Search

Relatively little is known about the epidemiology of allergic contact dermatitis in older individuals.We sought to determine the frequency of positive and clinically relevant patch test reactions in older individuals (≥ 65 years old) referred for patch testing, and to compare these results with those of adults (≤ 64-19 years) and children (18 years).This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data from 1994 to 2008.A total of 31,942 patients (older n = 5306; adults n = 25,028; children n = 1608) were patch tested. The overall frequency of at least one allergic reaction in older individuals was 67.3% as compared with 66.9% for adults (P = .5938) and 47% for children (P = .0011). Reaction rates that were statistically higher in older individuals as compared with both adults and children included: Myroxylon pereirae, fragrance mix I, quaternium-15, formaldehyde, imidazolidinyl urea, diazolidinyl urea, neomycin, bacitracin, methyldibromo glutaronitrile, methyldibromo glutaronitrile/phenoxyethanol, ethyleneurea melamine formaldehyde mix, and carba mix (P values.0004). Patch test reaction rates that were significantly lower in older individuals than both comparison groups included: nickel, thimerosal, and cobalt (P values.0001).Referral population was a limitation.Older individuals were more likely to have at least one positive patch test reaction as compared with children, but had similar rates to adults. The frequency of positive reactions to specific allergens differed by age group, most likely as a result of exposures.

Summary Background Acne vulgaris is a chronic and frequently recurring disease. A fixed-dose adapalene-benzoyl peroxide (adapalene-BPO) gel is an efficacious and safe acne treatment. Objectives To assess the long-term effect of adapalene-BPO on relapse prevention among patients with severe acne after successful initial treatments. Methods This is a multicentre, double-blind, randomized and controlled study. In total, 243 subjects who had severe acne vulgaris and at least 50% global improvement after a previous 12-week treatment were randomized into the present study to receive adapalene-BPO gel or its vehicle once daily for 24 weeks. Results At week 24, compared with vehicle, adapalene-BPO resulted in significantly higher lesion maintenance success rate (defined as having at least 50% improvement in lesion counts achieved in initial treatment) for all types of lesions (total lesions: 78·9% vs. 45·8%; inflammatory lesions: 78·0% vs. 48·3%; noninflammatory lesions: 78·0% vs. 43·3%; all P

not available. Disclosures: Study sponsored by Encore Dermatology. Copyright 2018 SKIN

Background iodopropynyl butylcarbamate (IPBC), a commonly used preservative, is found in industrial and personal care products. Objective to evaluate prevalence, clinical relevance, occupational relationship, and sources of positive reactions to IPBC in patients in North America. Methods the North American Contact Dermatitis Group (NACDG) tested IPBC 0.1% and/or 0.5% in petrolatum (pet) between 1998 and 2008. Two patient groups of interest were defined, based on patch-test reactions to IPBC: weak (+) reactors and strong (++ or +++) reactors. Patient characteristics, site(s) of dermatitis, sources of positive reactions, clinical relevance, and occupational relevance to IPBC were tabulated. Results of the 25,321 patients tested, there were 226 (0.9%) weak reactors and 67 (0.3%) strong reactors. For IPBC-positive patients, the most frequent sites of dermatitis were scattered generalized distribution, hands, and arms. The majority (> 50%) of currently relevant reactions were to personal care products, and most reactions (> 90%) were not related to occupation. Only four of the strong reactors had definite clinical relevance (positive use-test reaction or positive patch-test reaction to a product containing IPBC). The frequency of positive reactions increased (0.2% vs 1.5%) when the higher concentration of IPBC was utilized, but most (> 64%) were weak reactions, of which some were likely irritant. Conclusions allergy to IPBC is relatively uncommon. When clinically relevant, personal care products were the most likely allergen source. Because IPBC is a marginal irritant, caution should be utilized when testing with higher concentrations of IPBC (≥ 0.5% pet) and when interpreting weak (+) reactions. Verification of clinical relevance by use test or repeat patch testing or both is also important.

The diagnosis of acne usually can be made on the basis of a history and physical examination. The differential diagnosis includes a variety of possible causes and differs according to age group (mid-childhood, 1-7 years of age; pre-, peri-, and early pubertal, 8-11 years of age; pubertal/postpubertal, >or=12 years of age). The presentation of acne in adolescents tends to include both noninflammatory and inflammatory lesions, whereas in younger patients noninflammatory comedones are typical. Keratosis pilaris affecting the cheeks sometimes may be confused with early acne vulgaris. Screening tests, particularly bone age, may be considered to support the clinical diagnosis in younger children. Further testing usually is not indicated unless patients show signs of virilization.

It is clear that acne vulgaris often has medical and psychosocial implications that can range from mild to severe. To minimize these risks, evaluation and appropriate treatment are necessary, even in the younger pediatric patient. This article provides an overview of the current information on the topical and systemic treatment of acne, including innovative delivery options and new formulations and combinations of existing medications.

The direct and clinically obvious medical sequelae of acne vulgaris are well described. Physical comorbidities associated with classic acne are quite rare. Often more difficult to detect and measure are the short- and long-term psychosocial consequences of acne. These frequently are devastating and life-altering and in some cases are life-threatening.

BACKGROUND The positivity ratio (PR) and reaction index (RI) characterize the ability of patch-test preparations to produce strong (++ or +++) reactions as opposed to weak (+), questionable, or irritant reactions. OBJECTIVE This study evaluates these measures for North American Contact Dermatitis Group (NACDG) patch-test preparations. METHODS The PR and RI were calculated for 79 NACDG standard allergens tested from 1994 to 2006 (n = 26,479 patients). The median values were used as cutoff values for "acceptable" versus "problematic" preparations. RESULTS The top 10 "acceptable" patch-test preparations (PR 0.46) were mixed dialkyl thioureas 1% in petrolatum (pet), tixocortol-21-pivalate 1% pet, ethylenediamine dihydrochloride 1% pet, sesquiterpene lactone mix 0.1% pet, nickel sulfate 2.5% pet, bacitracin 20% pet, thimerosal 0.1% pet, epoxy resin 1% pet, colophony 20% pet, and mercaptobenzothiazole 1% pet. The most "problematic" patch-test preparations (PR > 55 and RI < or = 0.46) were cocamidopropyl betaine 1% aqueous (aq), benzalkonium chloride 0.1% aq, jasmine absolute 2% pet, iodopropynyl butyl carbamate 0.1% pet, 2-bromo-2-nitropropane-1,3-diol 0.5% pet, methyldibromoglutaronitrile 0.4% pet, methyldibromoglutaronitrile/phenoxyethanol 2% pet and 2.5% pet, dimethylol dihydroxyethyleneurea 4.5% aq, and clobetasol-17-propionate 1% pet. CONCLUSION Caution should be used when interpreting reactions to "problematic" patch-test preparations with a high proportion of weak, irritant, and questionable reactions.

