International Contact Dermatitis Research Group Research Articles

Fixed Drug Eruption to Biologics and Role of Lesional Patch Testing

A 40-year-old cashier with ankylosing spondylitis (AS) on anti–TNF-α therapy presented to the Immunology Clinic with an intermittent rash over her shin. She had been on regular subcutaneous adalimumab (AbbVie, North Chicago, IL) for the past 5 years and her AS was in remission. For the past 3 months, there was consistent recurrence of a solitary rash over her left anterior shin around 4 hours after every dose of adalimumab. Adalimumab was administered every 2 weeks to alternating thighs without history of local injection-site reactions. The lesions were well demarcated, beginning with an intense itch and burning sensation followed by a fixed erythematous oval plaque about 10 cm in diameter. The lesion would last for days with residual hyperpigmentation (Figure 1, A) and recurred after each dose. There was no interruption of her injections and no recent change in the “citrate-free” autoinjector formulation (confirmed with supplier). There were no new medications and she had no history of dermatological conditions. There was no history of trauma. The lesions got progressively worse with subsequent injections, and there was a localized vesicular eruption on her most recent episode (Figure 1, B). She declined a skin biopsy. Adalimumab was stopped and there was no recurrence of the rash. A fixed drug eruption (FDE) was suspected and drug patch testing was performed 2 months later after complete healing of the rash. Patch testing was performed using IQ Ultra chambers and adalimumab (directly extracted from the autoinjector and diluted 1:10 aqueous) with both control (uninvolved upper back skin) and lesional (residual pigmented lesion) patch test application. The patch tests were read on day 2 (D2) and day 4 (D4), in accordance with International Contact Dermatitis Research Group criteria. Patch testing result was negative at the control site at D2 and D4. Patch testing result was negative at the lesional site at D2 (Figure 2, A), but strongly positive (++) at D4 (Figure 2, B) with reactivation of the residual FDE lesion with a crescendo effect. Given the positive lesional patch test result and the suggestive clinical features, she was diagnosed with an FDE due to adalimumab. In view of her favorable response to TNF-α blockade, she consented to provocation testing with subcutaneous golimumab (another anti–TNF-α antagonist), which was well tolerated. Her AS continues to be in remission with golimumab. We previously reported on immediate-type hypersensitivity to adalimumab, and hypersensitivity reactions to biologics have been increasingly identified.1Li P.H. Watts T.J. Lui M.S. Lau C.S. Chung H.Y. Recall urticaria in adalimumab hypersensitivity.J Allergy Clin Immunol Pract. 2018; 6: 1032-1033Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 2Corominas M. Gastaminza G. Lobera T. Hypersensitivity reactions to biological drugs.J Investig Allergol Clin Immunol. 2014; 24: 212-225PubMed Google Scholar In this case, we report the first case of biologics-related FDE. An FDE is a delayed-type cutaneous hypersensitivity reaction to medication that recurs at the same site on further exposure and cross-reactivity is uncertain. In this case, tolerance to golimumab was demonstrated, suggesting a lack of cross-reactivity with an alternative anti–TNF-α antagonist. Adalimumab and golimumab are humanized IgG1 anti–TNF-α antibodies but likely structurally dissimilar, because both are complex macromolecules derived from different biological cell lines. We highlight the utility of lesional patch testing in biologics-related FDE and suggest that tolerance to other anti–TNF-α antagonists is possible, but more studies are required to determine the true rate of cross-reactivity.

