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Hair cosmetics are in fashion. Numerous products are commonly used in combination. Frequent allergens are present in hair cosmetics, which, with almost daily use, increase the risk of sensitization. Familiarity with the clinical distribution of the eczematous rash is necessary to seriously consider patch testing. Not all the products on the market are haptens. It is necessary to know how to patch your own products. When avoidance of the allergen is not possible, new treatments are evaluated to combat allergic contact dermatitis, mainly of the occupational type. In this manuscript, a complete and practical review of the main allergens and contact sources of hair cosmetic origin has been carried out. [ABSTRACT FROM AUTHOR]

Hair cosmetics are in fashion. Numerous products are commonly used in combination. Frequent allergens are present in hair cosmetics, which, with almost daily use, increase the risk of sensitization. Familiarity with the clinical distribution of the eczematous rash is necessary to seriously consider patch testing. Not all the products on the market are haptens. It is necessary to know how to patch your own products. When avoidance of the allergen is not possible, new treatments are evaluated to combat allergic contact dermatitis, mainly of the occupational type. In this manuscript, a complete and practical review of the main allergens and contact sources of hair cosmetic origin has been carried out.

Abstract 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.

The aim of this study is to summarize and analyze the occurrence of cosmetic adverse reactions in Shanghai Han population by using available survey data.Materials and Methods: Collection, statistics and analysis of patients with cosmetic adverse reactions in Shanghai Huashan Hospital from 2017 to 2021.Results: Among the 1004 patients, most of them (96.71%) were diagnosed as cosmetic contact dermatitis, which often occurred within 3 days of using cosmetics (51.79%). A total of 260 patients were tested with patch test, but the compliance rate was only 18.08%. Among them, 240 patients underwent additional European standard allergen tests, and positive allergens were detected in 210 cases (87.5%). Univariate analysis revealed that dosage form (emulsion and cream), age (≤ 25 years) and the allergic ingredients triethanolamine, rose oil, propylene glycol, thiomersal and musk ambrette are associated with the occurrence of cosmetic adverse reactions within seven days. A logit prediction model was also successfully constructed: Logit (P) = 1.710– 0.796× 1 + 1.185× 2 − 3.650X3-1.335X4.Conclusion: This study complements the data reported on cosmetic adverse reactions in the Chinese Han population and suggests that in future clinical diagnosis and data collection, emphasis should be placed on patch testing, combining the patch test with cosmetic protoplast with the European standard allergen test to improve the detection rate. [ABSTRACT FROM AUTHOR]

Resumen: La lectura de los parches de pruebas epicutáneas no es sencilla, presenta una gran variabilidad inter- e intraobservador y requiere experiencia. En ocasiones es realmente difícil determinar si se trata de una reacción alérgica de intensidad leve o si estamos ante una reacción irritativa. Recientemente se han publicado algunos trabajos que han estudiado las características dermatoscópicas de las distintas reacciones que se producen tras realizar pruebas epicutáneas. La característica dermatoscópica más frecuentemente observada en los parches alérgicos es el eritema homogéneo, si bien vasos puntiformes, vesículas o costras y áreas amarillo-anaranjadas también parecen indicar una reacción alérgica, guardando cierta similitud con lo observado en patología inflamatoria como en el eccema. Por otro lado, en cuanto a las reacciones irritativas, el patrón más indicativo sería el «patrón del poro», acompañado de eritema perifolicular. Estos hallazgos dermatoscópicos pueden ser de utilidad al clínico en su toma de decisiones ante una reacción dudosa. Abstract: 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.

Acute Localized Exanthematous Pustulosis (ALEP) is a rare skin reaction characterized by the sudden onset of multiple, small, sterile, non-follicular pustules in an erythematous and edematous base succeeding systemic drug administration. ALEP is considered a subtype of Acute Generalized Exanthematous Pustulosis (AGEP), although the exact pathogenic mechanism of the disease remains poorly defined. Numerous drugs have been implicated in the pathogenesis of ALEP, while contact mechanisms have also been reported. Herein, we describe the first case of ALEP attributed to minoxidil in a female patient with androgenetic alopecia. The positivity of patch tests and the topical application of minoxidil proposes a contact-induced hypersensitivity reaction. Identifying new agents—including minoxidil—which serve as inducers of drug-specific T-cell-mediated responses in the clinical spectrum of ALEP, adds further value in understanding the complex, yet unknown, pathophysiological mechanisms of this rare drug hypersensitivity reaction. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivo: La rosácea es una dermatosis acneiforme crónica donde la disrupción de la barrera cutánea puede provocar una facilidad para la sensibilización a distintos alérgenos. Nuestro objetivo es analizar la sensibilización alérgica de contacto en los pacientes con rosácea de nuestro medio. Material y métodos: Se realizó estudio de cohortes retrospectivo analizando todos los pacientes parchados en la consulta de Alergia Cutánea de nuestro servicio entre mayo de 1991 hasta mayo de 2019. Resultados: Durante el tiempo de estudio han sido remitidos a nuestra consulta un total de 200 pacientes con rosácea, el 2,1% del total de pacientes parchados en este tiempo. El 81% de los pacientes eran mujeres, con una edad media de 44,7 años. El 46,5% presentaron al menos un parche positivo, considerándose de relevancia presente (RP) en el 15%. Los parches positivos más frecuentes fueron níquel (26%), seguido de cloruro de cobalto (6,5%), isotiazolinonas (6%), PPDA (5,5%), mezcla II de perfumes (5%) y thiomersal (3,5%). Los parches positivos de RP más frecuentes fueron isotiazolinonas en 10/200 pacientes (5%), PPDA, mezcla II de fragancias, toluensulfonamida formaldehído resina en 4/200 pacientes cada uno (2%), tixocortol y mezcla I de fragancias en 2/200 cada uno (1%). El grupo de sustancias más frecuentemente detectadas fueron los metales, con una RP en el 12,6%, seguido de los fármacos con una RP en el 25,8%. Los conservantes y las fragancias fueron los siguientes grupos de sustancias más frecuentemente positivas, con una RP en el 70,8% y el 43,7%, respectivamente. La fuente de sensibilización más frecuente fueron los cosméticos, seguidos de los fármacos tópicos, destacando los corticoides y los antifúngicos tópicos. Conclusiones: Destacamos una elevada prevalencia de dermatitis alérgica de contacto en pacientes con rosácea, lo que sustenta la realización de pruebas epicutáneas, especialmente en aquellos con empeoramiento de sus lesiones en relación con la aplicación de productos cosméticos o fármacos tópicos. Abstract: Background and objective: Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. Material and methods: Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. Results: A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7 years). At least 1 positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mix II (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mix II, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mix I in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications — notably corticosteroids and antifungal agents. Conclusions: We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.

