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Background: Machine learning (ML) offers an opportunity in contact dermatitis (CD) research, where with full clinical picture, may support diagnosis and patch test accuracy., Objective: This review aims to summarise the existing literature on how ML can be applied to CD in its entirety., Methods: Embase, Medline, IEEE Xplore, and ACM Digital Library were searched from inception to February 7, 2024, for primary literature reporting on ML models in CD., Results: 7834 articles were identified in the search, with 110 moving to full-text review, and six articles included. Two used ML to identify key biomarkers to help distinguish between allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD), three used image data to distinguish between ACD and ICD, and one used clinical and demographical data to predict the risk of positive patch tests. All studies used supervision in their ML model training with a total of 49 704 patients across all data sets. There was sparse reporting of the accuracy of these models., Conclusions: Although the available research is still limited, there is evidence to suggest that ML has potential to support diagnostic outcomes in a clinical setting. Further research on the use of ML in clinical practice is recommended., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

The diagnosis of eczema ('dermatitis') is mostly clinical and depends on the clinical history and exploratory objective findings (primary lesions, patterns). Contact dermatitis remains as an important condition in the group of eczematous disorders, with important socioeconomic and occupational relevance. Although irritant and allergic contact dermatitis have a different pathogenesis, both are characterized by a rather typical morphology, are triggered by external factors and tend to occur primarily in the area of contact with the exogenous agent. In addition, allergic and irritant dermatitis may also co-exist. The importance of diagnosing contact dermatitis, especially when allergic in nature, is both due to the possibility of avoiding the trigger, and due to its role in aggravating other skin conditions. Nevertheless, the heterogeneity of clinical presentations in daily practice may pose an important challenge for the suspicion and correct diagnosis of contact dermatitis. Furthermore, other conditions, with different pathogenesis and treatment, may clinically simulate contact dermatitis. The Task Force aims to conduct a review of the unifying clinical features of contact dermatitis and characterize its main clinical phenotypes, and its simulators, in order to contribute to an early suspicion or recognition of contact dermatitis and enable a correct differential diagnosis., (© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Diaper dermatitis (DD) is an umbrella term with different clinical presentations, pathophysiology, treatments, and outcomes. The major subtypes include irritant contact dermatitis and candida-associated DD. In case of atypical presentation or unresponsiveness to treatment, other differential diagnoses should be considered. Although DD can occur at any age, it peaks in newborns and infants < 2 years of age. We will focus on this age group in our narrative review., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Background: Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD)., Objectives: The objective of this study is to describe the contact sensitisation pattern of female FCS with OD., Methods: In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD., Results: Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave-on and nail cosmetics. Occlusion and wetness were important co-factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common., Conclusions: FCS should be aware of the OD risk and prevention should be promoted., (© 2024 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Irritant contact dermatitis (ICD) is a nonspecific skin inflammation caused by irritants, leading to itch and pain. We tested whether differential responses to histamine-dependent and -independent pruritogens can be evoked in ICD induced by sodium lauryl sulfate (SLS). An ICD mouse model was established with 5% SLS in acetone versus a vehicle topically applied for 24 h to the cheek. Site-directed itch- and pain-like behaviors, occurring spontaneously and in response to mechanical, thermal, and chemical stimuli (histamine, ß-alanine, BAM8-22, and bradykinin) applied to the cheek, were recorded before (day 0) and after irritant removal (days 1, 2, 3, and 4). Skin inflammation was assessed through visual scoring, ultrasound, and measurements of skin thickness. SLS-treated mice exhibited hyperalgesia-like behavior in response to mechanical and heat stimuli on day 1 compared to the controls. SLS mice exhibited more spontaneous wipes (pain) but not scratching bouts (itch) on day 1. Pruritogen injections caused more scratching but not wiping in SLS-treated mice compared to the controls. Only bradykinin increased wiping behavior compared to saline. SLS-treated mice developed noticeable erythema, scaling, and increased skin thickness on days 1 and 2. SLS induced cutaneous inflammation and behavioral signs of spontaneous pain and itching, hyperalgesia to mechanical and heat stimuli and a chemical algogen, and enhanced itch response to pruritogens. These sensory reactions preceded the inflammation peak and lasted up to two days.

Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future., (© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

There are certain demographic characteristics that may serve as risk factors for exposure to a contact allergen. Volatile alkyl nitrites, colloquially known as "poppers," are commonly inhaled by men who have sex with men (MSM) for their psychoactive and muscle-relaxing effects. They have been reported to cause either allergic contact Dermatitis® (ACD) or irritant contact Dermatitis® (ICD), termed "poppers Dermatitis®." We searched PubMed, Embase, and Web of Science to understand the patient population, clinical presentation, diagnosis, and clinical course of poppers Dermatitis®. Our search returned 13 articles detailing 18 patients total. Most patient cases were male ( n  = 13/15; 87%), of whom 5 were MSM. The reports on the remaining 8 men did not disclose their sexual behaviors. The chemicals deemed responsible for adverse cutaneous side effects included amyl nitrite (6/18; 33%), butyl nitrite (3/18; 167%), isobutyl nitrite (2/18; 11%), and an unspecified alkyl nitrite (7/18, 39%). The most common diagnosis was ICD (10/18; 56%). Only 3 patients underwent alkyl nitrite patch testing, with 2 testing positive for ACD. The most commonly involved anatomic sites were perinasal (13/18; 72%) and perioral regions (10/18; 56%). Rash morphology has been described as yellow crusting, impetigo-like, eczematous, vesicular, edematous, and erythematous. Ulceration can occur with direct skin contact to concentrated nitrite solution. Poppers Dermatitis® was often self-limited with complete resolution. Dermatologists should consider poppers Dermatitis® in those presenting with a characteristic midfacial rash, especially in MSM.

Jacquet erosive dermatitis (JED) is a rare, severe form of napkin dermatitis associated with friction and irritant exposure in the napkin area. The condition typically causes erosions and erythematous punched-out ulcerations. We present two cases of JED in infants associated with the use of a common brand barrier cream Curash. This appeared to present following a change of several active ingredients., (© 2023 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Purpose: Electrical stimulation (ES) is a widely used technique in the medical field for various purposes. The effect of ES on several skin properties has been investigated; however, its effect on skin vulnerability to irritants remains unknown. This study aimed to investigate the effects of ES application on skin vulnerability to external irritants., Materials and Methods: An experimental study on 12 healthy male subjects (Mean ± SD, 22.9 ± 3.6 years) who completed the study. The subjects were free of skin abnormalities in the volar aspect of both forearms. Three areas were allocated to each forearm and marked as areas 1, 2, and A in the treated forearm, and areas 3, 4, and B in the control forearm. ES was applied to the volar aspect of the treated forearm for 30 min three times a week, for 2 weeks. The effect of ES on skin vulnerability was investigated using 5% and 0.5% sodium lauryl sulfate (SLS) patches applied to both treated and control forearms. The skin response to irritants was evaluated using transepidermal water loss (TEWL) and a visual erythema score 24 h after patch removal., Results: Compared to the control forearm, ES increased skin permeability and erythema in response to external irritants (SLS), as measured by the visual analog score (Z = 2.75, p = 0.006) and TEWL (p < 0.05), respectively., Conclusions: ES escalates skin reactions to low concentrations of irritant substances, such as SLS, in the area between the two electrodes. This emphasizes the use of this substance, and similar irritants should be avoided in areas treated with ES., (© 2024 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

The differential diagnosis of dermatoses in the axillae is broad. Contact dermatitis-both irritant and allergic-represents common etiologies. Axillary contact dermatitis can develop following exposure to a variety of irritants and/or allergens. Frequently implicated sources include deodorants, antiperspirants, detergents, soaps, and clothing. Fragrance, a ubiquitous ingredient within these products, as well as metals and dyes, are common causes of contact dermatitis. Clinical assessment, bedside diagnostic techniques, histopathology, and patch testing can aid in the diagnosis and help inform management directions.

