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Background: There are few studies reporting patch test results in skin of color patients, especially for Hispanic, Asian, and Indigenous populations. Objective: To characterize patch testing results in patients with skin of color at our center. Methods: A retrospective study of patients demonstrating at least 1 allergenic reaction in comprehensive patch testing (+, ++, +++, or +/-) with final interpretation as allergic by a board-certified dermatologist specializing in contact dermatitis. Results were stratified by self-reported race and the most common reactions for each group were characterized and compared to those of White patients. Results: A total of 1389 patients were identified; 270 (19.4%) having skin of color (1119 White, 102 Asian, 115 Black or African American, 44 Hispanic, 9 Indigenous). Most common reactions among Asian patients were nickel, methylisothiazolinone (MI), and hydroperoxides of linalool. In Black patients, MI, nickel, and p-phenylenediamine were most common. In Hispanic patients, MI, nickel, and formaldehyde were most common. The positivity of acrylates ( P < 0.001) and propylene glycol ( P < 0.05) in Asians as well as dyes and rubber accelerators in Black patients ( P < 0.05) was significantly higher than in White patients. Conclusions: Nickel and MI are common allergens in all groups, with certain allergens being overly represented in some groups. Differing cultural practices may result in these variations, emphasizing the need to capture patch testing trends in these populations.

Introduction: Allergic contact dermatitis (ACD) to salicylic acid (SA) is widely unreported. Furthermore, cross-reactivity between SA and other salicylates has not been reported despite well-documented in-group salicylate cross-reactivity., Objective: To describe our clinic's experience patch testing to SA, highlighting seven cases of relevant reactions and concomitant reactivity with other salicylates., Methods: Results of patch testing to 5% SA in petrolatum between 1 January 2020, and 9 February 2024, are reported. Seven cases of relevant reactions to SA are detailed., Results: A total of 489 patients (27.5%) were tested to SA, 21 of which were positive: 7 doubtful (+/-), 14 weak positive (+), and no strong/extreme positive reactions. Four irritant reactions were documented. Of the 14 weak positive (+) reactions, 7 had definite or probable clinical relevance, 5 of which also reacted to other salicylates., Conclusions: ACD to SA is likely underreported due to a lack of testing. In our experience, testing SA 5% petrolatum is tolerable without significant irritation. Cross-reactivity between SA and other salicylates is probable. Though SA appears to be the primary sensitizer in some cases, more studies are needed to understand its possible role as a marker for salicylate allergy., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Doubtful reactions in patch testing are infrequently reported in the literature; however, recent reports have suggested they be assessed with the same scrutiny as stronger reactions., Objective: Assess the clinical relevance of doubtful reactions in patch testing., Methods: Retrospective study of 1514 patients comprehensively patch tested via the NACDG standard series and additional allergens based on history. The clinical relevance of each reaction was graded based on the NACDG scale: definite, probable, possible, past, unknown and irritant. Reactions were considered 'unique' if an additional mild-to-strong reaction to the same chemical at a different concentration was not observed., Results: 68.9% (1043) of patients demonstrated at least 1 doubtful reaction. Of 4453 total doubtful reactions, 92.2% (4106) were unique. Only 3.3% (137) and 12.2% (500) of these were determined to be of definite or probable clinical relevance respectively. 'Fragrance' was the most common allergen family present among the unique definite doubtful reactions (37). However, 24 (64.9%) of these also had a stronger reaction to another fragrance. Cocamidopropyl betaine was the second most frequent allergen demonstrating definite doubtful reactions (27) and unique in 85.2% (23) of cases. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was most prevalent (36) but less frequently unique (58.3%, 21)., Conclusions: Doubtful reactions may not be as impactful to clinical decision making as theorised in the literature. Few demonstrate definite clinical significance, and many have related stronger reactions that capture them for clinical purposes. Identification of doubtful reactions to cocamidopropyl betaine and MCI/MI may be of greatest significance as they most frequently were not supported by stronger reactions., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Formaldehyde is a common preservative used to prevent microbial growth in water. It can be found in personal care products and household cleaning products, including laundry detergents. Formaldehyde has frequently been recognised as a cause of allergic contact dermatitis, but whether it remains present in textiles washed with formaldehyde-containing laundry detergents is unknown., Objectives: This study aimed to utilise the chromotropic acid method (CAM) to assess formaldehyde release from textiles washed with a laundry detergent known to contain formaldehyde., Materials and Methods: Textiles were laundered with a detergent containing calcium formate at four concentrations (0×, 0.5×, 1× and 5× the recommended amount per manufacturer label) and kept wet or allowed to dry. Select textiles were subjected to an additional rinse cycle. Textiles were then tested utilising the CAM. A sample of the pure laundry detergent was also tested using the CAM., Results: The CAM was positive only for wet textiles washed at 5× the recommended concentration of detergent and pure detergent. All dry textiles were negative., Conclusions: Formaldehyde release was not detected from any textiles washed following the manufacturer's recommendations. Once dry, it is likely safe for formaldehyde-allergic patients to wear textiles washed with formaldehyde-containing detergents., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Abstract Active ingredients of sunscreens, or UV filters, have increased in use because public awareness of sun safety has risen. In addition to this intentional use, unintentional exposures to UV filters also occur through application of personal care products, where the filters are incorporated into the product. There are 2 main types of UV filters: organic (chemical) filters and the 2 inorganic (mineral) filters, titanium dioxide and zinc oxide. Both allergic contact dermatitis (ACD) and photoallergic contact dermatitis (PACD) have been caused by organic filters; oxybenzone (benzophenone-3) is the most frequently reported contact and photocontact allergen compared with all other UV filters. There are no reports of ACD or PACD to the inorganic (physical) UV filters. Here, we review the categories of sunscreens available, currently marketed UV filters, and their corresponding ACD and PACD.

