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Recent studies have identified a subtype of the S1P-receptor family called sphingosine-1-phosphate receptor 2 (S1PR2), which plays a crucial role in maintaining the skin barrier. It has been observed that S1PR2 and Staphylococcus epidermidis (S. epidermidis) work together to regulate the skin barrier. However, the interaction between these two factors is still unclear. To investigate this, a study was conducted on healthy skin and allergic contact dermatitis (ACD) using 3,4-Dibutoxy-3-cyclobutene-1,2-dione (SADBE) on the ears of S1pr2fl/fl and S1pr2fl/flK14-Cre mice and using 1 × 106 CFU of S. epidermidis to examine its effects on the skin. The results showed that in S. epidermidis-conditioned ACD, the ear thickness of S1pr2fl/flK14-Cre mice was lower than that of S1pr2fl/fl mice, and mRNA expressions of Il-1β and Cxcl2 of S1pr2fl/flK14-Cre mice were lower than that of S1pr2fl/fl mice in ACD with S. epidermidis. Furthermore, the gene expression of Claudin-1 and Occludin in S1pr2fl/flK14-Cre mice was higher than that of S1pr2fl/fl mice in ACD with S. epidermidis. The study concludes that S. epidermidis colonization improves the skin barrier and prevents ACD even when S1P signaling malfunctions.

This article discusses a study conducted at Gentofte Hospital in Denmark on contact allergy to textile dye mix (TDM) in eczema patients. The study analyzed historical data from 2015 to 2023 and found that the overall prevalence of contact allergy to TDM was 2.3%. There was no significant trend in the prevalence of contact allergy to TDM over the study period. The study also found that leg eczema was significantly associated with contact allergy to TDM. The most prevalent dye causing contact allergy in TDM allergic patients was Disperse Orange 3 (DO 3), and there were concomitant reactions between DO 3 and another allergen called PPD. The authors suggest excluding DO 3 from TDM and introducing a new version of TDM without DO 3. However, they also propose temporarily including DO 3 in supplementary standard series for better surveillance. [Extracted from the article]

BackgroundPreservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited.ObjectiveTo evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group.MethodsWe conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016.ResultsA total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P

Inherited or acquired blockade of distal steps in the cholesterol synthetic pathway results in ichthyosis, due to reduced cholesterol production and/or the accumulation of toxic metabolic precursors, while inhibition of epidermal cholesterol synthesis compromises epidermal permeability barrier homeostasis. We showed here that 3β-hydroxysteroid-δ8, δ7-isomerase-deficient mice (TD), an analog for CHILD syndrome in humans, exhibited not only lower basal transepidermal water loss rates, but also accelerated permeability barrier recovery despite the lower expression levels of mRNA for epidermal differentiation marker-related proteins and lipid synthetic enzymes. Moreover, TD mice displayed low skin surface pH, paralleled by increased expression levels of mRNA for sodium/hydrogen exchanger 1 (NHE1) and increased antimicrobial peptide expression, compared with wild-type (WT) mice, which may compensate for the decreased differentiation and lipid synthesis. Additionally, in comparison with WT controls, TD mice showed a significant reduction in ear thickness following challenges with either phorbol ester or oxazolone. However, TD mice exhibited growth retardation. Together, these results demonstrate that 3β-hydroxysteroid-δ8, δ7-isomerase deficiency does not compromise epidermal permeability barrier in mice, suggesting that alterations in epidermal function depend on which step of the cholesterol synthetic pathway is interrupted. But whether these findings in mice could be mirrored in humans remains to be determined.

BackgroundA defective skin barrier and bacterial colonization are two important factors in maintenance and progression of atopic dermatitis and chronic allergic/irritant hand dermatitis. A water-based lipid delivery system containing physiologic lipids was previously shown to be a useful adjunct in the treatment of hand dermatitis. We tested the ability of this formulation to penetrate into the viable epidermis and in addition assessed its antibacterial properties.MethodsEpidermal penetration of the product was assessed by fluorescence microscopy. Recovery of Escherichia coli and Staphylococcus aureus MRSA from skin treated with Neosalus® foam was quantified.ResultsComponents of Neosalus® penetrated the stratum corneum and were distributed throughout the viable epidermis. Neosalus® significantly decreased recovery of both Staphylococcus aureus and Escherichia coli from the skin surface.ConclusionsThe ability of components of Neosalus® to be taken up into the viable epidermis and potentially made available for incorporation into the barrier lipids, combined with antibacterial properties, indicate that this formulation may be valuable not only in chronic hand dermatitis, but also in various other forms of dermatitis.Trial registrationCurrent Controlled Trials ISRCTN18191379 , 28/12/2018, retrospectively registered.

