Contact Allergy: Alternatives for the 2007 North American Contact Dermatitis Group (NACDG) Standard Screening Tray

TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface

The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

Medicated Lacquer For Application On Adornments To Treat Affections In Aesthetic Perforations

Aesthetic perforations are often associated with health issues, such as itching, inflammation, or microbial infection. Accordingly, this work proposed a lacquer to be applied on the adornment accessory forming a film from which a proper drug is released. For this, lacquers were formulated containing three different permeation enhancers (limonene - LIM, propylene glycol - PG, and oleic acid - AO) combined according to a mixture design with a model anti-inflammatory natural drug (naringenin) and a soluble film-former polymer (polyvinyl alcohol). Formulations were characterized by physicochemical tests and in vitro and in vivo skin permeation studies. The lacquers were stable and provided a vectorized drug release. LIM, combined with one of the other permeation enhancers, showed a synergic effect, enhancing topical skin penetration in vitro by 53% while preventing permeation to the receptor medium. The in vivo evaluation of lacquers in rodent models showed these systems could provide higher levels of drug retention in the ear (166.4 ± 14.9 µg per ear for F4 and 174.9 ± 29.3 µg per ear for F5) compared to the control (109.2 ± 16.3 µg) without allowing its permeation into the bloodstream, confirming the local drug delivery. Moreover, the anti-inflammatory activity was achieved in the animal model developed for lacquer application on the earring, obtaining inhibition of ear swelling up to 40.8% ± 2.3 compared to the untreated ear. Thus, such an innovative lacquer proved a promising vehicle for treating affections caused by adornments, enhancing skin permeation while avoiding a systemic effect.

In vitro skin penetration of bronidox, bronopol and formaldehyde from cosmetics

The objective was to evaluate the influence of the formulation in the in vitro transdermal absorption through pig ear skin of three preservatives, bronopol, bronidox and formaldehyde as well as the absorption of formaldehyde from bronopol and dimethyloldimethyl hydantoin (DMDM hydantoin). An aqueous solution, an O/W emulsion and a hydrogel were assayed. Bronidox and bronopol absorption depends on the formulation. The O/W emulsion was the system that least promoted absorption of bronidox while the absorption of bronopol was lower from the hydrogel. The aqueous solution provided maximal transdermal absorption of both preservatives. Moreover, the transdermal absorption of formaldehyde released from bronopol also depends on the formulation, being the aqueous solution the system that allowed greater absorption. Transdermal absorption of formaldehyde, applied directly or released from DMDM hydantoin, is not conditioned by the excipients. The degree of transdermal absorption of all the preservatives tested is low and therefore the concentrations allowed by regulations are safely used. Nonetheless, since formaldehyde was detected in the receptor compartment after a long time exposure to bronopol and DMDM hydantoin it would be important to consider the possibility of limiting the use of these two preservatives to rinse off products as is the case of bronidox.

Hidden Formaldehyde Content in Cosmeceuticals Containing Preservatives that Release Formaldehyde and Their Compliance Behaviors: Bridging the Gap between Compliance and Local Regulation

Background: Many personal care products, and particularly cosmetic products, contain preservatives that release formaldehyde. These are potentially harmful to consumer health, especially considering that the levels of formaldehyde in some products are hidden and excessive. Objectives: To study the formaldehyde levels of preservatives in personal care products and cosmetics on the UAE market and determine the extent of compliance with health and safety requirements. Methods and Materials: Sixty-nine personal care and cosmetic product samples from the UAE market were collected and prepared to determine their formaldehyde content. According to the Second European Commission Directive 82/434/EEC of 2000 and as per the Gulf Technical Regulation, Safety Requirements of Cosmetics and Personal Care Products in GSO 1943:2016, quantitative analyses were performed to identify and quantify the content of formaldehyde as free formaldehyde. Results: With a maximum permissible limit of ≤0.2% w/w, the average formaldehyde content was found to be 0.083 with a 95% CI (0.039–0.13). Nine of the tested personal care and cosmetic products exceeded the recommended formaldehyde level, corresponding to 13% of all samples. None of these samples listed the free formaldehyde content or formaldehyde releaser. Conclusion: Applying good manufacturing practices (GMP), education, and regulatory control to improve the regulation and inspection of cosmetics containing formaldehyde releasers as preservatives, conducting research, and reporting the adverse side effects are highly recommended. There is an urgent need to monitor the incidence of skin sensitivity resulting from the use of cosmetics containing formaldehyde releasers as preservatives.

