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Background: Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens., Objectives: To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers., Patients and Methods: Within the Information Network of Departments of Dermatology (IVDK), we performed a cross-sectional multicentre pilot study comprising 1091 patch-tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never-smokers., Results: We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never-smokers as shown by non-overlapping 95% confidence intervals., Conclusions: Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

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

Background: Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society., Objectives: To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations., Methods: The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n = 46 652) in whom an occupational causation was refuted served as comparison group., Results: The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time., Conclusions: Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Massage therapists are particularly exposed to constituents of massage preparations, wet work and mechanical strain and therefore, at high risk to develop occupational dermatitis (OD)., Objectives: To describe the sensitization spectrum of massage therapists with OD., Patients and Methods: In a retrospective study, patch test data of patients with OD (128 massage therapists and 24 374 patients working in other professions) collected by the Network of Departments of Dermatology (IVDK, 2008-2020) were analysed., Results: Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with OD. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) massage therapists and thus, more often than in other patients with OD. Concomitant positivity to several fragrances/essential oils was frequent. In 8 (14.8%) of the 54 massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series., Conclusions: Allergic contact dermatitis is common in massage therapists with OD and is mainly caused by fragrances and essential oils. Hence, massage therapists should be aware of this risk. When OD is suspected, not only the baseline series, but also special fragrance series should be patch tested in this occupational group., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Introduction: Painters and varnishers ("painters") are exposed to various contact allergens and skin irritants, and therefore, are at risk for developing occupational dermatitis (OD)., Objective: To describe the spectrum of occupational sensitizations in painters and revise the corresponding current patch test recommendations., Patients and Methods: Retrospective analysis of Information Network of Departments of Dermatology (IVDK) data from 2000 to 2019 with focus on male painters with OD, ages 20-59 years (n = 557) in comparison to age-matched male painters without OD (n = 422) and male OD patients who have had never worked as painters (n = 13 862)., Results: Male painters with OD have a significantly higher rate of allergic contact dermatitis and face dermatitis than male patients with OD who work in other professions. Positive patch tests to epoxy resin, methylisothiazolinone (MI), and methylchloroisothiazolinone (MCI)/MI were significantly more frequent in painters with OD than in the other groups. Epoxy resin sensitization was significantly associated with face dermatitis., Conclusions: Epoxy resin, MI, and MCI/MI represent the most important occupational sensitizers in painters. In addition to baseline, resins and glues, and industrial biocides series, the patients' own workplace materials should be tested in painters with suspected OD., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large-scale reports on contact allergy due to MWFs are more than 10-years-old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs., Objectives: To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD)., Patients and Methods: Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010-2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers., Results: Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles., Conclusions: The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs)., Objectives: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP)., Patients and Methods: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS)., Results: Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS., Conclusions: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Studies on patch testing with workplace materials and evaluation of current occupational relevance of positive patch test reactions are scarce in patients with occupational dermatitis (OD)., Objectives: To identify frequent sensitizations with occupational relevance and to determine the value of patch testing with workplace materials in OD patients., Patients and Methods: Results and clinical data of 654 patients with suspected OD patch tested between 2013 and 2017 were analysed., Results: Occupational allergic contact dermatitis was diagnosed in 113 (17.3%) patients. Mechanics had the widest range of occupational sensitizations. Sensitization to epoxy resin was rated occupationally relevant in almost all handicraft trades. Among positive patch test reactions to workplace products, those to water-based metal working fluids and leave-on cosmetic products were most frequent. Despite frequent testing, protective gloves only rarely elicited positive reactions. Preservatives and rubber compounds were most frequently identified as currently occupationally relevant., Conclusions: Rubber allergy is occupationally relevant especially in healthcare workers and cleaners. Generally, preservatives including formaldehyde releasers are important allergens in OD patients. Leave-on cosmetic products must not be forgotten as allergen sources. Patch testing both workplace materials and standardized test preparations has a complementary value and is beneficial for the diagnostic work-up of OD patients., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD)., Objectives: To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability of current German patch test recommendations for this occupational group., Patients and Methods: As part of the OCCUDERM project, occupational exposure of 230 metalworkers with suspected OD patch tested in the departments of dermatology in Göttingen and Osnabrück (both Lower Saxony, Germany) in 2012-2017 was recorded by questionnaire. These data, as well as results, of patch testing with standardized allergens and with workplace material were analysed., Results: Metalworking fluids and skin care products were the most important exposures. Among MWF allergens, most frequently sensitizations to formaldehyde and formaldehyde releasers, colophony/abietic acid and monoethanolamine were observed. Sensitization to methylisothiazolinone (MI) was frequent, probably as part of the general European epidemic of contact allergy to MI in leave-on cosmetics. Sensitization to glove ingredients only played a minor role., Conclusions: The known occupational allergen spectrum could largely be confirmed. In order not to miss relevant sensitizations, patch testing with material from the patients' workplaces in parallel to baseline and MWF series is recommended. Sensitizations diagnosed could not always be linked to particular occupational exposures., (© 2019 European Academy of Dermatology and Venereology.)

