Management Of Allergic Contact Dermatitis Research Articles

681 Patient satisfaction with health care in management of allergic contact dermatitis

681 Patient satisfaction with health care in management of allergic contact dermatitis

Trends in Patch Testing of Black Patients: The Mayo Clinic Decade Experience (January 1, 2011, to December 31, 2020)

Background: Trends in patch testing for allergic contact dermatitis (ACD) have not been well characterized in Black patients. Despite similar incidence of ACD in Black and White patients, there are differences in allergen profiles. Understanding patch testing trends in Black patients furthers knowledge that has considerable impact on the management of ACD in the Black population. Objective: The purpose of this study was to review the results of patch testing in Black patients at Mayo Clinic over a decade. Methods: We retrospectively reviewed the results of patch testing to the standard, extended standard, or hairdresser series in 149 Black patients seen at Mayo Clinic (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL) from January 1, 2011, to December 31, 2020. Results: During the 10-year period, 149 Black patients (mean age, 49.2 years [SD, 17.1 years]; female 67.1%) were patch tested at Mayo Clinic to the standard, extended standard, or hairdresser series. Most common sites of dermatitis were generalized (30.9%), hands (18.8%), leg (16.8%), trunk (16.1%), and arm (14.8%). Overall, 109 patients (73.2%) had at least 1 positive reaction and 74 patients (50%) had 2 or more positive reactions. Overall, the 10 allergens with the highest reaction rates (from highest to lowest) identified in our study population were 4-amino-2-hyroxytoluene (33.3%), thimerosal (20.4%), nickel sulfate (18.9%), methylisothiazolinone (16.5%), methyldibromo glutaronitrile (13.4%), methyldibromo glutaronitrile/phenoxyethanol (12.5%), captan (12.5%), carmine (12.5%), methylchloroisothiazolinone/methylisothiazolinone (11.5%), and hydroperoxide of linalool 1% (11.3%). Conclusions: We describe patch test results in Black patients over a decade at Mayo Clinic. The top 10 allergens were preservatives, hair dyes, and fragrances. Differing patterns of allergens may occur in Black patients due to different patterns of exposures related to cultural practices.

Photographic Evidence of Management of Allergic Contact Dermatitis with Graphites 30C - A Case Report

One of the major occupational risks for people working in the construction or cement industries is allergic contact dermatitis, which frequently affects the workers' quality of life and results in significant financial loss. The hands of cement workers come into touch with cement on a frequent basis, making them susceptible to developing hand contact dermatitis again and making a full recovery exceedingly challenging. The contact dermatitis in homoeopathy has been the subject of numerous prior researches. This case study demonstrated the effectiveness of the homoeopathic drug Graphites 30C on allergic contact dermatitis, with slow improvement at first and full recovery at the end.

Circadian rhythm affects the magnitude of contact hypersensitivity response in mice.

The circadian rhythm controls multiple biological processes, including immune responses; however, its impact on cutaneous adaptive immune response remains unclear. We used a well-established cutaneous type IV allergy model, contact hypersensitivity (CHS). We induced CHS using dinitrofluorobenzene (DNFB). Mice were sensitized and elicited with DNFB in the daytime or at night. In mice, a nocturnally active animal, we found that ear swelling increased when mice were sensitized at night compared with in the daytime. In addition, cell proliferation and cytokine production in the draining lymph nodes (LNs) were promoted when sensitized at night. We hypothesized that these differences were due to the oscillation of leukocyte distribution in the body through the circadian production of adrenergic hormones. Administration of a β2-adrenergic receptor (β2AR) agonist salbutamol in the daytime decreased the number of immune cells in blood and increased the number of immune cells in LNs. In contrast, a β2AR antagonist ICI18551 administration at night increased the number of immune cells in blood and decreased the number of immune cells in LNs. Accordingly, the severity of CHS response was exacerbated by salbutamol administration in the daytime and attenuated by ICI18551 administration at night. Our study demonstrated that the magnitude of adaptive CHS response depends on the circadian rhythm and this knowledge may improve the management of allergic contact dermatitis (ACD) in humans.

What We Have Learned-Milestones in Pediatric Contact Dermatitis.

Purpose of ReviewThis review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children.Recent FindingsACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use.SummaryACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.

Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis

Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens. To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances. A 17-year, retrospective cross-sectional analysis (January 1, 2001, to December 31, 2018) of North American Contact Dermatitis Group (NACDG) data from multiple centers in North America was conducted. A total of 43 417 patients with dermatitis underwent patch testing to the NACDG screening series in a standardized manner with 65 to 70 allergens and supplemental allergens as clinically indicated. Patients with 1 or more clinically relevant reactions to a supplemental (nonscreening) allergen/substance were analyzed between November 18, 2020, and March 12, 2021. The main outcomes were to assess the number of patients with clinically relevant reactions to supplemental (nonscreening) allergens and compare characteristics (including demographic characteristics and occupations) between patients with a clinically relevant patch test reaction to 1 or more supplemental allergens or substances (supplement-positive) and those without a reaction (supplement-negative) using odds ratios (ORs) and 95% CIs. Secondary outcomes included sources of allergic contact dermatitis and, for occupationally related cases, specific occupations and industries. Of 43 417 patients included in the study who underwent patch testing to the NACDG screening series (65-70 allergens), 9507 individuals (21.9%) had currently relevant reactions to 1 or more supplemental allergens or substances. Of these, 6608 were women (69.5%) and the mean (SD) age was 47.2 (0.54) years. Compared with patients who had supplement-negative results, patients with supplement-positive findings were significantly less likely to be male (OR, 0.90; 95% CI, 0.85-0.94; P < .001) and/or have atopic dermatitis (OR, 0.89; 95% CI, 0.84-0.93; P < .001). Common primary sites of dermatitis in 9499 patients with supplement-positive findings included the face (2856 [30.1%]), hands (2029 [21.4%]), and scattered/generalized distribution (1645 [17.3%]). Frequent sources of supplemental allergens in 9235 patients included personal care products (4746 [51.4%]) and clothing/wearing apparel (1674 [18.1%]). Of 9362 patients with available data, supplemental allergens/substances were occupationally related in 1580 (16.9%); of those with identified occupations, 25.1% (384 of 1529) were precision production, craft, or repair workers. Of 9507 patients with supplement-positive findings, 2447 (25.7%) had no currently relevant reactions to NACDG screening allergens. This cross-sectional study found that 21.9% of patients who underwent patch testing to an allergen screening series of 65 to 70 allergens had at least 1 relevant reaction to supplemental allergens/substances. Of these, one-quarter reacted only to a supplemental allergen/substance. Screening series include common, important allergens, but these findings suggest that the addition of specialty allergens and personal or work products is critical for the successful diagnosis and management of allergic contact dermatitis.

Patch Test Practice Patterns of Members of the American Contact Dermatitis Society.

Patch testing is the criterion standard for diagnosis and management of allergic contact dermatitis. Limitations on the number of allergens tested can negatively impact patient care. This study reports clinical practice patterns of American Contact Dermatitis Society (ACDS) members. In October and November 2018, the US-based members of the ACDS received an electronic survey regarding their procedures and experiences with patch testing. We evaluated the type of practice, number of patients tested, type of screening and supplemental series, number of allergens tested, and billing and reimbursement concerns. There were 149 respondents; 62% use ACDS Core 80, 70% "sometimes" or "always" test with supplemental series, and 70% "sometimes" or "always" test patient products. Participants estimated that supplemental series identify relevant allergens 35% of the time. Approximately 66% most commonly test more than 81 allergens per patient, and 78% expressed concerns regarding fair reimbursement. Most ACDS members routinely test more than 81 allergens per patient. Barriers to fair payment for beyond a fixed number of patches at any one visit may impede the diagnosis of allergic contact dermatitis, prolong suffering, and worsen outcomes.

Management of allergic contact dermatitis with Ayurvedic intervention

Contact dermatitis is an inflammatory process in the skin caused by an exogenous agent or an agent that directly or indirectly injures the skin. Agents that cause allergic contact dermatitis (ACD) induce an antigen, a specific immune response. Available treatment protocols in modern are identification and avoidance of causative allergens, topical or systemic corticosteroids which will lead complications in future. It was critically reviewed in the context of Vicharchika (eczema). In this case report, a female patient suffered from ACD for 1 year. First, she took allopathic medicine but was not benefited. Then she was treated with Ayurvedic formulations, Panchnimbadi churna, Panchatikta ghrit, sudh gandak, swarna gerik, amrita satva, haritaki churna and purodil ointment for 15 days. After 2 months of treatment, the improvement was noticed in symptoms like severe itching, redness and burning sensation in the skin. The line of treatment followed in this case was to treat provoked pitta dosha, vitiated Twaka, mamasa, vasa, and am

Survey of Patch Test Business Models in the United States by the American Contact Dermatitis Society.

Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges. This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges. All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement. A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support. Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.

