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Background/Purpose: Chronic actinic dermatitis (CAD) is a spectrum of diseases with chronic photosensitivity occurring mostly among middle‐aged and older men. We seek to explore the characteristics and pathogenesis of CAD among the Chinese population. Methods: The medical records of 488 CAD cases diagnosed by phototesting at Huashan Hospital, Fudan University from January 2014 to December 2018 were analyzed retrospectively. Results: Among the 488 patients, 344 were male and 144 were female. 84.8% of the cases were over 40 years old at the age of onset, while the remaining with an early age of onset had a prevalence of atopic history of 21.6%. Up to 45.0% of the patients reported excessive sun exposure and outdoor activities before the initiation of symptoms. The typical skin lesions were erythema, papules and plaques laid predominantly in sun‐exposed areas. 42.8% of the cases showed sensitivity to UVB only, 20.7% were both sensitive to UVA and UVB, and 18.2% had UVA sensitivity only. The most predominant photoallergens were chlorpromazine (80.1%), thimerosal (17.2%), potassium dichromate (12.7%), etc. The most prevalent patch test allergens were potassium dichromate (24.4%), thimerosal (20.5%), formaldehyde (16.8%), etc. Conclusions: CAD was more commonly seen in males over 40 years old. The action spectrum of Chinese patients is primarily in the UVB range. Exposure to excessive sunlight or contact allergens and photoallergens are important risk factors. Photobiology tests are essential in detecting photosensitivity and recognizing potential photosensitizers. Early avoidance of confirmed photoallergens and sun exposure may prevent photosensitive reactions from progressing into persistent photosensitivity. [ABSTRACT FROM AUTHOR]

Background: Current frequency and risk factors for sensitization to methylisothiazolinone (MI), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), benzisothiazolinone (BIT) and octylisothiazolinone (OIT) in Spain are not well known. Objectives: To study the frequency of sensitization, risk factors and simultaneous sensitization between the four isothiazolinones. Materials and Methods: We analysed all 2019–2021 consecutive patients patch‐tested with MI (0.2% aq.), MCI/MI (0.02% aq.), BIT (0.1% pet.) and OIT (0.1% pet) within the Spanish Contact Dermatitis Registry (REIDAC). Results: A total of 2511 patients were analysed. Frequencies of sensitization were: any isothiazolinone 15.7%, MI 6.8%, MCI/MI 4.8%, BIT 3.5% and OIT 0.5%. MI and MCI/MI sensitization was associated with being occupationally active, hand dermatitis, detergents and age over 40. BIT sensitization was associated with leg dermatitis and age over 40. About one in nine MI‐positive patients were positive to BIT, whereas one in five BIT‐positive patients were positive to MI. Conclusions: Sensitization to MI, MCI/MI and BIT is still common in Spain, while sensitization to OIT is rare. Currently, sensitization to MI and MCI/MI seems to be occupationally related. Although its origin is unknown, sensitization to BIT is more frequent in patients aged over 40 years. Simultaneous sensitization between MI and BIT is uncommon. [ABSTRACT FROM AUTHOR]

Background: Iodopropynyl butylcarbamate (IPBC) is a broad‐spectrum preservative for use in several product types, including cosmetics, in which its concentrations have been limited by EU legislation because of concerns related to its iodine content and release, and the risk of subsequent iodine overdose. Objectives: To report on concomitant patch test reactions observed with iodine and IPBC in patients sensitized to iodine‐containing antiseptics. Patients Between 2012 and 2018, seven patients, six from Belgium and one from France, two suffering from acute dermatitis during surgical interventions, four from dermatitis caused by wound treatment, and one from occupational dermatitis, were shown to be sensitized to iodine and/or povidone‐iodine (PVP‐I), which was considered to be relevant for their dermatitis. All patients were coincidentally also patch tested with IPBC. Results: All patients showed positive patch test reactions to several other allergens, including IPBC. No relevance could be detected for IPBC. Conclusions: We suspect that, notwithstanding the absence of firm evidence for IPBC being dehalogenated to produce free iodine in animals or in humans, the patch test reactions to IPBC in iodine‐allergic subjects were possibly caused by free iodine released from this preservative agent, thus underlining the EU restrictions regarding the use of this preservative in cosmetics. [ABSTRACT FROM AUTHOR]

Introduction Allergic contact dermatitis ( ACD) in children appears to be on the increase, and contact sensitization may already begin in infancy. The diagnosis of contact dermatitis requires a careful evaluation of a patient's clinical history, physical examination, and skin testing. Patch testing is the gold standard diagnostic test. Methods Based on consensus, the EAACI Task Force on Allergic Contact Dermatitis in Children produced this document to provide details on clinical aspects, the standardization of patch test methodology, and suggestions for future research in the field. Results We provide a baseline list of test allergens to be tested in children with suspected ACD. Additional tests should be performed only on specific indications. [ABSTRACT FROM AUTHOR]

Background Modern dressings ( MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers ( CLUs) to evaluate this. Objectives To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. Patients and methods A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. Results Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). Conclusions Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 69-year old female who was refereed with eczematous dermatitis affecting the temporal portion of forehead and cheeks. It states that she reported application of honey for cosmetic purpose. It mentions that the reaction to Myroxylon perierae resin was considered to be cross-reaction with propolis.

