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Background: The textile dye mix (TDM) 6.6% in petrolatum contains Disperse Blue (DB) 35, Disperse Yellow 3, Disperse Orange (DO) 1 and 3, Disperse Red 1 and 17, and DB 106 and 124. The most frequent allergen in TDM-positive patients is DO 3. Around 85% of para-phenylenediamine (PPD)-allergic dermatitis patients have been positive to DO 3. There has been a discussion to exclude DO 3 from TDM 6.6% because of strong simultaneous reactions to TDM and PPD. Objectives: To study if DO 3 can be excluded from TDM 6.6%. Methods: Patch tests were performed on 1481 dermatitis patients with TDM 6.6%, TDM 7.0% (without DO 3 but the other disperse dyes at 1.0% each), DO 3 1.0%, and PPD 1.0% pet. Results: Contact allergy to TDM 6.6% was 3.6% and to TDM 7.0% was 3.0%. All 26 DO 3-positive patients were positive to PPD. The 44 patients positive to TDM 7.0% plus the 13 positive to PPD and TDM 6.6% but negative to TDM 7.0% were 57, outnumbering the 53 positive to TDM 6.6%. Conclusion: TDM 7.0% can replace TDM 6.6% in the Swedish baseline series, since TDM 7.0% together with PPD 1.0% will detect patients with textile dye allergy.

Contact allergy can manifest in a variety of ways clinically. Systemic contact allergy may occasionally present with pain in muscles and joints. Fibromyalgia is a chronic rheumatic disease characterized by pain and with virtually unknown aetiology.The aim of this study was to investigate the contact allergy rates to the sensitizers in a baseline series and compare with corresponding rates in dermatitis patients and the general population.Patch testing with the Swedish baseline series was performed in 120 individuals with fibromyalgia. Fisher's exact test was used for pair-wise comparisons of contact allergy rates between the fibromyalgia group and two control groups, dermatitis patients and individuals in the general population.Contact allergy was significantly more common in the fibromyalgia group compared to the general population concerning nickel and the fragrance markers Myroxolon pereirae and fragrance mix I. There were fewer allergic reactions to preservatives in the fibromyalgia group compared with the dermatitis group.Myroxolon pereirae and fragrance mix I represent besides fragrance allergy also allergy to flavouring substances which indicate that oral exposure to flavouring substances and hygiene products might be important for sensitization and possibly elicitation of systemic contact allergy symptoms in fibromyalgia individuals.

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

BACKGROUND Since the spring of 2020, we have seen several patients experiencing severe allergic contact dermatitis (ACD) from the Dexcom G6 glucose sensor after the composition of the sensor's adhesive patch had been changed. We have previously reported the finding of a new sensitizer, 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate, in the Dexcom G6 adhesive patch. Three patients with ACD from Dexcom G6 tested positive to this sensitizer. They were also allergic to isobornyl acrylate, a sensitizer present both in Dexcom G6 and in other medical devices previously used by these patients. OBJECTIVE The aim of the study was to report the first 4 cases sensitized to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate without a simultaneous allergy to isobornyl acrylate. METHODS The cases were patch tested their own materials, a medical device series, and 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate in several concentrations. RESULTS All 4 cases tested positive to 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate at either 1.0% or 1.5% in petrolatum, whereas 20 controls tested negative to both concentrations. CONCLUSIONS The cases reported here provide further evidence of 2,2'-methylenebis(6-tert-butyl-4-methylphenol) monoacrylate as a relevant culprit sensitizer in patients with ACD from Dexcom G6. However, the initially used patch test concentration (0.3%) did not suffice to elicit positive reactions in these cases, which is why patch testing at 1.5% is recommended.