Clinico-epidemiological study of role of patch test in hand eczema

<p class="abstract"><strong>Background:</strong> Hand eczema is a common distressing condition in different occupational groups caused by various endogenous and exogenous factors. It appears to be the most common occupational skin disease, comprising 80% or more of all occupational contact dermatitis. Patch test at present is the only scientific method to diagnose the contact allergen and in subsequent management of patient.</p><p class="abstract"><strong>Methods:</strong> An observational study of patch test was conducted on 100 patients of hand eczema in the department of DVL, Basaveshwara Teaching and General Hospital, Kalaburagi. After detailed history and complete examination, patch testing was done using Indian Standard Series and graded by International Contact Dermatitis Research Group criteria at 48 hours and 72 hours.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 100 patients, there were 28 females and 72 males. The commonest age group seen was 20-40 years followed by 40-60 years. Commonest sensitizers were to potassium dichromate (34%) followed by nickel (18.7%), Parthenium (12.5%), PPD (7.8%), other (26%). Out of 64 patients who were positive, 82.8% were positive to single allergen, 10% to two allergens and 6.2% to multiple allergens.</p><p class="abstract"><strong>Conclusions:</strong> Patch test is considered as gold standard method for diagnosis of allergic contact dermatitis and thus preventing the morbidity of repeated episodes of eczema.</p>

Study of the clinical pattern of contact dermatitis over the face and its correlation with patch testing

<p class="abstract"><strong>Background:</strong> Contact dermatitis (CD) is an altered state of reactivity; occur due to direct contact with noxious agents in our environment. Face is a very common site for CD.</p><p class="abstract"><strong>Methods:</strong> Prospective hospital based study was conducted at A. J. Institute of Medical Sciences, Mangalore from June 2018 to November 2018. Fifty cases aged above 18 years with suspected allergic contact dermatitis (ACD) over face who gave written informed consent were enrolled. A complete history was taken and detailed clinical examination was done. Patch testing was done over the back in all patients which was removed after 48 hours and positive result was recorded based on the recommendation of the international Contact Dermatitis Research Group (ICDRG).<strong></strong></p><p class="abstract"><strong>Results:</strong> The most common clinical pattern observed was pigmented contact dermatitis(PCD) (70%), followed by irritation (6%), acneiform eruptions (5%) and contact urticaria (2%). Out of 50 patients, 20 patients developed CD to fragrances and perfumes. 14 patients developed to soaps and shampoos. On patch testing, most common allergen in fragrances/perfumes was fragrance mix (52.9%). In soaps and shampoos it was triclosan (68.4%), parabens (31.5%). Sesquiterpene lactone in parthenium plant (4%), Paraphenylenediamine in hair dye (8%). In face creams were gallate mix and cetrimide among metals, nickel and chromium (6%). In case of kumkum it was paraphenylenediamine (4%).</p><p class="abstract"><strong>Conclusions:</strong> Amongst the various patterns of contact dermatitis, PCD to cosmetics, fragrances and daily care products was most common pattern observed and the main allergens were triclosan, fragrance mix and balsum of Peru.</p>

Nickel Sensitivity in Rosacea Patients: A Prospective Case Control Study.

Rosacea is a frequently seen chronic disease. Certain allergens, some foods and beverages are known to trigger symptoms of rosacea. We aimed to assess if nickel sensitivity is more common in rosacea patients than the normal population. Fourty patients with rosacea and 40 healthy age and sex-matched volunteers were included in the study. From European standard patch test series, test units with nickel were applied on the skin of the upper back. According to the scheme of the International Contact Dermatitis Research Group (ICDRG), test results were evaluated at 48th, 72th and 96th hours. Seven days later, reevaluation was done for late reactions. Statistical analyses were done by using Statistics package for Social Sciences (SPSS) 17 package program and p<0.05 was accepted as statistically significant. Female/male ratio was 34/6 in patient group and 32/8 in control group. Mean age of the patient group and the control group were 39.97±12.65 (18-65 years), 40.82±11.79 (19-68 years), respectively. Age and sex distributions were found to be statistically similar. Nickel allergy in the patient and control group was found to be 52.5%, 22.5% respectively and the difference between groups was statistically significant (p=0. 006). Our results showed that there may be an association between nickel sensitivity and rosacea. Nickel sensitivity may be one of the underlying pathology or a triggering factor of the rosacea. Nickel restricted diet and avoiding the use of nickel-containing jewellery and piercings may extend the remission periods.

