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

Introduction: Hairdressers are exposed to wet work and manifold allergens at work, rendering exposure complex and the aetiology of occupational hand eczema (OHE) often multifactorial in this occupational group. Objectives: To identify exposure patterns associated with increased risk of hand eczema in hairdressers. Methods: All hairdressers graduating from 2004 to 2007 and 2015 to 2018 received a questionnaire in 2009 and 2020, respectively. Current exposures (with or without regular glove use) and OHE were self‐reported, and their association examined. Patterns of exposure were identified by latent class analysis (LCA). Results: A total response of 39.9% (668/1675) was obtained. Six exposure profiles (#1–6) were identified by LCA across 11 tasks performed with or without gloves as well as deep conditioning, that is, 23 task items. Compared to profile #1 with the lowest OHE risk (reference) an increased risk of current OHE were seen in profile #4 [adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.5–44.8 and #6 (aOR 39.4, 95%CI 6.1–362.8)] in logistic regression analysis. Profile #1 and #6 had performed the same tasks, but in profile #6 regular glove use was performed in 9.1% (1/ 11) of tasks compared to 72.7% (8/11) of tasks in profile #1 (p = 0.002). Conclusion: Although occupational exposures in hairdressing are complex, meaningful patterns associated with a wide range of OHE risk can be identified by LCA. The increase of OHE risk seems predominantly to be due to poor compliance with protective gloves. LCA could be applied to further fields of complex (skin) exposures. [ABSTRACT FROM AUTHOR]

Background: Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers. Objective: To assess the risk OHE and compliance with skin protective measures in hairdressers trained before and after implementation of a nationwide skin protection program in Danish hairdressing vocational schools in 2011. Methods: A repeated cross‐sectional study was performed. A questionnaire was sent in 2009 and 2020. The Danish Labour Market Supplementary Pension Scheme provided information on yearly payments from the hairdressing profession. Results: A response rate of 66.6% (305/460) was obtained in the 2009 survey and of 29.9% (363/1215) in the 2020 survey. The career time prevalence of OHE decreased from 42.8% to 29.0% (adjusted odds ratio 0.55 95% confidence interval [CI] 0.40‐0.77) and the incidence rate of OHE decreased from 57.5 (95%CI 48.4‐68.4) to 42.0 (95%CI 34.6‐50.9) per 1000 person years (incidence rate ratio 0.73 [95%CI 0.56‐0.95] between the two surveys). A statistically significant (P <.05) increase in glove use when doing wet‐work and when handling hair dyes, permanent wave solutions and bleaching products was observed in the 2020 compared to the 2009 survey. Conclusion: Our data suggest that skin protection training during apprenticeship reduces the risk of OHE in hairdressers. The lack of primary prevention of OHE in hairdressing vocational schools may be a missed opportunity in the prevention of the disease. [ABSTRACT FROM AUTHOR]

According to the World Health Organization and partner organizations, no protection against ultraviolet (UV) radiation is required on days with "low" values (i.e., values <3) of the Global Solar Ultraviolet Index (UVI). Erythemal irradiance (Eer) data of such days were analyzed to evaluate this claim. Measurements from 9 stations of the German solar UV monitoring network from 2007 to 2016 yielded 14,431 daily Eer time series of low UVI days. Erythemal doses for certain fixed time intervals—acquired from measurements on horizontal planes—were compared with the average minimal erythemal dose (MED) of skin phototype II. Doses from days with rounded UVI values of 0 were insufficient to induce erythema and even on days with rounded UVI values of 1 doses exceeding 1 MED of skin type II could only be acquired under very specific circumstances of prolonged exposure. Conversely, sun exposure on days with rounded UVI values of 2 can indeed provide doses sufficient to induce erythema in skin type II after two hours around noon. In conclusion, our analyses do not support the claim of harmlessness currently associated with the entire low UVI exposure category in public guidance on interpretation of the UVI. [ABSTRACT FROM AUTHOR]

The article presents an analysis of the Information Network of Departmernts of Dermatology (IVDK) data through machine-learning techniques in polysensitization-associated allergens' positive reactions. Topics discussed include an overview of IVDK data, the polysensitization of the positive reaction of allergens, and the unique view of polysensitization.

