Contact Dermatoses Research Articles

CD44 expression in human skin: High expression in irritant and allergic contact dermatitis and moderate expression in psoriasis lesions in comparison with healthy controls.

Previous research using animal models demonstrated that CD44 expression may contribute to directing inflammatory cells into skin lesions during inflammation development in allergic contact dermatitis (ACD). To examine CD44 expression in patients with ACD and irritant contact dermatitis (ICD), and to compare it to patients with psoriatic lesions and healthy controls' (HCs) skin. This study included 200 patients comprising four groups of 50 each: ACD, ICD, psoriasis vulgaris, and HCs. CD44 expression was determined by immunohistochemical analysis using an optical microscope, and the results were visualized semiquantitatively by determining the percentage of immunoreactive cells in the epidermis, dermis, and on lymphocytes. The highest CD44 expression was found in ICD, followed by ACD, psoriasis vulgaris, and lastly, the HCs (P < .001). Epidermal CD44 expression was significantly higher in contact dermatoses (especially in ICD) compared with psoriasis and healthy skin (P < .001). Similarly, CD44 expression in the dermis and on lymphocytes was strongest in ICD, although less pronounced than in the epidermis. Because significantly elevated CD44 expression in ICD might be related to its function in maintaining and preserving the skin barrier in affected patients, further research on disease pathogenesis and new treatment options is needed.

An Analysis of Skin Prick Tests to Latex and Patch Tests to Rubber Additives and other Causative Factors among Dental Professionals and Students with Contact Dermatoses

Background: Dental workers often experience unwanted allergic and nonallergic skin reactions resulting in different contact dermatoses (e.g., contact urticaria, irritant and allergic contact dermatitis) that are often attributed to rubber gloves. Objective: To examine allergic and nonallergic contact dermatoses by different methods amongst dental professionals and dental students, more specifically, reactions to natural rubber latex (NRL), rubber additives, and other causative factors. Methods: In this cross-sectional study we surveyed a total of 444 subjects (dentists, assistants, technicians, and students); 200 agreed to be tested to latex by the standard skin prick test (SPT) and prick-by-prick test, of whom 107 were patch tested to rubber additives (mercapto mix, thiuram mix, carba mix, and N-isopropyl-N-phenyl-4-phenylenediamine [IPPD]). Results: Skin lesions appeared significantly more frequently with longer work experience (p = 0.002; V = 0.181), frequent glove changes (p < 0.001; V = 0.310), and hand washing (p < 0.001; V = 0.263), and in subjects with a history of allergies (atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and others) (p < 0.001; V = 0.183). Positive SPTs to latex occurred in 14/200 subjects (7%), of whom 5/14 subjects (35.7%) were also positive in prick-by-prick tests. Patch tests were positive in 5/104 subjects (4.8%) (mercapto mix 1%, thiuram mix 1.9%, and carba mix 1.9%). Conclusion: Only a small number of our subjects were allergic to latex (7%) or rubber additives (4.8%). Thus, self-reported contact dermatoses (during NRL product use) in dental professionals and students are not commonly caused by allergies to latex and rubber additives, as is often assumed, but by other factors.

Occupational Contact Dermatitis in Mechanics and Repairers Referred for Patch Testing: Retrospective Analysis From the North American Contact Dermatitis Group 1998–2014

Contact dermatoses are common in mechanic and repair occupations. This study aimed to (1) estimate the prevalence of occupationally related contact dermatitis among mechanics/repairers patch tested from 1998 to 2014 by the North American Contact Dermatitis Group, (2) characterize responsible allergens and irritants, and their sources, and (3) compare results among 3 occupational subgroups (mechanics, electrical/electronic, and other). A cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group between 1998 and 2014. Of 38,784 patients patch tested, 691 (1.8%) were mechanics/repairers. Male sex (93.5%) and hand involvement (59.5%) were common overall. Occupationally related skin disease was more prevalent among vehicle and mobile equipment mechanics/repairers (52.7%) and other mechanics/repairers (41.4%) than electrical/electronic equipment mechanics/repairers (21.3%). Overall, carba mix, thiuram mix, and methylchloroisothiazolone/methylisothiazolone were the most common occupation-related clinically relevant allergens. Gloves, automotive vehicles, solvents, oils, lubricants, and fuels were the most common sources of responsible allergens. Common occupationally related allergens included rubber accelerators and the preservative methylchloroisothiazolone/methylisothiazolone.