Contact sensitivity to textile dyes in patients with pigmented purpuric dermatosis

Purpose: The aetiology of pigmented purpuric dermatoses is unclear. Recent studies speculate about contact sensitivity to play a role in the aetiology of the disease. In most patients, the lesions begin and stay limited on the lower extremities as textile products are in tight contact with the skin. Also, textile dyes can cause contact dermatitis of purpuric type. This study was conducted in order to understand whether the contact sensitivity plays a critical role in the aetiology of pigmented purpuric dermatoses.Materials and methods: Patients with diagnosis of pigmented purpuric dermatoses were included in the study. Patch tests were applied at the back of all patients with textile series (Chemotechnique Diagnostics TF-1000) which have 33 allergens containing textile dyes, material and protectors by IQ Ultra Chamber. Test sites were evaluated at 48, 72, 96. h and on the 7th day according to the criteria of the International Contact Dermatitis Research Group. The evaluation results were recorded in patient files and the results were statistically compared.Results: Eighteen males (60%) and 12 females (40%), a total of 30 patients were included in the study. Schamberg disease in 23 patients (76.7%), lichen aureus in 5 patients (16.7%) and Majocchi disease in 2 patients (6.7%) were described out of total 30 patients. No contact sensitivity was detected in any of the patients.Conclusion: Contact sensitivity to textile dyes was not found as an etiologic factor in our study group.

Analysis of Hypersensitivity in Fragrance Series by Patch Testing.

Introduction:Allergic contact dermatitis (ACD) is an inflammatory disorder, which occurs as a result of repeated contact with an allergen. Fragrances are the products obtained naturally or produced synthetically. The purpose of this study is to detect the fragrance allergens producing ACD.Materials and Methods:This is an open-label prospective observational study. Patients of age above 18 years with history of using cosmetic products with dermatitis lesions over face, neck, axilla and hands were included. Patch testing was done with fragrance series by using the standard technique. The results were interpreted on day 2 and day 4 as recommended by International Contact Dermatitis Research Group criteria.Results:Totally 27 patients were included in this study. Of them, 12 were males and 15 were females; the mean age was 43 years. The mean duration of symptoms was 12.5 months. The most common site of involvement was hands. Housewives and office workers were the most commonly affected occupational groups. The most commonly used category of cosmetic product was talcum powders by 13 (48.1%) patients. In this study, 85.18% patients showed at least one fragrance antigen positivity. Fragrance mix II is the most frequent allergen in this study.Discussion:We conclude that the fragrance mix II is an important marker to find out fragrance allergy. Hand dermatitis is the most common presentation in patients with fragrance allergy. Perfumed talcum powders, soaps and perfumes are the leading sources of sensitization to fragrance allergens.

Evaluation of the Skin Irritation and Sensitization Potential of the Cussons Baby Sensicare Skin Range of Products in Healthy Volunteers

Introduction: The Cussons Baby Sensicare Range is a newly developed set of products specially formulated for newborn, sensitive and eczema prone skin. As such, these products need to be tested to evaluate their skin irritation and sensitization potential before use. The products were evaluated with two separate tests. The first test was conducted in a single-center, within-subject comparison using assessor-blind, randomised human skin irritation patch test (48 hour/96 hour exposure) and conducted on healthy adults with sensitive, atopic skin. The second test was conducted in a single-center, controlled (sterile water), within subject using human repeat-insult patch tests (HRIPTs) and conducted on healthy female Indonesian and Asian adult female subjects, with sensitive skin. The sensitization potential of each product was determined from International Contact Dermatitis Research Group (ICDRG) scores at 30 minutes, 24 hours, 48 hours and 72 hours after patch removal. Skin irritation tests show that all products were significantly lower than the positive control sodium lauryl sulphate (SLS) (p < 0.05) but not significantly different to the negative control (sterile water) in terms of irritation scores at the respective time points. HRIPTs results show that Cussons Baby Sensicare Range was non-sensitizing. As such, it can be concluded that the Cussons Baby Sensicare Range tested is well tolerated on skin and has low skin irritation and sensitization potential. Thus, they can be considered hypoallergenic on sensitive skin and suitable for eczema prone skin.

