Contact Dermatitis Research Articles

Allergic Contact Dermatitis Associated With Men's Personal Care Products: A Review of Allergens.

Personal care product usage is becoming increasingly prevalent among men due to evolving attitudes surrounding appearance, aging, and masculinity. Given the specific characteristics of male skin compared with female skin and varying product use between males and females, the occurrence of allergic contact dermatitis (ACD) due to men's personal care products needs to be better characterized. The purpose of this review was to identify specific product types and ingredients causing ACD in males. PubMed search was conducted from conception to present day using keywords pertaining to male personal care product use. Case reports, case series, and case-control studies reporting a diagnosis of ACD due to a personal care product ingredient were analyzed. Products resulting in ACD included aftershave, cologne, deodorant, hair dye, hair gel, hair loss preparation, hand cleanser, lip balm, moisturizer, shampoo, and sunscreen. Although >90 allergens resulting in ACD were identified, the 5 most common allergens included para-phenylenediamine, minoxidil, musk ambrette, methylisothiazolinone, and cocamidopropyl betaine. Following this review, clinicians should be better able to recognize men's personal care products that commonly result in ACD, as well as specific allergens present across multiple product types. Doing so will lead to improved diagnosis and treatment of ACD due to personal care product usage in men and, in doing so, guide both clinical practice and future investigation in this area.

Potential for Allergic Contact Dermatitis in Popular Depilatory Wax Hair Removal Practices and Ingredients.

Allergic contact dermatitis (ACD) is a type IV delayed hypersensitivity reaction that can commonly arise from exposure to allergens in personal care and cosmetic products. Depilatory waxing, a common hair removal practice, involves the use of various products that may contain potential contact allergens. There is limited literature discussing ACD to hair removal products. We aim to discover the most common allergens prevalent in depilatory waxing products used in a popular wax center in the United States and those found in online marketplaces. Through communication with the salon staff, we reviewed the involved products and analyzed all ingredients for common allergens. We also conducted an online search to examine the ingredients and the most common allergens of the top 10 bestselling wax strips across four selected online marketplaces (CVS, Amazon, Walmart, and Walgreens). The final query of online products consisted of 12 distinct wax products and 10 postwax products. Among the products used in the salon, the most common allergens were vitamin E, colophony, botanicals, fragrance, beeswax/propolis, and color additives, in descending order. The most frequent allergens commonly encountered in online wax products included color additives, found in 67% (8/12) products, followed by botanicals and colophony, both present in 58% (7/12) products. In the postwax products, the most frequent allergen was vitamin E present in 100% (10/10) of the products, followed by fragrance (8/10). Although these allergens do not frequently cause ACD, it remains crucial to identify and note them in hair removal products to address any potential cases. Raising awareness of these allergens in all steps of hair removal can help ensure the safety and comfort of patients undergoing waxing treatments.

Immune response to topical sodium lauryl sulfate differs from classical irritant and allergic contact dermatitis.

Sodium lauryl sulfate (SLS) is used as a control irritant in patch testing for allergic contact dermatitis (ACD). However, up to 20% of those tested react to SLS, whereby the pathophysiological basis of this reaction is still unclear. To mimic patch test reactions, we repeatedly applied SLS to the skin of wild-type mice. Reactions were compared with those in a classical ACD model induced by oxazolone and an irritant contact dermatitis (ICD) model induced by croton oil. Skin inflammation was assessed with ear thickness measurements, immunohistochemistry, qRT-PCR, and flow cytometry. Topical SLS treatment was further investigated in Flg/Hrnr-/-, Myd88/Tlr3-/-, and Rag1-/- mouse models. All three compounds caused ear swelling with different courses. Oxazolone treatment, compared with the ICD model, resulted in a greater influx of immune cells (CD4+, MHCII+, CD11b+). Similarly, SLS did not induce immune cell infiltration or expression of selected inflammatory and regulatory cytokines. SLS induced the most pronounced keratinocyte proliferation. Compared with wild-type mice, topical SLS application did not increase ear swelling in skin barrier deficient Flg/Hrnr-/- mice, but led to significantly delayed swelling in mice with defects in innate or adaptive immune functions (Myd88/Tlr3-/-, Rag1-/-). SLS-induced contact dermatitis differed from classical ACD and ICD, as it elicited less pronounced immune alterations. Skin barrier impairment does not affect SLS-induced contact dermatitis, whereas both innate and adaptive components are involved in SLS skin reactions.