Objectives: Aim of this clinical study was to evaluate the angiosome concept with regard to the microcirculation of the foot in patients with CLI and to evaluate its relevance by means of combined laser Doppler flowmetrie and white-light tissue spectrophotometry. Methods: Twenty-eight patients who underwent leg revascularization in the stage of CLI were prospectively examined. The microperfusion was assessed by light guided spectrophotometry. The measuring points were set according to the angiosome concept into direct and indirect revascularized areas of the foot. Investigations were performed pre and postinterventionally and after 4 and 12 weeks in baseline-position as well as in an elevated position of the leg. Results: Microcirculation parameters (oxygen saturation, blood flow, velocity) of the revascularized leg showed a significant increase in elevation and baseline position compared to the preoperative values in most analyses. No significant differences between the direct and indirect revascularized angiosome were apparent. Conclusion: The light-guided spectrophotometry measurement proved to be feasible in terms of measuring changes in the microcirculation after leg revascularization. However, our data do not support the value of the "angiosome concept" concerning the individual changes in microperfusion of the foot in patients with CLI. [ABSTRACT FROM AUTHOR]

Background Patch test results often vary between departments, and also between countries. Such variation may be partly attributable to systematic effects introduced by patient characteristics, differing exposures, patient selection, or methodological differences. Objective To examine the amount of variation of patient characteristics in terms of the MOAHLFA index and of the proportion of patients with at least one positive reaction to the ( European) baseline series (' P' measure), and to examine potential reasons for the variation. Methods A retrospective analysis was performed of patch test data from 63 530 consultations collected by 53 departments from 12 countries participating in the European Surveillance System on Contact Allergies ( ESSCA) ( ) between 2009 and 2012. Results Considerable variation in the prevalence of the MOAHLFA factors between departments was found, caused, for example, by differing specializations (e.g. occupational dermatology) or patient characteristics. Notable variation concerning the ' P' measure was observed; however, larger national networks (contributing to the ESSCA) tend to have quite similar ranges of this measure. Conclusions Data from one department per country give valuable insights into the spectrum of contact allergy prevalence rates in that country, but are not as representative as national data pooled from several departments. [ABSTRACT FROM AUTHOR]

Fragrances are among the most common contact sensitizers. Changes in exposure lead to subsequent changes of sensitization incidence; patterns of exposure may be reflected in certain surrogate markers such as affected anatomical site or occupation. The objective of this study was to provide current results on sensitization prevalences to the fragrance allergy screening markers of the patch test baseline series, on time trends and on risk factors associated with sensitization. Data of all patients tested between 1999 and 2012 with fragrance mix I (8% petrolatum (pet.) n = 130 325), fragrance mix II (14% pet., since 2005, n = 81 290), Myroxylon pereirae resin (25% pet., n = 130 258) and oil of turpentine (10% pet., n = 131 595), respectively, in the Information Network of Departments of Dermatology (IVDK, ) were subject to descriptive and log-binomial regression analysis. Overall, 16.31% of patients had a positive patch test reaction to at least one of the four markers. The prevalence to each of the four single markers was 8.71, 4.87, 8.36 and 1.95%. A peculiar downward trend of FM I until around 2006/2007 with subsequent increase, both significant, was noted. Mostly, sensitization risk was higher in older patients and females, and was to a varying extent associated with certain anatomical sites. The mostly stable or even increasing time trends warrant further in-depth research into causative exposures, addressing the effectiveness of (self-) regulation, aggregate exposure and 'cocktail effect'. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Cobalt contact sensitization in consecutively tested patients is common. The sources of exposure, and thus clinical relevance, are mostly unclear. Objective To examine (i) long-term time trends of sensitization, (ii) risk factors that may point to relevant exposures, and (iii) coupling with nickel sensitization. Methods Data of all patients patch tested with cobalt( II) chloride hexahydrate (1% pet.) between 1992 and 2012 (n = 185 050) in the Information Network of Departments of Dermatology ( IVDK, ) were subjected to descriptive stratified and Poisson regression analysis. Results The overall prevalence of positive patch test reactions was 5.23% (95% confidence interal 5.13-5.33%). Regarding time trends, there were significant increases for males aged 18-44 years and for females aged ≥45 years, and a significant variation of co-reactivity with nickel over time. Female sex almost doubled the risk of sensitization; age ≥45 years was associated with a 30% decrease in the risk of positive patch test reactions to cobalt, and atopic eczema with an approximately 20% increase. Conclusions Notwithstanding some diagnostic difficulties with the test preparation, a persistent, notable proportion of cobalt sensitization, isolated or coupled with nickel allergy, can be observed. This warrants further in-depth research into causative exposures, both at the workplace and in consumers. [ABSTRACT FROM AUTHOR]