BACKGROUND Identification of putative contact allergen and source material is often done by a combination of patch testing and manufacturer-supplied product information. The accuracy of the identification of allergen-source material and level of allergen in that allergen-source material is not known. OBJECTIVE The objectives of the study were to survey the chemical allergen content of glove allergic contact dermatitis (ACD) patient-identified problem and nonproblem gloves and to evaluate the ability of the patient to discriminate between problem and nonproblem gloves. METHODS Gloves from patch-tested rubber allergen-positive ACD patients were analyzed for species and amount of rubber allergen. RESULTS Approximately half the subjects were able to correctly identify their problem and nonproblem gloves. Correct association of a glove with ACD was directly related to patch-test reaction severity and inversely related to the number of glove brands being used by the patient. Of note, thiurams were not detected in any of the gloves examined. CONCLUSIONS Although patch testing is invaluable in identifying individual allergen sensitivities, the identification of the ACD-causative specific chemical allergen and source material remains problematic. All glove brands used within days prior to and during an ACD episode should be considered potential sources of the contact allergen.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting children and adults. Approximately 85% of patients develop AD by age 5 years, and long-term topical treatment is often required. Unfortunately, topical therapies are associated with potential safety concerns and have not changed over the past 15 years. Crisaborole Topical Ointment, 2% (Anacor Pharmaceuticals, Inc., Palo Alto, CA), is a novel nonsteroidal, topical, anti-inflammatory phosphodiesterase 4 (PDE4) inhibitor currently being investigated for the treatment of AD to address the need for a more targeted and safe …

BACKGROUND The methylphenidate transdermal system (MTS) (Daytrana [Shire Pharmaceuticals Ireland Ltd., Wayne, PA]) has been shown to be well tolerated and effective; however, skin reactions, typically redness and itching, have also been noted with MTS use. OBJECTIVE The purpose of this study was to determine the irritancy threshold of methylphenidate (MPH), the active ingredient in the MTS, in healthy adults for use in subsequent patch testing. METHODS This was an open-label single-site pilot study. Eligible subjects had MPH (six different concentrations in two vehicles) patch tests applied to the paraspinous region of the upper back. Subjects returned after 48 hours and 96 hours for investigator assessments of each reaction. RESULTS All enrolled subjects (n = 20) completed the study. There were no definite positive reactions in any subject at any test concentration. Overall, doubtful (macular erythema) reactions were noted on 12 sites at the 48-hour reading and on 6 sites at the 96-hour reading. With both aqueous and petrolatum vehicles, more doubtful reactions were noted at the lower MPH test concentrations. CONCLUSION When performing patch testing to confirm possible allergic contact dermatitis from topical MPH, several test concentrations in the low-to-middle range (such as 0.1%, 1%, and 10%) prepared in petrolatum are advisable.

Background The North American Contact Dermatitis Group (NACDG) tests patients who have suspected allergic contact dermatitis with a broad series of screening allergens, and publishes periodic reports of its data. Objective To report the NACDG patch-test results from January 1, 2005, to December 31, 2006, and to compare results to pooled test data from the previous 10 years. Methods Standardized patch testing with 65 allergens was used at 13 centers in North America. Chi-square statistics were utilized for comparisons with previous NACDG data. Results NACDG patch-tested 4,454 patients; 12.3% (557) had an occupation-related skin condition, and 65.3% (2,907) had at least one allergic patch-test reaction. The 15 most frequently positive allergens were nickel sulfate (19.0%), Myroxilon pereirae (balsam of Peru, 11.9%), fragrance mix I (11.5%), quaternium-15 (10.3%), neomycin (10.0%), bacitracin (9.2%), formaldehyde (9.0%), cobalt chloride (8.4%), methyldibromoglutaronitrile/phenoxyethanol (5.8%), p-phenylenediamine (5.0%), potassium dichromate (4.8%), carba mix (3.9%), thiuram mix (3.9%), diazolidinylurea (3.7%), and 2-bromo-2-nitropropane-1,3-diol (3.4%). As compared to the 1994-2004 data, there were significant increases in rates of positivity to nickel, quaternium-15, potassium dichromate, lidocaine, and tea tree oil. Of patch-tested patients, 22.9% (1,019) had a relevant positive reaction to a supplementary allergen; 4.9% (219) had an occupationally relevant positive reaction to a supplementary allergen. Conclusion Nickel has been the most frequently positive allergen detected by the NACDG; rates significantly increased in the current study period and most reactions were clinically relevant. Other common allergens were topical antibiotics, preservatives, fragrance mix I and paraphenylenediamine. Testing with an expanded allergen series and supplementary allergens enhances detection of relevant positive allergens.