Performance and safety of transparent postoperative dressings with silicone adhesive in daily practice on fragile skin.

Currently there is limited real-world research on the adhesion qualities, pain and clinical performance of specific silicone adhesives products, and their role in maintaining skin integrity and preventing medical adhesive-related skin injuries (MARSI). This paper presents a clinical evaluation of performance and safety parameters of two silicone adhesive dressings on lacerations or surgical wounds and the surrounding skin in daily practice on fragile skin. An observational, prospective, multicentre, uncontrolled post-market clinical observational study with Leukomed T skin sensitive and Leukomed T plus skin sensitive (both BSN medical GmbH, Essity Group) was undertaken at three sites across Germany between June 2021 to November 2022. Inclusion parameters were acute wounds (surgical or laceration) in patients with at least one fragile skin condition. Endpoints included: the percentage of adhered dressing area seven days after application of the dressings; and evaluation of any signs of skin damage and erythema following dressing removal. Furthermore, self-reported patient pain, comfort during dressing wear, and the health professionals' ease of dressing handling with gloves were assessed. A total of 42 patients with fragile skin and surgical wounds (35 patients) or lacerations (7 patients) were recruited. Mean age was 78 years. There were no signs of erythema following dressing removal and no MARSI (skin stripping, blister, skin tears, maceration, irritant contact dermatitis or allergic dermatitis) occurred at removal after seven days of wear time. Data demonstrated a reliable wound coverage with sufficient adhesion without negatively affecting the periwound skin and wound improvement was observed in 94% of patients. The vast majority of patients reported minimal pain at removal, reduced wound pain and high satisfaction with wearing comfort. Health professionals found the dressings easy to apply and remove, even with gloved hands. The results of this real-world evidence showed effective and well-tolerated use of transparent dressings with silicone adhesive in patients with fragile skin. The dressings may reduce the risk of skin damage including MARSI, while providing patients a high wearing comfort and allowing an almost pain-free dressing change.

Contact allergy to neomycin in consecutively patch tested Danish eczema patients from 2000 to 2023: A cross-sectional study.

Neomycin is an aminoglycoside antibiotic that may cause contact allergy. It was withdrawn as a medicine for human use in Denmark in October 2009 but is still found in some vaccines. To identify time trends in contact allergy to neomycin in the period from 2000 to 2023. A cross-section study of patients ≥18 years consecutively patch-tested with neomycin sulfate (20% in pet.) at Gentofte Hospital, Denmark, during the period 2000-2023 was conducted. The overall prevalence of contact allergy to neomycin was 1.4%. The prevalence was significantly lower in the period '2010-2023' (1.2%) than in '2000-2009' (1.8%) (p < 0.005). Contact allergy to neomycin was significantly positively associated with facial dermatitis and age >40 years, and significantly negatively associated with occupational dermatitis and hand dermatitis. No changes in sex, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, or age > 40/≤40 (the MOAHLFA-index) were identified when comparing neomycin contact allergic-patients in the two periods '2010-2023' and '2001-2009'. Neomycin is a rare cause of contact allergy in Denmark with a significantly lower prevalence following its withdrawal as a medicinal product for human use in Denmark in 2009.

Acetylation of reed (Arundo donax) to prevent the contact dermatitis of woodwind musicians

Acetylation of reed (Arundo donax) to prevent the contact dermatitis of woodwind musicians

Angioedema-like allergic contact dermatitis in a pediatric patient due to an eyebrows dye.