Background Cosmetics for bleaching, waving/relaxing and dyeing hair contain well-known allergens, leading to a substantial number of cases of allergic contact dermatitis. Objective To compare the frequency of important contact allergens (i) between two distinct groups of exposed patients, and (ii) with previous surveillance data. Methods On the basis of data collected by the Information Network of Departments of Dermatology ( IVDK; ) between 2007 and 2012 in 824 female hairdressers and 2067 female clients, the current spectrum of contact sensitization to ingredients of hair cosmetics, as contained in different pertinent series, is described. Results A similar burden of sensitization as in previous analyses was observed, but with some increase in sensitization to oxidative hair dye components in clients. Some allergens mainly affected hairdressers, such as ammonium persulfate (18.7% positive) and glyceryl monothioglycolate ( GMTG; still 4.7% positive, with a few cases also in young hairdressers, despite removal from the German market). Conclusions Hair dyes remain important contact allergens, despite various attempts by the cosmetic industry to introduce hair dyes with lower allergenic potential. The re-emergence of GMTG as an occupational allergen should be considered as a warning signal ('sentinel event') prompting close monitoring. [ABSTRACT FROM AUTHOR]

Background No observed event is a special, but not uncommon, result in patch test studies. The interpretation of such findings depends critically on the sample size (n) of the investigation, and is statistically addressed by the use of confidence intervals ( CIs). Objective To define the statistically correct method of calculating a CI with a confidence level of 1 − α, where α denotes the tolerated statistical error probability, for an observed prevalence of 0%. Methods A literature survey and evaluation of the statistical methods was conducted. The popular statistical software packages spss™ and sas™ were examined with regard to the methods implemented, and the results obtained, for estimating such CIs in this special case. Results The evaluation identified [0; 1 − α1/n], which is well approximated by [0; 3/n] for α = 0.05, as an appropriate method to compute a CI with a confidence level of 1 − α. The resulting CI is an exact one, and more efficient than standard solutions. Popular statistical software such as spss™ and sas™ offers only various inefficient or even invalid procedures, but does not include this method. Conclusions It is easy to calculate a CI for an observed prevalence of 0% obtained in some studies. Such a CI facilitates the interpretation of such a finding, as it puts the observed zero result into adequate statistical perspective. [ABSTRACT FROM AUTHOR]

Background Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is a synthetic fragrance chemical and an important contact allergen, at least in Europe. Despite this importance, little is known about risk factors associated with this allergen. Objective To examine factors from the history and clinical presentation of patch tested patients associated with HICC sensitization. Methods Contact allergy surveillance data of 95 637 patients collected by the Information Network of Departments of Dermatology (IVDK, www.ivkd.org) in 2002-2011 were analysed. Point and interval estimates of the relative risk were derived from multifactorial logistic regression modelling. Results The overall prevalence of HICC sensitization was 2.24%. The strongest risk factors were polysensitization and dermatitis of the axillae, followed by dermatitis at other sites. No consistent and significant time trend was observed in this analysis. As compared with the youngest patients, the odds of HICC sensitization increased approximately three-fold in the 52-67-year age group, and strongly declined with further increasing age. Conclusions The risk pattern with regard to age and affected anatomical site differed from that observed with other fragrance screening allergens. Cosmetic exposure, as broadly defined here, was a stronger and more prevalent individual risk factor than occupational exposure. [ABSTRACT FROM AUTHOR]

