Search

Background: Permanent tattooing is the invasive introduction of tattoo ink (pigments) into the dermis. The ink and aftercare cosmetics applied on pre‐damaged skin may contain skin sensitisers. Objectives: To identify patient characteristics and the pattern of sensitisation in tattooed patients patch tested within the Information Network of Departments of Dermatology (IVDK). Patients and Methods: Comparative analysis of patient characteristics and reaction frequencies to baseline series allergens in 1648 consecutive patients with and 8045 consecutive patients without permanent tattoos. Non‐overlapping 95%‐confidence intervals were considered as significant. Results: Having permanent tattoos was related with female sex, age <40 years, tobacco smoking, atopic dermatitis, (occupational) hand dermatitis and being employed in particular occupational groups (e.g., healthcare workers, mechanics, hairdressers). Sensitisation to nickel was increased in tattooed patients and associated with female sex (OR 4.23 [95%‐CI, 3.48–5.18]), age ≥40 years (OR 1.26 [95%‐CI, 1.08–1.49]), tobacco smoking (OR 1.19 [95%‐CI, 1.01–1.40]) and having permanent tattoos (OR 1.27 [95%‐CI, 1.05–1.53]). Conclusions: The association between nickel sensitisation and permanent tattoos is probably confounded by past reactions to pierced costume jewellery. Socio‐economic factors most probably contribute to the connection between tattoos, tobacco smoking, occupational or hand dermatitis, and being employed in particular occupational groups. [ABSTRACT FROM AUTHOR]

Tattooing has been part of the human culture for thousands of years, yet only in the past decades has it entered the mainstream of the society. With the rise in popularity, tattoos also gained attention among researchers, with the aim to better understand the health risks posed by their application. 'A medical‐toxicological view of tattooing'—a work published in The Lancet almost a decade ago, resulted from the international collaboration of various experts in the field. Since then, much understanding has been achieved regarding adverse effects, treatment of complications, as well as their regulation for improving public health. Yet major knowledge gaps remain. This review article results from the Second International Conference on Tattoo Safety hosted by the German Federal Institute for Risk Assessment (BfR) and provides a glimpse from the medical‐toxicological perspective, regulatory strategies and advances in the analysis of tattoo inks. [ABSTRACT FROM AUTHOR]

Background: Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD). Objectives: The objective of this study is to describe the contact sensitisation pattern of female FCS with OD. Methods: In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD. Results: Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave‐on and nail cosmetics. Occlusion and wetness were important co‐factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common. Conclusions: FCS should be aware of the OD risk and prevention should be promoted. [ABSTRACT FROM AUTHOR]

Background Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. Objectives To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. Methods This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005–2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. Results A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). Conclusions Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'. [ABSTRACT FROM AUTHOR]

Background: EU Commission Regulation 2017/1410 prohibits using atranol and chloroatranol, the main allergens in Evernia prunastri (oakmoss), and hydroxyisohexyl 3‐cyclohexene carboxaldehyde (HICC) in cosmetic products. Oakmoss absolute is contained in fragrance mix (FM) I and HICC in FM II which are patch tested as screening mixtures in the baseline series. Objective: To describe the time trends of reaction frequencies to both FMs as well as to their components in FM‐positive patients. Methods: Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2012–2021. Results: Positive reactions to FM I (FM II) declined from 9.1% (4.7%) in 2012 to 4.6% (3.0%) in 2021. Full breakdown tests were performed in 24% (FM I) and 31% (FM II), respectively, of the mix‐positive patients. From this data, frequencies of sensitization to the 14 single fragrances of FM I and FM II were calculated. For the majority, a decline was noted from 2012/2013 to 2020/2021, for oakmoss absolute 1.9%–0.8% and for HICC 1.8%–0.9%. Conclusion: EU Commission Regulation 2017/1410 was an effective measure. However, our data have some limitations, possibly causing underestimation of sensitization frequencies to fragrances. [ABSTRACT FROM AUTHOR]

