Contact Dermatitis Unit Research Articles

Translated article] Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria

Background and objectivesContact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methodsRetrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. ResultsData for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). ConclusionsContact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Diagnostic keys for disseminated eczema: experience of a Dermatitis Contact unit (2003-2019)

The aim of this study was to establish the diagnoses of patients with disseminated eczema and analyze the allergens involved in disseminated eczema due to allergic contact dermatitis. We analyzed the data from patients with a diagnosis of disseminated / generalized eczema who had undergone anamnesis, physical examination and patch tests in a Contact Dermatitis consultation from 2003 to 2019. Allergic contact dermatitis was the most frequent diagnosis, folowed by atopic dermatitis, asteatotic eczema, and gravitational eczema. The allergens most frequently involved in allergic contact dermatitis were isothiazolinones, topical medications, paraphenylenediamine, and fragrances. Allergic contact dermatitis caused almost half of the cases of disseminated eczema. It would be therefore advisable for patients with disseminated eczema to be assessed at a Contact Dermatitis unit and undergo patch tests.

Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria

Background and objectivesContact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. Material and methodsRetrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. ResultsData for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). ConclusionsContact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Usefulness of Patch Testing With Patient's Own Products in the Diagnosis of Allergic Contact Dermatitis

Background The usefulness of using patient's own products in patch tests for the diagnosis of allergic contact eczema is well known. However, most of the literature is based on case series published decades ago, and they are focused on cosmetics and fragrances. Objective The aim of the study was to evaluate the usefulness of using patient's own products in patch tests for the diagnosis of contact eczema in a contact dermatitis unit, describing the most frequently positive own products, as well as the most frequently responsible allergens. Methods In a 17-year period, 3514 patients were patch tested in our department. In 2429 patients, patch testing with the patients' own products was performed. Results We found that 363 patients (10.33%) reacted to their own products. In 131 cases (3.81%), reacting to their own product was the only clue for detecting the responsible allergen for allergic contact eczema. Most reactions were found for topical medications, moisturizers, and adhesives. Fragrance mix I, methylchloroisothiazolinone/methylisothiazolinone, ketoprofen, and colophony were found to be the allergens most often responsible. Conclusions It is essential to include patient's own products in the study of allergic contact eczema to make a correct diagnosis. In our series, 3.81% of the patients would not have been correctly diagnosed if their own products had not been included in patch tests.

Perianal Dermatitis.

Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

Eccema de labios: experiencia en la Unidad de Eccema de Contacto de un centro terciario español

Background. Lip eczema is an infrequent problem in Contact Dermatitis Units (CDU). Very few series have been published to date that show the profiles of such patients and the causes of their eczemas, and none are Spanish. The goal of this study was to analyze the epidemiological profile of the patients who attend a CDU in our setting, the main diagnoses and the relevant allergens. Methods. A retrospective review was made of the patients referred to the CDU in the 2005-2014 period. Patch tests were carried out with the extended standard series of the Spanish Research Group on Allergic Contact Dermatitis ( Grupo Espanol de Investigacion en Dermatitis Alergica de contacto – GEIDAC), our own products and other complementary sets. Results. The most frequent diagnoses in the 78 patients studied were allergic contact dermatitis and atopic dermatitis. The most frequent relevant allergens were cosmetics and topical medications. Conclusions. It is essential to study the patients with lip eczema with patch tests to be able to correctly determine their etiology and accordingly to carry out the most suitable treatment.

Lip eczema. Experience in the Contact Dermatitis Unit of a Spanish tertiary hospital

Lip eczema is an infrequent problem in Contact Dermatitis Units (CDU). Very few series have been published to date that show the profiles of such patients and the causes of their eczemas, and none are Spanish. The goal of this study was to analyze the epidemiological profile of the patients who attend a CDU in our setting, the main diagnoses and the relevant allergens. A retrospective review was made of the patients referred to the CDU in the 2005-2014 period. Patch tests were carried out with the extended standard series of the Spanish Research Group on Allergic Contact Dermatitis (Grupo Español de Investigación en Dermatitis Alérgica de contacto - GEIDAC), our own products and other complementary sets. The most frequent diagnoses in the 78 patients studied were allergic contact dermatitis and atopic dermatitis. The most frequent relevant allergens were cosmetics and topical medications. It is essential to study the patients with lip eczema with patch tests to be able to correctly determine their etiology and accordingly to carry out the most suitable treatment.

