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Summary: Background: Changing patterns of exposure lead to changes in the spectrum of contact allergy in the general population and in patients patch tested for suspected contact allergy. The main contact allergens (haptens) are assembled in the so‐called 'baseline series'. Objectives: To present the current spectrum of contact allergy to baseline series allergens, and its temporal development over the last 12 years, based on data collected by the 56 active departments of the trinational Information Network of Departments of Dermatology (IVDK). Methods: Patch‐test data, along with core demographic and clinical information, subdivided into 4‐year periods for all patients patch tested with the baseline series in the IVDK, were analysed descriptively. Moreover, log‐binomial regression analysis addressed temporal trends of specific contact allergies, adjusted for potentially confounding factors. Results: Among the 125 436 patients tested with the German baseline series, the most common allergens were nickel (14·7%), fragrance mix I (8·1%), Myroxylon pereirae resin (7·5%) and cobalt (5·2%), with no conclusive trend. The rise and fall of contact allergy to methylchloroisothiazolinone/methylisothiazolinone (MI), following (self‐) regulation in the European Union, reflected the MI contact allergy epidemic. Propolis showed a marked upward trend with a prevalence of 3·94% during the period 2015–2018. Conclusions: Decreases in sensitization prevalence likely reflect reduced exposure, with some lag, as seen with hydroxyisohexyl 3‐cyclohexene carboxaldehyde. If no (sufficient) decrease can be observed despite interventions, such as for nickel and chromium, affected subgroups should be identified and their causative exposures explored. Finally, increases such as that observed with propolis, certainly warrant targeted investigation of the exposures driving sensitization, and possibly intervention. What is already known about this topic? Contact allergy is prevalent in the general population.Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends.This study describes the demographic and clinical profile of patients tested from 2007 to 2018.This research identifies contact allergens that require (further) preventive efforts. Linked Comment:Schuttelaar. Br J Dermatol 2020; 183:800–801. What is already known about this topic? Contact allergy is prevalent in the general population.Surveillance based on clinical data offers timely information on trends concerning certain allergens or subgroups at risk. What does this study add? This analysis provides an update of the current contact allergy prevalence in Central Europe, including time trends.This study describes the demographic and clinical profile of patients tested from 2007 to 2018.This research identifies contact allergens that require (further) preventive efforts. Linked Comment:Schuttelaar. Br J Dermatol 2020; 183:800–801. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Background: Psychological first aid is a common approach for providing support after potentially traumatic events (PTEs). In Germany, a peer support model is recommended by the German Statutory Accident Insurance (DGUV) to reduce sickness absence after occupational accidents, especially in public transportation. However, data on the effectiveness of peer support are very sparse. Aims: To analyse whether peer support has an impact on sickness absence after work-related traumatic events in public transportation. Methods: An analysis was conducted in two German public transportation corporations. Due to ethical requirements, we used a historical cohort study comparing peer support by colleagues (VAG-1), peer support at supervisor level (VGF) and a non-intervention group (VAG-0). The study period was from March 2003 to December 2012. We used a negative binominal regression model to estimate the relative risk associated with the interventions and potential confounders. Results: A total of 259 incident PTEs in employees were observed. A regression analysis identified the severity of PTE (severe and fatal events), VGF and age as significant factors in predicting duration of post-event sickness absence. In a stratified analysis, the mode of peer support (VGF) and age predicted sickness absence for less severe PTEs but this was not significant for severe PTEs. Conclusions: Severe and fatal PTEs had the strongest impact on sickness absence after PTEs. For less severe PTE, peer support provided by colleagues may be superior to supervisor support. [ABSTRACT FROM AUTHOR]