Airborne dermatitis belongs to a heterogeneous group of dermatoses of various etiopathology and clinical characteristics. This disease is characterized by acute or chronic inflammation of the uncovered skin exposed to irritants or allergens. Initially skin lesions are transient. The paper presents a description of chrysanthemum growers diagnosed with air-borne dermatitis from chrysanthemum. Etiology, pathomechanism, clinical course, diagnostics and therapeutical methods are described. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to provide current data on the incidence of allergy to various contact allergens in patients with allergic contact eczema and the analysis of selected socio-demographic data of the patients. Material and methods: The study included 1532 patients (1010 women and 522 men) treated for allergic contact dermatitis at the Department of Dermatology and Venereology and at the Dermatology Outpatient Clinic in Bialystok in 2007-2011. The assessment of selected demographic data and skin lesions was based on the MOAHFLA index, while the results of patch tests were analyzed with modified Baseline European Series consisting of 31 allergens. Results: In the group of patients with eczema, 34. 1% were men, and 55% of all respondents were people over 40 years of age. The occupational character of skin lesions was found in 22. 5%. Most frequently (38. 9%) skin lesions were localized on the hands, rarely involved legs (3. 98%). Atopic dermatitis was diagnosed in 4. 5% of patients. The ten most frequent allergens were: nickel sulfate (24%), cobalt chloride (15. 3%), fragrance mix (8. 25%), potassium dichromate (6. 8%), balsam of Peru (5. 5%), neomycin (4. 42%), paraphenylenediamine (3. 85%), Quatermium-15 (2. 1%), detreomycin (1. 83%) and budesonide (1. 44% of tested patients). Conclusions: Frequent allergy to detreomycin indicates the need of patch testing for this allergen of all examined patients with allergic contact dermatitis. The increased frequency of the nickel allergy is a worrying problem and indicates the need for education about the risk factors for nickel allergy development and the implementation of appropriate legal regulations. [ABSTRACT FROM AUTHOR]

Background Iodopropynyl butylcarbamate ( IPBC) is a preservative that may cause contact allergy. The first cases were reported in 1997, and IPBC is currently included in our extended European baseline series in Denmark. Objectives To assess trends during the period 2000-2011 concerning IPBC allergy in Denmark, and to address the question of the significance of concomitant reactions to the thiuram mix. Patients/materials/methods Nine thousand seven hundred and fifty-five (6449 female; 3306 male) patients were patch tested with IPBC and the European baseline series at Gentofte Hospital during 2000-2011. The results were registered in an anonymized database, and analyzed with spss™. Results Fifty-four cases of IPBC contact allergy were detected. A significant rising trend during 2000-2011 was observed, with no significant changes during 2006-2011. MOAHLFA index analysis showed that IPBC contact allergy was, in our cohort, significantly more prevalent among male patients, occupational, related to hand eczema, and more frequent among patients over 40 years old. A significant relationship between IPBC and thiuram mix allergy was found. Conclusions IPBC continues to be among the less frequent allergens. A 0.2% concentration in patch testing has contributed to the diagnosis of more sensitizations to this substance. Further studies are needed to clarify the reason for the over-representation of thiuram allergy in patients sensitized to IPBC. [ABSTRACT FROM AUTHOR]

Allergic Contact Dermatitis ( ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children. [ABSTRACT FROM AUTHOR]

The correct selection of vehicles for patch testing is crucial in evaluating suspected allergic contact dermatitis. We reviewed literature by searching Pubmed and Embase for the years 1971-2011 utilizing the subjects 'vehicle,' 'allergic contact dermatitis' and 'patch test' for advances in knowledge of vehicles.' A universal optimal vehicle more efficient than petrolatum remains undiscovered. Literature provides research supporting alternate vehicles for specific allergens and insights on vehicle characteristics, such as influence on bioavailability of chemicals and subsequent percutaneous absorption or interaction with allergens. These findings should accelerate our ability to define, and thus determine, the optimum vehicle(s). [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. Materials and Methods: The study was conducted in two stages. Stage I (pre-implantation) - 60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) - 48 subjects participated in the same procedures as those conducted in Stage I. Results: Stage I - symptoms of 'metal dermatitis' were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II - 10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre- and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Conclusions: Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals. [ABSTRACT FROM AUTHOR]

Contact allergy to topical corticosteroids is usually detected by patch testing. This study compares the test results obtained with patch, prick and intradermal testing, to assess the most sensitive method for diagnosing corticosteroid hypersensitivity. Nineteen corticosteroid-allergic subjects and three control subjects were included. Patch, prick and intradermal tests were performed with five commercial corticosteroid preparations, as well as with the respective active principles diluted in ethanol. The test readings were performed at different time points, i.e. at 8, 24, 48 and 96 hr, and at 7 days. Patch tests with ethanolic preparations produced more positive reactions than the commercial ones. The intradermal tests became positive earlier than the patch tests, a concordance between patch and intradermal tests being found in 11/15 (two positive intradermal test results with negative patch test results and vice versa). However, several subjects developed skin atrophy (14/22) at intradermal injection sites. Patch testing with the active principles diluted in ethanol remains the diagnostic method of choice for the detection of delayed hypersensitivity to corticosteroids. Intradermal tests with late readings, despite detecting additional contact allergy cases, should not be routinely performed, because of an important risk of atrophy, particularly with corticosteroid suspensions. [ABSTRACT FROM AUTHOR]

