Search

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]

Skin biomarkers for disease severity and treatment response in atopic dermatitis (AD) are needed. Biopsies cause scarring and tape stripping represents an alternative minimally invasive method for stratum corneum sampling. In this study, we examined the gene expression of cytokines in skin biopsies and cytokines in stratum corneum tape strips collected from adults with AD. We collected punch biopsies and tape strips from healthy controls (n = 6) and subjects with AD (n = 12) at baseline and after 2 weeks of topical treatment with mometasone furoate 0.1% cream. We found that IFN-γ, IL-13, and IL-10 mRNA (biopsies) and IL-1β protein expression levels (tape strips) were significantly increased in lesional AD skin compared to healthy control skin. Treatment with topical corticosteroid led to a significant decrease in mRNA levels for IL-13 and IL-4R but no significant differences in cytokine protein levels measured in tape strips. Finally, we found no significant correlations between cytokine levels in tape strips and mRNA levels in skin biopsies. [ABSTRACT FROM AUTHOR]

Background: Nickel allergy and dermatitis have been associated with filaggrin gene mutations in epidemiological studies, but the mechanisms mediating these associations are unknown. Objectives: To investigate whether filaggrin‐deficient flaky tail (ft/ft) mice show increased immune reactivity to nickel and elucidate the mechanisms mediating this. Methods: The immune responses to nickel, 2,4‐dinitrofluorobenzene (DNFB), cinnamal and p‐phenylenediamine were assessed in ft/ft and wild‐type (WT) mice. The amounts of nickel in the skin of ft/ft and WT mice were determined 20 hours after nickel exposure. The effect of blocking either the interleukin (IL)‐17A pathway or the IL‐1 pathway on the response to nickel in ft/ft mice was evaluated. Results: Increased responsiveness to nickel, DNFB and cinnamal was observed in ft/ft mice as compared with controls. A reduced amount of nickel was found in the skin of ft/ft mice as compared with WT mice, suggesting increased nickel absorption by the skin of ft/ft mice. Blocking either the IL‐17A pathway or the IL‐1 pathway reduced nickel responsiveness in ft/ft mice. Conclusions: These findings suggest that the increased nickel responsiveness associated with epidermal filaggrin deficiency is mediated by a combination of increased nickel penetration and the steady‐state inflammation found in the skin of filaggrin‐deficient mice. [ABSTRACT FROM AUTHOR]

Abstract: Skin diseases represent one of the most common work‐related diseases and may have a detrimental effect on social, personal and occupational aspects of life. Contact dermatitis (CD), which comprises predominately irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), accounts for vast majority of occupational skin diseases, especially in occupations associated with frequent skin contact with irritants and contact allergens. Although ICD and ACD have similar clinical manifestation, their pathophysiology and the role of the skin barrier are different. In ICD, perturbation of the skin barrier is the primary event which sets into motion diverse metabolic processes and triggers activation of innate immunity without the involvement of adaptive immune system. In ACD, a type IV hypersensitivity reaction induced by contact allergens, the skin barrier impairment may evoke innate signalling pathways during the sensitization phase required for the activation of T‐cell adaptive response. Thus, skin barrier impairment may increase the risk of ICD or ACD not only because of enhanced permeability and ingress of irritants and allergens but also by the generation of innate immune signal needed for the induction of allergic response. Hence, an efficient way to prevent CD is to avoid skin barrier damage in the workplace. This review focuses on the skin barrier, how it is affected by skin irritants and how its impairment contributes to the development of ICD and ACD. [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]

