Rates Of Allergic Contact Dermatitis Research Articles

Characterization of Pediatric Patch Testing: A Retrospective Review, 2020-2023.

Background: Recent evidence shows similar rates of allergic contact dermatitis (ACD) among children and adults despite children accounting for less than 10% of patch testing subjects. With a need for in-depth analyses of pediatric ACD, we herein characterize a pediatric cohort at a large North American patch testing center. Methods: A retrospective chart review was conducted for 135 patients ages 1-17 years who underwent patch testing from July 2020 from August 2023. Data were stratified by age 1-5, 6-11, and 12-17 years. Significance-Prevalence Index Numbers (SPIN) were calculated. Results: A total of 86% were sensitized, 40% had a relevant reaction, and positivity rates were equal between males and females. Top allergens by SPIN differed with age, but overall were linalool hydroperoxides (SPIN = 11.01), propylene glycol (10.30), limonene hydroperoxides (10.27), fragrance mix I (5.62), and lanolin (4.90). In total, 14% of the top allergens were not represented on the North American Contact Dermatitis Group standard series. Of those tested to personal products, 45% had positive reactions and 72% of which were relevant. Conclusions: Emulsifiers and fragrances were the most relevant allergen categories, with the impact of emulsifiers not previously reported. ACD may affect males and females equally in this population. Supplemental allergens and personal products tested "as-is" contribute to conclusive pediatric patch testing.

Wound Complications Are Affected by Different Skin Closure Methods in Primary Hip and Knee Arthroplasty

BackgroundThere is a lack of consensus on optimal skin closure and dressing strategies to reduce early wound complication rates after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsAll 13,271 patients at low risk for wound complications undergoing primary, unilateral THA (7,816), and TKA (5,455) for idiopathic osteoarthritis at our institution between August 2016 and July 2021 were identified. Skin closure, dressing type, and postoperative events related to wound complications were recorded during the first 30 postoperative days. ResultsThe need for unscheduled office visits to address wound complications was more frequent after TKA than THA (2.74 versus 1.78%, P < .001), and after direct anterior versus posterior approach THA (2.94 versus 1.39%, P < .001). Patients who developed a wound complication, had a mean of 2.9 additional office visits. Compared to the use of topical adhesives, skin closure with staples had the highest risk of wound complications (odds ratio 1.8 [1.07-3.11], P = .028). Topical adhesives with polyester mesh had higher rates of allergic contact dermatitis than topical adhesives without mesh (1.4 versus 0.5%, P < .0001). ConclusionWound complications after primary THA and TKA were often self-limited but increased burden on the patient, surgeon, and care team. These data, which suggest different rates of certain complications with different skin closure strategies, can inform a surgeon on optimal closure methods in their practice. Adoption of the skin closure technique with the lowest risk of complications in our hospital would conservatively result in a reduction of 95 unscheduled office visits and save a projected $585,678 annually.

Occupational contact dermatitis in painters and varnishers: Data from the Information Network of Departments of Dermatology (IVDK), 2000 to 2019.

Painters and varnishers ("painters") are exposed to various contact allergens and skin irritants, and therefore, are at risk for developing occupational dermatitis (OD). To describe the spectrum of occupational sensitizations in painters and revise the corresponding current patch test recommendations. Retrospective analysis of Information Network of Departments of Dermatology (IVDK) data from 2000 to 2019 with focus on male painters with OD, ages 20-59 years (n=557) in comparison to age-matched male painters without OD (n=422) and male OD patients who have had never worked as painters (n=13 862). Male painters with OD have a significantly higher rate of allergic contact dermatitis and face dermatitis than male patients with OD who work in other professions. Positive patch tests to epoxy resin, methylisothiazolinone (MI), and methylchloroisothiazolinone (MCI)/MI were significantly more frequent in painters with OD than in the other groups. Epoxy resin sensitization was significantly associated with face dermatitis. Epoxy resin, MI, and MCI/MI represent the most important occupational sensitizers in painters. In addition to baseline, resins and glues, and industrial biocides series, the patients' own workplace materials should be tested in painters with suspected OD.

Rates of allergic contact dermatitis due to common patch test allergens may be underreported: Comparison of patch test center data

Rates of allergic contact dermatitis due to common patch test allergens may be underreported: Comparison of patch test center data

Prevalence of Preservatives Across All Product Types in the Contact Allergen Management Program.