Background: Cobalt, nickel, and chromium are important skin sensitizers. However, knowledge about cobalt exposure and causes of cobalt sensitization is limited. Objectives: To study release of cobalt, nickel, and chromium from some cobalt-containing hard metal alloys and to test reactivity to the materials in cobalt-sensitized patients. Methods: Discs suitable for patch testing were made of some hard metal alloys. Cobalt, nickel, and chromium release from the materials was determined by immersion in artificial sweat (2 min, 1 hr, 1 day, and 1 week). Patch test reactivity to the discs and to serial dilutions of cobalt and nickel was assessed in previously patch-tested dermatitis patients (19 cobalt positive and 18 cobalt-negative controls). Results: All discs released cobalt, nickel, and chromium. Some discs released large amounts of cobalt (highest concentration: 290 μg/cm2/week). Seven discs elicited three or more positive test reactions. Conclusions: The concentration of released cobalt was high enough to elicit allergic contact dermatitis in cobalt-sensitized patients. As the materials in the discs are used in wear parts of hard metal tools, individuals with contact allergy to cobalt may develop hand eczema when handling such materials. [ABSTRACT FROM AUTHOR]

Background The nonsteroidal anti-inflammatory drug carprofen was used in humans in the 1980s, before its withdrawal due to adverse effects. It re-emerged for veterinary uses, for which it is still widely prescribed, in the 1990s. There has been one previous report published of photoallergic contact dermatitis (PACD) in a pharmaceutical factory worker exposed to carprofen. Objectives Investigation of carprofen as a cause of PACD in pharmaceutical factory workers presenting with facial dermatitis. Methods Photopatch testing to carprofen dilutions in two pharmaceutical factory workers and three healthy volunteer controls using the European consensus methodology. This was followed by testing of eight further employees, referred by occupational health services, in the same factory. Results The index patient suspected a problem with carprofen and was found to have PACD to carprofen. The second patient presented with a widespread, although especially photoexposed site, dermatitis and was initially labelled as having an ‘unclassified dermatitis’. Only subsequently was her exposure (indirect; she did not work in the packaging section of the factory like the first patient) to carprofen recognized and testing confirmed both contact allergy and PACD to carprofen. One of three healthy volunteer controls had an active photoallergy sensitization event to carprofen starting 10 days after photopatch testing. Three of eight factory employees subsequently referred because of skin problems had carprofen PACD. Conclusions Carprofen is a potent photoallergen. These cases emphasize the importance of photopatch testing, and considering agents not included in standard series, when investigating patients presenting with a photoexposed site dermatitis. [ABSTRACT FROM AUTHOR]

Background There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. Objectives The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. Method All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Results Four hundred and thirty-five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. Conclusion There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure. [ABSTRACT FROM AUTHOR]

OBJECTIVES. The goals were to evaluate the usefulness of skin tests, patch tests, serum specific IgE assays, and challenges in diagnosing hypersensitivity reactions to cephalosporins and to clarify the pathogenic mechanism of such reactions. METHODS. Children with immediate manifestations (within 1 hour) underwent immediate-reading skin tests with penicillin reagents and any suspect cephalosporins, serum specific IgE assays, and challenges; some children underwent reevaluations. Children with nonimmediate manifestations (after >1 hour) were assessed with patch tests, delayed-reading skin tests, and challenges. RESULTS. We evaluated 148 children with hypersensitivity reactions to cephalosporins, mainly cefaclor and ceftriaxone; 105 had experienced nonimmediate manifestations (mostly urticarial eruptions and maculopapular rashes) and 43 immediate manifestations (anaphylactic shock, urticaria and/or angloedema, and erythema). None of the nonimmediate reactors demonstrated positive results in patch tests and/or delayed skin tests; only 1 subject displayed immediate positive responses to penicillin skin-test reagents. Among the 104 patients with negative results, 96 underwent challenges; 95 tolerated the challenges, and 1 reacted to the cefaclor pediatric suspension and tolerated the challenge with a cefaclor capsule. In the first allergologic evaluation, 33 of the 43 children with immediate reactions displayed skin-test positivity. Of the 10 patients with negative results, 7 underwent challenges, followed by therapeutic courses and reevaluations for 4. All challenges and therapeutic courses were tolerated; in the reevaluation, 1 girl demonstrated positive skin-test results for both the responsible cephalosporin and penicillin reagents. Overall, IgE-mediated hypersensitivity was diagnosed for 34 (79%) of 43 subjects. [ABSTRACT FROM AUTHOR]