Perfil de los pacientes con dermatosis en las manos remitidos a la Unidad de Contacto de un hospital terciario e impacto de las pruebas epicutáneas en el diagnóstico

ObjectiveThis study aimed to define the epidemiological and clinical characteristics of patients referred to a contact dermatitis unit for hand dermatitis. Material and methodsWe retrospectively analyzed patients referred for hand dermatitis to the contact dermatitis unit of the Hospital Germans Trias i Pujol, Barcelona, Spain, between 2004 and 2007. ResultsA total of 96 patients were included. The most common diagnosis was irritant contact dermatitis, followed by allergic contact dermatitis, psoriasis, dyshydrosis, and atopic dermatitis. Standard patch tests were done for all patients and complementary batteries were ordered in 42 (44 %). Patch tests were positive in 59 % of the patients. Positive results were considered of present relevance in 59 %, of past relevance in 6 %, and of unknown relevance in the remaining positive tests. When proposed as the initial diagnosis, allergic contact dermatitis was confirmed in 67 % of the patients. The most frequent clinically relevant allergens were chrome, nickel, rosin, plant allergens, and p-phenylenediamine. ConclusionsHand dermatitis is a frequent presenting complaint in our contact dermatitis unit, with allergic contact dermatitis being the most common. Good correlation was found between presumed diagnosis of allergic contact dermatitis and the finding of clinically relevant allergens.

Characteristics of Patients With Hand Dermatitis Referred to the Contact Dermatitis Unit of a Tertiary Hospital and Impact of Patch Testing on Diagnosis

Objective This study aimed to define the epidemiological and clinical characteristics of patients referred to a contact dermatitis unit for hand dermatitis. Material and methods We retrospectively analyzed patients referred for hand dermatitis to the contact dermatitis unit of the Hospital Germans Trias i Pujol, Barcelona, Spain, between 2004 and 2007. Results A total of 96 patients were included. The most common diagnosis was irritant contact dermatitis, followed by allergic contact dermatitis, psoriasis, dyshidrosis, and atopic dermatitis. Standard patch tests were done for all patients and complementary batteries were ordered in 42 (44%). Patch tests were positive in 59% of the patients. Positive results were considered of present relevance in 59%, of past relevance in 6%, and of unknown relevance in the remaining positive tests. When proposed as the initial diagnosis, allergic contact dermatitis was confirmed in 67% of the patients. The most frequent clinically relevant allergens were chrome, nickel, rosin, plant allergens, and p-phenylenediamine. Conclusions Hand dermatitis is a frequent presenting complaint in our contact dermatitis unit, with allergic contact dermatitis being the most common. Good correlation was found between presumed diagnosis of allergic contact dermatitis and the finding of clinically relevant allergens.

Comparison of patch test results among white Europeans and patients from the Indian subcontinent living within the same community

There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Four hundred and thirty-five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure.

Audit of primary and secondary care as a source of patch test clinic referrals

Referral for patch testing is important in managing patients with eczema/dermatitis. These referrals come from many different sources. To assess the appropriateness of referrals from general practitioners (GPs) to a dedicated patch test clinic. Referral sources were recorded for patch testing in a dedicated contact dermatitis unit for a 4-month period between November 2002 and February 2003. Of 217 referrals reviewed, 45 (21%) were received from GPs. There was no significant difference in the percentages of positive patch test results and of relevant positive patch test results obtained from GP referrals compared with those received from other sources, including dermatology departmental referrals. Referrals from GPs, if selected appropriately, can be seen directly in the patch test clinic without prior assessment in a general dermatology clinic.

Foot dermatitis from the shoes.

Foot dermatitis from the shoes is a common disorder. Patients with foot complaints seen at the Contact Dermatitis Unit, Department of Dermatology, Gazi University Faculty of Medicine between May 2001 and May 2002 were evaluated. Four patients with foot dermatitis from shoe allergens were found. Their clinical and patch test results of shoe contact dermatitis were reviewed. We also summarized the standard test allergens for shoe dermatitis. All four patients were treated with topical corticosteroid creams and were informed about patch test-positive materials. Patients with foot dermatitis from shoes should undergo patch testing to exclude other causes of foot dermatosis. Contact dermatitis from shoes can be managed by the recognition and avoidance of the allergens responsible. The control of hyperhidrosis and the use of topical and systemic corticosteroid therapies may also be beneficial.

Contact allergy in construction workers: results of a multifactorial analysis.