Lebrikizumab (LEB) is a novel, high affinity monoclonal antibody that selectively binds to interleukin (IL)-13. Lebrikizumab has been shown to provide robust improvements in signs and symptoms in adolescent and adult patients with moderate-to-severe AD across three phase 3 clinical trials (ADvocate1, ADvocate2 and ADhere). However, little is known about the efficacy of LEB in difficult to treat regions such as the face and hands. This study aims to report efficacy of LEB in improving facial and hand dermatitis. ADvocate1 and ADvocate2 assessed LEB 250 mg every 2 weeks (LEBQ2W) vs. placebo for 16 weeks in monotherapy. ADhere compared low-to-mid potency topical corticosteroids (TCS) in addition to LEB Q2W vs. TCS and placebo for 16 weeks. In all trials, clinicians assessed for the presence or absence of facial and hand dermatitis. If present at baseline, at Week 16, clinicians assessed the change from baseline on a scale of cleared, improved, no change or worsened. Patients with improved or cleared dermatitis are described. In ADvocate1 at baseline, facial dermatitis was identified in 71.4% (202/283) of LEBQ2W patients and 80.9% (114/141) of placebo. At Week 16, 61.9% (125/202; P < 0.001) of LEBQ2W were improved or cleared vs. 31.6% (36/114) of placebo. At baseline, hand dermatitis was identified in 72.1% (204/283) of LEBQ2W patients vs. 73.0% (103/141) of placebo. At Week 16, 67.2% (137/204; P < 0.001) of LEBQ2W were improved or cleared vs. 29.1% (30/103) of placebo. In ADvocate2 at baseline, facial dermatitis was identified in 73.7% (207/281) of LEBQ2W patients and 78.8% (115/146) of placebo. At Week 16, 57.5% (119/207; P < 0.001) of LEBQ2W were improved or cleared vs. 21.7% (25/115) of placebo. At baseline, hand dermatitis was identified in 73.3% (206/281) of LEBQ2W patients and 72.6% (106/146) of placebo. At Week 16, 61.7% (127/206; P < 0.001) of LEBQ2W were improved or cleared vs. 18.9% (20/106) of placebo. In ADhere at baseline, facial dermatitis was identified in 72.4% (105/145) of LEBQ2W patients and 59.1% (39/66) of placebo. At Week 16, 68.6% (72/105; P = 0.02) of LEBQ2W were improved or cleared vs. 46.2% (18/39) of placebo. At baseline, hand dermatitis was identified in 71.0% (103/145) of LEBQ2W patients and 66.7% (44/66) of placebo. At Week 16, 72.8% (75/103; P = 0.001) of LEBQ2W were improved or cleared vs. 43.2% (19/44) of placebo. Lebrikizumab treatment is efficacious in improving and clearing hand and face dermatitis in most patients at Week 16. [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]

Adult atopic dermatitis (AD) is associated with overweight, obesity and cardiovascular diseases (CVD) in Americans, similarly to psoriasis, but no increased risk of CVD has been shown in European patients with AD. This study investigated the prevalence and risk of gallstones in adults with AD and in those with psoriasis as a proxy for obesity using nationwide data for all Danish citizens ≥ 30 years of age. Outcome was a diagnosis of gallstones. Odds ratios (ORs) were calculated by logistic regression (cross-sectional study) and hazard ratios (HRs) were estimated by Cox regression (cohort study). The study comprised 6,742 patients with AD, 53,810 patients with psoriasis, and 3,534,164 general population subjects. The prevalence of gallstones was 3.8%, 3.5% and 5.0% in the general population, AD and psoriasis patients, respectively. Adjusted ORs were 0.81 (0.71-0.92) for AD and 1.18 (1.14-1.23) for psoriasis. During follow-up, adjusted HRs were 0.72 (0.56-0.90) for AD and 1.10 (1.02-1.18) for psoriasis. The findings highlight important differences in obesity and lifestyle factors among patients with AD and those with psoriasis. [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]

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 Atopic dermatitis ( AD) is a chronic inflammatory skin condition with a multifactorial etiopathogenesis. Studies have suggested that several perinatal factors may influence the risk of AD in early childhood. We investigated possible neonatal risk factors such as jaundice, blue light phototherapy, birthweight, gestational age at birth, and season of birth on the risk of developing AD in the first 5 years of life. Materials & Methods Data were collected through Danish nationwide administrative registers. All newborn children between 1997 and 2007 (n = 673,614) were included in the cohort. Incidence rate ratios ( IRRs) were estimated with 95% confidence intervals (95% CIs) by multivariate Poisson regression analyses. Results We identified a total of 85,743 children with AD in the first 5 years of life. The risk of AD was slightly increased in children with neonatal jaundice ( IRR 1.13 [95% CI 1.06-1.21]). Preterm birth was inversely associated with the risk of AD ( IRR 0.74, [95% CI 0.68-0.81]) as well as low birthweight ( IRR 0.68, [95% CI 0.61-0.75]). Children born in fall and winter seasons had an increased risk of AD compared to spring and summer. No association between neonatal blue light therapy and the risk of AD was found. Conclusions Low birthweight and preterm birth were inversely associated with AD, while neonatal jaundice and cold seasons of birth were associated with an increased risk of AD. [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]

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]

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 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]

The article discusses research which showed the prevalence of cancer in adult patients with atopic dermatitis (AD), a common chronic inflammatory skin disease. Topics discussed include the potential explanatory factors for altered risk in AD, association between AD and non-melanoma skin cancer (NMSC) and cervical cancer and systemic anti-inflammatory agents associated with an increased risk of NMSC.