Abstract Background Atopic dermatitis is the most common inflammatory skin disease in childhood and has an important impact on quality of life, especially severe cases or those that are recalcitrant to treatments. Sensitization to allergens with the potential for allergic contact dermatitis is a factor associated with cases of recalcitrant atopic dermatitis. Understanding the relationship between atopic dermatitis, allergens, and allergic contact dermatitis is essential. In Brazil, there are no studies on sensitization to allergens found in patch tests with pediatric batteries in patients with atopic dermatitis. Objectives To verify the main sensitizing agents, the prevalence of allergic contact dermatitis and the epidemiological and clinical profile of children and adolescents with atopic dermatitis. Methods Cross-sectional, prospective study in patients between 4 and 18 years of age, with recalcitrant atopic dermatitis, treated at the Sanitary Dermatology Outpatient Clinic (RS). All patients underwent patch tests with a battery of pediatric allergens. Results The prevalence of sensitization and allergic contact dermatitis in the evaluated patients was 37.07% (20/54) and 27.7% (15/54), respectively. The most frequent allergens were: nickel sulfate (16.7%), disperse blue (5.6%), and fragrance mix I (5.6%). Nickel was associated with the female sex (p = 0.019). Study limitations Sample size and selection, absence of a control group. Conclusions A proportion of patients with recalcitrant atopic dermatitis may be sensitized to different allergens and may even have developed allergic contact dermatitis. Recognizing this context is important in the prevention strategy and management of the disease.

Objective: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. Data source: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. Data synthesis: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. Conclusions: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults. [ABSTRACT FROM AUTHOR]

Abstract The therapeutic approach to metastatic melanoma has revolutionized the clinical course of this disease. Since 2011, different immunotherapeutic drugs have been approved. Nivolumab is a humanized immunoglobulin IgG4 monoclonal antibody that binds to the PD-1 receptor, blocking its interaction with his ligand PD-L1. The authors present a new case of photosensitivity induced by nivolumab. The photo exposed distribution of the eruption, the sun exposure prior to the beginning of the eruption, and the chronological relationship with the beginning of the treatment are data that have allowed us to confirm the suspected clinical diagnosis.

Abstract Background: Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions. Objectives: To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions. Method: Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy. Results: 77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001). Study limitations: The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed. Conclusion: Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.

Abstract Objective: The aim of this study was to identify which types of skin reactions are associated with slime toys and which of their ingredients are most frequently involved in cases of poisoning. Data source: Between January and July 2021, articles were selected using PubMed, SciELO, and LILACS databases. The following descriptors were used: (dermatitis OR rash OR eczema OR inflammation) AND slime. Inclusion criteria were articles available in full, in either Portuguese, English, or Spanish, published between January 2000 and July 31, 2021, and articles reporting cases of contact dermatitis or eczema potentially or directly attributed to slime toys. Articles not meeting these criteria and duplicate texts in the databases were excluded. Data synthesis: In total, 65 publications were identified, of which 16 were included in this review. This resulted in a total of 22 children (2 males, 20 females), aged between 4 and 13 years, who were reportedly intoxicated by slime toys, most of these being linked to homemade preparations. Studies reported the occurrence of contact or allergic dermatitis on hands, fingers, nails, forearms, and cheeks. The most allergenic and/or irritant ingredients included liquid detergent and soap. Additionally, patch tests identified positive reactions to methylisothiazolinone and methylchloroisothiazolinone, the preservatives used by chemical industries on preparation of glue, soap, detergents, etc. Conclusions: Although slime toys might be important for improving motor development and parental relationships, homemade slime toy recipes include several allergenic and irritant ingredients which might be exposed to vulnerable children and cause intoxications. Therefore, homemade slime toys preparations should be used cautiously and under the supervision of adults.