To quantify the risk of contact allergy (CA) to important ubiquitous allergens associated with certain occupations, in particular the construction industry, and to identify possible time trends, controlling for potential confounding variables. Bivariate as well as Poisson regression analysis of standardized anamnestic and patch test data comprising 82,561 patients assessed in the 33 German and Austrian contact dermatitis units of the Information Network of Departments of Dermatology (IVDK) between 1992 and 2000. CA to five of the 18 (groups of) allergens considered here were observed significantly more often in construction workers: dichromate, epoxy resin (BADGE), cobalt, thiurams and N-isopropyl-p-phenylenediamine (IPPD). Multifactorial analysis confirmed an increased risk of CA to these allergens in construction workers, compared with other occupations. A very strong association between cobalt and chromate allergy was found in construction workers (OR 39.1, 95% CI 21.1-79.6). Dichromate is still an prominent allergen in construction workers; as yet, there is only weak evidence of a decrease in Germany. Therefore, the addition of ferrous sulphate to cement, which has been a successful intervention in other countries, should be promoted further. Although CA to other important occupational allergens like thiurams, IPPD and epoxy resin or cobalt (very often associated with dichromate CA) is less frequent, prevention should address these allergens, too. The use of protective gloves with minimal intrinsic CA risk, e.g. due to thiurams in (synthetic) rubber or chromate in leather gloves, should be promoted.

Risk factors for contact allergy to nickel - results of a multifactorial analysis.

To quantify the independent impact of potential risk factors for nickel contact allergy (NCA), a multifactorial Poisson regression analysis of standardized anamnestic and patch test data (with nickel sulfate, 5% in petrolatum) was performed, comprising 74 940 patients assessed in the 33 German and Austrian contact dermatitis units of the Information Network of Departments of Dermatology (IVDK) between 1992 and 2000. NCA was observed in 15.5% patients. Female sex was the strongest risk factor (prevalence ratio 3.74, 95% CI: 3.51-3.98). Risk increased monotonically and significantly with decreasing age. Atopic dermatitis was not a risk factor. The year of patch test had no influence on NCA risk. Significant variation of risk between occupations was observed. In conclusion, our multifactorial analysis was able to quantify the impact of established risk factors and additionally address other, e.g. occupational, factors yet unidentified.

An audit to identify the optimum referral rate to a contact dermatitis investigation unit

The principle of patch testing is to identify individuals with a contact allergy of relevance to their disorder and to provide avoidance advice in an attempt to improve or resolve their condition. We aimed to define an optimum referral rate to a centralized contact dermatitis unit using a retrospective analysis of data relating to 10 consultants. The results showed no significant difference (P = 0.21) in the percentage of relevant positive individuals identified between the consultants. However, a linear relationship (r = 0.99) was seen between the number of relevant positive allergic reactions and the number referred by individual consultants. We propose that the minimal annual referral rate for patch testing from a predominately urban population in a developed country is one in 700 of the population.

Nummular Dermatitis and Patch Testing

To study the significance of contact allergy in nummular dermatitis, these investigators retrospectively identified a group of 196 patients with nummular dermatitis who were patch tested at a contact dermatitis unit in Glasgow between 1981 and 1993. …

Results of routine patch testing with corticosteroid series in 2073 patients.

The patch test results of 61 patients allergic to at least 1 corticosteroid molecule are presented. These contact allergies were detected by testing with several corticosteroids included in our standard patch test series between February 1988 and December 1990. Whenever possible, further investigations were conducted by means of a more complete corticosteroid series. We found corticosteroids to be the 7th most frequent allergen, positive results being obtained in 2.9% of all patients referred to our contact dermatitis unit. In this series, budesonide was the most common allergen and often gave simultaneous reactions with other corticosteroids.

Artificial Intelligence and Contact Dermatitis: The CODEX/E System

The Contact Dermatitis Index or CODEX consists primarily of data on patients, products, and their ingredients that we began compiling in 1978 to form a computerized information system. These data bases are used to provide patients with lists of all the topical pharmaceutical products containing their allergens, to help dermatologists identify potential allergens and avoid prescription errors, and to assist scientists, authorities, and the industry by means of reports and epidemiological studies. Based on this system, we developed the CODEX/E, an expert system that has been operational in our contact dermatitis unit since September 1989. The dermatologist preparing the contact-allergy anamnesis and testing program is given on-line support in the determination of possible allergens. The primary rules are based on sex, lesion location, exposure, profession/hobbies, and topical pharmaceuticals used. The secondary rules are based on the nature of the lesions, cosmetic usage, literature data, and, are used to detect new trends data from the last 1,000 patients examined. The contact-allergy expert can also introduce “user rules.” The rules are derived from the Codex Patient File, which contains information on some 12,000 patients; the Codex Product File, which contains the complete composition of over 7,000 pharmaceutical products intended for application on the skin and mucous membranes and information on compiled on some 500 cosmetic products; and the Codex Raw Material File, which contains all the names of all the ingredients used in the manufacture of these pharmaceutical products to which an automatically updated allergenicity score has been assigned.