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 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 A spot test was recently developed for easy and rapid testing to detect whether cobalt is available on surfaces in contact with skin. Objectives To explore the potential use of the cobalt spot test as a tool for skin dose assessment, and to verify the sensitivity under laboratory conditions. Methods A cobalt dilution series (cobalt standards mixed with cobalt spot test reagent solution) was prepared to determine the threshold for colour change. Defined doses of cobalt were applied to the fingers of 5 volunteers. Acid wipe sampling was used to measure the recovery of applied cobalt skin doses on one hand, and cobalt-exposed areas on the other hand were spot tested. Results A weak colour gradient was visible from approximately 1 to 1.5 µg cobalt/ml in the dilution series. For a skin dose of 0.125 µg cobalt/cm2, 80% of the cobalt dose was collected by acid wipe sampling. Spot tests gave positive results in all cases (n = 5). Conclusions The cobalt spot test can be used to show cobalt on the skin. More experience is needed to understand and describe the most suitable test conditions. [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]

Nickel is used in coins because the metal has beneficial properties, including price, colour, weight, and corrosion resistance, and also because it is easy to stamp. It has often been claimed that the duration of skin contact with coins is too short to cause nickel release and dermatitis. However, it is well known by dermatologists specialized in occupational skin diseases, and by their nickel-allergic patients, that hand eczema in cashiers and other professionals who handle coins may be caused or aggravated by nickel release from coins. In this review, we present evidence from past studies showing that nickel-containing coins can indeed pose a risk for those who handle them. For protection of the health of consumers, cashiers, and other workers who handle coins, it is suggested that coins without nickel release should be used as a substitute for the high nickel-releasing coins currently in widespread use. The key risk factor in this situation is the ability of metal alloys in coins to release nickel and contaminate the skin after repeated contact from coin handling. [ABSTRACT FROM AUTHOR]

Background. Nickel is widely used in coins; nickel may cause contact allergy and allergic contact dermatitis in those who handle them. Objectives. To investigate alloy use, coin composition and nickel and cobalt release for a worldwide selection of currently circulating coins. Materials and methods. Eight hundred and fifty coins of 361 different denominations or issues from 52 countries were collected and analysed with X-ray fluorescence spectrometry and nickel and cobalt spot tests. Results. Copper-nickel was the most frequently identified coin alloy, being observed in 100 denominations (28%), followed by aluminium-bronze (62, 17%). In total, 239 denominations released nickel (28%). Coins from Bolivia, Brazil and Costa Rica did not release nickel. Fewer than one-third of the denominations or issues from China, India, the euro area and Indonesia released nickel. In the United States, the Russian Federation, Japan, and Mexico, one-third or more of the denominations released nickel. Conclusions. This worldwide selection of circulating coins covered countries with 75% of the world population, and shows that the majority of the world population lives in countries where coins release nickel. Pertinently, ∼ 40% of circulating coin denominations do not release nickel. [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]

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.

In July 2001, the EU Nickel Directive came into full force to protect European citizens against nickel allergy and dermatitis. Prior to this intervention, Northern European governments had already begun to regulate consumer nickel exposure. According to part 2 of the EU Nickel Directive and the Danish nickel regulation, consumer items intended to be in direct and prolonged contact with the skin were not allowed to release more than 0.5 µg nickel/cm2/week. It was considered unlikely that nickel allergy would disappear altogether as a proportion of individuals reacted below the level defined by the EU Nickel Directive. Despite this, the EU Nickel Directive part 2 was expected to work as an operational limit that would sufficiently protect European consumers against nickel allergy and dermatitis. This review presents the accumulation of epidemiological studies that evaluated the possible effect of this major public health intervention. Also, it evaluates recent exposure assessment studies that have been performed using the dimethyl glyoxime test. It is concluded that the EU Nickel Directive has started to change the epidemiology of nickel allergy in Europe but it should be revisited to better protect consumers and workers since nickel allergy and dermatitis remain very frequent. [ABSTRACT FROM AUTHOR]

