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Background: Hair loss significantly impacts an individual's appearance, self-confidence, quality of life, and social competitiveness. Over 250 million people in China suffer from hair loss, accounting for 18% of the population. To ensure the safe selection of topical hair products for hair loss patients, reduce the risks of allergies and irritation, and improve clinical efficacy and adherence, we developed a hair patch test based on clinical needs., Objective: In this study, we explored the allergic situation of hair diseases through the test of patch products, which provided a strong basis for clinical personalized treatment., Methods: We designed a hair patch test to screen for allergens that are highly associated with hair diseases. The experiment is based on screening of haptens and drugs commonly encountered by hair and scalp, covering hair dyes, scalp care products, and therapeutic drugs. The research subjects are patients diagnosed with hair related diseases (such as androgenetic alopecia, alopecia areata, etc.), ensuring that the samples are targeted. The allergen patch is fixed on the surface of the skin, with a contact time of 48 h, followed by recording and evaluating local skin reactions within 72 h. The experiment aims to identify allergens that may cause or exacerbate hair diseases, providing a basis for the etiology research and treatment of related diseases., Results: Common allergens in daily hair care products include dodecyl polyglucoside (10.2% positivity rate) and Balsam of Peru (8.67% positivity rate). Cobalt chloride (56.63% positivity rate) and nickel sulfate (32.65% positivity rate) were prevalent metal semiallergens. The positive rates of 5% minoxidil liniment were 22.96%, and the positive rate of 5% minoxidil tincture was 27.04%, indicating significant sensitization potential. Lowering minoxidil liniment concentration to 2% reduced positivity to 4.08%. The positive rate of Hasonide solution mixed with 5% minoxidil tincture was 16.33%, while Hasinide solution and 5% minoxidil liniment were not positive, suggesting that the addition of both Hasonide solution could reduce the sensitization of 5% minoxidil tincture and minoxidil liniment., Conclusion: The increasing prevalence of hair disorders necessitates personalized treatment approaches. This study demonstrated the utility of patch testing with hair care products to investigate allergenic reactions, offering robust evidence for tailored clinical interventions. Future research should refine patch testing methodologies to better simulate real-world conditions and conduct larger-scale studies to optimize therapeutic strategies., (© 2025 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Propolis was added to the European baseline series (EBS) in 2019., Objectives: To investigate the frequency and relevance of positive patch tests to propolis in the EBS and to study co-reactivities., Patients and Methods: Retrospective study in patients patch tested between June 2019 and November 2023 in a university hospital in Amsterdam, The Netherlands., Results: Of 3134 consecutive patients, 299 (9.5%) had a positive reaction to propolis 10% pet. Only nine reactions (3%) were judged to be clinically relevant. There were significant co-reactivities to Myroxylon pereirae resin (balsam of Peru), colophonium, fragrance mixes 1 and 2, and to limonene and linalool hydroperoxides. A steep increase in rates of positive reactions to propolis was observed from 2020 to 2023. This was highly likely the result of the replacement of Chinese propolis with Brazilian propolis by the manufacturer., Conclusions: Positive patch tests for propolis are very frequent in Amsterdam, but only a few of these reactions are relevant. Most are probably (pseudo-)cross-reactions in patients with fragrance allergies. Propolis in the EBS has very limited value for dermatologists and patients in The Netherlands. Changes in patch test materials should be provided to all users to avoid misinterpretation of patch test results., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy., Objectives: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy., Methods: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series., Results: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%)., Conclusions: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Because Myroxylon pereirae (MP), or balsam of Peru, is nowadays almost not used "as such," and fragrance mix 1 (FM1) apparently is more sensitive in detecting fragrance allergy, the usefulness of testing MP in baseline series was recently questioned., Objectives: Identification of the number of clinically relevant patch test reactions to MP not detected by FM1., Methods: Retrospective analysis of 12 030 patients patch tested with MP and FM1 for contact dermatitis between January 2018 and December 2019 in 13 Italian dermatology clinics., Results: Four hundred thirty-nine patients (3.6%) had a positive patch test reaction to MP; 437 (3.6%) had a positive patch test reaction to FM1. Positive reactions to both MP and FM1 were observed in 119 subjects (1.0%), 310 (2.6%) reacted to MP only, 304 (2.5%) to FM1 only, 5 to MP and sorbitan sesquioleate (SSO), 9 to FM1 and SSO, and 5 to MP, FM1, and SSO. Single sensitizations were clinically relevant in 75.2% of cases for MP (62.9% current, 12.3% past) and 76.3% for FM1 (70.1% current, 6.2% past)., Conclusions: Based on our results, MP appears to be still worth testing along with FM1 in baseline series, because it allows detection of a remarkable number of fragrance allergies, often relevant, which would be otherwise missed., (© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series., Objectives: To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments., Methods: Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control., Results: In the 4 years (2015-2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%)., Conclusions: While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS., (© 2020 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered., Competing Interests: Disclosure Nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

: Wine, beer, liquor, and spirits are widely consumed in many cultures across the globe, and for some individuals, ingestion, cutaneous contact, or other exposure can lead to dermatologic findings. However, there currently exist no comprehensive reviews on alcohol-related dermatitis. Herein, we will provide an overview of alcohol-related dermatitis and contact urticaria, including the epidemiology and clinical manifestations, potential allergens found in alcoholic beverages, testing approaches, and strategies for allergen avoidance.