Background: An updated understanding of allergic contact cheilitis is needed. Objectives: To characterize clinical characteristics and allergen relevance in patients with cheilitis referred for patch testing. Methods: Retrospective analysis of 43 772 patients patch tested with the North American Contact Dermatitis Group (NACDG) screening series from 2001 to 2018. Results: Overall, 2094 patients (4.8%) had lips as one of three sites of dermatitis, 1583 (3.6%) had lips as the primary site and 1167 (2.7%) had lips as the sole site of dermatitis. Prevalences of cheilitis at any, primary, and sole sites significantly increased throughout the study cycle from 2001–2002 (2.7%, 2.2% and 1.7%) to 2017–2018 (7.8%, 5.2% and 3.7%). Approximately 60% of patients with any, a primary, or a sole site of cheilitis had one or more positive allergic patch‐test reactions compared to 65% of those without cheilitis. Conclusion: Patients with cheilitis who were referred for patch testing had high rates of positive and relevant allergens. More than one in four patients with any, primary, or sole cheilitis had a positive reaction to non‐NACDG screening allergens (28.0%, 26.8%, 31.1% vs. 21.6%) compared to patients without cheilitis, emphasizing the need for expanded patch test series in cheilitis. [ABSTRACT FROM AUTHOR]

PurposeFormaldehyde allergic contact dermatitis (ACD) may be due to products with free formaldehyde or formaldehyde-releasing agents; however, assessment of formaldehyde levels in such products is infrequently conducted. The present study quantifies total releasable formaldehyde from "in-use" products associated with formaldehyde ACD and tests the utility of commercially available formaldehyde spot test kits.Materials and methodsPersonal care products from 2 patients with ACD to formaldehyde were initially screened at the clinic for formaldehyde using a formaldehyde spot test kit. Formaldehyde positive products were sent to the laboratory for confirmation by gas chromatography-mass spectrometry. In addition, 4 formaldehyde spot test kits were evaluated for potential utility in a clinical setting.ResultsNine of the 10 formaldehyde spot test kit positive products obtained from formaldehyde allergic patients had formaldehyde with total releasable formaldehyde levels ranging from 5.4 to 269.4 µg/g. Of these, only two shampoos tested listed a formaldehyde-releasing agent in the ingredients or product literature. Subsequently, commercially available formaldehyde spot test kits were evaluated in the laboratory for ability to identify formaldehyde in personal care products.ConclusionsChemical based formaldehyde spot test were more reliable than the enzymatic based test in identifying product releasable formaldehyde content. It is concluded that product labeled ingredient lists and available information are often inadequate to confirm the potential for formaldehyde exposure and chemical based spot test kits may have utility for identification of potential formaldehyde exposure from personal care products.

BackgroundAdverse skin reactions to skin care products have been increasing in recent years. However, to date, these reactions have not been well characterized.ObjectiveTo describe the symptoms, clinical signs and frequency of adverse cutaneous reactions to skin care products on the face in males vs females of various ages.Patients and methodsAll outpatients diagnosed with adverse cutaneous reactions to skin care products on the face examined by dermatologists at the Dermatology Hospital of South Medical University between November 1, 2016 and October 31, 2017, employing a questionnaire and an interview, were eligible. The associations of adverse cutaneous reactions with age and sex were analysed.ResultsA total of 433 outpatients, accounting for 0.12% of all outpatients, were assessed. Of these, 223 patients, including 204 females and 19 males, aged 4 to 75 years, were eventually diagnosed with adverse reactions to skin care products on the face. Eighty-two per cent of patients experienced pruritus, 80% showed erythema, and 48% showed visible swelling. The incidence rates of both xerosis and oedema correlated positively with age, whereas acne-like lesions were negatively associated with age, but not with sex.ConclusionsOur results indicate that pruritus, xerosis and erythema are common adverse cutaneous reactions to facial skin care products. These reactions vary with age, but not with sex. Vigorous safety testing should precede the marketing of skin care products.

Background: Allergic contact dermatitis (ACD) to cobalt is more common in children and adolescents than adults. However, detailed information on sites and sources of cobalt ACD is limited. Objectives: To assess trends in positive and clinically relevant patch test reactions to cobalt in children and associated patient characteristics, common sources and body sites affected. Methods: A retrospective analysis of children (<18 years) patch tested to cobalt by the North American Contact Dermatitis Group between 2001 and 2018. Results: Of 1919 children patch tested, 228 (11.9%) and 127 (6.6%) had a positive/allergic or currently relevant patch test reaction to cobalt, respectively. The most common primary body sites affected were scattered generalized (30.0%), face, not otherwise specified (10.6%) and trunk (10.1%). Patients with allergic and currently relevant allergic patch test reactions were more likely to have a primary site of trunk (p = 0.0160 and p = 0.0008) and ears (p = 0.0005 and p < 0.0001). Affected body site(s) varied by cobalt source among patients with currently relevant reactions, especially for less common sources. The most commonly identified sources of cobalt included jewellery, belts and clothing. Conclusions: Positive patch test reactions to cobalt were common in children. The most common body site was scattered generalized and the sources of cobalt varied by body site. [ABSTRACT FROM AUTHOR]