A study on correlation between allergen and allergic contact dermatitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Agents which cause contact dermatitis are simple chemical compounds and by themselves these agents will not cause sensitization and are called haptens. These require another molecule usually a protein called the carrier molecule derived from the epidermis to cause allergic sensitization. The confirmation of contact dermatitis is done by the patch testing. There is no substitute for the patch test in the management of allergic contact dermatitis.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;After selecting the patient suspected to have allergic contact dermatitis the findings were recorded in the proforma which also includes the systemic examination of CVS, CNS, GIT and respiratory system to study systemic correlation if any. Investigation were done which included Hb%, TLC, DLC, urine routine and microscopic examination, patch testing and other special investigations if required. The patient was subjected to patch testing after the acute stage has subsided and the patient was on no therapy with topical or systemic steroids prior to patch testing&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The incidence of allergic contact dermatitis due to cosmetics was found in 7 (5.6%) cases. In that hair dye (PPD) inducing dermatitis was found in 4 (57.4%) and due to hair oil 1 (14.2%), kumkum 1 (14.2%) and Sunsilk shampoo 1 (14.2%). The incidence of PPD sensitivity in this series of 125 cases was 4 (3.2%). &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;PPD is a well-known potent sensitizer, it is a chief constituent of the commonly used hair dyes and also some other cosmetics like nail polish.&lt;/span&gt;&lt;/p&gt;

Diagnosis and management of allergic contact dermatitis in children: common allergens that can be easily missed.

Contact dermatitis is an economically burdensome pediatric disease, and it is important to know the top allergens that have remained as top offenders for over the last decade. A comparative analysis of the 20-allergen screen was done against the current top 40 pediatric allergens, and it revealed that the 20-allergen screening series would have theoretically only captured 47.5% of the relevant contact allergens (52.5% failure to detect rate). In addition, the T.R.U.E. Test (SmartPractice, Phoenix, Arizona, USA) would have revealed 60% of the top 40 allergens (40% failure to detect rate). Patch testing in children has become a more common practice, and management requires the identification and avoidance of the offending allergen from the sensitized person's environment.

Drug-loaded poly(d,l-lactide-co-glycolide) microspheres as treatment for allergic contact dermatitis in mice model

Allergic contact dermatitis is a common skin disease and the current treatment always along with frequent medication and side effect. In this research, poly(d,l-lactide- co-glycolide) microspheres encapsulating tacrolimus are first employed as a therapy of allergic contact dermatitis in mice model by subcutaneous injection. Allergic contact dermatitis is successfully induced in BALB/c mice by repeated painting of dinitrofluorobenzene on mice ear. Tacrolimus is efficiently encapsulated into poly(d,l-lactide- co-glycolide) microspheres by emulsion evaporation method, and then the microspheres are subcutaneously injected into dermatitis-suffered BALB/c mice. We find that the dermatitis mice treated with tacrolimus-loaded microspheres get a sustained suppression on ear swelling, dermatitis index, inflammatory cell accumulation, and serum immunoglobulin E concentration. The curative effect of tacrolimus-loaded microspheres is similar to daily tacrolimus injection and is even better in the inhibition of ear swelling. Dermatitis mice treated with blank microspheres get no curative effect during the whole experiment. The data suggest that subcutaneous injection of drug-loaded microspheres could be a potential candidate for the management of allergic contact dermatitis.

Allergic Contact Dermatitis to Fragrances: Part 2

Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix i, fragrance mix ii, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances.

Dermatitis de contacto alérgica por fragancias. Parte II

Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix i, fragrance mix ii, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances.

Allergic Contact Dermatitis from Formaldehyde Textile Resins

Formaldehyde-based resins have been used to create permanent-press finishes on fabrics since the 1920s. These resins have been shown to be potent sensitizers in some patients, leading to allergic contact dermatitis. This review summarizes the history of formaldehyde textile resin use, the diagnosis and management of allergic contact dermatitis from these resins, and current regulation of formaldehyde resins in textiles.

Patch test reaction on Ethiopian subjects with eczema

Allergic contact dermatitis is a common condition with an incidence of 1-10% in the general population. An increasing number of allergens in the environment are responsible for the condition. These allergens can be identified using patch testing. Many countries have a standard series of common allergens used for patch testing. There is no standard series of allergens in Ethiopia, and our objective was to obtain baseline data for common allergens for future standardization. One hundred and eighty-one subjects with eczema were patch tested using 17 selected allergens from Chemotechnique Diagnostics AB employing a standard procedure. Positive patch test reactions were detected in more than 60% of subjects, the most common allergen being nickel, followed by fragrance mix and butylphenolformaldehyde. A higher incidence of positive reactions was seen in females. A high incidence of positive patch test reactions was identified in the study population, and the introduction of patch testing in Ethiopia is essential for the management of allergic contact dermatitis.