Background: Semipermeable membranes might be suitable for glove liners or comfort gloves in individuals with irritant contact dermatitis (ICD)., Objectives: To evaluate the effects of different glove materials on inflammation and epidermal barrier impairment after experimental skin irritation., Methods: Nine test areas on the volar forearms of 24 healthy volunteers were irritated with sodium lauryl sulfate (1%) and afterward covered for 6 days (6 or 8 h/day) with semipermeable Sympatex (SYM), vinyl (OCC), combinations of vinyl with Sympatex (SYM/OCC) or cotton (COT/OCC), or left uncovered (CON). Up to day 10, measurements of transepidermal water loss (TEWL), erythema (a*), skin humidity (SH) and visual scoring (VS) were applied., Results: No significant differences in skin parameters were found between COT/OCC and SYM/OCC as well as between each of the combinations and CON. SYM, COT/OCC and SYM/OCC led to better results for most skin parameters than OCC alone., Conclusions: Occlusive material has a negative impact on skin barrier recovery and inflammation after skin irritation whereas SYM is not inferior to uncovered areas indicating good tolerability. Altogether, the data suggest that SYM is a useful alternative to COT as material for glove liners and comfort gloves in ICD patients., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Fibreglass dermatitis is a common occupationally acquired irritant contact dermatitis, where small spicules of fibreglass lodging in the stratum corneum result in mechanical irritation. We present two patients, an air-conditioning ducting worker and an injection moulding machine operator, who both presented with generalized pruritus. In the first case, polarized microscopy of a skin biopsy specimen demonstrated rare small spicules, with a diameter of 1 µm, lodged in the stratum corneum. In the second case, skin tape stripping demonstrated fibreglass particles, not found on skin biopsy. Proper work practices, personal hygiene and use of impervious barrier materials were recommended. The first patient did not return for follow-up, and the second patient's dermatitis resolved after handling of fibreglass-containing material was eliminated from his job scope. In conclusion, we present two cases of fibreglass dermatitis to illustrate the challenges in diagnosis and highlight strategies for prevention., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Hand eczema (HE) is a highly prevalent, recurrent, and multifactorial disease. It encompasses a group of eczematous diseases that affect the hands, etiologically classified into irritant contact dermatitis (ICD), allergic contact dermatitis (ACD) and atopic dermatitis (AD). Few epidemiological studies in Latin America have investigated the characteristics of patients with this condition and the origin of the disease., Objectives: To analyze the profile of patients diagnosed with HE submitted to patch tests aiming to determine its etiology., Methods: A retrospective descriptive study was carried out on epidemiological data and patch tests of patients with HE treated at a tertiary hospital in the city of São Paulo from January 2013 to December 2020., Results: A total of 173 patients were studied, whose final diagnosis was 61.8% of ICD, 23.1% of ACD and 5.2% of AD, with diagnostic overlap in 42.8% of the cases. The main positive and relevant patch tests were: Kathon CG (42%), nickel sulfate (33%), and thiuram mix (18%)., Study Limitations: The number of treated cases and socioeconomic profile was limited to a vulnerable population group., Conclusion: HE is a diagnosis in which overlapping etiologies are frequent, with the main sensitizers identified in ACD being Kathon CG, nickel sulfate and thiuram mix., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: Few cases of skin diseases caused by exposure to artichokes have been published. Artichokes contain sesquiterpene lactones, which are known to be sensitizing. Irritant contact dermatitis (ICD) has also been diagnosed. To our knowledge, no protein contact dermatitis (PCD) has yet been reported to be induced by artichoke. Objectives: The aim of this study was to identify the different types of contact dermatitis that may be due to occupational exposure to artichokes and the professions concerned. Materials and Methods: We conducted a descriptive study, retrieving data from the French national database of occupational diseases for the period of 2001 to 2018. Results: Fifty-six cases were retrieved, and 10 cases were included in this study after data analysis and reading the clinical reports: 7 allergic contact dermatitis (ACD), 2 PCD, and 1 ICD caused by artichokes. Patients were farmers (4), agri-food workers (3), market gardener (1), cashier (1), and store employee (1). Conclusions: This is the first series of occupational contact dermatitis that can be induced by artichokes. Exposure to artichokes can lead to ICD, ACD, PCD, and perhaps contact urticaria. The sesquiterpene lactone mix patch test is not always sufficient to confirm an ACD by artichokes. Irritant contact dermatitis can be associated with ACD from artichokes or evolve on its own.

