Search

Hairdressers are at high risk of developing occupational hand eczema. Opinions on the health and safety concerns of nonfood consumer products, such as cosmetics and their ingredients, consider the exposure of a "common consumer," which may not account for occupational exposure of hairdressers. As a result, there is a parlous scenario in which serious safety concerns about occupational exposures are present. The purpose of this review is to compare the frequency of exposure to various types of hair cosmetic products among hairdressers and consumers. Database searches for this review yielded a total of 229 articles; 7 publications were ultimately included. The analysis showed that—dependent on the task—hairdressers were exposed 4 to 78 times more than consumers to a wide spectrum of hair cosmetic products used in their daily working life, ranging from shampoos, conditioners, oxidative and nonoxidative hair colors, to bleaching agents. The highest frequency was found for coloring hair with oxidative hair color. Consumer use frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk‐assessment procedures to be reconsidered. [ABSTRACT FROM AUTHOR]

Background: Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate‐type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA‐based COVID‐19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under‐diagnosis and under‐reporting of allergy to PEGs, putting patients at risk of repeated severe reactions. Objectives: To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019. Method: Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0–10) before and after diagnosis. Results: Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot‐steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2–6). Median time from first reaction to diagnosis was 20 months (range 2–120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis. Conclusion and clinical relevance: The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients' lives. [ABSTRACT FROM AUTHOR]

Background: Naturally derived cosmetic product ingredients of both plant and animal origin are being included increasingly in product formulations in order to cater to consumer preferences. They may be an overlooked cause of reactions to cosmetic products in some patients with dermatitis. Objectives: To identify naturally derived cosmetic product ingredients with allergenic potential (type I and type IV) and propose a cosmetic screening test series. Methods: The study was conducted in two steps. The first step was a market survey using a nonprofit application helping consumers avoid problematic substances in cosmetic products. The application contained 10 067 cosmetic products that were label checked for naturally derived cosmetic product ingredients. The second step was a literature search to examine how frequently the naturally derived ingredients were described and related to allergic reactions in cosmetics or other topically administered products. Results: We identified 121 different naturally derived cosmetic product ingredients that were included in at least 30 cosmetic products. In total, 22 ingredients were selected for a screening test series. Conclusions: We propose a supplemental patch test and a prick test screening series with naturally derived cosmetic product ingredients for patients with skin reactions to cosmetic products, aiming to identify a cause in more patients than is currently possible. [ABSTRACT FROM AUTHOR]

The article presents a case study of 55-year-old White non-atopic metalworker with the medical history of work-related hand eczema. It notes the allergic contact dermatitis caused by the emulsifying agent 2-Amino-2-methyl-1-propanol (AMP), which is used in metalworking fluids (MWF), and AMP used in cosmetics like hair dyes.

The article presents a case study of 10 female patients from age 51 to 77 years with lesions on neck and dermatological diseases, contact allergy, patch testing performed with European baseline series, skin biopsy and topical corticosteroids or topical tacrolimus as the effective treatments.

Background Cobalt is a strong skin sensitizer (grade 5 of 5 in the guinea-pig maximization test) that is used in various industrial and consumer applications. To prevent sensitization to cobalt and elicitation of allergic cobalt dermatitis, information about the elicitation threshold level of cobalt is important. Objective To identify the dermatitis elicitation threshold levels in cobalt-allergic individuals. Materials and methods Published patch test dose-response studies were reviewed to determine the elicitation dose ( ED) levels in dermatitis patients with a previous positive patch test reaction to cobalt. A logistic dose-response model was applied to data collected from the published literature to estimate ED values. The 95% confidence interval ( CI) for the ratio of mean doses that can elicit a reaction in 10% ( ED10) of a population was calculated with Fieller's method. Results On the basis of five included studies, the ED10 values of aqueous cobalt chloride ranged between 0.0663 and 1.95 µg cobalt/cm2, corresponding to 30.8-259 ppm. Conclusions Our analysis provides an overview of the doses of cobalt that are required to elicit allergic cobalt contact dermatitis in sensitized individuals, and thereby the basis for future prevention of cobalt allergy. [ABSTRACT FROM AUTHOR]