Background: Patch testing is the criterion standard for diagnosis of allergic contact dermatitis (ACD)., Objective: The aim of the study was to report the trends of patch testing results with the standard series at Massachusetts General Hospital from January 1, 2007, to December 31, 2016, compared with previous data from 1998 to 2006 and from 1990 to 2006 and those reported by the North American Contact Dermatitis Group., Methods: Data were collected and analyzed from retrospective chart reviews, focusing on 50 allergens in our standard series., Results: A total of 2373 patients were patch tested. One or more positive reactions were observed in 1428 patients (60.2%), and 1153 patients (48.6%) had a final primary diagnosis of ACD. Top 5 allergens were nickel (19.8%), fragrance mix I (14.6%), Myroxylon pereirae (balsam of Peru) (13.5%), neomycin (9.4%), and bacitracin (7.7%). Sensitization frequencies statistically increased over time for 3 allergens: nickel, neomycin, and propylene glycol, and decreased for 5 allergens: formaldehyde, paraben mix, thiuram mix, n-isopropyl-N-phenyl-4-phenylenediamine, and epoxy resin (P ≤ 0.001)., Conclusions: Surveillance of ACD trends is essential to detect emerging sensitizers. Patch testing is an important diagnostic tool for detection of ACD to commonly encountered and potential allergens.

Background: The American Contact Dermatitis Society Contact Allergen Management Program (CAMP) database was developed to provide patients with safe alternative products free of selected contact allergens. However, the CAMP database also records valuable information including the frequency of contact allergen searches for patients., Objectives: The aim of the study was to determine the relative prevalence of contact allergens in North America., Methods: Data from the CAMP database were analyzed from January 1, 2018, to January 1, 2019. The number of searches performed for each specific allergen served as a measure of the relative prevalence for each contact allergen. Results were then stratified by age, sex, atopic history, and patch screening tray used., Results: The 2018 CAMP data show that many of the prevalent allergens are not currently on any contact allergy screening series. These data strongly indicate that testing only to an 80-item screening series will not provide adequate care for many patients with contact allergy. The most prevalent contact allergens seen were fragrance mix, nickel, balsam of Peru, methylchloroisothiazolinone/methylisothiazolinone, and cobalt. Some important differences are seen when stratifying CAMP data by age, sex, atopic history, and patch screening tray used., Limitations: Possible sources of data error exist because of lack of uniformity of patch test practices., Conclusions: The CAMP database can be used to determine the relative prevalence of contact allergens, to help develop North American core screening patch test series, and to document the medical necessity of more comprehensive patch testing for patients with recalcitrant contact allergy.

Background: Dermatological services in Laos, South East Asia are limited to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population., Objectives: The aim of this study was to document positive patch tests in medical students without evidence of contact dermatitis in Laos., Patients/materials/methods: One hundred and fifty medical students were patch tested using TRUE Test® panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4., Results: Thirty-eight students (25.3%) had a positive reaction to at least one allergen, accounting for 52 reactions in total. The proportion of the students with positive patch test reading was significantly higher in the female [33/96 (34%)] than in the male [5/54 (9%)], p<0.001. The most common allergens were: nickel (10%), gold (6.6%), thiomersal (6.6%), cobalt dichloride (2%) and p-tert-Butylphenol formaldehyde resin (2%). Balsam of Peru (0.66%), black rubber mix (0.66%), Cl+Me-Isothiazolinone (0.66%), fragrance mix 1 (0.66%), quinolone mix (0.66%), methyldibromo glutaronitrile (0.66%), mercapto mix (0.66%), epoxy resin (0.66%), paraben mix (0.66%), thiuram (0.66%) and wool alcohols (0.66%) accounted for all of the other positive reactions., Conclusion: This study represents the first documented patch test results in Lao medical students and in the adult Lao population. The results of this study will inform any future research into contact allergy in Laos and give an insight into the background level of contact sensitivity in this population., Competing Interests: The authors have declared that no competing interests exist.