Background: Glove occlusion might enhance skin sensitivity to a subsequent detergent challenge (occlusion effect). Thus, some skin protection creams (PC) claim to protect against this effect of occlusion, and are recommended to be used before wearing liquid-proof gloves., Objectives: To evaluate the effect of PC applied prior to glove occlusion on the 'occlusion effect'-refers to increased susceptibility of the skin to a model detergent., Methods: One hundred and eleven volunteers were enrolled in a single-blind, randomized study. Seven PCs were applied before glove occlusion over 7 days (D1-D7). After sodium lauryl sulphate (SLS) challenge, we compared the irritation between the areas treated with PC and occlusion alone. Clinical scoring and bioengineering methods (capacitance, transepidermal water loss [TEWL], and colourimetry [erythema]) were used to quantify the irritant reactions., Results: After 1 week of occlusion and PC application, we did not observe significant changes in TEWL, nor in erythema, whereas skin hydration raised in three cream-treated areas. On day 10, after a challenge with SLS, some products significantly aggravated the skin irritation as compared to occlusion alone., Conclusions: The 'occlusion effect'-shown as higher skin susceptibility to a model detergent-was not mitigated by PCs when applied prior to glove occlusion. On the contrary, some PCs might have negative effects on skin barrier function and augment such sensitivity., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: To prevent irritant contact eczema even in occupational fields with heavy-duty soiling, it is generally recommended to use 'mild' hand cleansers (mild detergent without grits, MC). On the other hand, since grit-containing cleansers (GC) show a higher washing power that minimizes washing time, their usage is generally preferred in specific occupational fields., Objectives: To compare whether a shorter, intense washing period might cause less skin damage than a longer washing period with an MC., Methods: Differences in cleaning time were first verified in a pilot study using standardized model dirt. In the main study, the forearms of 35 healthy volunteers were washed with three standardized procedures over a period of 3 days, either using 2 min of MC with/without hand brush or 1-min GC. Clinical scoring, transepidermal water loss (TEWL), corneometry, colourimetry and scaliness/roughness (Visioscan) were used to evaluate the epidermal barrier, topography and irritation., Results: The pre-study showed that washing time doubled when using MC vs. GC. Using GC resulted in stronger barrier disruption, even after a shorter washing period - median ΔT4-T1 TEWL 0.96 g/m 2 /h vs. 4.91 g/m 2 /h respectively, p < 0.0001. The most harmful procedure for the skin was the additional application of a hand brush (18.86 g/m 2 /h)., Conclusions: Short-time washing with GC damages the skin barrier more significantly in comparison to a longer application of an MC. When washing with MC, the strongest irritant reaction occurred when accompanied with hand brushing., (© 2023 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Capsicum peppers-including chili peppers, paprika, and red peppers-are native to the Americas but used worldwide in spicy dishes. Capsaicin, the active ingredient of Capsicum peppers, is used topically to treat musculoskeletal pain, neuropathy, and other conditions. Capsaicin binds the transient receptor potential vanilloid 1 (TRPV1), releasing substance P and desensitizing nerves with long-term use. Capsicum peppers and capsaicin products (eg, medications, cosmetics, pepper sprays) can provoke an irritant contact dermatitis, causing erythema and cutaneous burning. Capsaicin-induced dermatitis can be relieved by washing the area with soap, detergents, or oily compounds. Ice water or high-potency topical steroids also can help. Capsaicin is available in creams, lotions, and patches. Synthetic TRPV1-agonist injectables based on capsaicin are in clinical trials for use in localized pain. Capsaicin is a neuropeptide-active compound found in Capsicum peppers with many promising applications; however, dermatologists should be aware of possible skin reactions to these plants and medications derived from them.

Vulvar allergic contact dermatitis (vACD) and irritant contact dermatitis (vICD) are common and accompanied by a great burden on the patient's life. We aimed to review the existing literature on vACD and vICD in order to provide a comprehensive reference list of potential vulvar allergens and irritants, as well as to establish the role of patch testing therein. A systematic search was performed in Medline, Embase and Web of Science using a search string based on the PICO-format. The study protocol was registered at PROSPERO (CRD42021239527). Multiple allergens were identified and included metals, topical drugs, fragrances, preservatives, cosmetic constituents and rubber components. Not all positive reactions were, however, considered to be relevant. Patch testing is the primary tool for the identification of the causal allergens. Testing with standard series alone was proven to be insufficient. Little information about irritants was found. In the future, additional series and late readings should be considered in standard practice. Studies on vICD are scarce and further research is necessary. More population-based research should be performed., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The objective of this review is to identify work-related and personal risk factors for contact dermatitis (CD), and assess their association with this frequently occurring occupational disease. A systematic review of the literature from 1990 to June 2, 2020, was conducted using Medline and Embase. Prospective cohort and case-control studies were included, and meta-analyses were conducted when feasible. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Twenty-nine studies were identified, comprising 26 study populations and with a total of 846 209 participants investigating 52 risk factors for CD. Meta-analyses were performed for five risk factors, all of them for irritant contact dermatitis (ICD). Moderate-quality evidence was found for associations between wet work and ICD (OR: 1.56, 95%CI: 1.21-2.01). High-quality evidence was found for the association between atopic dermatitis and ICD (OR: 2.44, 95%CI: 1.89-3.15). There was no evidence for an association between ICD and sex or history of hand dermatitis, respiratory and mucosal atopy. In conclusion, several work-related and personal risk factors associated with CD were identified. Our data emphasize the need for the assessment of both, work-related and personal, risk factors to prevent occupational CD., (© 2022 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management., Methods: A multisite retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed., Results: Two hundred twenty-eighty patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs. 14.5%, P = 0.004) topical corticosteroids (92.9% vs. 38.7%, P < 0.01), emollients (38.1% vs. 20.4%, P = 0.01) and less often advising antihistamines (16.7% vs. 44.6%, P < 0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs. 11.1%, P < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs. 4%, P = 0.01)., Conclusion: Improved understanding, diagnosis and management of CD are needed in EDs., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Daffodils (Narcissus species) are the most common cause of irritant contact dermatitis among florists. Calcium oxalate crystals contained in the sap of the daffodil plants lead to irritant contact dermatitis on the skin. Daffodil rash commonly presents with fissuring, scaling, and erythema of the fingertips, hands, and forearms. The best preventative measure is to wear appropriate protective gloves and clothing.