Preservatives are known causes of allergic contact dermatitis. The aim of this study was to determine the prevalence of preservatives in each product category in the Contact Allergen Management Program and compare prevalence with reported rates of allergic contact dermatitis. Contact Allergen Management Program product information was queried based on the 53 approved preservatives for cosmetic products by the European Union and Association of Southeast Asian Nations plus 5 additional preservatives used in US products. Phenoxyethanol and parabens were the most common preservatives with 23.9% of products containing phenoxyethanol and 20.75% of products containing parabens. Methylisothiazolinone (MI) was found in 12.9% of products, most commonly in hair care and household products. Preservatives like MI and methylchloroisothiazolinone (MCI) that are both common in products and have a high incidence of allergic contact dermatitis are of greatest concern as contact allergy hazards. Phenoxyethanol and parabens are common and have weak sensitizing power, making them preferred preservatives. Evaluating the prevalence of preservatives provides important information on allergen exposures. Using current positive reaction rates, the risk of sensitization to a given preservative can be more accurately estimated and may affect the use of certain preservatives by industry in the future.

Contact sensitization pattern in 172 atopic subjects

Some authors have claimed a decreased cell-mediated immunity among atopic individuals, which would lead to observations of decreased rates of allergic contact dermatitis (ACD). The purpose of our study was to investigate contact sensitization patterns in atopic subjects compared with non-atopic subjects. Patch test data for 1247 patients undergoing patch testing at Massachusetts General Hospital between 1990 and 2006 were reviewed. Using accepted criteria, 172 subjects were classified as atopic individuals (AIs), and 1075 were classified as non-atopic individuals (NAIs). Sensitization rates were compared between these two groups. Sensitization rates (65.0% and 57.4% in the AI and NAI groups, respectively) and average numbers of positive responses (1.5 and 1.2 in the AI and NAI groups, respectively) were higher in AIs. Leading allergens observed were similar for both groups. Sensitization to potassium dichromate and phenylmercuric acetate was significantly greater in the AI group. The most frequent diagnosis in both groups was ACD (41.9% and 45.5% in the AI and NAI groups, respectively). In addition, more NAIs who were employed in occupations with exposure to wet and/or irritant conditions had hand eczema (P < 0.005). Atopic individuals were shown to be at least as likely to have ACD as NAIs. The most common sensitizers were similar in both groups, suggesting common sources of sensitization.

Contact Dermatitis in Older Adults

Contact dermatitis is a significant health problem affecting the elderly. Impaired epidermal barrier function and delayed cutaneous recovery after insult enhances susceptibility to both irritants and allergens. Exposure to more numerous potential sensitizers and for greater durations influences the rate of allergic contact dermatitis in this population. Medical co-morbidities, including stasis dermatitis and venous ulcerations, further exacerbate this clinical picture. However, while these factors tend to increase the degree of sensitization in the elderly, waning immunity can actually decrease such a propensity. This interplay of both intrinsic and extrinsic factors makes a generalization on trends for contact dermatitis in older adults challenging. The literature has varying reports on the overall incidence of allergic contact dermatitis with advancing age. Nevertheless, it does clearly show that sensitivity to topical medicaments increases with age. Irritant contact dermatitis studies are more consistent, with less reactivity (to irritants) in older compared with younger skin. Diagnosis of both irritant and allergic contact dermatitis is based on a thorough history, complete skin examination, and comprehensive patch testing. The mainstay of therapy is avoidance of the offending chemical substances and the use of topical along with systemic therapies, depending on the severity of the condition.

Postoperative Topical Antimicrobial Use

Allergic contact dermatitis associated with topical antimicrobial agents is an increasing problem in the postoperative wound care period. We reviewed the topical antimicrobial agents most commonly used postoperatively in North America and Europe, examined the incidence of allergic contact dermatitis from each agent, and provided guidelines for the use of topical antimicrobials on closed and open wounds in the postoperative period. Neomycin was the most common cause of allergic contact dermatitis both in the general patch-tested population (11%) and in the postsurgical population. Bacitracin was also a common culprit, although at a lower rate (8%). There is a risk of co-reactivity between these two agents. Polymyxin B and mupirocin were not significant allergens. The rate of postoperative infectious complications in dermatologic surgery (1-2%) was similar to the rate of allergic contact dermatitis from topical antimicrobials (1.6-2.3%). We concluded that for closed wounds, the use of topical neomycin postoperatively should be avoided. White petrolatum is an efficacious and cost-effective alternative for closed wounds. For open wounds, topical antimicrobials that do not contain neomycin should be recommended.