Background: Exposure to ultraviolet (UV) radiation is the most important modifiable risk factor for skin cancer. Parents are responsible for sun protection of their young children and thus their knowledge and attitudes should be assessed. Methods: A survey that included 2619 children aged 3-6 years (response: 64.7%) was performed in Erlangen during 2001/2002. Parents' attitude, knowledge and behavior regarding sun protection were ascertained by using a self-administered questionnaire. Demographic and photosensitivity data of the children were recorded, along with the UV radiation-related outcomes. Results: Most parents correctly recognized the risk factors of skin cancer, except the intermittent and intensive sun exposure. Nevertheless, most parents also agreed with statements regarding sun- and tanning related beauty and well-being. The overwhelming majority of parents stressed the necessity of sun protection for their children; however, 50% of the children experienced some form of solar radiation injury during the preceding summer. Children eagerly pursued outdoor activities, especially boys compared with girls (P<0.01). A gender difference was also apparent, with boys showing more willingness to wear hats than girls (P<0.01). Conclusion: The relatively high level of knowledge was in contrast to a prevalent attitude of regarding sunlight as enhancing health and well-being. This may hamper UV radiation avoidance strategies. Thus, future campaigns should not only address preventive knowledge but also focus on associated attitudes to effectively modify the behavior. [ABSTRACT FROM AUTHOR]

Background: Surgical excision can cure most patients with malignant melanoma of the skin. However, the risk of recurrence remains for years. The aim of our study was to identify factors that influence time to recurrence and survival after the first recurrence with a special interest in late recurrences. Methods: Data from 2487 patients with malignant melanoma and primary treatment between 1978 and 1997 at the Department of Surgery or the Department of Dermatology, University Hospital Erlangen, Germany, were prospectively collected in the Melanoma Registry of the University Hospital Erlangen. After a median follow-up period of 13 years, overall survival, the time to first recurrence and survival after the first relapse were examined in univariate and multivariate analyses. Results: Overall survival was found to be significantly worse in older patients, men, melanoma of the head or trunk, and melanoma with high pT and pN categories. In 523 patients, relapse from malignant melanoma was observed after a median of 24 months. Among patients with recurrences, young age and low pT and pN categories proved to be independent factors that prolonged the disease-free interval. Advanced age at the time of the recurrence diagnosis, male sex, high pN category, and distant metastases as the first manifestation of recurrence were associated with a poor prognosis after the first recurrence. Conclusions: Although thin lesions have a favorable prognosis, among a cohort with recurrences they showed a relatively high rate of late recurrences. These late recurrences have an extremely poor prognosis when they present with distant metastases. [ABSTRACT FROM AUTHOR]

The article presents a study which focuses on the impact of short patch test training course for young professionals. The study uses the electronic voting system for the collection of the individual reading results. Results show the compromise of the digital image of a patch test reaction for the sake of feasibility.

Background: The proper reading of patch test (PT) reactions, based on morphological criteria, is of utmost importance. Digital images are increasingly used for medical training. Objectives: To assess the diagnostic validity of readings of 20 digital images of various PT reaction grades by congress attendants. Methods: 122 volunteers took a PT quiz offered during the 8th ESCD meeting, September 2006, Berlin. No information on the respective allergen was given, nor the gold standard grading determined by an European Environmental and Contact Dermatitis Research Group (EECDRG) expert panel was disclosed while the quiz was open. Results: Overall, 63.5% of all ratings agreed ‘exactly’ with the gold standard, and 87.8% ‘grossly’, that is, with regard to the distinction between non-positive [doubtful or irritant (IR)] and positive (+, ++, and +++) reactions. Most images prompted a fair proportion of correct classifications. The distinction between doubtful and + and between +++, and strong bullous IR reactions proved partly difficult, probably because of blinding of the test substance. The least experienced in particular tended to misclassify IR reactions. Conclusions: The rating of digital images of PT reactions represents just 1 particular, isolated aspect of PT evaluation. Results were largely valid. Thus, the method could be used for continuing medical education, and for standardization in multicentre networks. [ABSTRACT FROM AUTHOR]