Angioedema-like allergic contact dermatitis in a pediatric patient due to an eyebrows dye.

Allergic Contact Dermatitis in Pediatric Practice.

Allergic contact dermatitis (ACD) is prevalent among pediatric population, adolescent and young adults. Patients with ACD experience a lot of sociopsychological and qualityof- life (QoL) difficulties. Children and their caregivers alike are vulnerable to the burden of ACD. We have, in this paper, provided an overview of ACD and discussed common and unusual causes of ACD. We performed an up-to-date literature review in the English language on "allergic contact dermatitis" via PubMed Clinical Queries, using the keywords "allergic contact dermatitis" in August 2022. The search included meta-analyses, randomized controlled trials, clinical trials, casecontrol studies, cohort studies, observational studies, clinical guidelines, case series, case reports, and reviews. The search was restricted to English literature and children. ACD may be acute or chronic and it affects more than 20% of children and adults with significant quality-of-life impairments. ACD is manifested by varying degrees of cutaneous edema, vesiculation, and erythema. The hypersensitivity reaction is one of the most prevalent forms of immunotoxicity in humans. Localized acute ACD lesions can be managed with high-potency topical steroids; if ACD is severe or extensive, systemic corticosteroid therapy is often required to provide relief within 24 hours. In patients with more severe dermatitis, oral prednisone should be tapered over 2-3 weeks. Rapid discontinuation of corticosteroids can result in rebound dermatitis. Patch testing should be performed if treatment fails and the specific allergen or diagnosis remains unknown. ACD is common and can be a physically, psychologically, and economically burdensome disease. Diagnosis of ACD is primarily based on history (exposure to an allergen) and physical examination (morphology and location of the eruption). Skin patch test can help determine the causative allergen. Allergen avoidance is the cornerstone of management. Topical mid- or highpotency corticosteroids are the mainstay of treatment for lesions on less than 20% of the body area. Severe cases of ACD may require treatment with systemic corticosteroids.

An emerging epidemic of allergic contact dermatitis due to phytonadione epoxide (oxidised vitamin K1).

Reports of allergic contact dermatitis (ACD) to phytonadione epoxide (PE) in cosmetics suggest that PE is as powerful a sensitiser as its parent compound phytonadione. To evaluate a case series of ACD to PE in Spain. We reviewed the records of 20 patients with ACD to cosmetics containing PE diagnosed across Spain between January 2019 and June 2023. All 20 patients developed patch test (PT) or repeated open application test (ROAT) reactions to cosmetics containing PE. All involved women with eyelid eczema. PT or ROAT with PE preparations were positive in 17/20 (85%). PE at 1%, 5%, 10% and 20% in pet. was patch-tested in 8/17, 14/17, 11/17 and 8/17 patients; being positive in 6/8 (75%), 13/14 (92.85%), 11/11 (100%) and 8/8 (100%), respectively. Regulators should, not only ban the specific dangerous cosmetic ingredients, but also consider to ban or keep under close surveillance those closely related products or derivatives that might potentially cause similar harmful effects. PTs with PE are suggested to be performed at a 5% concentration in pet. Higher concentrations (10% pet.) should be tested whenever PTs with 5% pet. PE are negative.

Allergic contact dermatitis to chlorhexidine in children

Background: Hypersensitivity to chlorhexidine is rare in children. The usefulness of different diagnostic tests for allergic contact dermatitis (ACD) is unknown. Objective: We aim to describe a case series of children with hypersensitivity to chlorhexidine and to compare the results of different diagnostic tests. Patients: Nine children with hypersensitivity to chlorhexidine were included. Only six of these children and their parents consented to a comprehensive allergy assessment, which included the prick test, intradermal test, patch test, and repeated open application test (ROAT). Results: Seven children (78%) presented symptoms of chlorhexidine hypersensitivity within the first 5 years of life; two of them before the age of 1 year. In four children, the dermatitis lesions were suggestive of wound superinfection. All six children who participated in the comprehensive diagnostic evaluation had negative results on the prick test. The immediate-reading intradermal test was positive in one case and uncertain in two cases. The patch test was positive in five cases, and the ROAT was positive in all six cases when using 2% chlorhexidine alcohol solution. Conclusion: ACD to chlorhexidine in children appears to be rare and can be difficult to detect. Clinicians should consider this diagnosis when wounds worsen with chlorhexidine. Although the patch test is the most standardized method for detecting ACD, the ROAT with 2% chlorhexidine alcohol solution was the most sensitive test in our patients.

