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The panoply of products used by hair care professionals to wash, dye, shape and beautify hair is not entirely free from adverse events. Such effects consist mainly of irritation dermatitis and allergic contact eczema affecting the scalp, as well as the back and front of the neck, the forehead and periorbital areas, and the cheeks. The most frequently cited allergens include paraphenylenediamine (PPD) in hair dyes, glycerol monothioglycolate (GMTG) in acid perm lotions, and ammonium persulphate in hair lighteners (the latter substance being responsible primarily for contact urticaria). However, care should also be paid to other allergens such as cocamidopropyl betaine among surfactants, as well as certain components in hair formulations such as preservatives and fragrances (as well as minoxidil, frequently used by patients).

Henna is used for coloring hair, but also to draw labile skin tattoo. Henna is often mixed with paraphenylenediamine (PPD). We report the case of a female patient presenting with contact eczema due to labile tattoo containing PPD. The study involved a 23-year old young woman with an aesthetic Black Henna tattoo on the back of the hand and on the forearm. This labile tattoo contained PPD. Two days later, the patient developed intensely pruritic, burning erythematovesiculosus and edematous lesions. The lesions involved the tattooed area, corresponding with the original drawing. The lesions were improved using Class 1 of topical corticosteroids (Clobetasol propionate). The patient refused allergy patch testing, so no allergy test was performed. Now, henna is very popular in the western countries. PPD is added to reduce the fixing time or to obtain a darker coloration. It can result in severe systemic reactions. The most frequent allergic reaction is contact dermatitis. Treatment is based on local corticosteroid therapy. A better regulation on labile tattoo, the control of preparations as well as a regular annual information for the general public are essential. The interest of our study lies in highlighting the importance of informing, especially young people, on the risks of labile tattoo.

Allergic contact dermatitis around chronic leg ulcers (CLU) is a common complication in patients presenting CLU and prolongs healing times. The aim of this study was to describe the rate of sensitization to modern dressings (MD) used in these patients and to assess whether there is a relation between the number of sensitizations and ulcer type, the time from onset of the ulcer, and patient age and gender.We conducted a retrospective study at Reims University Hospital between 2010 and 2014 that included all patients with CLU of vascular etiology surrounded by eczematous lesions, and who had one of the patch-tests in the following 3 series: European baseline±leg ulcers±corticosteroids.Among the 73 patients included, 43 % were polysensitized. Thirty-three patients (45 %) were sensitized to MD (38 % to hydrocolloids, 18 % to hydrogels, 7 % to hydrocellular dressings, 7 % to hydrofiber dressings, 5 % to contact layers and 3 % to alginates). Median age and sex did not differ between "polysensitized" patients and "non-polysensitized" patients (P=0.84 and P=0.25, respectively). Polysensitization was more frequent among patients presenting ulcers for more than 5 years (P=0.032).Practically half of all patients presenting CLU with surrounding contact dermatitis had sensitization to modern dressings (mostly hydrocolloids and hydrogels). The rate of sensitization increased with the length of presence of CLU.

Whether they are professional or amateur, musicians are exposed to a various number of complications in relation to their practice, including cutaneous ones. The latter are often a simple musical stigma and a reason for pride for the musician. If they are symptomatic and disturb the musician, they have to be treated and prevented. We reviewed here those occupational and peculiar lesions that are often not that well known to the dermatologist.

Inability to tolerate cosmetics can result from distinct mechanisms which appear as the so-called sensitive skin corresponding to one aspect of invisible dermatosis, or which corresponds to manifestations of a contact allergic or irritation dermatitis.

Itchy skin rashes are a frequent reason to seek medical advice. The symptoms may be caused by hypersensitivity reactions to arthropod bites, waterborne parasites or setae from moth caterpillars and are sometimes mistaken for spontaneous urticaria or eczema. Some of these pests are resurging in Switzerland and elsewhere and increasingly responsible for emergency consultation. In this article we review itchy skin rashes caused by bed bugs, scabies, lice, cercariae, Pyemotes spp, caterpillars and harvest mites, which may be confounded with urticaria and allergic contact dermatitis. We detail here clinical manifestations, topographical distribution of skin lesions, epidemiology, treatment and preventive measures.