BACKGROUND The prevalence of lanolin sensitivity in referred patients is less than 4%. OBJECTIVES To (1) describe patients with positive patch-test reactions to lanolin, (2) determine clinical and occupational relevance associated with reactions to lanolin and common sources, and (3) examine the frequency of co-reacting allergens. METHODS A retrospective analysis of 26,479 patients patch-tested by the North American Contact Dermatitis Group (NACDG), 1994 to 2006. RESULTS Overall, 2.5% of patients (643 of 25,811) tested to lanolin alcohol 30% in petrolatum had positive reactions. Prevalence decreased from 3.7% in 1996 to 1998 to 1.8% in 2005 to 2006 (p

Background Propylene glycol (PG) may cause allergic or irritant contact dermatitis. It primarily functions as a vehicle, solvent, or emulsifier in cosmetics and topical medications. Objectives To characterize the prevalence of positive patch-test reactions to PG and the epidemiology of affected patients. Methods Retrospective analysis of cross-sectional data compiled by the North American Contact Dermatitis Group (NACDG) from 1996 to 2006. Results Of 23,359 patients, 810 (3.5%) had allergic patch-test reactions to 30% PG; 12.8% of the reactions were of definite clinical relevance (positive reaction to a personal product containing PG), 88.3% were considered to be currently relevant (definite, probable, or possible relevance), and 4.2% of reactions were occupation related, most commonly to mechanical and motor vehicle occupations. Common sources of PG were personal care products (creams, lotions, and cosmetics, 53.8%), topical corticosteroids (18.3%), and other topical medicaments (10.1%). In patients positive only to PG (n = 135), the face was most commonly affected (25.9%), followed by a scattered or generalized pattern (23.7%). The most common concomitant reactions included reactions to Myroxilon pereirae, fragrance mix, formaldehyde, bacitracin, methyldibromoglutaronitrile/phenoxyethanol, carba mix, and tixocortol pivalate. Conclusions In this select population of patients referred for patch testing, allergic reactions to PG were often currently clinically relevant but were rarely related to occupation. The most common sources were personal care products and topical corticosteroids.

Background There are few comprehensive estimates of the cost of psoriasis in the United States. Objective We sought to quantify the incremental direct medical and indirect work loss costs associated with psoriasis. Methods A de-identified claims database from 31 self-insured employers during the period 1998 to 2005 was used. Patients with at least two psoriasis diagnosis claims (N = 12,280) were compared with 3 control subjects (matched on year of birth and sex) without psoriasis. Multivariate two-part regression analysis was used to isolate the incremental cost of psoriasis by controlling for comorbidities and other confounding factors. Results After multivariate adjustment, the incremental direct and indirect costs of psoriasis were approximately $900 and $600 ( P Limitations The database used in this study does not contain information on patient out-of-pocket costs or loss of productivity costs at work. Conclusion The incremental cost of psoriasis is approximately $1500 per patient per year, with work loss costs accounting for 40% of the cost burden.

A scattered generalized distribution (SGD) of dermatitis is a challenging problem; patch testing is a strategy for evaluating allergic contact dermatitis as a relevant factor.We sought to analyze patient characteristics and most frequently relevant positive allergens in patients presenting for patch testing with SGD.We conducted retrospective cross-sectional analysis of North American Contact Dermatitis Group 2001 to 2004 data. Patients with SGD were compared with patients without SGD.Of 10,061 patients, 14.9% (n = 1497) had only a SGD. Men and patients with a history of atopic eczema were more likely to have dermatitis in a SGD (P.001). Preservatives, fragrances, propylene glycol, cocamidopropyl betaine, ethyleneurea melamine formaldehyde, tixocortol pivalate, and budesonide were among the more frequently relevant positive allergens. Top allergen sources included cosmetics/beauty preparations/skin and health care products, clothing, and topical corticoids.This was a retrospective analysis of patch-tested patients with SGD suspected to have allergy.A total of 49% of patients with SGD had at least one relevant positive allergen, thus demonstrating the benefit of patch testing these patients.

BACKGROUND Allergic and irritant contact dermatitis to food is likely underreported. OBJECTIVES To characterize relevant allergens and irritants associated with food in patients referred to the North American Contact Dermatitis Group (NACDG) for patch testing. METHODS Retrospective analysis of cross-sectional data from the NACDG from 2001 to 2004. RESULTS Of 10,061 patch-tested patients, 109 (1.1%) had a total of 122 reactions associated with food. Approximately two-thirds of patients (66%) were female, and one-third (36%) were atopic. The hands were the most common sites of dermatitis (36.7%). There were 78 currently relevant (definite, probable, or possible) allergic reactions to NACDG standard series allergens with a food source; the most common allergen was nickel (48.7%), followed by Myroxilon pereirae (balsam of Peru) (20.6%) and propylene glycol (6.4%). Twenty allergic reactions to non-NACDG standard allergens and 24 relevant food irritants were also identified. Overall, 21% (25 of 122) of all reactions (irritant and allergic) were occupation related; the majority of these (17 of 25) were relevant irritant reactions. Cooks were the most commonly affected occupational group (40%). CONCLUSIONS In this limited data set, nickel, Myroxilon pereirae, and propylene glycol were the most common allergens identified with a food source. Of food-related occupational disease, irritation was more common than allergy.

BACKGROUND Contact dermatoses are common in health care workers (HCWs). OBJECTIVES To (1) estimate the prevalence of occupation-relevant allergic contact dermatitis (ACD) among health care workers patch-tested from 1998 to 2004 by the North American Contact Dermatitis Group (NACDG), (2) characterize responsible allergens among health care workers overall as well as in specific health care occupational subgroups, and (3) compare these results to those of nonhealth care workers. METHODS Between 1998 and 2004, 15,896 patients were patch-tested by the NACDG. Occupation-related allergic patch-test results were analyzed among HCWs, subgroups of HCWs, and non-HCWs. RESULTS 1,255 patients (7.9%) were HCWs. Female gender (HCWs, 86.2%; non-HCWs, 63.6%) and hand involvement (HCWs, 54.7%; non-HCWs, 27.8%) were more common in HCWs (p < .05); 18.2% of HCWs and 6.6% of non-HCWs had occupation-related allergens of current clinical relevance. Thiuram mix (HCWs, 8.87% non-HCWs, 0.90%) and carba mix (HCWs, 5.43%; non-HCWs, 0.87%) were the most common occupation-related currently relevant antigens in HCWs and were more common in HCWs than in non-HCWs (p < .05). CONCLUSIONS Among HCWs patch-tested by the NACDG between 1998 and 2004, the most common allergens were thiuram mix and carba mix, followed by glutaraldehyde, cocamide diethanolamine, and chloroxylenol. Gloves, sterilizing solutions, and soaps were common sources of responsible allergens.

