Results Of Photopatch Testing Research Articles

Clinical profile and photocontact sensitivity pattern in patients with cosmetic dermatitis: A prospective study.

Background With the rise in cosmetic usage, adverse reactions related to cosmetics have also risen. Photocontact dermatitis to cosmetics is a challenging entity to diagnose and manage. Objectives To evaluate the clinical features and photocontact sensitivity patterns in patients with cosmetic dermatitis and establish their association based on patch and photopatch test results. Methods A prospective observational study, where 80 patients with a clinical diagnosis of cosmetic dermatitis were patch or photopatch tested (as per indication) with the Indian standard series, Indian cosmetic and fragrance series, and the patient's personal product(s). Results A total of 104 positive reactions were observed in 57/80 patients, of which 50 were relevant to cosmetics usage. Sixty-five patients underwent a photopatch test, and 17 tested positive. Photosensitivity in patients was significantly associated with a positive photopatch test (p-value < 0.001). Various new photo-allergens were discovered, including propylene glycol, triethanolamine, chloroacetamide, isopropyl myristate, cetrimide and hexamine. Facial melanosis was a predominant clinical finding in 44 patients, with pigmented contact dermatitis detected in 19 (43.2%) of these cases. Limitations Patients' personal products could not be tested on every patient. Chemical analysis of indigenous products and the individual chemical ingredients of the patient's personal products could not be patch-tested separately. Phototesting was not performed in patients with photosensitivity. Conclusion In patients with suspected cosmetic dermatitis with history of photosensitivity or those with facial melanosis of unknown origin, a photopatch test is crucial to detect potentially hidden photo allergens. Many new photo allergens have emerged in the present study. Cosmetic companies should provide detailed information regarding each constituent of the cosmetic products.

Photobiological responses in patients with chronic actinic dermatitis and their relationship with the melanocortin-1 receptor gene Arg163Gln variant: a preliminary study

Objective To explore differences in phototest and photopatch test results, and in skin color-related parameters between healthy subjects and patients with chronic actinic dermatitis (CAD), and to examine their relationship with the melanocortin-1 receptor gene (MC1R) Arg163Gln variant. Methods Phototests were performed by using a sun simulator SUN1000, and skin color was analyzed by using Hexameter MX18 in 25 patients with CAD and 25 healthy subjects. The MC1R genotype at position -163 was determined by PCR. Photopatch tests were performed on 25 patients with CAD and 5 healthy subjects using a standard series of photoallergens (RuiMin) and an ultraviolet (UV) phototherapy equipment, SS-03A. Results Regarding phototest results, both UVA-minimal persistent pigment darkening dose (MPPD) and UVB-minimal erythema dose (MED) were significantly lower in CAD patients compared with healthy controls (both P 0.05), but that of the CAA genotype differed significantly between the two groups (P < 0.01). UVA-MPPD and UVB-MED were both significantly lower in CAD patients with the CAA genotype at position-163 in the MC1R gene than in those without the genotype (P = 0.055, 0.325, respectively). Conclusions Skin photobiological testing plays a critical role in the diagnosis of CAD. Further studies are needed to clarify the role of the CAA genotype at position-163 in the MC1R gene in the diagnosis, prevention and treatment of CAD. Key words: Photosensitivity disorders; Pigmentation; Genes, Arg163Gln; Chronic actinic dermatitis; Photopatch tests

Photopatch testing in Bogota (Colombia): 2011-2013.

Photopatch tests are used to diagnose photoallergic contact dermatitis and identify the causal agents. The frequencies of positive results and associated allergens vary by country; therefore, it is necessary to know the information specific to each country. To establish the frequency of positive photopatch test results, and their relevance, in patients with suspected photoallergic contact dermatitis in a national dermatology centre located in Bogota, Colombia. One hundred patients investigated for possible photoallergic contact dermatitis were enrolled in the study. They were photopatch tested with a selected group of allergens, and occluded for 48 hours; the duplicate right-hand panel was irradiated with 5 J/cm(2) ultraviolet (UV)A. The readings were performed on day (D)2, D4, and D6, in accordance with the guidelines of the ICDRG, and the relevance was evaluated with the COADEX system. There were a total of 20 photopatch reactions in 15 patients, 95% of which were caused by UV filters, most frequently benzophenone-3 (55%). Eight of the positive reactions (53.3%) appeared on D6. UV filters continue to be the most common causes of photoallergic contact dermatitis in our patients. Readings up to D6 (96 h after irradiation) are important to identify delayed positive reactions.