Background Although there is poor scientific evidence that working with occlusive gloves is as damaging as wet work, prolonged glove occlusion is considered to be a risk factor for developing hand eczema similar to wet work. Objectives To assess the effects of wearing occlusive gloves during the whole working day, without exposure to any additional hazardous substances, on skin condition and skin barrier function. Methods We investigated 323 employees of a semiconductor production company in Germany: 177 clean-room workers wearing occlusive gloves during the whole shift (exposed group) and 146 employees working in administration (control group). A standardized interview was performed, the skin condition of both hands was studied using the quantitative skin score HEROS, and transepidermal water loss ( TEWL) and stratum corneum hydration were measured. Results There was no significant difference in skin condition between the two subgroups. Values for TEWL and corneometry were significantly higher in exposed participants ( P < 0·05). However, the TEWL values were similar to control values if participants took off the occlusive gloves at least 30 min before the measurement. Hence, the effect of occlusion on skin barrier function seems to be transient. Conclusions Prolonged wearing of occlusive gloves with clean hands and without exposure to additional hazardous substances does not seem to affect the skin negatively. [ABSTRACT FROM AUTHOR]

Background As previous observations have indicated an inter-relationship between irritant and allergic skin reactions we analysed data of synchronous allergen and sodium lauryl sulfate ( SLS) patch tests in terms of a relationship between SLS responsiveness and allergic patch test reactions. Objectives To analyse differences in terms of allergen-specific and overall reaction profiles between patients with vs. those without an irritant reaction to SLS. Methods Clinical data of 26 879 patients patch tested from 2008 to 2011 by members of the Information Network of Departments of Dermatology were analysed. After descriptive analyses, including the MOAHLFA index, the positivity ratio and the reaction index, a negative binomial hurdle model was adopted to investigate the correlation between SLS reactivity and positive patch test reactions. Results Men, patients aged ≥ 40 years and patients with an occupational dermatitis background were over-represented in the SLS-reactive group. Patients with an irritant reaction to SLS showed a higher proportion of weak positive reactions, as well as more questionable and irritant reactions to contact allergens than patients not reactive to SLS. The risk of an additional positive patch test reaction increased by 22% for SLS-reactive patients compared with those who were SLS negative. Conclusions The marked association between SLS reactivity and the number of positive reactions in patch test patients may be due to nonspecific increased skin reactivity at the moment of patch testing only. However, increased SLS reactivity could also be due to longer-lasting enhanced skin irritability, which may have promoted (poly-)sensitization. Further studies, for example with longitudinal data on patients repeatedly patch tested with SLS and contact allergens, are necessary. [ABSTRACT FROM AUTHOR]

Background Nickel allergy is common worldwide. It is associated with hand dermatitis, and sensitization is often induced by nickel-releasing jewellery. The European Union ( EU) introduced legislation to control nickel content and release from jewellery and other consumer items through the EU Nickel Directive 1994, which came into force in 2001 and is now part of the REACH regulation. Objectives To examine the effects of the EU nickel regulations on the prevalence of nickel allergy in four European countries. Methods Nickel patch-test data from 180 390 patients were collected from national databases in Denmark, Germany, Italy and the U.K. from between 1985 and 2002 to 2010. Patients with suspected allergic contact dermatitis who had been patch tested with nickel sulfate 5% in petrolatum were included in the analysis. The main outcomes studied were the percentage of positive results to nickel patch tests, and changes in trends with time in an age- and sex-stratified analysis. Results A statistically significant decrease in nickel allergy was observed in Danish, German and Italian women aged below 30 years. In female patients in the U.K. this was observed between 2004 and 2010. In young men, a statistically significant decrease in nickel allergy was observed in Germany and the U.K., whereas a nonsignificant increase was observed in Italy. Conclusions There has been a reduction in the prevalence of nickel allergy in young women, contemporaneous with the introduction of the nickel regulation. A reduction is also suggested in men in Germany and the U.K. A causative effect of the regulatory intervention is the most likely explanation. [ABSTRACT FROM AUTHOR]