BACKGROUND The most common differential diagnoses for patients presenting with lip dermatitis or inflammation include atopic, allergic, and irritant contact dermatitis. Patch testing can be performed to identify the allergic contact conditions. OBJECTIVE To report North American Contact Dermatitis Group (NACDG) patch-test results of patients who presented for patch testing with only lip involvement from 2001 to 2004. Patient characteristics, allergen frequencies, relevance, final diagnoses, and relevant allergic sources not in the NACDG screening series were evaluated. METHODS The NACDG 2001-2004 database was used to select patients presenting with only lip involvement. RESULTS Of 10,061 patients tested, 2% (n = 196) had lips as the sole involved site. Most (84.2%) were women. After patch testing, 38.3% (n = 75) were diagnosed with allergic contact cheilitis. Fragrance mix, Myroxilon pereirae, and nickel were the most common relevant allergens. Of 75 patients, 27 (36%) had relevant positive patch-test reactions to items not on the NACDG series; lipstick and cosmetics were the predominant sources. CONCLUSIONS Patch testing is valuable in the evaluation and identification of contact allergy in patients referred for lip dermatitis. The use of supplementary allergens based on history and exposure is important in the identification of additional relevant allergens. Over a third of patients with contact allergy had other factors, such as irritant dermatitis, considered relevant to their condition.

BACKGROUND Allergic contact dermatitis from thioureas is uncommon but may result from exposure to rubber, especially neoprene. OBJECTIVES To (1) describe the population with positive patch-test reactions to mixed dialkyl thioureas (MDTU) (ie, diethylthiourea and dibutylthiourea); (2) determine clinical and occupational relevance associated with reactions to MDTU and identify the most commonly related sources and occupations; and (3) examine the frequency of co-reacting allergens in MDTU-positive patients. METHODS A retrospective analysis of cross-sectional data of 22,025 patients patch-tested by the North American Contact Dermatitis Group between 1994 and 2004. RESULTS Of 21,898 patients tested with MDTU, 225 (1.0%) had positive reactions; of these, 173 (76.9%) were currently relevant and 29 (17.1%) were occupationally relevant. Patients positive to MDTU were 2.6 times more likely to have foot involvement than patients with positive reactions to other allergens (p < .0001). Footwear was the most commonly identified source overall (20.0%) whereas gloves were the most common occupational source. Of the 173 patients with currently relevant MDTU reactions, 24.9% also reacted to another rubber allergen. CONCLUSIONS Current clinical relevance of reactions to MDTU was high; occupational relevance was less frequent. Patch tests with common rubber allergens (carbamates, thiurams, and mercaptobenzothiazole) may fail to detect many cases of thiourea-induced rubber allergic contact dermatitis.

BACKGROUND Allergic contact dermatitis is a significant cause of both occupational and non-occupational skin disease. Patch testing is an important diagnostic tool for the determination of responsible allergens. OBJECTIVE This study reports the results of patch testing by the North American Contact Dermatitis Group from January 1, 2003, to December 31, 2004. METHODS At 13 centers in North America, patients were tested with the same screening series of 65 allergens, with a standardized patch-testing technique. Data were recorded on standardized forms and manually verified and entered. Descriptive frequencies were calculated, and trends were analyzed with chi-square statistics. RESULTS A total of 5,148 patients were tested. Of these, 3,432 (66.7%) had at least one positive reaction, 2,284 (44.4%) were ultimately determined to have primary allergic contact dermatitis, and 676 (13.1%) had occupation-related skin disease. There were 9,762 positive allergic reactions. Compared to the previous reporting period (2001-2002), allergies to nickel, budesonide, mercaptobenzothiazole, and paraben mix were at least 1.12 times more common (all p values < .03). Compared with the previous 8 years (1994-2002), only the prevalence rates of allergies to nickel and budesonide were statistically significantly higher (p values < .003). CONCLUSION Allergic contact dermatitis from nickel and budesonide may be increasing in North America. These results again underscore the value of patch-testing with many allergens.

BACKGROUND Allergy to topical anesthetics is not uncommon. The cross-reactivity among topical anesthetics and the screening value of benzocaine alone are not well understood. OBJECTIVES The goals for this study were: (1) to evaluate the frequency and pattern of allergic patch-test reactions to topical anesthetics, using North American Contact Dermatitis Group (NACDG) data, and (2) to compare these results to allergen frequencies from other published studies. METHODS The NACDG patch-tested 10,061 patients between 2001 and 2004. In this analysis patients were included who had positive patch-test reactions to one or more of the following: benzocaine, lidocaine, dibucaine, tetracaine, and prilocaine. RESULTS Of patch-tested patients, 344 (3.4%) had an allergic reaction to at least one anesthetic. Of those, 320 (93.0%) had an allergic reaction to only one topical anesthetic. Overall, reactions to benzocaine (50.0%, 172 of 344) were most prevalent, followed by reactions to dibucaine (27.9%, 96 of 344); however, reactions to dibucaine were significantly more frequent in Canada than in the United States (relative risk [RR], 2.31; 95% confidence interval [CI], 1.67-3.20; p < .0001). Of patients reacting to more than one anesthetic, most (79%, 19 of 24) reacted to both an amide and an ester. CONCLUSIONS Of the topical anesthetics tested, benzocaine was the most frequent allergen overall. Over 50% of allergic reactions to topical anesthetics in this study would have been missed had benzocaine been used as a single screening agent. Cross-reactivity patterns were not consistent with structural groups.

BACKGROUND: Nickel allergy has been studied by contact dermatitis groups around the world, and the frequency of nickel sensitivity has been reported to be decreasing in some populations. OBJECTIVE: To review the prevalence of nickel allergy as observed by the North American Contact Dermatitis Group from 1992 to 2004. METHODS: The computer database of the North American Contact Dermatitis Group was used to examine the prevalence of nickel allergy over the study period and to analyze it by time, sex, and age. RESULTS: From 1992 to 2004, 25,626 patients were patch-tested. The percentage of women tested was fairly constant (61.4-66.3%). A steady increase in nickel sensitivity was seen from 1992 to 2004. Subgroup analysis did not identify a population with declining nickel allergy. CONCLUSIONS: Nickel allergy continues to increase in younger and older men and women patch-tested in North America.