Objectives: To correlate the onset of clinical effects of add-on levetiracetam (LEV) therapy with daily serum LEV concentration, in pharmacoresistant focal epilepsies, using the TISA method. Methods: 25 adult patients (aged >16 years) with pharmacoresistant focal epilepsies undergoing presurgical evaluation at the Epilepsy Center Erlangen were enrolled in the study. Eligible patients on a maximum of one other antiepileptic drug (AED) were recruited into the 48-hour baseline phase. Those who had at least two seizures during this phase were randomized into the seven-day treatment phase, when they received either LEV or placebo, under continuous day-and-night video-EEG monitoring. The starting daily dose of LEV was 500 mg bid, titrated from the second treatment day to 1000 mg bid. The peak serum concentration of LEV was monitored daily at 8:00 am (one hour after drug administration) for every patient. The number and duration of seizures per 24h (N/24h and D/24h respectively) were investigated. Results: 23 patients completed the study (LEV group n = 11 and placebo group n = 12). Seven patients in the LEV group and two patients in the placebo group achieved seizure-freedom during the treatment phase. The intergroup comparison of the decrease in N/24h and D/24h from the baseline phase to the treatment phase was in favor of the LEV group (p < 0.05). A significant effect of LEV on D/24h was seen as early as the second treatment day (p = 0.013), becoming more apparent on the third treatment day (p = 0.009). Conclusion: The present study objectively quantified the correlation between the anticonvulsant effects of LEV in focal epilepsies and the peak serum concentration of the drug. For the first time, direct measurement was used to demonstrate the onset of action of LEV to be two days after drug initiation. [ABSTRACT FROM AUTHOR]

The present guidelines aim to support clinical researchers in adequately presenting data on contact allergy, and to use statistical tests appropriate for their data. A description of the mode of selection of patients, and of their relevant demographic details, is an essential prerequisite for the correct interpretation of study results. Proportions and rates, if regarded as estimate of these parameters of a target populations, should normally be supplemented with confidence intervals to address precision. Concordance, i.e., agreement between two ratings in a dependent sample, must be quantified with a chance-corrected measure such as Cohen's kappa coefficient. If the diagnostic quality of an outcome is being assessed, standard measures like sensitivity and specificity, as well as the prevalence-dependent positive and negative predictive values should be calculated. Often, contact allergy to a certain substance depends on several factors. In this situation, depending on the research question, techniques like stratification, standardization or multifactorial analysis should be employed. With increasing complexity of statistical description and analysis, consulting with a biostatistician is often mandatory. [ABSTRACT FROM AUTHOR]

To support the decision as to whether erythematous patch test reactions to allergens are irritant or allergic, sodium lauryl sulfate (SLS, 0·5% in water) has been added to the standard patch tests since July 1996 in the Dortmund Department of Dermatology. Data on 1600 patients patch tested up until June 2001, as well as standardized data on ambient temperature and humidity obtained by the German Meteorological Service, were included in a logistic regression analysis taking age, sex and atopy as potential confounders into account. The pattern of association was heterogeneous: while doubtful reactions to nickel sulfate were significantly associated with dry/cold weather conditions, but not with SLS reactivity, the opposite was observed for lanolin alcohol, benzocaine and Myroxylon pereirae resin (balsam of Peru). Doubtful reactions to other allergens, namely formaldehyde, fragrance mix or p-phenylenediamine, were associated with both factors. For several other allergens of the standard series, no distinct, significant pattern could be discerned. In conclusion, meteorological conditions and SLS reactivity independently contribute information on individual irritability at the time of patch testing, and both should be considered. [ABSTRACT FROM AUTHOR]

