Contact Dermatitis Clinic Research Articles

The use of complementary medicine by patients referred to a contact dermatitis clinic.

Our aim was to quantify and qualify the use of complementary medicine (CM) by patients referred to our contact dermatitis clinic in Leicester, UK. A face-to-face structured questionnaire study was made of 109 consecutive patients referred to the contact dermatitis clinic. 109 such questionnaires were completed. 21/109 (20%) of patients were Indo-Asian and 86/109 (79%) white Caucasian. 33/109 (30%) had tried some form of CM to treat their skin condition. This use was higher in the Indo-Asian group, where 13/21 (62%) had tried some form of CM. 21/33 (63%) who had used CM were happy to recommend it to other patients with skin disease, even though only 10/33 (30%) of these reported an improvement in their skin condition while using CM. The most frequently used CM treatments were herbal medicine [17/33 (51%)], Chinese herbal medicine [6/33 (18%)], traditional Indian medicine [4/33 (12%)] and aromatherapy [6/33 (18%)]. These proportions were similar in all ethnic groups. In a population of adults referred to a contact dermatitis clinic in a city-centre teaching-hospital dermatology department in Leicester, UK, 30% use, or intend to use, CM and this use is associated with ethnicity.

P80 Preliminary findings on the histopathology of chronic hand dermatitis

Chronic hand dermatitis is a common and distressing condition with a complex, multifactorial aetiology. In order to better understand its pathophysiology and hopefully improve diagnosis, we have begun a systematic histopathological study of various forms of hand dermatitis, with a particular emphasis on those in which exposure to irritants and allergens is strongly implicated. Suitable patients were recruited from amongst those presenting at the contact dermatitis clinic. Detailed past and present medical and personal histories, clinical examination, patch testing and prick testing were conducted in order to classify the eczema into one of several broad entities e.g. chronic irritant contact dermatitis (CICD), with or without atopy. After performing a range of bio‐engineering measurements on a pre‐selected affected area of the hand, biopsies were removed and processed for high resolution light microscopy and immunocytochemistry. Age/sex matched, healthy, non‐atopic individuals provided control skin from similar sites of the hand. Using a range of antibodies and quantification techniques, we examined the status and expression of certain immune‐associated cells and receptor/adhesion molecules. Of note amongst these, were the differences in epidermal CD1a+ cell density between groups. Non‐atopics with CICD, for example, had significantly fewer CD1a+ cells than both atopics with CICD and those with normal skin. CD54 (ICAM‐1) and several cytokine/chemokine receptors were more widely and strongly expressed by keratinocytes in those with an atopic diathesis. Although preliminary in nature at this stage, our results suggest that different forms of hand dermatitis display characteristic immunopathological features which may possibly be of diagnostic value.

Cutaneous and Oral Eruption from Oral Exposure to Nickel in Dental Braces

Oral eruptions due to nickel allergy are rare. A common presentation of intraoral contact dermatitis is the presence of lichenoid plaques on the buccal mucosa adjacent to the offending antigen. We report an unusual case of cutaneous and mucosal nickel allergy arising after placement of dental braces. An 11-year-old boy was referred by his orthodontist to the University of Minnesota Occupational and Contact Dermatitis Clinic to be evaluated for a possible metal allergy. The patient developed an itchy rash on his abdomen and under his wristwatch 1 week after dental braces were placed. He was diagnosed with allergic contact dermatitis from nickel. The patient avoided cutaneous nickel exposure and had a minimal resolution of his symptoms. One year later, the patient developed swelling and burning of the lips. Secondary to extreme discomfort, the braces, which contained nickel, titanium, and zinc, were removed. The patient underwent standard patch testing; the final reading at 96 hours showed a +++ reaction to nickel, palladium, cobalt chloride, and neomycin. The patient experienced relief of his oral symptoms after removal of the braces. No current relevance to palladium, cobalt, or neomycin has been found.

Palladium allergy in an Israeli contact dermatitis clinic.