BACKGROUND: Contact allergy to oxidized (ox.) linalool and ox. limonene has been reported to have a high prevalence, raising the question of inclusion into the baseline series. However, several important issues should be clarified and further investigated before inclusion can be warranted.OBJECTIVES: To report the trends of ox. terpenes allergy in patients with dermatitis, features of the patch test reactions, and clinical characteristics of the patients.METHODS: A retrospective analysis of 5773 patients was performed. All patients were patch tested with baseline series, individual ingredients of fragrance mix I and II, ox. linalool, and ox. limonene from 2013 to 2020.RESULTS: The prevalence rates of contact allergy to ox. linalool and ox. limonene were 7.0% and 5.1%, respectively. Significantly increasing trends of contact allergy were observed. More than 95% of contact allergy cases were identified on Day 3/4. Patients with contact allergy to ox. linalool and ox. limonene were significantly younger than those with contact allergy to other fragrances and were predominantly female. Strong reactions were associated with older age and multiple fragrance allergies.CONCLUSIONS: Contact allergy to ox. linalool and ox. limonene is becoming increasingly important, and findings show intriguing features. More studies concerning the clinical relevance before recommending these substances for screening are required. (Less)

Background: Polyaminopropyl biguanide (INCI name) and polyhexamethylene biguanide (PHMB) are polymeric biguanides. PHMB is a broad-spectrum antimicrobial substance used as a preservative in many products. Due to our limited knowledge on PHMB contact allergy frequency and the fact that cases of allergic contact dermatitis to PHMB might be missed, we have included PHMB as a screening allergen since 2016. Objective: To report the prevalence of positive patch-test reactions to PHMB as a screening allergen in patients with suspected allergic contact dermatitis. Methods: A retrospective analysis of 1760 patch tested patients from July 2016 to December 2018 was performed. Polyaminopropyl biguanide 2.0% aqua was included in the extended Malmo baseline series during the study period. Results: Of all patients, 1204 (68.4%) were female. Positive patch-test reactions were reported in 19 patients (1.1%). The most common sites of lesions were face, head, and neck (52.6%). There was a significant correlation between concomitant reactions to PHMB and other cosmetic-related allergens. Conclusion: The prevalence of positive reactions to PHMB was higher than that previously reported. Patch testing with PHMB should be performed in patient with dermatitis who have lesions on the face, head, and neck. (Less)

Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated.To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs.A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed.The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3-cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series.Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.

Recently, aluminum chloride hexahydrate (ACH) 10.0% petrolatum (pet) was recommended for patch testing to detect aluminum contact allergy. Aluminum lactate (AL) may be as reliable a test substance as ACH.We aimed to investigate the frequencies of aluminum allergy when ACH and AL were used in patch testing consecutive patients.Petrolatum preparations of ACH 10.0% and AL 12.0% were added to the baseline series in 2010-2017. Aluminum chloride hexahydrate 10.0% pet was added to the children baseline series from July 1, 2012, to December 31, 2017.A total of 5448 patients were patch tested with the extended baseline series and 196 children with the extended children baseline series. Forty-eight of the 5448 adults (0.9%) and 10 of the 196 children (5.1%) were diagnosed with aluminum contact allergy. A significant difference was found between the aluminum allergy frequencies in children and adults patch tested with ACH in 2013-2017 (P0.001). The difference between the frequencies of contact allergies for the 2 aluminum salts is not statistically significant.Patch testing with ACH and AL demonstrated similar contact allergy frequencies. To detect aluminum allergy, patch testing with ACH 10.0% pet is recommended. Aluminum chloride hexahydrate 10.0% pet should be considered for inclusion in baseline series for patch testing adults and children.

Background: Non-occupational cases of contact dermatitis to finished wood are occasionally reported from contact with wooden jewellery, musical instruments, knife handles and wooden footwear. Two female patients, 26 and 34 years old, developed acute eczema on the wrists after they worn in the summer a kind of catholic bracelet called “memorabilia” made by single wooden chunks with over-impressed iconic religious images. Objectives: To identify the culprit photoallergen responsible for the reported adverse reactions suspected to be a compound of the wooden bracelets. Methods: Three months after the resolution of the dermatitis, patch test and photo-patch tests were performed with the S.I.D.A.P.A. (Italian Society of Allergic, Occupational and Environmental Dermatology) standard series, and with wood sawdust obtained from both bracelets and tested at 5% in pet. A thin-layer chromatogram (TLC) strip and an extract made from the bracelets were tested in both the patients as patch test and photo-patch test. The extracts of the wooden bracelets were analyzed by gas chromatography – mass spectrometry (GC-MS). Results: Patch tests and photo-patch test with standard series turned out negative. Photo-patch tests with wood sawdust in pet. 5% evidenced a positive reaction (++) in both patients. Two chemicals were detected in the wooden bracelets with GC-MS: dibutylphthalate, commonly used as plasticizer, and 8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one, a coumarin. Patch test with TLC did not elicit positive reactions but the photo-patch test with TLC gave positive reactions in both the patients to the same invisible spot on the strips. Two coumarins (8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one and 8,8-dimethyl-2H,8H-benzo[1,2-b:5,4-b']dipyran-2-one) were detected in the spot with GC-MS. Conclusion: Coumarins are chemicals found in many plants with a known photo-allergic potential. They are probably the main photo-allergens in religious wooden bracelets instead of quinones and psoralens hypothesized in previous reports.