Background: Chronic actinic dermatitis (CAD) is a persistent eczematous photodermatitis classically described in older, white men with contact allergy to plants. However, evidence from recent studies suggests that some demographics of CAD patients may be changing., Objective: The aims of the study were to determine the frequency of CAD in patients presenting with photosensitive eruptions and to identify the allergens and photoallergens most closely associated with this condition., Methods: We identified all patients with a diagnosis of CAD from 246 consecutive records of patients undergoing photopatch testing from July 1994 to June 2018 and summarized the demographics and test results in comparison with non-CAD patients., Conclusions: Nineteen (7.7%) of the 246 patients evaluated had CAD with a male-to-female ratio of 1:1.7 among CAD patients. Compared with non-CAD patients, photocontact allergy and/or contact allergy to sesquiterpene lactone mix and contact allergy to fragrances were significantly more common in CAD. Contact allergy to p-phenylenediamine was also common. The results of this study suggest that CAD presents in a broader demographic range, including both men and women of both light and dark skin types. Phototesting and photopatch testing should be considered when patients present with clinical findings consistent with CAD.

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease of unknown etiology. It mainly affects the anogenital area, while the extragenital involvement is uncommon. It manifests as pale, ivory-colored lesions and partially atrophic skin. We report a case of a woman presenting to our department with LSA lesions at the level of the armpit. Furthermore, the patient was allergic to nickel sulfate and balsam of Peru. We assume the presence of an association between nickel allergy and onset of LSA., (© 2019 Wiley Periodicals, Inc.)

Systemic contact dermatitis is a rash secondary to systemic exposure to allergens after sensitization. Numerous agents are implicated including Balsam of Peru, a plant-derived compound often used for flavoring and fragrance. Alcoholic beverages can contain many possible allergens, including cinnamon, vanilla, citrus peels, and Balsam of Peru. Herein, we describe two patients presenting with recurrent, diffuse, erythematous, and pruritic cutaneous eruptions suspicious for contact dermatitis. Based on clinical history, exam, and formal and at-home patch testing results, we believe the most likely etiology was Balsam of Peru within the alcohol beverages leading to systemic contact dermatitis. Both patients markedly improved after avoidance of their alcoholic beverages. Overall, systemic contact dermatitis secondary to alcohol consumption is a rare phenomenon, whereas Balsam of Peru is a relatively common allergen. Suspicion must be high to identify possible allergens (including Balsam of Peru) exposure within alcoholic beverages such as artificial flavorings, aromas, and mixtures.

In this article, contact allergy to Myroxylon pereirae resin (MP) (balsam of Peru) is reviewed. The topics presented include the uses, the chemical composition, the frequency of sensitization, the relevance of positive reactions, the MP-containing products causing allergic contact dermatitis, co-reactivity with other fragrance and non-fragrance materials, the sensitizers, the usefulness of MP as a "marker" of fragrance allergy, and the effectiveness of, and indications for, "balsam-restrictive" diets. Sensitization to MP occurs in 4% to 8% of patients routinely tested for suspected contact dermatitis. There are few adequate data on relevance. Topical pharmaceuticals were formerly, but are not today, important sources of sensitization. Cosmetics and foods or drinks are hardly ever products responsible for sensitization to MP. Positive patch test reactions in the large majority probably result from previous sensitization to MP constituents because of their presence in fragrances and fragranced products, MP thereby acting as marker (or "indicator") of fragrance allergy. However, fragrance mix I is a more sensitive marker, and the added diagnostic value of testing with MP is unknown. The allergenic ingredients of MP include isoeugenol, eugenol and cinnamyl alcohol, but there are other-largely unknown-chemicals that are responsible for contact allergy. Suggestions are given for further research to address questions thus far unanswered and to improve patient care., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To review of contact dermatitis (CD) and its key allergens and provide updates and recommendations for the practicing allergist., Data Sources: Through the use of various scientific search engines (eg, PubMed and MEDLINE), we reviewed literature on CD, patch tests (PTs), key allergens, occupational dermatitis, and treatment., Study Selections: Studies on CD, important allergens, and PTs were considered., Results: Contact-induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria, and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT result is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance, and provision of alternative products the patient can use., Conclusion: CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute, or chronic dermatitis. The gold standard for diagnosing allergic CD is a PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice., (Copyright © 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Many patients with dermatitis over photo-exposed body areas are positive to many contact allergens and have a pre-existing allergic contact dermatitis., Methods: This study included patients who presented to a tertiary centre in India with dermatitis on photo-exposed body areas suspected of chronic actinic dermatitis. Their detailed histories were recorded and cutaneous and systemic examinations were performed. Patch testing was done in all the patients and photo-patch testing was carried out in 86 patients., Results: Altogether 101 patients were included (69 males, 32 females). The most common presentation was lichenified hyperpigmented plaques on the photo-exposed sites. Photosensitivity was recorded in 64 (63%) patients and summer exacerbation in 52 (52%). Exposure to the Parthenium hysterophorus weed was recorded in 70 (69%) patients, 27 (26.7%) had a history of hair dye application and 20 (20%) had a history of atopy. Photo-patch test was positive in 11 (12.8%) patients and patch testing was positive in 71 (70%). Parthenium hysterophorus was the most common allergen implicated and was positive in three (4%) photo-patch and 52 (52%) patch tests. Other positive photo-patch test allergens were perfume mix, balsam of Peru, thiuram mix, Compositae mix and promethazine hydrochloride. Other common patch test allergens were parthenolide, colophony, fragrance mix and p-phenylenediamine (PPD) base., Conclusion: In the Indian population parthenium and perfume mix are the most common photoallergens in patients with dermatitis over photo-exposed areas, while parthenium, colophony, fragrance mix and PPD are the common positive allergens., (© 2016 The Australasian College of Dermatologists.)