Thiuram mix is tested in the standard series at a test concentration of 1% pet. The single thiurams (DPTD, TMTD, TMTM, TETD), however, are usually tested at 0.25% pet. in Germany. In other countries, the individual components of thiuram mix are tested at 1% pet. The German Contact Dermatitis Research Group (DKG) compared both patch test concentrations in 530 patients in order to find out if (i) a significant number of positive patch tests are missed by testing at the lower concentration, (ii) problems with irritant test reactions occur by increasing the test concentration to 1%, and (iii) the sensitivity of the thiuram mix rises when the breakdown test is done with the higher concentration. Slightly more positive reactions were seen with the higher concentration, but this increase did not reach statistical significance. The reaction index, as a measure for the relation of positive to irritant and/or questionable reactions, remained unchanged for the individual thiurams. The sensitivity of the mix also did not change when the breakdown test was performed with 1% pet. instead of 0.25% pet. Thus, we conclude that both concentrations are of equal diagnostic value in patch testing. [ABSTRACT FROM AUTHOR]

The possible interference of neighbouring allergic patch-test reactions is still an open question. In this study, we investigated whether there is a distance-related mutual modification of neighbouring allergic patch-test reactions to nickel sulfate and potassium dichromate. We used a double-blind multicentre study design with randomized attachment of special TRUE Tests with 1, 3 and 7 cm distance between nickel sulfate and potassium dichromate patches. 589 patients with a history of nickel allergy (523 female, 66 male) were tested, with a mean age of 35 years. A log-linear modelling approach was used for statistical assessment of the relation between the distance separating neighbouring patch tests with nickel and dichromate and the reactions to the allergens. Non-reproducibility coefficients were compared by the generalized version of Fisher's exact test for arbitrary 2-dimensional contingency tables. For the left side of the back, virtually no differences (p=0.70) were found in the reaction patterns obtained for the 3 distances separating nickel and dichromate patch tests. On the right side of the back, the number of reactions to dichromate patches with only 1 cm distance from moderate/strong nickel reactions was lower than the number of positive dichromate tests at larger distances from nickel tests (on the border of statistical significance: p=0.05). Corresponding side-related results were obtained for subgroups of patients with and without a history of atopic dermatitis. The non-reproducibility of reactions to dichromate was not significantly related to the distance between neighbouring tests. Our data argue against a “spillover“ effect of strong/moderate nickel reactions, but indicate that such reactions may, under certain conditions, attenuate adjacent reactions to an unrelated allergen. In the case of future verification, this will have implications for the interpretation of patch tests. [ABSTRACT FROM AUTHOR]

Thirty years ago, the Global Solar UV Index (UVI) has been introduced as a health promotion instrument to improve sun protection. We assessed systematically global levels of awareness and use of the UVI as a prerequisite for the preventive effectiveness of this public health tool. We conducted a comprehensive literature search across 10 databases, including PubMed, Scopus and Web of Science Core Collection, as well as clinical trial registries and gray literature databases. The risk of bias of studies was evaluated using the Joanna Briggs Institute checklist for prevalence studies. In addition to narrative and descriptive analysis, we performed meta‐analyses with geographical subgroup analyses to statistically summarize the results. In total, we identified 40 publications from 39 different studies across multiple global regions. However, the number of studies in the analyses varies depending on the outcome. The results, especially the awareness of the UVI, were largely dependent on the specific geographical location of the studies. While the prevalence of awareness of the UVI is high among Australian populations, there is considerable variability in levels of awareness across other global regions. At the same time, the use of the UVI is at a low level across all regions, demonstrating the need for enhanced dissemination of knowledge about the perils associated with ultraviolet radiation and the advantages of using the UVI. [ABSTRACT FROM AUTHOR]

Examines patch test reactions after application of skin allergens in contact dermatitis. Differences in rates of positive reactions; Gain in positive reactions by late test readings after day three compared to the number of positive reactions at day three; Statistical significance of single allergen discrepancies.

Examines on the association between size of test chamber and patch test reaction. Interpretation of data on 495 patients; Analysis on the statistical aspects of this study; Difference on the reaction pattern between fragrance mix and wool wax alcohols.