Development of a clinical score system for the diagnosis of photoallergic contact dermatitis using a consensus process: item selection and reliability.

Photoallergic contact dermatitis (PACD) is an uncommon condition, and there is a lack of validated criteria for its diagnosis. To identify a set of relevant criteria to be considered when suspecting a diagnosis of PACD and to assess the reproducibility of these criteria. This was a diagnostic item selection and reliability study performed between July 2012 and October 2012. A panel of seven recognized experts was invited to consecutive rounds of a Delphi survey and to a conclusive face-to-face meeting with the aim of obtaining an agreement on criteria for the diagnosis of PACD. The panel was also provided with a series of 16 reports of suspected PACDs to be classified according to a five-point likelihood scale. Identified criteria with the weights attributed by experts were used to develop a score system for the diagnosis of PACD. Consensus was measured by calculating the Intraclass Correlation Coefficient (ICC). The performance of the score system was evaluated in terms of overall classification accuracy. Seven criteria were identified by experts as relevant for the diagnosis of PACD. The criteria were related to the type of skin lesions, accompanying symptoms, skin area involved, general medical history, modality of exposure to the culprit substance, history of exposure to the sun or other light sources and photopatch test results. Experts reached a moderate agreement on PACD cases classification, with ICC=0.69 (95% Confidence Interval, CI, 0.50-0.86). The score system enabled discrimination of probable and definite PACD cases from possible and unlikely or excluded ones, with a nearly perfect agreement being observed between the score system classification and judgment by experts. A diagnostic score was proposed. The score should receive a comprehensive validation on a larger series of cases and with multiple evaluators.

Photoallergic contact dermatitis from benzydamine presenting mainly as lip dermatitis

Benzydamine, a non-steroidal anti-inflammatory drug (NSAID) in use for more than four decades, has been reported to cause photosensitivity. To study the results of photopatch testing to benzydamine and the clinical features of the dermatitis during a 3-year period (2006-2008). During this period, 74 patients with photodermatoses were photopatch tested with an extended baseline series of allergens including benzydamine and in suspicious cases, with drugs that contain it. Test sites were irradiated on D2 with 5 J/cm(2) and readings were performed on D2 and D4. Ten patients (six females/four males), aged 21-84 years (mean 64.9) had a positive photopatch test to benzydamine [1-5% petrolatum (pet.) from Bial-Aristegui] and to drugs that contain it (Tantum verde oral solution and Momen gel). Nine patients had lower lip cheilitis and one lichenified eczema on photo-exposed sites. Photosensitivity from both topical and systemic benzydamine has been occasionally described, mainly in southern Spain. Despite its widespread use and its known photosensitizing capacity, photoallergic contact dermatitis from benzydamine is probably underdiagnosed as the clinical presentation of mainly the lip and chin is not typical of photoallergic contact dermatitis and benzydamine is not part of most photoallergen series.

Photopatch testing negative in systemic quinine phototoxicity

Drug-induced phototoxicity can be caused by topical or systemic agents and is diagnosed on the basis of clinical history, examination and appropriate investigations. Photopatch testing is the investigation of choice for topical photocontact allergic dermatitis, but its use in drug-induced phototoxicity has not been validated. We retrospectively analyzed the results of photopatch testing to the drug quinine sulfate in three patients in whom a diagnosis of drug-induced phototoxicity to this agent had been made. None of the three patients had positive photopatch test reactions at any time point. This demonstrates that in our patients, photopatch testing to quinine sulfate was not a useful additional investigation for diagnosing drug-induced phototoxicity.

Photopatch testing with an extended series of photoallergens: a 5‐year study

We conducted a retrospective study (2003-07) evaluating the results of photopatch tests (PPTs) performed with an extended series with the objective of determining the main photoallergens in our region and whether they would be detected by a recently recommended baseline PPT series. 83 patients (58 females/25 males, mean age 54.8 years) were tested with a photoallergen series, and among these, 30 were also tested with a non-steroidal anti-inflammatory drug (NSAID) series, irradiated at D2 with 5 J/cm(2) ultraviolet A (UVA). Thirty-six of 83 patients (43.3%) had at least one positive reaction, with 21 (25.3%) reacting in the photoallergen series. The main relevant reactions were as follows: 10 to ultraviolet filters (benzophenone-3 and benzophenone-4, 3 patients each), 7 to promethazine, and 2 to chlorpromazine. Twenty of 30 patients tested (70%) had a relevant positive PPT to an NSAID, 9 to piroxicam because of systemic photosensitivity, 8 to benzydamine from a topical gel or oral solution, and 2 to ketoprofen. Our results are discordant with most recently published studies because of the particularities of the population studied and to regional prescribing habits. Therefore, apart from the recommended baseline series of photoallergens, other substances must be tested according to regional peculiarities.