Background: Patients with lower leg dermatitis, chronic venous insufficiency or chronic leg ulcers have a high prevalence of contact sensitization., Objectives: To identify the current spectrum of contact allergens in these patients., Patients and Methods: Data of the Information Network of Departments of Dermatology on 5264 patients with the above diagnoses from the years 2003 to 2014 (study group) were compared with data on 4881 corresponding patients from 1994 to 2003 (historical control group) and with a current control group without these diagnoses (n = 55 510)., Results: Allergic contact dermatitis was diagnosed less frequently in the study group than in the historical control group (25.9% versus 16.9%; p < 0.001), and contact sensitization to most allergens had declined. The allergen spectrum, however, was largely unchanged. Important allergens are Myroxylon pereirae (balsam of Peru) (14.8% positive reactions), fragrance mix I (11.4%), lanolin alcohol (7.8%), colophonium (6.6%), neomycin sulfate (5.0%), cetearyl alcohol (4.4%), oil of turpentine (3.1%), and paraben mix (2.6%). Patch testing with additional series showed sensitization to Amerchol L-101 (9.7%), tert-butyl hydroquinone (8.7%), framycetin sulfate (5.0%), and gentamicin sulfate (3.1%)., Conclusions: Topical preparations for treating the above-mentioned conditions should not contain fragrances, Myroxylon pereirae, and colophonium. The special allergen spectrum has to be considered in patch testing., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Inflammatory scalp dermatoses can be associated with alopecia, which is nonscarring and reversible in its early stages. This association has been described in seborrheic dermatitis, psoriasis, and atopic dermatitis. We describe three girls with alopecia aggravated by contact allergy to balsam fragrances. All three had complete resolution with avoidance of balsam of Peru and other balsam derivatives (including discontinuation of fluocinolone oil, which contains balsam of pine)., (© 2016 Wiley Periodicals, Inc.)

Background: Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed., Objective: The aim was to quantify patch test results from providers evaluating US children., Methods: The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015-2016)., Results: One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%)., Conclusions: This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

Background: Colophony and propolis are among the complex plant resins used in a wide variety of medicinal and personal care products. A number of studies of colophony, propolis, and fragrance mixes suggest that contact with one of these allergens may increase the risk of delayed-type hypersensitivity reactions with additional compounds of significant cross-reactivity., Objective: The aims of this study were to determine rates of cross-reactivity between propolis, colophony, and different fragrance mixes and to determine significant cross-reactivity thresholds for which to counsel patient avoidance., Methods: Rates of cross-reactivity were calculated from the databases of 2 midwestern US patch testing centers. Rates were calculated both separately and collectively., Conclusions: For patients allergic to colophony, fragrance and propolis may be considered significant cross-reactors. For patients allergic to propolis, fragrance and colophony may be considered significant cross-reactors. Cross-reactions between colophony, propolis, and fragrance mixes are unidirectional so, for patients allergic to fragrance, cross-reaction to propolis or colophony is not significant. Colophony allergy is found in only a small number of fragrance-allergic patients and is not a good indicator for fragrance allergy.

Background: Ingredients of leave-on cosmetics and body care products may sensitize. However, not every case of cosmetic intolerance is due to contact sensitization., Objective: To describe the frequency of contact sensitization due to cosmetics in a large clinic population, and a possible particular allergen pattern., Methods: Retrospective analysis of data from the Information Network of Departments of Dermatology, 2006-2011., Results: Of 69 487 patients tested, 'cosmetics, creams, sunscreens' was the only suspected allergen source category in 10 124 patients (14.6%). A final diagnosis 'allergic contact dermatitis' was stated in 2658 of these patients (26.3%).Compared to a control group, there were significantly more reactions to fragrance mixes I and II, balsam of Peru, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and lanolin alcohols. No special pattern of fragrance sensitization could be identified. Among the preservatives, MI was by far the leading allergen, while sensitization to other widely used compounds like parabens or phenoxyethanol was rare., Conclusions: True allergic reactions to cosmetic ingredients are rarer than generally assumed. Limitation of exposure to MI in leave-on cosmetics and body care products is urgently needed., (© 2014 European Academy of Dermatology and Venereology.)

