Contact Dermatitis in Nail Cosmetics

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.

Acral manifestations of contact dermatitis

Benzocaine anaphylaxis

Pediatric skin has some peculiarities that may determine why children are more likely to develop some skin conditions. In pediatrics, contact dermatitis is one of the most prevalent skin diseases involving impaired epithelial barrier. To reduce skin inflammation, decrease in frequency, duration, and number of contacts with triggering factors along with skin barrier restoration are needed. The Anti-inflammatory hormonal topical therapy represents the main treatment method. This article demonstrated several clinical cases of contact dermatitis in toddlers that were treated with methylprednisolone aceponate accompanied by ceramides and showed high therapy effectiveness in toddlers. A case of treatment of a child aged 1 year, 3 months with asymmetrical widespread hyperemic spots on the back surface of the body, mainly in the lumbar region; a case of treatment of a 2-year-old child with multiple hyperemic spots located on the anterior and, to a greater extent, posterior surface of the lower extremities, having clear edges, accompanied by focal dryness and moderate peeling at the edges; as well as a case of treatment of a child aged 1 year 11 months with hyperemic asymmetrical dry spots of irregular shape on the posterior and medial surface of the left forearm, which tend to merge and have clear edges. The use of topical corticosteroid in combination with ceramides in pediatrics leads to effective and fast inflammation decrease along with visible skin restoration.

An epidemiological study of occupational contact eczema in a furniture factory is presented. The localization, distribution, and clinical features of the skin lesions were characteristic of contact eczema caused by a sensitizing or irritating dust. True teak—<i>Tectona grandis</i>—was the cause of the skin condition. That teak is a fairly potent sensitizer and also contains primary irritants is fully confirmed by the present study. About half the employees who were heavily exposed to teak dust suffered from eczema and/or severe itching. Only 8% of those with slight exposure to teak dust experienced skin symptoms. Patch tests with native teak dust moistened with water were applied on 10 “controls” and 112 workers who were exposed to teak in various working procedures. Moistened teak dust produced toxic reactions in 20·5%, while native teak dust did not have primary irritant effects and was, therefore, considered to be the substance of choice for patch testing; 18·7% of the workers showed an allergic skin reaction to native teak dust. The diagnosis of allergic contact eczema was made in 12·5%, and 6·2% were considered to have latent allergy. Primary irritant (contact) eczema was considered to be present in four individuals who had experienced acute, transitory, eczematous eruptions during the hot part of the summer when they perspired freely. In these cases the patch test to native teak dust was negative. Desensitization or “hardening” was observed in four workers. In most cases the skin lesions were not severe enough to cause sickness absence. The cause of the relatively high percentage of sensitization to teak among the workers in the factory is discussed. The importance of suitable prophylactic measures is stressed.

Aim:We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy.Background:Biofeedback therapy is an appropriate treatment for patients with solitary rectal ulcer syndrome (SRUS) but it seems that it is not effective alone. Topical medical therapies are supposed to have an additive role to biofeedback.Methods:This randomized, controlled trial was conducted on 63 patients with SRUS. Patients were randomly enrolled into two groups of combination and single therapy. The patients in combination group (n=31) received biofeedback plus a topical therapy (an enema contained dexamethasone, sulfasalazine and bismuth) and the patients in single therapy group (n=32) were treated with biofeedback alone. Results:Endoscopic responses to treatment in the combination and single groups were 80% and 50%, respectively (P<0.05). Clinical improvement in symptoms such as difficulty to evacuate, digitation to evacuate, feeling of incomplete evacuation, time to need to evacuation and life style alternation were significantly better in treated group by combination therapy than single therapy. Regarding to the mean total score based on all subjective parameters, the results were also significantly better in the treated group by combination therapy. Conclusion:Topical anti-inflammatory therapies in combination with biofeedback is an efficient treatment for patients with SRUS

Readability, Quality, and Timeliness of Patient Online Health Resources for Contact Dermatitis and Patch Testing.

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.

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.

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

We report the first two cases of allergic contact dermatitis from resacetophenone in a nail antifungal preparation. Patch tests gave positive reactions to resacetophenone (0.1% and 1% pet.). No cross-reactions with resorcinol or phenylethyl resorcinol were found. Patch testing with individual ingredients is paramount to diagnose new allergens.

