Dermatitis®

Body piercing provides a unique route of metal exposure.

The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals.

This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure.

Piercing was significantly associated with female sex, being older than 18 years, and atopy (P < 0.003). Nickel sensitivity was associated with 1 or more piercing for men and women combined (P < 0.0001; relative risk [RR], 2.54; 95% confidence interval [CI], 2.35–2.75), although this association was stronger for men (RR, 2.21; 95% CI, 1.77–2.76) than women (RR, 1.47; 95% CI, 1.31–1.65). The frequency of positivity to nickel increased with number of piercings (14.3% for 1 piercing to 34.0% with ≥5 piercings). Piercing was not significantly associated with cobalt sensitivity alone (P = 0.8992) and was negatively associated with chromium sensitivity (P < 0.0001). Jewelry was the most common source of allergic reactions to nickel irrespective of sex or pierced status.

Nickel sensitivity was significantly associated with piercing in both men and women. Jewelry was the most common source.

Alkyl glucoside surfactants, present in many cosmetic products, can cause allergic contact dermatitis. Decyl glucoside has been part of the North American Contact Dermatitis Group standard allergen panel since 2009.

This study aimed to identify rates and relevance of positive patch test reactions to decyl and lauryl glucosides and to determine how well one of these glucosides screens for contact allergic reactions to the other.

A retrospective analysis was performed on 897 patients suspected of having a cosmetic-related dermatitis and patch tested with both decyl and lauryl glucosides between 2009 and 2016.

Forty-eight patients (5%) had positive reactions to decyl glucoside and/or lauryl glucoside. Among the alkyl glucoside–allergic patients, 65% had positive reactions to both decyl and lauryl glucosides. In 41% of cases, reactions were of definite or probable relevance. In approximately 55% of cases, reactions were of possible relevance.

Sixty-five percent of glucoside-allergic patients exhibited co-reactions to decyl and lauryl glucosides. Thus, neither glucoside is an adequate screen for allergy to the other. Given that these reactions are often relevant, clinicians should patch test with decyl, lauryl, and other alkyl glucosides in cases of suspected cosmetic allergy.

Benzalkonium chloride (BAK) is a known irritant, and potentially cross-reacting quaternary ammonium compounds are commonly used as preservatives in personal care products.

The aim of the study was to review positive reactions to BAK in 615 patients patch tested for suspected allergic contact dermatitis.

A retrospective chart review was performed in 615 patients patch tested from June 2015 to October 2016. All patients were tested to a Modified American Contact Dermatitis Society core series of 70 allergens including BAK (0.1% aqueous). Initial readings were performed at 48 hours with final readings performed between 72 and 168 hours. Results were graded as + (weak: papules and erythema), ++ (strong: papules and edema or vesicles), or +++ (extreme: coalescing vesicles, spreading or bullous reactions).

A total of 141 men (23%) and 475 women (77%) were tested (mean age, 49 years). Four hundred thirty-two (70%) were atopic. Of 615 patients, 198 (32%) tested positive to BAK, and 64 (10%) had ++ or +++ reactions at their final reading. On average, BAK-positive patients were using at least 1 product containing BAK or possible cross-reactors.

Widespread exposure to irritants in dermatitis patients can predispose to sensitization. Products containing BAK or potential cross-reactors should be used carefully in patients with compromised skin barriers.

Allergic contact dermatitis commonly occurs on the face. Facial cleansing wipes may be an underrecognized source of allergens.

The aim of this study was to determine the frequency of potentially allergenic ingredients in facial wet wipes.

Ingredient lists from name brand and generic facial wipes from 4 large retailers were analyzed.

In the 178 facial wipes examined, a total of 485 ingredients were identified (average, 16.7 ingredients per wipe). Excluding botanicals, the top 15 potentially allergenic ingredients were glycerin (64.0%), fragrance (63.5%), phenoxyethanol (53.9%), citric acid (51.1%), disodium EDTA (44.4%), sorbic acid derivatives (39.3%), tocopherol derivatives (38.8%), polyethylene glycol derivatives (32.6%), glyceryl stearate (31.5%), sodium citrate (29.8%), glucosides (27.5%), cetearyl alcohol (25.8%), propylene glycol (25.3%), sodium benzoate (24.2%), and ceteareth-20 (23.6%)/parabens (23.6%). Of note, methylisothiazolinone (2.2%) and methylchloroisothiazolinone (1.1%) were uncommon. The top potential allergens of botanical origin included Aloe barbadensis (41.0%), chamomile extracts (27.0%), tea extracts (21.3%), Cucumis sativus (20.2%), and Hamamelis virginiana (10.7%).

Many potential allergens are present in facial wet wipes, including fragrances, preservatives, botanicals, glucosides, and propylene glycol.