Background 'Polysensitization' ( PS) is usually defined as contact sensitization to three or more unrelated haptens of the baseline patch test series. Despite PS being an important clinical phenotype indicating increased susceptibility to contact allergy, statistical approaches to analyse PS have hitherto been preliminary. Objectives To apply an appropriate regression model for count data, namely, negative binomial hurdle regression, to a large set of clinical patch test data with the aim of estimating PS risk in more detail than previously achieved. Methods The detailed information provided by the hurdle model includes a separate estimation of an 'increment factor' quantifying the likelihood of further positive reactions, i.e. PS. Clinical data of 126 878 patients patch tested by departments comprising the IVDK (Information Network of Departments of Dermatology) network (www.ivdk.org) between 1995 and 2010 were included. Results Regarding anatomical sites as exposure (surrogate), the axillae and the feet were found to be strong PS risk factors. Moreover, age was a strong PS risk factor, and less so, female sex. In comparison, atopic eczema and occupational dermatitis were less important risk factors. Single allergens contributed to PS to a varying extent. Conclusions The data presented point to some, very likely exposure-related, risk factors which need to be considered in future PS research, e.g. addressing the genetic basis for PS. [ABSTRACT FROM AUTHOR]

Summary Background Reducing exposure to ultraviolet (UV) radiation is the main effective measure for preventing skin cancer. Educational campaigns targeting sun protection have been focused either on behaviour on the beach during the summer holiday alone, or during everyday outdoor activities of the children. Little is known about the comparison between these different settings. Objectives To analyse whether parents apply similar protective measures to reduce UV exposure for their young children in different outdoor environments. Methods Families ( n = 2619) with children aged 3-6 years (response: 64·7%) were enrolled in a population-based survey in the German city of Erlangen and its surrounding rural county. Using a self-administered standardized questionnaire parents gave information about demographic and photosensitivity data of their children, their knowledge about risk factors for skin cancer and their typical instructions given to their children when these played outside on a summer day in different outdoor environments. Results Significant discrepancies regarding the four UV protective measures (clothes, shade, sunhat, sunscreen) for children between an everyday outdoor setting and a holiday setting on the beach were observed. A high level of parental risk factor knowledge was significantly associated with a better protection for children in all four measures only on the beach. Photosensitivity and demographic characteristics had some impact on protective behaviour, too. Measures of sun protection were reduced with children's increasing age. Conclusions Skin cancer prevention campaigns should target the encouragement of sun protection for children also in outdoor activities of daily living, not only during a summer holiday on the beach. [ABSTRACT FROM AUTHOR]

Preservatives are well-known and important contact allergens. To examine the frequency of sensitization to preservatives, including time trends. Retrospective analysis of data on patch testing of preservatives contained in the standard series and special series collected by the IVDK during 1996-2009. Some 120 000 and 80 000 patients were tested with the baseline and the preservative series, respectively. Sensitization frequencies of the standard series allergens all ranged above 1%: methyldibromoglutaronitrile (MDBGN) 2·36-4·5%, methyl(chloro)isothiazolinone (MCI/MI) 2·22%, formaldehyde 1·54%, paraben mix 1·33% and Bronopol 1·25%. Regarding the special preservative series, 1·54% reacted positive to methylisothiazolinone (MI), and < 1% to the other preservatives. Concomitant reactions to formaldehyde in formaldehyde releasers ranged from 15% to almost 50%, and 67% of MI positives reacted to MCI/MI. As indicated by the MOAHLFA index, sensitization to MI, iodopropynylbutyl carbamate (IPBC) and quaternium 15 was associated more often with occupational dermatitis, whereas sensitization to imidazolidinyl urea and diazolidinyl urea was associated with face dermatitis, indicating cosmetic exposure. Epidemiologically relevant decreases (> 10%) were seen in chloroacetamide, benzyl alcohol and MDBGN. Epidemiologically relevant increases were noted in IPBC, sodium benzoate and MI. Preservatives are still important contact allergens. The introduction of new preservatives should consider the specific characteristics of occupational and of nonoccupational (cosmetic, household) exposure, and preventive measures should aim equally at both areas. [ABSTRACT FROM AUTHOR]

Background: The role of the orexigenic hormone ghrelin is of major interest in the altered appetite regulation of the elderly. Methods. Basal and postprandial levels of active and total ghrelin were measured in 15 younger (mean age 35.4 years) and 19 older (80.7 years) participants following a carbohydrate-rich test meal. Results. Our results showed that older participants felt postprandially less hungry and more full. Although basal levels were not significantly different, active and total ghrelin levels declined postprandially only in the younger study participants. Highly significant differences between the two age groups were shown for the changes of the area under the curve for active ghrelin (p = .024). Conclusions. Our study demonstrates for the first time that differences in hunger and satiety sensations in relation to age are paralleled by a substantially different response of acylated and total ghrelin, that is, the absence of a postprandial decline in ghrelin levels. [ABSTRACT FROM PUBLISHER]

