714 Occupational contact dermatitis

BACKGROUND AND OBJECTIVESContact allergy is associated with a significant morbidity all over the world. This study was performed to investigate the pattern of sensitization by contact allergens in the local population.DESIGN AND SETTINGRetrospective study to investigate patch test reactivity among patients with clinical diagnosis of contact dermatitis who were referred to the allergy clinic at the King Khalid University Hospital, Riyadh, between April 2008 and March 2010.PATIENTS AND METHODSOf the 196 patients referred to the allergy clinic over the 2-year period, 91 (46.4%) patients reacted to one or more patch test allergens, and these patients were included in this study. The study group included 82 (91.1%) of Saudi nationality and 9 (8.9%) patients of other nationalities. The patch test was performed using the T.R.U.E TEST, containing 24 allergens/allergen mixes.RESULTSOf the 91 cases who reacted positively to one or more allergens, 67 (73.6%) were females with a mean age of 37 (8.3 years) and 24 (26.4%) were males with a mean age of 34 (11.6 years). Thirty-three (36.2%) patients reacted to nickel sulfate, 14 (15.3%) to p-phenylenediamine, 13 (14.2%) to p-tert-butylphenol-formaldehyde resin, 13 (14.2%) to thimerosal, and 9 (9.8%) to colophony. Reactivity against the rest of the allergens was not remarkable. A significantly higher percentage of females reacted to nickel sulfate (84.8% vs 15.2% in males; P=.0001), p-tert-butylphenol-formaldehyde resin (92.3% vs 7.7%; P=.0001), and thimerosal (76.9% vs 23.1%; P=.03).CONCLUSIONSPatch test reactivity to nickel sulfate was high. The pattern of contact allergy observed in this study indicates the need for large-scale investigations to identify local allergens responsible for contact allergy and for formulation of policies directed towards avoidance of exposure.

Epidemiological survey of contact dermatitis in Italy (1984–1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali)

Background Occupational contact dermatitis (OCD) is a skin disorder caused by contact with any substances found in the workplace. Occupational contact dermatitis is second most common occupational disease (15% of all cases of occupational disease). Occupational contact dermatitis is divided into allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) which is 80% of cases that affects hands. Batik is an art that is painted on cloth, it is one of Indonesian cultural heritage. Batik workers have a higher risk of obtaining OCD due to exposure to chemicals and fluids used during work. Natural dyes used in the dyeing process are less likely to cause ACD than standard allergens. Some of the natural dyes used in the dyeing process in batik industries are Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni) cause skin sensitisation. Objective To compare the results of patch testing between natural dyes (Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni) with standard allergens (p-phneyldiamine 0.1%, potassium dichromate 0.5% and formaldehyde 0.1%) as a cause of ACD in batik workers in Surakarta, East Java, Indonesia. Method A cross-sectional study was conducted on 63 subjects batik workers with OCD in Surakarta, East Java, Indonesia. Subjects were patch tested with three standard allergens (p-phenylenediamine 0.1%, potassium dichromate 0.5%, and formaldehyde 1%) and natural dyes (Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni). A closed patch test was evaluated 48 and 96 hour later. Screening of OCD in batik workers in Surakarta, East Java, Indonesia was based on Nordic Occupational Skin Questionnaire NOSQ-2002, and diagnosis of OCD was based on Mathias criteria (at least 4 out of 7 criteria were met). Data were analysed using a non-parametric Chi-square test with SPSS 21 with a significant difference if the p-value < 0.05. Result Natural dyes significantly caused allergic contact dermatitis in batik workers in Surakarta, East Java, Indonesia than standard allergens (p = 0.016). A positive patch test was found in 11 patients, standard allergen p-phenylenediamine (PPD) 0.1% was seen on one patient, potassium dichromate 0.5% on two patients, and formaldehyde 1% on two patients. A positive patch test using Indigofera tinctoria was found at one patient, sappan wood (Caesalpinia sappan) in three patients, and Mahagony (Swietenia mahagoni) in five patients. Conclusion Natural dyes cause more positive patch test results in batik workers.