A comparison of statistical approaches to the derivation of EC3 values from local lymph node assay dose responses

Effective risk assessment and management of allergic contact dermatitis require three key factors: adequate hazard identification, measurement of the relative potency of identified hazards and an understanding of the nature, extent and duration of exposure. Suitable methods for hazard identification, such as the murine local lymph node assay (LLNA) and the guinea-pig maximization test, are well established and conditions of human exposure normally can be well anticipated. Thus, the need is for a robust and quantitative method for the estimation of relative skin sensitizing potency. One possible approach is via the analysis of LLNA dose–response data, In the LLNA, contact allergens are defined currently as those chemicals that cause a threefold or greater increase in lymph node cell proliferative activity compared with concurrent vehicle-treated controls. It is possible to estimate the concentration of a sensitizer required to generate a threefold stimulation of proliferation in draining lymph nodes; such a concentration is known as the EC3 value. Using a variety of statistical approaches to derive EC3 values from LLNA dose–response data for 10 chemicals, it has been demonstrated that simple linear interpolation between the values either side of the threefold stimulation index provides a robust assessment of the EC3 value without the need for recourse to more sophisticated statistical techniques. Provided that the appropriate concentrations of test chemical have been selected, EC3 values obtained in this way are reproducible both within and between laboratories and form the basis for examination of the utility of this approach for the estimation of relative skin sensitizing potency.

A comparison of statistical approaches to the derivation of EC3 values from local lymph node assay dose responses

Effective risk assessment and management of allergic contact dermatitis require three key factors: adequate hazard identification, measurement of the relative potency of identified hazards and an understanding of the nature, extent and duration of exposure. Suitable methods for hazard identification, such as the murine local lymph node assay (LLNA) and the guinea-pig maximization test, are well established and conditions of human exposure normally can be well anticipated. Thus, the need is for a robust and quantitative method for the estimation of relative skin sensitizing potency. One possible approach is via the analysis of LLNA dose-response data. In the LLNA, contact allergens are defined currently as those chemicals that cause a threefold or greater increase in lymph node cell proliferative activity compared with concurrent vehicle-treated controls. It is possible to estimate the concentration of a sensitizer required to generate a threefold stimulation of proliferation in draining lymph nodes; such a concentration is known as the EC3 value. Using a variety of statistical approaches to derive EC3 values from LLNA dose-response data for 10 chemicals, it has been demonstrated that simple linear interpolation between the values either side of the threefold stimulation index provides a robust assessment of the EC3 value without the need for recourse to more sophisticated statistical techniques. Provided that the appropriate concentrations of test chemical have been selected, EC3 values obtained in this way are reproducible both within and between laboratories and form the basis for examination of the utility of this approach for the estimation of relative skin sensitizing potency.

An Economic Evaluation of Patch Testing in the Diagnosis and Management of Allergic Contact Dermatitis

An Economic Evaluation of Patch Testing in the Diagnosis and Management of Allergic Contact Dermatitis

An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis

Background : A previous retrospective study indicated that patch testing is cost-effective and well accepted by patients. Objective : The objective of this observational prospective study was to show the cost-effectiveness of patch testing in patients suspected of allergic contact dermatitis (ACD) and to determine the order in which different severity groups rank in terms of cost-effectiveness. Methods : This observational study was conducted in 567 patients from 10 investigator sites over a period of 1 year. All patients with a suspicion of contact allergy who exhibited at least moderate disease activity were included in the study and were stratified according to disease severity and whether or not they were patch tested. In each severity category, the cost-effectiveness of patch testing was evaluated. Patients who were ruled out for contact allergy by the first 6 months after admission were excluded. A validated dermatology-specific quality of life instrument was administered to all the patients at entrance into the study and at 6 and 12 months after that. The cost-effectiveness analysis is shown using a decision analysis model. Results : Patch testing was performed on 22% of patients with mild disease, 41% of patients with moderate disease, and 50% of patients with severe disease. As a result of changes made in their lifestyle, 66% in the patch-tested group and 51% in the non-patch-tested group reported 75% or more improvement in disease symptoms after 6 months. Early confirmation of diagnosis helped reduce the prediagnosis costs of treatment, which was mostly based on preliminary diagnosis. The greatest quality of life benefits from patch testing, relative to no patch testing, occurred in subjects with recurrent or chronic ACD. Conclusion : Patch testing is most cost-effective and reduces the cost of therapy in patients with severe ACD.