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Background: Parents report that children with aluminium contact allergy and vaccination granulomas may react to aluminium‐containing sunscreen following application. Objectives: To evaluate whether contact dermatitis develops following repeated application of aluminium‐containing sunscreens in children with aluminium sensitization and vaccination granulomas. Methods: Sixteen children aged 2‐9 years (mean age 5 years) with vaccination granulomas and a positive patch test reaction to aluminium chloride hexahydrate 2%/10% petrolatum completed a blinded repeated open application test (ROAT) with two daily applications of two sunscreens for 14 days. One cream contained aluminium and the other did not. The children served as their own controls. Results: Sixteen children completed the study. Only one child (6%) had a positive skin reaction during ROAT on day 2 to the sunscreen with aluminium. None reacted to the sunscreen without aluminium. Conclusions: Use of aluminium‐containing sunscreens may on a case basis lead to allergic contact dermatitis in aluminium allergic children. [ABSTRACT FROM AUTHOR]

Background: Hydroxyisohexyl 3‐cyclohexene carboxaldehyde (HICC) has been the most reported fragrance chemical for two decades and will be prohibited in cosmetic products from August 2021. Objectives: To describe the time trend of HICC contact allergy in European patients with dermatitis in 2009 to 2019, and the added value of testing HICC separately in the baseline series. Methods: Data were reviewed for 124 472 patients with dermatitis who were patch tested with HICC 5% pet. in the baseline series in the European Surveillance System on Contact Allergy (ESSCA) network (2009 to 2018) and at the Herlev‐Gentofte Hospital Department of Dermatology and Allergy (2009 to 2019). Results: Contact allergy to HICC was found in 1.98% of 9865 patients in Gentofte and 1.62% of 114 607 patients in the ESSCA network. Overall, the prevalence decreased annually, with 0.156 percentage points (P =.001) in Gentofte and 0.051 percentage points (P =.0002) in ESSCA. The frequency of missed contact allergy to HICC when testing only with fragrance mix II (FMII) was 0.17% (17/9865) and 0.35% (405/114607) of the whole test population in the Gentofte and ESSCA populations, respectively. Conclusions: This is the first study to demonstrate a significant decline in HICC allergy in European patients with dermatitis, most likely attributed to the upcoming European ban. [ABSTRACT FROM AUTHOR]

Background: Fragrance contact allergy is common, but few studies on quality of life (QoL) in affected patients exist. Recently, the disease‐specific Fragrance Quality of Life Index (FQLI) was developed. Objectives: To characterize QoL in European dermatitis patients with fragrance contact allergy at the time of diagnosis. Methods: This was a cross‐sectional study, in which 2011 Danish, British, Spanish and German adult consecutive dermatitis patients were invited to complete a questionnaire on self‐reported disease severity, the Dermatology Life Quality Index (DLQI), and the FQLI immediately prior to being patch tested. Results: One thousand seven hundred and fifty‐eight patients responded, and 259 (14.7%; country range 11.7%‐18.5%) were fragrance‐positive. Among these, the total (SD) DLQI score was 6.2 (5.6) and the total (SD) FQLI score was 60 (25), with both estimates being comparable to those in fragrance‐negative patients. Adjusting the total FQLI score for age, sex and self‐rated disease severity showed a higher (ie, worse) score in fragrance‐positive patients (3.6‐point increase; 95% confidence interval: 0.30‐6.8 points; P = 0.03). Specifically, contact allergy to oxidized linalool was associated with greater impairment in QoL. Conclusions: QoL in patients with fragrance contact allergy is impaired at a level comparable to that in other patch tested dermatitis patients, at the time of diagnosis, across several European countries. [ABSTRACT FROM AUTHOR]

Background: Methylisothiazolinone (MI) caused an epidemic of contact allergy in Europe, as shown by data from many countries, but no studies from Croatia exist. Also, data are lacking on the severity of allergic contact dermatitis (ACD) caused by MI, and its impact on quality of life and prognosis. Objectives: To determine the frequency of MI contact allergy among Croatian dermatitis patients, identify causative exposures, assess the impact of disease, and study the prognosis. Methods: Data were collected for consecutive dermatitis patients with MI contact allergy patch tested in Croatia between November 2, 2015 and November 3, 2016. Results: MI contact allergy was diagnosed in 13.2% of 798 tested patients. The most frequent dermatitis locations were the hands (76%) and face (61%). In 89.3% of patients, MI contact allergy was found to be of current relevance. Considerable severity and impact on daily life of disease was found at the first consultation, but this significantly decreased until follow‐up 3 months later. Conclusions: Patch testing is the standard method for the diagnosis of ACD, and it has been shown to have an important beneficial effect on prognosis. The severity of MI ACD and the impact on daily life emphasize the need for prevention. [ABSTRACT FROM AUTHOR]

Summary: Background: An increasing incidence of contact allergy to methylisothiazolinone (MI) has been seen, caused, in particular, by cosmetic products and paints. A study from 2015 showed that 93.0% of paints bought in five European countries contained MI. New regulations have been discussed for paints in the EU, which may have influenced this market. Objectives: To re‐evaluate the use and concentrations of MI and four other isothiazolinones in water‐based wall paints. Methods: Water‐based white wall paints (n = 60) were purchased in retail stores in five European countries: Denmark, France, Germany, Sweden, and the United Kingdom. The paints were analysed for isothiazolione content by the use of high‐performance liquid chromatography coupled to ultraviolet detection, and the results were confirmed with high‐performance liquid chromatography–tandem mass spectrometry. Results: MI was identified in 55 (91.7%) of the paints, with concentrations ranging from 1.1 to 142.7 ppm. The other isothiazolinones were identified in 20.0% [methylchloroisothiazolinone (MCI)] to 88.3% [benzisothiazolinone (BIT)] of the paints. BIT concentrations varied significantly between countries, whereas MI and MCI concentrations did not. There were no statistically significant differences in MI, MCI and BIT concentrations between the current study and the 2015 study. Conclusions: MI and other isothiazolinones are widely used in paints available in Europe. Their use does not seem to be decreasing. [ABSTRACT FROM AUTHOR]

Summary: Background: The current European baseline series consists of 30 allergens, and was last updated in 2015. Objectives: To use data from the European Surveillance System on Contact Allergies (ESSCA) to propose an extension to the European baseline series in response to changes in environmental exposures. Methods: Data from departmental and national extensions to the baseline series, together with some temporary additions from departments contributing to the ESSCA, were collated during 2013–2014. Results: In total, 31689 patients were patch tested in 46 European departments. Many departments and national groups already consider the current European baseline series to be a suboptimal screen, and use their own extensions to it. The haptens tested are heterogeneous, although there are some consistent themes. Potential haptens to include in an extension to the European baseline series comprise sodium metabisulfite, formaldehyde‐releasing preservatives, additional markers of fragrance allergy, propolis, Compositae mix, and 2‐hydroxyethyl methacrylate. Conclusion: In combination with other published work from the ESSCA, changes to the current European baseline series are proposed for discussion. As well as addition of the allergens listed above, it is suggested that primin and clioquinol should be deleted from the series, owing to reduced environmental exposure. [ABSTRACT FROM AUTHOR]

