Dermatitis®

The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods.

The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE–related dermatoses.

Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment–induced occupational dermatoses and management strategies were explored.

Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed.

There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.

Carmine is a natural red dye that may cause allergic contact dermatitis.

The aim of this study was to analyze patch test reactions to carmine (2.5% in petrolatum) and characterize carmine-positive patients.

This study conducted a retrospective analysis of North American Contact Dermatitis Group data compiled between 2011 and 2012.

Of 4240 patients patch tested to carmine, 132 (3.1%) had reactions with a final interpretation of “allergic” (positive). Carmine-positive patients were significantly more likely to be female (77.7% vs 68.3%; P = 0.0237) and have a final primary diagnosis of allergic contact dermatitis (74.8% vs 47.2%; P < 0.0001). As compared with carmine-negative patients, carmine-positive patients were significantly more likely to have involvement of all facial sites combined (48.1% vs 29.9%; P < 0.0001) and the lips (7.6% vs 3.6%; P = 0.0166). At final reading, most carmine reactions were weak (+; 64.9%). Approximately half (53.4%) were currently clinically relevant; identified sources were primarily personal care products (77.1%), especially makeup (31.4%) and lip products (8.6%).

Weak patch test reactions to carmine should be interpreted with caution. Allergic contact dermatitis to carmine should be suspected in women with facial and/or lip dermatitis, especially those using carmine-containing cosmetics.

Hair products are a potential cause of allergic contact dermatitis. There are limited data on the allergen content of ethnic hair products.

To identify allergens unique to ethnic hair products (shampoos, conditioners, styling products) and provide a resource for low allergen hair care products for patients with ethnic hair types.

The top 100 best-selling shampoos, conditioners, and styling products for ethnic and nonethnic hair products were determined from 3 major online retailers (Walmart, Target, Walgreens). Allergen was defined as presence on the 2017 American Contact Dermatitis Society Core 80 allergen list.

The 2017 American Contact Dermatitis Society Core 80 allergens were tabulated for ethnic and nonethnic shampoos, conditioners, and styling products. A list of low-allergen shampoos, conditioners, and styling products was identified. Fragrance was the most common allergen for ethnic shampoos, conditioners, and styling products. Other notable allergens included methylchloroisothiazolinone/methylisothiazolinone, formaldehyde releasers, cetyl steryl alcohol, tocopherol, decyl glucoside, sodium benzoate, and phenoxyethanol.

This study identifies important differences in allergens found in products marketed for ethnic hair compared with those marketed for nonethnic hair.

Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD).

This study documented the North American Contact Dermatitis Group (NACDG) patch testing results from March 1, 2017, to December 31, 2018.

At 14 centers in North America, patients with dermatitis were tested in a standardized manner with a screening series of 70 allergens and supplemental allergens as clinically indicated. Data were manually verified and entered into a central database. Descriptive statistics were estimated, and trends were analyzed using χ² test.

Overall, 4947 patients were tested. There were 3235 patients (65.4%) who had at least 1 positive reaction and 2495 patients (50.4%) had a primary diagnosis of ACD. Five hundred eighty-one patients (11.7%) had occupationally related dermatitis. There were 10,122 positive patch test reactions. Nickel remained the most commonly detected allergen (16.2%), followed by methylisothiazolinone 0.2% aqueous (15.3%) and methylchloroisothiazolinone/methylisothiazolinone 0.02% aqueous (200 ppm, 11.0%). Compared with the previous reporting periods (2015–2016 and 2007–2016), the proportion of positive reactions for the top 20 screening allergens statistically increased for only 1 allergen, propolis (3.4%; risk ratios = 2.05 [confidence interval = 1.66–2.54] and 1.82 [confidence interval = 1.57–2.11]).

Four newly added allergen preparations, hydroperoxides of linalool (8.9%), benzisothiazolinone (7.3%), sodium metabisulfite (2.7%), and hydroperoxides of limonene (2.6%), all had a prevalence of greater than 2%. Approximately 1 (19.7%) in 5 tested patients had 1 or more clinically relevant reactions to an allergen not on the NACDG screening series; 13.2% of these were occupationally related. T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed 30% to 40% of reactions detected by the NACDG screening series.

These results demonstrate the importance of a regularly updated screening allergen series. Methylisothiazolinone continues to be a significant allergen in North America. Patch testing with allergens beyond a screening tray is necessary for complete evaluation of occupational and non-occupational ACD.

Phenols and parabens (P&Ps) are commonly found in skin care products. However, P&Ps' role in pruritus and eczema has not been studied.

The aim of the study was to investigate the association between P&Ps, and pruritus and eczema.

This is a cross-sectional population-based study of 2202 participants. We examined the association between urinary phenols (triclosan, bisphenol A, benzophenone-3) and parabens (methyl and propyl parabens) and itchy rash/eczema using the 2005–2006 National Health and Nutrition Examination Survey database. Phenols and parabens were divided into quartiles (Qs) with the first Q as the reference. We calculated odds ratios and 95% confidence intervals, adjusting for multiple variables.

Urinary triclosan was inversely associated with itchy rash (P trend = 0.048). In a subpopulation analysis by race/ethnicity, urinary methyl paraben was positively associated with itchy rash in African Americans (fourth Q vs first Q: odds ratio, 12.60; 95% confidence interval, 1.03–154.06; P trend = 0.02). Triclosan was inversely associated with eczema in whites (P trend = 0.04).

Methyl paraben exposure may increase the risk of itchy rash in African Americans, whereas triclosan may decrease the risk of itchy rash and eczema. The potential effect of triclosan and methyl paraben in pruritus and eczema warrants further study.