include to find any correlation between morphological types and the etiological factors, and to determine the role of stress level in these patients. Patients with hand eczema who attended the outpatient department of our tertiary care institution were enrolled in this descriptive study. Sociodemographic and clinico-etiologic data were collected and patch testing of all patients were done. Stress levels were assessed with Perceived stress scale (PSS). Among the 62 patients enrolled, allergic contact dermatitis predominated with 37 (59.7%) cases and patch test was positive in 41 (66.1%). Potassium dichromate was the most common allergen in males, and fragrance mix in females. Significant levels of stress were seen in 67.7% of the subjects. There was no significant correlation between morphological subtypes and the identified aetiologies. Hand eczema is most commonly due to allergic contact dermatitis, and patch testing is helpful in reaching an etiological diagnosis in most of the cases. A large proportion of patients have high stress levels, and hence stress management should also be a part of treatment in addition to traditional treatment., (© 2020 Wiley Periodicals LLC.)

Contact dermatitis (CD) is a common skin condition caused by contact with an exogenous agent that elicits an inflammatory response. Although history and physical examination can be helpful in distinguishing between irritant CD and allergic CD (ACD), the gold standard for diagnosing ACD is patch testing. Although the actual patch test (PT) procedure and application is relatively straightforward, the decisions involving which allergens to use, interpretation of results, determination of relevant allergens, and subsequent patient management require more skill and expertise. Often, the distribution of the presenting dermatitis can provide insight into the potential causative allergens and should be taken into account when selecting PT allergens. Commercially available PT panels and personal care products can be used for patch testing. Determining the clinical relevance of PT results is a critical component of the PT procedure. Patients must be educated on avoidance of relevant allergens and given guidance on alternative products available for use. Special populations, including children with ACD and occupational CD, and patients with biomedical devices have unique allergen considerations, and PT panels should be directed as such to address all potential allergens., (Published by Elsevier Inc.)

Introduction: Patch tests are only indicated for hand eczema when it is diagnosed as chronic. A positive reaction of current relevance requires a change in treatment strategy. Knowing which clinical factors are associated with current relevance would allow tests to be performed sooner., Objective: To develop a model for predicting currently relevant patch test positivity in patients with hand eczema only., Material and Methods: Retrospective study of patients with hand eczema only. We collected data on age, sex, time since onset, occupation, and history of atopic dermatitis. We built a predictive logistic regression model and assessed discrimination by computing the area under the receiver operating characteristic curve., Results: We included 262 patients; 66.03% had positive patch tests (28.6% of current relevance). Univariate analysis detected significant associations between positivity of current relevance and employment as a hairdresser-aesthetician, a personal history of atopy, male sex, and a time since onset of over 6 months. Multivariate analysis confirmed employment as a hairdresser-aesthetician as an independent risk factor and male sex and a personal history of atopy as protective factors. The score suggested by the predictive model was 2.316(hairdresser-aesthetician)-1.792(atopic dermatitis)-0.601(male sex)., Conclusions: Occupation, sex, and a history of atopy influence the likelihood of patch test positivity of current relevance in patients with hand eczema in Spain. Our model suggests that a diagnosis of chronic eczema is not necessarily an indication for patch testing. Future studies with larger samples are needed to determine the true usefulness of predictive models in this setting., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Variables traditionally reported to influence the prognosis of occupational hand eczema (OHE) are atopic dermatitis (AD) and contact sensitization. However, recent studies indicate that lifestyle factors may be of major importance., Objectives: To identify factors influencing the prognosis in a cohort of patients with recognized OHE., Methods: In this register-based cohort study, individuals with hand eczema recognized as occupational disease in the period January 2010-December 2011 were identified using files from Labor Market Insurance Denmark and included in the study. At baseline, information on sex, age, occupation, wet work, AD and contact sensitization was collected. In 2015 participants received a questionnaire with questions about lifestyle factors, current occupation and healing of OHE., Results: In total, 2703 patients received the questionnaire; 1491 responded to the question about healing of OHE and were included in the study. Altogether, 19·3% of patients reported complete healing at follow-up. Current tobacco smoking and a high level of stress were factors inversely associated with healing of hand eczema (P < 0·001 and P = 0·030, respectively), while a high level of exercise was significantly related to healing of eczema (P = 0·011). Change of profession was a favourable prognostic factor, while age, sex, AD, contact sensitization and education did not significantly influence prognosis., Conclusions: Traditionally important risk factors such as AD and contact sensitization had no marked influence on prognosis, while lifestyle factors were of major importance. Our findings indicate that risk factors may vary over time, allowing for new perspectives on prevention. What's already known about this topic? Occupational hand eczema has a relapsing course and a poor overall prognosis. Atopic dermatitis and contact sensitization have previously been reported as risk factors for a poor prognosis. What does this study add? The results indicate that lifestyle factors are of importance for the prognosis of occupational hand eczema. Traditionally reported risk factors such as atopic dermatitis and contact sensitization do not currently influence prognosis., (© 2019 British Association of Dermatologists.)