Abstract: The etiology of pompholyx (dyshidrotic eczema) is a challenging diagnostic problem. The only established etiological link is between dyshidrosis and tinea pedis. Here, we report the results of a review of the causes of dyshidrosis in our patient population, focussing on allergic aspects. This was a prospective study carried out between June, 2003 and May, 2004. Epidemiological and clinical data were obtained for all the patients. They all had patch tests with the European patch test series. Sixty-two patients with pompholyx were included. Gender distribution was equal and the mean age of the patients was 31 years. Tinea pedis was reported in 35.5% of the patients. The patch tests were positive in 35.5% and relevant in 19% of the cases. The statistical analysis showed, on one hand, a significant relationship between gender and a positive patch test to nickel, and on the other hand, between work in a hot, wet environment and a positive patch test to chromium. These results revealed evidence of an increased frequency of tinea pedis and of sensitization to metals in patients with pompholyx compared to the general population. This suggests that in the development of pompholyx, sensitization to metals may be involved in a multifactorial process that includes both environmental and personal factors. However, we could not demonstrate a causal relationship between metal sensitization and pompholyx. Nevertheless, common factors might be involved in generating these two skin conditions. [Copyright &y& Elsevier]

Background The patch test is an essential procedure for the investigation of aetiologic diagnosis of allergic contact dermatitis, although it is not yet able to fully reproduce the events of the initial site of contact with the allergen. Objectives The aims of the present study are (i) to assess whether removal of the superficial corneous layer results in test positivity differences vs. the traditional technique, (ii) to assess the probable and/or possible and past and/or present sensitivity and relevance for each method, and (iii) to compare specific relevance of nickel sulphate for each method. Results Concordance of positive reactions was 75.9% (66 of 87), with 21.8% (19 of 87) positivity results on the abraded side only and 2.3% (2 of 87) on the unabraded side ( P < 0.05). Concordance of the substances with probable and/or possible and past and/or present relevance was 77.3% (58 of 75) for the abraded side and 21.3% (16 of 75) and 1.3% (1 of 75) for the unabraded side ( P < 0.05). Analysis of isolated relevance for nickel sulphate showed 95.6% (22 of 23) concordance. Conclusions (i) We found a greater number of positive substances on the abraded side, and when only the 2 + and 3 + reactions were considered, greater relative discordance was also observed; (ii) relevance analysis revealed a statistically significant difference between the two methods; (iii) differences in nickel sulphate test positivity and relevance for the two methods did not reach statistical significance. [ABSTRACT FROM AUTHOR]

Drug skin tests can be helpful in determining the cause of a cutaneous adverse drug reaction (CADR). Patch tests and prick tests can be performed with any commercialized form of a drug. Intradermal tests (IDTs) have a greater value, but their techniques have not been standardized. Moreover, IDTs can be done only if an injectable form of the drug is commercialized and are restricted to patients with nonsevere CADR. Prick tests and IDTs are used in investigating immediate hypersensitivity. Patch tests both with IDTs with delayed readings are helpful for maculopapular rash and generalized or localized eczema. Results obtained with drug skin tests in β-lactam sensitization have been extensively published, but fortunately, during the last few years the value of skin tests in CADR due to other drug classes (e.g., synergistins, platinium salts or radiocontrast medias) was also studied. The analysis of recent literature permits to propose which tests to choose for each clinical feature of CADR and to give the list of all drugs, having had patch tests with positive results but, emphasizes the lack of standardization in performing and reading IDTs. This standardization is absolutely necessary to determine the thresholds of specificity of the IDT. Except for IDTs, drug skin tests induce only rarely adverse reactions. False-positive results can occur and should be considered by testing new products. The negative predictive value of drug skin tests is a crucial point that will have to be studied in more detail in the near future. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis to topical glucocorticosteroids (GCS) is a delayed type cell-mediated hypersensitivity reaction; it is frequently observed in dermatological and allergological practice, although its incidence is likely underestimated. By contrast, allergic contact sensitization to inhalant GCS is virtually unknown to most pneumologists. Here, we review some cases of adverse reactions to inhalant GCS in terms of pathogenetic mechanisms, risk factors, epidemiology, and allergic cross-sensitivity. In fact, this particular form of sensitization to drugs that have a wide spectrum of use in pneumological practice deserves more attention than in the past. [ABSTRACT FROM AUTHOR]

Abstract: The diagnosis of allergic contact dermatitis to cosmetics is based on a careful history (anamnesis), taking into account all the cosmetic products that have been used by the patient, on inspection of the clinical symptoms and localisation of the lesions, and on the performance of epicutaneous tests or patch tests. In addition, other types of tests such as open and semi-open testing with products having a certain irritant potential as well as repeated open application tests (ROAT) on the forearm can also be very useful in the diagnosis of contact dermatitis caused by cosmetic products. [Copyright &y& Elsevier]