Background Lanolin has been tested as lanolin alcohols (30% pet.) in baseline patch test series since 1969, and this has shown clinically relevant allergic contact dermatitis cases. Objectives To investigate the temporal development of lanolin allergy (i.e. positive reaction to lanolin alcohols and/or Amerchol™ L-101), and the association between contact allergy to lanolin and patient characteristics from the MOAHLFA index. Methods A retrospective observational study of consecutively patch tested dermatitis patients (n = 9577) between 1 January 2004 and 31 December 2015 with lanolin alcohols 30% pet. and Amerchol™ L-101 50% pet. was performed. Results The prevalence of lanolin allergy increased from 0.45% in 2004 to 1.81% in 2015. In age-adjusted and sex-adjusted analyses, weak, significant associations were found between atopic dermatitis and lanolin and lanolin alcohols allergy, respectively, but no association with Amerchol™ L-101 allergy was found. Among 9286 dermatitis patients who were tested with both allergens, 108 had a positive test reaction to either lanolin alcohols or Amerchol™ L-101, whereas only 29 patients had positive test reactions to both markers. Conclusions The prevalence of lanolin contact allergy has increased over a 12-year period, and inclusion of Amerchol™ L-101 will increase the chance of detecting lanolin contact allergy. Patch testing with lanolin is helpful in atopics with dermatitis and suspected cosmetic allergy. [ABSTRACT FROM AUTHOR]

Nickel contact allergy remains a problem in EU countries, despite the EU Nickel Directive. To study the prevalence of nickel allergy in EU countries following the implementation of the EU Nickel Directive, we performed a systematic search in PubMed for studies that examined the prevalence of nickel allergy in EU countries published during 2005-2016. We identified 46 studies: 10 in the general population and 36 in patch tested dermatitis patients. A significantly lower prevalence of nickel allergy after than before the implementation of the EU Nickel Directive was found in women aged 18-35 years (11.4% versus 19.8%) ( p = 0.02), in female dermatitis patients aged ≤17 years (14.3% versus 29.2%) ( p < 0.0001), and in dermatitis patients aged 18-30 years (women: 20.2% versus 36.6%) ( p < 0.0001) (men: 4.9% versus 6.6%) ( p < 0.0001). Overall, the prevalence was higher in southern than in northern EU countries, and generally remained high, affecting 8-18% of the general population. A consistent pattern of decreasing prevalence of nickel allergy in some EU countries was observed, although the prevalence among young women remains high. Steps should be taken for better prevention of nickel allergy in EU countries. [ABSTRACT FROM AUTHOR]

Background Information concerning health-related quality of life ( HRQoL) and comorbidities of adult dermatitis patients stratified by loss-of-function mutations in the filaggrin gene ( FLG) is limited. Objective To investigate HRQoL, skin symptoms and comorbidities in adult FLG mutation carriers. Methods This cross-sectional study included patients diagnosed with atopic dermatitis and/or hand eczema (n = 520). Patients completed questionnaires about dermatitis, skin symptoms, HRQoL, and comorbidities, including actinic keratosis, and atopic and mental disorders. Results FLG mutations ( R501X, 2282del4, and R2447X) were identified in 16.9% of patients, and were significantly associated not only with atopic dermatitis, but also independently with skin fissures on the fingers and heels, and self-reported actinic keratosis. Although FLG mutations were significantly associated with reduced HRQoL, as measured by use of the Dermatology Life Quality Index ( DLQI), no association with self-reported anxiety or depression was identified. Notably, the highest median DLQI score, reflecting greater impairment, was reported by patients with both FLG mutations and atopic dermatitis. Overall, 19.7% of patients with both atopic dermatitis and FLG mutations reported a 'large or extremely large' impact on their lives; this represents twice the prevalence seen in patients with atopic dermatitis and wild-type FLG (9.6%). Conclusion Patients with both atopic dermatitis and common FLG mutations are more frequently affected by reduced HRQoL. [ABSTRACT FROM AUTHOR]

Case reports constitute a classic publication format that is being increasingly appreciated, for example because of its educational value. In the field of contact dermatitis research, case reports often serve as sentinel publications concerning new allergens, or new exposures to known allergens, or regarding other conditions leading to contact dermatitis. The CARE guideline published in 2013 addresses standardized and complete reporting of case reports in all fields of medicine. The present article takes up the CARE suggestions, and further specifies these in terms of application to case reports in the field of contact dermatitis. The objective of this structured guidance is to provide junior or inexperienced doctors and researchers with an annotated list, against which the fulfilment of essential or optional items of a complete, high-quality case report to be submitted to Contact Dermatitis or other journals can be checked. [ABSTRACT FROM AUTHOR]

A case study is presented for a 24-year-old male patient with acute dermatitis. It states he was a marine engineer on a container ship who developed severe oozing dermatitis on the forearms, dorsa of the hands, and thighs after he was exposed to warm oil from a centrifuge he was cleaning. It mentions that clinical presentation and patch testing results gave a suspicion of cobalt contamination and suggests the machine oils acted as a surfactant to allow the skin absorption of cobalt contaminants.

Background Chromium is an important skin sensitizer. Exposure to it has been regulated in cement, and recently in leather. Studies on the deposition of chromium ions on the skin as a result of handling different chromium-containing materials are sparse, but could improve the risk assessment of contact sensitization and allergic contact dermatitis caused by chromium. Objectives To determine whether the handling of chromium-containing samples of leather and metal results in the deposition of chromium onto the skin. Methods Five healthy volunteers participated. For 30 min, they handled samples of leather and metal known to contain and release chromium. Skin deposition of chromium was assessed with the acid wipe sampling technique. Results Acid wipe sampling of the participants' fingers showed chromium deposition on the skin in all participants who had been exposed to leather (range 0.01-0.20 µg/cm2) and in 3 of 5 participants after they had manually handled metal discs (range 0.02-0.04 µg/cm2). Conclusions We found that samples of leather and metal had the ability to deposit chromium on the skin at significant levels, in spite of a short duration of exposure. [ABSTRACT FROM AUTHOR]