Fragrance materials are widely used in various types of products in daily life and many of them can be contact sensitizers. Contact allergy to fragrances has been reported to be common worldwide. Unlike other groups of contact allergens such as metals and preservatives, fragrance materials in consumer products can be present as single fragrance chemicals or in the form of mixtures known as natural complex substances. Due to the complexity of the fragrance materials and the high number of fragrance substances known to cause contact sensitization, selecting suitable materials for patch testing is challenging. Emerging fragrance markers have been additionally introduced in different baseline series for screening to enhance the rate of fragrance contact allergy detection. Moreover, there have been continual updates on basic knowledge, clinical perspectives, sources of exposure, and regulations on the use of fragrance materials. Avoiding pitfalls while performing patch testing with fragrance test materials is also crucial and should not be overlooked. Therefore, this review aims to update knowledge to provide a high-quality holistic approach to fragrance contact allergy diagnosis and management.

Eyelid dermatitis (ED) affects a cosmetically significant area and leads to patients' distress. Despite ongoing and recent research efforts, ED remains a multidisciplinary problem that needs further characterization. We aimed to evaluate the atopic eyelid dermatitis (AED) frequency in ED patients and to perform their clinical profiling. PubMed databases were searched from 01.01.1980 till 01.02.2024 to PRISMA guidelines using a search strategy: (eyelid OR periorbital OR periocular) AND (dermatitis or eczema). Studies with patch-tested ED patients were included. Proportional meta-analysis was performed using JBI SUMARI software. We included 65 studies across Europe, North America, Asia and Australia, with a total of 21,793 patch-tested ED patients. AED was reported in 27.5% (95% CI 0.177, 0.384) of patch-tested ED patients. Isolated ED was noted in 51.6% (95% CI 0.408, 0.623) of 8453 ED patients with reported lesion distribution, including 430 patients with isolated AED. Our meta-analysis demonstrated that the AED frequency in patch-tested ED patients exceeded the previous estimate of 10%. Isolated AED was noted in adult patients, attending contact allergy clinics. Future studies are needed to elucidate the global prevalence and natural history of isolated AED in adults., (© 2024. The Author(s).)

Background: There is a dearth of effective treatments to counter retinol-induced skin irritation., Objective: This study aimed to investigate the efficacy of three potential mitigants: (i) phytosteryl/octyldodecyl lauroyl glutamate (PLG), (ii) a physiologic lipid mixture (PLM) comprised of ceramide three and cholesterol, and (iii) niacinamide, in ameliorating irritation instigated by retinol., Methods: An occlusive human patch test, spanning 5 days, was undertaken on 18 Chinese participants aged between 23 and 40. It was designed as a randomized, double-blind, and vehicle-controlled study. Clinician erythema assessment (CEA) and instrumental evaluations were employed pre and post-test. Subsequently, a 4-week consumer in-use test, randomized and double-blind in nature, was executed to substantiate the soothing effects of PLG., Results: Data from CEA and bioengineering assessments revealed that, in comparison to the vehicle control, both 2% PLG and 5% PLM notably curbed retinol-induced skin erythema and inflammation. Notably, PLG outperformed PLM. Conversely, 3% niacinamide did not offer relief against retinol-induced discomfort. The subsequent consumer in-use test affirmed that treatments with 2% PLG were better tolerated than those with the vehicle alone., Conclusion: To the best of our knowledge, this study represents the first confirmation that physiologic lipids effectively mitigate retinol-induced irritation. Given their capacity to counter retinol-induced irritation, physiologic lipids, particularly PLG, are recommended for incorporation in retinol regimens. Additionally, the Visia-CR a* value can serve as a robust objective measure for interpreting patch test outcomes., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Resumen: Antecedentes y objetivo: La actualización de las series estándar de pruebas epicutáneas debe basarse en datos objetivos de frecuencia de sensibilización de los alérgenos que componen cada batería. La última renovación de la batería estándar española se realizó en 2016 y de la europea en 2019, quedando pendiente valorar la inclusión de alérgenos emergentes. Material y método: Desarrollamos un estudio observacional, prospectivo y multicéntrico de los pacientes consecutivos del registro del Grupo Español de Investigación en Dermatitis y Alergia Cutánea sometidos a pruebas epicutáneas con hidroperóxido de linalool, hidroperóxido de limoneno, 2-hidroxi-etil-metacrilato, benzisotiazolinona, octilisotiazolinona, mezcla textil, metabisulfito sódico, propóleo, bronopol, mezcla de compuestas II, diazolidinil urea, imidazolidinil urea, decil glucósido y lauril glucósido, durante los años 2019 y 2020. Resultados: Se analizó una muestra de 4.654 pacientes estudiados con diazolidinil urea, imidazolidinil urea y bronopol, y de 1.890 pacientes con el resto de los alérgenos. El índice MOAHLFA fue: M 30%, O 18%, A 15%, H 29%, L 6,5%, F 23%, A 68%. Siete alérgenos mostraron una frecuencia de sensibilización mayor del 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato, benzisotiazolinona, hidroperóxido de limoneno, mezcla textil, metabisulfito sódico y propóleo. Tres alérgenos mostraron una frecuencia de relevancia presente superior al 1%: hidroperóxido de linalool, 2-hidroxi-etil-metacrilato e hidroperóxido de limoneno; para benzisotiazolinona y mezcla textil, esta frecuencia fue de entre el 0,9 y el 1%. Conclusiones: Nuestros resultados indican que debería valorarse la inclusión de siete nuevos alérgenos en la batería estándar española. Estos resultados podrían contribuir a la próxima actualización de la batería basal europea. Abstract: Background: Standard patch test series must be updated using objective data on allergen sensitization. The Spanish standard series was last updated in 2016 and the European series in 2019, and the inclusion of several emerging allergens needs to be evaluated. Material and methods: We conducted a prospective, observational, multicenter study of consecutive patients from the registry of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) who were patch tested in 2019 and 2020 with linalool hydroperoxide, limonene hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, octylisothiazolinone, textile dye mix (TDM), sodium metabisulfite, propolis, bronopol, Compositae mix II, diazolidinyl urea, imidazolidinyl urea, decyl glucoside, and lauryl glucoside. Results: We analyzed data for 4654 patients tested with diazolidinyl urea, imidazolidinyl urea, and bronopol, and 1890 tested with the other allergens. The values for the MOAHLFA index components were 30% for male, 18% for occupational dermatitis, 15% for atopic dermatitis, 29% for hand, 6.5% for leg, 23% for face, and 68% for age > 40 years. Sensitization rates above 1% were observed for 7 allergens: linalool hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, limonene hydroperoxide, TDM, sodium metabisulfite, and propolis. Three allergens had a current relevance rate of over 1%: linalool hydroperoxide, 2-hydroxyethyl-methacrylat, and limonene hydroperoxide. Benzisothiazolinone and TDM had a relevance rate of between 0.9% and 1%. Conclusions: Our results indicate that 7 new allergens should be considered when extending the Spanish standard patch test series. The data from our series could be helpful for guiding the next extension of the European baseline series.