Abstract: Aim of the study. – The capacity of fungi to induce eczema in head and neck dermatitis has already been studied. Malassezia has often been implicated in two other dermatitis of the cephalic region (seborrhoeic dermatitis and sebopsoriasis). We have explored the cellular and IgE dependant reactions to different groups of fungi in these three dermatitis using “patch” and “prick” tests. Tested allergens were: Alternaria, Penicillium, Aspergillus, Cladosporium, Trichophyton, Epidermophyton, Candida albicans, Malassezia, Saccharomyces cerevisiae. Material and methods. – Seventy persons including 42 females (60%) and 28 males (40%) aged 40 years old in average were distributed in four groups: Head and neck dermatitis (24 patients), seborrheic dermatitis of the face (21 patients) and sebopsoriasis of the face (10 patients) compared to 15 controls without these dermatoses. Results and conclusions. – Globally, in “prick” and “patch” tests, yeasts had the highest number of positivity comparing to the two other groups. Malassezia was the leader in “prick tests”. In “patch tests”, the global results showed a positivity rate, which was clearly lower than those in “prick tests”. Detailed analysis of the results revealed that in the head and neck dermatitis the highest number of positive “patch tests” for all of these allergens is found. For the three other groups, no significant difference for these two techniques for any of these allergens has been detected. [Copyright &y& Elsevier]

Abstract: Occupational dermatitis (irritant dermatitis, contact urticaria and contact eczema) is frequent among healthcare workers. Irritant hand dermatitis, the most common occupational dermatitis, occurs often in individual who work in a humid environment, who handle disinfectants, and who are required to wash their hands frequently; atopic dermatitis is a risk factor for this condition. Natural rubber latex present in rubber gloves is the most common cause of contact urticaria. Contact eczema can be induced by rubber accelerators (for example, thiurams) present in gloves, and also by disinfectants (glutaraldehyde, dodecyldimethylammonium), disinfectants and detergents, hand creams, acrylates (in dentists), and echography gels. Nurses sometimes develop contact dermatitis to drugs they handle; these allergies should be diagnosed by appropriate skin testing because sensitized individuals may develop a severe, generalized cutaneous adverse reaction if they are subsequently exposed systemically to the sensitizing drug. [Copyright &y& Elsevier]

Reflectance confocal microscopy (RCM) allows non-invasive visualization of human skinin vivo. It has been used to describe the histopathological features of acute contact dermatitis (CD). This work was designed to investigate the kinetics of both allergic and irritant CD (ACD and ICD)in vivo. Eighteen subjects with a prior diagnosis of ACD were patch tested with the specific allergen sodium lauryl sulfate as an irritant, and appropriate controls. RCM, transepidermal water loss (TEWL), and fluorescence excitation spectroscopy (FES) were performed at several time points within 2 wk after patch removal. After removal of the Finn chambers at 48 h, superficial epidermal changes, primarily involving the stratum corneum, and increased epidermal thickness were mainly present in ICD. ACD, on the other hand, showed microvesicle formation peaking at 96 h following patch removal. Both ACD and ICD showed exocytosis and similar degrees of spongiosis on RCM. TEWL and FES demonstrated a significant difference between ACD and ICD. RCM, TEWL, and FES are valuable non-invasive tools to quantitatively study the kinetics of the pathophysiology of acute CD reactionsin vivoand monitor the changes at a cellular level. [ABSTRACT FROM AUTHOR]

Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common duringβ-lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug-specific T-cell clones obtained from the circulating blood and the skin, suggest that a type-IV (cell-mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work-up, the patient's history is fundamental; patch testing is useful, together with delayed-reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard toin vitrotests, the lymphocyte transformation test may contribute to the identification of the responsible drug.Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions toβ-lactams. [ABSTRACT FROM AUTHOR]

To investigate the frequency and the features of contact sensitization to propolis in children, we patch tested 1255 consecutive children suspected of allergic contact dermatitis with propolis 20% petrolatum over an 8-year period (1995–2002). Positive responses were observed in 5.9% of patch-tested subjects, with a significantly higher frequency in boys than in girls. The dermatitis was localized mainly on the face, hands and limbs. A significant linear increase in the annual frequency of propolis allergy was noted. Confirming literature data, a significant association with balsam of Peru sensitivity was present in children reacting to propolis, linked to the presence of common constituents in the 2 substances. In conclusion, based on our data, we suggest that propolis should not be used in topical products for children because of its high sensitization rate at the paediatric age. [ABSTRACT FROM AUTHOR]

Contact dermatitis to gold has rarely been reported. This precious metal is generally considered as inert, insoluble and resistant to corrosion. Nevertheless, gold salts have a strong potential for sensitization. This condition can occur after contact with gold jewellery and dental alloys, after systemic therapy with gold salts and after occupational contact. The lesions may be expressed as contact dermatitis on the face, ear, neck and/or fingers, and as lichen planus and/or lichenoid stomatitis. The dermatitis is usually not very irritating and the lesions are rarely persistent. Diagnosis is based on the clinical history and examination, on the nature of the exposure sources, and on the results of patch tests with gold sodium thiosulfate (GSTS) at 0.5% in petrolatum. The patch test is read on days 2 and 3 and again after 1 and 3 weeks. Allergen avoidance can be expensive and tiresome, and improvement is not guaranteed. We report the case of a female patient who came to us complaining of burning in her mouth. She had polymetallism and lichenoid lesions facing gold tooth crowns. Patch tests were positive to GSTS at 72 h and at 1 week. Replacement of the gold crowns led to total disappearance of her symptoms within 1 year. Local factors, including humidity, temperature, acid pH, abrasion and contact with substance such as amino acids, bring about the liberation of the sensitizing metallic salts, which may be enhanced by galvanic corrosion secondary to the polymetallism. [Copyright &y& Elsevier]