Background Chlorhexidine is a widely used disinfectant in the healthcare setting and in cosmetic products. A high prevalence of chlorhexidine contact allergy was reported in Denmark in the 1980s (2.0-5.4% of patients patch tested). It is unknown whether the prevalence is still high, which products cause the contact allergy, and whether accidental re-exposure occurs in some patients. Objectives To estimate the prevalence of chlorhexidine contact allergy in a tertiary dermatology clinic in Denmark; to investigate whether patch testing with both chlorhexidine diacetate and chlorhexidine digluconate is necessary; to investigate how many patients have combined immediate-type allergy and contact allergy; and to identify which products cause chlorhexidine contact allergy, and whether patients are accidentally re-exposed. Methods This was a retrospective study including all patients patch tested with chlorhexidine during 2003-2013 at the Department of Dermato-Allergology at Copenhagen University Hospital Gentofte (n = 8497). All patients with a positive patch test reaction to chlorhexidine were sent a questionnaire comprising questions about the cause of the allergy and re-exposure. Results Overall, 1.0% (n = 82) of all patients patch tested with chlorhexidine were positive. A decrease in the prevalence was observed over time, most likely because of lowering of the test concentration from 1.0 to 0.5% in 2008. Of the 82 patients, 28 (0.3%) had positive test reactions to both chlorhexidine salts, 43 (0.5%) had a positive test reaction only to chlorhexidine diacetate, and 11 (0.1%) had a positive test reaction to chlorhexidine digluconate. Three patients were both patch test-positive and prick test-positive. A known cause of the allergy was reported by 19 patients (40%) in the questionnaire: the products used in the healthcare setting were mainly reported, but some reported cosmetic products. Accidental re-exposure was reported by 15 patients (32%), of whom 13 reported symptoms. Conclusions The prevalence of chlorhexidine contact allergy does not seem to be higher in Denmark than in other European countries. Patch testing with both chlorhexidine diacetate and chlorhexidine digluconate may be beneficial. Testing for immediate-type allergy in patients with a positive patch test reaction to chlorhexidine is recommended. Chlorhexidine-containing products used in the healthcare setting and in cosmetics are potential causes of sensitization and allergy. Re-exposure is common, highlighting the fact that patients and healthcare personnel need to be well informed about possible sources of exposure. [ABSTRACT FROM AUTHOR]

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

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

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

Background. Hand eczema is a common and fluctuating disease. Visual analogue scales (VASs) are used to assess disease severity, both currently and when at its worst. However, such patient‐reported outcomes may be at risk of being flawed owing to recall bias or response shifts. Objective. To explore whether the current state of hand eczema severity affects the recollection of the eczema when at its worst, thus resulting in a response shift. Methods. We utilized a dataset from a recent clinical trial examining nurse counselling of hand eczema patients. The patients assessed the disease severity currently (VASnow) and when at its worst (VASworst), both at baseline and at a 6‐month follow‐up. Results. The patients who reported improvement during the course were generally more likely to downwardly adjust their assessment of VASworst than patients reporting unchanged or worsened severity (odds ratio 1.94, p = 0.017). No other determinants were found. Conclusion. Patients may downwardly adjust their assessment of worst‐ever disease severity according to the assessment of present disease severity. Regular photographic documentation of the hand eczema along with the patient's self‐monitoring of symptoms as part of the treatment course could perhaps counteract this tendency for there to be severity habituation. [ABSTRACT FROM AUTHOR]

Background Chlorhexidine may cause type I and type IV allergy. Some chlorhexidine-allergic individuals have been exposed in the healthcare setting as patients or healthcare workers, but for others the source of sensitization is unknown. Chlorhexidine may be used as a preservative or an antimicrobial agent in cosmetic products at a concentration up to 0.3%, as set by the European Cosmetics Directive (now Regulations). Objectives To identify cosmetic product types containing chlorhexidine, and to measure the concentration of chlorhexidine in selected products. Methods Between February 2013 and April 2013, we checked for chlorhexidine in cosmetic products in 14 supermarkets, one hairdressing salon and one beauty and retail store in Copenhagen, Denmark by reading the ingredient labels. The chlorhexidine concentration was measured in 10 selected products by high-performance liquid chromatography ( HPLC) with an ultraviolet ( UV) detector. Results Chlorhexidine was found in 80 of 2251 checked products (3.6%) in the following categories: hair products (57/760), creams (9/324), face washes (4/24), wet wipes (4/63), skin tonics (3/22), make-up removers (2/25), and mouth washes (1/17). Chlorhexidine concentrations were 0.01-0.15%. Conclusions We found chlorhexidine in various cosmetic product types, predominantly aimed at females, and in hair products. The measured chlorhexidine concentrations were all within the permitted limit. The relevance for allergic sensitization should be further explored. [ABSTRACT FROM AUTHOR]