Introduction: Oral lichen planus (OLP) is a chronic autoimmune inflammatory disease with an unknown aetiology and a higher prevalence in women. Oral lichenoid lesions both clinically and histologically resemble oral lichen planus and are often associated with contact allergy to dental materials. Aim: To investigate the prevalence of delayed hypersensitivity reactions in patients with OLP and to identify the most common allergens that may exacerbate the disease. Material and methods: Twenty patients diagnosed with OLP and undergoing treatment in the Gerodontology and Oral Pathology Department of the Poznan University of Medical Sciences were enrolled in the study. The subjects underwent a detailed oral examination consisting of anamnesis and a clinical evaluation by a qualified dentist, while an assessment of the skin and skin appendages was carried out by a dermatologist. Patch testing was performed using the Polish Baseline Series and Dental Screening Series. Results: Fifty percent of the examined patients displayed positive patch test reactions. A total of 18 allergic reactions were revealed, but only four appeared during the first test. The most common allergens were found to be nickel, gold, and a fragrance mix. Only 1 patient had a positive reaction to more than three allergens. Conclusions: There seems to be a high contact reaction rate in patients with oral lichen planus, which is not related to contact with synthetic dental materials. However, further investigations on a larger population with the introduction of additional tests administered 7 days after exposure are required to confirm the effects of delayed hypersensitivity reactions on patients with OLP exacerbation. [ABSTRACT FROM AUTHOR]

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

Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis. [ABSTRACT FROM AUTHOR]

Background Isothiazolinones are preservatives which are present in cosmetics, household chemicals and many other industrial products. Initially, a mixture of methylchloroisothiazolinone and methylisothiazolinone (MCI/MI – Kathon CG) was used, and then, from the beginning of the 21st century, only methylisothiazolinone. Due to a significant increase in the number of contact dermatitis caused by allergy to this compound, it was withdrawn from leave-on cosmetics, and its concentration in rinse-off cosmetics was reduced. The aim of the study was to analyze the incidence of contact allergy to isothiazolinones among patients in the Nofer Institute of Occupational Medicine, Łódź, the intensification of patch test results and hypersensitivity depending on the occupation, and to assess the contribution of immediate allergy to the occurrence of that hypersensitivity. Material and Methods In a group of 1137 patients (832 females and 305 males) with suspected contact dermatitis, diagnosed in 2014–2018, patch tests series including methylchloroisothiazolinone/methylisothiazolinone (0.01%) and methylisothiazolinone (0.2%), produced by Chemotechnique Diagnostics, Sweden, were performed. In a group of 29 individuals with contact allergy to isothiazolinones, prick tests with methylisothiazolinone (0.001%, 0.01%, 0.1%, 1%) (Sigma-Aldrich, Germany) were conducted. Results Of the 1137 subjects, 95 (8.3%) were allergic to isothiazolinones, slightly more often females – 71 (8.5%) than males – 24 (7.9%). In total, 150 positive patch tests with isothiazolinones (13.2%) were obtained. The number of positive results with methylisothiazolinone alone (7.8%) was higher than the number with methylisothiazolinone from Kathon CG (5.4%). Among the subjects sensitized to methylisothiazolinone alone strongly positive patch tests (+++) concerned 60.7%. In the female group, office workers (42.3%) and medical staff (18.3%) predominated, and in the male group – locksmiths, turners, mechanics and similar ones (45.8%), and construction workers (25.0%). Prick tests with methylisothiazolinone were negative, and they became positive after 3–5 h. Conclusions Isothiazolinones, particularly methylisothiazolinone, are significant causal factors of contact allergy, including that of occupational origin. They have strongly allergenic properties, and in patch tests they often give very severe inflammatory reactions. The issue of the role of immediate allergy in the pathogenesis of isothiazolinones sensitization requires further research. Med Pr. 2020;71(5):603–11