Foot eczema and footwear dermatitis: Role of patch test using Indian standard series and footwear series

Context: Foot eczema is a common complaint encountered in dermatology outpatient department. Footwear dermatitis forms an important exogenous cause of foot eczema. Patch testing helps in identifying possible allergens causing footwear dermatitis. Aims: This study aims to study the clinical profile of foot eczema and to evaluate patch test results in these patients. Subjects and Method: Fifty patients with foot eczema were included in the study and underwent patch testing with Indian standard series and footwear series. Patch test results were read as per International Contact Dermatitis Research Group guidelines. Statistical Analysis Used: Descriptive data are given as mean standard deviation. Differences between patients were assessed by unpaired “t”-test and frequency of parameters by the Chi-square test. Linear regression analysis was used, and correlation coefficients were calculated by Pearson's method. P

Patch Testing in Allergic Contact Dermatitis over the Lower Extremities.

Background:There is an increased incidence of allergic contact dermatitis (ACD) over the lower extremities due to over-the-counter topical preparations, occupational risk, and usage of several chemicals in the manufacture of designer footwear.Aims and Objectives:The aim of the study was to identify the common allergens and polysensitization pattern involved in ACD over the lower extremities.Materials and Methods:It is a cross-sectional study, wherein a total of 80 patients were recruited over a period of 18 months. Demographic and clinical characteristics were noted. Patch test was done with the Indian standard series. Interpretation of patch test readings was read according to the International Contact Dermatitis Research Group criteria at 48 and 96 h.Results:There were 45 males and 35 females (M:F= 1.3:1). Mean age was 41.65 years. Most of the patients belonged to 21–40 years age group. Farmers, homemakers, and students were commonly affected. Most common presentation was itching, hyperpigmentation, and scaly plaques over the feet. Patch test was performed in 75% of the patients. One or more positive results were observed in 57% of the patients. Common allergens noted were potassium dichromate (35%), followed by nickel sulfate (23.5%), mercapto mix, and mercaptobenzothiazole. Potassium dichromate and nickel were the common allergens reported in males and females, respectively. Neomycin was the common medication responsible for dermatitis medicamentosa. Polysensitization was seen with mercapto mix, mercaptobenzothiazole, potassium dichromate, and fragrance mix.Conclusion:Potassium dichromate and nickel were the common allergens responsible for ACD over the lower extremities. Polysensitization was seen commonly with mercapto mix, mercaptobenzothiazole, and fragrance mix.Recommendation:Screening for usage of topical preparations and late patch test readings (96 h or more) is recommended.

Absence of human skin irritation and allergenic potential after repeated patch applications of a lamellar moisturizer.

SummaryBackgroundNew cosmetic products should undergo clinical evaluation for skin sensitization potential.ObjectivesTo assess the irritation and sensitization potential of a moisturizer containing lamellar structured lipids after repeated patch application in humans, using human repeated insult patch test methodology.MethodsThis 6‐week, single‐center, open‐label study compared a lamellar moisturizer with negative saline control in human subjects aged 18‐70 years and skin phototype (Fitzpatrick) classification I–IV. During an initial induction phase, semi‐occlusive multi‐test patches were applied to the skin of participants’ backs three times per week for 3 consecutive weeks; clinical assessments were performed per International Contact Dermatitis Research Group criteria. Participants subsequently underwent a challenge phase, where a new patch was applied to a contact‐naïve area of the skin to assess sensitization to the moisturizer.ResultsThe study commenced with 233 voluntary participants, 214 of whom completed the study and underwent the final dermatological assessment. Most participants (232/233; 99.6%) demonstrated negative patch test results. One participant had a positive reaction at the lamellar moisturizer application site, with visible erythema and edema (classified as an adverse event [AE]); however, this reaction was observed 24 hours after a reaction to another product in the patch test panel (a prototype cleanser). Importantly, no skin reactions were detected during the challenge phase. Two participants had AEs of mild contact dermatitis in the area of patch adhesive application during the induction phase. No serious AEs occurred during the study.ConclusionsThese findings suggest that the lamellar moisturizer has low irritant and allergenic potential.