Background We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers. Objectives The present study assessed the effectiveness of skin protection as presently recommended, especially the differential contribution of skin care and skin protection, to the prevention of occupational hand eczema. Methods Of 1355 metalworkers screened, 1020 male volunteers, all fit for work, were recruited for a prospective intervention study with four arms (skin care, skin protection, both combined, and control group, i.e. no recommendation). The study was performed from winter 2006/2007 to spring 2008, following each subject for up for 12 months. Both hands were examined using a quantitative skin score, and a standardized personal interview was performed three times. The change of the objective skin score from baseline to 12 months was used as primary outcome measure. Results After 12 months 800 subjects were included (78·4% of those recruited). The compliance to follow the randomized measure depended on the recommended measure and ranged from 73·7% to 88·7%. While in the control group a significant deterioration was found, the largest and significant improvement was noted in the group following the generally recommended skin protection programme (skin care + skin protection) followed by skin protection alone as second best. Conclusions The generally recommended skin protection regimen seems to provide effective prevention of occupational skin disease. Therefore, the compliance to follow the skin protection regimen, especially the use of skin protection, should be enhanced. [ABSTRACT FROM AUTHOR]

Background Patch test (PT) guidelines recommend classifying PT reactions based on morphological criteria only, i.e. irrespective of context information such as substance, concentration and vehicle. Objectives To analyse reclassification of PT reactions after revelation of context information subsequent to an initial blinded reading. Methods One hundred and twenty-two participants (experienced dermatologists and researchers) rated 20 digital images of different PT reactions twice, first blinded, then unblinded regarding substance, concentration and vehicle. Agreement between both ratings was quantified with Cohen’s kappa, and systematic differences statistically examined with tests for marginal homogeneity. Results Mostly, ratings remained stable, e.g. in > 90% of cases of images showing typical strong or extreme positive PT reactions. Reclassification was comparatively often observed in images depicting irritant reactions. Conversely, 16 of 122 participants re-rated doubtful reactions to thiuram mix and dichromate, respectively, as ‘allergic’ (weak or strong positive) after knowing the substance. Conclusions The considerable proportion of participants who choose an ‘allergic’ rating, despite a morphological presentation definitely not justifying this, points to a conceptual problem of the PT reading scale: the mixing up of morphological classification and interpretation. We therefore suggest amending the scale. Moreover, standardization of PT reading can be improved by continual PT training sessions. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus (S. aureus) is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, α-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion. Objectives To investigate the association between sensitization to inhalant allergens and skin colonization with α-toxin-producing S. aureus in AD. Patients and methods We investigated 127 patients with AD, aged 14–65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens. Results Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced α-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen. Conclusions Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with α-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with α-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards α-toxin-producing S. aureus. [ABSTRACT FROM AUTHOR]

Background  The effectiveness of a skin care programme is based mainly on the effectiveness of the products used and the frequency and diligence of the application of skin care products. Objectives  The present cross-sectional study was aimed at evaluating the implementation and acceptance of generally recommended skin protective means at the workplace. Methods  We included in our study 1355 metalworkers, employed in 19 factories, mainly of small or medium-size. The majority of participants were male (96·7%, n = 1310). The investigation included a standardized interview and a dermatological examination of the hands. Results  More than half of all participants (52·4%) had suffered from skin problems of the hands at some time. Three hundred and ninety-six subjects (29%) indicated they followed the skin protection regimen as it was generally recommended, i.e. the use of barrier creams in combination with moisturizers. A similar number of participants (28%) denied any use of protective creams. In general, compliance in men was significantly poorer than in women. Participants with past or present history of hand eczema used both barrier creams and moisturizers significantly more often. The skin condition of the hands, examined using a quantitative score, did not differ significantly in the four subgroups defined by different skin protection measures. While acceptance of protective measures was limited, these were available in all factories. Conclusions  Although barrier creams and moisturizers are highly recommended as effective means to prevent irritant contact dermatitis in Germany, our data prove that the compliance of application in this group at special risk for hand eczema is extremely low. [ABSTRACT FROM AUTHOR]

