Dermatitis®

Patients with allergic contact dermatitis rely on ingredient lists published in databases and by online retailers to find safe skincare products.

The aim of this study was to determine the accuracy of product ingredient labeling by comparing drugstore product labels to ingredient lists published online.

Amazon was queried for best-selling items in several categories of skincare, generating a list of 93 products. These products were then found at a local Target and Walgreens and online on Contact Allergen Management Program, SkinSAFE, and Consumer Product Information Database. Drugstore product labels were compared with online ingredient lists and analyzed for discrepancies.

There were 31 occurrences in which an allergen listed in the 2017 American Contact Dermatitis Society Core Allergen Series was omitted (present on the in-store label but missing from an online list.) Seven omissions occurred on Contact Allergen Management Program, 11 occurred on SkinSAFE, 5 occurred on Consumer Product Information Database, and 8 occurred on Amazon.

Definitive treatment of allergic contact dermatitis is avoidance of allergens found on patch testing. These data suggest that patients may be at risk of inadvertent exposure to allergens from products, which are supposedly deemed safe according to online ingredient lists.

The American Contact Dermatitis Society Contact Allergen Management Program (CAMP) database was developed to provide patients with safe alternative products free of selected contact allergens. However, the CAMP database also records valuable information including the frequency of contact allergen searches for patients.

The aim of the study was to determine the relative prevalence of contact allergens in North America.

Data from the CAMP database were analyzed from January 1, 2018, to January 1, 2019. The number of searches performed for each specific allergen served as a measure of the relative prevalence for each contact allergen. Results were then stratified by age, sex, atopic history, and patch screening tray used.

The 2018 CAMP data show that many of the prevalent allergens are not currently on any contact allergy screening series. These data strongly indicate that testing only to an 80-item screening series will not provide adequate care for many patients with contact allergy. The most prevalent contact allergens seen were fragrance mix, nickel, balsam of Peru, methylchloroisothiazolinone/methylisothiazolinone, and cobalt. Some important differences are seen when stratifying CAMP data by age, sex, atopic history, and patch screening tray used.

Possible sources of data error exist because of lack of uniformity of patch test practices.

The CAMP database can be used to determine the relative prevalence of contact allergens, to help develop North American core screening patch test series, and to document the medical necessity of more comprehensive patch testing for patients with recalcitrant contact allergy.

Previous studies have used databases from a limited number of practice sites to assess the relative prevalence of contact allergens.

Data from the American Contact Dermatitis Society CAMP database were analyzed to determine the relative prevalence of contact allergens in North America during 2018.

Data documenting the relative prevalence of contact allergens are critical in the selection of allergens for a North American core allergen series and to document the medical necessity for patch testing to additional allergens beyond the core series.

Essure is an effective method for hysteroscopic sterilization. Reports of adverse effects, the underlying mechanisms of which are unknown, have increased in recent years.

The aim of the study was to determine whether there is a relationship between adverse events attributed to Essure and nickel sensitization.

Patients presenting alleged adverse reactions to Essure were referred for nickel patch testing before removal. Data regarding medical history of nickel sensitization and symptoms attributed to Essure were collected. Dimethylglyoxime spot tests were performed on the explanted Essure. There was a follow-up at 3 months to evaluate whether there is improvement of the symptoms after Essure removal.

Nickel sensitization via the classic delayed hypersensitivity pathway did not seem to be responsible for adverse events attributed to Essure. Among systemic symptoms reported, extracutaneous symptoms had the highest prevalence. Systemic contact dermatitis to nickel could not be ruled out in one case.

Allergic contact dermatitis to rubber accelerators in gloves has been well described in the literature. In response to this, glove manufacturers have recently marketed “accelerator-free” gloves. Little research has been done, to confirm whether these gloves are truly free from the accelerators known to cause contact dermatitis.

The aim of the study was to verify use of accelerators in reportedly accelerator-free/low-dermatitis-potential gloves.

A total of 16 commercially available medical gloves touted as “accelerator-free,” “sensitive,” or “low dermatitis potential” were obtained and analyzed via mass spectrometry (liquid chromatography heated electrospray ionization tandem mass spectrometry and liquid chromatography heated electrospray high-resolution tandem mass spectrometry) to determine whether any of the 9 known rubber accelerators were present (thiurams, carbamates, mercaptobenzothiazole, and diphenylguanidine).

Despite marketing claims to the contrary, all tested gloves had at least 1 accelerant detected. Dipentamethylenethiuram disulfide, a thiuram, was found in all 16 gloves. Half of the gloves (8/16) contained more than 1 accelerator, with 1 glove having 5 rubber accelerators present.

Patients with allergic contact dermatitis to accelerators should be aware potentially sensitizing accelerators may be present in gloves that are reported to not contain them.

Urushiol, the culprit allergen in Toxicodendron plants such as poison ivy, is an oily mixture of 15 and 17 carbon side chain alk-(en)-yl catechols. Recently, consumer products have been identified that contain Toxicodendron as an ingredient on their label; however, no studies have assessed whether urushiol is indeed present within these products.

The aim of the study was to determine whether urushiol compounds are present in consumer products labeled as containing Toxicodendron species.