Chemicals used in leather tanning, rubber processing, and/or adhesives are the most often-cited culprits in footwear dermatitis. Patch testing patients with suspected shoe dermatitis is essential for diagnosis and management.The four goals for this study were to (1) determine the frequency of allergens associated with a shoe source in North American Contact Dermatitis Group (NACDG) patients with footwear allergic contact dermatitis; (2) compare these results to allergen frequencies from other published studies; (3) quantify the number of shoe-related reactions that were not identified with the NACDG standard series; and (4) identify relevant allergens not included on the NACDG standard series, based on data from other published studies.The NACDG patch-tested 10,061 patients between 2001 and 2004. Data were retrospectively analyzed by (1) allergen source coded as "shoe," (2) site of dermatitis as "feet," and (3) diagnosis of "allergic contact dermatitis."Among the 109 NACDG patients with allergic contact dermatitis (ACD) of the foot and a shoe source of allergens, p-tertiary butylphenol formaldehyde resin, an adhesive, was the most common allergen, accounting for 24.7% of positive patch-test results, followed by potassium dichromate (17.5%) and carba mix (11.7%). When the data were examined according to groups of allergens, rubber chemicals (40.4%) were the most frequent allergens, followed by adhesives (32.5%), and leather components (20.1%). When data from published studies were pooled, potassium dichromate (31.5%) was the most frequent allergen, followed by p-tertiary butylphenol formaldehyde resin (17.1%) and cobalt chloride (12.9%). NACDG patients were statistically more likely to have positive patch-test reactions to p-tertiary butylphenol formaldehyde resin and statistically less likely to have a positive patch-test reaction to potassium dichromate than patients represented in pooled data from past studies. Nineteen (17.4%) of the 109 NACDG patients with ACD of the foot and a shoe source of allergens were identified as having a shoe source of a relevant allergen not included in the NACDG standard series.In NACDG patients, the most common individual shoe allergen was p-tertiary butylphenol formaldehyde resin. As a group, rubber chemicals were most common, a finding consistent with those of other studies.

Rosacea is a chronic inflammatory facial condition that has traditionally been treated with topical therapies, oral antibiotics or both. The use of oral antibiotics at conventional doses can lead to antimicrobial resistance, alterations in the balance of normal microflora and potentially serious side effects. Anti-inflammatory dose doxycycline is a novel approach to the treatment of rosacea that separates the anti-inflammatory effects of doxycycline from its antimicrobial properties by limiting plasma concentrations to a range below the minimal inhibitory concentrations of susceptible bacteria. This review describes the evidence supporting the use of anti-inflammatory dose doxycycline in the treatment of rosacea, explores its mechanism of action and considers its place in therapy.

BACKGROUND The low concentration of propylene glycol (PG) in pimecrolimus cream makes it unlikely that the cream will induce a PG-related irritant or allergic contact dermatitis. OBJECTIVE To assess reactions to pimecrolimus cream in patients who are allergic to PG. METHODS A pilot double-blind within-patient study in 20 patients, with patch testing followed by a repeated open application test (ROAT). Limitations were that patch tests and ROATs were performed on normal skin, which may be less likely to develop an allergic response than would areas of active dermatitis. RESULTS Positive PG patch-test results were confirmed in 16 patients. Patch-test scores were compatible with allergic reactions in only two patients. However, ROAT scores were negative for these two patients. Reactions with pimecrolimus or vehicle during ROAT were identified in three patients, but an allergic reaction was uncertain because none of these patients reacted with both pimecrolimus cream and vehicle. Reactions with pimecrolimus were significantly less frequent (p

Background Hand dermatitis, including irritant and allergic contact dermatitis (ACD), is common. Objective To evaluate allergens, relevant irritants, sources and occupations associated with hand contact dermatitis using North American Contact Dermatitis Group (NACDG) data. Methods A cross-sectional analysis of 22,025 patients patch tested between 1994 and 2004. Results Hand involvement was found in 6953 patients; 959 had ACD as the only diagnosis. In these 959 patients, the 12 most frequent relevant allergens were quaternium-15 (16.5%), formaldehyde (13.0%), nickel sulfate (12.2%), fragrance mix (11.3%), thiuram mix (10.2%), balsam of Peru (9.6%), carba mix (7.8%), neomycin sulfate (7.7%), bacitracin (7.4%), methyldibromoglutaronitrile/phenoxyethanol 2.0% (7.4%), cobalt chloride (6.5%), and methyldibromoglutaronitrile/phenoxyethanol 2.5% (6.3%). Rubber allergens were most commonly associated with occupation. One third of patients with hand ACD had identifiable relevant irritants. Limitations Cross-sectional analyses prevent evaluation of causal associations. Conclusion In NACDG patients with hand ACD, the most common allergens included preservatives, metals, fragrances, topical antibiotics, and rubber additives.

Allergic contact dermatitis can be manifest as an eruption confined to the eyelids. In regard to this specific presentation, only limited information on which to base the selection of patch tests for proper evaluation is available.To identify the contact allergens most frequently found to be both patch test positive and relevant when only the eyelids are involved.Data collected from 2003 to 2004 by the North American Contact Dermatitis Group (NACDG) were analyzed for relevant allergens in the setting of dermatitis on the eyelids only. Data on eyelid dermatitis patients whose relevant allergens were not among the 65 allergens used for screening during this study period were also tabulated.Data showed that 268 patients had only eyelid dermatitis and a final diagnosis of allergic contact dermatitis. In 193 (72%) of these, reactions were of current relevance and were identified from a screening series of 65 allergens. The top 26 allergens identified 65% of cases (175 cases). Gold was the most frequently encountered allergen (22 of 175 cases [12.5%]). Of the 268 cases, 33 showed relevant reactions to an allergen that was not among the 65 NACDG standard screening allergens. No specific allergen was identified in the remaining 42 cases.The top 26 allergens identified in this study represent a potential eyelid dermatitis screening series.