Background: Metal work apprentices (MWAs) frequently develop work-related hand eczema (HE)., Objectives: To evaluate the effect of health education on incidence of work-related HE in MWAs and to assess confounding factors., Materials/methods: In a prospective controlled intervention study, 131 MWAs received educational training on prevention of HE, whereas 172 MWAs and 118 office work apprentices served as controls. At baseline and during three yearly follow-ups, questionnaires were completed and hands were examined. Saliva samples were collected for assessment of filaggrin (FLG) null mutations and an explorative genome-wide association study (GWAS), and levels of various cytokines were assessed from stratum corneum samples., Results: The 2-year and 3-year incidence of HE in the metalwork control group was 20.9% and 32.6%, respectively, which was significantly higher than in the intervention group (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.31 to 5.28, P < .01 and OR 3.47, 95% CI 1.88 to 6.40, P < .0001). The knowledge score was higher in unaffected MWAs (P < .05). Other factors significantly associated with developing HE in MWAs were smoking cigarettes (P < .01) and FLG mutations (P < .001). No significant associations were found regarding epidermal cytokine levels and GWAS., Conclusions: Health education is effective in primary prevention of HE in MWAs. Individual factors should be considered in targeted counseling., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Sensitization to methylisothiazolinone (MI) has seen an exceptional epidemic, mainly attributed to its use in cosmetics., Objectives: To trace the epidemic of MI allergy (2009-2018), and to analyze a possible change of patients' characteristics., Methods: Informationsverbund Dermatologischer Kliniken-data of patients patch tested between 2009 and 2018 with MI (0.05% aq.) were analyzed concerning anamnestic items and sensitization frequencies., Results: Overall, 4.9% reacted positive to MI. Comparing sensitization to MI in three periods (2009, 2013/14, and 2017/18), there was an increase to 7% in 2013 and a decrease to 3.4% in 2018. The MOAHLFA Index (M=Men, O=Occupational Dermatitis, A=Atopic Dermatitis, L=Leg Dermatitis, F=Face Dermatitis, A= Age > 40) for the period 2013/14 is characterized by a lower proportion of occupational dermatitis and a higher proportion of face dermatitis. The period 2017/18 is characterized by increases of occupational dermatitis and hand dermatitis, and a decrease of face dermatitis. Painters, personal care workers, and hairdressers were particularly affected. Sensitization in hairdressers and personal care workers (mostly cosmeticians) decreased after the peak in 2013/14, whereas sensitization to MI in painters continued to increase., Conclusions: After an unprecedented epidemic of MI allergy, mainly caused by its use in cosmetics, the continuous use of MI in industrial applications, for example, paints, and subsequent sensitization remain a matter of concern., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Contact urticaria (CU) is an infrequent, mostly occupational disease that may be life-threatening (CU syndrome stage 4)., Objectives: To identify the current frequency, elicitors and cofactors of CU., Patients: Three cohorts were retrospectively analysed for CU: (a) patients from the Information Network of Departments of Dermatology (IVDK) database (2000-2014; n = 159 947); (b) patients from an allergy unit (Department of Dermatology, University Hospital Erlangen, 2000-2015; n = 4741); and (c) patients from the Anaphylaxis Registry (2007-2015: 6365 reported cases, including 2473 patients with Ring and Messmer grade III-IV reactions) for severe cases with skin/mucosal manifestations occurring at the workplace vs cases not occurring at the workplace (n = 68 vs n = 1821)., Results: Four hundred and forty-eight CU patients (0.28%) were diagnosed in the IVDK cohort, and 16 (0.34%) (10 of immunological aetiology, and 6 of non-immunological aetiology) in the Erlangen cohort. The most frequent elicitors in the IVDK cohort were cosmetics, creams, sun protection agents (although these were less frequent in CU patients than in controls without CU; 26.8% vs 35.6%, P < .0001), and gloves (significantly more frequent in CU patients than in controls; 18.1% vs 6.5%, P < .0001). The most frequent elicitors in the Erlangen cohort were natural rubber latex and sorbic acid. Among the MOAHLFA index characteristics, in both cohorts occupational disease was more common in CU patients than in patients without CU. CU was significantly associated with allergic rhinitis and allergic asthma. Wet work was a relevant cofactor. In the Anaphylaxis Registry, 19 cases (0.3%) were identified with severe reactions including skin symptoms at the workplace linked to common occupational elicitors., Conclusions: CU is a rare occupational skin manifestation with a frequency of <0.4% in the examined patients; it may, however, progress to anaphylaxis. Preventive measures are important, and should take into account the identified elicitors and cofactors., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Professional musicians have prolonged and intense physical contact with their instruments. This can lead to occupational skin diseases, particularly irritant and allergic contact dermatitis., Objectives: To assess the skin diseases and sensitization patterns common among professional musicians., Methods: A retrospective analysis of the data of the Information Network of Departments of Dermatology (IVDK) was performed, including data from 1997 to 2017., Results: We identified 236 professional musicians. In this group, male sex (58.6%) and younger age (60.6% aged < 40 years) were common. The musicians suffered more frequently from facial dermatitis (23.7% vs 15.7%) and less often from leg dermatitis (5.1% vs 10.7%) than the control group (the non-musicians in the IVDK database). The most frequent diagnoses were allergic contact dermatitis, atopic dermatitis, and irritant contact dermatitis. The sensitization profile of the professional musicians was similar to that of the control group. In 8.9% of cases, an occupational background of skin disease was confirmed., Conclusions: Severe occupational skin diseases among professional musicians are not as common as in classic "skin-damaging" professions. However, as these skin conditions can mostly be controlled with simple preventive measures, we recommend that this group should be patch tested and treated by a specialist., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The Compositae plant family includes many thousands of species, making it one of the most widespread group of plants worldwide. Sensitization to Compositae allergens may occur in private or in occupational settings., Objectives: To monitor the current spectrum of sensitization to Compositae allergens, especially in cooks and florists., Methods: We retrospectively analysed patch test results obtained with two Compositae mixes (CMs) (CM I and CM II; switch in October 2011), their individual components, and sesquiterpene lactone (SL) mix in 1492 cooks, 851 florists, and a control group (118 358 other patients) registered in the IVDK, 2007 to 2016., Results: Florists reacted significantly more frequently to CM I and II (CM I, 8.7%; CM II, 10.6%) than did cooks (CM I, 2.1%; CM II, 0.8%) and controls (CM I, 1.3%; CM II, 1.2%). Additional testing with SL mix detected 14.3% more sensitizations than CM I or CM II alone., Conclusions: Florists are at considerable risk of sensitization to Compositae allergens. Patch testing with both CM and SL mix is recommended., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases (OSDs). Its prevalence and the causative allergens differ between occupations., Objectives: To evaluate the prevalence of ACD and the pattern of patch test results of patients taking part in a tertiary individual prevention programme (TIP) for OSD in Germany., Patients and Methods: In a retrospective cohort study, the data of 3411 TIP patients patch tested between 2007 and 2016 were analysed., Results: In 2687 (78.8%) patients, work-related skin disease was diagnosed, mostly hand dermatitis. The highest proportion of face dermatitis was seen in painters (8.1%). ACD was most common in painters (56.8%), hairdressers (45.8%), construction workers (31.5%), gardeners/florists (26.7%), and metalworkers (26.5%). On average, hairdressers had the youngest age (31.4 ± 12.6 years, P < 0.0001) and the shortest time in the profession prior to the TIP (mean 13.7 years). The pattern of patch test reactivity showed occupation-specific differences related to work exposures., Conclusions: Identification of occupational groups at risk for ACD and relevant allergens may help in the development and implementation of targeted prevention strategies. Our data suggest that there should be a particular focus on hairdressers and painters., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The food sector is one of the high-risk areas for occupational irritative and allergic contact eczema., Objectives: The present work provides an overview of the main allergens as well as sensitization frequencies and risk in various food industry occupations., Methods: The literature on type IV sensitization in the food sector is summarized., Results: The relative risk of developing a work-related eczema in food processing is increased by more than 3 times. The comparison group was calculated on the basis of the proportion of documented cases in the IVDK (Informationsverbund Dermatologischer Kliniken) network per 100,000 working persons in relation to the average of the years 2005 and 2010. For this purpose, the average risk of all patients was set as reference to 1. Bakers, pastry chefs, cooks and meat and fish processors are mainly affected. In addition to irritant contact eczema, allergic contact eczema and protein contact dermatitis often occur. Leading haptens (main allergens) are rubber ingredients, but also disinfectants and compositae., Conclusion: Only a few contact allergens are responsible for the majority of job-relevant sensitizations in the food industry.