A review of acrylates: Super glue, nail adhesives, and diabetic pump adhesives increasing sensitization risk in women and children

Allergic contact dermatitis (ACD) is a cutaneous type IV hypersensitivity immune reaction mounted against substances in contact with the skin to which the patient has been sensitized. ACD is common, affecting approximately 72 million Americans per year, and is more common in women. One common contact allergen group is acrylates, which are monomers that are polymerized in the making of glues, adhesives, and plastic materials. It is the monomers that are sensitizing, whereas the final polymers are inert. Acrylates were the 2012 Contact Allergen of the Year with the specific acrylate, isobornyl acrylate, being the 2020 Contact Allergen of the Year. This article reviews the history of acrylate use, epidemiology, and both known and emerging sources of acrylates resulting in ACD.

A Review of Medicinal Plants in Cardiovascular Disorders: Benefits and Risks

Many cultivated and wild plants are used for the management of various diseases, specifically renal and hepatic diseases and those of the immune and cardiovascular systems. In China, medicinal plants from ancient to modern history have been used in patients with angina pectoris, congestive heart failure (CHF), systolic hypertension, arrhythmia, and venous insufficiency for centuries. The latest increase in the fame of natural products and alternative medicine has revived interest in conventional remedies that have been consumed in the management of CVD. The cardio-protective properties of the various herbs are possibly due to their anti-oxidative, antihypercholesterolemic, anti-ischemic activities, and inhibition of platelet aggregation that reduce the risk of CVD. Ethno-pharmacological and biological properties of these plants are explored, based upon published scientific literature. Although a majority of medicinal plants having a biological mechanism that linked with CVD management, to date, published literature pertaining to their promising scientific properties are still poorly understood. Compared with synthetic medicines, alternative medicines do not need scientific studies before their formal approval from the government sector and due to this purpose; their safety, as well as efficacy, still remain elusive. Taken together, we addressed all accessible evidence on alternative medicines commonly consumed in CVD management. Our comprehensive analysis of the scientific literature indicated that many TCMs are available and valuable herbal medication would be the best alternative for the management of CVD as a complementary therapy. Furthermore, practitioners should always discuss possible benefits-risks of alternative medicines with patients so that they are aware of the consumption of alternative medications.

Making Glove Decision Less of a White Knuckling Experience: A Systematic Review and Inventory of Glove Accelerator Contents

Background

Accelerators in medical gloves are a common cause of allergic contact dermatitis among healthcare workers.

Objective

A systematic review of medical and nursing literature, patch testing reports, and chemical analyses of gloves was conducted to assess accelerator contents reported in the literature and to identify accelerator-free gloves.

Methods

A systematic literature search was performed in OVID Medline and OVID EMBASE. Hand-searching of reference lists of articles in the field and author input generated the remainder of articles assessed.

Results

We present an inventory of accelerator contents of gloves and accelerator-free glove options as reported in the literature as a clinical reference tool to assist allergen-free glove selection for individuals suffering from allergic contact dermatitis due to rubber accelerators.

Limitations

Pertinent limitations of our review include lack of predefined study exclusion criteria and screening of the studies identified in the search by 1 review author only.

Conclusion

The glove inventory we provide summarizes the available literature regarding medical and surgical glove accelerator content, describing gloves both by brand and manufacturer as well as by accelerators.

Sensitization to Formaldehyde in Northeastern Italy, 1996 to 2012

BACKGROUND

Formaldehyde is a widely used organic compound, used in several applications (hard thermoset resins, adhesives, disinfectants, tissue fixatives, etc), in its free form or released by formaldehyde releaser products. Its use is under control due to its toxic, carcinogenic, and allergenic properties.

OBJECTIVE

The aim of this study was to investigate the frequency of formaldehyde sensitization, time trend, and correlation to occupations.

METHODS

This study is a cross-sectional study on a population of 23,774 patients tested from 1996 to 2012 in Northeastern Italy.