The prevalence of respiratory allergies is increasing and is a serious global health problem. The objective of the study was to determine the prevalence of skin sensitization to inhalant allergens in patients consulting for respiratory allergy, to identify the main allergens involved and to evaluate the profile of skin prick-test reactivity related to sex, age and season. This retrospective study included 379 patients consulting during 2009-2012 in three private medical offices of Tetouan. Of the 379 patients, 39.6% were monosensitized and 60.4% polysensitized. The percentages of polysensitized patients were higher in patients exhibiting rhinoconjunctivitis and astma-rhinoconjunctivitis than in subjects with asthma. The prevalence of symptoms according to sex showed no significant difference (P=0.64). Regarding age, a significant difference was observed in the case of rhinoconjunctivitis (P0.01), while asthma and asthma-rhinoconjunctivitis showed no significant difference. Sensitization to house dust mites was the most frequent followed by grasses, olives and Parietaria. The multiple correspondence analyses (ACM) showed that patients under 20-years of age with asthma and asthma-rhinoconjunctivitis profile are more associated with sensitization to mites during the spring and autumn. The 20-49-year age group was represented mainly by polysensitized patients with rhinoconjunctivitis. Sensitization to mites ranks first in Tetouan followed by the percentage of sensitized patients to grass pollen and olive. The ACM showed that the house dust mite asthma seems to affect more children and adolescents while the 20-49 year age of polysensitized group suffers significantly rhinoconjunctivitis.

Cutaneous eruption around a peritoneal dialysis (PD) catheter exit site is a rare complication. Herein we report a case of bullous eruption; we discuss the diagnostic approach and the related therapeutic implications.A 63-year-old man presented a bullous periumbilical eruption two months after initiation of PD. Cultures of laboratory samples ruled out an infectious origin and systemic corticosteroids initiated at 0.5mg/kg for suspected eosinophilic peritonitis produced significant improvement of the cutaneous eruption. Recurrence of the bullous eruption was observed upon dose-reduction of the corticosteroid. Skin histology showed a clinical picture of eczema and direct immunofluorescence was negative. Patch testing was carried out using the European Standard Battery comprising antiseptic, cosmetic and plastic series; a semi-open test was performed with the dressing used for PD, and ROAT was carried out on the povidone iodine (Betadine™) 10% used for topical care during PD. The patch testing and ROAT were positive (++), confirming contact dermatitis due to Betadine™. The eruption totally disappeared on substitution of Betadine™ by chlorhexidine for topical antisepsis of the PD catheter, thus enabling PD to be continued rather than instituting hemodialysis.Allergic contact dermatitis around a PD catheter is a rare and little-known complication. In the present case, ROAT testing showed sensitization to Betadine™ and enabled an alternative antisepsis solution to be found, allowing PD to be continued.

Chronic hand dermatitis is often multifactorial but allergic causes are frequent and can complicate atopic dermatitis or irritant dermatitis. The management of patients affected by hand dermatitis includes detailed interrogation and a complete examination of the skin. Allergologic tests must be systematically realized if examination is suggestive of contact dermatitis or protein contact dermatitis, if an occupational origin is suspected but also in all patients in which treatment is ineffective. Skin tests include patch tests with the European standard series, specialized or additional series if necessary. Skin tests may also include personal items used by patients on a daily basis. If protein contact dermatitis is suspected skin tests include prick tests. Only complete and definitive eviction of allergens can allow a complete and definitive cure of chronic hand dermatitis.