Background Hand eczema is the commonest occupational skin disease in Denmark, and hairdressing is a high-risk profession. In 2008-2010, a clinically controlled, prospective intervention study aimed at reducing the development of hand eczema was conducted at hairdressing schools in Denmark. The findings showed that significantly fewer apprentices in the intervention group developed hand eczema over a period of 18 months. Objectives To investigate the long-term effect of the intervention. Methods Two hundred and eighty-four participants were identified from the original dataset, and were sent a questionnaire. Results No difference was seen between the intervention and control groups. This may partly be attributable to the two groups no longer being well matched, and improved work habits in the control group. Overall, there was an improvement in work habits. Participants had a 1-year prevalence of hand eczema of 22.4%. Reactions to hair dye were reported for 24.5%, and 35.5% had left the trade; 36.4% used gloves when shampooing, and 21.3% stated that they cut hair before colouring it. Conclusions The effect of the intervention was not visible after 6 years, but an overall improvement in work habits was noted. [ABSTRACT FROM AUTHOR]

Background Limonene and linalool are common fragrance terpenes. Both oxidized R -limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively. Objective To investigate concomitant reactions between oxidized R-limonene and oxidized linalool in consecutive dermatitis patients. Methods Oxidized R-limonene 3.0% (containing limonene hydroperoxides 0.33%) and oxidized linalool 6% (linalool hydroperoxides 1%) in petrolatum were tested in 2900 consecutive dermatitis patients in Australia, Denmark, Singapore, Spain, Sweden, and the United Kingdom. Results A total of 281 patients reacted to either oxidized R-limonene or oxidized linalool. Of these, 25% had concomitant reactions to both compounds, whereas 29% reacted only to oxidized R-limonene and 46% only to oxidized linalool. Of the 152 patients reacting to oxidized R-limonene, 46% reacted to oxidized linalool, whereas 35% of the 200 patients reacting to oxidized linalool also reacted to oxidized R-limonene. Conclusions The majority of the patients (75%) reacted to only one of the oxidation mixtures, thus supporting the specificity of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance materials. [ABSTRACT FROM AUTHOR]

The history of chromium as an allergen goes back more than a century, and includes an interventional success with national legislation that led to significant changes in the epidemiology of chromium allergy in construction workers. The 2015 EU Leather Regulation once again put a focus on chromium allergy, emphasizing that the investigation of chromium allergy is still far from complete. Our review article on chromium focuses on the allergen's chemical properties, its potential exposure sources, and the allergen's interaction with the skin, and also provides an overview of the regulations, and analyses the epidemiological pattern between nations and across continents. We provide an update on the allergen from a dermatological point of view, and conclude that much still remains to be discovered about the allergen, and that continued surveillance of exposure sources and prevalence rates is necessary. [ABSTRACT FROM AUTHOR]

Background Along with chromium, nickel and cobalt are the clinically most important metal allergens. However, unlike for nickel and cobalt, there is no validated colorimetric spot test that detects chromium. Such a test could help both clinicians and their patients with chromium dermatitis to identify culprit exposures. Objectives To evaluate the use of diphenylcarbazide ( DPC) as a spot test reagent for the identification of chromium( VI) release. Methods A colorimetric chromium( VI) spot test based on DPC was prepared and used on different items from small market surveys. Results The DPC spot test was able to identify chromium( VI) release at 0.5 ppm without interference from other pure metals, alloys, or leather. A market survey using the test showed no chromium( VI) release from work tools (0/100). However, chromium( VI) release from metal screws (7/60), one earring (1/50), leather shoes (4/100) and leather gloves (6/11) was observed. We found no false-positive test reactions. Confirmatory testing was performed with X-ray fluorescence ( XRF) and spectrophotometrically on extraction fluids. Conclusions The use of DPC as a colorimetric spot test reagent appears to be a good and valid test method for detecting the release of chromium( VI) ions from leather and metal articles. The spot test has the potential to become a valuable screening tool. [ABSTRACT FROM AUTHOR]

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance. [ABSTRACT FROM AUTHOR]

Background Several studies have shown nickel and cobalt release from jewellery by using spot tests, but the metal composition of jewellery is largely unknown. Objectives To evaluate the metal composition of a large worldwide sample of mainly inexpensive jewellery items, and investigate the release of nickel, cobalt and lead from a subsample by using EN 1811:1998-required methods. Methods A total of 956 metallic jewellery components were examined with X-ray fluorescence spectroscopy. A subsample of 96 jewellery items purchased in the United States were investigated for nickel, cobalt and lead release by the use of artificial sweat immersion and plasma optical emission spectroscopy. Results Eighteen elements were detected. The 10 most frequently occurring were, in order of frequency, copper, iron, zinc, nickel, silver, chromium, tin, manganese, lead, and cobalt. Release of nickel was noted from 79 of the 96 US samples (0.01-98 µg/cm2/week), release of cobalt from 35 samples (0.02-0.5 µg/cm2/week), and release of lead from 37 samples (0.03-2718 µg/cm2/week). Conclusions We present here a comprehensive list of the most frequently encountered metals in jewellery and fashion accessories. Different allergenic and non-allergenic metals are utilized. We also report the frequent release of nickel, cobalt and lead from these objects, despite legislative restrictions. [ABSTRACT FROM AUTHOR]

Background Hand eczema is frequent among Danish hairdressers, and they are advised to use gloves as protection. However, studies indicate that a significant proportion use gloves inappropriately. Objectives To determine whether hairdressers and apprentices use protective gloves in the correct way, and to determine whether a demonstration of correct use could cause an improvement. Methods Forty-three hairdressers and apprentices were asked to perform a hair wash while wearing gloves. The shampoo used was contaminated with an ultraviolet ( UV) trace material. Two rounds of hair washing were carried out by each person, interrupted by a demonstration of how to use gloves correctly. Photographs were taken to compare UV contamination before and after the demonstration. Results All of the participants (100%) had their hands contaminated during the first round; the area ranged between 0.02 and 101.37 cm2 (median 3.62 cm2). In the second round, 55.8% were contaminated (range 0.00-3.08 cm2; median 0.01 cm2). The reduction in contaminated skin areas was statistically significant ( p < 0.001), proving an effect of the glove demonstration. There were no significant differences between hairdressers and apprentices. Conclusions Hairdressers and apprentices lack knowledge on how to handle gloves correctly. A short demonstration of correct glove use made a significant difference in the skin protection provided by gloves. [ABSTRACT FROM AUTHOR]