BackgroundComprehensive studies on costs of moderate to severe plaque psoriasis (MSPP) have not been conducted in the United States.ObjectiveWe sought to evaluate current health care resource use, productivity, and costs among patients with MSPP in routine practice.MethodsA total of 200 adults seeking MSPP treatment enrolled in 9 US sites. Consented patients reported symptoms, treatment, lost productivity, and costs; 6-month retrospective chart review captured health care resource use and clinical characteristics. Costs were assigned to health care resource use and lost productivity using standard algorithms. Differences by Psoriasis Area and Severity Index (PASI) group, based on PASI score (≤10, >10-≤20, >20) at enrollment, were evaluated. Analyses included descriptive statistics and analysis of variance or Kruskal-Wallis tests.ResultsMost patients (79.5%) were prescribed 1 or more MSPP medications (mean: 1.5); 36.0% and 9.0% received self-administered biologics and systemic therapies, respectively. Mean number of nonprescription treatments was 12.3. Differences by PASI group were observed for overall work and activity impairment (P

Severe chronic hand eczema (sCHE) is a persistent, disfiguring disease that responds poorly to conventional treatment and causes substantial physical and psychological disability. The objective of this study was to evaluate efficacy and safety of oral alitretinoin in sCHE in a Phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group study comparing alitretinoin with placebo. Efficacy was assessed every 4 weeks during treatment and 4 weeks after end of treatment (EOT, 24 weeks); responders were assessed every 4 weeks for a further 48 weeks after EOT. The study was conducted at academic and private dermatology centers. The participants were 596 patients with sCHE refractory to potent topical corticosteroids. Patients were treated with daily oral alitretinoin 30 mg or placebo for up to 24 weeks. Primary endpoint was proportion of responding patients based on Physician Global Assessment (PGA) of "clear" or "almost clear" at EOT. Key secondary endpoints: Patient Global Assessment (PaGA), change in modified Total Lesion Symptom Score (mTLSS), time to response (TTR), extent of disease at EOT, and duration of response (DOR). At EOT, 40% of alitretinoin-treated patients were responders vs 15% placebo-treated patients (odds ratio [OR] = 3.78; P.001); a greater proportion of alitretinoin-treated patients achieved a PaGA of "cleared" or "almost cleared" (OR = 4.05; P.001). A greater decrease in mTLSS occurred from baseline to EOT in alitretinoin- vs placebo-treated patients (treatment difference -24% P.001). Median TTR for responders at EOT was shorter with alitretinoin vs placebo (65 vs 117 days; P.001). Greater decreases in extent of disease at EOT were observed with alitretinoin vs placebo (treatment difference -22%; P.001). The most common treatment-emergent adverse event was headache. Alitretinoin significantly improved signs/symptoms of sCHE, was well tolerated in patients refractory to potent topical corticosteroids, and may provide benefit to this population.

Colloidal oatmeal suspensions are currently available in bath soaps, shampoos, shaving gels, and moisturizing creams, and several studies have been conducted that demonstrate the efficacy and safety of colloidal oatmeal for the treatment of inflammatory skin conditions. The diverse chemical polymorphism of oats translates into numerous clinical utilities for atopic dermatitis (AD) and eczema. Avenanthramides are the principle polyphenolic antioxidants in oats, and they have been shown to assuage inflammation in murine models of contact hypersensitivity and neurogenic inflammation and also reduce pruritogen-induced scratching in a murine itch model. Moreover, avenanthramides are a potent antioxidant. This paper will discuss various studies that have found colloidal oatmeal compounds to be beneficial in the treatment of AD and also as adjunctive treatments for AD.

Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD).This study documents the North American Contact Dermatitis Group (NACDG) patch-testing results from January 1, 2011, to December 31, 2012.At 12 centers in North America, patients were tested in a standardized manner with a series of 70 allergens. Data were manually verified and entered into a central database. Descriptive frequencies were calculated, and trends analyzed using χ statistics.Four thousand two hundred thirty-eight patients were tested; of these, 2705 patients (63.8%) had at least 1 positive reaction, and 2029 (48.0%) were ultimately determined to have a primary diagnosis of ACD. Four hundred eight patients (9.6%) had occupationally related skin disease. There were 7532 positive allergic reactions. As compared with previous reporting periods (2009-2010 and 2000-2010), positive reaction rates statistically increased for 6 allergens: methylchloroisothiazolinone/methylisothiazolinone (5.0%; risk ratios [RRs]: 2.01 [1.60-2.52], 1.87 [1.61-2.18]), lanolin alcohol (4.6%; RRs 1.83 [1.45-2.30], 2.10 [1.79-2.47]), cinnamic aldehyde (3.9%; 1.69 [1.32-2.15], 1.53 [1.28-1.82]), glutaral (1.5%; 1.67 [1.13-2.48], 1.31 [1.00-1.71]), paraben mix (1.4%; 1.77 [1.16-2.69], 1.44 [1.09-1.92]), and fragrance mix I (12.1%; RRs 1.42 [1.25-1.61], 1.24 [1.14-1.36]). Compared with the previous decade, positivity rates for all formaldehyde-releasing preservatives significantly decreased (formaldehyde 6.6%; RR, 0.82 [0.73, 0.93]; quaternium-15 6.4% RR 0.75 [0.66, 0.85]; diazolidinyl urea 2.1%; RR, 0.67 [0.54, 0.84]; imidazolidinyl urea 1.6%, 0.60 [0.47, 0.77]; bronopol 1.6%; RR, 0.60 [0.46, 0.77]; DMDM hydantoin 1.6%; RR, 0.59 [0.54, 0.84]). Approximately a quarter of patients had at least 1 relevant allergic reaction to a non-NACDG allergen. In addition, approximately one-fourth to one-third of reactions detected by NACDG allergens would have been hypothetically missed by T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark).These data document the beginning of the epidemic of sensitivity to methylisothiazolinones in North America, which has been well documented in Europe. Patch testing with allergens beyond a standard screening tray is necessary for complete evaluation of occupational and nonoccupational ACD.

Tolerability and safety of 0.1% tacrolimus ointment in treating nickel-induced allergic contact dermatitis (ACD) were evaluated.Patients allergic to nickel applied nickel patches to each upper inner aspect of the arm for 4 to 8 hours daily. Tacrolimus was applied to patch site on one arm and vehicle to patch site on the other, twice daily. Physician's Global Assessment, signs and symptoms of ACD, pruritus scores, and adverse events were evaluated.After 8 weeks, dermatitis in 45% of patients was clear or almost clear (Physician's Global Assessment) with tacrolimus; and 1% with vehicle (P.001). Significant results were achieved as early as day 8. Tacrolimus was superior in ACD signs and symptoms improvement and pruritus reduction (P.001). Adverse events were similar between treatments.This model, involving one agent, may not be generalizable for other agents.Tacrolimus ointment 0.1% is well tolerated and significantly more effective than vehicle in treating chronically exposed, nickel-induced ACD.