Analysis of Epicutaneous Patch Test Results in Patients with Contact Dermatitis.

Background:Allergic contact dermatitis (ACD) is a delayed type of hypersensitivity from contact with a specific allergen to which the patients has developed a specific sensitivity. The aim of the study was to evaluate the results of epicutaneous patch testing with standard series of contact allergen in patients suspected to have ACD.Methods:355 cases of ACD were included in the study. Test substances were applied on the upper part of the patient’s back, on clinically uninvolved and untreated skin. All patients were free from therapy with oral antihistamines, steroids and immunosuppressants. The patch test was removed and reaction were evaluated after 48 h and 72 h. Grading of negative (-) to positive (+ to ++++) patch test was done according to the International Contact Dermatitis Research Group. Statistical data analysis was performed by using χ2–test.Results:Of the 355 cases, 146 patients were male (41.1%) and 209 were female (58.9%). The youngest patients in the study was 16 years of age and the oldest was 67 years of age. The commonest age group affected was 41-50 years. Hands were the most common site of involvement. The occupational character of skin lesions was find in 75 (21.1%). The most common positive reactions were recorded to nickel sulphate 99 (27.8%), cobalt chloride 46 (12.9%), thimerosal 31 (8.7%), colophony 23 (6.5%), carba mix 21 (5.9%), potassium dichromate 20 (5.6%), acid chromici 19 (5.3%), fragrance mix 18 (5%), balsam of Peru 13 (3.7%), formaldehyde 9 (2.5%), and other allergens 26 (7.3%). Females were significantly more likely to show a positive response to two or more allergens (p<0.05). There was no statistically significant impact of age, occupation and duration of disease on results of patch testing (p>0.05).Conclusions:Our results indicate that nickel sulphate, cobalt chloride and thimerosal are the most common allergens responsible for induction of ACD. These findings are crucial in the treatment, long term management, an education of patients with ACD.

Development of Novel Faster-Dissolving Microneedle Patches for Transcutaneous Vaccine Delivery.

Microneedle (MN) patches are promising for transcutaneous vaccination because they enable vaccine antigens to physically penetrate the stratum corneum via low-invasive skin puncturing, and to be effectively delivered to antigen-presenting cells in the skin. In second-generation MN patches, the dissolving MNs release the loaded vaccine antigen into the skin. To shorten skin application time for clinical practice, this study aims to develop novel faster-dissolving MNs. We designed two types of MNs made from a single thickening agent, carboxymethylcellulose (CMC) or hyaluronan (HN). Both CMC-MN and HN-MN completely dissolved in rat skin after a 5-min application. In pre-clinical studies, both MNs could demonstrably increase antigen-specific IgG levels after vaccination and prolong antigen deposition compared with conventional injections, and deliver antigens into resected human dermal tissue. In clinical research, we demonstrated that both MNs could reliably and safely puncture human skin without any significant skin irritation from transepidermal water loss measurements and ICDRG (International Contact Dermatitis Research Group) evaluation results.