Background: Hydroperoxides of limonene (Lim‐OOHs) and linalool (Lin‐OOHs) are potent contact sensitizers. Objectives: To investigate the prevalence of positive patch test (PT) reactions to Lim‐OOHs and Lin‐OOHs in consecutive patients, their demographic factors and concomitant reactions. Methods: Between 7/2018 and 12/2020, Lim‐OOHs 0.3% pet. and Lin‐OOHs 1% pet. were patch tested in 5511 consecutive patients. We assessed PT reactivity and analysed data from patients with either positive or negative PTs to Lim‐OOHs and Lin‐OOHs. Results: Positive PT results to Lim‐OOHs (n = 170, 3.1%) and Lin‐OOHs (n = 483, 8.8%) were frequent. Most of the positive reactions were weak (LimOOHs n = 134/LinOOHs n = 429), and even more frequently, doubtful (n = 252/n = 578) or irritant reactions (n = 81/n = 178) were documented. PT reactivity to Lim‐OOHs and Lin‐OOHs was increased in patients with irritant reactions to sodium lauryl sulphate (SLS). The proportion of leg dermatitis and concomitant positive reactions to fragrances and essential oils was increased in patients with reactivity to these hydroperoxides. Conclusion: The observed reaction pattern suggests that both test preparations display an irritant potential with an increased risk of false positive reactions. Preparations should be chemically monitored in order to reduce irritancy. Mindful interpretation of PT results and aimed patch testing of lower concentrations is recommended. [ABSTRACT FROM AUTHOR]

Background: Benzisothiazolinone (BIT; CAS no. 2634‐33‐5) is used as a biocide in various products, including water‐based paints, metalworking fluids, and household products. In recent years, increasing sensitization rates have been observed in Europe. Objective: To describe a time trend of sensitization to BIT, analyse concomitant reactions, and identify patients with increased risk of BIT sensitization. Methods: Retrospective analysis of data from 26 739 patients patch tested with BIT, sodium salt, 0.1% petrolatum as part of several special test series within the Information Network of Departments of Dermatology (IVDK), 2002 to 2021. Results: Positive reactions to BIT were noted in 771 patients (2.9%). Sensitization frequency varied over time and increased in recent years, peaking at 6.5% in 2020. Painters and metalworkers handling metalworking fluids, but not cleaners, had a significantly increased risk of BIT sensitization. From our data, there is no evidence of immunological cross‐reactivity between BIT and other isothiazolinones. Conclusion: The increasing frequency of sensitization justifies adding BIT to the baseline series. More research on the clinical relevance of positive patch test reactions to BIT and the cause for the rising numbers of BIT sensitization is needed. [ABSTRACT FROM AUTHOR]

Patch testing shellac in consecutive patients - Data of the Information Network of Departments of Dermatology (IVDK) 2021 Keywords: allergic contact dermatitis; cosmetics; epidemiology; patch test; shellac; tattoo EN allergic contact dermatitis cosmetics epidemiology patch test shellac tattoo 77 80 4 12/21/22 20230101 NES 230101 INTRODUCTION Shellac ("lac resin", "lacca", "gum lac", CAS: 9000-59-3) is purified by alcoholic extraction from a resin secreted by female I Laccifer lacca i (Coccidae).[1] Shellac is mainly produced in Thailand, China, Myanmar, and India and is used in a wide range of applications as a binder (e.g., in lacquers, tattoo inks), emollient (e.g., in lipstick), for hair fixing (hair spray), as a film forming agent in several types of coatings, for example, of food (E904) and oral medication, as well as thickener in cosmetics like mascara and eyeliner.[1] Terpenic acids are main constituents (~50%) of shellac without substantial variation between samples of different origin.[2] In the literature, allergic contact dermatitis to shellac was recently described from using hair spray,[3] a mouthguard,[4] tattoo ink[5] and in the occupational context of food handlers.[6] In two cross-sectional patch test (PT) studies of the North American Contact Dermatitis Group from 2009-2010 and 2011-2012, positive reactions to shellac were detected in 1.6% and 1.7% of the patients, respectively.[[7]] METHODS To investigate the diagnostic performance of the PT preparation (20% alc, Chemotechnique Diagnostics, Vellinge, Sweden) and to identify potential risk factors of sensitization, shellac was patch tested in a subset of 21 departments joining the IVDK (www.ivdk.org) in an extension of the German Contact Dermatitis Research Group (DKG) baseline series in 2021. Sixty-eight of 76 patients with positive PTs to shellac were tested with colophony, 56 with propolis, all 3 preparations in 53 patients. [Extracted from the article]