Background: Isobornyl acrylate (IBOA) has recently been identified as one sensitizer in the FreeStyle Libre glucose sensor. Analyses with gas chromatography-mass spectrometry (GC-MS) have indicated the presence of N,N-dimethylacrylamide (DMAA) in the sensor. Material and methods: Seven patients were referred for patch testing after developing skin reactions when using FreeStyle Libre. All patients were patch tested with IBOA and DMAA. Two patients were tested with adhesive patches that had been removed from the sensors “as is,” and two patients were tested with acetone extracts of materials from the sensor. The extracts were analysed with GC-MS. Results: Six patients reacted to both IBOA and DMAA, and one patient reacted only to DMAA. Positive reactions were also observed in both patients tested with the adhesive patch "as is". One patient reacted to both an extract of the adhesive patch and an extract of the sensor itself. When analysed with GC-MS, IBOA was found in both extracts and DMAA was found in the extract of the sensor. Conclusion: Both IBOA and DMAA may be present in adhesives used in medical devices such as glucose sensors or insulin pumps, and should be patch tested when suspected contact allergic reactions to these products are investigated. (Less)

Since the spring of 2020, we have seen several patients experiencing severe allergic contact dermatitis (ACD) from the Dexcom G6 glucose sensor after the composition of the sensor's adhesive patch had been changed. We have previously reported the finding of a new sensitizer, 2,2'-methylenebis(6- tert -butyl-4-methylphenol) monoacrylate, in the Dexcom G6 adhesive patch. Three patients with ACD from Dexcom G6 tested positive to this sensitizer. They were also allergic to isobornyl acrylate, a sensitizer present both in Dexcom G6 and in other medical devices previously used by these patients.The aim of the study was to report the first 4 cases sensitized to 2,2'-methylenebis(6- tert -butyl-4-methylphenol) monoacrylate without a simultaneous allergy to isobornyl acrylate.The cases were patch tested their own materials, a medical device series, and 2,2'-methylenebis(6- tert -butyl-4-methylphenol) monoacrylate in several concentrations.All 4 cases tested positive to 2,2'-methylenebis(6- tert -butyl-4-methylphenol) monoacrylate at either 1.0% or 1.5% in petrolatum, whereas 20 controls tested negative to both concentrations.The cases reported here provide further evidence of 2,2'-methylenebis(6- tert -butyl-4-methylphenol) monoacrylate as a relevant culprit sensitizer in patients with ACD from Dexcom G6. However, the initially used patch test concentration (0.3%) did not suffice to elicit positive reactions in these cases, which is why patch testing at 1.5% is recommended.

Simultaneous contact allergies are common in individuals with photocontact allergy to ketoprofen. The rate of contact allergy to the fragrance substances oxidized linalool and oxidized limonene in ketoprofen-photo-allergic individuals were investigated in comparison with the corresponding rates in individuals without photo-contact allergy to ketoprofen, using Fisher's exact test. A total of 4,021 patients were routinely tested with oxidized linalool; of whom 190 (4.7%) tested positively. For oxidized limonene the numbers were 3,797 patients and 111 positive reactions (2.9%). A total of 19 contact allergic reactions to oxidized linalool were noted in 29 patients (65.5%) who also had photocontact allergy to ketoprofen (p

Occupational dermatosis are common all over the world [1, 2, 3, 4, 5]. The prevalence depends on many factors including whether the legal system acknowledges both causation and aggravation of occupational dermatosis [6, 7].