Psychopathology in patients with DCM is as complex as its clinical forms where the factors are numerous and often intricate. It combines psychophysiological, psychopathological factors, behavioral disorders which can be the cause or the consequence of DCM but also the negative impact on quality of life and the simplest daily activities. DCM affects the quality of life of every patient, regardless of the severity. Women are more affected by the DCM that man older age, male sex, atopy and the existence of a contact sensitization are independent risk factors of severity. Depression may affect up to 10 % of patients, should involve greater attention from dermatologists and general practitioners. Health authorities and all health actors should be aware of interactions between secondary cognitive troubles or inherent to DCM and efforts required in terms of preventive measures. Thus, the presence of psychiatric comorbidity is more common in patients with chronic dermatoses. Today it is considered that the emotional environment, built by the mother - child relationship must be optimal, otherwise the mental stability of body image may be compromised. Diminished self-esteem, affects less well managed and somatic expression of emotional content. Recently, a surprising study showed that most patients with refractory occupational dermatitis were not able to recognize the warning sign of flare or the role of psychological factors in the formation and maintenance of the dermatose. In fact, they rejected their personal responsibility in the occurrence of the new flare. To address this public health problem, health authorities, trainers and caregivers should be aware of the cognitive impact of DCM in these patients and interactions with current means of prevention. The role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of DCM and in the therapeutic management.

Contact dermatitis--irritant contact dermatitis, allergic contact dermatitis and protein contact dermatitis--are the most common occupational skin diseases, most often localized to the hands. Contact urticaria is rarer The main occupational irritants are wet work, detergents and disinfectants, cutting oils, and solvents. The main occupational allergens are rubber additives, metals (chromium, nickel, cobalt), plastics (epoxy resins, acrylic), biocides and plants. Diagnosis is based on clinical examination, medical history and allergy testing. For a number of irritating or sensitizing agents, irritant or allergic dermatitis can be notified as occupational diseases. The two main prevention measures are reducing skin contact with irritants and complete avoidance of skin contact with offending allergens.

The number of household pets increased greatly during the twentieth century, with the numbers of new pets (NP, i.e. any pet other than cats and dogs) rising especially sharply over the last decade. Contact with such animals, whose owners do not always know how to look after them properly, expose the population to new risks such as trauma, infection and allergy. While the most common allergies are respiratory, allergic skin reactions, both immediate and delayed, may also result from contact with these new allergens. The animal itself or its environment may be the cause. Herein, we review NPs and reports of allergic dermatitis associated with them.

The number of household pets increased greatly during the twentieth century, with numbers of new pets (NP, i.e. any pets other than cats and dogs) rising especially sharply over the last decade.We first of all report the case of a female patient with eczema lesions on areas skin coming into contact with a ferret, with removal of the animal resulting in wound healing, followed by two patients presenting atypical polymorphous erythema reactions induced by dermatophytes present in their pet rat.While the most common allergies are respiratory, allergic skin reactions, both immediate and delayed, may also result from contact with these new allergens. The animal itself or its environment may be the cause.

The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors.The aim of our study was to evaluate the prevalence of sensitizing to aeroallergens in the child and to determine the risk factors of sensitizing.We carried out a cross-sectional study relating to 200 pediatric patients of the Mahmoud El Matri hospital, aged from 3 to14 years. We performed skin prick test to 12 current aeroallergens.The prevalence of sensitizing to aeroallergens was 14%. Acarina (DP and/or DF) represented the allergens accused in the majority of the cases (96,4% of the cases). The statistical analysis of the various risk factors of sensitizing showed that these factors were: the presence of a family atopy (p= 0,0034) particularly a maternal asthma (p0,001), the personal atopy specially an asthma, an allergic rhinitis or eczema atopic (p10-5), the short breast-feeding (p= 0,033) and the home humidity (p=0,0072). Several risk factors reported in the literature did not seem to intervene in our study (the passive smoking, the urban dweling, the age of food diversification, infections at the low age).The prevalence of sensitizing to aeroallergens is relatively high in our series. Many factors could explain the increase of the allergic diseases. Our study stresses the importance of the genetic, nutritional and environmental factors in the appearance of aeroallergens sensitization.

Le gel d’échographie est un gel utilisé en échographie pour la transmission ultrasonique médicale, il est connu par la plupart des cliniciens pour ces avantages d’être un gel non gras, non irritant, hypoallergénique, incolore et inodore. Cependant, ce gel peut être responsable de la survenue d'un eczéma de contact allergique après son application. Nous rapportons le cas d'une jeune fille qui a présenté une dermite de contact allergique quarante huit heures après la réalisation d'une échographie cervicale.