Background: Dental technicians (DTs) are at increased risk for allergic contact sensitization., Objectives: To assess the current spectrum of occupational sensitization in DTs with occupational contact dermatitis (OCD)., Methods: A retrospective analysis of Information Network of Departments of Dermatology patch test data from the years 2001-2015 concerning DTs with OCD was performed., Results: Patients of the study group (226 DTs with OCD) were significantly more often diagnosed with allergic contact dermatitis (37.6% versus 18.5%; p = 0.0002) than patients of the control group (124 DTs without OCD). In the study group, positive reactions were most frequently observed to methacrylates and/or acrylates (n = 67). Of these, 61 patients showed positive reactions to at least one of the five most frequent allergens in this group, namely 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, methyl methacrylate, ethyl methacrylate, and/or ethylene glycol dimethacrylate. In contrast, no positive reactions to diurethane dimethacrylate (DUDMA) occurred. Among allergens of the German Contact Dermatitis Research Group series 'dental metals', positive reactions were less frequent and were mainly to palladium chloride (n = 6)., Conclusions: The present data analysis showed that the sensitization spectrum and spectrum of cross-reactivity are largely unchanged as compared with the 1990s. It can be concluded that test recommendations are still valid and useful, except for the methacrylate DUDMA, which could be omitted., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Rubber additives constitute an important group of contact allergens, particularly in certain occupations., Objectives: To collect information regarding the current practice of using a 'rubber series' in Europe, and discuss this against the background of evidence concerning the prevalence of allergy in order to derive a recommendation for a 'European rubber series'., Methods: The following were performed: (i) a survey targeting all members of the COST action 'StanDerm' consortium, (ii) analysis of rubber contact allergy data in the database of the European Surveillance System on Contact Allergies, and (iii) a literature review., Results: Information from 13 countries was available, from one or several departments of dermatology, and occasionally occupational health. Apart from some substances tested only in single departments, a broad overlap regarding important allergens was evident, but considerable variation existed between departments., Conclusions: An up-to-date 'European rubber series' is recommended, with the exclusion of substances only of historical concern. A 'supplementary rubber series' containing allergens of less proven importance, requiring further analysis, is recommended for departments specializing in occupational contact allergy. These should be continually updated as new evidence emerges., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Beside the basic resins, reactive diluents and hardeners are important sensitizers in epoxy resin systems (ERSs). Because of chemical similarities, immunological cross-reactivity may occur., Objectives: To analyse concomitant reactivity among reactive diluents and hardeners in the patients concerned, as one integral part of a research project on the sensitizing capacity of ERSs (FP-0324)., Methods: A retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2002-2011, was performed., Results: There was close concomitant reactivity to 1,6-hexanediol diglycidyl ether and 1,4-butanediol diglycidyl ether (1,4-BDDGE), and to phenyl glycidyl ether (PGE) and cresyl glycidyl ether (CGE), whereas reactions to p-tert-butylphenyl glycidyl ether occurred more independently from those to PGE and CGE. Concomitant reactions to butyl glycidyl ether and 1,4-BDDGE may point to a common allergenic compound derived from the metabolism of 1,4-BDDGE. Among the structurally more diverse group of hardeners, there was no evidence of immunological cross-reactions., Conclusions: More detailed knowledge of cross-reactivity among ERS components facilitates the interpretation of patch test results and will allow safer ERSs to be composed in the future., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Epoxy resin systems (ERSs), consisting of resins, reactive diluents, and hardeners, are indispensable in many branches of industry. In order to develop less sensitizing ERS formulations, knowledge of the sensitizing properties of single components is mandatory., Objectives: To analyse the frequency of sensitization in the patients concerned, as one integral part of a research project on the sensitizing potency of epoxy resin compounds (FP-0324)., Methods: A retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2002-2011, and a comparison of reaction frequencies with (surrogate) exposure data, were performed., Results: Almost half of the patients sensitized to epoxy resin were additionally sensitized to reactive diluents or hardeners. Among the reactive diluents, 1,6-hexanediol diglycidyl ether was the most frequent allergen, followed by 1,4-butanediol diglycidyl ether, phenyl glycidyl ether, and p-tert-butylphenyl glycidyl ether. Among the hardeners, m-xylylene diamine (MXDA) and isophorone diamine (IPDA) were the most frequent allergens. According to the calculated exposure-related frequency of sensitization, MXDA seems to be a far more important sensitizer than IPDA. Up to 60% of the patients sensitized to hardeners and 15-20% of those sensitized to reactive diluents do not react to epoxy resin., Conclusions: In cases of suspected contact allergy to an ERS, a complete epoxy resin series must be patch tested from the start., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Allergic contact eczema in children is frequent. If clinically suspected, a patch test should be performed. In the present study, data obtained from 116,742 patients who had undergone a patch test from 2005-2014 were analysed. The children group (range 0-12 years) included 925 patients. If at least 700 tested individuals were considered, the most frequent sensitizations in this group were nickel sulfate (8.5 %), fragrance mix I (5.5 %), and colophony (3.4 %), whereby sensitisation in adults was higher for nickel sulfate (15.5 %) and fragrance mix 1 (8.4 %), while being similar for colophony (3.7 %). In adolescents with and without a profession, nickel sulfate (11.1 and 13.6 %, respectively) and cobalt (II) chloride (3.9 and 3.4 %, respectively) were the most frequent positively tested contact allergens. Sensitisations toward fragrance mix I was low (3.9 and 3.4 %, respectively) in comparison to the adult group (8.4 %). In both children and adolescents, toluene diamine and paraphenylenediamine sensitizations were not infrequent, but it must be considered that these allergens were only tested if suspected. The data show that the sensitisation profile among children and adolescents display patterns similar to those in adults. Sensitisations in childhood and adolescence towards dyes like paraphenylendiamine may be associated with increased use of tattooing in these groups.

