Dermatitis®

Allergic contact dermatitis in young children may be an under-recognized cause of perineal dermatitis. The diapered infant skin is uniquely susceptible to allergic contact dermatitis because of more permeable neonatal skin, a moist environment, frequent contact with irritants and resultant skin barrier breakdown, and exposure to topical products such as diaper wipes, diaper preparations, and disposable diapers. To our knowledge, potential allergens in these products have not been thoroughly catalogued or studied.

We explore and review potential allergenic ingredients in diaper wipes, topical diaper preparations, and disposable diapers.

We analyzed 63 diaper wipes, 41 topical diaper preparations, and the 3 top selling diaper brands available from two of the largest retailers in the United States. Each potential allergen is discussed, and epidemiologic studies of rates of sensitization to potential allergens in children are also reported.

Botanical extracts, including members of the Compositae family, were the most commonly represented potential allergen in both diaper wipes and topical preparations. Other potential allergens identified with high frequency include α-tocopherol, fragrances, propylene glycol, parabens, iodopropynyl butylcarbamate, and lanolin. Frequent culprits such as formaldehyde releasers and methylchloroisothiazolinone/methylisothiazolinone were not prevalent in our analyzed products.

Polymyxin B is not included in most standard contact allergen series. The aim of this study was to determine the prevalence of contact sensitization to polymyxin B in a population of patients referred for patch testing.

A retrospective cohort study design was used to collect data on 795 patients referred to the contact dermatitis clinic of the McGill University Health Centre, as well as to the office of one of the authors (L.M.), between March 2014 and November 2015. Patients were patch tested to the North American Contact Dermatitis Group baseline series and polymyxin B sulfate 3% in petrolatum.

Out of 795 tested individuals, 18 were allergic to polymyxin B, for a prevalence of 2.3%. The eruptions affected almost all body parts, but mostly the face. The degree of reaction ranged from 1+ to 2+. Isolated reactions to polymyxin B occurred in 9 (50%) patients, whereas reactions to bacitracin and polymyxin B were seen in the other 9. Only 1 patient reacted to bacitracin, polymyxin B, and neomycin (11.1%). Most reactions (12/18) were from past exposure to polymyxin B.

Allergic reactions to polymyxin B are not rare, and this antibiotic warrants inclusion in the standard patch testing series.

Colophony and propolis are among the complex plant resins used in a wide variety of medicinal and personal care products. A number of studies of colophony, propolis, and fragrance mixes suggest that contact with one of these allergens may increase the risk of delayed-type hypersensitivity reactions with additional compounds of significant cross-reactivity.

The aims of this study were to determine rates of cross-reactivity between propolis, colophony, and different fragrance mixes and to determine significant cross-reactivity thresholds for which to counsel patient avoidance.

Rates of cross-reactivity were calculated from the databases of 2 midwestern US patch testing centers. Rates were calculated both separately and collectively.

For patients allergic to colophony, fragrance and propolis may be considered significant cross-reactors. For patients allergic to propolis, fragrance and colophony may be considered significant cross-reactors. Cross-reactions between colophony, propolis, and fragrance mixes are unidirectional so, for patients allergic to fragrance, cross-reaction to propolis or colophony is not significant. Colophony allergy is found in only a small number of fragrance-allergic patients and is not a good indicator for fragrance allergy.

Lichen simplex chronicus (LSC) and chronic hand eczema (CHE) are 2 common dermatological disorders that affect physical, social, and psychological aspects of life. The aim of this study was to compare quality of life and obsessive-compulsive tendencies between patients with LSC and patients with CHE.

Sixty patients with LSC, 60 patients with CHE, and 60 healthy controls were included in the study. Quality of life was evaluated according to the Dermatology Life Quality Index (DLQI). Patients were also assessed for compulsive behavior with the Leyton Trait Scale.

Patients with LSC (13.00 [1.41]) had a statistically significant higher mean (SD) DLQI compared with patients with CHE (11.33 [1.53]). Patients with LSC (13.97 [2.14]) presented statistically significant higher levels of obsessive-compulsive personality traits than patients with CHE (12.48 [2.69]), whereas both groups also differed from the healthy controls (10.68 [3.87]). The DLQI was not correlated with the Leyton Trait Scale in either the patients with LSC (r = 0.10, P = 0.50, not significant [NS]) or in the CHE patients (r = 0.01, P = 0.92, NS).

Although both LSC and CHE are associated with impaired quality of life and obsessive-compulsive tendencies, significantly higher scores were recorded in patients with LSC.

The prevalence of chromate allergy has declined worldwide in the last decades.

The aim of the study was to assess tendencies in chromate allergy in northern Israel and its possible causes.

Retrospective analysis of patch test data during 1999-2013 and a review of the medical records of patients with chromate allergy were conducted.

A total of 4846 consecutive patients were patch tested, of whom 146 (3%) were found to be chromate sensitive. The prevalence of chromate allergy decreased significantly from 4.7% in 1999–2001 to 2.8% in 2002–2004 (P = 0.02). Since then, no significant fluctuations have occurred. A gradual and consistent decline in chromate allergy was recorded among women from 4.8% in 1999–2001 to 2.3% in 2008–2010. Cement (18.4%) was the most frequent source of exposure and was mainly observed in men. The frequency of clinically relevant cement exposure increased significantly from 7.7% in 2002–2004 to 28.7% in 2011–2013 (P = 0.04), whereas the frequency of relevant detergent exposure decreased significantly from 25% in 1999-2001 to 5.7% in 2011–2013 (P = 0.04). Hand (68.5%) was the most frequently involved anatomical site.

The prevalence of chromate allergy in northern Israel is stable in the general population and gradually decreasing among women. These changes may be caused by reduced exposure to water-soluble hexavalent chromium in detergents but not in cement.

Photoallergic contact dermatitis (PACD) is a hypersensitivity reaction that occurs when a previously photosensitized exogenous agent comes into contact with UV radiation. The best method for testing PACD is photopatch testing (PPT).

The primary objective of the study was to determine the frequency of PACD to 20 different photoallergens in common usage in China during a 10-year period.

All patients (n = 6153) who had PPTs done between 2005 and 2014 at the Department of Dermatology of Huashan Hospital, Fudan University, were included.

A total of 3767 PACD reactions in 3668 subjects (59.61%) were recorded. Of these allergens, chlorpromazine (CPZ) (51.82%), para-aminobenzoic acid (11.94%), thimerosal (9.81%), potassium dichromate (6.37%), sulfanilamide (5.38%), and formaldehyde (4.7%) were the top 6 allergens that elicited PACD reactions. A comparison of PACD reactions between January 2005 to December 2009 and January 2010 to December 2014 revealed a statistically significant decrease in PACD reaction for chlorpromazine, potassium dichromate, p-aminobenzoic acid, and p-phenylenediamine. Formaldehyde showed a trend toward a statistically significant increase in sensitization over the 10-year period.

In conclusion, positive PACD reactions were most frequent to chlorpromazine in our population. New allergens such as potassium dichromate and formaldehyde should be added to the test series.