Role of contact allergens in chronicity and relapses of nummular eczema

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Endogenous eczemas are often complicated by exogenous factors like environment and contact allergens. Nummular eczema, a variant of endogenous eczema is no exception to this. Our study aimed at investigating the incidence of allergic contact dermatitis and finding offending agent responsible for chronicity or relapsing course of nummular eczema in patients from a hilly region with cold and dry environmental conditions&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Forty patients of nummular eczema with a mean age of 39.1±19 years were patch tested with the Indian Standard Patch Test Series. Positive reactions were graded as per recommendations of International contact dermatitis research group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Twenty one out of forty patch tested patients showed positive reactions. The most common allergens were found to be: fragrance mix in seven (17.5%) patients, nickel in five (12.5%) patients, PPD in three (7.5%) patients and gentamicin in two (5%) patients. Sensitivity to thiuram mix, black rubber mix, P. tert. butylphenol formaldehyde, neomycin, benzocaine and chinoform was observed in one patient each (2.5% each)&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patients of nummular eczema of a hilly region are at a significant risk of developing allergic contact dermatitis owing to xerosis due to dry environmental conditions. This results in chronic nature of their disease. Patch testing should be considered in such patients and avoidance of offending allergens can improve their quality of life&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Multicenter Patch Testing With Methylchloroisothizoline/Methylisothiazolinone in 100 and 200 ppm Within the International Contact Dermatitis Research Group.

The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known contact sensitizer. Historically, there have been different opinions on the optimal patch test concentration of MCI/MI, and both 0.01% and 0.02% aqueous (aq.) have been proposed. In 2011, based on literature reviews, it was recommended that the concentration of 0.02% aq. should be used in the international baseline series. The aim of this study was to verify the recommendation from 2011 by comparing the patch test results from consecutive patch testing with MCI/MI 0.01% and 0.02% in clinics representing countries around the world. Two thousand seven hundred three consecutive patients with dermatitis in 8 dermatology clinics representing 8 countries were patch tested with MCI/MI 0.01% aq. and, in parallel with MCI/MI 0.02% aq., provisionally included in the baseline series. Contact allergy to MCI/MI at 0.01% and 0.02% was found in 3.7% and 5.6% of the patients, respectively (P < 0.001). Methylchloroisothiazolinone/MI 0.02% aq. (dose, 6 μg/cm) diagnoses significantly more contact allergy than 0.01% (dose, 3 μg/cm), without resulting in more adverse reactions. Methylchloroisothiazolinone/MI at 0.02% aq. should therefore be continuously used in the international baseline series.

Nickel sensitivity in patients with gastroesophageal reflux disease

Objective: Various foods play important role in the pathogenesis of gastroesophageal reflux disease (GERD). These foods are shown to increase gastroesophageal reflux symptoms via various mechanisms and majority of these foods also contain nickel. The purpose of this study is to evaluate the relationship between Nickel sensitivity and GERD.Material and methods: Fifty-four patients diagnosed with GERD and 50 healthy volunteers who were admitted to our gastroenterology outpatient clinic were took part in the study. European standard patch test series, nickel-containing test units and corticosteroids were applied to the patient body; upper back. Evaluation was performed according to the scheme of the International Contact Dermatitis Research Group (ICDRG). The positive and negative reactions were recorded at the hours of 48, 72 and 96. Following the test implementations, 7 days later, the tests were reevaluated for late reactions. Statistics package for Social Sciences (SPSS) 17 package program was used for statistical evaluation and results of tests were compared between groups with the Chi-squared test. p < 0.05 was considered statistically significant.Results: Individuals in both groups were statistically similar in terms of age and gender. Nickel sensitivity was found to be positive in 48.2 and %22 of the GERD patients and control group, respectively. Difference between groups was statistically significant (p = 0.008).Conclusions: Nickel sensitivity was significantly higher in GERD patients compared to the control group. In addition to imbalance between defensive and aggressive forces of the esophagus, there seems to be an association between nickel sensitivity and GERD.