Background: In Germany, occupational skin diseases rank first in the occupational skin disease statistics for many years. Especially, occupationally acquired contact allergies as well as multi-sensitization are the most important predictors for a poor prognosis and persistent eczema., Objectives: To update the spectrum and sensitization frequencies of most frequent allergens from the standard series in Germany in patients with occupationally acquired type IV sensitizations in general and within different occupational groups., Methods: Data of all employed patients (age range: 16-68 years, n = 14234) patch tested between 2003 and 2013 in the German Departments of the Information Network of Departments of Dermatology (IVDK) and diagnosed occupationally acquired contact dermatitis after patch testing were analyzed. The control group was composed of all other patients (n = 31706) within the same time frame, in which occupationally acquired allergic contact dermatitis was negated explicitly., Results: The prevalence Ratio (PR; indicating risk) was significantly increased for: Thiuram-mix (PR 5.63 95 %CI 4.97-6.4), zinkdiethyldithiocarbamate (PR 6.22 95 %CI 4.76-8.22), mercaptobenzothiazole (MBT) (PR 3.88 95 %CI 3.09-4.89), mercapto-mix without MBT (PR 3.23 95 %CI 2.59-4.03), N-isopropyl-N'-phenyl-p-phenylene diamine (IPPD) (PR 2.3195 %CI 1.87-2.86), epoxy resin (PR 2.82 95 %CI 2.45-3.25), chloromethylisothiazolinone/methylisothiazolinone (MCI/MI) (PR 2.19 95 %CI 1.97-2.42) and compositae mix II (PR 2.05 95 %CI 1.45-2.89). They were the predominant occupational allergens and were at least associated with a doubled risk (PR ≥ 2.0) for acquiring occupationally allergic contact dermatitis. The highest risk increase was identified in employees in the health services, in agriculture, metal industry, food and service industry as well as building trades, Conclusions: A limited number of occupationally relevant allergens cause the majority of sensitizations in the workforce, if standard series allergens are concerned. Data analysis of national and international contact allergy data bases provide valuable information on sensitization rates and profiles in skin risk occupations to implement targeted prevention strategies. To diagnose occupational allergic contact dermatitis in individual cases additional testing of occupation related patch test series as well as patients' own products is commonly inevitable.