Abstract Background: Despite being widely used in different areas of dermatology, there have been few studies evaluating the benefit of dermoscopy in the interpretation of patch tests, especially in weak and doubtful reactions. Objectives: To evaluate the role of dermoscopy in the interpretation of patch tests and describe the main findings of the reactions. Method: Prospective study, carried out in dermatology reference centers in southern Brazil, which evaluated the final results of patch tests analyzed with the aid of dermoscopy. Results: 77 patients and 160 reactions were included. The most prevalent substances were nickel sulphate (23.8%), kathon CG (9.4%), and perfume mix (8.8%). The main dermoscopic findings were reaction area greater than half of the chamber site (90%), homogeneous erythema (86.9%), vesicles (30%), crusts (21.3%), perifollicular erythema (35%), pore reaction (19.4%) and pustules (8.8%). Dermoscopy was found to facilitate the definition of erythema in reactions on black skin and when due to substances with deposition of pigment. Of the 64 weak or doubtful reactions, 36 (56.25%) showed a change in the final result after dermoscopy evaluation; of the 36 doubtful reactions, 33 (91.6%) showed a change in the final result after dermoscopy evaluation (p < 0.001). Study limitations: The probable limitation of the study is its sample size. Though certain significance levels have been reached, other possible relationships may not have been observed. Conclusion: Dermoscopy improves significantly the interpretation of patch tests, especially in weak and doubtful reactions.

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Keywords: 4-phenylenediamine; dermatitis; allergic contact; drug-related side effects and adverse reactions; immunotherapy; patch tests EN 4-phenylenediamine dermatitis allergic contact drug-related side effects and adverse reactions immunotherapy patch tests 377 379 3 09/08/22 20221001 NES 221001 Abbreviations ACD allergic contact dermatitis CTLA-1 cytotoxic T-lymphocyte associated protein 4 ICP immune check points ICPI immune check point inhibitor IRAE immune-related adverse events MI methylisothiazolinone PD-1 programmed cell death protein 1 PDL1 programmed death ligand 1 PPD para-phenylenediamine Treg T regulatory cells Allergic contact dermatitis (ACD) arising during immune check point inhibitor (ICPI) therapy has rarely been reported and is likely an under-recognized cause of a number of cutaneous immune-related adverse events (IRAE), especially treatment refractory dermatitic eruptions. Dermatitis, allergic contact, drug-related side effects and adverse reactions, 4-phenylenediamine, immunotherapy, patch tests Just as immunosuppression risks false-negative results,7 an immune-enhanced anti-PD-1 state could theoretically cause allergy induction, severe patch test reactions and false positives. [Extracted from the article]

Background: Few studies have examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD). Objective: To examine trends, associations, and clinical relevance of ACD in patients with NE who were referred for patch testing. Methods: Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group. Results: Overall, 748 patients (1.9%) were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001 and 2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE increased steadily with age and was associated with male sex and Asian and other race/ethnicity, and inversely associated with a history of atopic dermatitis (AD) and hay fever. Patients with NE had lower proportions of one or more positive allergic reactions and lower odds of a positive reaction in multiple individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium 15, fragrance mix I, and propylene glycol. Conclusion: NE is a heterogeneous disorder with distinct subsets of lesional distributions and a profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly one in four patients with NE had ACD, supporting the role of patch testing in patients with NE. [ABSTRACT FROM AUTHOR]

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Contact allergies are complex diseases, and one of the important challenges for public health and immunology. The German 'Federal Institute for Risk Assessment' hosted an 'International Workshop on Contact Dermatitis'. The scope of the workshop was to discuss new discoveries and developments in the field of contact dermatitis. This included the epidemiology and molecular biology of contact allergy, as well as the development of new in vitro methods. Furthermore, it considered regulatory aspects aiming to reduce exposure to contact sensitisers. An estimated 15-20% of the general population suffers from contact allergy. Workplace exposure, age, sex, use of consumer products and genetic predispositions were identified as the most important risk factors. Research highlights included: advances in understanding of immune responses to contact sensitisers, the importance of autoxidation or enzyme-mediated oxidation for the activation of chemicals, the mechanisms through which hapten-protein conjugates are formed and the development of novel in vitro strategies for the identification of skin-sensitising chemicals. Dendritic cell cultures and structure-activity relationships are being developed to identify potential contact allergens. However, the local lymph node assay (LLNA) presently remains the validated method of choice for hazard identification and characterisation. At the workshop the use of the LLNA for regulatory purposes and for quantitative risk assessment was also discussed.