Contact DermatitisVolume 49, Issue 4 p. 216-217 Palladium allergy in an Israeli contact dermatitis clinic Edith Orion, Corresponding Author Edith Orion The Dermatology Unit, Kaplan Medical Center, Rechovot,Edith Orion, MD Dermatology Unit Kaplan Medical Center Rechovot, 76100 Israel Tel: +972 3 6416028 Fax: +972 3 6436086 e-mail: nukituli@inter.net.ilSearch for more papers by this authorHagit Matz, Hagit Matz The Dermatology Unit, Kaplan Medical Center, Rechovot, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, IsraelSearch for more papers by this authorRonni Wolf, Ronni Wolf The Dermatology Unit, Kaplan Medical Center, Rechovot,Search for more papers by this author Edith Orion, Corresponding Author Edith Orion The Dermatology Unit, Kaplan Medical Center, Rechovot,Edith Orion, MD Dermatology Unit Kaplan Medical Center Rechovot, 76100 Israel Tel: +972 3 6416028 Fax: +972 3 6436086 e-mail: nukituli@inter.net.ilSearch for more papers by this authorHagit Matz, Hagit Matz The Dermatology Unit, Kaplan Medical Center, Rechovot, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, IsraelSearch for more papers by this authorRonni Wolf, Ronni Wolf The Dermatology Unit, Kaplan Medical Center, Rechovot,Search for more papers by this author First published: 28 January 2004 https://doi.org/10.1111/j.0105-1873.2003.0206e.xCitations: 17Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume49, Issue4October 2003Pages 216-217 RelatedInformation

Compound tincture of benzoin: a common contact allergen?

The results of patch testing to compound tincture of benzoin in 477 patients performed at the Contact Dermatitis Clinic at the Skin and Cancer Foundation in Melbourne during 1999 are presented. There have been fewer than 30 reported cases of contact allergy from compound tincture of benzoin, and none in the last decade. Our results showed 45 out of the 477 patients had a positive reaction to compound tincture of benzoin, which was the third most common allergen in our series. Of these 45 patients, 14 had strong positive reactions, but only two definitely recalled exposure to compound tincture of benzoin and these were clinically relevant. Twenty-eight of these patients had cross-reactions to similar allergens (fragrance mix, balsam of Peru, colophony and tea tree oil). Of the 14 patients with a strong positive reaction to compound tincture of benzoin, 11 had at least one other positive cross-reaction to the above allergens. This may explain the high frequency of reaction to compound tincture of benzoin found in our study.

Allergic Contact Cheilitis in the United Kingdom: A Retrospective Study

Background: To date, only a few cohorts of patients with allergic cheilitis have been described, most of them from Australia and Asia. Objective: To establish the prevalence of cheilitis in a UK specialist contact dermatitis clinic and to identify the most common allergens. Method: We analyzed our patch-test database in a tertiary referral center in the United Kingdom, retrospectively. All patients presenting with cheilitis over a 19-year period (1982 to 2001) were included. Results: Data were available from a total of 146 patients. A positive allergic patch-test reaction was thought to be relevant in 15% of the patients (n= 22) and to be of possible relevance in 6.8% (n= 10). Of the 22 patients with relevant allergic results, 95% (n= 21) were women. The most common allergens included fragrance mix (mainly cinnamaldehyde, oak moss, and isoeugenol) in 41% of patients, shellac in 18%, colophony in 18%, andMyroxylon pereiraein 14%. For half of the patients, the allergen was believed to stem from lipsticks or lip products. Eighteen percent of patients with allergic cheilitis reacted to only their own products. Conclusions: Patients should be tested to extended lipstick/cosmetic vehicle series in addition to standard series. As a significant percentage of patients react to their own products only, a thorough clinical history and testing to patients' own products are important.

Oral lichenoid lesions (OLL) and mercury in amalgam fillings.

84 patients with oral lichenoid lesions (OLL) were seen in the contact dermatitis clinic. All these patients had reticulate, lacy, plaque-like or erosive lichenoid changes adjacent to amalgam fillings. Patch testing to metallic mercury, 0.1% thimerosal, 1% ammoniated mercury, 0.1% mercuric chloride, and in some cases 0.05% phenylmercuric nitrate and amalgam discs was undertaken. 33 (39%) patients had positive patch test findings. 30/33 patch test positive patients had replacement of their amalgam fillings, with 28 (87%) patients experiencing improvement of symptoms and signs within 3 months. This confirms that mercury allergy is a factor in the pathogenesis of OLL in some cases. In cases where patch test negative patients improve with amalgam replacement, mercury may be acting as an irritant in the pathogenesis of OLL.