Examines the prevalence of hand dermatitis in the hairdressing trade in Germany. Risk factors of occupational irritant hand dermatitis; Factors affecting the change of job by hairdressers; Implementation of prevention of occupational skin disease in hairdressers.

In alcoholics, disturbances of the autonomie nervous system as well as of the hypothalamic-pituitary-adrenal axis (HPA) are known. However, these two systems have never been analyzed, under stimulated conditions, in parallel in the same patients. Moreover, studies using intravenous (iv) corticotropin releasing factor (CRF) to assess neuroendocrine function bypass the hypothalamic component of the HPA axis. Therefore, iv human (h) CRF (pituitary stimulation/exogenous CRF) and a multifaceted stress test (hypothalamic activation/ endogenous CRF) were compared with respect to their effects on hemodynamics as well as plasma norepinephrine (NE), epinephrine (E), ACTH, and cortisol in abstinent alcoholics ( n= 11) versus healthy men ( n= 10). Each stimulus was tested twice, 12 weeks apart, in two separate experimental blocks (I and II). Alcoholics entered block 18 days after the last ethanol ingestion and were controlled for abstinence up to block II. hCRF caused a fall in mean arterial pressure (MAP), most pronounced in alcoholics, particularly in block II. In contrast, stress testing raised MAP in both groups and blocks. A sustained increase in ACTH, cortisol, and NE occurred after hCRF, although the ACTH response in alcoholics was blunted in both blocks. Stress testing elevated NE in both groups and blocks, while raising plasma ACTH and cortisol during block I only in controls. However, unlike the persistently blunted ACTH response to iv CRF, a normalization of the stress-induced ACTH output occurred in alcoholics after 12 weeks of abstinence. During block I, basal E levels were elevated in alcoholics whereas NE levels tended to be lower than in controls, resulting in a significantly decreased NE/E ratio that returned to near control values in block II. Neither CRF nor stress had any effect on circulating E in either group or block. To conclude: (1) Normalization of the ACTH response to stress, but not to iv CRF, after 12 weeks of abstinence, suggests that other ACTH secretagogues may be compensating for CRF dysfunction in alcoholics. (2) Despite the dramatically lowered plasma NE/E ratio in alcoholics, the NE response to stimuli was unaffected. (3) The exaggerated hypotensive reaction and blunted ACTH response to iv CRF may reveal a long-term dissociative dysregulation of CRF actions in alcoholics. [ABSTRACT FROM AUTHOR]

Insight into the dynamic time courses of patch test reactions may be useful for patch test evaluation. To put this to the proof, we have analyzed the time courses of allergic patch test reactions that were filed between 1990 and 1994 by the lnformation Network of Departments of Dermatology in Germany (IVDK). Based on reaction strength at days 1 to 3, each allergic patch test was assigned to 1 of 5 distinct dynamic reaction patterns: crescendo, plateau, decrescendo, crescendo/decrescendo, or decrescendo/crescendo. The frequencies of these patterns were determined for those 10 standard allergens yielding the highest numbers of allergic reactions (n between 180 and 12410), arid dynamic patterns were classified as type 1 (crescendo or plateau patterns) or type 2 (other patterns). Influences of population characteristics upon the classification of patterns were evaluated by logistic regression analyses. Different Frequencies of reaction patterns were found for distinct allergens. For all 10 allergens, type-1 patterns were significantly more often observed for allergic reactions assessed as clinically relevant. For 5 allergens, female sex of patients was associated with a lower frequency of type-2 patterns. A history of atopic dermatitis and the age of patients were only weakly associated with a certain classification of reaction patterns in some of the allergens. In a comparison of reaction patterns obtained with different allergens in the same population, we found that nickel sulfate elicited type 1 reaction patterns more often than fragrance mix. We conclude that the dynamic reaction patterns should he taken into account in the evaluation of patch tests. The relation of type-1 patterns to clinical relevance of the reaction needs further attention. [ABSTRACT FROM AUTHOR]