Background On skin contact, nickel accumulates in the stratum corneum, where it is probably bound to proteins and amino acids. One probable contributor is filaggrin, which binds nickel avidly. Filaggrin gene ( FLG) null mutations lead to a complete lack of filaggrin production from the affected allele, and have been associated with an increased risk of nickel contact sensitization in German and Danish adults. Objectives To investigate whether the experimental nickel elicitation threshold level differed between heterozygous FLG mutation and non-mutation carriers. Method Thirteen nickel-sensitized female patients, seven heterozygous mutation carriers and six non-mutation carriers (genotyped for R501X, 2282del4, or R2447X), were patch tested and performed a repeated open application test ( ROAT) with a nickel sulfate dilution series. Logistic threshold dose-response analyses were used to test for differences between the two groups. Results No difference was found in the dose-response relationship between FLG mutation and non-mutation carriers. Conclusions On the basis of this small patient study, it appears that the elicitation threshold level for nickel is independent of FLG null mutation single-allele carrier status. [ABSTRACT FROM AUTHOR]

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

Background 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]

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

Atopic dermatitis, hand eczema and contact sensitization are prevalent disorders, and may, in many cases, be secondary to skin barrier abnormality. The aim of this study was to investigate the association between self-reported generalized xerosis, atopic dermatitis, hand eczema and contact sensitization, taking filaggrin gene mutations into account. Questionnaire data were collected from a cross-sectional study performed in a general population in Copenhagen. A total of 3,460 18-69-year-olds were patch-tested and 3,335 were genotyped for the 2282del4 and R501X mutations in the filaggrin gene. Atopic dermatitis and hand eczema were significantly associated with generalized xerosis, whereas contact sensitization (not nickel) showed only a borderline significant association. These results suggest that generalized xerosis may increase the risk of common skin disorders. [ABSTRACT FROM AUTHOR]

Background. Despite the political intention to limit nickel allergy and dermatitis in Europeans, nickel allergy remains frequent. There are several explanations for the persistence of nickel allergy and dermatitis, including the increasing use of mobile phones. Before regulation of nickel release from mobile phones, we showed that eight (19.5%) of 41 mobile phones marketed in Denmark between 2003 and 2007 released nickel in concentrations that may result in nickel allergy and dermatitis. In 2009, the EU Nickel Directive was revised to include nickel-releasing mobile phones. Objectives. To investigate the proportion of mobile phones sold in Denmark that release nickel after regulation. Methods. Metallic parts from 50 randomly selected mobile phones currently for sale in Denmark were tested for nickel release by use of the dimethylglyoxime (DMG)-nickel spot test. Results. Nine (18%) phones showed at least one positive DMG test reaction and two phones had more than one DMG test-positive spot. Conclusions. Apparently, the proportion of mobile phones with significant nickel release remains unchanged, despite the 2009 revision of the EU Nickel Directive. We encourage manufacturers to measure nickel release from metallic components used in the assembly of mobile phones to ensure safe products. [ABSTRACT FROM AUTHOR]

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

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]

Background: Hairdressers are occupationally and personally exposed to hair dye substances and adverse reactions from the skin are well known. Currently, little is known about personal exposure to hair dye ingredients and temporary black tattoos. [ABSTRACT FROM PUBLISHER]

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]

There is evidence that stimulants such as alcohol and tobacco have an effect on the immune system, but little is known about how these lifestyle factors affect the prevalence of contact sensitization. This study investigated whether smoking and alcohol consumption were associated with contact sensitization and nickel sensitization. A random sample of adults (n = 3460) from the general population of Copenhagen was invited to participate in a general health examination including patch-testing. Alcohol consumption was not associated with nickel sensitization, whereas a significant trend (p < 0.05) was identified between smoking status and nickel sensitization in an adjusted model; i.e. nickel sensitization was higher among both previous smokers (odds ratio (OR) = 1.19; confidence interval (CI) = 0.81–1.76), current light smokers (OR = 1.50; CI = 0.94–2.37) and current heavy smokers (OR = 1.56; CI = 0.87–2.80) compared with never smokers. This study confirmed that smoking is associated with nickel sensitization, but rejected an association with alcohol consumption. [ABSTRACT FROM AUTHOR]

The article describes the case of a female patient with acute dermatitis on her lower right arm caused by a cream containing panthenol applied as aftercare treatment of a tattoo. Topics discussed include results of the patch tests performed on the patient, discontinuation of the panthenol cream and treatment involving topical corticosteroids.