Periodically updated, the European baseline series (EBS), first introduced in France in 1980, is an indispensable tool for the exploration of contact allergy. The aim of our study was to describe the prevalence of contact sensitization in a French centre between 1981 and 2011 to determine whether certain allergens may be deleted from the current BSE.A retrospective study was conducted in a department of dermatology-allergology to analyse the results of all EBS tests performed every 10 years, from 1981 to 2001, and annually from 2007 to 2011. Some added allergens, introduced in 2010, were also studied. Changes in allergen positivity were analysed using a Cochran-Armitage test.Among the 4551 patients included for the 8-year period studied, the prevalence of positivity was 42.91%. The most common allergens in the general population were nickel sulphate (17.25%), with a constantly increasing prevalence, Myroxylon pereirae (10.68%), fragrance mix I (8.11%), cobalt chloride (6.99%) and chromium (6.33%). The least frequent sensitizations, with a decreasing prevalence, were found with clioquinol (0.25%), primin (0.54%) and benzocaine (0.55%).Due to modifications in exposure to allergens, the incidence of contact sensitization can change, but nickel sulphate sensitization is increasing despite recent European directives. Allergens with less than 1% of positive results could be withdrawn from the EBS, with benzalkonium chloride, methylisothiazolinone and lavender absolute being added.

We report the case of a girl presenting acute allergic contact dermatitis due to methoxy PEG 22 dodecyl glycol contained in Mustela Cold Cream Nutriprotecteur®.A 6-year-old girl was referred with acute eczema of the face occurring within 12h of applying a new moisturizing cream, Mustela Cold Cream Nutriprotecteur®. Patch tests were performed on the upper back using the Finn Chamber technique with the European standard series and the patient's own cream. Readings were performed after 2 days and the sole positive ++ reaction was associated with Mustela Cold Cream®. Additional patch testing was carried out with the ingredients of the cream, with the sole positive ++ reaction again being to methoxy PEG 22 dodecyl glycol copolymer. The other ingredients were negative.Methoxy PEG 22 dodecyl glycol is a copolymer used in cosmetics as an emulsion stabilizer and viscosity-increasing agent. It is found in 20 cosmetics currently on the market, most of which are prescribed for children.Although it is rare, doctors must be aware of allergic contact dermatitis due to methoxy PEG 22 dodecyl glycol because of the extent of clinical reactions and because it chiefly affects the paediatric population.

Ritual and artistic tattoos rely on the use of numerous pigments which are not all entirely inert once placed in the dermis. The compositions of some tattoo inks are identified. However, new but less well identified compounds appear on the market. Allergic reactions can be present under different aspects. They may correspond to allergic contact dermatitis or to photodermatitis. Other reactions include allergic hypersensitivity reactions as well as lichenoid, granulomatous or pseudolymphoma reactions. Pulsed light and laser are typically used for regular tattoo removal. These procedures are not indicated in inflamed tattoos. Indeed, the pigment dispersed during photolysis may perpetuate the reaction. Pseudotattoos due to the stratum corneum staining are frequently responsible for photoeczema.

Lymphomatoid contact dermatitis is a delayed hypersensitivity reaction predominantly featuring T-cell infiltration. We report a case mainly involving B-cell infiltration associated with eczema and resulting from an indirect proxy contact with an allergen in a conjugal setting.A 32-year-old man had an infiltrated cutaneous lesion on the interior aspect of the left arm with eczematous lesions of the waist and the anterior aspect of the left arm which were present for 6 months. All of these lesions were unresponsive to strong local steroids. Biopsy of the infiltrated lesion showed a dense lymphoid dermal infiltration chiefly comprising B cells. Histological examination of a waist lesion revealed chronic eczema. Patch testing was performed with the ECDRG test battery. A PPD (paraphenylenediamine) patch test was the only examination yielding a positive result. Detailed questioning revealed use of a hair dye by the patient's spouse and withdrawal of the allergen resulted in complete remission of the two types of lesion.This case highlights the ability of a single allergen to induce different lymphoid phenotypes. It also underscores the value of detailed questioning in allergology.