Common Contact Sensitizers among Patients with Hand Eczema: A Multicenter-Study in Nepal

Introduction: Allergic contact dermatitis in Nepal is not an uncommon disorder. Patch testing is a well established method of diagnosing allergic contact dermatitis. Patients with contact dermatitis are well known to have impaired quality of life which often leads to frequent dermatological consultations.Objective: Lack of data from Nepal has prompted us to undertake this study with the aims to know the frequency of allergic contact dermatitis and the commonest contact allergens among the patients with Hand eczema attending the out-patient department of dermatology, B.P. Koirala Institute of Health Sciences and Kathmandu Medical College Teaching Hospital.Material and Methods: A total of 256 patients were included in the study. Out of them 195 with hand eczema agreed to participate and undergo patch testing. The antigens used included the Indian standard series of patch test allergens approved by Contact and Occupational Dermatoses Forum of India.Results: Hundred and ten cases (56.4%) were patch test positive (PTP) at 48 as well as 96 hours to at least one allergen. PTP was seen more commonly in females. The most common allergen in females was nickel sulphate followed by cobalt chloride, gentamicin and mercapto mix while males were positive to potassium dichromate, followed by epoxy resin, fragrance mix and nickel sulphate.Conclusion: Patch testing has proved a useful tool for the detection of allergic contact dermatitis and for identification of contact allergens. When positive reactions correlate with environmental exposure the test usually assists the physician in establishing the cause of dermatitis, hence treating the patients and improving their quality of life.Nepal Journal of Dermatology, Venereology &amp; Leprology, Vol.14(1) 2016, pp.14-17

Occupationally Related Contact Dermatitis in North American Food Service Workers Referred for Patch Testing, 1994 to 2010

Contact dermatoses are common in food service workers (FSWs). This study aims to (1) determine the prevalence of occupationally related contact dermatitis among FSWs patch tested by the North American Contact Dermatitis Group (NACDG) and (2) characterize responsible allergens and irritants as well as sources. Cross-sectional analysis of patients patch tested by the NACDG, 1994 to 2010, was conducted. Of 35,872 patients patch tested, 1237 (3.4%) were FSWs. Occupationally related skin disease was significantly more common in FSWs when compared with employed non-FSWs. Food service workers were significantly more likely to have hand (P < 0.0001) and arm (P < 0.0006) involvement. The rates for irritant and allergic contact dermatitis in FSWs were 30.6% and 54.7%, respectively. Although the final diagnosis of irritant contact dermatitis was statistically higher in FSWs as compared with non-FSWs, allergic contact dermatitis was lower in FSWs as compared with non-FSWs. The most frequent currently relevant and occupationally related allergens were thiuram mix (32.5%) and carba mix (28.9%). Gloves were the most common source of responsible allergens. The NACDG standard tray missed at least 1 occupationally related allergen in 38 patients (4.3%). Among FSWs patch tested by the NACDG between 1994 and 2010, the most common allergens were thiuram mix and carba mix. Gloves were the most common source of responsible allergens.

Evaluating interventions aimed at reducing occupational exposure to latex and rubber glove allergens

ObjectiveConcerns over occupational exposures to blood-borne viruses resulted in increased protective glove use; consequentially latex allergy became a hazard for some occupational groups. Interventions aimed at managing this problem included...

Occupational dermatitis to epoxydic and phenolic resins

Contact dermatitis to epoxydic and phenolic resins are the most frequent contact dermatoses due to plastics, in particular in the form of airborne dermatitis. The chemical formulas of the various components of these resins and their additives are complex and the patch tests available in the trade are insufficient and often arrive at a late stage in the progress of industry, in particular in advanced technologies like aeronautical engineering, shipbuilding or the new floor and wall coverings in buildings. This article is a review of the actions to be taken with these allergies, as well as with regards to their diagnosis, prevention and medico-legal compensation.