Vulvar tissue is more permeable than exposed skin due to differences in structure, occlusion, hydration and susceptibility to friction. The safety assessment of products that contact the vulva should account for this potentially heightened permeability. Standard clinical patch tests may not sufficiently mimic vulvar exposures. Because testing on the vulva is not routinely feasible, we are investigating new and modified cutaneous test methods to increase the degree of conservatism of the safety assessment. To this end, we have 1) developed a method to assess chemical and frictional effects by means of repeated application to the popliteal fossa (the behind-the-knee test); 2) modified the quantitative risk assessment for the induction of allergic contact dermatitis; and 3) proposed a modified human repeat insult patch test for assessing materials intended for vulvar contact. Modification of the traditional 4-day, irritation patch test by using wet samples or compromized skin sites failed to enhance test sensitivity. Future studies will evaluate testing in subjects with heightened susceptibility to chemical and sensory irritation, in order to increase test sensitivity to chemical irritants. These approaches can be employed to augment the margin of safety when cutaneous test methods are applied to agents that contact the vulva. [ABSTRACT FROM AUTHOR]

Occupational contact dermatitis is often of multifactorial origin, and it is difficult to determine the relative significance of the various contributing factors. Contact allergies are relevant in 20–50% of recognised occupational contact dermatitis cases. The reported frequency in different studies varies, depending on differences in how occupational diseases are notified and recognised, in types of occupation in a geographical area, and the "quality" of the dermatological examination, including the accuracy of the diagnostic patch-test investigation. However, the clinical relevance of the reported contact allergies is often uncertain. Many occupational contact dermatitis patients with documented contact allergies develop chronic eczema, in spite of work changes and attempted allergen avoidance. Recognition/non-recognition of a notified case may be based on circumstantial evidence, because of difficulties in the establishing of a firm proof of work exposure and subsequent development of skin disease. Reliable quantitative exposure measuring techniques are needed. Methods are developed for the measurement of exposure to allergens such as nickel and acrylates, which makes it possible for exposure–effect relationships to be established with increased certainty. For prevention of allergic contact dermatitis it was a major step forward, with mandatory ingredient labelling of cosmetic products. However, improved labelling of the presence of contact allergens in household and industrial products is needed. For the identification of hazardous contact allergenic compounds, guinea pig or mice assays are still required. The local lymph node assay (LLNA), which is an objective and sensitive mouse assay has now been internationally validated and accepted. [ABSTRACT FROM AUTHOR]

Background Variable results have been obtained when patients with atopic dermatitis (AD),) have been patch tested with allergens known to produce a positive prick lest. The significance of patch test results in our understanding of the pathogenesis of AD therefore remains questionable. Objective This study was designed to determine the relevance of either positive or negative patch test results in relation to the expression of cell mediated immunity to allergens in patients with AD. Methods Thirty-five patients with AD exhibiting patch test positivity to one or more aeroallergens on "tape stripped* areas of the back were retested without prior tape stripping. Nine patients again showed positivity to one or more allergens while 26 failed to show positive reactions. In six of the positive patients both positive and negative patch tests were observed. Skin biopsies were taken from these matched positive and negative patch test sites as well as from an area of uninvolved skin. Samples were frozen and cryostat sections were analysed with immunohistological techniques using monoclonal antibodies to investigate the distribution of immunocompetent cells. Results All positive patch tests exhibited characteristics of a cell mediated immune response. The negative patch test sites were also found to contain evidence of mononuclear cell infiltration. Both negative and positive patch test sites showed significantly greater proportions of T cells compared to uninvolved skin. No increase in numbers of RFDl positive and RFD7 positive macrophages were observed in either positive or negative patch test sites. Expression of CD23 by CDl positive Langerhans cells was raised in both negative and positive patch tests compared to uninvolved areas. A significant increase in the population (RFD7+, CD23+) was seen in positive patch test sites compared to uninvolved skin. An increase in the proportion of RFDl positive cells expressing CD23 was also seen in both negative and positive patch tests compared to uninvolved skin. Conclusions This paper demonstrates that immunological reactions are promoted at 'non-tape stripped' patch test sites where no clinical evidence of reactivity is seen. Together the data demonstrate that the presence of systemic cell mediated immunity to specific allergens identified in patients by positive patch test, may also be present when no clinical signs are seen at the patch test site. [ABSTRACT FROM AUTHOR]

A group of 36 normal control persons was patch-tested with glass fibers. The tested filaments had a length of about 3 to 5 mm and a diameter of 9 to 13 µm. The glass fibers were obtained from the normal production process. They were coated with cured epoxy resin. A group of 29 normal control persons was tested with the same type of fibers from which the epoxy finish had been burned off. Another group of 36 persons was patch-tested with ultrasmall glass globes with a diameter of 10 to 15 µm. Coated and uncoated glass globules were tested. On every person 5 patch tests with the same material were done. They were removed after 1, 5, 24, 48 and 72 h. On coated fiber, 12 of 36 tested people reacted with either a + or a ++ reaction. On the uncoated fibers a reaction could be noted in 10 out of 29 persons. The patch tests with coated as well as uncoated glass globules were all negative. A total of 60 biopsies was performed In those cases where + or ++ reactions were noted. The histological examination of the biopsies showed no differences between the reactions on coated and uncoated fibers. The skin reactions to glass fiber showed, besides microtraumatic changes, several histological characteristics of an eczematous reaction, like spongiosis and perivascular lymphocytic infiltration. The importance of these findings is discussed. It is emphasized that histological alterations are only one of the six points which must be taken into account when the diagnosis of eczema is considered. [ABSTRACT FROM AUTHOR]