Background: Irritant contact dermatitis (ICD) is a localized, nonimmune-induced inflammatory skin reaction, characterized by multiform skin lesions, including erythema, scaling, edema, blisters, and erosion. Mercury and its related compounds are highly allergic agents that can induce allergic contact dermatitis., Aims: This article aims to clarify the skin damage caused by irritant contact dermatitis caused by the addition of high doses of mercury to skin care products., Patients: A 30-year-old female patient sought treatment at our Institute for contact dermatitis., Results: Through the patch test of the patients and the component detection of the skin care products her use. A large amount of mercury was found in skin care products, and the patient had no apparent allergic reaction to mercury., Conclusions: We considered irritant contact dermatitis caused by excess mercury, and the patient's condition improved with treatment., (© 2022 Wiley Periodicals LLC.)

The occurrence of skin lesions in healthcare workers is associated with a negative impact on important skin functions, including protection from mechanical injuries, sunlight, dehydration, and penetration of chemical substances or pathogenic microorganisms. In healthcare professionals, the most common occupational skin disease is contact dermatitis (CD), either irritant (ICD) or allergic (ACD), and typically on the hands. ICD accounts for about 80% of occupational CD, making it the most frequent cause. According to the literature, CD frequency is higher among healthcare professionals than other occupations, with critical occupational risk factors including contact with irritants and allergens at the workplace. Furthermore, ICD is a multifactorial disorder influenced by many constituent and environmental factors. Constituent factors include age, gender, body location, atopy, and genetic factors, while environmental factors include temperature, airflow, humidity, and occlusion. Commonly encountered irritants are water, detergents and surfactants, solvents, oxidizing agents, acids, and alkalis; however, use of protective gloves or equipment, hand-washing habits, use of cleansers and creams, active inflammatory skin diseases, and daily activities are also important for ICD onset. Additionally, ICD is known to predispose to ACD. Important risk factors for ACD development include occupation, age, history of atopic dermatitis, genetics, female gender, and fair skin phototype. In summary, numerous skin features and other occupation-related factors contribute to CD among healthcare practitioners. Given the high level of exposure to contact irritants/allergens in the healthcare setting, implementation of preventive measures is crucial for a safer work environment., (Sestre Milosrdnice University Hospital.)

Competing Interests: Competing interests: None declared.

Background: Occupational contact dermatitis (OCD) is a skin disorder caused by contact with any substances found in the workplace. Occupational contact dermatitis is second most common occupational disease (15% of all cases of occupational disease). Occupational contact dermatitis is divided into allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) which is 80% of cases that affects hands. Batik is an art that is painted on cloth, it is one of Indonesian cultural heritage. Batik workers have a higher risk of obtaining OCD due to exposure to chemicals and fluids used during work. Natural dyes used in the dyeing process are less likely to cause ACD than standard allergens. Some of the natural dyes used in the dyeing process in batik industries are Indigofera tinctoria , sappan wood ( Caesalpinia sappan ), and Mahagony ( Swietenia mahagoni ) cause skin sensitisation., Objective: To compare the results of patch testing between natural dyes ( Indigofera tinctoria , sappan wood ( Caesalpinia sappan ), and Mahagony ( Swietenia mahagoni ) with standard allergens (p-phneyldiamine 0.1%, potassium dichromate 0.5% and formaldehyde 0.1%) as a cause of ACD in batik workers in Surakarta, East Java, Indonesia., Method: A cross-sectional study was conducted on 63 subjects batik workers with OCD in Surakarta, East Java, Indonesia. Subjects were patch tested with three standard allergens (p-phenylenediamine 0.1%, potassium dichromate 0.5%, and formaldehyde 1%) and natural dyes ( Indigofera tinctoria , sappan wood ( Caesalpinia sappan ), and Mahagony ( Swietenia mahagoni ). A closed patch test was evaluated 48 and 96 hour later. Screening of OCD in batik workers in Surakarta, East Java, Indonesia was based on Nordic Occupational Skin Questionnaire NOSQ-2002, and diagnosis of OCD was based on Mathias criteria (at least 4 out of 7 criteria were met). Data were analysed using a non-parametric Chi-square test with SPSS 21 with a significant difference if the p -value < 0.05., Result: Natural dyes significantly caused allergic contact dermatitis in batik workers in Surakarta, East Java, Indonesia than standard allergens ( p  = 0.016). A positive patch test was found in 11 patients, standard allergen p-phenylenediamine (PPD) 0.1% was seen on one patient, potassium dichromate 0.5% on two patients, and formaldehyde 1% on two patients. A positive patch test using Indigofera tinctoria was found at one patient, sappan wood ( Caesalpinia sappan ) in three patients, and Mahagony (Swietenia mahagoni) in five patients., Conclusion: Natural dyes cause more positive patch test results in batik workers.