Occupation-Related Contact Dermatitis in North American Health Care Workers Referred for Patch Testing: Cross-Sectional Data, 1998 to 2004

Contact dermatoses are common in health care workers (HCWs). To (1) estimate the prevalence of occupation-relevant allergic contact dermatitis (ACD) among health care workers patch-tested from 1998 to 2004 by the North American Contact Dermatitis Group (NACDG), (2) characterize responsible allergens among health care workers overall as well as in specific health care occupational subgroups, and (3) compare these results to those of nonhealth care workers. Between 1998 and 2004, 15,896 patients were patch-tested by the NACDG. Occupation-related allergic patch-test results were analyzed among HCWs, subgroups of HCWs, and non-HCWs. 1,255 patients (7.9%) were HCWs. Female gender (HCWs, 86.2%; non-HCWs, 63.6%) and hand involvement (HCWs, 54.7%; non-HCWs, 27.8%) were more common in HCWs (p < .05); 18.2% of HCWs and 6.6% of non-HCWs had occupation-related allergens of current clinical relevance. Thiuram mix (HCWs, 8.87% non-HCWs, 0.90%) and carba mix (HCWs, 5.43%; non-HCWs, 0.87%) were the most common occupation-related currently relevant antigens in HCWs and were more common in HCWs than in non-HCWs (p < .05). Among HCWs patch-tested by the NACDG between 1998 and 2004, the most common allergens were thiuram mix and carba mix, followed by glutaraldehyde, cocamide diethanolamine, and chloroxylenol. Gloves, sterilizing solutions, and soaps were common sources of responsible allergens.

Contact dermatoses in healthcare workers: reduction in type I latex allergy in a UK centre

Natural rubber latex (NRL) allergy has been recognized as a public health concern. NRL allergy frequently occurs in healthcare professionals. In this retrospective study we report the changing frequency of Type I NRL allergy amongst healthcare workers suffering from hand dermatitis referred to our department between 1996 and 2003. We identified 224 healthcare workers from the patch test database with a diagnosis of hand dermatitis who had undergone NRL skin prick testing (SPT). We report the SPT results, patch test results and diagnoses for each individual. The percentage of positive SPT to NRL in healthcare workers decreased from 62% in 1996 to 10% in 2003. Type IV allergy to fragrance mix (13%) was the most frequent cause of allergic contact dermatitis. Thiuram mix (8%) and carba mix (4%) were the most frequent indicators of type IV allergy to chemicals in rubber gloves. Fragrance allergy was the most frequent type IV allergen found in healthcare workers with hand dermatitis. We conclude that hand care preparations free from fragrance allergens should be available in all areas of clinical work.

An update on airborne contact dermatitis.

This review is an update of 2 previously published articles on airborne contact dermatoses. Because reports in the literature often omit the term 'airborne', 18 volumes of Contact Dermatitis (April 1991-June 2000), 8 volumes of the American Journal of Contact Dermatitis (1992 1999) and 4 volumes of La Lettre du Gerda (1996-1999) were screened, and the cases cited were classified as to history, lesion locations, sensitization sources, and other factors. Reports on airborne dermatitis are increasingly being published, sometimes in relation to specific occupational areas.

Increase in occupational skin diseases of dental personnel.