A 46-year-old atopic woman presented with a 4 month history of recurrent angioedema of her mouth and lips, without respiratory symptoms or wheals (Figure 1); each episode lasted about 24–48 h. Patch tests with the SIDAPA (Società Italiana di Dermatologia Allergologica Professionale e Ambientale) baseline series (SmartPractice, Rome, Italy) were performed. Patch test chambers (Van der Bend, Brielle, The Netherlands) were applied on the upper part of the patient's back. Readings at D2 and D4, according to Italian guidelines, showed positive reaction to potassium dichromate 0.5%, (+/+), nickel sulphate 5% (++/+++), cobalt chloride 1% (−/+), methylisothiazolinone (MI) 0.2% aq. (+++/+++), methylchloroisothiazolinone (MCI)/MI 0.02% aq. (++/++). All the positive reactions were at first considered not relevant for the dermatitis, but with further questioning the patient admitted that relapses occurred after rinsing her oral cavity with a mouthwash (Curasept® biosmalto collutorio denti sensibili). Oedema developed about 5 h after the contact and became more severe in the following hours. The label on the mouthwash revealed the presence of MI. A repeated open application test (ROAT) with Curasept® mouthwash in the left antecubital fossa was performed by the patient, with no evidence of positive reaction after 3 days. We therefore performed the patch test with Curasept® mouthwash, tested ‘as is’, which resulted in a positive reaction (+) at D3. MI is an isothiazolinone derivative responsible for sensitization in about 9% of patients referred to patch tests.1 Previously widely used as a preservative in cosmetics and personal care products, MI use in cosmetic products has decreased; the European authorities, in fact, decided to no longer allow the use of MI in leave-on cosmetics from April 2013, while a maximum concentration of 0.0015% (15 ppm) was considered safe in rinse-off cosmetic products.2 Since then a decline in contact sensitization to MI due to cosmetics has been observed. On the other hand, because MI is still present in many non-cosmetic products (paints, household detergents, industrial cleaning products, metal-working fluids, etc.), many occupational contact dermatitis are frequently observed; cases of contact dermatitis may also be due to MI in medical devices.1, 3, 4 In the present case MI was responsible for an uncommon clinical manifestation, an angioedema-like contact dermatitis of the lips and oral cavity. Another case caused by a mouthwash has been recently reported, confirming that sensitization to MI can be triggered in the oral cavity.5 However, a different clinical pattern (recurrent oral ulcerations) was described. The Curasept® mouthwash is marketed in Italy as a medical device. In this case the presence of MI in the mouthwash was correctly declared in the label by the manufacturer and this facilitated the diagnosis. However, the current regulations concerning medical devices do not require the complete declaration of all the ingredients in the label.6 A more stringent regulation about the complete declaration would be highly desirable. At the same time a more stringent regulation about MI content in medical devices should be considered, with the aim of reducing the incidence of allergic contact dermatitis due to isothiazolinones in these products. Alberto Monti: Conceptualization; data curation; formal analysis; investigation; writing – original draft; writing – review and editing. Monica Corazza: Conceptualization; data curation; formal analysis; investigation; methodology; writing – review and editing. Natale Schettini: Data curation; investigation. Lucrezia Pacetti: Investigation; data curation. Alessandro Borghi: Formal analysis; investigation; supervision; validation; writing – review and editing. The authors declare no conflicts of interest.

Background:Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials.Aim:This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials.Materials and Methods:Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG).Results:Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities.Conclusion:The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

North American Contact Dermatitis Group patch test results for the detection of delayed-type hypersensitivity to topical allergens

Tetraglycidyl-4,4'-methylenedianiline (TGMDA) is an aniline epoxy resin used in, for example, resin systems of pre-impregnated composite materials (prepregs) of the aircraft industry. Allergic contact dermatitis caused by TGMDA in prepregs has been described previously. To report on 9 patients with occupational allergic contact dermatitis caused by TGMDA in epoxy glues used in helicopter assembly. The patients were examined with patch testing at the Finnish Institute of Occupational Health in 2004-2009. The first patient was diagnosed by testing both components of two epoxy glues from the workplace, and was also tested with glue ingredients, including TGMDA. The following patients were tested with the glues and TGMDA. The resin parts of the glues were analysed for their epoxy compounds, including TGMDA. All of the patients had a patch test reaction to one or both of the resin parts of the TGMDA-containing glues. Eight of them had a strong allergic reaction to TGMDA, and one had a doubtful reaction to TGMDA. Two of the patients also had an allergic reaction to triglycidyl-p-aminophenol (TGPAP), another aniline epoxy resin, which was not present in the TGMDA-containing glues. In aircraft industry workers with suspected occupational dermatitis, aniline epoxy resins should be considered and patch tested as possible contact allergens.