Acute Localized Exanthematous Pustulosis (ALEP) is a rare skin reaction characterized by the sudden onset of multiple, small, sterile, non-follicular pustules in an erythematous and edematous base succeeding systemic drug administration. ALEP is considered a subtype of Acute Generalized Exanthematous Pustulosis (AGEP), although the exact pathogenic mechanism of the disease remains poorly defined. Numerous drugs have been implicated in the pathogenesis of ALEP, while contact mechanisms have also been reported. Herein, we describe the first case of ALEP attributed to minoxidil in a female patient with androgenetic alopecia. The positivity of patch tests and the topical application of minoxidil proposes a contact-induced hypersensitivity reaction. Identifying new agents—including minoxidil—which serve as inducers of drug-specific T-cell-mediated responses in the clinical spectrum of ALEP, adds further value in understanding the complex, yet unknown, pathophysiological mechanisms of this rare drug hypersensitivity reaction.

After the meeting held by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) back in October 2021, changes were suggested to the Spanish Standard Series patch testing. Hydroxyethyl methacrylate (2% pet.), textile dye mixt (6.6% pet.), linalool hydroperoxide (1% pet.), and limonene hydroperoxide (0.3% pet.) were, then, added to the series that agreed upon in 2016. Ethyldiamine and phenoxyethanol were excluded. Methyldibromoglutaronitrile, the mixture of sesquiterpene lactones, and hydroxyisohexyl 3-cyclohexene (Lyral) were also added to the extended Spanish series of 2022., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Psoriasis is a chronic inflammatory dermatosis whose clinical and topographic distribution requires differential diagnosis, or the possible association with allergic contact dermatitis (ACD), requiring patch testing (PT) as part of the diagnostic procedure., Objectives: To describe the epidemiological, clinical, and allergic profile of patients with a primary or secondary diagnosis of psoriasis undergoing PT and compare them with patients with a diagnosis of ACD at the end of the diagnostic process., Methods: Cross-sectional study with data from REIDAC from 2018 through 2023 of selected patients with a diagnosis of psoriasis and/or ACD., Results: A total of 11 502 patients were included, 513 of whom had been diagnosed with primary or secondary psoriasis, 3640 with ACD, and 108 with both diseases. Men were more predominant in the groups of patients with psoriasis, psoriasis+ACD, and lesions were more predominantly seen in the hands with little association with atopic factors vs the ACD group. The rate of positivity in PT to the 2022 Spanish battery of allergens was lower in the group with psoriasis only in 27% of the patients. The most common allergens found in the psoriasis group were also the most common ones found in the overall ACD population., Conclusions: Overall, 36.2% of psoriatic patients tested positive in PT to the 2022 Spanish battery of allergens, which proved that this association is not uncommon. Overall, psoriatic patients had a higher mean age, were more predominantly men, and showed more hand involvement., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Allergic contact dermatitis induced by the use of ophthalmic topical drugs is one of the most common causes of eyelid dermatitis. The introduction of new formulations, both of active ingredients and excipients, and the lack of marketing in some of them, makes patch testing in patients whose source of contact are topical ophthalmic drugs truly challenging. Across this manuscript, most, if not all, topical ophthalmic drugs used in our national health system have been collected, including information on the allergens available, and the concentration and vehicle advised for those that still remain unavailable., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Aim: Celiac disease is one of the most common autoimmune disorders. This study aimed to evaluate the relationship between celiac disease and wheat sensitization., Subjects and Methods: In the current study, children aged < 18 years with confirmed celiac disease were included. Data were analyzed using SPSS., Results: Gastrointestinal problems were the most common indication for evaluation in terms of celiac disease. Prick and patch tests were positive in 43.4% and 34% respectively., Conclusion: Prick test and patch test for wheat sensitization were positive in about 30-45% of the children for celiac disease., (© 2024. The Author(s).)

Allergic proctocolitis is a cell-dependent food allergy that is present in both breast and formula-fed infants. The presence of blood with different amounts in the stool is the main manifestation of the disease. Different results have been published on the accuracy and specificity of the atopic patch test (APT). The purpose of this study was to evaluate the results of the APT and compare them with those obtained in the food elimination/introduction (E/I) challenge, as the gold standard of confirming the allergy. Twenty-eight patients (18 boys, 10 girls, <1 year) with allergic proctocolitis were recruited in this study. The mean age of the disease onset and enrolling the study were 2.23±1.7 and 5.25±2.19 months, respectively. After performing APT with fresh foods, an E/I challenge was done in a patient with positive tests, and results were analyzed. APT was positive in 14/28 (50%) individuals. The most common foods detected by APT in all of the individuals were: milk (10/28), rice (5/28), soy (4/28), and egg white (4/28), while in E/I challenge in the APT-positive individuals were: milk (8/10), rice (3/5), egg white (1/4), and soy (0/4). APT was positive in half of the infants<1 year with allergic proctocolitis and there was no significant correlation between the APT results and the E/I challenge test for all foods. Comparing the results of APT and E/I challenge methods showed a convergence between the milk and rice sensitivity, thus we suppose APT to be a useful tool in identifying these two allergens in cell-mediated food allergies like allergic proctocolitis. [ABSTRACT FROM AUTHOR]