The level of knowledge and awareness of skin cancer risks in parents of young children is largely unknown. The Erlangen Kindergarten study, which enrolled 3,129 parents of 3- to 6-year-old children in southern Germany, addressed this. The population-based survey found an overall high level of knowledge about skin cancer risks and strong support for the necessity of sun protection but identified two areas (role of intermittent sun exposure, sun protection on cloudy summer days) offering a target for improvement in future public health campaigns. [ABSTRACT FROM AUTHOR]

The article examines the changes of the patch test population in long-term participants of the Information Network of Departments of Dermatology from 1999-2006. It discusses the profound impact of demographic and clinical characteristics of patients on the observed spectrum and frequency of contact allergy. It intends to supplement results of the study with present data and discuss the consequences for the interpretation of patch test data.

Presents a letter to the editor on reproducibility of patch test readings.

Background. The preservative methylchloroisothiazolinone (MCI)/methylisothiazo- linone (MI) is an important allergen, and has thus been subject to regulation in some areas of exposure, mainly in cosmetics. Objectives. To examine whether a decline in sensitization prevalence and intensity of elicitation (by the patch test) can be observed, either overall, or in certain subgroups defined by causative exposures. Methods. On the basis of long-term contact allergy surveillance data collected by the Information Network of Departments of Dermatology (www.ivkd.org), 1992-2010, in the course of 171 883 consultations, the time trend of (different grades of) positive patch test reactions to MCI/MI (0.01% aqua) was examined in an age-stratified analysis. Results. The overall frequency of positive patch test reactions was 2.33% (95% confidence interval 2.26-2.4%). No significant overall trend of positive reactions or of the distribution of +, ++ and + + + reactions ( p > 0.05) was observed, similarly to what was found for patients in whom cosmetics were recorded as causative exposure ( p = 0.55). In contrast, in patients with occupational contact dermatitis who were < 40 years of age, a significant increase in prevalence, by 0.87 percentage points per decade, was identified ( p = 0.018). Conclusions. Both applications of MCI/MI, cosmetic and industrial, should be the target of further preventive efforts. [ABSTRACT FROM AUTHOR]

Objective: A number of different variables have been proposed as risk factors for mortality in patients with rheumatoid arthritis (RA), but limited prospective information on the magnitude of their effects is available. This study was undertaken to evaluate the relative predictive strength and usefulness of a wide range of variables on the risk of mortality in a large, long-term, prospectively studied cohort of patients with RA., Methods: Over a 20-year period of followup beginning in 1981, 1387 consecutive RA patients were seen in a single clinic. A wide range of clinical and demographic assessments were recorded and entered into a computer database at the time of each clinical assessment. Assessment of predictive strength included determination of standardized and fourth-versus-first-quartile odds ratios (ORs), goodness-of-fit measures, and contributing fraction., Results: The Health Assessment Questionnaire (HAQ) disability index was the strongest clinical predictor of mortality. A 1-SD change in the HAQ resulted in a much larger increase in the odds ratio for mortality compared with a 1-SD change in global disease severity, the next most powerful predictor of mortality (OR 2.31 versus 1.83). Considering the contributing fraction, mortality would be reduced by 50% for the HAQ and by 33% for global disease severity if patients in the fourth quartile for these variables could be switched to the first quartile. Global disease severity, pain, depression, anxiety, and laboratory and radiographic features were significantly weaker predictors. Disease duration, nodules, and tender joint count were clinical variables that provided very little predictive information. In multivariable analyses, HAQ and other patient self-report measures were significantly better predictors than were radiographic and laboratory variables. A single baseline observation provided the least information, with substantially increasing predictive ability associated with 1-year, 2-year, and all-time point followup observations (time-varying covariates)., Conclusion: In this large 20-year study from routine clinical practice, the HAQ was the most powerful predictor of mortality, followed by other patient self-report variables. Laboratory, radiographic, and physical examination data were substantially weaker in predicting mortality. We recommend that clinicians collect patient self-report data, since they produce more useful clinical outcome information than other available clinical measures.