Background: Nickel dermatitis may be caused by frequent and prolonged use of cell phones. Because little is known about the frequency of nickel release from cell phones, it is difficult to estimate the risk of nickel sensitization and dermatitis among their users. Objective: Inspired by a recent case of nickel dermatitis from prolonged cell phone use, the frequency of dimethylglyoxime (DMG)-positive cell phones on the Danish market was investigated. Methods: Five major cell phone companies were contacted. Two were visited, and the DMG test was performed on a sample of their products. Results: 5 of 15 (33.3%) phones from company A and 3 of 26 (11.5%) phones from company B showed at least 1 positive reaction. 3 phones had more than 1 positive DMG spots. Conclusions: This study documents that excessive nickel release (i.e. a positive DMG test) is relatively frequent in a sample of cell phones from the Danish market. Prolonged use of cell phones may in some cases fulfil the criteria for items included in the European Union Nickel Directive. We believe that this new cause of nickel dermatitis should be carefully followed and that regulatory steps may be necessary. [ABSTRACT FROM AUTHOR]

Background: The preservative methyldibromo glutaronitrile (MDBGN) has been banned, first from stay-on, and later from rinse-off cosmetics, in the EU countries because of increasing rates of contact allergy. Objectives: To evaluate the frequency of contact allergy to MDBGN among patients patch tested by the Danish Contact Dermatitis Group just before and following regulatory decisions. Patients/Methods: The data set comprised 19 279 consecutive eczema patients patch tested from 2003–2007 with MDBGN 0.3% in petrolatum (pet.) or, in a minority of patients, with Euxyl K™ 400 1.5% in pet. Results: A significantly decreasing trend in the frequency of positive patch tests to MDBGN was found from 4.6% in 2003 to 2.6% in 2007 ( P < 0.001). The decreasing trend was seen for both men and women. A significantly decreasing proportion of cases with a current relevance of contact allergy to MDBGN was also seen from 51.3% in 2003 to 29% in 2007 ( P < 0.001). Conclusions: Regulatory interventions have already had a major effect on allergic disease due to MDBGN in Denmark. The same trends are likely to be seen in other EU countries. [ABSTRACT FROM AUTHOR]

Chloroatranol and atranol are degradation products of chloroatranorin and atranorin, respectively, and have recently been identified as important contact allergens in the natural fragrance extract, oak moss absolute. Oak moss absolute is widely used in perfumery and is the cause of many cases of fragrance allergic contact dermatitis. Chloroatranol elicits reactions at very low levels of exposure. In oak moss absolute, chloroatranol and atranol are present together and both may contribute to the allergenicity and eliciting capacity of the natural extract. In this study, 10 eczema patients with known sensitization to chloroatranol and oak moss absolute were tested simultaneously to a serial dilution of chloroatranol and atranol in ethanol, in equimolar concentrations (0.0034–1072 µM). Dose–response curves were estimated and analysed by logistic regression. The estimated difference in elicitation potency of chloroatranol relative to atranol based on testing with equimolar concentrations was 217% (95% confidence interval 116–409%). Both substances elicited reactions at very low levels of exposure. It is concluded that the differences in elicitation capacity between the 2 substances are counterbalanced by exposure being greater to atranol than to chloroatranol and that both substances contribute to the clinical problems seen in oak moss absolute-sensitized individuals. [ABSTRACT FROM AUTHOR]