Introduction: Chromium has been responsible for occupational skin disease, both irritant and/or allergic contact dermatitis. In order to minimize this problem, regulatory measures limiting its use have been implemented. The impact of these regulations should be monitored over time. Material and Methods: A retrospective study from 2009 to 2018 was carried out in the Department of Dermatology to assess the temporal trend of chromium sensitization evaluated by patch testing with potassium dichromate 0.5% pet, particularly considering age, sex and its relationship with occupational activity. Results: 3277 individuals were studied, 2369 females (72.29%) and 908 males (27.71%). Of those 621 (18.95%) fulfilled criteria for occupational contact dermatitis. Chromium allergy was found in 118 (3.60%) patients, 64 females (54.4%) and 54 males (45.76%). We found that male patients were significantly more frequent (45.76% vs 27.03%; p

Allergic proctocolitis is a cell-dependent food allergy that is present in both breast and formula-fed infants. The presence of blood with different amounts in the stool is the main manifestation of the disease. Different results have been published on the accuracy and specificity of the atopic patch test (APT). The purpose of this study was to evaluate the results of the APT and compare them with those obtained in the food elimination/introduction (E/I) challenge, as the gold standard of confirming the allergy. Twenty-eight patients (18 boys, 10 girls,

Palmoplantar pustulosis (PPP) is a chronic and relapsing disease of the palms and soles, which tends to be difficult to treat. Classically it was described as a subtype of psoriasis. Nowadays it is regarded as a separate entity, although plaque-type psoriasis affects concomitantly many patients with PPP. A link between allergic contact dermatitis (ACD) and PPP has been described, and the former may encompass a potential to perpetuate the latter. Hereby we report two cases of difficult to treat plantar pustulosis. Underneath the dermatosis’s refractive nature was an allergic sensitization to potassium dichromate and cobalt chloride. Leather shoes and leather insoles were commonly worn, and both allergens are employed by the leather industry. Clinical remission was achieved in both cases with allergen eviction. Patch testing must be considered in cases of PPP without response to treatment. If relevant sensitization is found, allergen eviction measures are mandatory.

Introduction: Chromium has been responsible for occupational skin disease, both irritant and/or allergic contact dermatitis. In order to minimize this problem, regulatory measures limiting its use have been implemented. The impact of these regulations should be monitored over time. Material and Methods: A retrospective study from 2009 to 2018 was carried out in the Department of Dermatology to assess the temporal trend of chromium sensitization evaluated by patch testing with potassium dichromate 0.5% pet, particularly considering age, sex and its relationship with occupational activity. Results: 3277 individuals were studied, 2369 females (72.29%) and 908 males (27.71%). Of those 621 (18.95%) fulfilled criteria for occupational contact dermatitis. Chromium allergy was found in 118 (3.60%) patients, 64 females (54.4%) and 54 males (45.76%). We found that male patients were significantly more frequent (45.76% vs 27.03%; p<0.001), as well as occupational dermatitis (31.35% vs 18.47%; p<0.001), hand dermatitis (53.54% vs 23.52%; p<0.001) and age above 40 years (70.34% vs 56.76%; p=0.003). Discussion/Conclusion: The results show a high prevalence (3.60%) of chromium positive patch tests. In our study, there has not been a significant decrease in sensitization to chromium over the years. Interestingly cases classically related to this allergy (cement in the building industry) are no longer the main cause of the problem. We found other sources such as leather as a main cause of allergic sensitization, suggesting a change of the panorama. [ABSTRACT FROM AUTHOR]

Abstract: Background: Contact dermatitis affects up to 20% of the population. Patch testing for contact allergy may be needed to confirm the diagnosis. Objectives: To describe and discuss the results of patch tests performed in a city in southern Brazil. Methods: A cross-sectional analysis was performed on all skin test results over ten years. Variables such as gender, age at the time of testing, and test results were evaluated. Triggering factors, duration of complain, and previous medications used related to the clinical history were retrieved for some patients by reviewing their medical records. Results: The sample was composed of 539 patch tests, of which 411 (76.2%) were from women. The age of the tested subjects ranged from 5 to 87 years. The prevalence of positive reactions in the patch tests was 391 (72.5%). The most prevalent positive reaction was to nickel sulfate (196; 36.4%), which had statistical significance when associated with female gender (p

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered.

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered. [ABSTRACT FROM AUTHOR]

Background: Data on the cutaneous side effects of herbal medicine is scarce, especially with regard to allergy skin testing. Our objective was to determine the relevancy of patch testing in the exploration of the cutaneous side effects of herbal medicine. Material and Methods: A prospective study was conducted in the Department of Dermatology of the Hospital Institute of Social Hygiene of Dakar over a one-year period. Patch tests were given to patients with cutaneous side effects related to the exclusive use of herbal medicine. The plants recovered were turned into macerates and powders and mixed with Vaseline at concentrations of 5%, 20%, and 30%. Results: Patch tests were given to 31 of the 53 patients included. They were positive in 11 patients (35.48%). Positive patients displayed systemic eczema (n = 7/15 of cases), Stevens--Johnson syndrome (n = 2/3), contact eczema (n = 1/1), and fixed pigmented erythema (n = 1/2). Positive tests were obtained for 11 medicinal plants identified: Jatropha chevalieri (n = 2), Terminalia avicennoïde (n = 2), Detarium microcarpum, Acacia seyal, Acacia albida, Acacia italic, Sesamum indicum, Mangifera indica, Momordica charantia, Nauclea latifolia, and Anogeisius leiocarpus (in one case each). There was no statistically significant relationship between the type of cutaneous side effect and the test result (p = 0.388) and between the nature of the plant used and the test result (p = 0.402). Conclusion: In view of their high rates of positivity, patch tests could prove promising in the exploration of the cutaneous side effects of herbal medicine. [ABSTRACT FROM AUTHOR]