Background Cobalt is a strong skin sensitizer and a prevalent contact allergen. Recent studies have recognized exposure to leather articles as a potential cause of cobalt allergy. Objectives To examine the association between contact allergy to cobalt and a history of dermatitis resulting from exposure to leather. Methods A questionnaire case-control study was performed: the case group consisted of 183 dermatitis patients with a positive patch test reaction to cobalt chloride and a negative patch test reaction to potassium dichromate; the control group consisted of 621 dermatitis patients who did not react to either cobalt or chromium in patch testing. Comparisons were made by use of a χ2-test, Fisher's exact, and the Mann-Whitney test. Logistic regression analyses were used to test for associations while taking confounding factors into consideration. Results Leather was observed as the most frequent exposure source causing dermatitis in the case group. Although the case group significantly more often reported non-occupational dermatitis caused by leather exposure ( p < 0.001), no association was found between cobalt allergy and dermatitis caused by work-related exposure to leather. Conclusions Our study suggests a positive association between cobalt allergy and a history of dermatitis caused by non-occupational exposure to leather articles. [ABSTRACT FROM AUTHOR]

Background R-Limonene is a common fragrance terpene found in domestic and industrial products. R- Limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a recent multicentre study, 5.2% (range 2.3-12.1%) of 2900 patients showed a positive patch test reaction to oxidized R-limonene. Objective To study the exposure to limonene among consecutive dermatitis patients reacting to oxidized R-limonene in an international setting, and to assess the relevance of the exposure for the patients' dermatitis. Methods Oxidized R-limonene 3.0% (containing limonene hydroperoxides at 0.33%) in petrolatum was tested in 2900 consecutive dermatitis patients in Australia, Denmark, the United Kingdom, Singapore, Spain, and Sweden. A questionnaire assessing exposure to limonene-containing products was completed. Results Overall, exposure to products containing limonene was found and assessed as being probably relevant for the patients' dermatitis in 36% of the limonene-allergic patients. In Barcelona and Copenhagen, > 70% of the patients were judged to have had an exposure to limonene assessed as relevant. Conclusions Oxidized R-limonene is a common fragrance allergen, and limonene was frequently found in the labelling on the patients' products, and assessed as relevant for the patients' dermatitis. A large number of domestic and occupational sources for contact with R-limonene were identified. [ABSTRACT FROM AUTHOR]

Background In recent years, the prevalence of contact allergy to isothiazolinones has reached epidemic levels. Few studies have presented data on occupations at risk of developing contact allergy to isothiazolinones. Objectives To present demographics and examine risk factors for sensitization to methylisothiazolinone ( MI), methylchloroisothiazolinone ( MCI) in combination with MI and benzisothiazolinone ( BIT) in Danish dermatitis patients. Materials and methods A retrospective epidemiological analysis of data from three Danish hospitals departments was conducted. All patients consecutively patch tested with MI, MCI/ MI and BIT between 2009 and 2013 were included. Results MI contact allergy showed a significantly increased trend in prevalence from 1.8% in 2009 to 4.2% in 2012 ( p < 0.001). Females with facial dermatitis mainly drove the increase in 2012. Adjusted logistic regression analysis showed that MI sensitization was significantly associated with occupational exposures, hand and facial dermatitis, age > 40 years, and the occupational groups of tile setters/terrazzo workers, machine operators, and painters. MCI/ MI contact allergy was significantly associated with the following high-risk occupations: painting, welding (blacksmiths), machine operating, and cosmetology. The occupational group of painting was frequent in the group of patients with BIT contact allergy. Conclusion Several high-risk occupations for sensitization to isothiazolinones exist. Regulation on the allowed concentration of isothiazolinones, and especially MI, in both consumer products and industrial products is needed. [ABSTRACT FROM AUTHOR]

Background Methylchloroisothiazolinone ( MCI) and methylisothiazolinone ( MI) are the active ingredients in commonly used preservative systems (e.g. Kathon CG®). MCI/ MI is present in the European baseline patch test series at 100 ppm aq. Since 1986, 200 ppm (dose 0.006 mg/cm2) has been used in Sweden without causing skin irritation. Centres in Spain, the United Kingdom and Ireland have also used 200 ppm in their baseline series. Objectives To find the optimal patch test concentration for MCI/ MI. Materials and methods MCI/ MI 100 ppm aq. and MCI/ MI 200 ppm aq. were simultaneously patch tested in 3300 consecutively tested dermatitis patients at eight European patch test clinics and one US patch test clinic. With the Finn Chambers® technique (diameter 8 mm), 15 µl was micropipetted on to the filter paper in the chamber. The corresponding volume for Van der Bend® chambers was 20 µl, and that for IQ Chambers® was 25 µl. Results Contact allergy to MCI/ MI at 100 and 200 ppm was found in 1.2% and 2.1% of patients, respectively ( p < 0.001). Conclusions MCI/ MI 200 ppm aq. (dose 0.006 mg/cm2) diagnoses significantly more contact allergy than the presently used concentration of 100 ppm (dose 0.003 mg/cm2), without resulting in more adverse reactions. MCI/ MI at 200 ppm should therefore be considered for inclusion in the European baseline test series. [ABSTRACT FROM AUTHOR]

Background Occupational contact dermatitis among hairdressers is frequent, owing to daily exposure to irritants and allergens. Objectives To identify sensitization to the most common allergens associated with the occupation of hairdressing. Methods Patch test results of 399 hairdressers and 1995 matched controls with contact dermatitis, registered by the Danish Contact Dermatitis Group between January 2002 and December 2011, were analysed. All patients were patch tested with the European baseline series, and hairdressers were additionally tested with the hairdressing series. Results Occupational contact dermatitis ( p < 0.001) and hand eczema ( p < 0.001) were observed significantly more often among hairdressers than among controls. Atopic dermatitis was less commonly observed among hairdressers (21.3%) than among controls (29.4%) ( p < 0.01). Allergens from the European baseline series with a statistically significant association with the occupation of hairdressing were p-phenylenediamine, thiuram mix, and benzocaine. Frequent sensitizers from the hairdressing series were ammonium persulfate, toluene-2,5-diamine, 3-aminophenol, and 4-aminophenol. Cysteamine hydrochloride and chloroacetamide emerged as new sensitizers. Conclusions These results indicate a healthy worker effect among hairdressers diagnosed with eczema. Ammonium persulfate and p-phenylenediamine remain frequent sensitizers in hairdressers with contact dermatitis. Cysteamine hydrochloride and chloroacetamide should be included in future surveillance studies. [ABSTRACT FROM AUTHOR]

Background Fragrance allergy is a lifelong condition that may give rise to permanent or recurrent contact dermatitis and may affect quality of life ( QoL). The effect on QoL has not yet been investigated, and no disease-specific QoL instrument for fragrance allergy exists. Objective To develop and validate a disease-specific instrument to investigate QoL among fragrance-allergic subjects. Method A fragrance QoL instrument ( FQL index) was developed on the basis of narratives from 68 fragrance-allergic subjects, and consisted of 13 items. It was tested in a postal survey among 1650 participants patch tested at Gentofte University Hospital (2000-2010). The survey included other QoL instruments [Dermatology Life Quality Index ( DLQI) and Short Form 36 ( SF36) version 2] and questions on eczema severity (response rate of 66%). A retest was conducted after 3-6 months (response rate of 72.5%). Results The FQL index showed a significant and strong correlation with the DLQI ( rS = 0.70), and disease severity, but a weak correlation with SF36 [mental component summary score, rS = − 0.22; physical component summary score, rS = − 0.31]. Good reliability and responsiveness to changes in disease severity were seen. Conclusion The FQL index is a good instrument with which to investigate QoL in subjects with fragrance allergy. Good correlations with the DLQI and self-estimated disease severity were seen, and it showed good reliability, reproducibility and ability to distinguish changes in disease severity. [ABSTRACT FROM AUTHOR]