Introduction: Occupational hand dermatitis is common among healthcare workers, with increased incidence during the COVID-19 pandemic. Irritant contact dermatitis accounts for the majority of occupational hand dermatitis and is largely due to frequent contact with hand hygiene products. Long-term prognosis of occupational contact dermatitis is often very poor. This study aims to identify and implement suitable workplace interventions to aid in the recovery of occupational irritant hand dermatitis among healthcare workers during the COVID-19 pandemic., Methods: A quality improvement (QI) project was performed in a tertiary hospital using the Plan-Do-Study-Act model. Healthcare workers seen at the Occupational Dermatology Clinic from March 2020 to May 2021 for the first time for likely occupational irritant dermatitis were targeted for the project. Four workplace interventions were implemented: (a) substitute current alcohol-based hand rub (ABHR) with a different, gentler ABHR, (b) alternate ABHR with gentle hand wash products, (c) temporary job modification with less clinical work (d) switch latex gloves to nitrile gloves. The improvement was assessed after 2 months of workplace intervention using a visual analogue scale, based on changes seen on photographs taken at the baseline and monthly review. The target improvement was set at 70% after 2 months of workplace interventions., Results: A total of 21 participants were included in the QI project. All participants were found to have significant improvement in their hand condition. The estimated mean reduction of signs and symptoms was 80% in comparison to their baseline hand condition before intervention., Conclusion: Workplace interventions such as substituting irritant hand hygiene products with gentler alternatives and temporary reduction in clinical duties may be useful in improving the recovery rate of irritant hand dermatitis among healthcare workers. Areas with high hand hygiene workload or high incidences of hand dermatitis may opt to implement systemic workplace changes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Loi, Aribou and Fong.)

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis, characterized by inflammation with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society commissioned an initiative that led to the addition of multiple International Classification of Diseases, Tenth Revision, Clinical Modification codes (ICD-10-CM) for irritant contact dermatitis caused by various forms of MASD for use in the United States. In a recent issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions for each of these codes. This is the second in a series of 2 follow-up articles providing a more detailed description of the MASD conditions to which the newest irritant contact dermatitis ICD-10-CM codes apply. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis associated with digestive secretions from a stoma or fistula, and fecal or urinary effluent from an abdominal stoma or enterocutaneous fistula., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Wound, Ostomy, and Continence Nurses Society.)