Mast cells play an important role in both adaptive and innate immunity, and a large body of literature demonstrates their functions in skin immunity. This article reviews the literature on the role of this cell type in the pathogenesis of a number of immunological skin diseases, including contact dermatitis, atopic dermatitis, immunobullous disease, scleroderma, and chronic graft-vs.-host disease. In all these diseases, mast cells are noted to increase in number and undergo degranulation in the affected skin, and in some cases, their specific mediators are detected. Elucidation of the contribution of mast cells to the pathogenesis of these diseases has been aided significantly by the use of animal models, especially mouse models. The studies of mast cell-deficient mice in conjunction with normal congenic mice have been particularly fruitful, although in some cases, such as contact dermatitis, a definitive conclusion has not been achieved despite extensive efforts. The role of mast cells in atopic dermatitis has also been suggested by studies of gene polymorphism, which have linked some of the mast cell-related genes to the disease. In the case of scleroderma and chronic graft-vs.-host disease, the function of mast cells in fibrosis is further supported by the ability of these cells and their mediators to induce activation and proliferation of fibroblasts. Therapies targeting mast cells may prove beneficial for treatment of these inflammatory and autoimmune diseases.

This article overviews research in the interdisciplinary area of textile/skin interaction and related cutaneous intolerance. Microclimate in the skin/clothing system and especially the skin responses relates to the moisture and heat transfer within this system and plays a critical role in skin irritation from textiles. A discussion is then given on skin irritation reactions to textiles, including intolerance caused by chemicals (dyes and finishes) and physical contact/friction. Finally, two skin injuries, blisters and pressure ulcers, which are caused by physical contact, pressure, and friction, are documented. Despite the prevalent problems caused by ill textile/skin interactions, minimal efforts have been devoted to this field. In addition, the in vivo experimental studies infrequently lead to a solid conclusion. The cause may lie in the dramatic variation of skin conditions among individuals as well as among different anatomic sites of the same person. Another reason might be the lack of communications between researchers in the areas of textiles and dermatology.

Allergic contact dermatitis (ACD) is a frequent inflammatory and the most common type of occupational skin disease. Chloroacetophenone (CN) has been one of the most typical riot control agents known since the end of the First World War. It is used by the armed and police forces and as pocket tear gas for personal protection. However, it is considered to be safe and, therefore, should not cause fatal health effects. Although CN is stated to provoke ACD, there are only a few cases found in the literature similar to the one shown below. [ABSTRACT FROM AUTHOR]

Introduction: Occupational allergic contact dermatitis is a very common occupational disease and epoxy resins are among its main causes. The aim of this study was to characterize patients with positive patch test reactions to epoxy resin detected in the Coimbra Hospital and University Center between 2012 and 2018 and compare with the results of patients patch tested be- tween 1999 and 2008 at the same Institution. Material and Methods: Within a retrospective analysis of the files of patients with positive patch test reactions (1+ or more intense) to epoxy resin of bisfenol A tested at 1% pet. within the baseline series between 2012 and 2018, we characterized demographic and clinical data of reactive patients, evaluated the relevance of the reaction, sources of exposure to epoxy resin with particular attention to occupational exposures, other positive reactions and the impact of the results of the tests in the work conditions of these patients. Lastly, we compared these results with a previous study performed in the same Hospital between 1999 and 2008. Results: Among 2363 patch tested patients during the study period we found 23 patients (0.97%), 17 males and six females, who developed contact allergy to epoxy resins. In 22 cases we identified a relevant occupational exposure: nine from construction industry; nine workers from wind-mill turbines factory for eolic energy; two from fiberglass factories; one from a chemical factory and one from a wastewater treatment plant. In one patient (a teacher) no relevance was found. Of these 22 workers, nine (39.1%) had both hand and airborne lesions, while eight (34.8%) had lesions exclusively on the hands and five (21.7%) had predominately airborne dermatitis. Four of the 23 (17.4%) reacted exclusively to the epoxy resin, and 11 of 18 (61.1%) also reacted to 0.25% hexanediol diglycidyl ether. Avoidance resulted in a significant improvement of symptoms. Compared to the previous period (1999-2008), there are no significative changes apart from a slight increase in the frequency of the allergic reactions to epoxy resins and its main source of exposure. Conclusion: The prevalence of allergic contact dermatitis to epoxy resin has slightly increased in this Portuguese Center mostly due to workers from wind-mill turbines factory for eolic energy, a recent industry implanted in this region. This allergen still causes almost exclusively occupational dermatitis, either hand, airborne, or both. [ABSTRACT FROM AUTHOR]

A 78-year-old man with no history of allergy, underwent endovascular aortic repair for abdominal aortic aneurysm rupture. Postoperatively, he had low-grade fever and persistently raised white blood cell counts, but tests showed no infection. A skin rash appeared on the trunk and upper arms; we suspected a drug allergy. Despite withdrawal and/or change of medications, the symptoms remained. Finally, a patch test for nickel showed a strongly positive result. Oral prednisone 5 mg·day−1 was started, and the clinical findings resolved thereafter. No recurrence of allergy, infection, or exacerbation of the treated abdominal aortic aneurysm was noted at the 2-year follow-up. [ABSTRACT FROM AUTHOR]

A retrospective study was carried out between 2006-2011. Six hundred and eighteen patients with suspected allergic contact dermatitis underwent the standard patch test series recommended by the Brazilian Contact Dermatitis Research Group. The aim of our study was to evaluate the variation of positive patch-test results from standard series year by year. The most frequently positive allergens were: nickel sulfate, thimerosal and potassium bichromate. Decrease of positive patch-test results over the years was statistically significant for: lanolin (p=0.01), neomycin (p=0.01) and anthraquinone (p=0.04). A follow-up study should be useful in determining which allergens could be excluded from standard series, as they may represent low sensitization risk.