Background Fragrance ingredients can cause contact allergy, which may affect quality of life ( QoL). However, few studies have investigated this topic. Objectives To investigate QoL life among subjects with a fragrance allergy as compared with other eczema patients. Methods A case-control survey was sent to subjects with a positive patch test reaction to a fragrance ingredient/marker (n = 550) and to a control group (n = 1100). It contained questions on eczema and the newly developed fragrance QoL index. Participants had been consecutively patch tested at Gentofte University Hospital (2000-2010). The response rate was 65.7%. Information on patch test data was retrieved from the National Contact Dermatitis Database. Results An increase in impairment of QoL was observed in women with fragrance allergy as compared with the control group ( p = 0.042), which was not found among men. Several factors played a significant role in impairment of QoL in women: (i) number of fragrance allergies, (ii) severity of the patch test reaction, (iii) age combined with recent diagnosis; and (iv) allergy to specific fragrance ingredients/markers. Conclusion Fragrance-allergic subjects are just as affected in their QoL as other eczema patients. However, women, and in particular recently diagnosed young women, seem to be more impaired in their QoL than other eczema patients. [ABSTRACT FROM AUTHOR]

Background A patient who had suffered from persistent generalized dermatitis for 7 years was diagnosed with cobalt sensitization, and his leather couch was suspected as the culprit, owing to the clinical presentation mimicking allergic chromium dermatitis resulting from leather furniture exposure. Materials and methods The cobalt spot test, X-ray fluorescence, inductively coupled plasma mass spectrometry and scanning electron microscopy were used to determine cobalt content and release from the leather couch that caused the dermatitis and from 14 randomly collected samples of furniture leather. Results The sample from the patient's leather couch, but none of the 14 random leather samples, released cobalt in high concentrations. Dermatitis cleared when the patient stopped using his couch. Conclusions Cobalt is used in the so-called pre-metallized dyeing of leather products. Repeated studies have found high levels of cobalt sensitization, but not nickel sensitization, in patients with foot dermatitis. We raise the possibility that cobalt may be widely released from leather items, and advise dermatologists to consider this in patients with positive cobalt patch test reactions. [ABSTRACT FROM AUTHOR]

Background The prevalence of contact allergy to the isothiazolinone preservative methylchloroisothiazolinone ( MCI) in combination with methylisothiazolinone ( MI) and MI alone has increased in the last couple of years. Objectives To investigate the prevalence of contact allergy to MI, MCI/ MI and benzisothiazolinone ( BIT) among patch tested patients at Gentofte Hospital, as well as the use of MI in cosmetic products. Methods Patients patch tested with either MI, MCI/ MI or BIT from 2010 to 2012 were included in the study. The MOAHLFA index was registered in all patch tested patients, and relevant exposures were determined in patients with an isothiazolinone allergy. In a market survey, the ingredient labels of cosmetic products were investigated for MI content. Results The prevalence of MI and MCI/ MI contact allergy increased significantly from 2010 to 2012: from 2.0% to 3.7% for MI (n = 2766), and from 1.0% to 2.4% for MCI/ MI (n = 2802). MI-allergic patients had occupational, hand and face dermatitis significantly more often, and were aged > 40 years. Cosmetics were the most common substances causing relevant exposure found in both MCI/ MI-allergic and MI-allergic patients. MI was found in 3.3% of cosmetics on the Danish retail market. Conclusions The increase in MI contact allergy is alarming, and urgent action is needed. [ABSTRACT FROM AUTHOR]

Contact allergy to fragrances is still relatively common, affecting ∼ 16% of patients patch tested for suspected allergic contact dermatitis, considering all current screening allergens. The objective of the review is to systematically retrieve, evaluate and classify evidence on contact allergy to fragrances, in order to arrive at recommendations for targeting of primary and secondary prevention. Besides published evidence on contact allergy in humans, animal data (local lymph node assay), annual use volumes and structure-activity relationships ( SARs) were considered for an algorithmic categorization of substances as contact allergens. A total of 54 individual chemicals and 28 natural extracts (essential oils) can be categorized as established contact allergens in humans, including all 26 substances previously identified as contact allergens (SCCNFP/0017/98). Twelve of the 54 individual chemicals are considered to be of special concern, owing to the high absolute number of reported cases of contact allergy (> 100). Additionally, 18 single substances and one natural mixture are categorized as established contact allergens in animals. SARs, combined with limited human evidence, contributed to the categorization of a further 26 substances as likely contact allergens. In conclusion, the presence of 127 single fragrance substances and natural mixtures should, owing to their skin sensitizing properties, be disclosed, for example on the label. As an additional preventive measure, the maximum use concentration of 11 substances of special concern should be limited to 100 ppm. The substance hydroxyisohexyl 3-cyclohexene carboxaldehyde and the two ingredients chloroatranol and atranol in the natural extracts Evernia prunastri and Evernia furfuracea should not be present in cosmetic products. [ABSTRACT FROM AUTHOR]

Background. Although heterozygous filaggrin gene ( FLG) mutation carriers seem to have an increased risk of atopic, irritant and allergic nickel dermatitis, it remains unclear whether the risk of contact sensitization to allergens other than nickel is also elevated in FLG mutation carriers. Objectives. We hypothesized that heterozygous FLG mutation carriers who suffer from dermatitis will have strongly reduced or even absent filaggrin levels during episodes of inflammation, potentially increasing the penetration of contact allergens, and hence the risk of becoming sensitized. Materials and methods. During 2006-2008, 3335 randomly invited 18-69-year-old adult Danes participated in a general health examination, filled out a questionnaire, and were genotyped for the R501X and 2282del4 mutations in FLG. Results. A logistic regression analysis restricted to individuals who reported atopic dermatitis and frequent episodes of hand eczema showed a strong association between FLG mutations and contact sensitization to allergens other than nickel (odds ratio 5.71; 95% confidence interval 1.31-24.94). In participants without dermatitis, no association was found between contact sensitization and FLG mutations. Conclusion. FLG mutation carriers with self-reported dermatitis have an increased risk of contact sensitization to substances other than nickel, whereas FLG mutations alone may not, or may only slightly, increase the risk of sensitization. [ABSTRACT FROM AUTHOR]