Systemic contact dermatitis (SCD), a cutaneous reaction that is a direct manifestation of systemic exposure to a known allergen in a sensitized individual, has been increasingly recognized as a cause of persistent cutaneous contact dermatitis that is refractory to conventional therapies. While SCD in response to drugs has been described well in the literature, SCD to allergens in common foodstuffs is a less well-articulated phenomenon. Several foods that are universally consumed throughout the world contain potent allergens including nickel, balsam of Peru, trace metals, urushiol, and sesquiterpene lactones as well as a host of others that may cause a distinctive clinical picture. In this review article, the authors review the typical presentation and prevalence of SCD to foods, pathophysiology, the most common offensive ingestible food allergens, several appropriate diets, and effectiveness of dietary avoidance for situations in which SCD is suspected.

Fragrances are a common cause of allergic contact dermatitis in Europe and in North America. They can affect individuals at any age and elicit a spectrum of reactions from contact urticaria to systemic contact dermatitis. Growing recognition of the widespread use of fragrances in modern society has fueled attempts to prevent sensitization through improved allergen identification, labeling, and consumer education. This review provides an overview and update on fragrance allergy. Part 1 discusses the epidemiology and evaluation of suspected fragrance allergy. Part 2 reviews screening methods, emerging fragrance allergens, and management of patients with fragrance contact allergy. This review concludes by examining recent legislation on fragrances and suggesting potential additions to screening series to help prevent and detect fragrance allergy.

Background: Balsam of Peru and fragrance mix are commonly used in cosmetic products. Allergy to fragrance is the most common cause of cosmetic contact dermatitis., Methods: In the present study, ex vivo local lymph node assay-5-bromo-2'-deoxyuridine (LLNA-BrdU) was used to evaluate the dermal sensitization potential of these cosmetic mixtures. The stimulation index values and estimated concentration (EC3) values were calculated and the potency classification was found for each mixture. At the same time, in order to measure the irritant effect without having to use additional animals, a combination of ex vivo LLNA-BrdU and the irritancy assay was conducted., Results: Th1 [interleukin (IL)-2, interferon-γ] and Th2 cytokine (IL-4, IL-5) releases from lymph node cell culture were investigated as non-radioactive endpoints. According to the results of ex vivo LLNA-BrdU assays, EC3 values were found to be 3.09% (moderate) for balsam of Peru and 4.44% (moderate) for fragrance mix. Cytokine analysis results indicate that both Th1 and Th2 cytokines are involved in the regulation of murine contact allergy and can be considered as useful endpoints., Conclusion: In conclusion, according to our results, fragrance mix and balsam of Peru can be considered as moderate sensitizers; however, in high concentrations, both of them have irritation properties. The cytokines investigated can be considered as the endpoints of the ex vivo LLNA-BrdU assay., (© 2014 S. Karger AG, Basel.)

Balsam of Peru (BOP) is a well-known contact allergen that is one of the most prevalent in the United States. For some patients allergic to BOP, external avoidance of fragrance is not enough to eliminate their dermatitis. A BOP avoidance diet has been shown to help many of these patients. This article reviews BOP allergens found in food. A special patch test series of allergens found in BOP along with data regarding which foods contain specific BOP constituents makes it possible to design potential targeted, refined, and simplified diets for BOP systemic contact dermatitis.

Systemic manifestations of allergic contact dermatitis due to consumption of foods containing balsam of Peru (Myroxylon pereirae)-associated chemicals have recently been reported in children. We present seven children with widespread, recalcitrant dermatitis who experienced 60-80% clearance after initiating a diet low in balsam of Peru, specifically the tomato product ketchup. Furthermore, because we have observed a high prevalence of ketchup in our pediatric patients' diets, we recommend consideration of moderate consumption of this product in patients with recalcitrant widespread dermatitis., (© 2012 Wiley Periodicals, Inc.)