Background: Allergic contact dermatitis caused by (meth)acrylates used in artificial nails is a relevant problem in both nail artists and consumers., Objective: To analyse the frequency of this problem in the contact allergy surveillance network Information Network of Departments of Dermatology in 2004-2013, and address possible time trends and patterns of co-sensitization., Methods: A retrospective analysis of patch test results with (meth)acrylates, along with clinical and demographic data, was performed. These were used to subdivide patients according to (i) a potentially exposed occupation and (ii) nail cosmetics as the suspected cause of contact dermatitis., Results: Among the 114 440 patients patch tested, 72 244 were female and were considered further. Eighty-seven patients both worked as nail artists/cosmetologists and suspected nail cosmetics as the cause of dermatitis. Among these, 47.1% reacted to at least one (meth)acrylate, most often to 2-hydroxyethyl methacrylate (n = 27), 2-hydroxypropyl methacrylate, and hydroxyethyl acrylate (n = 26 each), with marked coupled reactivity. In other subgroups of interest, frequencies of sensitization to (meth)acrylates were less elevated but higher than in all remaining female patients (n = 69 419)., Conclusions: The results indicate a not entirely common, but potentially serious, problem, especially concerning occupationally exposed, and sensitized, nail artists. Adequate protective measures should be taught as part of the vocational training., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Healthcare workers are occupationally exposed to various allergens in protective gloves, surface or instrument disinfectants, drugs, and skin care products. An increased prevalence of sensitization to thiurams, glutaraldehyde, formaldehyde and glyoxal in nurses with occupational contact dermatitis (OCD) has been known since the 1990s., Objectives: To update the range of occupational allergens in healthcare professionals., Methods: We retrospectively analysed patch test data from the Information Network of Departments of Dermatology (IVDK), 2003-2012. Patch test results from 2248 nurses with OCD were compared with those of 2138 nurses without OCD., Results: Significantly increased sensitization rates were found for thiuram mix (6.7%), potassium dichromate (5.7%), methylchloroisothiazolinone/methylisothiazolinone (4.4%), colophonium (3.4%), 2-bromo-2-nitropropane-1,3-diol (1.7%), and zinc diethyldithiocarbamate (1.7%). Patch testing with products from the patients' workplaces gave additional clues to further allergens, for example tetrazepam., Conclusions: The known range of contact sensitization in nurses with OCD has been confirmed. Formaldehyde allergy seems to be less important today. Drugs such as tetrazepam are occupational sensitizers in nurses. The increase in chromium sensitization remains unexplained., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

In clinical practice occupational skin diseases usually present as hand dermatitis. Occupationally acquired contact allergies are of eminent relevance in many work place products e.g. skin care products, dyes and paints, epoxy resins or protective gloves. However, not infrequently, a range of other dermatoses of different etiology and localization can be occupationally induced and, at least in Germany, thus be medically treated and--if necessary--compensated for with full coverage by the statutory employers' liability insurance. Examples regarding non-eczematous skin diseases triggered by external factors are psoriatic lesions, cutaneous type-1-allergies, occupationally acquired infections, and dermatoses in other localizations which are occupationally exposed to irritant influences (e.g. feet in workers wearing occlusive safety boots). Moreover, outdoor workers deserve specific attention by the dermatologist if squamous cell carcinomas including precursor lesions like actinic keratoses or Bowen disease have occurred. In Germany, recently the scientific advisory committee to the Ministry of Labor has recommended including these skin cancers caused by occupational solar UV exposure in the national list of occupational diseases. The framework for dermatological preventive care of occupationally-induced inflammatory dermatoses has been continuously improved in the last years. The aim is to reach a similar level of care and preventive measures for patients with occupational skin cancer, including primary preventive workers' education.

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; www.ivkd.org) 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., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: As previous observations have indicated an inter-relationship between irritant and allergic skin reactions we analysed data of synchronous allergen and sodium lauryl sulfate (SLS) patch tests in terms of a relationship between SLS responsiveness and allergic patch test reactions., Objectives: To analyse differences in terms of allergen-specific and overall reaction profiles between patients with vs. those without an irritant reaction to SLS., Methods: Clinical data of 26 879 patients patch tested from 2008 to 2011 by members of the Information Network of Departments of Dermatology were analysed. After descriptive analyses, including the MOAHLFA index, the positivity ratio and the reaction index, a negative binomial hurdle model was adopted to investigate the correlation between SLS reactivity and positive patch test reactions., Results: Men, patients aged ≥ 40 years and patients with an occupational dermatitis background were over-represented in the SLS-reactive group. Patients with an irritant reaction to SLS showed a higher proportion of weak positive reactions, as well as more questionable and irritant reactions to contact allergens than patients not reactive to SLS. The risk of an additional positive patch test reaction increased by 22% for SLS-reactive patients compared with those who were SLS negative., Conclusions: The marked association between SLS reactivity and the number of positive reactions in patch test patients may be due to nonspecific increased skin reactivity at the moment of patch testing only. However, increased SLS reactivity could also be due to longer-lasting enhanced skin irritability, which may have promoted (poly-)sensitization. Further studies, for example with longitudinal data on patients repeatedly patch tested with SLS and contact allergens, are necessary., (© 2014 British Association of Dermatologists.)