Competing Interests: The authors have no funding or conflicts of interest to declare.

Background: Popularity of eyelash enhancements has increased dramatically. Eyelash enhancements are available as an over-the-counter consumer product with glue included and as a professional product where proprietary glues are typically used. Both types of eyelash extension glues may release formaldehyde despite not being declared as an ingredient. Although formaldehyde is a carcinogen and may cause allergic contact dermatitis, few studies have assessed its presence in eyelash glues., Objective: The aim of the study was to evaluate professional and consumer eyelash glues for the presence of formaldehyde using the chromotropic acid method (CAM)., Methods: A total of 37 eyelash glues were evaluated: 17 consumer eyelash glues (2 of which declared formaldehyde) and 20 professional eyelash glues (none of which declared formaldehyde) were purchased and analyzed with the CAM of testing., Results: For consumer eyelash glues, the 2 glues that declared formaldehyde were positive on CAM testing as well as 2 glues (13.3% [2/15]) that did not declare formaldehyde. Of the 20 professional eyelash glues, 15 (75.0%) were positive for formaldehyde., Conclusions: Some consumer eyelash glues and most professional eyelash glues released formaldehyde when evaluated with CAM. Patients and clinicians should be aware that both consumer and professional eyelash glues can be sources of formaldehyde., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 American Contact Dermatitis Society. All Rights Reserved.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Background: Aerosolized liquid (e-liquid) of electronic cigarettes can be toxic. Beyond the solvent (propylene glycol, vegetable glycerin) and nicotine, little is known about the liquid composition. Formaldehyde, a carcinogen and source of contact dermatitis, has been reported in the vaporized e-liquid, but no studies have assessed the actual e-liquid., Objective: The aim of the study was to evaluate e-liquid products for the presence of formaldehyde., Methods: Sixteen e-liquid products were purchased and analyzed for the release of formaldehyde using the chromotropic acid method of detection., Results: Of the 16 e-liquids purchased, 4 (25%) were positive for the presence of formaldehyde; 2 were flavored and 2 were nonflavored. All positive e-liquids were in pods or disposable electronic cigarette devices, and 2 were purchased from local vape shops. The average nicotine content in the positive e-liquids was 3.85% versus 4.03% in the negative e-liquids., Conclusions: The e-liquid products contain toxic chemicals not declared on product labels, as shown in this study with 25.0% of e-liquids containing formaldehyde. All positive e-liquids were within pods or disposable devices. Continued analysis of e-liquids and increased product regulation are needed., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2022 American Contact Dermatitis Society. All Rights Reserved.)