Objective: Allergic contact dermatitis (ACD) is a hypersensitivity reaction which develops against substances contacting the skin. Patch tests are used for the detection the allergens that cause ACD. The most common substances that cause ACD vary based on geographic regions. In this study, detection of the most common allergens in patients who underwent patch testing with the diagnosis of ACD and comparison of the results with literature were aimed.Mateials and Methods: One hundred forty-eight patients, who underwent European standard patch test with the diagnosis of ACD in our clinic between January 2010 and June 2013, were enrolled in our study. The data about age, sex, duration of disease, occupation, the presence of atopy, localization of the lesion of the patients and patch test results were recorded retrospectively.Results: Eighty-nine females and 59 males, a total of 148 patients, were included in the study. The mean age of the patients was 35.3 ± 14.8. Positive reactions to one or more allergens were observed in forty-five (30.4%) of 148 patients who underwent patch test. The allergens that were the most common cause of positive reactions were nickel sulfate (11.5%), potassium dichromate (6.1%), cobalt chloride (4.7%), paraben mix (4.1%), thiuram mix (2.7%), neomycin sulfate (2.7%) and fragrance mix (2.7%), respectively. Conclusion: We believe that our study will contribute to the determination of contact allergens which is the most common cause of sensitization in our country

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

Background:Allergic contact dermatitis (ACD) is a delayed type of hypersensitivity from contact with a specific allergen to which the patients has developed a specific sensitivity. The aim of the study was to evaluate the results of epicutaneous patch testing with standard series of contact allergen in patients suspected to have ACD.Methods:355 cases of ACD were included in the study. Test substances were applied on the upper part of the patient’s back, on clinically uninvolved and untreated skin. All patients were free from therapy with oral antihistamines, steroids and immunosuppressants. The patch test was removed and reaction were evaluated after 48 h and 72 h. Grading of negative (-) to positive (+ to ++++) patch test was done according to the International Contact Dermatitis Research Group. Statistical data analysis was performed by using χ2–test.Results:Of the 355 cases, 146 patients were male (41.1%) and 209 were female (58.9%). The youngest patients in the study was 16 years of age and the oldest was 67 years of age. The commonest age group affected was 41-50 years. Hands were the most common site of involvement. The occupational character of skin lesions was find in 75 (21.1%). The most common positive reactions were recorded to nickel sulphate 99 (27.8%), cobalt chloride 46 (12.9%), thimerosal 31 (8.7%), colophony 23 (6.5%), carba mix 21 (5.9%), potassium dichromate 20 (5.6%), acid chromici 19 (5.3%), fragrance mix 18 (5%), balsam of Peru 13 (3.7%), formaldehyde 9 (2.5%), and other allergens 26 (7.3%). Females were significantly more likely to show a positive response to two or more allergens (p<0.05). There was no statistically significant impact of age, occupation and duration of disease on results of patch testing (p>0.05).Conclusions:Our results indicate that nickel sulphate, cobalt chloride and thimerosal are the most common allergens responsible for induction of ACD. These findings are crucial in the treatment, long term management, an education of patients with ACD.

Reflectance confocal microscopy may differentiate acute allergic and irritant contact dermatitis in vivo

Results of Evaluating Health Care Workers With Prick and Patch Testing

Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms under-pinning each condition, the differentiation between them presents a significant diagnostic challenge. This study aimed to determine whether a combination of clinical evaluation and noninvasive measurements-encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume-could distinguish ICD from ACD. Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments. ICD prompted an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incited a delayed response (72 hours). Noninvasive evaluated parameters such as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (P < 0.05). The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress. The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study was constrained by a limited sample size.