Occupational diseases of dentists and dental nurses were compiled from the Finnish Register of Occupational Diseases. The cases were recorded during 3 3-year observation periods, namely 1982-1984, 1986-1988, and 1992-1994 (i.e., 9 observation years). The relative risk of developing occupational allergic contact dermatitis in different occupations was calculated from the statistics of the years 1986-1991, and was expressed as the age-standardized rate ratio (SRR). During the 9 observation years, the majority of registered occupational diseases of dentists and dental nurses were skin diseases (221/312; 70.8%), followed by occupational repetitive strain injuries (61/312; 19.6%) and occupational respiratory diseases (20/312; 6.4%). The incidence rate (IR) for allergic contact dermatoses/10,000 workers (contact urticaria included) increased from 26 (95% confidence interval (CI) 16-40) in 1982-1984 to 79 (95%, CI 64-97) in 1992-1994. The IR/10,000 of allergic contact dermatoses increased especially for dentists, from 5.4 (95% CI 0.7-19) in 1982 to 67 (95% CI 45-95) in 1992-1994. The increase of the IR/10,000 dental nurses was smaller: from 43 (95%, CI 26-66) in 1982-1984 to 87 (95% CI 67-111) in 1992-1994. There was no increase in the IR/10,000 cases of irritant dermatoses. The most common causes of allergic contact dermatitis were plastics, disinfectants and antimicrobials, rubber chemicals, and mercury/mercury salts. The most common causes of irritant contact dermatitis were detergents, wet and dirty work, plastic chemicals and antimicrobials. Currently, Finnish dentists have the highest risk and dental nurses have the 4th highest risk of any occupation for developing occupational allergic contact dermatitis: the risk was 6.4-fold (SRR 6.4) in dentists and 6.1-fold in dental nurses, as compared to the general working population. It is evident that safer acrylics and protective gloves, better product declarations and material safety data sheets, as well as more information about protective measures, including non-touch working techniques, are needed.

Occupational dermatoses from plastic composites

Occupational dermatoses caused by plastic composites based on polyester resins, epoxy resins and vinyl ester resins (epoxy diacrylates) were reviewed. Common causes of irritant contact dermatitis are glass-fibre reinforcement and dust from product-finishing processes. Irritant contact dermatoses are also caused by resins, styrene, acetone, benzoyl peroxide, etc. Diglycidyl ether of bisphenol A (DGEBA) epoxy resin, amine hardeners, dicarboxylic (phthalic) anhydride hardeners and reactive epoxy diluents are common causes of allergic contact dermatitis. Non-DGEBA epoxy resins, tetraglycidyl-4,4′-methylenedianiline (TGMDA) and triglycidyl-p-aminophenol (TGPAP) used in carbon fibre reinforced composites may cause sensitization from prepregs. Diethylene glycol maleate is a new allergen in polyester resin cement. Natural rubber latex in protective gloves, and low molecular weight chemicals such as the epoxy resin hardener methyl tetrahydrophthalic anhydride (MTHPA) are causes of immunologic contact urticaria. Patch-testing with materials used by the patients at work, together with chemical analysis, is often needed to find the causative allergen, in addition to patch testing with standard test trays. Avoidance of skin contact with resin compounds, use of protective gloves, local ventilation, proper working methods, and informing the workers, are needed to lower the prevalence of occupational dermatoses in the manufacture of plastic composites. Copyright © 1999 John Wiley & Sons, Ltd.

The so-called contact dermatoses.

The so-called contact dermatoses.

Statistical data on occupational contact urticaria.

Data on occupational contact urticaria (protein contact dermatitis included) in Finland during 1990-1994 were analyzed. Altogether 815 cases were reported to the Finnish Register of Occupational Diseases during this period, compared with 1944 cases of occupational allergic contact dermatitis. Accordingly, the total number of occupational allergic contact dermatoses was 2759, 29.5% being contact urticaria and 70.5% being allergic contact dermatitis. Occupational contact urticaria was much more common in women (70%) than in men (30%). The 6 most common causes of contact urticaria were (1) cow dander (362 cases = 44.4%), (2) natural rubber latex (193 cases = 23.7%), (3) flour, grains and feed (92 cases = 11.3%), (4) handling of foodstuffs (25 cases = 3.1%), (5) industrial enzymes (14 cases = 1.7%) and (6) decorative plants (13 cases = 1.6%). The occupations with the highest numbers of occupational contact urticaria were farmers (341 cases), domestic animal attendants (61), bakers (53), nurses (42), chefs (40) and dental assistants (28). The ranking list of the most common occupations with occupational contact urticaria per 100,000 employed workers was as follows: (1) bakers (140.5 cases per 100,000 employed persons), (2) preparers of processed food, (3) dental assistants, (4) veterinary surgeons, (5) domestic animal attendants, (6) farmers and silviculturalists, (7) chefs, cooks and cold buffet managers, (8) dairy workers, (9) horticultural supervisors, (10) laboratory technicians and radiographers, (11) physicians, (12) butchers and sausage makers, (13) laboratory assistants, (14) dentists and (15) nurses (21.2 cases per 100,000 employed person). Low-molecular-weight chemicals caused very few cases of occupational contact urticaria, the most common being 2-ethylhexyl acrylate (5 cases). To summarize, occupational contact urticaria forms a large group of occupational contact dermatoses, and dermatologists need to be able to diagnose IgE-mediated immediate skin allergic diseases.