Background Nurses have a high risk of developing hand eczema due to hand disinfection procedures. Objectives To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). Methods A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. Results The majority (PS 60·1%; MC 69·5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79·2%/52·1%; HW 65·5%/36·2%) compared with an allergenic potential (ADI 10·4%/5·8%; HW 7·8%/3·9%). The prevalence of hand dermatitis in the MC was 13·4% by self-diagnosis and 22·4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. Conclusions Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards. [ABSTRACT FROM AUTHOR]

Background para-Phenylenediamine (PPD) is an important contact allergen and primarily used in hair dyeing. Objectives To quantify cases of contact allergy (CA) to PPD attributed to sources of exposure. Methods Patients with PPD CA, diagnosed by the Information Network of Departments of Dermatology (IVDK; n = 3307 of 83 030 patients tested), were divided into five subgroups of exposure. Demographic variables and pattern of concomitant reactions were used to characterize the subgroups further. The impact of individual factors on the risk of PPD CA was examined with a logistic regression analysis. Clinical epidemiology and drug utilization research (CE-DUR) methods were employed to estimate the 10-year prevalence of PPD CA in the general population. Results The 4% prevalence of PPD CA in patients was extrapolated to a prevalence of 0·96% in the general population. The defined profiles were found to ‘explain’ the following percentages of PPD CA: (i) hair dyeing in clients 22% (0·2% of the general population); (ii) different occupational exposures, namely hair dyeing by hairdressers, paint- and rubber-associated exposures 23% (0·22% of the general population); (iii) clothing/shoes 12% (0·12% of the general population). A probable causal exposure to PPD could not be identified in about 44% of patients with PPD CA. Conclusions In more than 50% of cases of PPD CA, a (very) probable causal exposure was identified. In the large remainder (44%) this was not possible. ‘Historical’ CA without current relevance and active sensitization through patch testing (a further important exposure to PPD) must be considered in these patients. [ABSTRACT FROM AUTHOR]

Background Fluctuating irritability of the skin induced by low ambient temperature and humidity may compromise the reproducibility of patch testing. Objectives To assess the impact of temperature and absolute humidity at the time of patch testing on the occurrence of irritant or doubtful (IR/?), weak positive (+) and (strong) positive (++/+++) reactions, respectively, among 12 allergens included in the German Standard Series. Methods Analysis of clinical data collected in the surveillance network IVDK ( ) between January 1993 and December 2001 ( n = 73 691 patients) combined with meteorological data obtained by the national services in Germany and Austria. Multinomial logistic regression analysis was used to estimate the risk associated with temperature, absolute humidity and vapour pressure, respectively, adjusted for sex, age, atopic dermatitis and duration of patch test application. Results For low temperature and humidity, a relevant increase of IR/? reaction frequency was observed in the cases of paraben mix and (chloro-) methylisothiazolinone. Both IR/? and + reactions were significantly increased with respect to the allergens fragrance mix, oil of turpentine, methyldibromo glutaronitrile + phenoxyethanol and particularly formaldehyde, while ++/+++ reactions were hardly affected by weather conditions. Conclusions The observed increase of IR/? reactions may be due to epidermal barrier function impairment. The impact of dry/cold weather on + reactions in terms of possibly false-positive reactions is restricted to few allergens. In the case of + reactions of unknown relevance, a re-test under warm conditions or verification tests such as the repeated open application test or the provocative use test may be recommendable. [ABSTRACT FROM AUTHOR]

Linked article: Bruze et al. Br J Dermatol 2020; 182:955–964. [ABSTRACT FROM AUTHOR]