Sensitization to Palladium Chloride: A 10-Year Evaluation

Palladium is increasingly used in industry, jewelry, and dentistry and is becoming more common since the European directive restricting the use of nickel in all products placed in direct and prolonged contact with the skin. The role of palladium sensitization is still unclear, and the aim of our study is to evaluate the trend of sensitization in a contact dermatitis clinic population during a 10-year period. We report our experience with 4,446 patients (3,077 female, 1,369 male; mean age, 40.1 +/-13.7 years) with suspected contact dermatitis patch-tested during the period of 1991 to 2000. A positive patch-test result to palladium chloride 1% was indicated in 236 patients (5.3%), with a higher percentage in females (6.7%) than in males (2.3%), and the sensitization to this metal has increased over the specified period, to a maximum in the year 2000 (9.7%). In the majority of cases, subjects were polysensitized (92.8%), but 7.2% of subjects were patch-test positive only to palladium. Of palladium-sensitized patients, 40.5% complained of hand dermatitis, 47.4% complained of body dermatitis, and 1.7% complained of burning mouth syndrome. Palladium sensitization is significantly related to female sex (OR = 3.08; 95% CI, 2.07-4.61) and to sensitization to other metals, with a maximum for nickel sulfate (OR = 32.9; 95% CI, 21.3-51.5). Sensitization to palladium is increasing by the year, reaching high values, but its role in reducing sensitization and symptoms is still unclear because of the frequent cosensitization with nickel and the low number of monosensitized patients with relevant sensitizations. We need to follow palladium sensitization in future years to verify an increase of sensitization due to the increasing use of this metal.

Patch testing with thimerosal in a Canadian center: an 11-year experience.

Thimerosal has been used for decades as an antiseptic, a disinfectant, and a preservative in various consumer products. It is also a notoriously frequent contact allergen, but the significance of positive patch-test reactions has been debated over the past decade. The aim of this study was to assess the prevalence and relevance of positive patch-test reactions to thimerosal in a large Canadian center and to compare our results with those of previous publications. A retrospective analysis of data collected over the course of 11 years in the contact dermatitis clinic of a university hospital was performed. Of 2252 subjects patch-tested for thimerosal, positive reactions were observed in 102 individuals (4.53%), placing thimerosal as the fifth most common allergen in our practice. The sensitization rate was equivalent between the patients who underwent aimed patch testing and those who were routinely tested for reaction to thimerosal when this allergen was included in our standard patch-testing series 8 years into the study. There was an increased incidence of thimerosal sensitization in chemists and laboratory technicians, as well as in health care workers, including medical doctors, registered nurses, dentists, and dental assistants. While eight reactions were deemed possibly relevant, in none of the cases was it possible to definitely establish the relevance of positive reactions to thimerosal, either because the presence of this allergen could not be verified in patients' products or because patch testing with these products gave negative results. In agreement with previous reports, we conclude that even though positive reactions to thimerosal are frequent, very few seem to be clinically relevant.

Allergic Contact Cheilitis in the United Kingdom: A Retrospective Study

To date, only a few cohorts of patients with allergic cheilitis have been described, most of them from Australia and Asia. To establish the prevalence of cheilitis in a UK specialist contact dermatitis clinic and to identify the most common allergens. We analyzed our patch-test database in a tertiary referral center in the United Kingdom, retrospectively. All patients presenting with cheilitis over a 19-year period (1982 to 2001) were included. Data were available from a total of 146 patients. A positive allergic patch-test reaction was thought to be relevant in 15% of the patients (n = 22) and to be of possible relevance in 6.8% (n = 10). Of the 22 patients with relevant allergic results, 95% (n = 21) were women. The most common allergens included fragrance mix (mainly cinnamaldehyde, oak moss, and isoeugenol) in 41% of patients, shellac in 18%, colophony in 18%, and Myroxylon pereirae in 14%. For half of the patients, the allergen was believed to stem from lipsticks or lip products. Eighteen percent of patients with allergic cheilitis reacted to only their own products. Patients should be tested to extended lipstick/cosmetic vehicle series in addition to standard series. As a significant percentage of patients react to their own products only, a thorough clinical history and testing to patients' own products are important.

Photosensitivity: the 9-year experience at a Sydney contact dermatitis clinic.

In this retrospective study, 81 patients with photosensitivity were referred to the Contact and Occupational Dermatitis Clinic at The Skin and Cancer Foundation Australia, in Sydney, between 1991 and 1999. Photoallergic contact dermatitis (PACD) was diagnosed in 39.5% of patients, with 87.5% of these reactions being to sunscreen chemicals. Polymorphic light eruption (PMLE) accounted for 19.7% of cases, drug photosensitivity 14.8%, and photoaggravated atopic dermatitis and chronic actinic dermatitis (CAD) each constituted 7.4%. Compared with overseas studies, there was a high incidence of PACD, possibly reflecting the referral bias and widespread use of sunscreens. The incidence of PMLE and CAD was less than studies from cooler climates overseas. No cause could be determined for three photosensitive patients.

A Preliminary Report of the Occupation of Patients Evaluated in Patch Test Clinics

Background: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. Objective: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. Methods: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. Results: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. Conclusion: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.