Keywords: 2,4,6-Tris(dimethylaminomethyl)phenol; CAS 90-72-2; epoxy resin; patch testing; tris-DMP EN 2,4,6-Tris(dimethylaminomethyl)phenol CAS 90-72-2 epoxy resin patch testing tris-DMP 316 318 3 03/15/23 20230401 NES 230401 2,4,6-Tris(dimethylaminomethyl)phenol (tris-DMP; CAS No. 90-72-2) is a hardener/accelerator frequently used in epoxy resin systems (ERS), especially at low ambient temperature.[1] First cases of contact sensitization to tris-DMP have been observed at the Finnish Institute of Occupational Health (FIOH) around 1990.[2] Since then, contact sensitization to tris-DMP has been described in several case reports from various European countries.[1] In the FIOH, 14 cases of contact sensitization to tris-DMP have been registered from 1991 to 2013, rendering it the second most frequent sensitizer among epoxy resin hardeners.[1] Since 2016, tris-DMP is available as patch test preparation at 0.5% in pet. from Chemotechnique, Vellinge, Sweden. However, 9 out of 14 FIOH patients (64%) sensitized to tris-DMP, but only 3 of the 28 tris-DMP positive IVDK patients (11%), were painters. DISCUSSION Consistent with the FIOH data,[1] we found sensitizations to tris-DMP less frequently than sensitizations to MXDA, but with a similar frequency as sensitizations to IPDA. [Extracted from the article]

Background: Patch test (PT) readings are recommended after 48 h and 72 h (D3). An additional day 7 (D7) reading has been suggested by some, although data on efficient patient selection are scarce. We investigated positive D7 reactions regarding (i) allergens in the baseline series and additional PT series of the German Contact Dermatitis Research Group (DKG) and (ii) characteristics of the patients tested. Methods: Retrospective, multicentre analysis of 190 allergens derived from 17 DKG test series in 4687 patients with an additional D7 reading. Patients were patch tested with the baseline series and additional series, if required. Occurrence of novel D7 reactions as well as increasing skin reactions from D3 to D7 was analysed separately. Results: Depending on the allergen tested, waiving D7 readings would have missed 4.4–26.8% of positive PT results. Patch test series with the highest number of novel D7 reactions were baseline series, metal series, and leather/shoe series. New positive reactions on D7 were associated with age over 50 years and with a negative irritant control containing sodium lauryl sulphate. Of note, application of the PT allergens for 48 h instead of 24 h was positively associated with late PT reactions. Conclusion: Within the most frequently tested allergens, without late readings, on average 11.7% of sensitizations would have been missed. Novel late reacting allergens were identified. This study comprehensively dissects patient‐, allergen‐ and test‐dependent parameters in support for D7 readings. We propose to always consider late readings individually based on effort‐benefit considerations. [ABSTRACT FROM AUTHOR]

Background: In 2019, a number of allergens (haptens), henceforth, "the audit allergens," were considered as potential additions to the European Baseline Series (EBS), namely, sodium metabisulfite, 2‐bromo‐2‐nitropropane‐1,3‐diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5% or 5% pet), linalool hydroperoxides (lin‐OOH), limonene hydroperoxides (lim‐OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, and lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments as well. Objectives: To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe. Methods: Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the European Surveillance System on Contact Allergies testing these, as well as further collaborators from the EBS working group of the European Society of Contact Dermatitis (ESCD), and the Spanish Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. As patch test outcome, reactions between day (D) 3 and D5 were considered. Results: Altogether n = 12 403 patients were tested with any of the audit allergen. Positive reactions were most common to lin‐OOH 1% pet. (8.74% [95%CI: 8.14–9.37%]), followed by lin‐OOH 0.5% pet., and lim‐OOH 0.3% pet (5.41% [95% CI: 4.95–5.89%]). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72% (95% CI: 4.2–5.28%), followed by sodium metabisulfite 1% pet. (3.75% [95%CI: 3.32–4.23%]) and Compositae mix 5% pet. (2.31% [95% CI: 1.84–2.87%]). For some allergens, clinical relevance was frequently difficult to ascertain. Conclusions: Despite many positive patch test reactions, it remains controversial whether lin‐ and lim‐OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion and ultimately decision on their implementation into routine testing among the ESCD members. Highlights: Twelve preservatives, fragrances, and emulsifiers were evaluated as potential additions to the European Baseline Series (EBS)The highest prevalences of positive reactions were to linalool hydroperoxides 1% pet. or 0.5% pet. and limonene hydroperoxides 0.3% pet. Benzisothiazolinone 0.1% pet. was positive in 4.7%, followed by sodium metabisulfite 1% pet. (3.8%) and Compositae mix 5% pet. (2.3%).The results are a basis for further discussion and ultimately a decision on their implementation into routine testing among the European Society of Contact Dermatitis (ESCD) members. [ABSTRACT FROM AUTHOR]