Background: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process., Objectives: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022., Methods: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend)., Results: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend., Conclusions: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Allergic contact dermatitis is reported among individuals using continuous glucose monitoring systems and insulin pumps. The aim of this study was to describe contact allergy patterns for allergens in the Swedish baseline series and medical device-related allergens among users. Contact allergy to baseline series allergens and isobornyl acrylate was compared between diabetes patients and dermatitis patients patch-tested at the Department of Occupational and Environmental Dermatology during 2017 to 2020. Fifty- four diabetes patients and 2,567 dermatitis patients were included. The prevalence of contact allergy to fragrance mix II and sesquiterpene lactone mix was significantly higher in diabetes patients compared with dermatitis patients. Of the diabetes patients 13.0% and of the dermatitis patients 0.5% tested positive to sesquiterpene lactone mix (p < 0.001). Of the diabetes patients 7.4% and of the dermatitis patients 2.3% tested positive to fragrance mix II (p = 0.041). Of the diabetes patients 70.4% tested positive to medical device-related allergens. Of the diabetes patients 63.0% and of the dermatitis patients 0.2% were allergic to isobornyl acrylate (p < 0.001). In conclusion, not only medical device-related contact allergies, but also contact allergy to baseline series allergens (fragrance mix II and sesquiterpene lactone mix), is overrepresented in diabetes patients who use medical devices.

Background: Allergic contact dermatitis is one of the most common forms of skin diseases that require medical intervention. Appropriate detection of allergens by patch test and accurate avoidance of them is the key to management. The objective of this study is to determine the types and frequency of allergens responsible for Allergic contact dermatitis in a tertiary hospital of Nepal., Methods: Altogether 120 patients with Allergic contact dermatitis were enrolled in the study. Patch test was performed to find out the most common inciting allergen, utilizing the Indian Standard Series of allergens approved by The Contact and Occupational Dermatoses Forum of India. Results were read at 48 and 96 hours. Grading of the reactions was done based on the criteria of the International Contact Dermatitis Research Group. Pattern of reactivity of different allergens was assessed., Results: Of all the patients, 63 (53%) showed positivity to at least one allergen. Nickel sulfate was the most frequent sensitizing agent in 22 (18%) cases, followed by Fragrance mix in 11(9%) and Paraphenylenediamine in 7 (6%) cases. Out of all positive results, Grade 1 positivity was seen in 44 (51%), Grade 2 positivity in 41(47%) and only 2 (2%) cases showed Grade 3 positivity. Mercaptobenzothiazole, Balsam of Peru, Nitrofurazone and Wool Alcohol did not show positive results in any of our patients., Conclusions: Patch testing helps in the treatment, long term remission, and patient counseling for prevention. Larger scale studies are required to know the sensitivity to allergens in Nepalese population.

Psoriasis, a chronic inflammatory skin disease, goes beyond visible symptoms and affects the general well-being of patients. The aim of this study is to understand how patients with psoriasis perceive their skin characteristics and reactivity to allergens. The study population includes 11,283 participants within the European Dermato-Epidemiology Network (EDEN) Fragrance study, covering several European regions. The study compared perceptions of skin dryness, sensitivity, product avoidance and reactivity to allergens between patients with psoriasis and controls, evaluating the potential influence of psoriasis severity. The results showed that subjects with psoriasis reported dry skin (71.1%) and sensitive skin (49.4%) more often than did controls (51.6% and 38.5%, respectively). Psoriasis patients were more likely to avoid specific products. Interestingly, there were no significant differences in patch-test results between the 2 groups and the severity of psoriasis did not have a consistent impact on these perceptions. In conclusion, people with psoriasis tend to perceive their skin as drier and more sensitive. Notably, the severity of psoriasis did not consistently influence these perceptions and objective reactivity to allergens did not align with subjective perception. Understanding these aspects is crucial for tailoring treatments to improve the well-being of patients with psoriasis, which warrants further research to explore subjective perceptions of skin well-being in patients with psoriasis.

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Abstract: Background: In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes. Objectives: To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens. Methods: This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy. Results: Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses. Study limitation: Small sample size. Conclusions: Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.