It has been suggested that contact allergy to hydrocortisone alcohol is a frequent phenomenon. A recent study showed that all patients with allergic patch reactions to tixocortol pivalate reacted to intradermal hydrocortisone sodium phosphate. We studied patients with positive patch test reactions to tixocortol pivalate but negative to hydrocortisone alcohol, with penetration enhancers in hydrocortisone alcohol patch tests and oral challenges with hydrocortisone alcohol. Additionally, prick and intradermal tests with hydrocortisone sodium succinate were used. Using penetration enhancers and oral challenges enabled detection of more contact allergies to hydrocortisone alcohol compared to conventional patch testing alone. &frac912; patients with allergic reactions to tixocortol pivalate reacts to intradermal hydrocortisone sodium succinate. No immediate reactions were seen in prick or intradermal tests, suggesting that hydrocortisone contact hypersensitivity is probably not associated with immediate allergy to hydrocortisone. The present study suggests that allergic patch test reactions to tixocortol pivalate are caused by hypersensitivity to hydrocortisone alcohol itself or to one of its metabolites in the skin. [ABSTRACT FROM AUTHOR]

We have studied a group of 104 patients with pompholyx. to investigate the relationship between allergotogical factors and its etiopathogenesis, The following examinations were performed, blood sampling routine tests and IgE levels. allergological tests (patch, prick. intradennal. and oral renovation tests with nickel sulphate), skin biopsy to exclude pemphigus vulgarism or bullous pemphigoid. An accurate history of familial and personal allergic diathesis was enquired for and various possible aggravating factors (season. microclimate, perspiration and emotional stress) were considered. The results were age `and sex-matched with a healthy control group (208 Subjects). We found familial and personal atopic diathesis in 50% of patients versus 11.5% of controls (P < 0.001); 39 positivity on patch testing 20.19% versus 6.25% of the control group (P<0.001) the % of Patients allergic to nicked reached 26% meluding those (6 Patients) reacting to the oral propagation test season 143 patients) and hyperhidrosis (38) were the aggravating factors most commonly claimed. We detected no correlation between age, sex, grading of pompholyx, and the allergological parameters investigated. Though several different allergological findings have previously been reported indydhidroiss their role in its pathogenses has not yet been fully explained. We think that different haptens or antigens can produce the same clinical and histological picture of pompholyx in predisposed subjects [ABSTRACT FROM AUTHOR]

Of 7887 patients with eczema seen in a private dermatological practice over a period of 2 years and 4 month a specific final diagnosis was found in 5376 (68%), while a final diagnosis of non-specific eczema was made in 2511 cases (32%) The most common final diagnoses were seborrhoeic dermatitis (1351) contact dermatitis (1317), atopic dermatitis (1009) and nummular eczema (822). Battery patch testing was the initial diagnostic procedure performed, and 897 of the 3164 patients who were patch tested had one or more positive patch tests. In 545 cases, the reactions were considered of relevance to the current dermatitis. Tests for immediate-type allergy were carried out in 618 patients, and 284 of these had once or more positive tests. In 86 patients,these test results were of diagnostic significance 257 patients with positive patch tests were challenged orally with the relevant substance , and 53 of 156 reacted to metal salts, most commonly nickel, while 25 of 101 reacted to orally ingested balsam of Peru. Among patch-test-negative patients, 66 of 408 had positive reactions to one or more metal salts; 41 of 180 reacted to balsam of Peru, while 15 of 41 reacted to various food additives. [ABSTRACT FROM AUTHOR]

Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined. The patients were provoked by wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders, RAST, tests were performed using an extract from rubber tree (Hevea brasiliensis). In 6.15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated. [ABSTRACT FROM AUTHOR]

Nickel is the most important sensitizer in Lagos, with an incidence of 12.3% of 453 patients tested. There was no sex difference, as the wearing of necklaces and bracelets was equally fashionable among both sexes. Housewife eczema is not common, probably because of hardening. Dermatitis from additives in the processing of leather and rubber footwear was the next most common. Chromate sensitivity comes usually from leather or cement. Cultural and climatic factors are mainly responsible for differences in the incidence of contact dermatitis found in Lagos from other countries. [ABSTRACT FROM AUTHOR]