Background and Objectives: Allergic contact dermatitis (ACD) of the vulva arises as a primary condition or develops secondary to topical agents. We aimed to describe the incidence of ACD in patients presenting with vulvar symptoms and to identify the allergens of most importance., Patients and Methods: Using a database of the patch testing results from 3 geographically distinct sites, we identified patients tested to a gynecologic series between 2003 and 2010. Patients had patch testing to the standard European battery and a gynecologic series. Patch testing was in line with accepted universal methods: application on day 1, allergen removal and initial reading on day 3, and final reading on day 5., Results: Ninety patients were included. Thirty-five (39%) had a relevant positive result. The 5 allergens with the highest number of cases with a relevant reaction were natural fragrance mix 2%, balsam of Peru, benzocaine 5%, fragrance mix 8%, and quaternium 15 1%. The most common gynecologic series allergen to cause a relevant reaction was terconazole., Conclusions: Allergic contact dermatitis is a frequent finding in patients presenting with vulvar symptoms. We identified a relevant positive result to patch testing in 39%. We found fragrances, medicaments, and preservatives to be of most relevance.

Background: Patients with a sore or burning mouth associated with clinically normal oral mucosa present a difficult diagnostic challenge., Objective: The objective of this study was to assess the value of patch testing in patients with burning mouth syndrome., Methods: We retrospectively reviewed the results of patch testing to an oral series in patients with burning mouth syndrome seen at Mayo Clinic, Rochester, Minnesota, between January 2000 and April 2006., Results: Of 195 consecutive patients with a burning or sore mouth, 75 had patch testing to an oral series, and 28 of these patients (37.3%) had allergic patch test reactions. The most common allergens were nickel sulfate hexahydrate 2.5%, balsam of Peru, and gold sodium thiosulfate 0.5%. On follow-up, 15 patients reported improvement, 4 removed or avoided the offending dental metal, and 6 avoided the dietary allergen. Thirteen patients did not improve; 6 avoided identified allergens, but without improvement; 1 removed dental metals without symptom change; and 5 avoided test-positive dietary allergens but without improvement. The remaining 7 nonresponders had nonrelevant patch test results or did not avoid allergens., Conclusions: Patch testing can identify patients who may be allergic to dental metals or dietary additives and who may benefit from removal or avoidance of these.

Background: Although allergic contact dermatitis of the eyelids is a common condition, limited information is available regarding the selection of patch-testing chemicals for proper evaluation., Objective: The purpose of this analysis was to evaluate the relevance of allergens responsible for allergic eyelid dermatitis among a series of patch-tested patients attending our clinic at the University of Miami and compare these results to published studies in the literature., Methods: Data were retrospectively reviewed for eyelid-only dermatitis from clinically relevant patch-test evaluations performed between December 2004 and January 2007., Results: Formaldehyde was the most frequently encountered antigen, accounting for 45.83% (11/24) of the cases, followed by nickel 33.33% (8/24) and balsam of Peru (Myroxylon pereirae) 29.17% (7/24). In addition, not only did we find a higher prevalence of certain allergens when compared with other studies, but we identified several relevant allergens not previously reported at other referral centers., Conclusions: The allergens found to be relevant in eyelid dermatitis vary among different regions. These data may help contribute to generating a standard screening tool to improve the detection and management of these cases.

Two patients presented with cheilitis and perioral dermatitis. Patch testing revealed positive reactions to both Myroxylon pereirae (MP; formerly known as Balsam of Peru) and Lucas Papaw Ointment (LPO; Lucas Papaw Remedies, Bisbane, Qld, Australia). MP was not listed as an ingredient in LPO, however the manufacturer confirmed that a small amount of MP was present in LPO and we believe this to be the cause of the patients' dermatitis., (© 2011 The Authors. Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists.)

Systemic contact dermatitis is an under-recognized skin reaction that occurs secondary to systemic (oral, intravenous, intramuscular, inhaled, or subcutaneous) exposure to a hapten in a previously sensitized individual. Medicaments are the most common cause of SCD in the adult population, but other chemicals like nickel, cobalt, balsam of Peru, and formaldehyde have been implicated as well. Few reports in children exist to date. Dietary restriction has shown to be of some benefit in managing some adult patients. We present a case series of 8 pediatric patients diagnosed with SCD from the contact dermatology clinic, who showed marked improvement of their dermatitis after adequate dietary avoidance. We review common presentations of chemicals causing SCD in children and potential dietary modifications., (© 2010 The Authors. Journal compilation © 2010 Wiley Periodicals, Inc.)