34 - Contact Dermatitis

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Obtułowicz A, Nowak-Ślusarczyk M, Pirowska M, Lipko-Godlewska S, Wojas-Pelc A. The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(1):68-69. doi:10.5114/pdia.2016.57765. APA Obtułowicz, A., Nowak-Ślusarczyk, M., Pirowska, M., Lipko-Godlewska, S., & Wojas-Pelc, A. (2016). The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(1), 68-69. https://doi.org/10.5114/pdia.2016.57765 Chicago Obtułowicz, Aleksander, Magdalena Nowak-Ślusarczyk, Magdalena Pirowska, Sylwia Lipko-Godlewska, and Anna Wojas-Pelc. 2016. "The flare-up phenomenon: recurrence of distant dermatitis during patch testing". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 33 (1): 68-69. doi:10.5114/pdia.2016.57765. Harvard Obtułowicz, A., Nowak-Ślusarczyk, M., Pirowska, M., Lipko-Godlewska, S., and Wojas-Pelc, A. (2016). The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 33(1), pp.68-69. https://doi.org/10.5114/pdia.2016.57765 MLA Obtułowicz, Aleksander et al. "The flare-up phenomenon: recurrence of distant dermatitis during patch testing." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 33, no. 1, 2016, pp. 68-69. doi:10.5114/pdia.2016.57765. Vancouver Obtułowicz A, Nowak-Ślusarczyk M, Pirowska M, Lipko-Godlewska S, Wojas-Pelc A. The flare-up phenomenon: recurrence of distant dermatitis during patch testing. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2016;33(1):68-69. doi:10.5114/pdia.2016.57765.

The diagnosis of combined allergic and irritant contact dermatitis is an accepted subdiagnosis for hand dermatitis, and it is often considered in a patient with contact dermatitis, a positive and relevant patch test result, and wet work exposure. We therefore hypothesize that it is arbitrary for wet work exposure to be taken into consideration in a patient with newly diagnosed relevant contact allergy. Furthermore, an overestimation of the diagnosis will probably occur if the criteria for wet work exposure are applied correctly, as many occupations have an element of wet work. To find the statistically expected number of combined allergic and irritant contact dermatitis cases in 1000 patients, and to evaluate the diagnostic criteria for the diagnosis. One thousand consecutive patients with occupational contact dermatitis from a hospital unit in Denmark were assessed. The expected number of cases with the diagnosis of combined allergic and irritant contact dermatitis was 0.33%, as compared with the observed number of 6.4%. Females occupied in wet occupations were often diagnosed with combined allergic and irritant contact dermatitis (p < 0.005). The diagnosis of combined allergic and irritant contact dermatitis should be used critically to avoid misclassification, and possible criteria for the diagnosis are proposed.

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.

Our understanding of the complex genetic susceptibility to occupational contact dermatitis (OCD) is still in the early stage. The search for candidate susceptibility genes focused mainly on proteins involved in skin barrier and immune response which have a key role in both irritant and allergic contact dermatitis (respectively, ICD and ACD). Furthermore, for ACD genetic variations in enzymes involved in metabolism of contact allergens have been investigated. Among skin barrier genes, lossof- function mutations in the filaggrin gene (FLG) have been identified as a risk factor for irritant contact dermatitis (ICD); the riskmodifying effect of FLG mutations was stronger in the presence of atopic dermatitis. In ACD, the impact of FLG mutations was allergen specific and dependent on the outcome measure and the exposure pattern. Several studies reported association of genetic polymorphisms in the metabolizing enzymes N-acetyltransferase and glutathione S-transferase with ACD; however the results are so far inconclusive. Among inflammatory genes, there appears to be an effect of TNFgene polymorphisms on susceptibility to both irritant and allergic CD, suggesting that they share some common pathways. At present, the predictive value of genetic markers for the appearance of OCD is too low for reasonable identification of susceptible individuals in occupational health practice. Further well-designed studies in larger cohorts with a well-defined disease phenotype and external exposure in the control as well as in the case group are needed to confirm and extend our knowledge of the impact of genetic variations on the susceptibility to OCD.

Environmental light levels can affect physiological functions, such as general activity, body temperature and metabolism. Irregular lifestyles, such as those involving exposure to light during the night, can exacerbate the clinical symptoms of several inflammatory skin diseases. However, the effects of constant light exposure on immune responses are not fully understood. This study aimed to elucidate the effects of constant light exposure on two major types of skin reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). BALB/c mice were kept under constant light conditions or a normal light and dark cycle, and their ACD and ICD responses were assessed after the topical application of 2,4,6-trinitro-1-chlorobenzene and croton oil, respectively, to the ear skin. Interestingly, in both ACD and ICD, the ear-swelling response and local leukocyte infiltration were aggravated by constant exposure to light, which has previously been shown to severely disturb the behavioural rhythms of mice. In ACD, these findings were accompanied by increases in the numbers of degranulated mast cells and eosinophils. These results suggest that constant light exposure intensifies allergic and non-allergic skin inflammation.