Photopatch Testing of 182 Patients: A 6-Year Experience at the Mayo Clinic

Photopatch testing is important for diagnosing photoallergic contact dermatitis. Although results of photopatch testing have been presented from many European centers, there have been few reports of the results of photopatch testing in the United States. To review the Mayo Clinic's recent experience with photopatch testing, identify common photoallergens, and compare our current and previous findings. We retrospectively reviewed records of patients who underwent photopatch testing at the Mayo Clinic between January 1, 2000, and December 31, 2005 (N = 182). Fifty-four patients (29.7%) had photoallergic contact reactions, and 29 (15.9%) had allergic contact reactions. The most common photoallergens were medications, sunscreen agents, fragrances, and antiseptics. Photopatch testing is the technique useful in identifying photoallergens. The series of allergens used must be constantly updated to reflect newly identified and outdated photoallergens. We present a 6-year experience with photopatch testing. Medications, sunscreen agents, fragrances, and antiseptics were the most frequently identified photoallergens.

Resultados y evaluación del fotoparche en España: hacia una nueva batería estándar de fotoalergenos

Introduction While the standardization of exploration with photoallergy tests or photopatch testing runs its course in Europe, we have carried out an epidemiological study about the current situation of photoallergy in our country. Material and methods We have gathered the results of photopatch testing in seven hospital centres of Madrid, Cataluña, Galicia and Comunidad Valenciana during the years 2004 and 2005. The exploration has included, at least, the standard set of the Spanish Photobiology Group (GEF), with 16 (photo) allergens, that have been irradiated with 10 joules/cm 2. We have assessed the total number of explored patients, their sex, present, past or unknown relevance of positive photopatch testing, cross reactions, and allergens responsible for photosensitization. Results Of 224 patients explored by photopatch testing, 39.3 % show one or more positive tests. Seventy-one percent (103) were considered relevant with respect to clinical history, 14 cases (9.6 %) were cross reactions, and 28 (19.3 %) were considered of unknown relevance. The most prevalent allergens were nonsteroidal antiinflammatory drugs, specially ketoprophen (43 patients), followed by bencydamine (7 patients) and etofenamate (5 patients). The mixture of four sunscreens from the standard set of the GEF only detected 10 of 16 patients with photoallergy to sunscreens. Photopatch testing of unknown relevance was mainly due to antiseptics (fenticlor) and topical antihistamines. Conclusions We propose the modification of the standard set of photoallergens from the GEF, that should include the majority of nonsteroidal antiinflammatory drugs and sunscreens available in Spain. Ketoprophen continues to be the most frequent photoallergen in our country. It is also important for the cross sensitizations that may present. Sunscreens should be explored separately and not in form of a mixture.

Results and Assessment of Photopatch Testing in Spain: Towards a New Standard Set of Photoallergens

Introduction While the standardization of exploration with photoallergy tests or photopatch testing runs its course in Europe, we have carried out an epidemiological study about the current situation of photoallergy in our country. Material and methods We have gathered the results of photopatch testing in seven hospital centres of Madrid, Cataluña, Galicia and Comunidad Valenciana during the years 2004 and 2005. The exploration has included, at least, the standard set of the Spanish Photobiology Group (GEF), with 16 (photo) allergens, that have been irradiated with 10 J/cm 2. We have assessed the total number of explored patients, their sex, present, past or unknown relevance of positive photopatch testing, cross reactions, and allergens responsible for photosensitization. Results Of 224 patients explored by photopatch testing, 39.3% show one or more positive tests. Seventyone percent (103) were considered relevant with respect to clinical history, 14 cases (9.6%) were cross reactions, and 28 (19.3%) were considered of unknown relevance. The most prevalent allergens were nonsteroidal antiinflammatory drugs, specially ketoprophen (43 patients), followed by bencydamine (7 patients) and etofenamate (5 patients). The mixture of four sunscreens from the standard set of the GEF only detected 10 of 16 patients with photoallergy to sunscreens. Photopatch testing of unknown relevance was mainly due to antiseptics (fenticlor) and topical antihistamines. Conclusions We propose the modification of the standard set of photoallergens from the GEF, that should include the majority of nonsteroidal antiinflammatory drugs and sunscreens available in Spain. Ketoprophen continues to be the most frequent photoallergen in our country. It is also important for the cross sensitizations that may present. Sunscreens should be explored separately and not in form of a mixture.