RESULTS

Frequency of sensitization was 3.3%, without any significant time trend. Hands (39.8% overall) and face (25.6% females, 15.5% males) were mainly involved. We found a trend toward decrease by age in females (3.11% in first quintile [14-26 years], 2.29% in fifth quintile [59-97 years], P < 0.01). On a logistic regression analysis (control group: white-collar workers), we found associations in health care (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.04-1.81), wood (OR, 2.14; 95% CI, 1.30-3.51), and textile (OR, 1.79; 95% CI, 1.14-2.79) sectors and professional drivers (OR, 1.94; 95% CI, 1.05-3.60). We found a high rate of cosensitization to formaldehyde in patients with positive patch test reactions to quaternium-15 (OR, 18.7; 95% CI, 12.6-27.7).

CONCLUSIONS

Sensitization to formaldehyde is relevant in our population, especially in the health care sector, wood and textile industries, and professional drivers. No significant time trend was found.

Contact alternatives to nickel

Allergic contact dermatitis to nickel is a continued health concern internationally. Nickel has been found to be the most prevalent and relevant allergen in tested populations for the last 3 decades. Furthermore, recent data from the North American Contact Dermatitis Group demonstrate positive patch-test reactions to nickel at approximately 19.5% of their tested population and a significant increase in the positivity rates for the last decade (Dermatitis. 2013;24:10-21. J Am Acad Dermatol. 1998;38:911-918). Because of the rise in allergic contact dermatitis rates to nickel, the American Contact Dermatitis Society recognized nickel to be the 2008 Allergen of the Year (J Am Acad Dermatol. 2009;60:1067-1069; Dermatitis. 2008;19:3-8). This article recognizes the importance of nickel avoidance and highlights potential alternatives.

Is propolis safe as an alternative medicine?

Propolis is a resinous substance produced by honeybees as defense against intruders. It has relevant therapeutic properties that have been used since ancient times. Nowadays, propolis is of increasing importance as a therapeutic, alone or included in many medicines and homeopathic products or in cosmetics. Propolis is produced worldwide and honeybees use the flora surrounding their beehives for its production. Therefore its chemical composition may change according to the flora. The phenolic and volatile fractions of propolis have been revised in the present study, as well as some of the biological properties attributed to this natural product. An alert is given about the need to standardize this product, with quality control. This has already been initiated by some authors, mainly in the propolis from the poplar-type. Only this product can constitute a good complementary and alternative medicine under internationally acceptable quality control.

Systematized contact dermatitis and montelukast in an atopic boy

Upon ingestion, the artificial sweetener, aspartame is metabolized to formaldehyde in the body and has been reportedly associated with systemic contact dermatitis in patients exquisitely sensitive to formaldehyde. We present a case of a 9-year-old Caucasian boy with a history of mild atopic dermatitis that experienced severe systematized dermatitis after being started on montelukast chewable tablets containing aspartame. Patch testing revealed multiple chemical sensitivities which included a positive reaction to formaldehyde. Notably, resolution of his systemic dermatitis only occurred with discontinuation of the montelukast chewables.

Allergic contact dermatitis in children: common allergens and treatment: a review

PURPOSE OF REVIEW

The following study reviews the recent literature pertaining to allergic contact dermatitis (ACD) in the pediatric population. This study also provides an overview of the most common allergens and discusses various therapeutic modalities.

RECENT FINDINGS

The pathophysiology of ACD is intricate and multifaceted, resulting in a characteristic, delayed inflammatory response. Although commonly recognized in adults, its existence in the pediatric population was questioned. Recent literature suggests that pediatric ACD exists and is more common than previously recognized. The diagnosis relies on the clinical presentation combined with appropriate use and interpretation of a patch test. Although many studies have investigated ACD in children, few have documented the relevance of positive patch test reactions until recently. The most current prevalence estimates of positive patch test reactions range from 14 to 70% of children patch tested. Although that range is broad, these studies have demonstrated the relevance of positive reactions and confirmed ACD as a disease entity in children.

SUMMARY

ACD is a previously underrecognized disease process in the pediatric population that can manifest as a serious dermatologic challenge for both patients and physicians. This review will address the prevalence, diagnostic methods, frequent allergens and treatment options in pediatric ACD.