Iodopropynyl butylcarbamate (IPBC) is a new preservative in medical and cosmetic leave-on products. Although cases of allergic contact dermatitis to IPBC have been reported, it is not known whether the usual test concentration of 0·1% is appropriate for screening tests with IPBC.To determine the concentration of IPBC that should be used in screening patch tests.An analysis was made of data filed by 26 centres of dermatology on patch tests performed with one or two concentrations of IPBC (0·1%, 0·2%, 0·3% or 0·5%) in 8106 unselected patients. Criteria used to determine the best test concentration of IPBC were the reaction index, the positivity ratio, the rate of crescendo reactions, and the relations between IPBC reactions and the MOAHLFA index irritant reactions to sodium lauryl sulphate (SLS), and allergic reactions to other contact allergens including preservatives.IPBC 0·1%, 0·2%, 0·3% and 0·5% yielded 0·5%, 0·8%, 1·3% and 1·7% positive reactions, but this increase was accompanied by an even greater increase in doubtful and irritant reactions. These figures and the other criteria examined suggested the range of suitable test concentrations of IPBC to lie between 0·2% and 0·3%. A detailed analysis of MOAHLFA indices and of associations between reactions to IPBC and reactions to other allergens and to SLS showed that most of the positive reactions to IPBC 0·2% can be assumed to be allergic ones and that with IPBC 0·2% fewer false-positive reactions can be expected than with IPBC 0·3%.Patch testing with IPBC 0·2% is suggested for patients with eczema possibly related to preservatives. [ABSTRACT FROM AUTHOR]

Summary Background Atopic eczema, a multifactorial disease, is influenced by bacterial factors, particularly Staphylococcus aureus . Consequently, treatment includes therapy with antibiotics and nonantibiotic antimicrobials. Objectives In our study the sensitizing potential of some topical antimicrobials was investigated by comparing proportions sensitized to various antibiotics and antiseptics between patients with current or past atopic eczema, and patients who had never had atopic eczema. Methods Data of all patients patch tested in the Departments of Dermatology participating in the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999 were analysed. Patients with a current leg ulcer or stasis dermatitis that might cause a confounding effect were excluded. Results Controlling for the additional confounding effect of sex and particularly age, we did not find that patients with atopic eczema had a generally higher risk compared with nonatopic individuals. Conclusions While the risk of sensitization should always be considered when applying topical therapy, our data—within the methodological limitations of this type of study—would not support a very restrictive use of these agents in the management of atopic eczema. [ABSTRACT FROM AUTHOR]

Reports on studies on the relation between age and contact allergy to fragrance mix. Aim of confirming the findings by Buckley and his colleagues in an identical descriptive, age- and sex-stratified analysis of another set of patch test data; Increase sensitization to fragrance mix up to a certain age; Higher prevalence in female patients; Role of endocrine factors in contact allergy; Adjustment for dermatitis.

The author reflects on the scarcity of epidemiological studies focusing on the burden of contact allergy on the population level and recognizes the publication of results from the industry-sponsored EDEN study conducted from 2008 to 2011 in 5 European countries. He references the article "Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study" by TL Diepgen and colleagues which appeared within the issue.

In the course of a cohort study, 2275 hairdressing apprentices were examined a median of 6 weeks after the start of their training in the years 1992, 1993 and 1994. Skin changes were noted in 821 (36%). The site most often affected was the interdigital web space (664 of those with skin changes: 81%). The proportion of participants with a high atopy score and previous hand and flexural dermatitis was larger in the subset with interdigital dermatitis than in healthy persons, but was particularly elevated in those affected by dermatitis involving other sites. Interdigital dermatitis can be regarded as a potential precursor of more severe hand dermatitis in hairdressers, and probably of irritant hand dermatitis in wet work occupations in general. Thus, it is an important ‘sentinel’ for secondary prevention, e.g. regular and thorough application of emollients. [ABSTRACT FROM AUTHOR]

The author discusses the study by J. P. Thyssen and colleagues on the relation between hand fissures and vesicles and filaggrin gene mutations R501X o 2282del4. The author says that the study has identified a significant association only with the former morphology. Moreover, it suggests that filaggin mutation was associated with dry, fissured skin in patients without atopic eczema.

Presents a letter to the editor about a special case of subungual haematoma.