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

The preservative methyldibromo glutaronitrile (MDBGN) has caused an epidemic of contact allergy in Europe. However, most data concerning contact allergy comes from hospital departments of dermatology. As a part of the primary health care sector, Danish dermatologists in private practice provide the front line of care for patients with skin diseases. Data from this source may therefore better reflect trends in the general population than material from hospital departments of dermatology. In this study, the frequency of MDBGN allergy and the characteristics of patients seen by dermatologists in private practice were studied. In 1 year, 2146 patients were patch tested by the participating dermatologists from 4 clinics in various parts of Denmark. 5% (110) had positive patch tests to MDBGN, with no difference between the sexes. After adjustment was made for other background variables, multivariate analysis using logistic regression showed a significant association between hand eczema and MDBGN allergy (OR 2.5,P < 0.001). In 53 cases (52.4%), the patch test reaction to MDBGN was judged to be of current relevance. Creams and lotions accounted for 31% of the identified causative products and liquid soaps for 23%. It is concluded that contact allergy to MDBGN is frequent among patients seen by dermatologists in private practice. This is consistent with results from hospital departments of dermatology in Europe and indicates a general trend and ongoing epidemic in the general population. The significant relationship between hand eczema and MDBGN allergy is of concern, and the finding that wash-off products, especially liquid soaps, play a significant role in MDBGN allergy calls for a revision of the safety assessment of MDBGN in wash-off products. [ABSTRACT FROM AUTHOR]

Most people in modern society are exposed daily to fragrance ingredients from one or more sources. Fragrance ingredients are also one of the most frequent causes of contact allergic reactions. The diagnosis is made by patch testing with a mixture of fragrance ingredients, the fragrance mix. This gives a positive patch-test reaction in about 10% of tested patients with eczema, and the most recent estimates show that 1.7–4.1% of the general population are sensitized to ingredients of the fragrance mix. Fragrance allergy occurs predominantly in women with facial or hand eczema. These women typically have a history of rash to a fine fragrance or scented deodorants. Chemical analysis has revealed that well known allergens from the fragrance mix are present in 15–100% of cosmetic products, including deodorants and fine fragrances, and most often in combinations of three to four allergens in the same products. This means that it is difficult to avoid exposure, as products labelled as ‘fragrance free’ have also been shown to contain fragrance ingredients, either because of the use of fragrance ingredients as preservatives or masking perfumes, or the use of botanicals. About 2500 different fragrance ingredients are currently used in the composition of perfumes and at least 100 of these are known contact allergens. Therefore, it is advisable to supplement standard patch testing with the patient’s own stay-on cosmetic products, as well as the fragrance chemical hydroxyisohexyl-3-cyclohexane carboxaldehyde, which on its own gives responses in 1–3% of tested patients. The focus in recent years on the ingredients of the fragrance mix will probably result in the fragrance industry changing the composition of perfumes, and thus make the current diagnostic test less useful. New diagnostic tests are under development to identify contact allergy to new allergens, reflecting the continuous developments and trends in exposure. [ABSTRACT FROM AUTHOR]

This article, published in the British Journal of Dermatology, discusses the role of neutrophil infiltration in allergic contact dermatitis (ACD) to nickel. ACD is a common inflammatory skin disease, and it is typically observed through patch testing on the back of patients. While previous studies have not shown significant neutrophil infiltration during ACD, this study found that neutrophils do play an important role in human ACD reactions. The authors suggest that targeting the survival of allergen-specific CD8+ TRM cells or their ability to recruit neutrophils could be a novel strategy for treating ACD. The study was supported by various funding sources and the authors declare no conflicts of interest. [Extracted from the article]

Background: Nickel is the leading cause of contact allergy in Europe, with 14.5% of the adult population being sensitized. Despite regulations limiting nickel release from consumer items, the incidence and prevalence of nickel allergy remain high. Objective: To investigate the clinical and subclinical immune response to low‐dose nickel exposure on nickel pre‐exposed skin to assess the adequacy of current regulatory limits. Method: Nickel‐allergic and healthy controls were patch tested with nickel twice with a 3–4 weeks interval. The first exposure used the diagnostic concentration of 2000 μg/cm2 nickel sulphate, and the same skin areas were then re‐exposed to 0.2, 0.5, 12.8 and 370 μg/cm2 nickel sulphate. After 48 h, the patch reactions were examined for clinical signs of eczema, and skin biopsies were collected. The transcriptomic immune profile was analysed with Nanostring nCounter and quantitative polymerase chain reaction. Results: Two nickel‐allergic participants (15%) had clinical reactions to the regulatory limiting doses for nickel (0.2/0.5 μg/cm2) following re‐exposure. There was immune activation in all skin areas following re‐exposure to nickel, predominantly mediated by up‐regulation of cytokines and chemokines. In all nickel re‐exposed skin areas, 81 genes were up‐regulated independent from the clinical response. In skin areas exposed to 0.2 μg/cm2, 101 immune‐related genes were differentially expressed, even when no clinical response was observed. Healthy controls showed up‐regulation of three genes in response to nickel re‐exposures without any clinical reactions. Conclusion: Immune activation can be induced in skin with local memory to nickel upon challenge with nickel doses within the regulatory limits. Our findings suggest that the regulatory limits in the European nickel regulation may not provide sufficient protection for consumers against low‐dose exposures. [ABSTRACT FROM AUTHOR]