Background: One of the greatest challenges in occupational dermatology is the identification of chemical substances used by patients in their work in order to determine their allergenic potential. Numerous techniques have been described for the identification of allergenic compounds. These tests must be sensitive, specific, and safe. We describe a study to detect the presence of paraphenylenediamine (PPD) in hair dyes that are commercially available in Spain., Material and Methods: We undertook an experimental study involving qualitative and semiquantitative detection of PPD in hair dyes sold in Spain. The qualitative technique we used was a previously described colorimetric method involving dilution of the dye with isopropyl alcohol followed by addition of a reagent solution (1g of vanilla in 15 ml of isopropyl alcohol and 7.5 ml of hydrochloric acid). A quantitative study was then done in which the dye was extracted in 96% ethanol and subjected to 1-dimensional thin-layer chromatography., Results: A total of 15 brown and 12 blonde dyes were analyzed. PPD was identified in all of the brown dyes analyzed, irrespective of whether it was indicated (n = 12) or not (n = 3) in the composition. PPD was found in 6 of the 9 blonde dyes that indicated it in the composition and 2 of the 3 in which it was not indicated. Semiquantitative analysis by thin-layer chromatography revealed that the concentration of PPD in brown hair dyes (mean, 3%) was higher than in blonde dyes (mean, 0.1-0.3%)., Conclusions: The presence of PPD in hair dyes is related to the color of the dye. It is consistently present in darker dyes and at low levels in blonde dyes. This study highlights the clinical and epidemiological importance of identifying allergens in dermatology, particularly in occupational dermatology., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)

Because of their widespread use, fragrances are among the most common causes of contact allergic dermatitis, second only to nickel. During a five-year period 3,065 patients with contact dermatitis were patch tested using a specific mix of fragrances. 509 (16.6%) patients were allergic to the fragrance mix, while 258 (8.4%) patients exhibited an allergic reaction to Myroxylon pereirae (balsam of Peru). Between those 509 patients, 157 were patch tested with eight individual substances contained in the fragrance mix: cinnamal, cinnamyl alcohol, eugenol, isoeugenol, geraniol, hydroxycitronellal, alpha-amyl cinnamal and Evernia prunastri (oak moss). The most frequent allergens were isoeugenol 57.9% (91/157), eugenol 55.4% (87/157), cinnamyl alcohol 34.4% (54/157) and Evernia prunastri (oak moss) 24.2% (38/157). There were 62 patients (39.5%) who exhibited an allergic reaction to both the fragrance mix and Myroxylon pereirae (balsam of Peru). The results prove the importance of avoiding allergens in daily life, especially in industrial and cosmetic products. In order to prevent ACD, better cooperation between industry and dermatologists is needed.

Background: many topical products are used in the genital region. Allergic contact dermatitis (ACD) may develop from product use or due to treatment of an underlying dermatosis., Objectives: our goal was to identify the frequency of ACD and identify top allergens in the genital region., Methods: data were analyzed for 1,238 patients tested between January 1990 and December 2006. Fifteen allergens caused reactions at rates greater than 1%. Thirteen anatomic regions were assessed. Statistical analyses were by chi-square test and Fisher exact test. Adjusted level of significance due to multiple testing was α  =  .002., Results: of individuals with genital dermatitis (n  =  37; aged 24-77 years, 48.6% female), 41% (15 of 37) had at least one positive patch-test result although only 30% (11 of 37) had a final diagnosis of relevant ACD. Mean age was 46 years for males and 41 years for females. The top five allergens were balsam of Peru (10.8%), fragrance mix I (8.1%), tolu balsam (8.1%), phenylmercuric acetate (8.1%), and neomycin (5.4%). Females were more often allergic (50%) compared to males (37%); 59.5% of patients had no positive reactions., Conclusion: genital dermatitis is rare; the minority tested positively for ACD. The top five allergens were present in toiletries and cosmetics used on genital skin. The top three allergens are fragrance related, underscoring the importance of using fragrance-free products on mucosal skin.

Objectives: The aim of the study was to determine the frequency of contact sensitization in patients with lower extremity dermatitis., Methods: Between the years 2001 and 2007, the authors investigated 462 patients (mean age 49.1 years, 196 men and 266 women) with the eczema/dermatitis localized on their lower extremities, including feet. The patients were investigated with epicutaneous tests of the European Standard Series and also with other special patch tests., Results: The most frequent allergens were balsam of Peru, 44/462 (9.5%); wool alcohols, 41/462 (8.9%); nickel sulphate, 39/462 (8.4%); propolis, 35/462 (7.6%); fragrance mix, 34 (7.4%) and colophony, 29/462 (6.3%)., Conclusions: In patients with lower extremity dermatitis the frequency of contact sensitization is still high, and therefore investigation with epicutaneous tests should belong to the routine dermatological diagnostic procedure in these patients.

The etiology of cheilitis is often not readily apparent. We present a case series of four patients with allergic contact cheilitis (ACC) secondary to exposure to peppermint oil contained in a lip balm product. These patients developed eczematous dermatitis involving their lips and perioral skin. They were tested with the North American Contact Dermatitis Group standard series as well as with an expanded series of flavoring agents, sunscreens, plant and fragrance components, and their own products. The lip balm contained potential sensitizers such as propolis, lanolin, coconut oil, almond oil, peppermint oil, and vitamin E. Our patch-test results showed that peppermint oil was the most likely culprit in these patients' ACC. Peppermint oil is less commonly reported as causing ACC than are more common contactants such as balsam of Peru or nickel sulfate. However, with the widespread use of lip balms containing peppermint oil, more cases of peppermint oil-induced ACC may be expected.