Routine patch testing with a series of 6 industrial biocides containing methylene-bis-thiocyanate (Cytox 3522®), benzisothiazolin-3-one (BIT), chlorocresol (Preventol CMR®), 2-n-octyl-4-isothiazolin-3-one (Kathon 893®), polyhydroxymethylene monobenzylether (Preventol D2®) or 1,3,5-tris (hydroxy-ethyl) hexahydrotriazine (Grotan BK®) was carried out in 6 Danish out-patients clinics to evaluate guinea pig allergy test results with the same compounds. A total of 1652 consecutive patients with dermatitis were tested. The usefulness of this patch test battery was limited. There was a few positive reaction to Cytox 3522® , BIT and the 2-formaldehyde releaser, Preventol D2® and Grotan BK®. These reactions could not however, be explained. The MOAHL-index (% of Male patients from the 6 clinics showed equal frequencies of male patients and atopics, but significant differences in the frequencies of occupational cases, hand eczema, and leg ulcer/ stasis dermatitis, indicating possible variations in referral patterns, use of patch tests, and / or environmental factors. [ABSTRACT FROM AUTHOR]

The incidence of hand dermatitis and contact allergies was analyzed among dental technicians. A survey was carried out by postal questionnaire. It was returned by 106 technicians (88%): 30 had skin problems, and 20 (19%) had present eruptions. All 20 were invited to a detailed dermatological investigation, but only seven participated. Epicutaneous tests to prosthetic materials were negative in these patients. The hand eruptions in 4 patients appeared to be irritant, 4 other patients (4%), who had previous hand dermatitis, had a history of positive patch test reactions to methyl methacrylate, but they had become symptomless and refused to participate in further studies. [ABSTRACT FROM AUTHOR]

Forty-eight patients with a positive patch test to potassium dichromate 0.5 % were retested after 4-7 years; 38 patients (79 %) still had a positive patch test. Chromate allergy seems to be persistent. In 72 % of the cases a history of occupational exposure to chromates could be proved. [ABSTRACT FROM AUTHOR]

Contact allergy to fragrances is very common. It is the second sensitizer in contact allergic dermatitis, after nickel sulphate. The fragrance mix and Balsam of Peru affects about 50-80% of patients affected by fragrance allergy, but the study of recent literature highlights new markers implicated in the pathogenesis of this dermatitis. We report an unusual case of contact allergy to limonene in a young woman after daily use of a self-made cosmetic product containing lemon juice and peel (rich in limonene), with a positive reaction to Balsam of Peru to patch test and a positive reaction to patch by patch performed with her cosmetic and lemon peel. This simultaneous sensitization has been previously described in literature. [ABSTRACT FROM AUTHOR]

Metallic gold has long been regarded as a relatively safe material when in contact with the skin and mucosal membranes, with only sporadic reports of allergic contact dermatitis or stomatitis. This is probably due to its stability and low tendency to ionization. Lymphomatoid reactions have been described in cutaneous responses to several products. We report a patient who developed bilateral nodules on the earlobes at the sites of piercing earrings. Histologically, these lesions presented a lymphomatoid appearance, with a T-cell diffuse infiltrate. The patch test demonstrated a strong reaction to 1% gold sodium thiosulfate. [ABSTRACT FROM AUTHOR]

In patients suspected of allergic contact dermatitis because of topical ophthalmic medicaments, patch tests performed with patients' own products are often negative. The irritant anionic surfactant sodium lauryl sulfate (SLS) may alter the stratum corneum and increase antigen penetration. Pre-treatment of the skin with SLS 0.5% for 24 h was performed in the sites of patch tests with patients' own products in 15 selected patients. In patients previously negative to their own products tested with conventional patch tests, SLS pre-treatment showed 6 new relevant positive reactions and induced a stronger positive reaction in 1 patient. SLS pre-treatment could be proposed as an alternative promising method, which may increase sensitivity of patch tests with patients' own products. [ABSTRACT FROM AUTHOR]

From the large number of substances used in perfumes it is difficult and tedious to identify the allergen in a specific case of dermatitis. Many substances arc both irritants and sensitizers. Based on personal experience, a list has been prepared of potential sensitizers, their concentrations and diluents suitable for patch testing. [ABSTRACT FROM AUTHOR]

A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal, patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articaine. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, and quinoline or aminoalkylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated. [ABSTRACT FROM AUTHOR]

Clinical examinations, patch tests and prick tests were carried out in a group of railwaymen. Only 3 had both eczema and atopy. Prick tests were positive in a high proportion of subjects, including both those with eczema and controls. [ABSTRACT FROM AUTHOR]

The article presents a study which assessed allergic contact dermatitis after surgery. It discusses the case of three patients who have eczematous reactions at the surgical sites after undergoing orthopaedic surgery. The results show that the only one of the patients was sensitized both to octyl- and ethyl-cyanoacrylate and found out that 2-octyl-cyanoacrylate, a glue used in orthopaedic surgery, causes the contact dermatitis as a result of active sensitization due to adhesive application.

The article reports on cases of allergic contact dermatitis brought by topical budesonide and in sprays and aerosols for rhinitis and bronchial asthma. It discusses that a case of airborne allergic contact dermatitis in relatives of a patient treated with aerosols of budesonide. A discussion on the dermatitis is also presented.

The article describes a case of allergic contact dermatitis due to Cineraria hybrid flower, belonging to the Compositae (Asteraceae) family in a 58-year-old housewife. A localized, chronic dermatitis affecting the sites of contact with the plant was observed in the patient, and the Compositae mix was used for patch testing.