A recent Danish study showed a significant increase in the prevalence of chromate contact allergy after the mid-1990s, probably as a result of exposure to leather products. To reproduce the results by analysing data from the period 1992-2009 at Odense University Hospital, Denmark. The temporal development in the occurrence of chromate contact allergy and assumed causative exposures were investigated. A retrospective analysis of patch test data was performed ( n = 8483), and medical charts from patients with chromate allergy (n = 231) were reviewed. Comparisons were made using the χ-test. A test of the reproducibility of the TRUE Test was also performed. Logistic regression analyses were used to test for associations. No significant changes in the prevalence or exposure sources of chromate allergy during 1992-2009 were identified. Leather shoes (24.4%) were the most frequent exposure sources in chromate allergy, and were mainly registered in women, although the difference between men and women was not significant ( P = 0.07). Cement and leather glove exposure occurred significantly more often in men than in women ( P = 0.002). Foot dermatitis (40.3%) was the most frequent anatomical location, apart from hand eczema (60.6%). The reproducibility of the TRUE Test was 93.3%. Apart from hand eczema, the most frequent clinical picture of chromate allergy was foot dermatitis caused by leather shoe exposure. A tendency for an increasing prevalence of chromate contact allergy from 1997 was shown, but no significant change was detectable. [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: 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]

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: Filaggrin null (FLG) mutations lead to skin barrier disruption with a reduced resistance towards exogenous agents and also influence the course of disease in atopic dermatitis. Objectives: To examine the association between FLG mutations and contact allergy, polysensitization, hand eczema at first appearance of disease, occurrence, and course of dermatitis. Methods: A venous blood sample from 430 individuals was genotyped for FLG mutations R501X and 2282del4 with polymerase chain reaction followed by typing through hybridization to paramagnetic polystyrene beads and analysis on a BioPlex 200. All individuals had a minimum of one positive patch test reaction. Results: In all, 3.5% were 2282del4 heterozygote and 5.1% were R501X heterozygote. An odds ratio (OR) of 1.49 [95% confidence interval (CI) 0.74–3.00] was found for nickel allergy, OR 0.84 (95% CI 0.41–1.74) for polysensitization, OR 0.78 (95% CI 0.25–2.43) for dermatitis, OR 0.96 (95% CI 0.48–1.92) for hand eczema at debut, OR 1.25 (95% CI 0.99–1.57) for duration of disease, and OR 0.76 (95% CI 0.59–0.97) for age at onset. Conclusions: No association between nickel allergy, polysensitization, hand eczema at first appearance or occurrence of dermatitis, and FLG mutations was found. However, patients with FLG mutations had an earlier age of onset compared with the wild-type genotype and a trend towards longer duration of disease. [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]

Background: Fragrance contact allergy has for long been recognized as an important health issue. In Denmark, the frequency of fragrance mix (FM) I contact allergy increased between 1985–1986 and 1997–1998 among male and female dermatitis patients. Objectives: To investigate the development of FM I and Myroxylon pereirae (MP) contact allergy between 1985 and 2007 with an emphasis on recent years. Methods: A retrospective analysis of all patch test data from our database was performed. Comparison of sensitivity rates was made using a chi-squared test for trend. Logistic regression analyses were used to test for associations. Results: Of 16 173 patients, 7.2% were sensitized to FM I and 4% to MP. FM I contact allergy was associated with female sex [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.33–1.74] and age between 41 and 60 years (OR = 3.20; 95% CI = 1.98–5.21). Significant declines of FM I and MP reactions among women but not men were observed between 1999 and 2007. Conclusions: Although the frequency of FM I contact allergy has decreased in Denmark in recent years, it is still high. Furthermore, fragrance contact allergy is caused by other important allergens not included in this analysis. Allergic contact reactions to the ingredients of FM I remain a problem in European consumers. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Atopic dermatitis (AD) is mainly driven by type 2 inflammation and often treated with topical agents. Studies comparing differences in biomarkers between these treatments are lacking.The aim of this study was to evaluate the effects of topical betamethasone 17‐valerate 0.1% and tacrolimus 0.1% ointment on skin barrier function and inflammatory biomarkers in skin and blood in adults with AD.In this randomized parallel‐group double‐blind double‐dummy active‐comparator study design, 36 adults with AD were treated with either whole‐body topical corticosteroid (betamethasone ointment 0.1% plus placebo once daily, n = 18) or calcineurin inhibitor (tacrolimus ointment 0.1% twice daily, n = 18). At baseline, after 2 weeks of daily treatment and after further 4 weeks of twice‐weekly maintenance treatment, we evaluated AD severity, levels of natural moisturizing factor (NMF) and cytokines in the skin and blood and characterized circulating T cells.Mean AD severity at baseline corresponded to moderate disease and decreased significantly in both groups. Levels of NMF increased significantly in the tacrolimus group after 2 weeks of treatment (p = 0.002) and tended to increase more than betamethasone at week 6 (p = 0.06). Most skin cytokines decreased with both treatments. However, IL‐8, IL‐18, IL‐22, IP‐10, MDC, MMP‐9 and TARC were significantly more decreased with betamethasone than tacrolimus after 2 weeks, while after 6 weeks this was only the case for IL‐8 and MMP‐9. Approximate half of the systemic cytokines decreased significantly with both treatments, but betamethasone decreased MDC significantly more after 2 weeks of treatment. T‐cell characterization analyses indicated slight differences in the expression and activation of T cells between groups.Topical treatment of AD with betamethasone and tacrolimus ointment effectively reduced disease severity, cutaneous and systemic inflammatory markers. Betamethasone was more effective in decreasing inflammation, but tacrolimus improved skin hydration (NMF levels) more than betamethasone. [ABSTRACT FROM AUTHOR]