Background: Psoriasis is an immune-mediated disease with a genetic background. Local psoriatic changes can be triggered by exogenous mechanical or irritant factors. Causative occupational factors have to be distinguished from the spontaneous course of psoriasis in occupational medical evaluations. The objective of this work is to demonstrate the medico-legal grounds for a homogenous assessment., Patients and Methods: The presented recommendations were developed in a working group for Occupational and Environmental Dermatology (ABD) and the German contact dermatitis group (DKG) of the German Dermatologic Society (DDG) based on the German medico-legal framework., Results: Causality between the insured activity and the appearance of psoriasis is a prerequisite for the recognition of the occupational nature of the disease. This is the case if the occupational activity is the exclusive or a legally essential contributing factor either for first manifestation or aggravation of the disease. A connection must be denied if everyday events are sufficient to trigger the psoriasis. From 1995 to 2010, 130 cases of psoriasis have been recognized as occupationally related by the German statutory accident insurance., Conclusions: The appraisal of psoriatic disease in the occupational medical evaluation is subject to the case assessment of the expert witness. In this position paper we present recommendations for a homologous basis for diagnosis, causality assessment, estimation of reduction in earning capacity and rehabilitation of occupational psoriasis., (© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Background: The preservative methylisothiazolinone (MI) has become an important allergen, with a dramatic increase in sensitization prevalence being seen over the last few years., Objective: To examine risk factors associated with MI sensitization, in order to identify targets of prevention aimed at curtailing the present epidemic., Methods: On the basis of contact allergy surveillance data collected by the Information Network of Departments of Dermatology (www.ivkd.org), 2009-2012, in the course of 28,922 patch tests with MI, 500 ppm in water, included in a series of cosmetic preservatives, logistic regression analysis was employed to quantify the risk associated with a number of putative risk factors., Results: The prevalence of MI sensitization increased from 1.94% in 2009 to 6.02% in 2012, the increase being mainly driven by female patients aged≥ 40 years, patients with face dermatitis, and the use of cosmetics. Adjusted multifactorial analysis additionally identified several occupations (e.g. painters and beauticians) and ano-genital dermatitis as risk factors for MI sensitization., Conclusions: The present use concentrations of MI, both cosmetic and industrial, are too high; (self-)regulatory action is urgently needed. MI should be added to the baseline series., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Allergic contact dermatitis caused by rubber gloves is not infrequent, and has almost exclusively been attributed to contact sensitization to accelerators. Thiurams have been the most frequent allergens, followed by dithiocarbamates., Objectives: To describe the current allergen pattern in patients with occupational allergic contact dermatitis caused by rubber gloves., Methods: This study was a retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2002-2010., Results: Of 93 615 patients patch tested in the IVDK, 3448 both suffered from occupational dermatitis and were tested because of suspected glove allergy. Among these, healthcare workers were the largest group (n = 1058). Of all occupational dermatitis patients, 13% were sensitized to thiurams, 3.5% to dithiocarbamates, 3% to mercaptobenzothiazole and/or its derivatives, and 0.4% to thioureas. Positive test reactions to 1,3-diphenylguanidine were seen in 3.0%. Reaction frequencies varied with the years, but showed no uniform time trend., Conclusions: As compared with a former IVDK data analysis (1995-2001), there was no change in sensitization pattern and no decline in sensitization frequencies. This is in line with data from the literature. Particularly in healthcare, there is a need for (i) allergen declaration on the glove package, and (ii) gloves with reduced accelerator content., (© 2012 John Wiley & Sons A/S.)

A total of 56 departments of dermatology from Germany, Austria, and Switzerland collaborate to study the clinical epidemiology of contact allergies (CA). Data generated in the course of the diagnostic work-up of CA (e.g., patch test data) have been stored since 1989 in the data center in Göttingen, Germany, including data for more than 200,000 patients (March 2011). These data can be used as a register and as a surveillance system. Analysis of the register may identify and quantify risk factors of sensitization to an allergen, which is exemplified with the case of the allergen para-phenylenediamine. It turned out that-in addition to the risk factor hair dyeing-other important risk factors must be considered. In contrast, data collected every 6 months (from approximately 6,000 patients) allow for time-trend analyses of allergens, thus, identifying allergens of concern, which is of utmost importance for early preventive intervention. Here, the epidemiology of allergies to epoxy resins serves as an example. Continuous monitoring of contact allergens will also be mandatory in the future, as the CA premarketing screening systems will have imperfect predictive values with regard to human CA risk. Unfortunately, the (current) national regulatory framework severely hampers clinical surveillance/epidemiology of contact sensitization and, thus, prevention of contact allergy.

