Dermatitis®

Sensitization to methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) is a worldwide problem. Washing machine detergents are suspected to cause cutaneous symptoms in highly sensitized patients. Little is known about the persistence of isothiazolinones in clothes that have been washed.

The aim of the study was to analyze the possible persistence of MI, MCI, benzisothiazolinone, and octylisothiazolinone in common fabrics after machine washing.

Different clothes (cotton, polyester, linen, and wool) were collected, and 4 types of wash were done (control, standard, standard + conditioner, and standard + double rinse). The samples were analyzed using ultrahigh-performance liquid chromatography.

The results showed that the concentrations of isothiazolinones were very low, independent of the type of material or wash. The highest levels were found in the control wash (hand wash), reaching a maximum of 0.4 ppm in the linen.

Our findings suggest that it is not necessary to recommend that patients sensitized to MI avoid isothiazolinones in machine detergents or fabric conditioners or to double rinse. However, after using the detergent for hand washing (the control in our study), there may remain sufficient concentrations of isothiazolinones in clothes to produce symptoms in highly sensitized patients.

Common recommendations for tattoo aftercare to ensure proper healing include application of topical products. Little is known about tattoo aftercare products.

Tattoo aftercare products were identified from a previous study and a search on Amazon.com using the phrase “tattoo aftercare.” Duplicates and products without complete ingredient lists were excluded. Marketing claims were tabulated. All ingredients were entered in Excel and grouped according to Contact Allergen Management Program categories. Comparison of ingredients to North American Contact Dermatitis Group (NACDG) screening and American Contact Dermatitis Society (ACDS) Core allergens was conducted.

A total of 84 tattoo aftercare products from 52 distinct brands were found. Forty-eight distinctive market claims were identified; the use of “natural ingredient(s)” (42.9%) was most common. There were 4 to 28 ingredients per product (mean = 11.8 ± 5.5) with a total of 369 distinct ingredients listed. Products contained an average of 7.9 ± 3.9 ACDS Core allergens per product and 7.0 ± 3.7 NACDG allergens per product. Most common allergens included fragrance/botanicals (n = 529), vitamin E derivatives (n = 43), and vitamin B₅ derivatives (n = 11).

This review of 84 products found that tattoo aftercare products contain an average of 8 ACDS Core and 7 NACDG allergens. Clinicians should be aware of potential allergens in tattoo aftercare products.

Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis.

The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate.

This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (DL-α-tocopherol 100% and/or DL-α-tocopherol acetate 100%) from 2001 to 2016.

Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers.

Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.

Assessment of chronic hand eczema (CHE) is complex and warrants standardization.

We sought to guide clinicians on the assessment of CHE.

An electronic questionnaire regarding the diagnosis and assessment of CHE was completed by councilors (n=45) of the International Eczema Council, an international group of clinicians and researchers with expertise in CHE. The survey consisted of 52 statements for consensus.

Overall, nine statements (17.3%) had strong, twenty-three (44.2%) moderate, 12 (23.1%) low, and 8 (15.4%) very low levels of agreement. Five statements had considerable disagreement, including the value of conducting a skin biopsy (62.2% disagreement), investigating for possible type 1 reactions (60.0%), conducting a fungal culture (44.4%), finding no history of relevant allergens and/or irritants (31.1%) in most or all cases, and performing patch testing irrespective of lesion location and morphology (28.9%). Agreement was generally highest among respondents from Europe (28.6–77.8% agreement), followed by Asia (7.1%–35.7% agreement), North America (0%–35.5% agreement), and other (0%–13.3% agreement).

There were substantial differences of agreement, suggesting there are many knowledge and/or practice gaps with respect to CHE. Future research is needed to inform evidence-based and/or consensus guidelines for CHE.

Allergic contact dermatitis to tattoo ink may last from weeks to years. Formaldehyde is a strong sensitizer that may be present in predispersed tattoo inks.