Background: Medical devices are increasingly being reported to cause contact allergic dermatitis reactions. Objective: Review of patients with diabetes type I referred for suspected allergic contact dermatitis to insulin pump or glucose sensor systems. Method: We have reviewed 11 referred diabetes mellitus patients investigated for allergic contact dermatitis reactions to medical devices and specifically Dexcom G6®. Extracts from the medical devices were analysed. Results: The majority of patients was children, the majority had relevant allergies and particularly allergy to isobornyl acrylate which was also found in the glucose sensor system Dexcom G6®. Conclusions: The following case reports bring in focus the fact that patients sensitized through use of one medical device and being advised the use of another, or find another product for a while useful, are not by necessity free from future episodes of allergic contact dermatitis. The case reports emphasize the need for collaboration since it is impossible for even well-equipped laboratories to properly investigate the medical devices when information on the substances used in production is not uniform and complete and material to investigate are scarce. The importance of adequate patch test series and testing with own material and furthermore the importance to re-analyse medical devices and re-analyse test data are emphasized. (Less)

Background: The textile dye mix (TDM) 6.6% pet. contains Disperse Blue (DB) 35, Disperse Yellow 3, Disperse Orange (DO) 1 and 3, Disperse Red 1 and 17, and DB 106 and 124. The most frequent allergen in TDM-positive patients is DO 3. Around 85% of p-phenylenediamine (PPD)-allergic dermatitis patients have shown positive patch test reactions to DO 3. There has been a discussion to exclude DO 3 from TDM 6.6% because of frequent, strong reactions to TDM 6.6% and PPD. Objectives: To study if DO 3 can be omitted from a TDM. Methods: Patch tests were performed on 2250 dermatitis patients with TDM 6.6%, TDM 5.6% pet., TDM 7.0% pet., and PPD 1.0% pet.; 122 patients were also patch tested with DO 3 1.0% pet. Results: Among the 2250 patients patch tested, contact allergy prevalence to TDM 6.6% was 2.4%, to TDM 5.6% 1.8%, and to TDM 7.0% 2.0%. Of the 54 TDM 6.6%-positive patients, 55.6% reacted to PPD; as much as 42.2% of PPD-allergic women and 50% of PPD-allergic men reacted to TDM 6.6%. Of the 17 DO 3-positive patients, 94.1% showed a positive reaction to PPD. Conclusion: Results indicate that DO 3 can probably be omitted from TDM, but patch testing with TDM 6.6%, TDM 7.0%, DO 3 1.0%, and PPD 1.0% simultaneously is needed to finally decide whether it is possible or not. (Less)

Dental professionals and dental patients are exposed to the same sensitizers, but the outcome is very different. Dental professionals suffer predominantly from irritant contact dermatitis and to a lesser degree from allergic contact dermatitis to acrylates and rubber products. Dental patients rarely have allergic contact stomatitis. In this chapter, the reader will learn about the multiple factors that lead to irritant contact dermatitis and also about the major sensitizers, e.g., methacrylates in dentin bonding agents, dental composite resins (DCR), and prostheses, in addition to rubber chemicals, metals, fragrances, and disinfectants. The various sensitizers that may give lichenoid reactions in patients are also discussed.

Background: Solvent Orange (SO) 60 is a perinone-type dye that is often used in plastic materials such as spectacle frames and has been shown to cause contact allergy. The first case of SO 60 allergic contact dermatitis caused by spectacle frames was reported in 1999, and the second in 2011. We have recently seen 10 patients, of whom 6 developed dermatitis in the retroauricular/temporal area after wearing plastic spectacles. Objectives: To report the cause of the dermatitis in the 10 patients and to describe our first case with occupational SO 60 contact allergy. Methods: In this retrospective study, patch test results of 10 patients, tested with the Swedish baseline series and our specific spectacle and/or plastic series, including SO 60 1.0% pet., in 2011-2017 were analysed. Results: Ten patients, 2 males and 8 females, aged 43 to 71 years, reacted positively to SO 60 1.0% pet., namely, 4 pensioners, 2 nurses, 1 office worker, 1 teacher, 1 shop assistant, and 1 unemployed person. Four of the patients had an atopic history. Patch test reactions varied from + to +++; some had spread >20 cm outside the test area in terms of erythematous, infiltrated skin with papules. Retesting of patient no. 1 with serial dilutions of SO 60 in acetone showed positive reactions down to 1 ppm. Three patients reacted to the extracts of their earpieces. Gas chromatography-mass spectrometry was used to confirm the presence of SO 60 in 2 earpieces. Conclusions: SO 60 should be included in any spectacle patch test series that may be used. If there is a strong suspicion of contact allergy to SO 60 before patch testing, lowering the test concentration from 1.0% to 0.01% should be considered. (Less)

The use of permanent hair dyes exposes hairdressers to contact allergens such as p-phenylenediamine (PPD), and the preventive measures are insufficient.