4-Methylcyclohexanemethanol (MCHM) is a flotation reagent used in fine coal beneficiation. On January 9, 2014, crude MCHM, a mixture containing predominantly MCHM, was inadvertently released into the Elk River, a municipal water source that serves about 300,000 people in the Charleston, WV area, resulting in temporary contamination of 15 percent of the state's tap water and causing significant dermal exposure. The current studies were undertaken to determine whether crude MCHM or MCHM has the potential to produce dermal irritancy and/or sensitization. BALB/c female mice were treated daily for 3 consecutive days by direct epicutaneous application of 25 μL of various concentrations of crude MCHM or MCHM to the dorsum of each ear. A mouse ear-swelling test was used to determine irritancy potential and was undertaken in combination with the standardized Local Lymph Node Assay (LLNA) to determine skin sensitizing potential. MCHM was found to produce skin irritation at concentrations above 20% and did not produce sensitization. Crude MCHM also produced irritation, although weaker, and in addition was found to be a weak to moderate skin sensitizer. The results are discussed in terms of potential human health hazard. [ABSTRACT FROM AUTHOR]

Introduction: Allergic contact dermatitis in children, although usually considered infrequent, has been the object of numerous recent publications and an apparent increase in prevalence. This may be due to early exposure and sensitization to contact allergens, increasing the likelihood of skin reactions in a new exposure, or the more widespread use of patch tests, which are crucial to the diagnosis of this pathology. Methods: In order to know the characteristics and causes of allergic contact dermatitis in the pediatric age, we evaluated the medical records of patients with < 18 years who were patch tested between January 2005 and December 2014 at the Contact Allergology Unit of the Department of Dermatology University Hospital of Coimbra. The following parameters were analyzed: sex, age, personal and familiar history of atopy, main location of the dermatitis, reactive allergens within the baseline or complementary test series, suspected and final diagnosis. Results: A total of 106 pediatric patients were tested (3.6% of all patients), 68 females (64.2%) and 38 males (35.8%), four aged between 3-5 years (3.8%), 28 between 6-11 years (26.4%) and 74 between 12-17 years (69.8%), 52,8% with a personal history of atopy, 36.8% with facial and/or neck lesions. At least one positive test was observed in 51 patients (48.1%), mostly in girls especially because of nickel (18.9%). Nevertheless there were no positive tests to nickel in the last two years of the study. After nickel, cobalt, p-phenylenediamine, caine mix and palladium were reactive in five patients. Twelve patients reacted to allergens that are not included in the baseline series, mostly to drugs. Discussion: Contact allergy and allergic contact dermatitis were a relatively common diagnosis before the age of 18. An early etiologic diagnosis is important to prevent chronicity of lesions and a possible future negative personal and professional impact. Knowing the main allergens in this age group is important to establish avoidance measures and prevent further sensitization. [ABSTRACT FROM AUTHOR]

Introduction: Occupational allergic contact dermatitis (ACD) is frequent among health care workers (HCW) and culprit allergens may vary with time, occupational setting and exposure hazards. Objectives and Methods: In order to characterize the main contact allergens in HCW with dermatitis and its occupational relevance, we performed a retrospective analysis of clinical data and patch test (PT) results from HCW who were studied in the Department of Dermatology of Coimbra Hospital and University Centre (CHUC) between 2010-2015. All patients were tested with a baseline and additional series, according to the tasks developed. Results: Among 1858 patch tested patients, 125 (6.7%) were HCW, 114 females/11 males, mean age 39,26±12,5 years, mainly nurses (56), technical assistants (48) and doctors (21), 71 with hand dermatitis (56,8%), 22 with atopic dermatitis and/or other atopic symptoms (17,6%). Ninety patients (72%) had at least one positive PT, 47 (37,6%) with occupational relevance. Patients with hand dermatitis were significantly more likely to have positive PT (76.1%). We observed 51 positive PT to metals (Ni-41, most with past relevance, Co-8; Cr -2), 30 to fragrances (FM-I-10; Myroxylon pereirae-8; lyral-5; FM-II-4; citronellol-3), 29 to preservatives (mostly methylisothiazolinone (MI) and/or chloromethylisothiazolinone (MCI)-20), 24 to rubber chemicals (P-phenylenediamine (PPD)/Isopropyl-PPD-9), and 14 to topical medicaments (iodopovidone - 5; caine mix - 4). The main occupational causes of ACD were hand soaps/disinfectants and patients' hygiene products (15), protective gloves/shoes-9 and topical or systemic drugs (antiseptics-8 and parenteral antibiotics-3). Main allergens with occupational relevance were MI and/or MCI/MI (15), although isolated MI was tested only after mid 2012, lanolin and/or amerchol L101 (9), formaldehyde and/or formaldehyde releasers (7), iodopovidone (5), thiuram mix (5), carbamates (4), FM-I (3), cephalosporins (3) and (meth)acrylates (3 dentists/dental technicians). In 37 out of 42 evaluated cases there was marked improvement/resolution of the dermatitis, namely after eviction of the hospital hand soap which contains MCI/ MI under the designation of Acticide® MV. Conclusions: Hand dermatitis was the main presentation of ACD in HCW with no apparent relation with atopy. Isothiazolinones and formaldehyde releasers induced more positive PT and were more frequent among HCW than in the whole population studied very probably due to the cumulative exposure to these preservatives in personal and occupational hand soaps and hygiene products. PT was important to orient eviction in each individual case but also for the hospital community to understand the presence of moderate or potent sensitizers in the work place and, therefore, establish the most adequate preventive measures. [ABSTRACT FROM AUTHOR]