Background: p‐Phenylenediamine (PPD) is a potent contact allergen found in many hair colour products. However, not all individuals develop allergic contact dermatitis (ACD) although they are regularly exposed to PPD. It is unclear whether these asymptomatic individuals are true non‐responders to PPD or whether they mount a response to PPD without showing any symptoms. Methods: Skin biopsies were collected from 11 asymptomatic hairdressers regularly exposed to PPD and from 10 individuals with known ACD on day 4 after patch testing with 1% PPD in petrolatum and petrolatum exclusively as control. RNA sequencing and confocal microscopy were performed. Results: T cell activation, inflammation and apoptosis pathways were up‐regulated by PPD in both asymptomatic and allergic individuals. Compared to asymptomatic individuals with a negative patch test, individuals with a strong reaction to PPD strongly up‐regulated both pro‐ and anti‐inflammatory cytokines genes. Interestingly, PPD treatment induced significant up‐regulation of several genes for chemokines, classical type 2 dendritic cell markers and regulatory T cell markers in both asymptomatic and allergic individuals. In addition, apoptosis signalling pathway was activated in both non‐responders and allergic individuals. Conclusion: This study demonstrates that there are no true non‐responders to PPD but that the immune response elicited by PPD differs between individuals and can lead to either tolerance, subclinical inflammation or allergy. [ABSTRACT FROM AUTHOR]

In the present study, we have investigated 42 cosmetic products based on natural ingredients for content of 11 fragrance substances; geraniol, hydroxycitronellal, eugenol, isoeugenol, cinnamic aldehyde, cinnamic alcohol, α-amylcinnamic aldehyde, citral, coumarin, dihydrocoumarin and α-hexylcinnamic aldehyde. The study revealed that the 91% (20/22) of the natural ingredients based perfumes contained 0.027%-7.706% of 1 to 7 of the target fragrances. Between 1 and 5 of the chemically defined synthetic constituents of fragrance mix were found in 82% (18/22) of the perfumes, 35% (7/20) of the other cosmetic products (shampoos, creams, tonics, etc.) were found to contain 0.003-0.0820% of 1 to 3 of the target fragrances. Relatively high concentrations of hydroxycitronellal, coumarin, cinnamic alcohol and αamyl cinnamic aldehyde were found in some of the investigated products. The detection of hydroxycitronellal and α-hexylconnamic aldehyde in some of the products demonstrates that artificial fragrances, i.e. compounds not yet regarded as natural substances, may be present in products claimed to be based on natural ingredients. [ABSTRACT FROM AUTHOR]

Regular and correct glove use is important[3] and it may impair compliance when almost one-third of the hairdressers report gloves as reasons for their hand eczema, as hairdressers may begin to question the overall benefit of gloves. Of these, 93.8% (544/580) had worked in the hairdressing occupation at the onset of hand eczema and 84.1% (487/579) believed their hand eczema were caused or exacerbated by their occupation. Keywords: contact dermatitis; hairdressers; hand eczema; occupational disease EN contact dermatitis hairdressers hand eczema occupational disease 162 164 3 01/13/23 20230201 NES 230201 INTRODUCTION Hairdressers have a high incidence of occupational hand eczema (OHE).[1] The risk of OHE in hairdressers is associated with a high degree of occupational exposure to wet work and allergens in hair cosmetics. [Extracted from the article]

The article presents a case study of a 52-year-old woman who was referred with swelling and chronic pain in the oral cavity at the site of a palladium-consisting dental implant. It says that histological examination confirmed that the patient has developed a granulomatous reaction at the site of palladium patch test, which resulted to dysaesthesia and pain upon skin contact. It adds that the contact dermatitis experienced by the patient was caused by palladium content in the dental implant.