Systemic contact dermatitis (SCD) describes a cutaneous eruption in response to systemic exposure to an allergen. The exact pathologic mechanism remains uncertain. The broad spectrum of presentations that are often nonspecific can make it difficult for the clinician to suspect this disease, but it is an important diagnosis to consider in cases of recalcitrant, widespread, or recurrent dermatitis, in which patch testing often reveals allergy to nickel or balsam of Peru. Diagnosis and appropriate management can be life-altering for affected patients. This article on SCD provides an overview of the disease with descriptions of common allergens and some insight into the possible mechanism of action seen in SCD.

Background: The prevalence of sensitization to fragrance mix (FM) I and Myroxylon pereirae (MP, balsam of Peru) has decreased in recent years among Danish women with dermatitis., Objectives: This study investigated whether the decrease could be confirmed among women in the general population. Furthermore, it addressed the morbidity of FM I sensitization., Methods: In 1990, 1998 and 2006, 4299 individuals aged 18-69 years (18-41 years only in 1998) completed a premailed questionnaire and were patch tested to FM I and MP. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs)., Results: The prevalence of FM I and MP sensitization followed an inverted V-pattern among women aged 18-41 years (i.e. an increase from 1990 to 1998, followed by a decrease from 1998 to 2006). Logistic regression analyses showed that 'medical consultation due to cosmetic dermatitis' (OR 3.37, 95% CI 1.83-6.20) and 'cosmetic dermatitis within the past 12 months' (OR 3.53, CI 2.02-6.17) were significantly associated with sensitization to FM I., Conclusions: In line with trends observed in Danish patients with dermatitis, our results supported a recent decrease in the prevalence of FM I and MP sensitization in Denmark. The study also showed that fragrance sensitization was associated with self-reported cosmetic dermatitis and use of health care related to cosmetic dermatitis.

Background: Studies show that balsam-restricted diets result in significant improvement of systemic contact dermatitis in patients with contact allergy to balsam of Peru (BOP). While tomatoes have been implicated as a frequent cause of BOP-related dermatitis, the presence of BOP in tomatoes has never been confirmed., Objectives: High-performance liquid chromatography coupled with mass spectrometry (liquid chromatography [LC]-MS) and UV spectrometry (LC-UV) was used to detect the possible presence of BOP constituents in tomatoes., Methods: Samples of beefsteak, cherry, and plum tomatoes were extracted in ethyl acetate and analyzed with LC-MS and LC-UV for the presence of the following sensitizing constituents of BOP: benzoic acid, benzyl alcohol, trans-cinnamic acid, cinnamic alcohol, cinnamyl cinnamate, coniferyl alcohol, eugenol, isoeugenol, and methyl cinnamate., Results: The initial LC-MS analysis of each tomato extract showed multiple peaks. Two of these peaks had molecular weights of 134 and 180, which correspond to cinnamic alcohol and coniferyl alcohol, respectively. The analysis did not show peaks corresponding to the molecular weights of the remaining compounds. Cochromatography of tomato extract with cinnamic alcohol and coniferyl alcohol using LC-UV further suggested the presence of these compounds in the tomato extract., Conclusion: Coniferyl alcohol and cinnamic alcohol, constituents of BOP, are present in beefsteak, cherry, and plum tomatoes.

Background: With the development of industry, the numbers of allergens are increasing, and the frequency of these allergens show variations from country to country. The aim of this retrospective study was to determine the distribution of patch-test results by age, gender, and occupation in our region., Methods: In a retrospective study, the patch-test results of 3,017 patients were evaluated. The results were statistically examined by frequency of age, gender, and occupation. Chi-square and Fisher exact tests were used for statistical evaluation., Results: Of 3,017 patients, 1,975 (65.5%) were female and 1,042 (34.5%) were male. Their ages ranged from 5 to 85 years (mean, 40.38 +/-14.69 years). In 944 (31.3%) patients, at least one positive reaction to an allergen was observed. The allergens that most commonly caused positive reactions were nickel sulfate (12.2%), cobalt chloride (7.1%), potassium dichromate (5.6%), and balsam of Peru (2.8%). Balsam of Peru and nickel were the most common allergens in female patients older than 45 years and in female patients younger than 35 years, respectively., Conclusions: Nickel sulfate and cobalt chloride were found to be the most common allergens. The most frequently seen allergens were nickel sulfate (in females) and fragrance (in males).

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.