Background: Occupational contact allergy is a common problem in the cleaning industry., Objectives: To identify the most frequent occupation-associated allergens and time trends in contact allergy in female cleaners., Methods: We analysed the patch test data concerning 803 female cleaners, who were evaluated for occupational contact dermatitis in 45 dermatological departments contributing to the Information Network of Departments of Dermatology (IVDK) from 1996 to 2009. Female patients, except cleaners, with occupational dermatitis (n = 14494) and female controls without occupational dermatitis (n = 64736) patch tested during this time period formed the control groups., Results: One hundred and fifty-six (19.4%) cleaners had past or present atopic dermatitis. Six hundred and fifty-five (81.6%) cleaners suffered from occupational hand dermatitis. Allergic contact dermatitis was diagnosed in 249 (31%) of the cleaners. As compared with the control group without occupational dermatitis, female cleaners were significantly more often sensitized to occupationally relevant allergens such as rubber additives, especially thiurams [11.6%, 95% confidence interval (CI) 9.1-14.1 vs. 1.5%, 95% CI 1.4-1.6], zinc diethyldithiocarbamate (3.4%, 95% CI 2.1-4.7 vs. 0.4, 95% CI 0.3-0.4), and mercaptobenzothiazole (1.8, 95% CI 0.7-2.9 vs. 0.5, 95% CI 0.4-0.6), as well as formaldehyde (3.4, 95% CI 2.0-4.7 vs. 1.4%, 95% CI 1.3-1.5). No differences were seen in patterns of sensitization to occupational allergens in younger (≤40 years of age) and older (>40 years of age) female cleaners., Conclusion: Formaldehyde and rubber additives such as thiurams, zinc diethyldithiocarbamate and mercaptobenzothiazole are occupationally relevant allergens in female cleaners. Prevention strategies are needed to address the problem., (© 2011 John Wiley & Sons A/S.)

Background: Preservatives are well-known and important contact allergens., Objectives: To examine the frequency of sensitization to preservatives, including time trends., Methods: Retrospective analysis of data on patch testing of preservatives contained in the standard series and special series collected by the IVDK during 1996-2009., Results: Some 120,000 and 80,000 patients were tested with the baseline and the preservative series, respectively. Sensitization frequencies of the standard series allergens all ranged above 1%: methyldibromoglutaronitrile (MDBGN) 2·36-4·5%, methy(chloro)isothiazolinone (MCI/MI) 2·22%, formaldehyde 1·54%, paraben mix 1·33% and Bronopol® 1·25%. Regarding the special preservative series, 1·54% reacted positive to methylisothiazolinone (MI), and < 1% to the other preservatives. Concomitant reactions to formaldehyde in formaldehyde releasers ranged from 15% to almost 50%, and 67% of MI positives reacted to MCI/MI. As indicated by the MOAHLFA index, sensitization to MI, iodopropynylbutyl carbamate (IPBC) and quaternium 15 was associated more often with occupational dermatitis, whereas sensitization to imidazolidinyl urea and diazolidinyl urea was associated with face dermatitis, indicating cosmetic exposure. Epidemiologically relevant decreases (> 10%) were seen in chloroacetamide, benzyl alcohol and MDBGN. Epidemiologically relevant increases were noted in IPBC, sodium benzoate and MI., Conclusions: Preservatives are still important contact allergens. The introduction of new preservatives should consider the specific characteristics of occupational and of nonoccupational (cosmetic, household) exposure, and preventive measures should aim equally at both areas., (© 2011 The Authors. BJD © 2011 British Association of Dermatologists.)

We have reviewed formaldehyde-releasers used in metalworking fluids (MWFs) in this and a previous part of a two-part article. These biocides do not appear to be frequent or important sensitizers. Even in highly selected patient groups of metalworkers, mean prevalence rates of sensitivity are low: 0.2% for Tris(hydroxymethyl)nitromethane, 1.6% for tris(N-hydroxyethyl)hexahydrotriazine, 1.9% for Bioban P-1487 and Bioban CS-1246, and 2.8% for Bioban CS-1135. In the case of the Biobans, many reactions may have been irritant. Only N,N'-methylenebis(5-methyloxazolidine) has a fairly high mean score of 4.0% in metalworkers. With the exception of Bioban P-1487, there is a clear relationship between positive patch test reactions to the releasers and formaldehyde sensitivity: 40-70% of reactions to releasers occur in patients sensitive to formaldehyde and may therefore be caused by formaldehyde allergy. There is a lack of reliable data on the clinical relevance of contact allergy to the formaldehyde releasers in MWF. In most studies, no data on relevance were provided and in those that did, relevance was often found for a (very small) minority of the reactions only. Also discussed here are the formaldehyde-releasers MDM hydantoin, methenamine, N-methylolchloracetamide, paraformaldehyde, and Preventol D2.

This is part of a series of review articles on formaldehyde-releasers and their relationship to formaldehyde contact allergy. Formaldehyde-releasers used in metalworking fluids (MWF) and a group of releasers not presented in previous articles are discussed. Here, in Part 1 of the article, there is a short overview of the composition and functions of MWF, the function of biocides in them, and adverse reactions to MWF. In addition, the releasers in MWF that have caused contact allergy are presented with CAS, synonyms, molecular formula, chemical structure, applications, patch test studies, and amount of formaldehyde released by them. In Part 2 of the article, the relationship between formaldehyde-releasers used in MWF and formaldehyde contact allergy is discussed as are data on miscellaneous releasers not previously presented, followed by a discussion of Parts 1 and 2 of the article.