Background. Limonene is a common fragrance terpene that, in its pure form, is not allergenic or is a very weak allergen. However, limonene autoxidizes on air exposure, and the oxidation products can cause contact allergy. Oxidized R-limonene has previously been patch tested in multicentre studies, giving 2-3% positive patch test reactions in consecutive patients. Objectives. To investigate whether oxidized R-limonene 3.0% in petrolatum, with a stable concentration of the main haptens, limonene hydroperoxides (Lim-OOHs), could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized R-limonene 3.0% (Lim-OOHs 0.33%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 5.2% (range 2.3-12.1%) of the patients showed a positive patch test reaction to oxidized R-limonene. Doubtful reactions were found in 7.0% of the patients (range 0-24%). Few irritant reactions were seen. Conclusions. Oxidized R-limonene at 3.0% pet. with a specified content of Lim-OOHs 0.33% is a standardized and useful tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized R-limonene would not be informed of their fragrance allergy if this specific test had not been performed. [ABSTRACT FROM AUTHOR]

Background. Linalool is a common fragrance terpene that, in pure form, is not allergenic or is a very weak allergen. However, linalool autoxidizes on air exposure, and the oxidation products can cause contact allergy. In a Swedish study, oxidized linalool 6.0% in petrolatum (pet.) gave 5% positive patch test reactions in 2500 dermatitis patients. Objectives. To investigate whether oxidized linalool 6%, with a stable concentration of the main haptens, the linalool hydroperoxides (Lin-OOHs) in pet., could be a useful tool for the detection of contact allergy in an international setting. Methods. Oxidized linalool 6.0% (Lin-OOHs 1%) pet. was tested in 2900 consecutive dermatitis patients in Denmark, the United Kingdom, Singapore, Spain, Sweden, and Australia. Results. Overall, 6.9% (range 3-13%) of the patients showed positive patch test reactions to oxidized linalool. Doubtful reactions were found in 9.2% of the patients (range 0-36%). Few irritant reactions were seen. Conclusions. In an international setting, oxidized linalool has been shown to be a common allergen. Oxidized linalool 6.0% (Lin-OOHs 1%) pet. is a useful, standardized and stable tool for the detection of contact allergy in dermatitis patients. Many patients showing positive patch test reactions to oxidized linalool would not have been informed of their fragrance allergy if this specific test had not been performed. [ABSTRACT FROM AUTHOR]

Background. Painters are among the occupational groups that most commonly experience occupational contact dermatitis, but few investigations exist concerning this occupation. Objectives. To characterize painters with contact dermatitis and identify the most common allergens associated with the occupation. Materials and methods. All patch test results of 219 painters and 1095 matched controls registered by the Danish Contact Dermatitis Group between 2001 and 2010 were analysed. Results. Hand eczema ( p < 0.0001) and occupational contact dermatitis ( p < 0.0001) were observed significantly more often in the painters than in the group of controls. Sensitizations to the following allergens from the European baseline series were associated with the occupation and were statistically significant: methylchloroisothiazolinone/methylisothiazolinone, epoxy resin, formaldehyde, and quaternium-15. Three different isothiazolinones emerged as the most frequent sensitizers of the allergens tested in addition to the baseline series. Conclusions. The results indicate that painters have an increased risk of developing occupational hand eczema. Isothiazolinones and epoxy resin proved to be the two most frequent sensitizers in painters. [ABSTRACT FROM AUTHOR]

Background. Cobalt allergy is prevalent in dermatitis patients. Very little documentation exists about current sources of cobalt exposure. Objectives. To investigate and discuss putative sources of cobalt exposure and to present selected epidemiological data on cobalt allergy from patch-tested dermatitis patients in an attempt to better understand cobalt allergy. Materials and methods. 19 780 dermatitis patients aged 4-99 years were patch tested with nickel, chromium or cobalt between 1985 and 2010. The cobalt spot test was used to test for cobalt ion release from mobile phones as well as cobalt-containing dental alloys and revised hip implant components. Results. Six of eight dental alloys and 10 of 98 revised hip implant components released cobalt in the cobalt spot test, whereas none of 50 mobile phones gave positive reactions. The clinical relevance of positive cobalt test reactions was difficult to determine in the majority of patients. Isolated patch test reactivity to cobalt was less associated with occupational dermatitis and hand eczema than patch test reactivity to cobalt in combination with other contact allergies. Conclusions. It is often difficult to interpret the relevance of a positive patch test reaction to cobalt, and there is a need for further studies to determine sources of cobalt exposure. [ABSTRACT FROM AUTHOR]

Cutaneous and systemic hypersensitivity reactions to implanted metals are challenging to evaluate and treat. Although they are uncommon, they do exist, and require appropriate and complete evaluation. This review summarizes the evidence regarding evaluation tools, especially patch and lymphocyte transformation tests, for hypersensitivity reactions to implanted metal devices. Patch test evaluation is the gold standard for metal hypersensitivity, although the results may be subjective. Regarding pre-implant testing, those patients with a reported history of metal dermatitis should be evaluated by patch testing. Those without a history of dermatitis should not be tested unless considerable concern exists. Regarding post-implant testing, a subset of patients with metal hypersensitivity may develop cutaneous or systemic reactions to implanted metals following implant. For symptomatic patients, a diagnostic algorithm to guide the selection of screening allergen series for patch testing is provided. At a minimum, an extended baseline screening series and metal screening is necessary. Static and dynamic orthopaedic implants, intravascular stent devices, implanted defibrillators and dental and gynaecological devices are considered. Basic management suggestions are provided. Our goal is to provide a comprehensive reference for use by those evaluating suspected cutaneous and systemic metal hypersensitivity reactions. [ABSTRACT FROM AUTHOR]

Background. Allergens included in the European baseline series should result in positive patch test reactions in at least 1% of a patch test population. Inclusion of local anaesthetics other than benzocaine in the baseline series has previously been debated. Objectives. To investigate temporal trends of benzocaine and lidocaine allergy in dermatitis patients who underwent routine patch testing in a tertiary referral patch test centre, and to clarify and discuss whether lidocaine and benzocaine should be included in routine series. Methods. Dermatitis patients who underwent routine patch testing with benzocaine as a part of the European baseline series between 1985 and 2010 (n = 19 347) and dermatitis patients who underwent routine patch testing with lidocaine between 1994 and 2001 (n = 6265) and between 2007 and 2009 (n = 1360) were included. Results. The overall prevalences of contact allergy were 0.5% (benzocaine), 0.3% (lidocaine for the period 1994-2001), and 0.14% (lidocaine for the period 2007-2009). Current relevance was observed in 10% of those with benzocaine allergy and in 5% of those with lidocaine allergy. Conclusions. Benzocaine and lidocaine allergy is infrequent in Danish dermatitis patients. Lidocaine should only be used for aimed testing, and benzocaine should be removed from the baseline series used in Denmark. [ABSTRACT FROM AUTHOR]