The article presents a case study of a 37-year old woman with localized dermatitis due to jewelry exposure. It says that the jewelries to which the patient reacted was collected to examine through chemical analysis and microstructural surface characterization with the use of scanning electron microscope. Moreover, nickel and cobalt release testing shows that the patient was allergic to nickel.

Background: Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge. Objectives: To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic‐related allergens and a new test series with cosmetic‐relevant natural ingredients (CRNIs). Methods: This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic‐relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life). Results: Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic‐induced FD. The most common cosmetic‐related allergens were fragrances and preservatives. The most common patch test‐positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test‐positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life. Conclusions: Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi‐step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success. Objectives: To examine the effectiveness of a Danish‐adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3‐month follow‐up. Methods: Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish‐adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3‐month follow‐up using self‐reported questionnaires. Results: A statistically significant decrease in the severity of eczema was found at 3‐month follow‐up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3‐month follow‐up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences. Conclusions: These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis. [ABSTRACT FROM AUTHOR]

Background: Rubber accelerators are used in the production of rubber gloves and may cause contact allergy. Objectives: To estimate long‐term trend and prevalence of contact allergy to rubber accelerators for a 30‐year period in Denmark, high‐risk occupations, and exposures. Methods: Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch‐tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted. Results: The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12‐years, followed by a stable frequency in the past 18‐years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet‐work occupations were most often affected and gloves the most frequent exposure. Conclusions: Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention. [ABSTRACT FROM AUTHOR]

Background: Occupational contact dermatitis (OCD) is a common occupational disease. Atopic dermatitis (AD) is a known risk factor for OCD. Objectives: To determine the prevalence of previously diagnosed AD among young workers with recognized OCD and assess its impact on OCD prognosis. Methods: A retrospective cohort study. A questionnaire was sent to 6251 workers with recognized OCD who were under 35 years at notification (response rate: 47%). Of the respondents, 2392 answered a question about previous doctor‐diagnosed AD and were included in the study. Eczema severity, occupational consequences and quality of life were examined using statistical analyses comparing workers with and without previously diagnosed AD. Results: The prevalence of previously diagnosed AD was 41.8% (95% CI: 39.8–43.8). Women had a higher AD prevalence, and workers with AD reported OCD at a younger age. Workers with AD reported more frequent and severe eczema symptoms and had a higher risk of OCD negatively affecting job and occupation choices. Health‐related quality of life was more adversely affected in workers with AD. Conclusions: AD significantly impacts severity and has long‐term consequences for young people with OCD. Targeted prevention strategies need to be developed. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 66-year-old non-atopic woman suffered with dermatitis on the face and neck and orbital oedema, accompanied by a burning skin sensation, after the use of Eucerin volume-filler day and night cream on her face. The article discusses use of magnolia officinalis bark extractin traditional Chinese medicine and skin care products because of its anti-inflammatory and anti ageing effect.

The article presents a case study of a 28-year-old woman with a history of atopic dermatitis presented with a one-year history of hand eczema involving the second to fourth fingers on both hands. Topics discussed include occupational exposure to methylisothiazolinone in adhesive labels; diagnostic patch testing for allergens; and exposure assessment of methylisothiazolinone in consumer products.

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 a case study of a small case series of frictional dermatitis caused by occupational paper and cardboard. The patients were diagnosed with primary hand eczema characterized by initial skin dryness, scaling, and fissures. The article also discusses history of atopic dermatitis, occupational hyperkeratoses, and disease susceptibility of shoemakers.

The article presents a case study of a 9-year-old boy who developed severe vesicular and bullous dermatitis on his arms and trunks caused by a temporary henna tattoo. He was diagnosed with acute allergic contact dermatitis and was treated with topical corticosteroids and clobetasone under occlusion by his general physician.

The article presents a case study of a 61-year-old man who suffered from facial oedema associated with erythema after his intake of the herbal medicine Echinaforce®. Topics discussed include allergic reactions to Sesquiterpene lactones (SL), its effect in patients with atopic dermatitis, and contact allergic reactions to plants. It also mentioned the use of patch testing to detect contact allergy.

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 discusses the clinical study conducted by the National Allergy Research Centre in Denmark which has showed the spot testing of cobalt presence in copper items resulting in false-positive test reactions. It mentions that the clinicians uses patch testers repeatedly to challenge the correlation results of patch testing with patients exposures. It also notes that cobalt spot test solution is uses to determine the chemical reactions of cobalt.