Propolis and Beeswax in Cosmetics: A Market Survey and Literature Review on Their Relationship and Role in Allergic Contact Dermatitis.

Nickel allergy in the United States: A public health issue in need of a “nickel directive”

Allergic skin diseases

Allergic contact dermatitis (ACD) is a rare but significant cause of hand eczema (HE). To evaluate positive patch test reactions in HE patients, focusing on frequency, clinical/occupational relevance and sources of exposure at a tertiary referral centre in Turkey. Retrospective analysis of 1499 HE patients from 2533 consecutively patch-tested individuals (1996-2021). Positive patch test reactions occurred in 55.6% of HE patients, most commonly to nickel sulphate, potassium dichromate and thiuram mix. ACD was diagnosed in 34.2% of cases, with 54.1% being occupational, mainly in males. Occupational ACD was predominantly associated with potassium dichromate/cement among construction workers, and thiurams/rubber gloves among construction and healthcare workers. Non-occupational ACD (45.9%) was more frequent in females, typically associated with methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), MI and fragrances in cosmetics and personal care products. Nickel was not a leading cause of HE; however, it was the inducer of systemic allergic dermatitis in 2.7% (14/512) of patients with hand ACD. Recurrent vesicular HE and bilateral dorsal, periungual, or wrist involvement were significantly associated with ACD. Nickel was a frequent sensitiser but an uncommon cause of hand ACD, often triggering systemic allergic dermatitis. Occupational ACD and male gender predominated. Recurrent vesicular HE and bilateral dorsal, periungual, or wrist involvement were key patterns helping identify patients for patch testing.

Formaldehyde is a common contact allergen. The prognosis of formaldehyde-sensitive patients is generally considered to be bad because of widespread exposure to formaldehyde. 11 patients with eczema and a positive patch test to formaldehyde were interviewed by a dermatologist and a toxicologist/chemist and instructed to fill in a questionnaire on exposure to chemical products. The content of formaldehyde and formaldehyde releasers in such products was examined using the database of the Danish Product Register (PROBAS) and by supplemental inquiries of manufacturers or importers. All the patients used one or more products containing formaldehyde or formaldehyde releasers. Sources of exposure were cosmetics and personal care products, dishwashing liquids, water-based paints, photographic products, etc. Patients were advised to use alternatives to those products containing formaldehyde or formaldehyde releasers. The status of 10 out of the 11 patients' eczema at follow-up was about 1/3 healed, 1/3 improved and in 1/3 no change. When the relevance of positive patch test reactions to formaldehyde was based on information obtained on exposure, a very high rate of current relevance was found. Computerized data on product composition allows the screening of products for contact allergens and also generates lists of contact allergens indicated for patch testing, based on the patients' own products.

Contact dermatitis is a common cause of eczematous cheilitis. In a Singapore series, allergic contact dermatitis is commoner than irritant contact dermatitis. More females are affected than males. Eczematous cheilitis usually presents in the 3rd and 4th decades of life. Eczematous cheilitis tends to occur among office workers and professionals (50.5%). This is probably due to the more frequent use of cosmetics and lip preparations among office workers compared to ‘blue collar’ workers. Irritant contact cheilitis is often seen in individuals with an underlying endogenous tendency to eczema, e.g. atopic dermatitis. Contact irritants include lip cosmetics, toothpastes and dentrifices. In the early 1990s, tartar control (pyrophosphates) toothpastes were reported to cause outbreaks of irritant contact dermatitis on the lips and peri-oral skin. Other irritants include traditional Chinese medicines. Allergic contact cheilitis occurs from lip cosmetics, toothpastes and medicaments. Allergic contact cheilitis accounted for 35% of eczematous cheilitis presenting at the Singapore clinic. The commonest cause of allergic contact cheilitis was lip cosmetics. They include lipsticks, lip balms and other cosmetic preparations. In Singapore, ricinoleic acid present in lipsticks accounted for about 10% of all cases of allergic contact dermatitis. Other allergens include other lipstick ingredients, sunscreen agents, toothpaste ingredients, colophony in dental floss and toothpicks, nail varnish, cosmetics and nickel in the mouthpiece of a flute. Recently sunscreens have become a common sensitizer in lip cosmetics. Other allergens include fragrance, balsam of Peru, lanolin and flavourings (strawberry and vanilla). Toothpastes are the next most common cause of allergic contact cheilitis. Dentrifices and dental prostheses have been reported to cause allergic contact dermatitis. Diagnostic clues have to be obtained from a careful history which includes a review of oral rinses, toothpastes, cleansers, mouthwashes, dentrifices, denture materials, chewing gum and lipsticks used by the patient. Patch testing with these products is essential for investigating the possible cause of allergic contact cheilitis. However, there is a group of patients with troublesome cheilitis, who are often severely affected, but in whom the cause of the cheilitis remains obscure. This group may represent patients with endogenous cheilitis or factitious cheilitis.

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.

Irritant and allergic contact dermatitis are common inflammatory skin diseases induced by repeated skin contact with low molecular weight chemicals, called xenobiotics or haptens. Although both diseases may have similar clinical presentations, they can be differentiated on pathophysiological grounds. Irritant contact dermatitis (ICD) is a non-specific inflammatory dermatitis brought about by activation of the innate immune system by the pro-inflammatory properties of chemicals. Allergic contact dermatitis (ACD) corresponds to a delayed-type hypersensitivity response with a skin inflammation mediated by hapten-specific T cells. Recent progress in the pathophysiology of chemical-induced skin inflammation has shown that ICD and ACD are closely associated and that the best way to prevent ACD is to develop strategies to avoid ICD. The immunological diagnosis of ICD or ACD requires investigation of the presence (ACD) or absence (ICD) of antigen-specific T cells. The detection of T cells can be performed in the skin (collected from ACD lesions or positive patch tests) and/or in the blood, particularly by using the enzyme-linked immunospot assay (ELISPOT). This method, recently developed in ACD to metals, offers a new biological tool enabling the immunobiological diagnosis of ACD.

Allergic contact dermatitis is often under-recognized in the pediatric population but it may affect greater than 20% of this age group. We conducted a retrospective review of the Mayo Rochester, Jacksonville and Arizona patch test database of all children 18 or younger over a 7-year period (January 1, 2000-December 31, 2006). One-hundred thirty-six children were patch tested from age 3 to 18. Females constituted 66% of those tested and males 34%. Eighty percent of the children were equally distributed between age groups 11-15 and 16-18, with the remainder being 10 years or younger. Sixty-one percent of the children tested positive to at least one allergen. Fifty-three percent of these reactions were deemed to be of current relevance, 31% questionable relevance, 5% past relevance, and 10% not relevant. Males younger than 10 were most likely to have a positive patch test. However, the percent of positive tests in males decreased with increasing age. Females younger than age 10 were less likely to have a positive test than older females. The most common allergens were nickel, cobalt, gold, and thimerosal. In children suspected to have allergic contact dermatitis, 61% were confirmed to have a positive reaction to at least one allergen. The utility of patch testing children whose clinical presentation is suggestive for allergic contact dermatitis is high.

Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13.3% and 24.5% has been reported. Patch testing infants may be particularly difficult, and false-positive reactions may occur. The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified. Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child. Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant (P < 0.001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0.62 (95% confidence interval 0.41-0.95; P = 0.029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p-phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result. The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing.

Background:Allergic contact dermatitis (ACD) is a major cause for foot wear dermatitis. Patch testing is the standard investigation for diagnosis of ACD. Identification of the causative allergen and avoidance of the same is the most important for patient management.Aims:This study was conducted to find the common allergens in footwear, causing ACD, by retrospective analysis of the data of patients who had undergone patch testing with footwear series (FWS), approved by the Contact and Occupational Dermatoses Forum of India.Materials and Methods:A total of 276 cases with footwear dermatitis who underwent patch test with FWS using Finn chamber method were studied. Statistical analysis was done using statistical package for social sciences (SPSS) version 24. Data was described using frequency and percentages. P value of less than 0.05 was considered significant.Results:In this study 101 (36.5%) patients had positive patch test to at least one allergen. Among this, 43 (15.6%) were positive for single allergen only and 58 (21.01%) patients had positive patch test reactions to multiple allergens. The most common allergens with positive patch test were black rubber mix, mercapto benzo thiazole, and thiuram mix. Patients with either a positive or negative patch test had no statistically significant difference in the history of atopy. The limitations of this study include the lack of patch testing with the patient's own footwears and lack of follow-up after informing patients regarding allergen avoidance.Conclusions:Patch test must be done for all foot eczema cases for early identification of the causative allergen and also to provide suitable alternatives.

The panel of patch test allergens used for the evaluation of patients with suspected photoallergy typically does not include plant and pesticide allergens. The prevalence of allergic contact dermatitis and photoallergic contact dermatitis to plant and pesticide allergens was determined for this subgroup of patients. Positive reactions were detected in 12 of 26 patients who were tested with our photoallergen series: 5 with allergic contact dermatitis, 5 with photoallergic contact dermatitis, and 2 with both. Four of the 12 patients had positive patch and photo-patch test reactions to plant allergens, pesticide allergens, or both. The positive patch test reactions were to the plants Taraxacum officinale (dandelion) and Tanacetum vulgare (tansy) and to the pesticides folpet and captafol. Positive photo-patch test reactions were to the pesticides folpet and captan. The histories of the patients suggested that 2 or 3 of the 4 patients had clinically relevant reactions. In the other 8 patients, positive reactions to the patch and photo-patch tests included fragrances, sunscreens, and antibacterial agents. Plant and pesticide allergens should be included in the patch and photo-patch test series used for the evaluation of patients with suspected photoallergy.

Dear Editor: Nipple eczema, considered mostly as a minor manifestation of atopic dermatitis, may have unknown causes. However, its clinical course and pattern often make it difficult to differentiate its underlying causes such as irritation or sensitization. Nevertheless, allergic contact dermatitis must be considered an important cause of nipple eczema. In the present study, we analyzed the patch test results from pateints of nipple eczema by using the Korean standard series comprising 25 antigens (Chemotechnique Diagnostics, Malmo, Sweden). Antigens were carefully added into an IQ Ultra chamber® (Chemotechnique Diagnostics) which is made of additive-free polyethylene plastic foam with a filter paper incorporated, and stuck to the backs of the patients. Results were recorded 30 minutes after patch removal (as usual), and the patients were re-evaluated 48 hours later. On the basis of the recommendations of the International Contact Dermatitis Research Group, a reading of +1 (patients with erythematous papules and edema but without any vesicles) or higher was deemed a positive response. Among a total of 12 patients (all women) who were patch tested, 5 were clearly diagnosed with atopic dermatitis on the basis of their medical history and physical examination results. Nine patients showed a positive response to more than 1 antigen. Of 5 patients with a history of atopic dermatitis, 4 patients (80%) showed a positive response. Antigens with a high frequency of positive responses were, in decreasing order of frequency, Cl+Me-isothiazolinone, cobalt chloride, thimerosal, nickel sulfate, and 4-tert-butylphenol-formaldehyde resin (Table 1). Table 1 Patch test results for 12 patients with nipple eczema Of 9 patients who had positive patch test responses, 7 (77.78%) had a bilateral distribution of lesions, and 8 patients (88.89%) showed spreading of lesions over the periareolar skin. With respect to the progression of eczema, 8 patients (88.89%) had acute lesions. However, 3 patients with negative patch test responses showed only unilateral lesions, which were restricted to the nipple and areola rather than the periareolar skin. Thus, there was a significant difference with respect to the involved area and distribution of the lesions (p<0.05) (Table 2). Table 2 Clinical characteristics of nipple eczema according to distribution of lesion and history where the positive patch test reaction indicated allergic contact dermatitis Nine patients with a positive patch test were advised to avoid the use of products containing the positive antigens, after which 5 patients (56%) showed reduced recurrence of nipple eczema. Nipple eczema is a characteristic minor dermatologic finding indicating atopic dermatitis1. Nevertheless, cases in which nipple eczema was not a characteristic finding of atopic dermatitis have been reported2,3. If nipple eczema does not improve after conventional treatment for atopic dermatitis, or if active symptoms of eczema such as severe erythema and exudation are limited to areas that are frequently affected by atopic dermatitis, allergic contact dermatitis should always be considered first. In this study, positive patch tests to ≥1 antigens were found in 9 of 12 patients (75%). According to an epidemiological survey by the Korean Contact Dermatitis Research Group, Cl+Me-isothiazolinone is not considered a frequent antigen; however, in the present study, this antigen provoked positive responses as frequently as metal ions did. Cl+Me-isothiazolinone is commonly found in preservatives, deterge nts, and fabric softeners; therefore, traceable amounts remaining in undergarments after washing or in personal-care products may act as antigens. Both repeated contact, even at the subclinical threshold, and a weak barrier function in skin affected by atopic dermatitis can contribute to the development of contact sensitization. To prevent chronic recurrent contact dermatitis, the causative antigens should be identified by screening with patch test series, and an avoidance-learning program should be followed4. We found considerable clinical improvements and reduced recurrence in 5 of the 9 patients who had positive patch tests and followed an avoidance-learning program. In conclusion, allergic contact dermatitis should be considered first in the differential diagnosis of nipple eczema, especially in patients showing bilateral lesions and lesions extending into the periareolar skin.