Pimecrolimus is a topical calcineurin inhibitor that demonstrates anti-inflammatory properties through selective inhibition of the skin’s immune system, with low potential for systemic immunosuppression. A large development program has shown that, when used twice daily from the first signs or symptoms of an exacerbation, pimecrolimus benefits the long-term management of atopic dermatitis by reducing the number of major flares and the need for topical corticosteroids. Additional studies have demonstrated the usefulness of pimecrolimus in other inflammatory skin diseases and investigation of the disease-modifying properties of pimecrolimus on atopic dermatitis and systemic manifestations of atopy is underway. Data from clinical studies indicate that pimecrolimus has a favorable safety profile, characterized by a lack of steroid-associated side effects, low incidence of local and systemic adverse events, low systemic absorption and lack of deleterious effects on the immune system.

Background In published reports from Europe, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral) has been described as a common cause of allergic contact dermatitis (ACD). In Europe, the rates of reaction to HMPCC among patients undergoing patch testing for suspected ACD have varied from 1.2 to 17.0%, depending on the country. Data on the incidence of sensitivity to HMPCC among North Americans with suspected ACD have not been reported. Objectives The goals of this study were (1) to assess the incidence of delayed-type hypersensitivity reactions to HMPCC among patients undergoing patch testing for evaluation of eczematous dermatitis at six centers throughout North America; (2) to determine the most appropriate concentration of HMPCC to use in performing patch tests; and (3) to compare and contrast the incidence rates for HMPCC hypersensitivity to those for other fragrance materials screened with the North American Contact Dermatitis Group (NACDG) screening tray, which includes fragrance mix, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, ylang ylang oil, jasmine absolute, and tea tree oil. Methods This report represents the prospective multicenter data on patients tested with the fragrance-related allergens on the NACDG standard screening tray and with HMPCC at 5%, 1.5%, and 0.5% concentrations in petrolatum. Statistical analyses were performed with Student's t-test (two tailed) and the chi-square test. Results Data from 1,603 patients evaluated at five US sites and one Canadian site were analyzed. Most patients (87.8%) were Caucasian. The majority (67%) were women, and 26.2% had a history consistent with atopic dermatitis. The patients ranged in age from 1 to 88 years, and the mean +/- standard deviation was 46.3 +/- 16.5 years. Myroxilon pereirae (balsam of Peru) and fragrance mix were the most frequent patch-test-positive fragrance allergens (6.6% and 5.9%, respectively). Cinnamic aldehyde (1.7%), ylang ylang oil (0.6%), jasmine absolute (0.4%), HMPCC (0.4% for 5% HMPCC, 0.3% for 1.5% HMPCC, and 0.2% for 0.5% HMPCC), and tea tree oil (0.3%) less frequently yielded positive reactions. Men were more likely than women to be allergic to cinnamic aldehyde. Women were more likely than men to be allergic to jasmine absolute. Atopic patients were no more likely to react to fragrance materials than were nonatopic patients. Patients who reacted to jasmine absolute tended to be older than the general population whereas those who reacted to tea tree oil tended to be younger than the general population. There were no other demographic differences between patients who reacted to a given fragrance material and the entire population studied. Testing with fragrance mix and balsam of Peru failed to identify the majority of patients in this study who were found to be sensitized to jasmine absolute, HMPCC, or tea tree oil. Conclusion HMPCC is an uncommon allergen in the North American population. We recommend testing with 5% HMPCC in petrolatum for those patients suspected of having a fragrance allergy.

Good skin care has two overall goals: to support and maintain healthy stratum corneum function and to help restore barrier function perturbed by disease processes or injuries. In this article, we discuss the special attention that is required in the initial skin care of newborns, and we address what measures, beyond the basic skin care principles, are required for patients with conditions such as atopic dermatitis, acne, contact and allergic dermatitis, and diaper rash.

Background:Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis.Objective:This study reports patch-testing results from July 1, 1998, to December 31, 2000, by the North American Contact Dermatitis Group.Methods:Patients were t

Background: Allergic contact dermatitis (ACD) to optical brighteners and enzymes in laundry detergents was the focus of numerous reports in the early 1970s. Subsequently, there has been little published on the incidence of allergic reactions to chemicals in laundry detergents. Nonetheless, consumers and physicians continue to ascribe allergic contact reactions to laundry detergents. Objective: This article reports the findings of a multicenter study on the prevalence of patch test reactions to a liquid and a granular laundry detergent provided by Procter & Gamble Company (Cincinnati, Ohio). Methods: Patients referred to members of the North American Contact Dermatitis Group for evaluation of potential ACD were invited to participate in the study, which involved the placement of 2 patch tests (a 0.1% aqueous dilution of a granular laundry detergent and a 0.1% aqueous dilution of a liquid laundry detergent). Whether the patients had atopic dermatitis and whether they or their physicians felt that their dermatitis might be related to laundry detergents were noted. Reactions to the laundry detergents were correlated with allergic reactions to the following screening chemicals: fragrances, nickel, and potassium dichromate. Patients who experienced a reaction to at least one of the laundry detergents could enter phase II of the study, which involved testing to varying dilutions of the laundry detergents, to 0.1% sodium lauryl sulfate (as an irritant control), and to laundered patches of cotton. Patients positive in phase II could enter phase III, which involved wearing a garment laundered with the detergent. Phases II and III were double blinded. Results: Of the 3120 patients seen by members of the North American Contact Dermatitis Group during the 2 years of this study, 738 patients volunteered to enroll. Enrollment was not statistically randomized. Of these 738, 5 (0.7%) had positive patch test reactions to granular laundry detergent (0.1%, aqueous); 3 of these 5 also had positive reactions to the liquid laundry detergent (0.1%, aqueous). In 4 of the 5 patients, the reaction to detergent was thought to have present relevance to their dermatitis; in 1 of the 5, the reaction was deemed to have past relevance. One of these 5 patients had allergy to fragrances. None of the patients was positive to nickel or chromate. Two of the 5 entered phases II and III. Of these 2 patients, 1 had essentially negative repeat dilutional patch testing and "use testing" suggesting that the earlier reaction patterns may have been irritant. The remaining patient had positive dilutional reactions to both the liquid and granular laundry detergent; however, she also had a positive reaction to sodium lauryl sulfate and to a swatch from a T-shirt laundered without detergent. Upon "use testing" in phase III, this latter patient experienced diffuse dermatitis under both the half of the T-shirt laundered with detergent and that laundered without detergent. Conclusion: Laundry detergents appear to be a rare cause of ACD. Among 738 patients with dermatitis, 5 (0.7%) reacted to a 0.1% aqueous dilution of a laundry detergent. Only 2 of these 5 patients could be evaluated in greater detail to differentiate allergic from irritant patch test reactions to detergents. Upon further testing in 2 patients, the reaction in 1 of 2 could not be reduplicated and the reaction in the other was invoked both by the detergents and the controls. Thus, whether our study patients were truly allergic and, if so, what the allergenic material(s) in detergents might be, remains unknown. Therefore the reported incidence rate for detergent-induced allergy of 0.7% in dermatitic patients may be too high, possibly because of false-positive irritant reactions. (J Am Acad Dermatol 2002;46:200-6.)