Occupational dermatoses from the manufacture of plastic composite products

Background: Workers in the reinforced plastics and more advanced plastic composite industries are exposed to reinforcing fibers and to various chemicals used for the resinous matrix or in the finishing and assembling work of composite products. Accordingly, the workers may develop both irritant and allergic contact dermatoses. Objective: The objective was to report analyzed cases of occupational contact dermatoses diagnosed in plastic composite workers during a 20-year period. Methods: The study consists of 43 of 2,178 workers diagnosed as having an occupational skin disease from 1974 to 1993. These 43 workers were employed in the plastic composite industry or exposed to plastic composite material in their work. The patients were patch tested with the standard series and the plastics and glues series. Most patients were also patch tested with substances they handled at work. Patients with upper respiratory symptoms or patients suspected to have immediate skin allergy were also tested using prick, scratch, or scratch chamber methods and 20 common commercial environmental allergens. Low molecular weight chemicals used in the plastics composite industry were prick tested as conjugates of human serum albumin. Results: Twenty-one subjects (49%) had irritant contact dermatitis (ICD), 18 (42%) had allergic contact dermatitis (ACD), and 4 (9%) had immunologic contact urticaria. ICD was caused by the mechanical irritation of glass fiber in 18 cases (86%). The rest of the cases of ICD were caused by solvents or sawing dust from cured plastic products. Diglycidyl ether bisphenol A epoxy resin caused 13 cases of ACD. One case of ACD was caused by sensitization to the epoxy compounds triglycidyl- p-aminophenol and tetraglycidyl-4-4′-methylene dianiline, two cases were caused by cobalt naphtenate in unsaturated polyester resin, and one case was caused by phenolformaldehyde resin glue. The cases of contact urticaria were caused by natural rubber latex (three cases) and epoxy resin hardener, methyltetrahydrophthalic anhydride (MTHPA). Two patients had bronchial asthma caused by epoxy resin or its hardener MTHPA. One patient had allergic rhinitis caused by MTHPA. Immunoglobulin E-mediated allergy was verified by skin prick and radioallergosorbent tests. Conclusion: In the plastic composite industry, ICD is mostly caused by man-made mineral fibers and various solvents. ACD occurred most frequently in the industry using epoxy resin compounds. Patch tests with plastic compounds to which the workers have actually been exposed are recommended.

What is Occupational Contact Dermatitis? An Operational Definition

Occupational contact dermatitis remains an important cause of disability. Eight steps in an operational definition of OCD are as follows: 1. Relevant clinical history 2. Relevant morphology 3. Positive diagnostic patch test with appropriate vehicle and concentration 4. Repeat patch test when excited skin syndrome is suspected 5. Positive provocative use test or repeat open application test to refine clinical relevance 6. Serial dilutions, when necessary, of the chemical tested 7. Reviewing controls for nonirritating concentrations when this is not known by the investigator 8. Generally, clearing of the dermatitis when allergen is removed, or exposure significantly decreased The diagnosis is not always easy. Well-conducted clinical investigations are needed, including clinical history, clinical examination, and patch testing with careful follow-up. However, many of the chemicals reported in the literature as sensitizers induce only sporadic allergic reactions. Thus, epidemiologic animal and human studies are necessary to determine the capacity of the chemicals used in industry to induce contact dermatoses. It is necessary to standardize the predictive tests to compare results among laboratories and to predict the potential for sensitization.

Airborne contact dermatitis: an update

This review is an update of a previously published one on airborne-induced contact dermatoses. Because reports in the literature often omit the term 'airborne', 12 volumes of Contact Dermatitis (July 1985-April 1991) were screened, and the cases cited were classified as to history, lesion locations, causative agents, and other factors. The number of reports of airborne dermatoses has increased considerably in recent years.