Contact dermatitis is a common disease that is caused by repeated skin contact with contact allergens or irritants, resulting in allergic contact dermatitis (ACD) and/or irritant contact dermatitis. Attempts have been made to identify biomarkers to distinguish irritant and allergic patch test reactions, which could aid diagnosis. Some promising candidates have recently been identified, but verification and validation in clinical cases still need to be done. New causes of ACD are constantly being recognized. In this review, 10 new contact allergens from recent years, several relating to anti-aging products, have been identified. Frequent allergens causing considerable morbidity in the population, such as the preservative methylisothiazolinone, have been regulated in the European Union. A significant drop in the number of cases has been seen, whereas high rates are still occurring in other areas such as North America. Other frequent causes are fragrance allergens, especially the widely used terpenes and acrylates found in medical devices for control of diabetes. These represent unsolved problems. Recent advances in immunology have opened the way for a better understanding of the complexity of contact dermatitis, especially ACD-a disease that may be more heterogenous that previous understood, with several subtypes. With the rapidly evolving molecular understanding of ACD, the potential for development of new drugs for personalized treatment of contact dermatitis is considerable., (Copyright © 2022 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings., Objective: Provide an overview of occupational skin disease (OSD) and an analysis of occupational ACD in North American patients undergoing patch testing between 2001and 2016., Methods: Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded., Results: Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators., Limitations: Our cohort may not reflect the general working population., Conclusion: This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis., Competing Interests: Conflicts of interest Dr Warshaw has received an investigator-initiated grant from Wen by Chaz Dean and served as a consultant for Wen by Chaz Dean and Noven Pharmaceuticals. Dr Atwater received a Pfizer Independent Grant for Learning & Change and has consulted for Henkel. Dr Sasseville receives royalties from UpToDate (Wolters Kluwer Health). Dr Taylor owns non-controlling shares of stock in AstraZeneca, Cigna, Merck, Johnson & Johnson, and Opko Health and he has consulted for Kao Brands and Monsanto (Bayer), is a member of the Cosmetic Ingredient Review Steering Committee, and has a nondependent child employed by Pfizer. Drs J DeKoven, Mathias, Belsito, Fowler, Pratt, Zug, Maibach, DeLeo, Silverberg, Reeder, and Holness, and Author B DeKoven have no conflicts of interest to declare., (Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence., Competing Interests: Mikel Gray is a clinical consultant for Coloplast, Hollister, and KCI/3M, Inc. Donna Bliss declares no conflict of interest. Laurie McNichol is a clinical consultant for Hollister, Inc, and 3M. No author received compensation for authorship of this article., (Copyright © 2022 by the Wound, Ostomy and Continence Nurses Society.)

Contact dermatitis usually presents as erythematous macules, papules, and vesicles. Sometimes, unusual clinical presentations of contact dermatitis are reported, including pustular, lymphomatoid, lichenoid, and pigmented variants. We describe the first patient with bullous irritant contact dermatitis caused by perfume, mimicking impetigo lesions. We report this case to raise awareness concerning the possibility of serious cutaneous reactions, such as bullous impetigo-like irritant contact dermatitis due to perfumes which are ubiquitous, especially after direct contact with the solution. Perfume ingredients, such as fragrance, solvents, and preservatives all may cause or contribute to irritant contact dermatitis., (© 2022 Wiley Periodicals LLC.)

Background: Skin exposure to chemicals may induce an inflammatory disease known as contact dermatitis (CD). Distinguishing the allergic and irritant forms of CD often proves challenging in the clinic., Methods: To characterize the molecular signatures of chemical-induced skin inflammation, we conducted a comprehensive transcriptomic analysis on the skin lesions of 47 patients with positive patch tests to reference contact allergens and nonallergenic irritants., Results: A clear segregation was observed between allergen- and irritant-induced gene profiles. Distinct modules pertaining to the epidermal compartment, metabolism, and proliferation were induced by both contact allergens and irritants; whereas only contact allergens prompted strong activation of adaptive immunity, notably of cytotoxic T-cell responses. Our results also confirmed that: (a) unique pathways characterize allergen- and irritant-induced dermatitis; (b) the intensity of the clinical reaction correlates with the magnitude of immune activation. Finally, using a machine-learning approach, we identified and validated several minimal combinations of biomarkers to distinguish contact allergy from irritation., Conclusion: These results highlight the value of molecular profiling of chemical-induced skin inflammation for improving the diagnosis of allergic versus irritant contact dermatitis., (© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Background: Personal care products (PCPs) are commonly responsible for allergic contact dermatitis and irritant contact dermatitis. PCP use was historically associated with females, but male-targeted PCPs are increasingly being marketed., Objective: To characterize and compare males with PCP-related contact dermatitis (MPCPs) and females with PCP-related contact dermatitis (FPCPs)., Methods: This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016)., Results: Four thousand six hundred eighty of 16,233 men (28.8%) and 12,730 of 32,222 (39.5%) women had a PCP identified as a source of irritant contact dermatitis or a positive patch test reaction. The proportion of PCP-related dermatitis in both sexes significantly increased (>2.7-fold) over the decade of study. Compared with FPCPs, a larger proportion of MPCPs were older or had trunk or extremity dermatitis (P < .0001). MPCPs were twice as likely to have soaps as a source while FPCPs were twice as likely to have hair care products (P < .0001). The most common PCP-related North American Contact Dermatitis Group allergens for both sexes were methylisothiazolinone (MPCP 28.8% and FPCP 21.5%), fragrance mix I (MPCP 22.3% and FPCP 20.1%), balsam of Peru (MPCP 18.5% and FPCP 14.1%), quaternium-15 (MPCP 16.1% and FPCP 12.3%), and paraphenylenediamine (MPCP 11.5% and FPCP 11.1%)., Limitations: Patient population referred for suspected contact dermatitis., Conclusions: PCP-related dermatitis is increasing. Sites of involvement and relevant PCP sources are distinct between sexes. Male and female variation in exposure history may explain differences in reactivity to some allergen groups., (Published by Elsevier Inc.)