Spectrum of cross-photosensitization in 18 consecutive patients with contact photoallergy to ketoprofen: associated photoallergies to non-benzophenone-containing molecules.

Contact photoallergy to ketoprofen gels has been widely reported, and cross-sensitivity reactions with other compounds, such as tiaprofenic acid, fenofibrate and benzophenones, are well known. However, positive photopatch tests to other different non-benzophenone-related compounds have recently been observed. We report the results of photopatch testing in patients with contact photoallergy to ketoprofen and discuss the spectrum of cross-sensitization to ketoprofen. 18 consecutive patients with a history of photocontact dermatitis from ketoprofen were investigated. Patch and photopatch tests were performed. As expected, we observed positive photopatch tests to Ketum* gel and ketoprofen 2.5% in petrolatum in all patients (100%). However, it was remarkable to note positive photopatch tests to other unexpected and non-relevant allergens, including fentichlor (67%), tetrachlorosalicylanilide (28%), triclosan (17%), tribromsalan (11%) and bithionol (11%), with no clinical relevance. Interestingly, these agents belong to the family of halogenated salicylanilides and related compounds, which have been forbidden in Europe since the 1970s. Our results raise the question of hyper-photosusceptibility to non-relevant allergens induced by photosensitivity to ketoprofen. The mechanism may involve the high photoreactivity induced by the association of a benzene ring with an oxygen group.

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte.

Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.

Photopatch Testing in Seven Cases of Photosensitive Drug Eruptions

OBJECTIVE:The most important goal in the management of photosensitive drug eruptions, as in other types of drug eruptions, is identification of the causative drugs to prevent reexposure to them.CASE SUMMARIES:Seven patients whose lesions were mainly distributed on sun-exposed areas underwent laboratory tests, phototests, and photopatch tests with suspected drugs. Phototests were done with ultraviolet A (UVA), UVB, and visible light. Drugs used in the photopatch tests were usually prepared as 10% concentrations in petroleum base, which did not produce reactions in 10 control subjects, followed by irradiation of suberythema doses of UVA. Systemic provocation by oral administration of small doses of causative drugs with irradiation of suberythema doses of UVA was performed to confirm the results of skin tests in four patients. Two patients were not rechallenged with the causative drugs. None of the patients had systemic lupus erythematosus, porphyria, or pellagra. All showed positive reactions to photopatch testing. Systemic provocation confirmed the results of photopatch tests in four patients. The two patients who were not rechallenged had no recurrence of lesions. One patient ingested only one drug at the time of eruptions, and provocation or avoidance was not attempted. A photoallergic mechanism was considered in five cases.CONCLUSIONS:Although there is no information about the appropriate concentrations or vehicles for suspected drugs, photopatch testing could be reliable for identification of causes of photosensitive drug eruptions. Besides piroxicam (a well-known photosensitizer) and carbamazepine, isoniazid and triflusal were identified as the causes of the reactions.

Fenofibrate-induced photosensitivity

During the past 20 years, fibric acid derivatives have been the drugs most commonly used in the treatment of hyperlipidemia. Among them, fenofibrate is the most frequently prescribed. 1 Side effects of these drags are mainly gastrointestinal, but skin manifestations also occur in approximately 2% of patients. 2-6 Only a few instances of photosensitivity have been reported. 7-11 In these reports, the results of photopatch testing have been variable. 8, 9 Thus systemic photochallenge may be a more appropriate test to determine fenofabrate-induced photosensitivity. W e describe three patients in whom photosensitivity caused by fenofibrate was proved by systemic photochallenge.

Photopatch test reactivity: effect of photoallergen concentration and UVA dosaging.

We have studied the influence of variations in allergen concentration and UVA dosaging on the results of photopatch testing with the Scandinavian standard photopatch series in 29 patients with photocontact and/or contact allergy to 1 or several of the allergens in that series. Photocontact test reactions were more sensitive to allergen dilution than plain contact test reactions. Even dilution from the standard 5% to 2.5% significantly reduced para-aminobenzoic acid photocontact test reactions. Reducing the UVA dose from the standard 5 J/cm2 to 2.5 or 1 J/cm2 in 2 out of 5 cases turned a significant (++) reaction into a doubtful one (+). Increasing the standard UVA dose of 5 J/ cm2 to 20-40 J/cm2 turned a single + photocontact reaction to trichlorcarbanilide and a single 1 + plain contact reaction to chlorhexidine into ++ reactions. In the majority of cases, however, neither photocontact nor plain contact test reactions were augemented by UVA doses up to 80 J/cm2. We conclude that a UVA dose of 5 J/cm2 is sufficient for eliciting photocontact allergic test reactions, and that a reduction of either the UVA dose level or the standard allergen concentrations of the Scandinavian photopatch test guidelines may cause loss of significant photocontact test reactions in a proportion of the cases.