Tert-butylhydroquinone and tert-butylcatechol positivity as warning lights of skin sensitization to tert-butylphenol derivatives in adhesives and diabetes devices.

Tert-butylphenol (TBP) derivatives, antioxidants in adhesives and diabetes devices, may provoke allergic contact dermatitis (ACD). The objective of this study is to report sensitization to TBP derivatives in medical devices and to highlight that tert-butylhydroquinone (BHQ) and tert-butylcatechol (TBC) are potential screeners in this regard. Fifteen patients with ACD from adhesives and diabetes devices were patch tested to different TBPs: BHQ 1% pet., TBC 0.25% pet., BHA 2% pet., BHT 2% pet., 4-tert-butylphenol (TBP) 1% pet. and 2,4-di-tert-butylphenol (di TBP) 1% pet. The culprit devices (medical adhesives, sanitary pads, diabetes devices) and TBP patch preparations were analysed using gas chromatography-mass spectrometry (GC-MS). BHQ (9/13), TBC (7/13), and to a lesser extent BHT (3/15), BHA (2/15) and TBP (2/13) gave positive reactions. Seven patients had developed ACD from adhesives and diabetes devices, respectively, and one patient from sanitary pads. GC-MS analyses of the medical devices and patch test materials confirmed the presence of the patch-test positive TBPs, or chemically related derivatives, or, interestingly, tert-butylbenzoquinones (BBQ) were found, that is, spontaneously formed, highly reactive TBP metabolites, likely (pseudo-) cross reacting with the patch tested TBPs. TBPs might be overlooked sensitizers in medical devices, and BHQ and TBC are potential screeners in this regard.

Chromium and cobalt in leather: A Danish market survey.

Leather has been a significant source of chromium (Cr) allergy in Denmark since the 1990s. More recently, cobalt (Co) allergy has been identified in leather as a source of allergic contact dermatitis. To measure Cr and Co levels in Danish leather goods. A total of 87 leather samples were collected, all tanned in Europe. Handheld X-ray fluorescence (XRF) device was used to screen for the presence of Cr and Co. The 20 leather samples with the highest concentrations of Co and Co were tested using International Organization for Standardization (ISO)-standards. XRF analysis showed Cr in 78/87 (83.9%) samples and Co in 52/87 (59.7%), with average concentrations of 41 mg/kg (range: 0.0-77 mg/kg) and 0.22 mg/kg (range: 0.0-2.9 mg/kg), respectively. ISO 10195 and 17 075-1 testing identified Cr (VI) in 7 out of 20 samples (1.4; 0.3-4.2 mg/kg), while ISO 17072-1 detected Co in 6 of 20 samples, averaging 3.95 mg/kg (range: 0.22-7.9 mg/kg). Most leather samples contained Cr, which was expected, while Cr (VI) was detectable in seven out of twenty tested samples but only detected in one product above the regulatory limit of 3 mg/kg. A potentially significant concentration was found for Co.