The aim of this study was to evaluate the presence of formaldehyde in predispersed tattoo inks using the chromotropic acid method.

Tattoo inks from 39 companies were evaluated. Inclusion criteria included availability to purchase inks online through US tattoo product wholesalers or individual Web sites. Brands were grouped based on prevalence of use: common, uncommon, or rare. For common brands, 8 colors (primary colors, secondary colors, black, and white) were purchased. For uncommon and rare brands, 5 colors (primary colors, black, and white) were purchased. Each ink was tested with standard chromotropic acid method procedures; concentration of formaldehyde released was quantified using spectrophotometry.

In total, 127 tattoo inks were purchased and tested. Ninety-three (73%) tested positive for formaldehyde release; 34 (27%) tested negative. Formaldehyde release did not correlate with color or brand. At least 1 ink from all brands (except 1) was positive for formaldehyde release.

Approximately three-quarters of selected US tattoo inks tested positive for formaldehyde release. Clinicians should be aware of tattoo ink as a potential source of formaldehyde.

Data regarding patient-reported symptoms during patch testing are limited.

To provide frequency of symptoms (pain, sleep difficulty, medication need, site itching, itch elsewhere, and worsening rash) experienced by patients undergoing extensive patch testing and to determine association of these symptoms with patient characteristics.

This was a retrospective chart review of patients who underwent patch testing at a tertiary referral, contact dermatitis clinic over 15 months. Demographics, number of patches placed, patch location(s), and number of reactions (total and ++/+++) were extracted by chart review. Frequency of symptoms reported on a questionnaire administered at the 48-hour (48H) and final (F) visits was tabulated, and associations were evaluated using χ² and Fisher exact tests.

Six hundred forty-one patient records were accessed. The most common symptom was patch site itching (48H, 77.4%; F, 76.5%). Frequency of pain and sleep difficulty were significantly higher at 48H compared with F (P < 0.0001). Worsening of rash was significantly higher at F compared with 48H (P < 0.0001). The number of patches was significantly associated with all symptoms except sleep difficulty (P ≤ 0.0141). Patch location was significantly associated with pain, medication need, itch elsewhere, and worsening rash but not sleep difficulty or site itch (P ≤ 0.0257). The number of reactions (total and ++/+++) was significantly associated with all symptoms except itch elsewhere (total P ≤ 0.0316; ++/+++: P ≤ 0.0445).

Most patients reported symptoms during patch testing, most commonly itching (at patch site and elsewhere), sleep difficulty, and need for medication. The number of positive patch test reactions (total and ++/+++) was the most common characteristic associated with the symptoms.

The human repeated insult patch test (HRIPT) has a history of use in the fragrance industry as a component of safety evaluation, exclusively to confirm the absence of skin sensitization at a defined dose.

The aim of the study was to document the accumulated experience from more than 30 years of conducting HRIPTs.

A retrospective collation of HRIPT studies carried out to a consistent protocol was undertaken, with each study comprising a minimum of 100 volunteers.

The HRIPT outcomes from 154 studies on 134 substances using 16,512 volunteers were obtained. Most studies confirmed that at the selected induction/challenge dose, sensitization was not induced. In 0.12% of subjects (n = 20), there was induction of allergy. However, in the last 11 years, only 3 (0.03%) of 9854 subjects became sensitized, perhaps because of improved definition of a safe HRIPT dose from the local lymph node assay and other skin sensitization methodologies, as well as more rigorous application of the standard protocol after publication in 2008. This experience with HRIPTs demonstrates that de novo sensitization induction is rare and becoming rarer, but it plays an important role as an indicator that toxicological predictions from nonhuman test methods (in vivo and in vitro methods) can be imperfect.

The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood.

This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD.

The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores.

Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06–1.31), home behavior (OR, 1.18; 95% CI, 1.06–1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06–1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05–1.31) and with siblings (OR, 1.14; 95% CI, 1.02–1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22–1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22–1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety.

AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.