Background: An increasing number of studies have investigated the adverse effect profile of oral cannabinoids; however, few studies have provided sufficient data on the tolerability of topical cannabinoids in human participants., Aim: To assess the tolerability profile of several commercial topical formulations containing cannabidiol (CBD) and palmitoylethanolamide (PEA) on the skin of healthy human participants., Methods: Three human clinical trials and one in vitro study were conducted. The potential for skin irritation, sensitization and phototoxicity of several products, were assessed via patch testing on healthy human skin. The products assessed included two formulations containing CBD and PEA, one containing hemp seed oil and four concentrations of CBD alone. Ocular toxicity was tested using a traditional hen's egg chorioallantoic membrane model with three CBD, PEA and hemp seed oil formulations., Results: There was no irritation or sensitization of the products evident via patch testing on healthy participants. Additionally, mild phototoxicity of a hemp seed oil product was found at the 48-h time point compared with the negative control. The in vitro experiment demonstrated comparable effects of cannabinoid products with historically nonirritating products., Conclusion: These specific formulations of CBD- and PEA-containing products are nonirritating and nonsensitizing in healthy adults, and further encourage similar research assessing their long-term safety and efficacy in human participants with dermatological diseases. There are some limitations to the study: (i) external validity may be limited as formulations from a single manufacturer were used for this study, while vast heterogeneity exists across unregulated, commercial CBD products on the market; and (ii) products were assessed only on normal, nondiseased human skin, and therefore extrapolation to those with dermatological diseases cannot be assumed., (© 2021 British Association of Dermatologists.)

Competing Interests: The authors have no funding or conflicts of interest to declare.

Competing Interests: The authors have no funding or conflicts of interest to declare.

The recent coronavirus disease 2019 (COVID-19) pandemic has led to the dramatic increase in use of personal protective equipment (PPE) among health care providers and the general public. Herein the authors discuss the various occupational dermatoses including allergic and irritant contact dermatitis, acne, seborrheic dermatitis, and rosacea related to frequent handwashing, disinfecting of surfaces, and prolonged wear of various PPE including face masks, gloves, and gowns. The authors provide an overview of published PPE-associated occupational dermatoses during the COVID-19 pandemic and also discuss prevention strategies and treatment options to help patients with these complaints., Competing Interests: Disclosure The authors have no commercial or financial conflicts of interests relevant to this publication., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Competing Interests: The author has no funding or conflicts of interest to declare.

Surfactants, many of which are used as detergents, can be found in many common household items, such as shampoos, conditioners, soaps, and cosmetics. One should recognize the multitude of surfactants that are used in today's products to identify any potential allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). Given their abundance in everyday products, it is understandable that many cases of occupational contact dermatitis that arise can be attributed to surfactants. The products most connected with ACD are cocamidopropyl betaine, oleamidopropyl dimethylamine, decyl glucoside, 3-dimethylaminopropylamine, amidoamine, and cocamide diethanolamine. Similarly, the most common surfactant-related causes of ICD are sodium lauryl sulfate and benzalkonium chloride. It is important for dermatologists to identify the causes and differentiate between the two, to adjust treatments and products accordingly. Here, the most frequently used surfactants, as well as their correlation between ACD and ICD, will be reviewed., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Environmental, or exogenous, dermatitis is comprised of irritant and allergic contact dermatitis, which account for 80% and 20% of cases of contact dermatitis, respectively. Contact dermatitis is extremely common, and failure to diagnose this entity may result in overlooking a potentially curable driver of disease. In this review, we describe how clinical features, such as morphology or history, can assist in distinguishing exogenous from endogenous causes of dermatitis, and allergic from irritant contact dermatitis. Additionally, we provide an overview of common contact allergens and how dermatitis distribution can suggest possible culprit allergens. Patch testing is needed to confirm contact allergy., Competing Interests: Disclosure The authors have no relevant conflicts of interest to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)