Background: Beeswax, both white and yellow, has many uses, such as in lip balm. This material can cause contact allergy, although not many cases have been described., Methods: Ninety-five patients with contact cheilitis, facial eczema or a suspicion of contact allergy to beeswax were patch tested with yellow and white beeswax and with propolis, in addition to the Swedish baseline series. Patients who reacted positively to beeswax were additionally tested with caffeic acid, and two derivatives thereof that are believed to be important haptens in propolis., Results: Seventeen patients had positive reactions to beeswax. Fourteen of these patients had been tested with both yellow and white beeswax. Among those 14, eight had positive reactions to both types of wax, five only to yellow wax, and one only to white wax. Of the 10 wax-positive patients tested with caffeic acid derivatives, three reacted positively. Fourteen beeswax-positive patients also had positive reactions to propolis., Conclusion: Patch testing cheilitis patients is important, as contact allergy is common. Our suggestion is to patch test, apart from the baseline series and the patient's own products, also with beeswax and propolis. Many beeswax-allergic cheilitis patients would not have been diagnosed with a relevant contact allergy if only the Swedish baseline series had been used., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

One in 4 adults with atopic dermatitis (AD) report adult-onset disease. Adult-onset AD appears to be associated with a different disease phenotype compared with childhood-onset AD. A broad differential diagnosis must be considered in a patient presenting with an adult-onset eczematous eruption, including allergic contact dermatitis, mycosis fungoides/cutaneous T-cell lymphoma, psoriasis, scabies, and so forth. This review will specifically address the diagnosis, workup, and management of adult-onset AD. In adults presenting a new-onset chronic eczematous eruption, consideration should be given to a diagnosis of adult-onset AD. Patch testing should be performed to rule out allergic contact dermatitis. A biopsy may be obtained to exclude alternative diagnoses, including cutaneous T-cell lymphoma and psoriasis., (Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Hand eczema (HE) in healthcare workers (HCWs) is common. Besides wet work, healthcare work also implies exposure to contact allergens., Objectives: To assess HE and contact allergy related to occupational exposures in HCWs., Methods: In a cross-sectional study, 311 HCWs with HE within the preceding 12 months and a control group of 114 HCWs without HE were investigated with the baseline series and a special patch test series based on substances found in the gloves, soaps, alcoholic hand disinfectants and hand creams provided at the hospitals., Results: Contact allergy to rubber additives was significantly more common in HCWs with HE (6%) than in HCWs without HE (1%, P = .02). The corresponding percentages for fragrances were 11% and 3%, respectively (P = .004). Occupational HE was found in 193 of 311 (62%) HCWs. Of these, 22 of 193 (11%) had occupational allergic contact dermatitis, including 17 with glove-related rubber contact allergy. Contact allergy to diphenylguanidine was as common as contact allergy to thiurams. Occupational contact allergy to rubber additives was significantly associated with sick-leave related to HE., Conclusion: Contact allergy to rubber additives in medical gloves is the most common cause of occupational allergic contact dermatitis in HCWs. Aimed patch testing with relevant rubber additives is mandatory when HE in HCWs is investigated., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Contact sensitization (CS) and allergic contact dermatitis (ACD) were once thought to be rare in children. The aim of our study was to assess CS and ACD in children affected by eczematous conditions referring to our contact and occupational dermatoses service, and to compare the obtained data to the results of a similar study performed in our Department in late Eighties., Methods: A retrospective analysis of Patch Test data from the Database of Contact Allergy of the Department of Dermatology, University Federico II of Naples, was performed. Moreover results were compared to previous data recorded and analyzed in our center., Results: Of the 416 examined patients, tested during 2005-2010 with the pediatric series, 37.5% developed at least one positive reaction, 15.4% was diagnosed with ACD. The most common allergen was nickel sulphate (16.8%) and the most frequently involved body sites were head and neck (16.3%). Compared to the 1989 study data, our current results highlighted an increase of CS (P<0.001) and ACD diagnosis (P<0.01)., Conclusions: ACD and CS are significantly increased during the last 20 years in our young patients population. The widespread chemical use and premature adult-like attitude may be responsible for earlier and extended exposure to sensitizers.