Contact dermatitis complicating pinnaplasty

Proflavine allergy is uncommon, occurring in approximately 6% of patients attending contact dermatitis clinics. Proflavine wool is used by many surgeons in the UK as a dressing that can be moulded to conform to the contours of a corrected prominent ear. It may have bacteriostatic properties. We present a case where contact dermatitis in response to proflavine developed after pinnaplasty. This caused diagnostic confusion, a lengthened hospital stay and an unsightly hypertrophic scar.

Results of a quality of life questionnaire in a patch test clinic population.

There has been increasing interest in quality of life outcomes, but there has been little reported on this topic for individuals with contact dermatitis. The objectives of this study were (i) to pilot a dermatology-specific quality of life instrument to assess its acceptability in a patch test clinic population, (ii) to see the effects of contact dermatitis on the patients' lives and (iii) to determine what factors may influence quality of life outcomes in this population. A dermatology-specific quality of life instrument was modified and used for 339 patients undergoing patch testing in a contact dermatitis clinic. The most common effect was pain or itching in 61%. Approximately 1/3 noted embarrassment, interference with work, or sleep disturbance. Other concerns were reported by less than 25% of the population. On multivariate analysis, the key factor influencing most outcomes was hand involvement. The instrument was well accepted by the clinic population and is now being used in a prospective study of outcomes. In the population assessed, it demonstrated the effects of disease. Analysis suggests that a key factor influencing these quality of life outcomes is hand involvement.

Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition

Background: Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis. Objectives: To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to disperse blue dyes in these patients. Methods: We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%). Results: Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments. Conclusions: Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.

Textile dermatitis in Israel: A retrospective study

Background: The diagnosis of contact dermatitis caused by clothing may be difficult because of its clinical polymorphism. Data in the literature suggest that textile dermatitis is more common than previously thought. Objective: Our purpose was to study our patients suspected of having textile contact dermatitis from 1991 to 1997. Methods: The records of the patients with positive reactions to allergens from the Textile Colors and Finish series in 3 contact dermatitis clinics were reviewed. All the patients were clinically evaluated and patch tested with the European Standard series and the Textile Colors and Finish series (Chemotechnique Diagnostics, Malmö Sweden). Results: Twenty-two of the 55 patients (40%) had positive patch tests to the textile dye allergens. Four of them had occupationally related textile dermatitis. The most frequent allergens were Disperse Blue 124, Disperse Blue 85, Disperse Red 17, and Disperse Blue 106. Erythematosquamous lesions were the most common forms of textile dermatitis (56%), followed by pustular lesion (16%) and hyperpigmented patches (8%). Conclusions: The relatively high percentage of positive results (40%) was attributable to the selected cohort of patients. In our series, positive reactions to the allergens Disperse Blue 124, 85, and 106 were common findings. Clinically, pustular allergic contact dermatitis, triggered by textile dyes was observed along with the more frequent erythematosquamous clinical form.

Prevalence of Gold Sensitivity in Asymptomatic Individuals with Gold Dental Restorations

Background: The clinical relevance of positive patch test reactions to gold sodium thiosulfate in asymptomatic individuals with gold dental restorations is often unclear. Knowledge of the prevalence of gold sensitivity in individuals with and without gold dental restorations is required to better understand the relevance of these reactions. Objective: To determine the prevalence of positive patch test reactions to gold in asymptomatic individuals with gold dental restorations (goldpatients) compared with similar individuals without gold dental appliances (nongoldpatients). Methods: One hundred thirty-six healthy, asymptomatic patients were patch tested to gold sodium thiosulfate, nickel sulfate and palladium chloride. Readings occurred after 2 days and 7 days. Results: Of the patients tested, 24 of 71 (33.8%) gold patients had a positive reaction to gold versus 7 of 65 (10.8%) of the nongold patients,P < .001. Of those with a positive gold reaction, 12 of 31 (38.7%) also had a positive nickel reaction. Nickel alone was positive in 18 of 71 (25.4%) of gold patients versus 11 of 65 (16.9%) of nongold patients. 19 of 29 (65.5%) of those with a positive nickel reaction also reacted to palladium and 19 of 22 (86.4%) of those with a palladium reaction also reacted to nickel. The rate of allergy to gold computed over a 3-year period for patients patch tested in the Oregon Health Sciences University (OHSU) Contact Dermatitis Clinic was 13.5% (46/342). Conclusions: The prevalence of gold sensitivity in individuals with gold dental restorations is approximately 33.8%. This is significantly greater than the 10.8% prevalence seen in individuals without gold dental appliances, as well as greater than the 3-year rate from the OHSU Contact Dermatitis Clinic. This data should help shed light on issues of clinical relevance.

