Dermatitis®

The current method for patch test tray assembly requires hand dispensing a small volume of hapten onto chambers. Because of human error, this technique produces inaccurate and inconsistent results. The recommended volume of hapten for patch testing using Finn Chambers is 20 μL.

The aims of this study were to create a device that standardizes the delivery of 20 μL and to compare it with the current hand dispensing technique.

A device, named the Revolution, was created using the SolidWorks program. Five nurses in our Contact Dermatitis Clinic were asked to load 10 Finn Chambers using the current technique and also using the Revolution. Assembly time, volume of petrolatum, and accuracy of placement were measured. After the 3 trials, the nurses completed a survey on the 2 methods.

The amount of petrolatum dispensed using the current technique ranged from 16 to 85 μL, with an average amount of 41.39 μL. The Revolution design dispensed an average of 19.78 μL.

The current hand dispensing technique does not allow for accurate and consistent dispensing of 20 μL for patch testing. In contrast, the Revolution is an accurate and consistent device that can help standardize the patch testing method.

The evidence on the safety of topical preparations containing emulsifiers is limited.

The aims of the study were to assess (1) the prevalence of sensitization to some emulsifiers commonly found in topical products, (2) the sensitization to emulsifiers in relation to sex, age, and predisposing factors, and (3) the frequency of concomitant sensitization to other common allergens.

All consecutive patients presenting to the Allergy Unit of our Dermatological Department for allergological investigation were enrolled. All patients were patch tested with the Italian Società Italiana di Dermatologia Allergologica Professionale ed Ambientale baseline series and an additional emulsifiers series. Doubtful patch test reactions were not considered.

Of 310 patients, 50 (16%) were sensitized to emulsifiers with 72 positive reactions. Lauryl polyethylene glycol/polypropylene glycol-18/18 methicone gave 26 positive reactions, glyceryl oleate 19, myristyl alcohol, and Amerchol L101 11. Concomitant sensitization to emulsifiers was found in 16 patients. Patients allergic to emulsifiers showed concomitant allergic reactions to allergens commonly found in cosmetics. No significant differences by sex, age, atopic diathesis, and clinical pattern at presentation were noticed.

Contact allergy to emulsifiers is more frequent than reported. Patients allergic to emulsifiers show frequent positive patch tests to other constituents of cosmetics and topical products.

Nickel is the most common allergen found by patch testing; however, not all cases of nickel allergy are type 4 (delayed) allergies. Contact urticaria (CU) to nickel (immediate reaction) has been reported; however, few seem to evaluate it as per a recent published survey of American Contact Dermatitis Society members.

The aim of the study was to present a series of patients who had clinical histories suggestive of nickel allergy and yet were patch test negative but prick test positive to nickel, thus demonstrating CU.

We reviewed the charts of 11 patients who were patch test negative but prick test positive.

All 11 patients demonstrated evidence of CU by prick testing (or closed chamber test in 1). None were patch test positive to nickel 2.5% or 5.0%. Four patients’ histories mentioned reactions to various jewelry/earrings within minutes, whereas 2 histories mentioned reacting within a few hours. These histories are consistent with CU. Others (except 1 patient) recalled reacting to jewelry/earrings but did not recall a time frame.

Our series suggests that CU to nickel may be far more common than anticipated and should be evaluated with prick testing when patients’ history suggests nickel allergy and yet they are patch test negative.

The North American Contact Dermatitis Group patch tests patients with suspected allergic contact dermatitis (ACD) to a broad series of screening allergens and publishes periodic reports. We have previously reported on the association of race and ethnicity with the rates of positive responses to standard patch test allergens. This report extends those observations.

The aim of the study was to report the North American Contact Dermatitis Group patch testing results from January 1, 1998, to December 31, 2006, comparing the frequency of positive reactions between white and black subjects.

Standardized patch testing with 45 allergens was used at 13 centers in North America. χ² analysis of results in black subjects as compared with whites was examined.

A total of 19,457 patients were tested; 92.9% (17,803) were white and 7.1% (1,360) were black. The final diagnoses of ACD (whites, 45.9%; blacks, 43.6%) and irritant contact dermatitis (13.0%/13.3%) were similar in the 2 groups. The diagnosis of atopic dermatitis was less common in the white patients (8.9%) as compared with the black patients (13.3%). Positive patch test reactions rates were similar for most allergens. However, statistically, blacks reacted more frequently to p-phenylenediamine (7.0% vs 4.4%, P < 0.001), bacitracin (11.6% vs 8.3%, P = 0.0004), as well as specific rubber accelerators mercaptobenzothiazole (2.7% vs 1.8%), thiuram (6.2% vs 4.3%), and mercapto mix (1.9% vs 0.8%, P < 0.001). Whites had an increase in positive reactions to fragrances (12.12% vs 6.77%, P < 0.0001), formaldehyde (9.25% vs 5.45%, P < 0.0001), and some formaldehyde releaser preservatives used in personal care products and textile resins (9.80% vs 6.18%, P < 0.0001).

There were statistically different rates of positive patch test reactions to specific allergens between black and white patients suspected of having ACD. The etiology of these differences is unclear but probably relates to culturally determined exposure patterns rather than genetic differences.

Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed.

The aim was to quantify patch test results from providers evaluating US children.

The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015–2016).

One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%).

This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

para-Phenylenediamine (PPD) is a potent allergen with frequent exposure through use of hair dyes or henna tattoos.

We wished to determine if prevalence of PPD sensitivity is changing through time as trends in its use change.

A total of 3631 patients were patch tested consecutively with the environmental standard series between 2007 and 2014 to map the prevalence of PPD sensitivity and its distribution according to age, sex, and diagnosis.

Two hundred nine patients (5.75%) were proven to be PPD sensitive. Most PPD-sensitive patients were approximately in their 60s in 2007, whereas in 2014, they were in their 20s and 30s. In 2014, 61.1% of the patients were younger than 35 years and 50% were younger than 25 years. Of 209 PPD-sensitive patients, 32.5% had present relevance related to hair dyeing and eyebrow or eyelash coloring procedures. All affected male patients were hairdressers. Adverse reaction to henna was detected in only 1 case after henna hair dye use.

The 5.75% prevalence of PPD sensitization in our study was higher compared with that in the European data. It is alarming that PPD hypersensitivity occurred even among teenagers. This may be mainly explained by hair dyeing at an early age.

Occupational skin disease is common in healthcare workers. If the healthcare worker develops moderate to severe dermatitis, return to work (RTW) may be challenging.

The study objectives were to review the impact of an RTW program on the work status of nurses with occupational hand dermatitis and to identify successful intervention methods and strategies.

Nurses who received RTW services at a tertiary occupational medicine clinic were identified, and information related to their diagnosis and RTW was abstracted from their charts.

Eighteen nurses with irritant hand dermatitis who received RTW services were identified. Twelve nurses (67%) were performing administrative duties because of their skin condition when admitted to the RTW program, and others were performing patient care with modifications. A graduated RTW trial was commonly implemented with optimized skin care management and monitoring by physicians and the RTW coordinator. Upon discharge, 14 nurses (78%) had returned to their nursing roles with direct patient care, 3 (17%) were working as nurses in non–patient care roles, and 1 (6%) was on permanent disability.

A graduated RTW trial to reduce cumulative irritant exposure is a crucial strategy to facilitate nurses’ transition back to work and to maintain direct patient care nursing roles.