Background: Chronic hand eczema (CHE) is not a homogenous disease, necessitating complex differential diagnostics. Interleukin (IL) -1 family members are significantly up-regulated in ACD and psoriasis patients skin., Methods: The present study aims to deepen the knowledge about clinical assessment and characterization of patients affected by chronic hand dermatitis (CHD) as well as to investigate the role of possible biomarkers which may help in the diagnostic process. An observational case-control study was performed enrolling 30 CHD patients and 20 healthy controls. Each patient underwent detailed medical history, clinical examination, epicutaneous patch test, and lesional skin biopsies for histological and immunohistochemical analysis., Results: Patient history, clinical examination and patch testing led us to a final CHD characterization in only 8/30 subjects (26.7%). In the remaining subjects, clinical and histological features suggested a diagnosis of psoriasis in 9/22 (30%) and idiopathic chronic hand eczema (CHE) in 13/22 (43.3%). Trying to find a possible marker for the latter dermatosis, we analyzed IL-1 family in all the recruited subjects. IL-1 members were increased in all conditions, but IL-36α was the only analyzed cytokine able to characterize patients who end up with a diagnosis of idiopathic CHE., Conclusions: In conclusion, we can assess that medical history and patch testing remain essential investigations in CHD patients even if not always sufficient to perform a final diagnosis. Moreover, IL-1 members are probably involved in CHE skin inflammation, with IL-36α being a possible future biomarker which might help in the complex diagnostic process of CHE.

Background: Occupational contact dermatitis is common in healthcare workers. Although irritant contact dermatitis resulting from wet work is the most frequently reported cause, healthcare workers also constitute high-risk group for the development of allergic contact dermatitis and contact urticaria., Objectives: To evaluate the prevalence of delayed-type and immediate-type hypersensitivity in 120 healthcare workers with hand eczema., Methods: One hundred and twenty healthcare workers from three major hospitals in Denmark with self-reported hand eczema within the last year participated in the study. Patch tests included baseline series plus selected allergens, and prick tests included standard inhalational allergens plus natural rubber latex and chlorhexidine. Levels of IgE specific for latex, chlorhexidine and ethylene oxide were measured., Results: Of the participants, 53% had positive patch test reactions. The most frequent positive patch test reactions were to nickel, thiomersal, fragrances, rubber chemicals, and colophonium. The prevalence of natural rubber latex allergy as diagnosed by prick testing was 2.5%, and chlorhexidine allergy (both contact allergy and IgE-mediated allergy) was found in <1%. Ethylene oxide allergy was not identified in any of the participants., Conclusions: Our results confirm previous reports on contact allergy patterns in healthcare workers. Testing for natural rubber latex allergy is still important, but increased risks of chlorhexidine and ethylene oxide allergy could not be confirmed., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)