Positive rates to propyl gallate on patch testing: a change in trend

Propyl gallate (E310) has, until recently, been used as a major antioxidant in fatty food and, in the cosmetic industry, in the manufacture of lipsticks. Propyl gallate has a high sensitizing potential; however, the frequency of allergic contact dermatitis from antioxidants of the gallate type was previously thought to be surprisingly low. Previous exposure and orally induced tolerance, as suggested by Khan and colleagues, may have explained the low rates of allergic contact dermatitis to propyl gallate in the past. The objectives were to assess the prevalence of allergic contact dermatitis to propyl gallate in our centre from 1988 to 2005. From 1988 to 2005, 9529 patients were patch tested to the face series, 6973 were females and 2556 were males. Patch tests were read at 2 D and 4 D. Positive reactions were scored as per International Contact Dermatitis Research Group recommendations as negative, +, ++, and +++ reactions. Propyl gallate was used at a 1% petrolatum (pet.). A total of 55 patients had positive reactions to propyl gallate 1% pet. (0.57%), 46 were female (0.65%) and 9 were male (0.33%). Using chi-square, there was a significant difference (P < 0.05) in the positivity rates between the 1988-96 period (0.45%) and the 1997-2005 period (0.77%). A review of our face series performed in the last 18 years has shown a statistically significant increase in propyl gallate-positive rates on patch testing over the last decade. An increase in its use in the cosmetic industry may well be the explanation for this. Nevertheless, a concomitant reduction of propyl gallate as an antioxidant in food, with oral tolerance being less likely to develop, may also be a contributing factor in the increasing trend of allergic contact dermatitis caused by propyl gallate.

Allergic contact dermatitis in children

The following paper reviews the recent literature pertaining to allergic contact dermatitis in the pediatric population. Allergic contact dermatitis may affect as many as 20% of the pediatric population. Recent studies implicate the following chemicals as the most common causes: nickel, topical antibiotics, preservative chemicals, fragrances and rubber accelerators. Several less common, but emerging, allergens have also been reported recently, including para-phenylenediamine in henna tattoos, cocamidopropyl betaine in 'no tears' shampoos and cleansers, and disperse dyes in clothing materials. Allergic contact dermatitis occurs less frequently in the first few months of life and increases in prevalence with increasing age. In the adolescent age group, females have significantly higher rates of allergic contact dermatitis on the face. This is likely explained by increased exposures to nickel in piercings and to preservative and fragrance chemicals in cosmetic products. The documented rates of allergic contact dermatitis in children are on the rise. This increased prevalence may be due to increased chemical exposures in this age group, better recognition by pediatricians and perhaps more widespread use of epicutaneous patch testing. This review outlines the basic pathophysiology, epidemiology and clinical manifestations of allergic contact dermatitis in children.

An epidemiological comparison between hand eczema and non-hand eczema

Thirty four per cent of 2110 patients with eczema attending a contact dermatitis clinic presented with hand eczema. An epidemiological comparison was made of patients with hand eczema and non-hand eczema (defined as eczema on parts of the body other than the hands). Occupational eczema was significantly more common in the hand eczema than the non-hand eczema group (P = 0.0011). The prevalence of atopy was the same in both groups (13%). The prevalence of irritant contact dermatitis was higher in the hand eczema group (32%) than the non-hand eczema group (13%) (P less than 0.0001). The rate of allergic contact dermatitis was lower in the hand eczema group (23%) than the non-hand eczema group (39%) (P less than 0.0001). The rate of positive patch test reactions was lower in the hand eczema group (41%) than the non-hand eczema group (56%) (P less than 0.0001). Nickel sulphate (8%), cobalt chloride (3%), potassium dichromate (3%), and fragrance mix (4%) were common allergens encountered in hand eczema group. None of these allergens was specifically more prevalent in the hand eczema than the non-hand eczema group. However, the prevalence of allergy to nickel, colophony, epoxy resin and medicaments was significantly higher in the non-hand eczema group.