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.

A case study of 9-year-old non-atopic boy developed eczema on his face, chest, arms and legs, after his bedroom had been painted with Flügger Flutex. is presented. It discusses importance of a complete declaration of isothiazolinones in products beyond cosmetics. It further discusses risk of sensitization for contact allergens.

The article presents a case study of a 53-year-old man presented with pain and bleeding during defecation. Topics include general practitioner suspected with haemorrhoids and began treatment with doloproct and proctosedy and then treated with a gel containing the calcium channel blocker diltiazem by gastrointestinal surgeon, systemic allergic dermatitis due to application of diltiazem and neomycin in the gel used to treat anal fissures and dermatitis from other agents such as amlodipine.

The article discusses the findings of a study to assess the release of chromium (VI) in 848 jewellery items using the diphenylcarbazide (DPC) spot test. It notes that the jewellery items were purchased from different locations including Denmark, Poland, and Great Britain. The results of the DPC spot test confirm that the jewellery items failed to release more than 0.5 parts per million (ppm) of chromium (VI) which is less than the amount needed to elicit dermatitis in allergic patients.

The article presents the case of a 61-year-old man with occupational allergic contact dermatitis after exposure to the Central American hardwood cocobolo. He was referred with a relapsing eczematous rash on the face and hands with spread to the arms and genital region. Being a woodwork teacher, he was able to link four episodes of dermatitis to occupational exposure.

The article presents a case study of 48 year old non-atopic women, suffering from hand eczema and periorbital dermatitis. The article reports that a patch test was performed on patient and found that contact dermatitis was due to air borne thiuram exposure from latex gloves used in the occupation. The patient was advised to use accelerator free nitrile gloves after which she had not reported any complaint of hand eczema and periorbital dermatitis.

The article presents a case study of Christmas tree dermatitis caused by colophonium allergy. It cites the case of a 28-year-old atopic woman, who was diagnosed with colophonium allergy as a child and was referred to a dermatology due to acute onset of dermatitis on her hands, arms, and face after decorating a Christmas tree. It also discusses the causes of the condition of the patient and indicates that they should be informed about the risk of allergic contact dermatitis with Christmas trees.

The article focuses on the study related to occupational hand eczema caused by nickel allergy and semi-quantified from dimethylglyoxime testing of the skin. It mentions that nickel is an important cause of occupational allergic contact dermatitis. It states that excessive nickel exposure is shown in many occupations.

The article presents case study of a 59-year-old female with uncommon case of allergic airborne contact dermatitis caused by exposure to the volatile anaesthetic sevoflurane. Topics discussed include details of symptoms and occurrence of the dermatitis in the patient, finding of diagnostics tests and probable treatment options for the disease.

The article presents a case study of a 28-year-old male baker who experienced persistent hand dermatitis for the past 6 months. It states that due to the nature of the patient's work, performing different tasks including the mixing of food ingredients and placing those onto baking sheets, skin contact took approximately 80-100 times in every working day. It also points out the impact of cobalt on the condition of the patient.