A broad spectrum of various substances may cause occupational allergic contact dermatitis. Often, it is difficult to identify potentially or truly relevant allergens at the workplace. Therefore, the consulting physician must have a comprehensive knowledge of possible allergens in different occupations to perform specific diagnostics and to initiate efficient secondary prevention by allergen avoidance. In this review, we give some practically relevant general comments on patch testing in occupational dermatitis, followed by a discussion of important occupational allergens in those occupational groups most frequently affected by occupational dermatitis. Finally, recommendations on which allergens should be tested in the respective occupational groups are given or reported from the literature.

Background: Despite rare simultaneous exposure, concomitant sensitisation to bisphenol A diglycidyl methacrylate (BIS-GMA) and epoxy resin frequently occurs. Immunological cross-reactivity has not been proven by animal experiments so far., Objective: Our objective was to examine cross-reactivity epidemiologically by analysing data of the Information Network of Departments of Dermatology (IVDK)., Patients/methods: From 2001 to 2005, 3,777 patients were patch tested with epoxy resin and BIS-GMA in the IVDK. We retrospectively analysed concomitant reactions to these allergens and to BIS-GMA and selected methacrylates. Additionally, we compared clinical characteristics of patients reacting to both, epoxy resin and BIS-GMA, with those of patients reacting to epoxy resin or BIS-GMA only., Results: 185 patients reacted to epoxy resin, and 40 to BIS-GMA. Of the latter, 34 reacted to epoxy resin. There was no difference concerning exposure between the above-mentioned groups of patients. Concomitant reactions to BIS-GMA and methacrylates hardly ever occurred., Conclusions: Considering the fact that very few patients had been potentially exposed to BIS-GMA and that 85% of those reacting to BIS-GMA also reacted to epoxy resin, we conclude that our data are presumably indicative of immunological cross-reactivity. A verification of this hypothesis by animal experiments would be promising.

Background: Hair cosmetics, in particular hair dyes, bleaches, and permanent wave solutions, contain a number of potential contact allergens. The pattern of exposure to these in hairdressers, clients and home-users may change over time., Patients and Methods: Data on female patients who consulted centers of the Information Network of Departments of Dermatology (IVDK, http://www.ivdk.org) between 01/2003 and 12/2006 was analyzed. Patients were divided into a) hair-dressers, given they worked in this occupation and suffered from occupational skin disease (n = 480),and b) "clients",who never worked as hairdressers, but in whom hair cosmetics were considered a potential cause of contact dermatitis (n = 780)., Results: In hairdressers, the most important allergens were ammonium persulfate (21.7% positive),p-toluenediamine (PTD,19.6% positive),p-phenylenedi-amine (PPD,18.1% positive) and, with decreasing time trend, glyceryl monothioglycolate (2005/2006 still 7.5% positive). Biocides must be regarded as important allergens in hairdressers, namely,(chloro) methylisothiazolinone and methyldibromoglutaronitrile. Clients, who were considerably older on average, had possibly been tested in a more aimed fashion, yielding (strikingly) higher sensitization prevalences to a number of allergens of oxidative hair dyes such as PPD or PTD., Conclusions: The continual analysis of sensitization prevalences in patients patch tested can identify areas needing in-depth research and preventive intervention, such as avoiding the use of certain biocides in shampoo intended for professional use by hairdressers or further reducing the concentrations in oxidative hair dyes.

Background: Although many allergens in metalworking fluids (MWF) are identified, there are still some MWF components, which are not sufficiently investigated concerning their sensitizing properties., Objectives: To investigate sensitization to 10 frequently used MWF components, which are not part of the established MWF test series, in metalworkers with suspected occupational dermatitis due to MWF., Patients/methods: Oleyl alcohol, myristyl alcohol, dimethylolurea, 4,4'-methylenebis morpholine, imazalil, 1-amino-2-propanol (monoisopropanolamine; MIPA), 2-amino-2-ethyl-1,3-propanediol (AEPD), 2,5-bis(n-octyldithio)-1,3,4-thiadiazole, zinc alkyl dithiophosphate and dibenzyl disulfide have been patch tested in 144 patients., Results: 7 patients reacted positively to the formaldehyde releaser 4,4'-methylenebis morpholine, and 6 of these patients also reacted to formaldehyde and/or other formaldehyde releasers. 4 patients reacted positively to myristyl alcohol tested at 10% petrolatum (pet.). Additionally, 20 doubtful or irritant reactions occurred. 1 patient each reacted positively to oleyl alcohol, MIPA, and AEPD. None of the other test substances mentioned above elicited any clear-cut positive reaction. Patch testing with well-known MWF allergens showed proportions of positive reactions, which were comparable to those from other studies, e.g. 11% to monoethanolamine, 8% to colophonium and 3%-5% to various preservatives., Conclusions: 4,4'-methylenebis morpholine may be an important MWF allergen, although clinical relevance could not be stated definitely in every case. Myristyl alcohol should not be patch tested at 10% pet., but at a lesser concentration, due to irritant properties.

Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4-butanediol diglycidyl ether (1,4-BDDGE). The chemical triglycidyl-p-aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP-patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo.