Allergic Contact Dermatitis Reactions Research Articles

Perioral Contact Dermatitis Caused by Limonene Hydroperoxide in Cannabis Vaping Products

Limonene is a fragrant terpene commonly found in household and cosmetic products due to its fresh aroma. When exposed to air, limonene autoxidizes to form limonene hydroperoxide, a potent allergen that can cause allergic contact dermatitis. Recently, as the popularity and availability of limonene increased, it has been incorporated into novel products such as flavoring agents for electronic cigarettes or vapes. With the rising acceptance and popularity of marijuana, this usage has extended to cannabis vaping products. Here, we report an unusual presentation of an allergic contact dermatitis reaction to limonene hydroperoxide stemming from cannabis vaping products.

33306 Identification of risk factors associated with benzoate/benzoic acid reactivity in patch tested patients

Background: Benzoates and benzoic acid, which are a component of Balsam of Peru, are found in a growing number of cosmetic, personal products and used as preservatives in food products. With its increased use in consumer products, a growing number of patients have shown reactivity to this allergen. In this study we aim to better identify patient characteristics associated with allergic contact dermatitis reactions to benzoates.

Follicular eczema and accentuation: A survey of published data

To the Editor: Follicular eczema or follicular atopic dermatitis presents with a predominant pattern of very pruritic follicular accentuation, usually over the chest, back, abdomen, and flanks (Fig 1). Distinguished from follicular keratosis by spongiotic dermatitis of the follicle, the differential diagnosis of follicular dermatitis also includes allergic contact dermatitis, follicular mucinosis, infundibulofolliculitis, and drug reactions. Clinically, follicular eczema has been reported to be poorly responsive to low-potency topical corticosteroids.

Continuous glucose monitoring systems give contact dermatitis in children and adults despite efforts of providing less 'allergy- prone' devices: investigation and advice hampered by insufficient material for optimized patch test investigations.

Medical devices are increasingly being reported to cause contact allergic dermatitis reactions. Review of patients with diabetes type I referred for suspected allergic contact dermatitis to insulin pump or glucose sensor systems. We have reviewed 11 referred diabetes mellitus patients investigated for allergic contact dermatitis reactions to medical devices and specifically Dexcom G6® . Extracts from the medical devices were analysed. The majority of patients was children, the majority had relevant allergies and particularly allergy to isobornyl acrylate which was also found in the glucose sensor system Dexcom G6® . The following case reports bring in focus the fact that patients sensitized through use of one medical device and being advised the use of another, or find another product for a while useful, are not by necessity free from future episodes of allergic contact dermatitis. The case reports emphasize the need for collaboration since it is impossible for even well-equipped laboratories to properly investigate the medical devices when information on the substances used in production is not uniform and complete and material to investigate are scarce. The importance of adequate patch test series and testing with own material and furthermore the importance to re-analyse medical devices and re-analyse test data are emphasized.

T Helper 2 Inhibitors in Allergic Contact Dermatitis.

Clinical trials are currently underway to evaluate the benefit of dupilumab in treating allergic contact dermatitis (ACD). Dupilumab use has been reported to improve ACD reactions in some patients, but not all. Varying clinical responses to T helper 2 (TH2) inhibition challenge the classical view that ACD proceeds through a TH1-dominant pathway. Selective TH2 inhibitors, such as dupilumab, may attenuate ACD when the delayed hypersensitivity response is due to TH2-predominate activation; conversely, it may have no effect on ACD if it is elicited via TH1 or TH17 pathways. We hypothesize that allergen-specific T-cell responses and patient-specific factors both play an important role in determining which pathways are recalled in delayed hypersensitivity reactions.

Proinflammatory and regulatory mechanisms in allergic contact dermatitis caused by methylchloroisothiazolinone and methylisothiazolinone.

Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are the cause of an increasing number of contact allergies. Understanding the mechanisms by which MCI/MI induces proinflammatory and regulatory factors production is necessary to understand the outcome of allergic contact dermatitis (ACD). To evaluate the dysfunction of proinflammatory cytokines and regulatory factors in the positive MCI/MI patch test at the transcriptional and protein expression levels. Moreover, to analyse the cytokines production induced by MI in peripheral blood mononuclear cells (PBMCs). The selected patients had positive MCI/MI patch test results. The expression of proinflammatory factors was evaluated by q-PCR and immunochemistry at 48hours of positive MCI/MI patch test. The MCI/MI- or MI- induced secretion of IL-1β, TNF and IL-6 by PBMC was analysed by flow cytometry. The results showed a decreased TLR4 expression with upregulated IL6, FOXP3, IL10 and TGFβ mRNA expression as assessed by q-PCR at the site of the MCI/MI skin reaction. We detected increased protein levels of TLR4, FOXP3 and IL-10 in the dermis layer in the ACD reaction by immunocitochemistry. Moreover, MCI/MI induced proinflammatory cytokine production by PBMC through the NF-κB signalling pathway. Considering the altered innate immune response triggered by MCI/MI sensitization, these findings indicate that the regulatory process at the induction phase of ACD is a crucial mechanism. Given the increase in occupational and domestic exposure to MCI/MI, the underlying immunological mechanisms should be understood.

Common allergens present in personal care products: identification, diagnosis, and management.

The incidence of allergic contact dermatitis (ACD) reactions to personal care products has progressively increased, affecting women more so than men. Fragrances and preservatives are the major sensitizers behind cosmetic-induced ACD, due to their ubiquitous presence in these products, though emulsifiers, ultraviolet filters, and botanical allergens have been implicated as well. While patch testing is the standard for diagnosing ACD, many cosmetic-specific antigens are not currently included within the commercially available kits. Therefore, patch testing for potential cosmetic-induced ACD should be supplemented with additional compounds commonly found in personal use products. Effective treatment of ACD must involve accurate identification and removal of the offending agent.

Clinical Experience with a Novel Topical Adhesive for Dermatologic Excisional Wound Closure: A Case-Series

Background. The topical adhesive, 2-octyl cyanoacrylate, has been used as an alternative to sutures for closure of skin in a variety of surgical procedures. While potential benefits exist, reports of allergic contact dermatitis and exothermic reactions have been a barrier to widespread adoption by dermatologic surgeons. Objective. To describe our experience using a novel formulation of 2-octyl cyanoacrylate for skin closure after surgical excision of cutaneous lesions. Methods. We describe the results of 9 office-based dermatologic excisions in 8 patients utilizing a novel formulation of 2-octyl cyanoacrylate for skin closure. At two weeks of follow-up, all incisions were examined for cosmetic result and signs of infection as per the office’s standard of care. Results. At follow-up, there were no signs of infection. One wound demonstrated mild tissue hypertrophy, while another showed very minimal skin separation (< 1mm) that did not require reintervention. No incidences of contact dermatitis, application discomfort, or burns were noted. Patient satisfaction was high. Conclusion. A novel formulation of 2-octyl cyanoacrylate topical adhesive demonstrates feasibility as a potential alternative to the use of sutures for skin closure following dermatologic excisions. Larger studies are imperative to fully describe the outcomes associated with use of this new preparation.

Propylene Glycol.

Propylene glycol (PG), an emollient and emulsifier found in cosmetics, medications, and food, has been granted the dubious honor of being named the American Contact Dermatitis Society's Allergen of the Year for 2018. Allergic and irritant contact dermatitis and systemic cutaneous reactions to PG, which has become an increasingly common ingredient, have been documented. Propylene glycol is as contentious as it is ubiquitous because it acts as both a weak sensitizer and an irritant, confounding the results of positive patch tests. This report serves to increase awareness about PG sensitization and appropriate testing and evaluation of PG patch tests.

Contact Sensitization to Allergens in Nail Cosmetics.

Ingredients found in the nail cosmetic industry, including but not limited to methacrylate and acrylate monomers, formaldehyde, and toluene sulfonamide-formaldehyde resin, can incite allergic contact dermatitis. An eczematous outbreak presents on areas surrounding the nail plate and may spread through contact transfer of the allergen, commonly to the face and neck. Even components that were originally deemed nonsensitizing, such as the ubiquitous cyanoacrylate adhesive family, have been found to be allergenic. They do not, however, cross-react with methacrylates and acrylates. Alternative options for individuals with allergic contact dermatitis reactions to these ingredients can be avoidance of these procedures or use of products that are "3, 4, 5 free" in which the common allergens dibutyl phthalate, toluene, and formaldehyde are absent. In cases where strengthening of the nail is the sole purpose, nail wraps or preformed nails can be applied for non-cyanoacrylate-sensitive individuals.

Skin diseases and tattoos: a five-year experience.

Decorative tattooing as a body art form underwent an exponential increase during the last two decades, particularly among teenagers and young adults. Consequently, the number of reported adverse reactions after tattooing has increased. The most frequent reported skin reactions to tattoo include infectious (bacterial, viral, fungal) or inflammatory (allergic contact dermatitis and granulomatous reaction) diseases. Moreover, tattoos can also induce the development of typical skin lesions of pre-existing dermatoses, a phenomenon known as isomorphism reactive or Koëbner phenomenon, which commonly occurs in patients with psoriasis, vitiligo, or lichen planus. A retrospective study analyzing records data of patients attending the Department of Dermatology, University of Naples "Federico II" during 2011-2015 was performed. All cases of tattoo-related or closely-located dermatitis were selected. We observed 19 patients (mean age: 26.4 years old) showing cutaneous conditions related to the practice of tattooing. Allergic contact dermatitis was reported as the most common cutaneous disease linked to tattooing (31.6%), followed by granulomatous reactions (26.3%). These data are consistent with those already reported in the literature. Our results highlight the need to develop detailed regulations regarding tattoos practice, used materials, as well as execution procedures in order to limit the outbreak of tattoo-related skin diseases.

GPR91 deficiency exacerbates allergic contact dermatitis while reducing arthritic disease in mice.

BackgroundSuccinate, in addition to its role as an intermediary of the citric acid cycle, acts as an alarmin, initiating and propagating danger signals resulting from tissue injury or inflammatory stimuli. The contribution of this immune sensing pathway to the development of allergic and inflammatory responses is unknown.MethodsEar thickness of wild‐type (wt) and Sucnr1‐deficient (Sucnr1 −/−) mice, sensitized and challenged with oxazolone, was used as a criterion to assess the relevance of SUCNR1/GPR91 expression mediating allergic contact dermatitis (ACD). Results obtained in this system were contrasted with data generated using passive cutaneous anaphylaxis, ovalbumin‐induced asthma and arthritis models.ResultsWe found augmented ACD reactions in Sucnr1 −/− mice. This observation correlated with increased mast cell activation in vitro and in vivo. However, exacerbated mast cell activation in Sucnr1 −/− mice did not contribute to the enhancement of asthma or arthritis and seemed to be due to alterations during mast cell development as augmented mast cell responses could be recapitulated in wt mast cells differentiated in the absence of succinate.ConclusionsA deficiency in succinate sensing during mast cell development confers these cells with a hyperactive phenotype. Such a phenomenon does not translate into exacerbation of asthma or mast cell‐dependent arthritis. On the contrary, the fact that Sucnr1 −/− mice developed reduced arthritic disease, using two different in vivo models, indicates that GPR91 antagonists may have therapeutic potential for the treatment of allergic and autoimmune diseases.

Patients with atopic dermatitis have attenuated and distinct contact hypersensitivity responses to common allergens in skin

Atopic dermatitis (AD) is the most common inflammatory disease. The prevalence of allergic contact dermatitis to allergens (eg, fragrance) is higher in patients with AD, despite a trend toward weaker clinical allergic contact dermatitis reactions. The role of the AD skin phenotype in modulating allergic sensitization to common sensitizers has not been evaluated. We sought to investigate whether patients with AD have altered tissue immune responses on allergen challenge. Gene expression and immunohistochemistry studies were performed on biopsy specimens from 10 patients with AD and 14 patients without AD patch tested with common contact allergens (nickel, fragrance, and rubber). Although 1085 differentially expressed genes (DEGs) were commonly modulated in patch-tested skin from patients with AD and patients without AD versus control skin, 1185 DEGs were uniquely altered in skin from patients without AD, and only 246 DEGs were altered in skin from patients with AD. Although many inflammatory products (ie, matrix metalloproteinase 12/matrix metalloproteinase 1/S100A9) were upregulated in both groups, higher-magnitude changes and upregulation of interferon responses were evident only in the non-AD group. Stratification by allergen showed decreased expression of immune, TH1-subset, and TH2-subset genes in nickel-related AD responses, with increased TH17/IL-23 skewing. Rubber/fragrance showed similar trends of lesser magnitude. Negative regulators showed higher expression in patients with AD. Through contact sensitization, our study offers new insights into AD. Allergic immune reactions were globally attenuated and differentially polarized in patients with AD, with significant decreases in levels of TH1 products, some increases in levels of TH17 products, and inconsistent upregulation in levels of TH2 products. The overall hyporesponsiveness in skin from patients with background AD might be explained by baseline immune abnormalities, such as increased TH2, TH17, and negative regulator levels compared with those seen in non-AD skin.

Adverse reactions to sunscreen agents: epidemiology, responsible irritants and allergens, clinical characteristics, and management.

Sunscreen is a key component in the preventive measures recommended by dermatologists and public health campaigns aimed at reducing sunburn, early skin aging, and skin cancer. To maximize compliance, adverse reactions to sunscreens should be minimized. Although inactive ingredients cause many of these reactions, it is important for dermatologists to be aware of reactions to active ultraviolet filters. There are approximately 120 chemicals that can function as ultraviolet (UV) filters. This review focuses on the 36 most common filters in commercial and historical use. Of these, 16 are approved for use by the US Food and Drug Administration. The benzophenones and dibenzoylmethanes are the most commonly implicated UV filters causing allergic and photoallergic contact dermatitis (PACD) reactions; benzophenone-3 is the leading allergen and photoallergen within this class. When clinically indicated, patch and photopatch testing should be performed to common UV filters.

Allergic contact dermatitis in psoriasis patients: typical, delayed, and non-interacting.

Psoriasis is characterized by an apoptosis-resistant and metabolic active epidermis, while a hallmark for allergic contact dermatitis (ACD) is T cell-induced keratinocyte apoptosis. Here, we induced ACD reactions in psoriasis patients sensitized to nickel (n = 14) to investigate underlying mechanisms of psoriasis and ACD simultaneously. All patients developed a clinically and histologically typical dermatitis upon nickel challenge even in close proximity to pre-existing psoriasis plaques. However, the ACD reaction was delayed as compared to non-psoriatic patients, with a maximum intensity after 7 days. Whole genome expression analysis revealed alterations in numerous pathways related to metabolism and proliferation in non-involved skin of psoriasis patients as compared to non-psoriatic individuals, indicating that even in clinically non-involved skin of psoriasis patients molecular events opposing contact dermatitis may occur. Immunohistochemical comparison of ACD reactions as well as in vitro secretion analysis of lesional T cells showed a higher Th17 and neutrophilic migration as well as epidermal proliferation in psoriasis, while ACD reactions were dominated by cytotoxic CD8+ T cells and a Th2 signature. Based on these findings, we hypothesized an ACD reaction directly on top of a pre-existing psoriasis plaque might influence the clinical course of psoriasis. We observed a strong clinical inflammation with a mixed psoriasis and eczema phenotype in histology. Surprisingly, the initial psoriasis plaque was unaltered after self-limitation of the ACD reaction. We conclude that sensitized psoriasis patients develop a typical, but delayed ACD reaction which might be relevant for patch test evaluation in clinical practice. Psoriasis and ACD are driven by distinct and independent immune mechanisms.

Is the Use of PPD in Black Henna Tattoo Criminal or Remiss?

Para-phenylenediamine (PPD) is a known strong sensitizer and allergen. It has been directly associatedwith severe allergic contact dermatitis reactions and systemic toxicities. While PPD is permitted inhair-dye with restriction, it is prohibited for direct use on skin. Unfortunately, skin application continuesthrough temporary tattoos with black henna dyes, because these products are unregulated by the US Foodand Drug Administration. Policy change, and parent and child-oriented educational campaigns are necessaryto build knowledge of this serious issue.

Flow Cytometric Analysis of Regulatory T Cells During Hyposensitization of Acquired Allergic Contact Dermatitis

We previously demonstrated that repeated intradermal steroid injections administered at weekly intervals into positive patch-test sites induce hyposensitization and desensitization. To examine changes in CD4CD25CD127lo/ regulatory T cells during the attenuation of the patch-test response. Ten patients with known allergic contact dermatitis were patch tested weekly for 10 weeks. The patch-test site was injected intradermally with 2 mg triamcinolone. At weeks 1 and 7, a biopsy was performed on the patch-test site in 6 patients, and flow cytometry was performed assessing CD4CD25CD127lo/ regulatory T cells. Secondary outcomes were clinical score, reaction size, erythema, and temperature. Statistical analysis included regression, correlation, and repeated-measures analysis of variance. The percentage of CD4CD25CD127lo/ regulatory T cells, measured by flow cytometry, increased from week 1 to week 7 by an average of 19.2%. The average grade of patch-test reaction decreased from +++ (vesicular reaction) to ++ (palpable erythema). The mean drop in temperature following treatment was 0.28°C per week. The mean area decreased 8.6 mm/wk over 10 weeks. Intradermal steroid injections of weekly patch-test reactions resulted in hyposensitization of the allergic contact dermatitis reaction. CD4CD25CD127lo/ regulatory T cells showed a tendency to increase; however, further studies are needed to determine if this is significant.

Tattoo-associated skin reaction: the importance of an early diagnosis and proper treatment.

Tattoo is going to be a very common practice especially among young people and we are witnessing a gradual increase of numerous potential complications to tattoo placement which are often seen by physicians, but generally unknown to the public. The most common skin reactions to tattoo include a transient acute inflammatory reaction due to trauma of the skin with needles and medical complications such as superficial and deep local infections, systemic infections, allergic contact dermatitis, photodermatitis, granulomatous and lichenoid reactions, and skin diseases localized on tattooed area (eczema, psoriasis, lichen, and morphea). Next to these inflammatory skin reactions we have to consider also the possibility of the development of cutaneous conditions such as pseudolymphomatous reactions and pseudoepitheliomatous hyperplasia. The aim of this study is to underline the importance of an early diagnosis by performing a histological examination especially when we are in front of suspected papulonodular lesions arising from a tattoo, followed by a proper treatment, since cutaneous neoplastic evolution is known to be a rare but possible complication.

Is the Use of PPD in Black Henna Tattoo Criminal or Remiss?

Para-phenylenediamine (PPD) is a known strong sensitizer and allergen. It has been directly associatedwith severe allergic contact dermatitis reactions and systemic toxicities. While PPD is permitted inhair-dye with restriction, it is prohibited for direct use on skin. Unfortunately, skin application continuesthrough temporary tattoos with black henna dyes, because these products are unregulated by the US Foodand Drug Administration. Policy change, and parent and child-oriented educational campaigns are necessaryto build knowledge of this serious issue.

Effect of the Hot Water Extract of <i>Artocarpus camansi</i> Leaves on 2,4,6-Trinitrochlorobenzene (TNCB)-Induced Contact Hypersensitivity in Mice

Medicinal plants with reported anti-inflammatory activity could have the potential use as anti-allergens and inhibitors of allergic contact dermatitis reactions produced by allergens and chemicals. Some species from the genus Artocarpus were reported to have anti-inflammatory activity. In the Philippines one local source is Artocarpus camansi BLANCO (Moraceae), which is utilized as an ingredient of their cuisine, and decoction of leaves is used for diabetes and baths of people with rheumatism. The objective of this study was to evaluate the effect of the hot water extract of A. camansi leaves on contact hypersensitivity (CHS) in mice. Contact hypersensitivity was induced using 2,4,6-trinitrochlorobenzene (TNCB). The results showed that the A. camansi hot water extract exhibited significant activity against the swelling produced during 24 h and 48 h post-challenge. The same responses were observed from the mice that received the kamansi ethanol-precipitate (KEP) and kamansi ethanol precipitate water-soluble (KEPWS) fractions. Since the high molecular mass fraction showed the significant activity, we therefore speculate that the compound responsible might be a polysaccharide and/or glycoprotein. In conclusion, our results suggest that the hot water extract of A. camansi leaves might be an effective natural product to treat allergic contact dermatitis. However, further investigations are required to understand the mechanisms involved.