Not Available

Not Available

Not Available Study supported by BioPharmX.

Background Once-daily brimonidine tartrate (BT) 0.5% gel was shown to provide significantly greater efficacy vs. vehicle for the treatment of facial erythema in patients with rosacea. Objectives To demonstrate that patient satisfaction with overall appearance is correlated with reduction in facial erythema, as measured by clinician and patient assessments. Methods Data from two identical phase III, multicentre, randomized, controlled trials of moderate facial erythema of rosacea (study A: n = 260; study B: n = 293) with topical BT 0.5% compared to vehicle gel once-daily for 4 weeks were analysed. Correlations of Patient's Assessment of Appearance (PAA) with Clinician's Erythema Assessment (CEA) and Patient's Self-Assessment (PSA) of erythema were evaluated by calculation of gamma statistics. Results PAA correlated with CEA post-application on Days 1, 15 and 29 for the intent-to-treat population and provided a median gamma value of 0.57 (min = 0.28, max = 0.61). PAA and PSA was also highly correlated post-application on Days 1, 15 and 29; with a median gamma value of 0.87 (min = 0.66, max = 0.89). Subjects who achieved a clinically meaningful improvement in both CEA and PSA scales were more likely to report satisfaction with the overall appearance of their skin (P

Background: The subject of lichen planus (LP) and dental metal allergy long has been debated. An overwhelming majority of the existing literature focuses on mercury and gold salts in relation to oral lichen planus. Objective: Our objective was to expand current knowledge regarding LP and lichenoid lesions (LL) and dental metal allergy by investigating more metals and investigating cutaneous and genital disease in addition to oral disease. Methods: Fifty-one patients with known LP or LL were patch tested to a series of dental metals. Patients chose to replace their dental metals or make no revision. A telephone survey was conducted after 1 year to determine disease state. Results: Thirty-eight of 51 patients (74.5%) had at least 1 positive reaction. Twenty-five of 51 patients (49.0%) showed sensitivity to at least 1 mercurial allergen. Prevalence data for patients patch tested by the North American Contact Dermatitis Group (NACDG) from 1996 to 1998 was available for chromate, cobalt, gold, nickel, and thimerosal. The prevalence of positive reactions was higher in our group than in the NACDG group for all 5 of these allergens, and statistical significance was achieved for chromate (P = .028), gold (P = .041), and thimerosal (P = .005). Of patients who had a positive patch test reaction to 1 or more metals, 100% (9 of 9) reported improvement after metal replacement, whereas 62.5% (15 of 24) reported improvement without metal replacement. Conclusion: Sensitization to dental metals is more common among LP and LL patients than in routinely tested patients, and might be an etiologic or triggering factor in the disease.

Sommaire Antecedents: L'eczema d'irritation ou allergique des mains est difficile a maitriser chez les individus qui ne peuvent eviter l'exposition aux agents irritants ou allergisants. Les cremes «protectrices» se sont averees peu efficaces. Objectif: Determiner si l'eczema des mains, principalement de nature professionnelle, pourrait etre ameliore par l'utilisation d'une creme hydratante de conception nouvelle contenant du quaternium-18-bentonite. Methodes: Des hommes et des femmes d'âge adulte presentant une dermatite chronique des mains et dont la nature de la dermatite semblait etre, apres une periode d'observation de deux semaines, soit allergique, soit irritative soit combinee ont recu la creme a l'etude pour en faire l'application systematique. Lors des deuxieme, quatrieme et huitieme semaines, la peau de ces sujets a ete examinee par l'expert clinique et a fait l'objet de parametres, y compris l'erytheme, la desquamation, la formation de fissures ou de phlyctenes et le prurit selon une echelle numerique. Une evaluation globale a egalement ete effectuee. Des photographies ont ete prises a chaque visite. L'utilisation de corticoides topiques a ete consignee au dossier. Aucun autre traitement par voie generale a part les antihistaminiques ne fut permis. Resultats: Sur 37 sujets inclus dans l'etude, 33 ont ete suivis jusqu'a la fin. La moyenne des resultats des premieres evaluations globales du medecin et du sujet etait de 6,0 et de 5,8, respectivement (sur une echelle de 1-10). Les resultats finals etaient de 2,9 et de 2,8, respectivement, une amelioration de 50% (p < 0,001). L'utilisation de corticoides topiques a ete reduite chez 29 des 33 sujets. Quinze des 35 sujets ont eu un resultat final de 0-2, indiquant une guerison complete ou quasi complete. Seuls 10 sujets, dont deux ayant abandonne l'etude, n'ont pas reagi favorablement au traitement. Aucun effet indesirable n'a ete signale. Commentaires: La creme hydratante a nettement ameliore la dermatite chronique des mains chez la majorite des individus dont on n'avait pas reussi a maitriser la dermatite auparavant, et ce, malgre le fait qu'ils aient poursuivi leurs activites professionnelles normales.

Background: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. Objective: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. Methods: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. Results: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. Conclusion: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.