Classification of hand eczema has traditionally been based both on aetiology and clinical appearance. For 20% of cases, the aetiology is unknown. To suggest a classification based on well-defined aetiology as well as on predefined clinical patterns and on the dynamics of hand eczema. Literature studies and discussions among members of the Danish Contact Dermatitis Group. Criteria are given for the aetiological diagnoses of allergic contact dermatitis of the hands, irritant contact dermatitis of the hands, protein contact dermatitis of the hands, atopic hand eczema and aetiologically unclassifiable hand eczema. Six different clinical patterns are described and illustrated. Suggestions for general treatment principles are given. Operational guidelines for the diagnosis and treatment of hand eczema are described. [ABSTRACT FROM AUTHOR]

Methylisothiazolinone (MI) used alone is a new preservative causing a high prevalence of contact allergy. The eliciting threshold of MI is unknown. The combination of MI and phenoxyethanol enhances the antimicrobial efficacy of MI. The eliciting doses of MI contact allergy in a patch test and a repeated open application test (ROAT) were investigated. In the patch test, it was determined whether phenoxyethanol influenced the reactivity to MI. Eleven MI-allergic individuals were patch tested with two dilution series of 12 doses of MI and the same 12 doses with phenoxyethanol. The ROAT mimicked the use of a cream preserved with 100, 50 and 5 ppm MI (corresponding to 0.21, 0.105 and 0.0105 µg MI/cm). Phenoxyethanol had no influence on the reactions to MI. The lowest eliciting dose in the patch test was 1.47 µg MI/cm. In the ROAT, 7 patients (64%) reacted to 0.21 and 0.105 µg MI/cm and 2 patients (18%) reacted to 0.0105 µg MI/cm, corresponding to a cream preserved with 5 ppm MI. A maximum of 100 ppm MI is permitted in cosmetic products. Eighteen per cent of MI-allergic patients reacted to a concentration 20 times lower in a ROAT. The amounts used in cosmetics should be reduced, and the development of MI contact allergy should be monitored closely. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) with implantation of a metal stent is a common procedure performed in patients with symptomatic ischaemic heart disease. Intracoronary stents typically have a backbone of stainless steel, which contains nickel, chromium, and molybdenum, and it remains unclear whether individuals who are allergic to these metals have an increased risk of restenosis after PCI with stent implantation. To further evaluate whether dermatitis patients with nickel and/or chromium allergy had an increased risk of developing cardiac in-stent restenosis with stainless steel stents. An individual-level linkage study was performed to identify dermatitis patients who had been patch tested with the European baseline series between 1979 and 2007 at Gentofte University Hospital ( N = 18794) and who had also undergone PCI at some point in a Danish hospital. One hundred and forty-nine (0.8%) dermatitis patients who had undergone PCI with a metal stent were included. One hundred and forty-seven were patch-tested before undergoing PCI. Of the patients, 14.1% (21/149) had cardiac in-stent restenosis. Among patients with metal allergy, 2 (11.8%) had restenosis. Nickel and/or chromium allergy in dermatitis patients does not appear to increase the overall risk of in-stent restenosis after PCI. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates whether an increase in contact allergy to para group chemicals are associated to the prevalence of p-phenylenediamine (PPD) allergy in Danish dermatitis patients between 1989 to 2007. The study is investigated through patch testing with the use of 5% benzocaine, 1% PPD free base, and 16% paraben mix in petrolatum. The results of the study indicate that the prevalence of PPD is not associated with the increase in contact allergy to para group chemicals.

Background: Fragrance mix II (FM II) is a relatively new screening marker for fragrance contact allergy. It was introduced in the patch test baseline series in Denmark in 2005 and contains six different fragrance chemicals commonly present in cosmetic products and which are known allergens. Aim: To investigate the diagnostic contribution of including FM II in the baseline series by comparing it with other screening markers of fragrance allergy: fragrance mix I (FM I), Myroxylon pereirae and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC). Method: Retrospective study of 12 302 patients consecutively patch tested with FM II by members of the Danish Contact Dermatitis Group 2005-2008. Results: FM II gave a positive patch test in 553 patients (4.5%), and in 72.2% of these patients the reaction was judged to be clinically relevant. FM II ranked second in detecting fragrance allergy, after FM I. If FM II had not been included as a screening marker in the baseline series, 15.6% ( n = 202) of individuals with fragrance allergy would not have been identified by the other fragrance screening markers (FM I, M. pereirae or HICC). Conclusion: FM II contributes substantially to detecting fragrance allergy. It ranked second among the fragrance screening markers tested in the baseline series and detects individuals with an allergy who otherwise would not have been identified. [ABSTRACT FROM AUTHOR]

Background: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) has been one of the most frequent sensitizers since the 1980s. In 2005, the use of MI alone was approved for the preservation of cosmetic and household products in the EU. Before that, MI was used in industrial products, and the first cases of isolated MI contact allergy were published. Objectives: To present the prevalence and causes of MI contact allergy. Materials and methods: Patch test results from 2536 dermatitis patients tested with MI at Gentofte University Hospital between May 2006 and February 2010 were analysed. A retrospective investigation of medical records from MI-allergic patients was performed to reveal the causes of their MI contact allergy. Results: Of patch-tested patients, 1.5% had MI contact allergy. It was associated with occupational dermatitis, hand eczema and age above 40 years. Exposure to MI in cosmetic products was found in 12 (32%) cases, and exposure to MI in occupational products was found in 11 (30%) cases; 5 of the 11 were painters. Conclusions: The prevalence of MI contact allergy is already at the same level as that of other sensitizing preservatives, which have been on the market for several years, but no rising trend was identified. MI contact allergy was associated with both occupational and consumer products. [ABSTRACT FROM AUTHOR]

Introduction: Nickel allergy is prevalent as assessed by epidemiological studies. Objectives: In an attempt to further identify and characterize sources that may result in nickel allergy and dermatitis, we analysed items identified by nickel-allergic dermatitis patients as causative of nickel dermatitis by using the dimethylglyoxime (DMG) test. Materials and methods: Dermatitis patients with nickel allergy of current relevance were identified over a 2-year period in a tertiary referral patch test centre. When possible, their work tools and personal items were examined with the DMG test. Results: Among 95 nickel-allergic dermatitis patients, 70 (73.7%) had metallic items investigated for nickel release. A total of 151 items were investigated, and 66 (43.7%) gave positive DMG test reactions. Objects were nearly all purchased or acquired after the introduction of the EU Nickel Directive. Only one object had been inherited, and only two objects had been purchased outside of Denmark. Conclusions: DMG testing is valuable as a screening test for nickel release and should be used to identify relevant exposures in nickel-allergic patients. Mainly consumer items, but also work tools used in an occupational setting, released nickel in dermatitis patients. This study confirmed ‘risk items' from previous studies, including mobile phones. [ABSTRACT FROM AUTHOR]