Bullous Photodermatosis After Lomefloxacin

Lomefloxacin is a recently introduced antibacterial quinolone. The photosensitizing properties of quinolone compounds are well recognized, but only a few cases have been reported after lomefloxacin intake. 1 We report a case of severe eczematous bullous photodermatosis where epicutaneous photopatch test results were positive to both the culprit drug and the structurally related ciprofloxacin. Report of a Case. A 68-year-old gardener presented with a pruriginous erythema, with edema and vesicles, primarily located on light-exposed areas, such as the face, neck, the V-shaped area of the anterior aspect of the chest, and the forearms. The edema and erythema spread to adjacent nonexposed areas. Multiple confluent vesicles in an erythematous base and several tension blisters were especially evident in the dorsal aspect of his hands and forearms ( Figure 1 ). The reaction evolved over a 4-day period and began 13 days after introduction of lomefloxacin (400 mg/d) and 2 days after intensive sunlight

Photoallergic contact dermatitis. Results of photopatch testing in New York, 1985 to 1990.

Over a 6-year period, 187 patients with a history of photosensitivity were photopatch tested using standard techniques. Seventy-six patients were male and 111 were female. Most patients were white (151 patients). Two thirds of the patients were between the ages of 31 and 60 years. Testing revealed a total of 63 positive reactions: 14 plain contact, 41 photocontact, and eight combined contact and photocontact in 37 (20%) patients. Careful history taking resulted in a diagnosis of clinically relevant photoallergic contact dermatitis in 54% of these 37 patients or 11% (20) of the total tested. Ten of the relevant responses were due to fragrance ingredients (musk ambrette and 6-methylcoumarin); 18 were due to sunscreen agents (nine to p-aminobenzoic acid and esters, nine to oxybenzone). The fragrance reactions occurred in the early years of the study (1985, 1986, and 1987) while the sunscreen agents accounted for all but two of the 14 positive reactions in the last 3 years of the study (1988, 1989, and 1990). These data suggest that the incidence of photoallergy due to fragrances is declining, while reactions to sunscreen agents, in particular oxybenzone, are increasing. This trend may reflect an altered use pattern by the general population for products containing these chemicals.

Photopatch testing: A six-year experience

The results of photopatch testing performed at the Mayo Clinic from 1980 through 1985 were analyzed. During the 6 years, 70 patients underwent photopatch testing. Of the 70 patients, 27 (38.5%) had positive photopatch test reactions and 22 (31%) had ordinary contact reactions. Of the 27 patients with photocontact reactions, 14 had relevant reactions. The most frequent positive reactions were to chlorpromazine (13 patients), musk ambrette (nine patients), and promethazine (eight patients). Photopatch testing is an essential part of the evaluation of patients who are suspected of having photosensitive dermatitis. In some patients with recalcitrant eruptions, testing may help in excluding photosensitivity as a possible contributing factor.

Measurement of urinary constituents and output using diposable napkins

The results of photopatch testing performed at the Mayo Clinic from 1980 through 1985 were analyzed. During the 6 years, 70 patients underwent photopatch testing. Of the 70 patients, 27 (38.5%) had positive photopatch test reactions and 22 (31%) had ordinary contact reactions. Of the 27 patients with photocontact reactions, 14 had relevant reactions. The most frequent positive reactions were to chlorpromazine (13 patients), musk ambrette (nine patients), and promethazine (eight patients). Photopatch testing is an essential part of the evaluation of patients who are suspected of having photosensitive dermatitis. In some patients with recalcitrant eruptions, testing may help in excluding photosensitivity as a possible contributing factor.

Contact photodermatitis due to tribromsalicylanilide.

SUMMARY.— During a period of 3 months contact photoallergy to tribrom-salicylanilide (TBS) in a toilet soap was diagnosed in 39 patients in Copenhagen. The clinical features are described and the results of photopatch tests are reported. The importance of using long wave UV in photopatch testing is emphasized. Evidence is presented that TBS is a primary photosensitizer with a sensitizelzing potential approximately equal to that of tetrachlorsalicylanilide. The frequency of photosensitization is estimated as 1:1000 users.