Abstract: Background: Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects. Objectives: To analyze and compare with previous studies the profile of metal sensitization between 2003-2015. Methods: Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology. Results: Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p

Introduction: : Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. According on the culprit drug(s), imputability can be confirmed by patch test (PT). Our objective was to evaluate the value of PT in DRESS in the last 10 years, in comparison with our study in the preceding 10 years. Material & Methods: From 2009 to 2018, patients with DRESS performed PT at the Dermatology Department of Coimbra University Hospital, with the main culprit drug(s) and all drugs administered concomitantly or suspected of inducing DRESS flares. Drugs at 1% - 10% pet (Chemotechnique diagnostics®) or from a commercial preparation diluted at 10% pet were patch tested. Results: We studied 41 patients (20 male/21 female, mean age 53 years). The main culprits were allopurinol (n=15), antiepileptics (n=14), trimethoprim/ sulfamethoxazole (n=4), salazopyrine (n=3), diclofenac (n=2), antiretrovirals, ezetimibe/simvastatin and strontium ranelate (1 each). In 15 patients other drugs (n=18) were suspected of worsening DRESS, amoxicillin (n=8), ciprofloxacin (n=2), cefoxitin (n=2), levofloxacin, ceftriaxone, ceftazidime, vancomycin, acyclovir and metamizole (1 each). A positive PT to the culprit drug was observed in 10 patients (24.3%), all to antiepileptics. All patients tested for alopurinol had negative results. Positive reactions were observed to drugs related with flares in 12/18 suspected drugs (67%), but not to quinolones. Conclusion: Results were similar to the study conducted 10 years before when 18/56 (32.1%) patients had positive PT, mostly to carbamazepine and other anticonvulsants. Distinct from our previous study, when no tests were performed with the antibiotic series or other drugs used after the initiation of DRESS, we showed that PT can be a valuable tool to diagnose co-sensitisation in DRESS and emphasise the importance of testing all medications taken during the whole episode, even when PT has no value for the main culprit, like allopurinol. Recognising a co-sensitisation can prevent a new DRESS induced by the second drug. [ABSTRACT FROM AUTHOR]

Abstract: Fragrances may cause allergic contact dermatitis. Data on patients who were patch tested, between 2000 and 2015, with fragrance allergens included in the Brazilian baseline series (balsam of Peru, colophony and fragrance mix I), were collected and analyzed. Of these patients, 258 (13.8%) were positive for fragrance markers, 9.8% being positive for fragrance mix I. Among these 258 there was a predominance of women in their 40s, with hand eczema. The frequency of sensitization to fragrances, as well as the epidemiological profile, was supported by the literature. Fragrance mix I was the main marker. It is important to expand the fragrance markers used in the Brazilian baseline series of patch tests.

Introduction: The patterns of positive patch test in Nepal have not been defined so far. The aim of this study was to describe the patterns of patch test reactivity in suspected Allergic Contact Dermatitis (ACD) patients. Methods: This was a hospital based retrospective study performed to investigate patch test reactivity in patients with ACD from April, 2016 through October, 2016. The data of patients who underwent patch test during this period were extracted and analyzed. Results: A total of 35 patients were included in the study. Nineteen (54.3%) tested positive to either one or more allergens. Among them, 17 (89.4%) reacted positively to a single allergen. The following patterns of positives were seen: nickel sulfate, 5 (26.3%), fragrance mix 3 (15.7%), and parthenium 3 (15.7%). Cobalt sulfate, formaldehyde, potassium dichromate, benzocaine, nitrofurazone, chlorocresol each was positive in single patient. Majority of the patients were housewives (22.6%) followed by students and officers (13% each), farmers (10%), health care workers (9.7%), wet work (6.5%) and others (20). Less than half (45%) of the hand eczema showed positive patch test. Similarly,40% of the patient of scattered generalized dermatitis showed reactivity to parthenium, nickel sulfate and multiple antigens. Conclusions: The most common allergens identified were nickel sulfate, fragrance mix and parthenium. Since, there is no well defined contact allergen in the Nepalese community, so patch test kits developed elsewhere might not have been beneficial and calls for need of large scale investigation to identify the local allergens.

Introduction : Contact dermatitis is a relatively common dermatosis reported among several population groups from all around the globe. However, the data from Kuwait is unavailable. Patch tests are essential for the diagnosis of contact sensitization. Aim : To determine a relative frequency and pattern of sensitizers to different allergens in patients of suspected contact dermatitis in Kuwait and, also to study the role of the commonest sensitizer in detail. Material and methods: Patch tests were performed in 2461 consecutive patients with a clinical diagnosis of contact dermatitis seen at our hospital between September 1, 2014 and August 31, 2015. Out of the total of 1381 (56.1%) patients with positive patch test results to at least one allergen, 546 (22.2%) patients with a single positive reaction to nickel only (single largest sensitizer) were selected as the study population for further detailed analysis. Results : At least one positive patch test reaction was found in 1381 (56.12%) patients. Nickel was found to be the most common sensitizer seen in 546 (40%) patients. The mean age was 37.3 ±13.8 years and the mean duration of disease was 27.3 ±13.8 months. Most (387/546) patients sensitized were females. The forearms/hands and wrists were the most prevalent sites (52.56% of the participants). In 58.91% of women, dermatitis was more often confined to other sites, mostly ears and the neck due to earrings and necklaces. Just more than half of the number (51.09%) of nickel allergic patients were found in the age group of 15–25 years. Hairdressers/beauticians were the most affected group followed by house workers (housewives, cleaners, housekeepers). Conclusions : Nickel is the single most common sensitizer found in our patients, and female sex, young age, occupation with long hours of contact to nickel are high risk factors. We recommend that a directive, which limits the release of nickel from products with extended skin contact, be approved in Kuwait.