Thyssen Jacob Pontoppidan Carlsen Berit Christina Menné Torkil

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Recently, it was demonstrated that a large proportion of individuals with AD have an epidermal expression deficiency of filaggrin (FLG). This unique finding may have great implications for our understanding of nickel sensitization because nickel is chelated in the epidermis and perhaps to FLG. This review aims to briefly present the current knowledge about nickel sensitization in relation to FLG deficiency and speculate on its possible implications. The new knowledge concerning loss-of-function mutations in the FLG gene (the lack of specific nickel-chelating power in the stratum corneum and a generally defective skin barrier) suggests that an additive effect from irritants and nickel may aggravate hand eczema in individuals with loss-of-function mutations in the FLG gene. This hypothesis calls for a reevaluation of the potential risk of nickel sensitization through the establishment of cohorts with and without such mutations.

Verallo-Rowell Vermén M. Dillague Kristine M. Syah-Tjundawan Bertha S.

BACKGROUND:Atopic dermatitis (AD) skin is dry and readily colonized by Staphylococcus aureus (SA). Coconut and olive oils are traditionally used to moisturize and treat skin infections.OBJECTIVE:To compare virgin coconut oil (VCO) and virgin olive oil (VOO) in moisturizing dryness and removing SA from colonized AD skin.METHODS: This was a double-blind controlled trial in two outpatient dermatology clinics with adult AD patients who were diagnosed by history, pattern, evolution, and skin lesions and who were randomized to apply VCO or VOO twice daily at two noninfected sites. SA cultures, photography, and objective-SCORAD severity index (O-SSI) scoring were done at baseline and after 4 weeks.RESULTS:Twenty-six subjects each received VCO or VOO. Of those on VCO, 20 were positive for SA colonies at baseline versus 12 on VOO. Post intervention, only 1 (5%) VCO subject remained positive versus 6 (50%) of those on VOO. Relative risk for VCO was 0.10, significantly superior to that for VOO (10:1, p  =  .0028; 95% CI, 0.01–0.73); thus, the number needed to treat was 2.2. For the O-SSI, the difference was not significant at baseline (p  =  .15) but was significantly different post treatment (p  =  .004); this was reduced for both oils (p < .005) but was greater with VCO.CONCLUSION:VCO and monolaurin's O-SSI reduction and in vitro broad-spectrum activity against SA (given clinical validity here), fungi, and viruses may be useful in the proactive treatment of AD colonization.

Malerich Patricia G. Wilson Morgan L. Mowad Christen M.

BACKGROUND:Adverse reactions to natural rubber latex gloves are an important cause of workers' compensation claims among health care personnel. In an effort to reduce latex-related illness, our institution transitioned to powder-free latex gloves in 2001.OBJECTIVE:To examine the effect of this transition on the number of workers' compensation claims for latex-related illness.METHODS:A review of claims data from 1997 to 2005 was conducted.RESULTS:The incidence of claims for latex-related illness was significantly lower following the switch to powder-free gloves.CONCLUSIONS:The switch to powder-free latex gloves was associated with a significant decrease in workers' compensation claims for latex-related illness. The cost of gloves increased but was partially offset by a decrease in workers' compensation payments and operating room expenses.

Lazzarini Rosana Duarte Ida Cadore de Farias Débora Almeida Santos Camila Iam Tsai Andréia

BACKGROUND:Liquid nail varnish has been used since 1919, and allergic contact dermatitis (ACD) has been recognized for at least 80 years, but it is difficult for nonspecialists to identify this condition.OBJECTIVES:(1) To verify the frequency of ACD from nail varnish in patients with a presumptive diagnosis of contact dermatitis seen at an outpatient clinic, (2) to characterize the groups studied according to site of skin disorder, and (3) to determine the main sensitizer related to varnish.METHODS:Patients with a final diagnosis of ACD caused by nail varnish were assessed by means of retrospective analysis of medical charts and protocols used in the clinic from January 1996 to December 2006. Patch tests with the Brazilian standard series and a complementary series were applied to all patients.RESULTS:Diagnosis of ACD from nail varnish was made in 8% of cases (157 of 1,971). The most affected sites were the face and neck; however, involvement of some uncommon areas, such as periungual and perianal regions, was also observed.CONCLUSIONS:ACD from nail polishes is a common event and recognition of the condition must be improved. Toluenesulfonamide formaldehyde resin (TSFR) was the most common allergen in the group studied.

Asarch Adam Scheinman Pamela L.