The Moderna COVID-19 vaccination was approved for use in the United States in December of 2020 1 and since that time massive public health efforts have been made to vaccinate patients against the COVID-19 infection. Adverse reactions from the vaccination are well-reported and include both local skin reactions, such as pain, swelling, and erythema at the injection site, as well as systemic reactions including fever, malaise, headache, muscle aches, drowsiness, nausea, and vomiting. While severe serious cutaneous adverse reactions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), remain rare; two cases of SJS/TEN related to COVID-19 vaccination have been reported. We herein review the two previously reported cases of SJS/TEN and report the first case of SJS precipitated by the Moderna Inc., MRNA 1273 COVID-19 vaccination in the United States. Although we review potential adverse reactions to vaccination, the benefits of COVID-19 vaccination outweigh the risks based on current data. Cases should be reported to the Vaccine Adverse Event Reporting System (https://vaers.hhs.gov/) to help public health officials recognize and track these severe but rare adverse events., (© 2022 the International Society of Dermatology.)

Abstract: Consideration of contact allergen concomitant reactivity, which encompasses cross-reactors, co-reactors, and pseudo cross-reactors, is an important aspect of patient care, yet information on how these terms are differentiated and used in clinical practice is lacking. In this review, we provide definitions of cross-reactors, coreactors, and pseudo cross-reactors and discuss the utility of the American Contact Dermatitis Society Contact Allergen Management Program database cross-reactor groupings. We also discuss limitations to the current categorization of cross-reactivity and recommend incorporating new terms, including "apparent cross-reactor" and "derivative cross-reactor," when classifying cross-reactors., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Background: The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods., Objectives: The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses., Methods: Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored., Results: Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed., Conclusions: There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses., Competing Interests: S.C. serves as a consultant for Kimberly-Clark. S.E.J. is a founder and chief executive officer of the Dermatitis Academy and has consulted for L'Oreal and Johnson & Johnson. The other authors have no funding or conflicts of interest to declare., (Copyright © 2020 American Contact Dermatitis Society. All Rights Reserved.)

Background: Prolonged wear of facial protective equipment can lead to occupational dermatoses., Objective: To identify important causes of occupational dermatoses from facial protective equipment., Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both., Results: We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare., Limitations: Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies., Conclusion: This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis., (Copyright © 2020. Published by Elsevier Inc.)

: Cutaneous exposure to aluminum may occur via contact with metal items, medications, and personal care products. Despite the widespread use of aluminum, allergic contact dermatitis is relatively rare. Sensitization is often incidentally identified during patch testing with aluminum-based chambers. This article presents several cases along with a literature review summarizing prevalence and clinical manifestations of cutaneous reactions to aluminum, recommendations for patch testing, sources of aluminum, and reproducibility of aluminum allergy over time.

Allergic contact dermatitis (ACD) is a cutaneous type IV hypersensitivity immune reaction mounted against substances in contact with the skin to which the patient has been sensitized. ACD is common, affecting approximately 72 million Americans per year, and is more common in women. One common contact allergen group is acrylates, which are monomers that are polymerized in the making of glues, adhesives, and plastic materials. It is the monomers that are sensitizing, whereas the final polymers are inert. Acrylates were the 2012 Contact Allergen of the Year with the specific acrylate, isobornyl acrylate, being the 2020 Contact Allergen of the Year. This article reviews the history of acrylate use, epidemiology, and both known and emerging sources of acrylates resulting in ACD., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)