Methyl methacrylate (MMA), a widely used monomer in dentistry and medicine has been reported to cause abnormalities or lesions in several organs. Experimental and clinical studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes, and mucous membranes, allergic dermatitis, stomatitis, asthma, neuropathy, disturbances of the central nervous system, liver toxicity, and fertility disturbances.

Copyright of Revista de Medicina e Saúde de Brasília is the property of Revista de Medicina e Saude de Brasilia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pine caterpillar, Thaumetopoea pityocampa, is a phyto-lepidopteran, responsible for the delay in the growth or the death of various types of pine trees. Besides nature damage, pine caterpillar causes dermatological reactions in humans by contact with the irritating hairs of the larvae. Although dermatitis occurs among outdoor professionals, it is primarily non-professional. Means of contamination comprise direct contact with the nest or the processional caterpillar and indirect contact with air dispersed hairs. Dermatitis is generally observed in late spring and particularly from March to June, among campers and tourers. The eruption has its onset 1-12 hours after contact with the hairs and presents with intense and continuous itching. Apart from the skin, T. pityocampa can involve the eyes and rarely the airways. Despite the considerable damages to humans and nature, pine caterpillar infestation is an underestimated problem; medical literature lists few studies and, often, relevant information is referred to local media and popular wisdom. [ABSTRACT FROM AUTHOR]

Contact dermatitis includes any inflammatory skin reaction due to direct or indirect skin contact with noxious agents. The main clinical expression is eczema and other delayed reactions, but immediate reactions, namely contact urticaria, can also occur. Contact urticaria has a broad range of clinical manifestations. The limited form is restricted to the area of contact between the allergen and the skin or mucosa, but more severe presentations include generalized urticaria lesions, angioedema and even anaphylaxis. All topical drugs can theoretically precipitate contact urticaria. The culprit may be either the active compound or the excipients, and the mechanisms of the immediate reactions can be both immune-mediated (IgE-dependent) and non-immune-mediated. The authors present an overview of the different drugs reported to induce contact urticaria, emphasizing the specific contexts of mucosal exposure and contact urticaria induced by drugs in occupational settings. [ABSTRACT FROM AUTHOR]

Introduction: Allergic contact dermatitis to the constituents of the prosthesis occurs in 5% of patients and may be the etiology of the failure of arthroplasty. The most common sensitizer's metals are nickel, cobalt and chromium. The components of the cement have also been implicated as allergens. Methods: A retrospective study of patients with arthroplasties, who performed patch tests, after suspicion of allergic contact dermatitis in the last 2 years was done. We carried out tests with the standard battery of the Portuguese Group for the Study of Contact dermatitis and supplemental batteries, including metals, acrylates/methacrylates and topical antibiotics. Results: Fourteen patients were included: 10 underwent knee arthroplasty, 3 hip arthroplasty and 1 ankle arthroplasty. Patients had limited function of joints. The mean age of patients observed was 61.6 years and 12 patients were females and 2 males. The symptoms appeared on average 14.4 months after surgery. Nine patients had positive reactions to nickel, 5 to cobalt, 1 to chromium, 1 to gentamicin and neomycin. In these cases we opted for placing the prosthesis revision with oxinium and/or titanium, with improvement of symptomatology. Discussion and conclusions: This review showed the importance of performing patch tests in patients with clinical signs of failure of arthroplasty, since patients with sensitization to its constituent improved with the replacement of prosthesis. [ABSTRACT FROM AUTHOR]