Differential Diagnosis of Irritant Versus Allergic Contact Dermatitis Based on Noninvasive Methods

Introduction: Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms underpinning each condition, the differentiation between them presents a significant diagnostic challenge. Objective: This study aims to determine whether a combination of clinical evaluation and noninvasive measurements—encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume—can distinguish ICD from ACD. Methods: Two cohorts, each comprising 21 patients, were evaluated: one diagnosed with ICD and the other with ACD. All participants underwent biophysical and clinical assessments, along with Antera® 3D evaluations. Tape strips were utilized for skin sampling, and oxidative stress levels were measured via fluorescence assessments. Results: ICD prompts an almost immediate inflammatory reaction (peaking at 24 hours), whereas ACD incites a delayed response (72 hours). Noninvasive evaluated parameters as hemoglobin concentration, skin texture and volume, melanin content, erythema, and TEWL showed significant differences between the ICD and ACD cohorts (p &lt; 0.05). The allergens amcinonide, nickel sulphate, cobalt chloride, budesonide, PPD, and thiuram mix were found to induce elevated levels of oxidative stress. Conclusions: The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study is constrained by a limited sample size.

Recommendations for patch testing with patient’s own materials in occupational dermatology

AbstractAllergic contact dermatitis is one of the most common occupational skin diseases. Due to the limited availability of commercial patch test preparations, patch testing patient’s own material (POM) is of great importance in the diagnosis of occupational contact dermatitis. In a research project (FB 317b) funded by the German Social Accident Insurance (DGUV), a comprehensive assessment of the quality of patch testing with POM in individuals with suspected occupational skin diseases was carried out for the first time in Germany. The initial results show considerable deficiencies in the documentation and in some cases also in the performance of patch testing POMs. Therefore, recommendations for patch testing POM and in particular patch testing with workplace materials are presented.

Exploring the Causal Relationship between Plasma Lipidome and Allergic Diseases: A Mendelian Randomization Study

Allergic diseases, including Allergic Rhinitis (AR), Allergic Asthma (AA), Allergic Conjunctivitis (AC), and Allergic Contact Dermatitis (ACD), affect a significant portion of the global population. Recent advances in lipidomics have highlighted the role of plasma lipids in immune regulation and inflammation.

The Clinical Phenotype of Patients with Contact Polysensitization, a Retrospective Cohort.

Background: Polysensitization, defined as contact sensitization to three or more allergens, is an allergic phenotype with a common genetic background. Our study aims to characterize the clinical features of patients with polysensitization. Methods: We analyzed patch test results of 5,082 patients from a designated contact dermatitis clinic in Tel Aviv between 2012 and 2022 and compared the polysensitized group with nonsensitized and oligosensitized patients, hence patients reacting to 1 or 2 allergens. Results: About 8.5% of patients were polysensitized. In the nonsensitized group, there were significantly fewer female patients and more children (P < 0.05) than in the polysensitized group. Asthma prevalence was linearly associated with the number of positive reactions in patch test. Polysensitized patients were more commonly suffering from hand eczema and an occupational etiology (P < 0.05). Textile dye mix, lyral, fragrance mix II, formaldehyde, colophonium, and p-phenylendiamine were more common sensitizers among the polysensitized group, whereas nickel sulfate, 2-hydroxyethyl methacrylate, fragrance mix 1, p-tert-butylphenol formaldehyde resin, and sodium metabisulfite were more common among the oligosensitized group. Conclusions: The association between polysensitization, asthma prevalence, and sensitization to volatile allergens raises an intriguing clinical phenotype. Further mechanistic studies are needed in this regard.

Metabolipidomic changes induced by dermal nickel penetration determined in an ex vivo porcine ear skin model.

Nickel is one of humans' most prevalent triggers of allergic contact dermatitis. However, the underlying mechanisms of this allergy still need to be fully understood. One aspect that has yet to be explored is the direct impact of common metal allergens on the skin's metabolites and lipids composition. Our study employed matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) to analyze spatially resolved metabolic alterations induced by nickel exposure. Cross-sections of ex vivo porcine ear skin exposed to increasing nickel (II) ion concentrations (17-167 μg/cm2) were measured with an AP-SMALDI5 AF ion source coupled to Q Exactive HF Orbitrap mass spectrometer. Additionally, the penetration of nickel ions into the skin was observed through its pink complexation with dimethylglyoxime under light microscopy. For nickel ion concentrations up to 84 μg/cm2, most nickel ions were stopped within the stratum corneum, while only a very small proportion of nickel ions penetrated the viable epidermis and dermis. Stratum corneum locations with high nickel ion concentrations showed a decrease in arginine and ceramides. Furthermore, several phosphatidylcholine and sphingomyelin species were found to be downregulated in the viable epidermis and dermis due to the nickel exposure. Nickel penetrates at a trace level into the viable skin and induces severe metabolomic and lipidomic changes in the stratum corneum, epidermis, and dermis, indicating a change in the skin (barrier) function. These findings contribute to a deeper understanding of nickel-induced skin allergies and provide a solid foundation for further research.