Angiotensin II receptor blockers (ARBs) are drugs generally well tolerated. There are few reports about cutaneous side effects of ARBs. The present authors describe herein four cases of purpuric eruption mainly involving sites of friction in patients taking ARBs. These eruptions completely cleared after stopping the drug and implementing preservative measures to reduce friction.

Hair dyes contain strong allergens and are widely available. Correct labelling is a necessity in order to provide information about the contents. To compare the labelling and content of hair dyes. In total, 52 hair dyes, from 11 different countries, were bought over the counter. High-pressure liquid chromatography was used for the analysis of p-phenylenediamine (PPD), toluene-2,5-diamine (2,5-TDA), and three oxidation products of PPD. There was good agreement between labelling and content, although seven of the 52 products (13.5%) studied were incorrectly labelled. There were differences in the geographical use of PPD and 2,5-TDA; 2,5-TDA was more common in European products, while PPD was more common in products purchased outside Europe and was present in higher concentrations. All dyes purchased in Europe contained PPD and 2,5-TDA at levels within the limits defined by European legislation, however, levels were higher in some products purchased outside Europe. Only a small group of hair dyes sold in Europe were mislabelled. Further improvement in labelling, by providing the concentration of chemicals, may facilitate products to be purchased both locally and within the global market, when travelling or on the internet.

Alkyl glucosides and alkyl poly-glucosides are widely used as wetting agents, surfactants and emulsifiers in several industrial and cosmetic products. They are known as well-tolerated and are usually added to the primary surfactants in order to reduce the irritating potential of the main foaming agents.Recently, some authors suggested that allergic contact dermatitis to alkyl glucosides might be more frequent than suspected. On the other hand, the chemical structures of glucosides do not show potentially allergenic chemical groups or strongly polarized structures. The aim of our study is to investigate alkyl glucosides carrying out a detailed chemical analysis on samples of raw materials to identify potentially allergenic impurities or by-products contained in commercial samples of alkyl glucosides.We chemically analyzed samples of cocoyl glucoside, decyl glucoside and lauryl glucoside by three different analytical methods, in order to identify any undesired or polluting substances.In each of the three samples, we detected the presence of isobornyl acrylate. Its approximate content in the tested samples is 500 ng/g of the product.Isobornyl acrylate is not used in the synthesis of alkyl glucosides, but as a plasticizer in many plastic materials. It can be easily released to materials flowing over these surfaces when they have high extraction power, as glucosides.Isobornyl acrylate may play a role as hidden allergen, in the form of an impurity collected during the industrial process, explaining some cases of allergic reaction to alkyl glucosides.

The use of permanent hair dyes exposes hairdressers to contact allergens such as p-phenylenediamine (PPD), and the preventive measures are insufficient.To perform an in vivo test to study the protective effect of gloves commonly used by hairdressers.Six gloves from Sweden, Italy and Germany were studied: two vinyl, one natural rubber latex, two nitrile, and one polyethylene. The hair dye used for the provocation was a dark shade permanent dye containing PPD. The dye was mixed with hydrogen peroxide, and 8 PPD-sensitized volunteers were tested with the gloves as a membrane between the hair dye and the skin in a cylindrical open chamber system. Three exposure times (15, 30 and 60 min) were used.Eczematous reactions were found when natural rubber latex, polyethylene and vinyl gloves were tested with the dye. The nitrile gloves gave good protection, even after 60 min of exposure to the hair dye.Many protective gloves used by hairdressers are unsuitable for protection against the risk of elicitation of allergic contact dermatitis caused by PPD.

Necrobiosis lipoidica diabeticorum (NLD) is a chronic condition, which is characterized by single or multiple lesions on the legs, and occurs in 0.3% of patients with diabetes. Recently, platelet-rich plasma (PRP) has been used in several clinical settings to promote sustained healing and better outcome. We propose the use of PRP for the treatment of NLD-associated recalcitrant wounds. In this study, 15 patients were treated with homologous PRP; all showed marked enhancement in wound healing without any adverse effects. After PRP application, advanced dressings were used until closure of the lesion was obtained, which was complete for all our patients. We therefore propose the use of PRP for recalcitrant wounds in patients with NLD.