Background: Eyelid dermatitis is a common disease and its etiology frequently difficult to ascertain, although allergic contact dermatitis is the most common cause in patch-tested patients. This is a 5-year retrospective study to evaluate the most frequent causes and allergens in patients with allergic eyelid dermatitis. Materials and Methods: Using a computerized database, patients with eyelid dermatitis patch tested over a 5-year period from 2009-2013 on the Dermatology Consultation of Hospital Curry Cabral were identified. Results: Over the 5-year period (2009-2013) from a total of 1341 patch tested patients, 117 (8.7%) had eyelid dermatitis. The most frequent etiology was allergic eyelid dermatitis (54 patients), followed by atopic dermatitis (22 patients). Toluenesulfonamide Formaldehyde resin was the most frequent allergen identified. The preservative allergens group was the most frequently identified, followed by fragrances and drugs. [ABSTRACT FROM AUTHOR]

Introduction: Allergic contact dermatitis to mercaptobenzothiazole and its derivatives has been increasingly recognized in industrialized countries because of their widespread use in polymerization of synthetic rubber. The authors describe two clinical cases with relevant occupational exposure. Case reports: A 46 year-old male patient, with an eight month pruritic dermatitis, limited to the wrists, refractory to high potency topical corticosteroid and oral antihistamine. Physical examination showed erythematous-violaceous infiltrated plaques and excoriated erythematous papules on both wrists. Prick tests and RAST to latex were negative. Epicutaneous tests were performed with basic series from Portuguese Contact Dermatitis Group, rubber and glue series and fragments of the sleeve and it was found positivity for mercaptobenzothiazole (++), mercapto mix (++) and elastic band of gloves in reading at 72h and at 7 days. A 61 years old non atopic man, woodworker, with a 12- month history of itching, erythema, infiltration of genius region of face and extension to posterior cervical region. Epicutaneous tests were performed with basic series from Portuguese Contact Dermatitis Group, rubber and glue series, cosmetics series and fragments of the protection mask work and it was found positivity for mercaptobenzothiazole (++), mercapto mix (++) and elastic band of mask (++) in reading at 72h and at 7 days. Discussion: Despite being well known allergens, mercaptobenzothiazole and its derivatives may be present in other sources of exposure to rubber like elastic fabric in clothing. Once the worker sensitized, it can be an important cause of disability in an occupational and personnal setting. [ABSTRACT FROM AUTHOR]

Abstract: The average nickel uptake in the group of students aged 20 to 25 was determined at 227μg/day. The same study conducted among 9 senior researchers aged 40 to 50 brought a mean nickel uptake of 161μg/day. Trace amounts of nickel are present in the majority of foodstuffs. Absorbed from digested aliment, its ions are directly responsible for the occurrence of allergic symptoms. Assimilation of nutrients varies with individual susceptibility and overall health condition. However, it also has a lot to do with dietary habits and food characteristics. In this manuscript, we delineated main parameters related to nickel accumulation, such as its uptake, release from foodstuffs and assimilability. Each of them, their scale and proportions potentially affect allergic response from hypersensitive organism. We analyzed several nickel-rich commodities of various characteristics for their nickel level with a particular interest in the metal amounts being released from digested matter and their proportions. Quantitatively profiled samples of chocolate (3–5μgnickel/g), popular plant products (1–4μg/g), nuts (1–10μg/g) and herbal spices (0.3–10.8μg/g) underwent simulated digestion followed by atomic absorption spectrometry measurements to evaluate nickel release ratio. Groups of samples composed of analogous food matrices showed consistent release rates. As opposed to chocolate and nuts (both average 50% release), less homogenous individual herbal spice samples indicated nickel release between 20% and 90%. The release ratio gives an idea of how much metal allergen is available for assimilation out of the total intake of food-borne nickel. Absorption ratio accounts for the amount that ultimately supplies blood serum. We determined mean nickel absorption rate at 16% relative to the daily uptake. Elimination diets should acknowledge release rates specific to individual nutrients as their criterion in designing aware consumption. Apart from crude quantitative approach, specific biochemical food characteristics should be considered in the context of systemic hypersensitivities related to exogenous nickel uptake. [Copyright &y& Elsevier]

A large number of contact allergic reactions to benzocaine have been reported since its introduction to the pharmaceutical market as an active ingredient in different over-the-counter anesthetic ointments. Benzocaine is used as a key ingredient in many pharmaceuticals, such as products for oral ulcers, wound and burn preparations, sunburn remedies, hemorrhoidal preparations, oral and gingival products, sore throat sprays/lozenges, callous and wart remedies, creams for treatment of poison ivy dermatitis, tooth ache and denture irritation products. We present a 56-year-old Caucasian male with chronic rash, accompanied by intense itching in the perianal area. The lesions occurred two months earlier and the patient was treated with a wide range of topical antifungals, antibiotics and corticosteroids, with temporary improvement. The skin lesions were consistent with chronic allergic contact dermatitis. The patient denied using any topical preparations other than those prescribed by his dermatologist. Patch testing with the European baseline series was performed. A strongly positive reaction to benzocaine was identified on reading days 2 and 3. Targeted history showed intermittent use of benzocaine anti-hemorrhoidal cream to treat concomitant hemorrhoids. Benzocaine was discontinued and treatment with methylprednisolone aceponate 0.1% was initiated, resulting in significant improvement. No relapse was observed at 3-month follow-up. In conclusion, patients with confirmed benzocaine allergy should pay special attention to product labels and avoid products that contain benzocaine and its related substances. All products labelled as 'anaesthetic' or 'caine' should be suspected of containing benzocaine or related compounds. Patient education and awareness are critical to avoid further episodes and relapses. [ABSTRACT FROM AUTHOR]