Prevalence of gold sensitivity in asymptomatic individuals with gold dental restorations

Background: The clinical relevance of positive patch test reactions to gold sodium thiosulfate in asymptomatic individuals with gold dental restorations is often unclear. Knowledge of the prevalence of gold sensitivity in individuals with and without gold dental restorations is required to better understand the relevance of these reactions. Objective: To determine the prevalence of positive patch test reactions to gold in asymptomatic individuals with gold dental restorations (gold patients) compared with similar individuals without gold dental appliances (nongold patients). Methods: One hundred thirty-six healthy, asymptomatic patients were patch tested to gold sodium thiosulfate, nickel sulfate and palladium chloride. Readings occurred after 2 days and 7 days. Results: Of the patients tested, 24 of 71 (33.8%) gold patients had a positive reaction to gold versus 7 of 65 (10.8%) of the nongold patients, P < .001. Of those with a positive gold reaction, 12 of 31 (38.7%) also had a positive nickel reaction. Nickel alone was positive in 18 of 71 (25.4%) of gold patients versus 11 of 65 (16.9%) of nongold patients. 19 of 29 (65.5%) of those with a positive nickel reaction also reacted to palladium and 19 of 22 (86.4%) of those with a palladium reaction also reacted to nickel. The rate of allergy to gold computed over a 3-year period for patients patch tested in the Oregon Health Sciences University (OHSU) Contact Dermatitis Clinic was 13.5% ( 46 342 ). Conclusions: The prevalence of gold sensitivity in individuals with gold dental restorations is approximately 33.8%. This is significantly greater than the 10.8% prevalence seen in individuals without gold dental appliances, as well as greater than the 3-year rate from the OHSU Contact Dermatitis Clinic. This data should help shed light on issues of clinical relevance.

Concomitant positive reactions to allergens in a patch testing standard series from 1988–1997

Background: Patch testing is a useful diagnostic technique in patients with suspected allergic contact dermatitis (ACD). Concomitant reactions may reflect associations between tested allergens. Objective: This study was performed to identify positive correlations between reactions to test substances in a standard screening series. The results of patch testing in patients seen from 1988 to 1997 are described. Methods: Data were collected from chart review for patients who underwent patch testing to the full standard screening series at the Massachusetts General Hospital Contact Dermatitis Clinic. The Fisher exact test was used to evaluate associations between allergens. Results: A total of 927 patients were patch tested to 22 allergens included in a screening tray. The mean age was 43.9 years, and 68.6% were women. Two or more positive reactions occurred in 36.5% of patients. Reactions to 13 pairs of allergens were found to be significantly correlated: balsam of Peru/fragrance mix, carba mix/thiuram mix, carba mix/paraben mix, cobalt chloride/potassium dichromate, cobalt chloride/nickel sulfate, ethylenediamine/neomycin sulfate, formaldehyde/imidazolidinyl urea, formaldehyde/paraben mix, formaldehyde/quaternium-15, imidazolidinyl urea/quaternium-15, neomycin sulfate/potassium dichromate, paraben mix/quaternium-15, and potassium dichromate/thimerosal. Conclusion: Concomitant reactions to 13 pairs of allergens in a standard series occurred at a rate greater than would be predicted by chance. Such associations may reflect cross-sensitization or cosensitization.

Cheilitis: Analysis of 75 cases referred to a contact dermatitis clinic

Background: Cheilitis is a common problem, the cause of which is often obscure. Objective: Data on 75 cases of recalcitrant cheilitis were analyzed. These had been referred to a tertiary care center. Methods: Each of the 75 patients had undergone a detailed history, physical examination, and patch tests. Results: Of the patients, 53 were female (67%), and the age range was 9 to 79 years. Of the cases, 36% included irritant contact dermatitis (ICD), 25% included allergic contact dermatitis (ACD), 19% were attributed to atopic eczema, and in 9% the dermatitis was of unknown cause. Nine percent were noneczematous. The materials causing ACD were medicaments applied to the lips, lipstick ingredients, sunscreen agents, toothpaste ingredients, colophony in dental floss and toothpicks, nail varnish, cosmetics, and nickel in the mouthpiece of a flute. Conclusion: The most common cause of cheilitis was irritation, frequently caused by liplicking. About one quarter was caused by ACD. Medicaments, lipsticks, sunscreens, and toothpaste were the most common allergens. Atopic eczema is a commonly overlooked cause of cheilitis. However, there is a troublesome group of patients, 9% in this series, who are often severely affected, but the cause of their cheilitis remains obscure.