Contact allergy in children is becoming increasingly recognized as a cause of eczema. The causal agents may change with time, but there are few comparative data for this age group. To compare data from the past 10 years with a similar study from the previous decade. Between 2005 and 2014, 500 consecutive children who had been patch tested at Leeds Teaching Hospitals were identified, and the results were reviewed. Twenty-seven per cent (134 cases) of children had one or more positive patch test findings. The mean ± standard deviation age of patients with a positive test reaction was 11.9 ± 4.1 years, which was significantly higher than that of patients with a negative result (10.9 ± 4.0 years) (p = 0.01; Mann-Whitney U-test). No significant relationship between sex and a positive patch test result was found (p = 0.48, chi-squared). Allergy to nickel was the most frequent finding, although this accounted for 18%, rather than 33% (1995-2004), of all positive reactions. The next most common allergens included fragrance mix 1 (17%), p-phenylenediamine (16%), and methylchloroisothiazolinone/methylisothiazolinone (6%). Although the overall incidence of contact allergy in our paediatric population is static, there has been a significant change in the allergens detected, probably as a result of changes in European legislation and cosmetic product use in children.

Lip balm is a waxy substance that is applied to the lips to keep them moisturized. The lip balm was developed to protect the lips from external influences such as the winter cold and to prevent dry and chapped lips. The lip balm prevents irritation and infection to lips. It also reduces the pain associated with chapped lips. The ingredients used in making the lip balm moisturize the lips and help heal chapped lips. Most of them have a waxy texture. A lip balm is a moisturizer that is applied to the lips to keep them from drying out and to protect the lips from environmental influences.The lip-care products for everyday basis contains harmful heavy metals and preservatives Other than leaching through the pores on your lips, these heavy metals and other chemicals can also be accidently ingested. Lip balm formulations are most widely usedto enhance the beauty of lips and add glamour touch to the make-up. Lip balms offer a natural way to maintain and promote healthy lips. Current cosmetic lip products are based on use of enormous chemical ingredients which has a various side effect. Hence, an attempt has made to study the natural ingredients which is used to formulate the natural lip balm. The natural lip balm can be made using naturally occuring base, oils, colour, flavouring agent etc.Organic lip balm nourishes the lips and help to get hydrated and protect lips which are affected by the dryness. Organic lip balm could be better option for treatment of various lip issues. Lip balm is the one of regularly use cosmetics item. to keep them from drying out and to protect the lips from environmental influences. Use of herbal ingredients in lip balm decreases the negative effect.

Allergic Contact Dermatitis and Patch Testing in Skin of Color Patients.