Place du patch-test dans le diagnostic des réactions d’hypersensibilités retardées induites par les antiépileptiques

Antiepileptic drugs are widely used and are associated with numerous side effects including skin eruptions. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to evaluate the profitability of epicutaneous tests in delayed hypersensitivity reactions induced by antiepileptic drugs. We analyzed all cases of allergic skin reactions to antiepileptic drugs notified in regional pharmacovigilance center of Sfax (Tunisia) between June 1, 2014and April 30, 2016. The imputation score, determined using the French imputation method, should be at least doubtful. Patch-tests were performed in accordance with the general Europen network on Drug Allergy/European Academy of Allergy and Clinical Immunology (ENDA/EAACI) guidelines. Patch-tests were read according to the generally accepted criteria of the International contact dermatitis research group (ICDRG). In our study, 20patients were included, among which 23events were observed. The drug involved in delayed hypersensitivity reactions was carbamazepine in 11cases, phenobarbital in 10cases and valproic acid in 4cases. The clinical reactions caused by the drug were classified as maculopapular exanthema (11cases), DRESS syndrome (6cases), Stevens-Johnson syndrome (2cases), fixed drug eruption (2cases) and erythroderma (2cases). Patch-tests were positive in 19patients (95%). Cross-reactivity between antiepileptic drugs was observed in 4cases: between valproic acid and carbamazepine in 2cases between valproic acid and phenobarbital in 1case and between phenobarbital and carbamazepine in 1case. In this study, patch testing was a safe and useful method in confirming the culprit drug in delayed hypersensitivity reactions induced by antiepileptic drugs.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy.

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

ESCD invited speaker abstracts: Focus Sessions

The introduction of a methoxymethyl side chain into para-phenylenediamine (PPD) resulted in the development of a new hair dye molecule: 2-methoxymethyl-para-phenylenediamine (Me-PPD). Besides having excellent hair colouring properties, this PPD derivate has significantly lower skin-sensitizing properties than PPD and toluene-2,5-diamine. In a simulated hair dye model (i.e. open-use test), cross-reactivity to Me-PPD occurred in PPD-allergic individuals, but the number of cross-reactors was substantially lower than one would expect in an open-use test with a PPD-containing hair dye. Patch testing with Me-PPD has never been performed. The current study aimed to find the optimal patch-test concentration for detecting cross-reactivity to Me-PPD. PPD-allergic patients with a documented history of hair dye-related allergy, and different grades (+, ++, +++) of positive patch-test reactions to PPD, will be included in the study. Patch testing will be performed with Me-PPD 0.1%, 0.25%, 0.5%, 1.0% and 2.0% in petrolatum. In a simulated hair dye use model on the volar forearm, the reactivity to use concentrations of Me-PPD 2% and PPD 2% will be investigated. On the adjacent skin a similar open-use test with the same basic formula, but without Me-PPD or PPD, will be applied as a control. After 45min the hair dye will be removed from the skin surface by rinsing with water. Reading of the patch tests and the open-use tests will be performed at days 2, 3 and 7, according to the International Contact Dermatitis Research Group reading criteria. In total 30 PPD-allergic individuals will be included in this Me-PPD dose-finding pilot study. At the moment a number of individuals have been enrolled; full data will be available at the meeting.

Patch Test as a Diagnostic Tool in Hand Eczema.

Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country. To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing. This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test. Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate. Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Multicenter Patch Testing With a Resol Resin Based on Phenol and Formaldehyde Within the International Contact Dermatitis Research Group.

Contact allergy to phenol-formaldehyde resins (PFRs) based on phenol and formaldehyde is not detected by a p-tertiary-butylphenol-formaldehyde resin included in most baseline patch test series. The aims of this study were to investigate the contact allergy rate to PFR-2 in an international population and to investigate associated simultaneous allergic reactions. Thirteen centers representing the International Contact Dermatitis Research Group included PFR-2 into their patch test baseline series during a period of 6 months in 2012. Of 2259 patients tested, 28 (1.2%) reacted to PFR-2. Of those 28 individuals, one had a positive reaction to formaldehyde and 2 to p-tertiary-butylphenol-formaldehyde resin. Simultaneous allergic reactions were noted to colophonium in 3, to Myroxylon pereirae in 5, and to fragrance mix I in 8. The contact allergy frequency in the tested population (1.2%) merits its inclusion into the international baseline series and possibly also into other baseline series after appropriate investigations. Significantly, overrepresented simultaneous allergic reactions were noted for M. pereirae and fragrance mix I.