Numerous professional or leisure activities expose individuals to plants susceptible to provoke contact allergies. The immunological mechanisms that are responsible for these ailments (delayed cellular reaction linked to allergic dermatitis or immediate IgE mediated reaction of the allergic urticaria) differ according to the plant families involved. A differential diagnosis must be made in the case of the even more frequent non-allergic reactions implying either a simple mechanical irritation, or a contact with toxic substances. The role of UV (phytophotodermatosis), as well as the contact allergy to wood is also evoked in this paper.

Henna, or Lawsonia inermis, has been used since antiquity by women in the Orient for dyeing the hair, hands, and feet. Contact dermatitis to pure henna is very rare, most often caused by additives such as perfume oils or paraphenylenediamine (PPD). We report the case of a girl who presented contact dermatitis to henna associated with eczema to draw attention to the dangers related to its use.A 12-year-old girl developed erythematovesicular and edematous lesions with very itchy burning, suggestive of contact dermatitis, 48 hours after application of black henna. Lesions were located at the tattooing site exactly following the original design. The patient also had eczema lesions on the left cheek after contact with the tattooed hand. The lesions were improved by treatment with level II corticosteroids.Today, henna has become very popular in Western countries. PPD is added to reduce the fixation time or to obtain a darker color. It can cause severe systemic reactions. The most common allergic reaction is contact dermatitis. Treatment is based on topical steroids. Better legislation on temporary tattooing practices and control preparations as well as regular annual information aimed at the general public are essential.This observation raises awareness of the importance of information on the serious risks of a labile tattoo, most particularly for the young.

We report a case of atopic dermatitis in relation with a surgical titanium clip. Such a complication has only been reported once in the literature. We advocate to ask the patients about query atopic manifestations especially contact dermatitis to metal before any procedure involving metallic implants.

This article reviews the key points in the history of patch testing, which spans more than a century, starting with the first description of the method by J. Jadassohn in 1895. Special attention is paid to the contribution of French schools in this field, which led to the foundation of the Groupe d'études et de recherches en dermato-allergologie (GERDA).

Patch testing using standard and specific batteries, as well as the ingredients of products brought in by patients, is still the most reliable way of identifying contact allergens. However, under certain conditions, other methods such as the semi-open test and the repeated open application test (ROAT test) may be more appropriate.

This chapter reviews pitfalls and mistakes in patch testing. Most sources of false-positive and false-negative reactions are indicated and analysed. Cross-sensitivity among allergens is discussed and compound allergy is debated. Keys for establishing relevance are indicated, for a better reading and interpretation of patch testing by practitioners (trainees or experienced dermatologists).

Detailed analysis of symptoms indicates which skin tests should be performed in a patient presenting an allergic reaction to cosmetics: the tests should be read after 15 to 60 min for immediate reactions and after 48 and either 72 or 96 h for eczematous reactions. If the results are inconclusive, additional tests should be performed (ROAT, re-test, usage test). Discrepancies between clinical symptoms and tests results should raise a suspicion of false-positive or false-negative tests.

Plant-induced dermatoses involve a variety of mechanisms and result from direct contact with the plant itself, part of the plant or an extract thereof; they may also involve phototoxic or photoallergic reactions. Subjects most exposed are woodworkers, agricultural workers, orchard workers, gardeners, etc. However, many subjects are also exposed during leisure activities (fishing, country walks, gardening, sports, etc.). History-taking is thus essential before beginning testing in order to establish any differential diagnoses. Tests consist of challenges using commercially available allergens, patch-tests using the plant itself or plant extracts, and skin prick-tests or photopatch-tests.

The tests in the European standard battery must occasionally be supplemented by specialised or additional batteries, particularly where the contact allergy is thought to be of occupational origin. These additional batteries cover all allergens associated with various professional activities (hairdressing, baking, dentistry, printing, etc.) and with different classes of materials and chemical products (glue, plastic, rubber...). These additional tests may also include personal items used by patients on a daily basis such as cosmetics, shoes, plants, textiles and so on.

We describe the methods used in patch-testing: various kinds of chamber tests, the standard and additional series of patch-tests, mix of allergens, information about allergens comprising the European Standard Series.

Patch testing may be desirable or even essential for cases of suspected allergic contact dermatitis. Such testing allows identification with absolute certainty of the causative agent in "supposed" allergic contact dermatitis.