Effects of Thioglycolate Compounds in an Emerging Technique in the World of Cosmetics-Brow Lamination.

The side effects of two related chemicals, ammonium thioglycolate (ATG) and thioglycolic acid (TGA) have been widely highlighted in the world of cosmetics. These thioglycolate compounds are considered essential ingredients in a new technique known as brow lamination. This technique is widely used nowadays, with the aim of changing the eyebrow shape. To our knowledge, this is the first study to address the possible side effects of brow lamination. The hydrophilic characteristic of ATG and TGA reflects their transdermal absorption through the intracellular and transappendageal pathways. These compounds can affect the skin through allergic contact dermatitis (ACD), characterized by skin irritation, dryness, and erythema. Moreover, these thioglycolates can alter several mechanical and chemical reactions in the eyebrows' hair, therefore affecting their shape, structure, and pigmentation. In addition, these chemicals contained in brow lamination can exert systemic manifestations, at the level of the reproductive, ocular, respiratory, and endocrine systems. More studies should be elaborated to shed light on the possible side effects of this trend. Additionally, further regulations should be taken into consideration to ensure the concentration and the measures applied are convenient to minimize these side effects.

Outbreak of contact allergy to dicyclohexylcarbodiimide in a biotechnology laboratory.

Dicyclohexylcarbodiimide (DCC) is known to cause occupational allergic contact dermatitis in biotechnology laboratory workers. This study aimed to assess the prevalence of DCC sensitization among workers of one biosynthesis laboratory and to determine the optimal DCC concentration for patch testing. 23 laboratory workers frequently exposed to DCC of whom 21 suffered from dermatitis and 11 controls were enrolled into the study. All participants underwent skin patch testing with different concentrations of DCC and other substances used in the work environment. Statistical analysis was conducted to compare results between active and control groups. Of the 23 workers tested, 56.5% showed positive reactions to DCC. All of them had dermatitis. Morpholine also elicited positive reactions in 26.1% of workers who were all sensitized to DCC. Dimethylformamide and chloroform yielded negative results. Dicyclohexylcarbodiimide was a major cause of contact dermatitis in the active group indicating an outbreak of contact allergy to DCC in the company necessitating preventive measures. Both DCC 0.1% ac. and DCC 0.05% pet. should both be used for patch testing.

"Beezin": Analysis of TikTok Content Related to a Viral Social Media Trend.

To evaluate "beezin," a social media trend that involves applying Burt's Bees Lip Balm to the eyelids to induce intoxication, which has the potential to cause ocular problems. Researchers identified the top TikTok videos about beezin using the search terms "beezing," "beezin," "burtsbees," "Burt's Bees on eyelids," and "burtsbeeschallenge." Researchers watched each video and recorded key information. Descriptive statistics were calculated. Sixty top videos were included in the analysis; they had more than 158 million views and more than 11 million likes. More than half (n = 37, 61%) portrayed the trend positively, 11 (18%) portrayed the trend negatively, and 12 (20%) took a neutral stance on the trend. None of the videos were created by a health care provider. Beezin is a viral social media trend that may cause ocular problems. There is a need for factual TikTok content to combat the trend. Health care providers should consider beezin when adolescent patients present with contact dermatitis, conjunctivitis, or other possible sequelae of beezin. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX-XXX.].