Angiotensin II receptor blockers (ARBs) are drugs generally well tolerated. There are few reports about cutaneous side effects of ARBs. The present authors describe herein four cases of purpuric eruption mainly involving sites of friction in patients taking ARBs. These eruptions completely cleared after stopping the drug and implementing preservative measures to reduce friction.

Introduction Oral sex is usually considered a lower‐risk sexual activity when compared with sex, but it is frequently the cause of sexually transmitted infections (STI). In particular, STI transferred through oral sex might have no visible symptoms, depending on the type of infection. Aims The aim of this study is to review the literature about the role of oral sex in the transmission of nonviral STI. Main Outcome Measures State‐of‐the‐art information in the area of STI in relation to sexual function and self–care, this last important for development of STI prevention products such as vaginal microbicides. Sexual behaviors assessed focusing on receiving oral sex and giving oral sex. Methods A search of the main electronic databases including registers of clinical controlled trials was performed in addition to a hand search of the most relevant Journals. The following electronic databases were searched: PubMed, Embase, Google Scholar, literature review of research articles, and public health department Internet Web sites, for the period of 1945–2011. In addition to searching the Clinical Trials Registry at the US National Institutes of Health, we also used the meta Register of Controlled Trials and the Cochrane Central Register of Controlled Trials. Results STI affect the mucous membranes both directly and indirectly producing characteristic diagnostic signs and lesions. Daily dental clinical activity needs an appropriate knowledge of any kind of oral lesions‐related STI. The reader is offered a practical approach with clinically relevant recommendations that may prove useful in his/her daily practice when dealing with STI. Conclusions. These data provide a foundation for understanding diverse STI. We advise physicians to be receptive to discuss sexuality issues and provide patients with adequate therapy. Ballini A, Cantore S, Fatone L, Montenegro V, De Vito D, Pettini F, Crincoli V, Antelmi A, Romita P, Rapone B, Miniello G, Perillo L, Grassi FR, and Foti C. Transmission of nonviral sexually transmitted infections and oral sex. J Sex Med 2012;9:372–384.

A 46-year-old nonatopic male bricklayer was referred with a severe erythematous vesicular dermatitis on the arms, forearms, trunk, and face, associated with a marked periorbital oedema. History rev...

In order to characterize the different sources of exposure to arsenic (As), urinary excretion of total As, the sum of inorganic As+MMA+DMA determined by the hydride generation-atomic absorption spectrophotometry technique, and the species As3, As5, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA) and arsenobetaine were determined in 49 workers at a steel foundry, with presumed occupational exposure to As, and 50 subjects from the general population, all males. No evidence of occupational exposure to As resulted from environmental monitoring performed in the foundry, although the analysis of minerals used as raw materials showed the presence of As, particularly in fossils and fine ores. The urinary concentrations of As3, MMA, DMA, the sum of inorganic As+MMA+DMA and total As were not different in the two groups, while arsenobetaine appeared significantly higher in the controls than in the workers. The different species of urinary As were all significantly correlated. Urinary excretion of As3 was associated with the consumption of mineral water and with residence in an industrial zone, while MMA, DMA, arsenobetaine, the sum of inorganic As+MMA+DMA and total As urinary excretion were associated with the consumption of crustaceans and/or shellfish 3 days or less before urine collection. Multiple regression analysis confirmed these results. In conclusion, in populations with a high consumption of seafood, living in areas characterized by coastal/marine As pollution, only speciation of As can identify a prevalent role of environmental sources, like the consumption of seafood contaminated by As, in determining urinary As excretion, and exclude an occupational origin of the exposure.

We report the case of a 46-year-old veterinarian who developed rhinoconjunctivitis and contact urticaria (CU) on his hands and forearms after contact with dog's milk. Prick tests results revealed a positive reactions to Parietaria pollens, Dermatophagoides farinae and D. pteronyssinus, dander of cat, grass, olive (+++), and to undiluted dog's milk (++++). Control prick tests with dog's milk performed in 5 healthy veterinarians were negative. We consider it important to take into account the possibility that dog's milk may be the aetiological agent of CU in veterinarians.