Occupational skin diseases from epoxy compounds. Epoxy resin compounds, epoxy acrylates and 2,3-epoxypropyl trimethyl ammonium chloride.

Of a total of 3731 patients investigated between 1974 and 1990, 1844 (49.4%) had an occupational skin disease. Of them 142 (7.7%) had an occupational skin disease caused by epoxy compounds--135 patients (95%) had allergic contact dermatitis, five had irritant contact dermatitis, and two had contact urticaria. Apart from dermatoses, two patients had IgE-mediated asthma from exposure to DGEBA epoxy resins. Thus epoxy compounds are one of the main causes of occupational allergic contact dermatoses and can be considered potential causes of occupational asthma. The most frequent causes were epoxy resin compounds, which together induced 93% (132 cases) of all epoxy compound dermatoses. The three most common causative products were epoxy paints and their raw materials (31%, 41 cases), epoxy resin compounds used in electrical insulation (29%, 38 cases) and epoxy glues (18%, 24 cases). Fewer cases were caused by products containing epoxy acrylate and EPTMAC. The present study found that, in addition to contact allergy to DGEBA epoxy resins, contact allergy to epoxy hardeners, non-DGEBA resins and reactive diluents is common. Polyamine hardeners, most frequently MDA, DETA and TETA, rarely IPDA, tris-DMP, EDA, TMD and XDA, were the second commonest causes of contact allergy induced by epoxy resin compounds, after DGEBA epoxy resins. Cycloaliphatic epoxy resins and other non-DGEBA epoxy resins, including heterocyclic dimethyl hydantoin, phenol novolak and brominated epoxy resins, were the third commonest causes, and reactive diluents the fourth commonest cause of allergic dermatitis due to epoxy resin compounds. Most patients sensitized to reactive diluents were allergic to PGE, ortho-CGE, HDDGE and BDDGE, whereas fewer patients were sensitized to AGE, NPGDGE and BGE. Cross-sensitization between reactive diluents was common. Cardura E 10 and Epoxide 8 provoked no reactions. The present study also indicated that DGEBA epoxy resins with a high average MW ought to be regarded as potential sensitizers, and organic solvents probably promote sensitization to DGEBA, even if the amount of DGEBA is low in the causative products. When contact dermatitis induced by epoxy compounds is suspected, an accurate diagnosis is made with the use of detailed data on the patient's exposure and extensive patch testing, including tests with the patient's own products. No chemical can be used alone to screen for sensitization to all different contact allergens of epoxy compounds.(ABSTRACT TRUNCATED AT 400 WORDS)

Contact dermatitis caused by airborne agents: A review and case reports

A general review is given of airborne-induced contact dermatoses, particularly of the irritant and allergenic types. Because the reports in the literature often omit the term airborne, 12 volumes of Contact Dermatitis (January 1975-July 1985) were screened, and the cases cited were classified in function of the anamnesis, lesion locations, causative irritants and allergens, and other factors. The present article also discusses differential diagnoses, in particular with regard to contact dermatitis of the face, ears, and neck. Finally, seven case reports of occupational and nonoccupational contact dermatitis problems caused by airborne agents are presented. In some of the cases the allergens have not been mentioned in published literature previously.

AN OUTBREAK OF ARSENICAL DERMATOSES IN A MINING COMMUNITY.

Arsenic trioxide, or white arsenic, an ancient and oft-used poison, produced by the smelting of arsenic-containing nonferrous ores. Although exposure of smelter workers to arsenic is frequently high enough to produce contact skin diseases, irritation of the mucous membranes of the respiratory tract, and elevated levels of arsenic in the urine, manifestations of systemic intoxication are surprisingly rare. In an outbreak of contact arsenical skin disease observed recently at a metal smelter, family members in the adjoining mining community were also affected. A variety of skin and mucous membrane lesions were observed: eczematous contact dermatitis, folliculitis, pyoderma, ulcerations, and conjunctivities and rhinitis. The eczematous dermatitis was pruritic and usually involved the face and flexures. Perforation of the nasal septum was observed only in roaster operators. On the basis of a patch test study with arsenic trioxide (5% in starch), it is believed that allergy was not an important factor in the onset or recurrence of the arsenical contact dermatoses.