Background: It is often difficult to establish clinical relevance of metal exposure in cobalt-allergic patients. Dermatologists and patients may incorrectly assume that many metallic items release cobalt at levels that may cause cobalt dermatitis. Cobalt-allergic patients may be unaware that they are exposed to cobalt from handling work items, causing hand dermatitis. Objectives: To present early findings with a newly developed cobalt spot test. Methods and Results: A cobalt spot test based on disodium-1-nitroso-2-naphthol-3,6-disulfonate was able to identify cobalt release at 8.3 ppm. The test may also be used as a gel test if combined with an agar preparation. We found no false-positive reactions when testing metals and alloys known not to contain cobalt. However, one cobalt-containing alloy, which elicited cobalt dermatitis in cobalt-allergic patients, was negative upon cobalt gel testing. Conclusions: The cobalt test detects amounts of cobalt release that approximate the elicitation concentration seen in cobalt-allergic patients. It may serve as a useful tool in dermatology offices and workplaces. [ABSTRACT FROM AUTHOR]

Background: Formaldehyde and formaldehyde-releasers are widely used in consumer products and may often cause contact allergy. Objective: To investigate the prevalence of concomitant contact allergy to formaldehyde and formaldehyde-releasers in dermatitis patients, and to determine the sources of formaldehyde exposure based on personal and occupational products obtained from dermatitis patients. Methods: Patch test data from referred dermatitis patients with a positive patch test reaction to formaldehyde or formaldehyde-releasers were analysed. For the period 2000–2008, the formaldehyde content in products obtained from formaldehyde-allergic patients was analysed by chromotropic acid test and/or acetylacetone test. Results: Patients allergic to a formaldehyde-releaser often had simultaneous contact allergy to formaldehyde. Other combinations were also prevalent. In patients who reacted to more than two formaldehyde-releasers, nearly all reacted simultaneously to formaldehyde. Seventy-five percent of the formaldehyde-allergic patients used a product that contained formaldehyde. The main source of formaldehyde exposure was cosmetics (78%). Conclusions: Concomitant contact allergy to formaldehyde and formaldehyde-releaser remains common. Furthermore, contact allergy to a formaldehyde-releaser was nearly always concomitant with another formaldehyde-releaser. Formaldehyde was commonly found in personal products used by formaldehyde-allergic patients. [ABSTRACT FROM AUTHOR]

Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. These studies are of high value as they tend to be less biased than studies using clinical populations and as they are important for healthcare decision makers when they allocate resources. This study aimed to review the epidemiology of hand eczema in the general population. Literature was examined using Pubmed-Medline, Biosis, Science Citation Index, and dermatology text books. On the basis of studies performed between 1964 and 2007, the point prevalence of hand eczema was around 4%, the 1-year prevalence nearly 10%, whereas the lifetime prevalence reached 15%. Based on seven studies, the median incidence rate of hand eczema was 5.5 cases/1000 person-years (women = 9.6 and men = 4.0). A high incidence rate was associated with female sex, contact allergy, atopic dermatitis, and wet work. Atopic dermatitis was the single most important risk factor for hand eczema. Hand eczema resulted in medical consultations in 70%, sick leave (> 7 days) in about 20%, and job change in about 10%. Mean sick time was longer among those with allergic hand eczema than those with atopic and irritant hand eczema. Moderate to severe extension of hand eczema was the strongest risk factor for persistence of hand eczema. Other risk factors included early onset of hand eczema and childhood eczema. The aetiology of hand eczema is multifactorial and includes environmental as well as genetic factors. Future studies should focus on unresolved areas of hand eczema, for example, genetic predisposition. [ABSTRACT FROM AUTHOR]

Limonene, one of the most often used fragrance terpenes in any kind of scented products, is prone to air-oxidation. The oxidation products formed have a considerable sensitizing potential. In previous patch test studies on consecutively tested dermatitis patients, oxidized R-limonene has been proven to be a good and frequent indicator of fragrance-related contact allergy. The current study extends these investigations to 6 European clinics of dermatology, where the oxidation mixture of both enantiomers of limonene ( R and S) have been tested in 2411 dermatitis patients. Altogether, 63 out of 2411 patients tested (2.6%) reacted to 1 or both the oxidized limonene preparations. Only 2.3% reacted to the oxidized R-limonene and 2.0% to the oxidized S-limonene. In 57% of the cases, simultaneous reactions were observed to both oxidation mixtures. Concomitant reactions to the fragrance mix, colophonium, Myroxylon pereirae, and fragrance-related contact allergy were common in patients reacting to 1 or both the oxidized limonene enantiomers. Our study provides clinical evidence for the importance of oxidation products of limonene in contact allergy. It seems advisable to screen consecutive dermatitis patients with oxidized limonene 3% petrolatum, although this patch test material is not yet commercially available. [ABSTRACT FROM AUTHOR]

Axillary dermatitis is common and overrepresented in people with contact allergy to fragrances. Many people suspect their deodorants to be the incriminating products. In order to investigate the significance of isoeugenol in deodorants for the development of axillary dermatitis when used by people with and without contact allergy to isoeugenol, patch tests with deodorants and ethanol solutions with isoeugenol, as well as repeated open application tests (ROAT) with roll-on deodorants with and without isoeugenol at various concentrations, were performed in 35 dermatitis patients, 10 without and 25 with contact allergy to isoeugenol. A positive ROAT was observed only in patients hypersensitive to isoeugenol (P < 0.001) and only in the axilla to which the deodorants containing isoeugenol had been applied (P < 0.001). Deodorants containing isoeugenol in the concentration range of 0.0063–0.2% used 2 times daily on healthy skin can thus elicit axillary dermatitis within a few weeks in people with contact allergy to isoeugenol. [ABSTRACT FROM AUTHOR]

The article presents a study which focuses on the investigation of the occurrence of contact allergy to hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) among eczema patients. It says that the evaluation and recording of the clinical relevance were according to the standardized guidelines set by the Danish Contact Dermatitis Group (DCDG). Results show that the positive patch test reaction to HICC is more significant in women than in men.

The article presents two case studies of allergic contact dermatitis caused by exposure to methyldibromo glutaronitrile (MDBGN) in a cleaning detergent and sunscreen agent. The first case was that of a 62-year-old woman, who was presented with chronic hand eczema and periodic flares during the past 3 years. Another case involved a 41-year-old woman who complained of a generalized eczematous rash starting during a 1-month vacation in Guatemala.