BACKGROUND:In the past, sorbitan sesquioleate (SSO) was reported as an uncommon allergen, but recent data suggest SSO may be an important sensitizer.OBJECTIVE:To present data on 13 of 112 dermatitis patients who reacted to SSO and/or sorbitan monooleate (SMO) on patch testing.METHODS:A retrospective data analysis was conducted on data from 112 dermatitis patients patch-tested from December 2006 to May 2007. All patients were tested with a modified North American Contact Dermatitis Group standard series, a cosmetic series, and a fragrance series.RESULTS:Of 112 patients, 10 (8.9%) reacted to SSO, 1 (0.9%) to SMO, and 2 (1.8%) to both. Nine of 12 (75%) SSO-positive patients were using topical corticosteroids emulsified with sorbitan derivatives or sorbitol; 2 of the 13 sorbitan-allergic patients were allergic to one or more corticosteroid screening chemicals tested.CONCLUSION:SSO is a common emulsifier derived from sorbitol and is used in many high- to super-potent corticosteroids. It has only recently been identified as an important contact allergen. The high prevalence of reactions to sorbitol derivatives in this small group of patients suggests that these chemicals may be sensitizing when applied to dermatitic skin. Larger studies should be conducted to confirm these findings.

Jacob Sharon E. Barland Chantal ElSaie Mohamed L.

“Recall dermatitis” classically refers to the uncommon phenomenon of chemotherapy-induced reactivation of skin damage originally induced by radiotherapy months or years earlier. We compare this condition to ectopic flare-up reactions presenting as dermatitis at existing or previous sites by an inducing agent. Enhanced sensitization of an existent allergen by patch testing is rarely described. We describe a case of a 61-year-old man's developing localized allergic contact dermatitis at previous neomycin-treated sites following the diagnosis of neomycin sensitivity on patch testing, which we attribute to a “flare-up” phenomenon.

Knopp Eleanor Watsky Kalman

We present the case of a 42-year-old woman with intractable eyelid dermatitis. Patch testing revealed sensitization to 3-(dimethylamino)propylamine (DMAPA). DMAPA is an important etiology of allergic contact dermatitis of the eyelids and face but is easily missed even with expanded-series patch testing. We also review the most common causative allergens in eyelid dermatitis cited in the literature over the past decade. DMAPA is a reagent used in the formation of cocamidopropyl betaine (CAPB), a common additive to liquid soaps, shampoos, and other cleansing products because of its utility as a surfactant. Beginning in the 1980s, reports of allergy to CAPB surfaced in the literature. Ultimately, a majority of patch testing studies have shown that clinical allergy to CAPB-containing products actually reflects allergy to contaminant DMAPA in most cases. Amidoamine, another intermediate in the formation of CAPB, may also be implicated through a proposed mechanism of conversion to DMAPA in the skin. When patch-testing for eyelid and facial dermatitis, it is crucial to test with DMAPA directly, not just with CAPB; unlike commercial-grade CAPB, the CAPB in patch test kits is ultrapure and does not contain contaminant DMAPA.

Amado Antoine Taylor James S.

A 29-year-old bowling pro shop operator presented with recurrent disseminated erythematous and edematous patches and plaques. Patch-testing with the North American Contact Dermatitis Group (NACDG) standard series yielded ++ and + reactions to epoxy resin at 2 and 7 days, respectively. We could find no other report of epoxy resin contact allergy in a bowling pro shop operator.

Asarch Adam Scheinman Pamela L.

Sorbitol-based emulsifiers such as sorbitan sesquioleate (SSO) are commonly used in topical corticosteroids, topical antibiotics, topical antifungals, moisturizing creams and lotions, and topical retinoids. Contact dermatitis from sorbitol derivatives appears to be increasingly prevalent. Patch-testing with SSO can be useful in the work-up of patients with presumptive cosmetic allergic contact dermatitis. Those sensitized to SSO can be counseled to avoid sorbitol-containing products, especially topical corticosteroids. Herein we discuss case reports of SSO allergy and a recent case series of 12 of 112 dermatitis patients (10.7%) patch-tested during a 6-month period who showed contact allergy to SSO. We provide a list of key corticosteroids and products that can contain SSO, sorbitol, or sorbitol derivatives.

Jacob Sharon E. Zapolanski Tamar Chayavichitsilp Pamela

para-Phenylenediamine (PPD) is a contact allergen that cross-reacts with a variety of medications, including thiazide diuretics and sulfonamides. We present the case of a 52-year-old African American atopic woman who came for evaluation of a severe eyelid dermatitis and recurrent outbreaks of acneiform (follicular-based) pruritic papules on her face, chest, and back. These symptoms presented after the patient was started on hydrochlorothiazide for hypertension. The patient also reported a history of eyelid dermatitis associated with “black hair dye.” Patch testing revealed a positive reaction to para-phenylenediamine (1+) and Disperse Blue 106 (1+). It was suspected that the patient might be demonstrating cross-reactivity to hydrochlorothiazide and a flare-up reaction of the eyelid dermatitis. After her cardiologist changed her blood pressure medication, the patient's eyelid dermatitis and eruption cleared. This case highlights the impact of PPD sensitization on the medical care of a patient with hypertension and the importance of choosing safer PPD-free alternatives and minimizing PPD exposures.

Wilson Morgan L. Elston Dirk M. Mowad Christen M.

Duarte Ida Fusaro Melissa Lazzarini Rosana

Parsons Laurie M.

Parsons Laurie M.