Gas chromatography–mass spectrometry and liquid chromatography–tandem mass spectrometry were performed on 9 consumer products labeled as containing Toxicodendron species, including topical homeopathic remedies. Single ion monitoring gas chromatography–mass spectrometry was programmed in selective ion mode to detect 3-methylcatechol characteristic fragment ions of alk-(en)-yl catechols after silanization. Similarly, single ion monitoring liquid chromatography–tandem mass spectrometry was programmed to detect 4 urushiol pentadecylcatechols and 5 urushiol heptadecylcatechols using previously reported mass-to-charge ratios.

Gas chromatography–mass spectrometry detected alk-(en)-yl catechols in 67% (6/9) of the products tested. Liquid chromatography–tandem mass spectrometry detected multiple urushiol pentadecylcatechols and heptadecylcatechols in 44% (4/9) of the products tested.

Alk-(en)-yl catechols and multiple urushiols were detected in consumer products listing Toxicodendron species as an ingredient. Clinicians should be aware of these known allergenic ingredients in consumer products.

Allergic contact dermatitis (ACD) caused by (meth)acrylates used in nail products is being increasingly reported in nail technicians and consumers.

The aim of the study was to assess the incidence of sensitization to (meth)acrylates in technicians and users of nail products with ACD, referred for patch testing in a tertiary center, during the last 10 years.

All patients with ACD, who reported a profession associated with cosmetic nail procedures or use of such services and were referred for patch tests in our department between January 2009 and December 2018, were identified. The incidence of positive sensitization to (meth)acrylates was assessed.

Contact allergy to 1 or more (meth)acrylates was found in 116 (74.4%) of 156 nail technicians or nail product users, all women. One hundred thirty-eight (88.5%) were occupationally exposed, and 18 (11.5%) were consumers. In addition, there was a statistically significant increase in (meth)acrylate ACD during 2014–2018 (100/127 cases [79%]) when compared with 2009–2013 (16/29 cases [55%]). The most common sensitizer among the 156 allergic individuals was ethylene glycol dimethacrylate, which was positive in 113 cases (72.4%), and among patients with acrylate-positive patch test, the rate was 97.4%.

Our experience confirms the worldwide changing landscape of rising (meth)acrylate sensitization in nail technicians and nail products users with ACD. Efforts to improve prevention are needed, and clinicians should have a high index for suspicion in this occupational group.

Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children.

The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures.

Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis.

Of the 29 patients (mean ± SD age = 10.9 ± 5.1 years), 25 children demonstrated at least 1 positive reaction, with a total of 81 reactions overall. 40 (49.4%) of the reactions came from allergens outside of the T.R.U.E. Test, including cocamidopropyl betaine, which was frequent in patients with atopic dermatitis.

Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD.

Allergic contact dermatitis (ACD) has become more frequent in children. The prevalence of contact sensitization varies with respect to age, sex, and geographic localization.

The aim of the study was to investigate the experience of a tertiary health center regarding the patch test results of contact sensitization in children without atopic dermatitis.

This is a retrospective review of 89 children (30 boys and 59 girls) who were aged between 3 and 18 years and who were diagnosed with ACD between July 2013 and July 2017. Children with a known history of atopic dermatitis were excluded. All patients were tested with the TRUE (Thin-layer Rapid Use Epicutaneous) test series.

The most frequently determined allergens by TRUE test were methylchloroisothiazolinone (n = 7 [16.3%]), disperse blue 106 (n = 5 [11.6%]), and bacitracin (n = 5 [11.6%]). Formaldehyde-related allergens produced 15 positives.

Preservatives, such as methylchloroisothiazolinone, formaldehyde, and formaldehyde releasers, emerge as the most frequent allergens in children who undergo patch testing because of ACD. This finding might be attributed to the increase in the utilization of these chemical compounds in personal hygiene products for children.

Atopic dermatitis (AD) is associated with altered skin barrier, microbiome, and immune dysregulation that may increase risk of skin infections.

The aim of the study was to determine whether AD is associated with skin infections and related outcomes.

Data from the 2006 to 2012 National Emergency Department Sample were analyzed, including an approximately 20% sample of all US emergency department (ED) visits (N = 198,102,435 adults or children).

Skin infections were increased in ED visits of adults (7.14% vs 3.76%) and children (5.15% vs 2.48%) with AD. In multivariable logistic regression models, AD was associated with significantly higher odds of skin infection in adults (adjusted odds ratio [95% confidence interval] = 1.93 [1.89–1.97]) and children (2.23 [2.16–2.31]). Pediatric and adult AD were associated with significantly higher odds of carbuncle/furuncles, impetigo, cellulitis, erysipelas, methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections, molluscum contagiosum, cutaneous warts, herpes simplex and zoster viruses, eczema herpeticum, dermatophytosis, and candidiasis of skin/nails and vulva/urogenitals. Adults with AD had significantly higher odds of genital warts (1.51 [1.36–1.52]) and herpes (1.23 [1.11–1.35]). Skin infections were associated with US $19 million excess annual costs of ED care in persons with AD.

Atopic dermatitis patients had higher odds of multiple bacterial, viral, fungal, and sexually transmitted skin infections.