Palmoplantar pustulosis (PPP) is a chronic and relapsing disease of the palms and soles, which tends to be difficult to treat. Classically it was described as a subtype of psoriasis. Nowadays it is regarded as a separate entity, although plaque-type psoriasis affects concomitantly many patients with PPP. A link between allergic contact dermatitis (ACD) and PPP has been described, and the former may encompass a potential to perpetuate the latter. Hereby we report two cases of difficult to treat plantar pustulosis. Underneath the dermatosis's refractive nature was an allergic sensitization to potassium dichromate and cobalt chloride. Leather shoes and leather insoles were commonly worn, and both allergens are employed by the leather industry. Clinical remission was achieved in both cases with allergen eviction. Patch testing must be considered in cases of PPP without response to treatment. If relevant sensitization is found, allergen eviction measures are mandatory. [ABSTRACT FROM AUTHOR]

Abstract Introduction The online Occupational Medicine Tutorial prepares students to diagnose occupational diseases in their patients. The material is comprehensive enough to allow faculty who do not specialize in occupational medicine to run this activity. Methods The tutorial is broken into three sections and is designed to take approximately 30-minutes to complete. The first section includes an overview of the importance of taking an occupational history, a list of common occupations, exposures and resultant diseases, and a methodology for obtaining a problem-focused occupational history. The second section asks the students to complete their own personal occupational history using the framework outlined in the previous section. The third section allows the student to work through one of two clinical vignettes. Results Both students and faculty graded the online tutorial favorably. Eighty-one percent of students rated the relevance of the online tutorial as good to excellent. Seventy-four percent thought the quality of the material is good to excellent and seventy percent rated the quality of the presentation as good to excellent. Faculty respondents were much more enthusiastic with 92.8% judging the relevance, quality of content, and presentation within the good to excellent range. Discussion After completing the tutorial students appreciated the range of occupational exposures and the importance of taking an occupational history. Because the tutorial encourages the students to take their own occupational histories, they are more familiar with the tools available to determine if a patient's workplace exposures could be associated with their presenting symptoms and illness.

Chemical sensitization is a serious condition caused by small reactive molecules and is characterized by a delayed type hypersensitivity known as allergic contact dermatitis (ACD). Contact with these molecules via dermal exposure represent a significant concern for chemical manufacturers. Recent legislation in the EU has created the need to develop non-animal alternative methods for many routine safety studies including sensitization. Although most of the alternative research has focused on pure chemicals that possess reasonable solubility properties, it is important for any successful in vitro method to have the ability to test compounds with low aqueous solubility. This is especially true for the medical device industry where device extracts must be prepared in both polar and non-polar vehicles in order to evaluate chemical sensitization. The aim of this research was to demonstrate the functionality and applicability of the human reconstituted skin models (MatTek Epiderm® and SkinEthic RHE) as a test system for the evaluation of chemical sensitization and its potential use for medical device testing. In addition, the development of the human 3D skin model should allow the in vitro sensitization assay to be used for finished product testing in the personal care, cosmetics, and pharmaceutical industries. This approach combines solubility, chemical reactivity, cytotoxicity, and activation of the Nrf2/ARE expression pathway to identify and categorize chemical sensitizers. Known chemical sensitizers representing extreme/strong-, moderate-, weak-, and non-sensitizing potency categories were first evaluated in the skin models at six exposure concentrations ranging from 0.1 to 2500 µM for 24 h. The expression of eight Nrf2/ARE, one AhR/XRE and two Nrf1/MRE controlled gene were measured by qRT-PCR. The fold-induction at each exposure concentration was combined with reactivity and cytotoxicity data to determine the sensitization potential. The results demonstrated that both the MatTek and SkinEthic models performed in a manner consistent with data previously reported with the human keratinocyte (HaCaT) cell line. The system was tested further by evaluating chemicals known to be associated with the manufacture of medical devices. In all cases, the human skin models performed as well or better than the HaCaT cell model previously evaluated. In addition, this study identifies a clear unifying trigger that controls both the Nrf2/ARE pathway and essential biochemical events required for the development of ACD. Finally, this study has demonstrated that by utilizing human reconstructed skin models, it is possible to evaluate non-polar extracts from medical devices and low solubility finished products. [ABSTRACT FROM AUTHOR]