Dermatitis®

Contact dermatitis to hair dyes remains a health concern. Regulations in many countries require consumer self-testing for hair dyes, but no standardized procedure exists.

The aim of this study was to develop a self-test protocol for an allergy alert test (AAT) that can elicit a self-noticeable alert signal in p-phenylenediamine (PPD)–allergic consumers.

Simulating consumer use conditions (open application for 45 minutes after mixing with a developer), PPD-positive hair dye–allergic subjects and PPD-negative control subjects were tested on the forearm and behind the ear with experimental products containing 0.05%, 0.25%, 0.75%, and 2% PPD. Reactions were self-evaluated by subjects and independently assessed by dermatologists.

The AAT caused a reaction self-noticeable on the forearm in 90.5% (38/42) and behind the ear in 93% (39/42) of the PPD-positive subjects. This was objectified by a dermatological evaluation. The strength of the AAT response and the number of responding subjects increased with increasing PPD concentrations. Allergy alert test responses were also dependent on the reaction strength of the diagnostic patch test to PPD before the study; in subjects with (+++) patch test reactions, 19 of 19 were positive. All 48 control subjects were negative to the AAT. Therefore, the AAT protocol provides a signal indicative of an allergic reaction in PPD-allergic hair dye consumers.

Dose/area and reading paradigms for gold patch testing are controversial and not standardized worldwide.

The aims of this study were to determine the optimum patch test dose of gold sodium thiosulfate (GST) in a hydrogel (HYD) and to establish GST HYD safety/efficacy and further characterize normal morphology and time course of GST reactions.

Twenty gold-allergic patients were patch tested with a dilution series of GST HYD and with GST 2% petrolatum (pet). Furthermore, this previously determined optimal dose was compared with GST 0.5% pet in 19 known-allergic and 216 consecutive subjects.

The optimal GST HYD dose was 0.075 mg/cm², not statistically different from GST 2% pet (P = 0.4795). Gold sodium thiosulfate HYD outperformed GST 0.5% pet in both known-allergic subjects (79% vs 63%, P = 0.2482) and consecutive subjects (30% vs 9%, P < 0.0001). Late reactions were common in consecutive patients with both HYD and pet. Significantly more persistent reactions were associated with GST HYD than with GST 0.5% pet.

Gold sodium thiosulfate HYD 0.075 mg/cm² is the optimal dose for diagnosis of gold contact allergy with GST. Gold sodium thiosulfate 0.5% pet yielded false-negatives in some patients, suggesting inadequate dose per centimeter squared. Late reads are normal, expected, and necessary for diagnosis of gold contact allergy in this cohort.

Pigmented cosmetic dermatitis (PCD) is frequently encountered in dark-skinned individuals as gradual hyperpigmentation on the face without preceding erythema or itching. Little is known about the allergen profile in PCD.

The aim of the study was to describe the clinical profile and common allergens in PCD and allergic contact dermatitis (ACD) to cosmetics in Delhi.

Records of patients suspected of PCD and ACD to cosmetics were analyzed. All patients were patch tested with the Indian standard series, Indian cosmetic and fragrance series, and personal cosmetics and, in relevant cases, hairdresser series.

One hundred six patients were analyzed. Patch test was positive in 77 cases (72.6%). Cetrimonium, gallate mix, thiomerosal, and skin lightening creams were more frequently positive in cases of PCD (P = 0.019–0.003), whereas p-phenylenediamine, toluene-2,5 diamine sulfate, p-aminophenol, m-aminophenol, and nitro-p-phenylenediamine were predominantly positive in ACD to cosmetics (P < 0.001).

Preservatives, antioxidants, and skin lightening creams seem to play a role in causation of PCD, whereas hair dye allergens cause ACD to cosmetics in India.

Little is known about the impact of sleep disturbances (SD) or sleep-related impairment (SRI) in adults with AD or their relationship with severity of AD and itch and other predictors.

The aim of this study was to determine the relationship between AD severity, SD, and SRI.

We conducted a prospective online questionnaire-based study of 287 adults with AD, including assessment of AD severity by Patient-Oriented Eczema Measure, self-reported global AD severity, Self-Assessed Eczema Area and Severity Index and visual analog scale–itch, Patient-Reported Outcome Measurement Information System SD and SRI individual items, and T scores.

Adults with AD commonly endorsed all SD and SRI symptoms examined; only 58 (21.8%) reported having good or very good sleep quality in the past week. However, only a minority of adults with AD endorsed a more profound impact from these individual aspects of SD and SRI in the past week or Patient-Reported Outcome Measurement Information System T scores greater than 55. In particular, SD and SRI were associated with severe or very severe AD (Patient-Oriented Eczema Measure, self-reported severity, visual analog scale–itch, and/or Self-Assessed Eczema Area and Severity Index). Sleep-related impairment was also associated with comorbid hay fever and/or anxiety.

This study suggests that SD and SRI are common in adults with AD, particularly those with severe diseases. Sleep disturbances and SRI should be considered when assessing burden of AD and therapeutic decisions.

Despite being widely reported by patients with atopic dermatitis (AD), pain symptoms, unlike itch, have not been widely assessed.

The aim of the study was to understand the distinct pain symptoms in patients with AD.

Responses from an anonymous questionnaire were collected from our eczema clinic (in-person survey) and collaboration with Global Parents for Eczema Research Group and the National Eczema Association (online survey) to assess skin pain among patients with AD 5 years and older. Eczema Area and Severity Index was measured in the clinic cohort to correlate with pain symptoms.

In our international cohort of 103 patients with AD, 78% reported concomitant pain and itch. The greatest pain burden occurred on the hands (odds ratio [OR], 0.77), perioral region (OR, 0.74), and toes (OR, 0.7), corresponding to regions with the greatest sensory nerve density. Pain was most commonly described as “burning” and “stinging,” particularly when lesions were red, cracked, and dry. Its presence significantly interfered with sleep, leisure activities, and activities of daily living. Among the clinic cohort, we observed a strong Spearman correlation between objective Eczema Area and Severity Index score and subjective skin pain. It is imperative that clinicians understand patients’ unique pain burden to best evaluate clinical severity and quality-of-life interference.