Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016

Incidence of allergic contact dermatitis in Finland 1998-2021: A nationwide registry-based study

BACKGROUND

Allergic contact dermatitis (ACD) may be chronic and can cause distress, disability, and absence from work. Nationwide epidemiological studies of ACD are sparse.

OBJECTIVES

To use national registry data to study the incidence and aetiology of ACD in the working age population of Finland.

METHODS

Patient records from the years 1998-2021 were obtained from the Finnish Care Register for Health Care. Study subjects aged 18-65 years were selected on the basis of a diagnosis of ACD.

RESULTS

Total number of study subjects was 26 701. The incidence of ACD increased until 2016 after which it started to decrease. The increase was more marked in females and ACD was particularly common in women reporting reactions to cosmetics and other chemical products and in people of both sexes reacting to adhesives. The incidence 'ACD of unspecific cause' has decreased since 2016. The most commonly reported allergens were metals, followed by cosmetics. One fourth of subjects had ≥2 ACD diagnoses.

CONCLUSIONS

The incidence of ACD in working age subjects rose from 1998 to 2016, especially in females. However, the incidence has been decreasing since 2016. Our findings highlight the ongoing and even increasing burden of ACD among the working age population.

A genome-wide association study of hand eczema identifies locus 20q13.33 and reveals genetic overlap with atopic dermatitis

BACKGROUND

Twin studies revealed that genetic effects play a role in hand eczema (HE), but the responsible genetic factors are unknown.

OBJECTIVES

To identify and characterise genetic loci associated with HE and to provide insight into the genetic overlap between HE and atopic dermatitis (AD).

METHODS

We used questionnaire-derived and genotype data from the European population-based Lifelines cohort and biobank. We performed a discovery genome-wide association study (GWAS) of HE (2879 cases and 16 249 controls) and of AD (1706 cases and 17 190 controls). We replicated our findings in an independent Lifelines sample for HE (1188 cases and 6431 controls) and AD (757 cases and 6747 controls). We conducted several post-GWAS analyses and performed genetic correlation analyses between our HE results and independent AD data.

RESULTS

The two-step GWAS of HE, regardless of adjusting for AD, identified one independent locus 20q13.33, likely driven by a number of causal single-nucleotide polymorphisms. For the AD GWAS, we replicated a known stop-gained rs61816761 at locus 1q21.3 (FLG, FLGAS1). We found a strong genetic correlation (p < 0.01) between HE and AD (rg = 0.65), regardless of adjusting for AD (rg = 0.63).

CONCLUSIONS

Locus 20q13.33 is associated with HE, and there is a large genetic overlap between HE and AD.

Beyond Avoidance: Advanced Therapies for Contact Dermatitis

Contact dermatitis (CD) is a common and burdensome condition divided into irritant contact dermatitis and allergic contact dermatitis. Treatment relies on accurate diagnosis and identification of the trigger, because definitive treatment is irritant or allergen avoidance. However, avoidance is not always possible, such as when the patient is reacting to a necessary medical device, when the trigger is integral to the patient's occupation, and when avoidance is practically untenable. In these cases, treatment is particularly challenging, especially because the literature on treatments in this clinical scenario is limited. In addition, CD has a complex pathophysiology that varies according to the trigger type, leading to variable treatment efficacy. This article reviews the current literature on treatments for CD with a focus on treatments when trigger avoidance is not feasible.

Hand eczema in Italian patients referred for patch testing: A retrospective SIDAPA study (2016-2023)

BACKGROUND

Hand eczema (HE) is a common skin disease with a negative impact on patients' quality of life in occupational and non-occupational settings. Up-to-date, data on HE in Italian patients referred for patch testing are lacking.

OBJECTIVES

To characterise the profile in terms of demographics, aetiology and patch test results of Italian patients affected by HE referred for patch testing.

METHODS

A retrospective descriptive study on consecutive patients affected by HE who underwent patch testing from 2016 to 2023 in eight dermatology clinics was performed. HE patients were divided into two groups according to the exclusive (HE-only group) and not-exclusive (HE+ group) hand involvement, and compared to patients with eczema localised in body areas other than hands (NHE group).

RESULTS

One thousand five hundred and ninety-seven patients were affected by HE (35.3% males; mean age 42.7 years), 60.2% belonging to the HE-only group and 39.8% to the HE+ group. Occupational dermatitis was diagnosed in 33.2% of HE-only patients, 25.0% of HE+ patients and 5.2% of NHE patients (p < 0.001). HE-only patients presented: Allergic Contact Dermatitis (ACD), Irritant Contact Dermatitis (ICD), atopic HE in 48.1%, 47.5% and 7.1%, respectively; hyperkeratotic palmar, acute recurrent vesicular and nummular clinical subtypes in 52.2%, 43.9% and 11.9%, respectively; relevant positive patch test reactions in 48.1% (nickel sulphate 18.9%, methylchloroisothiazolinone/methylisothiazolinone 10.6%, methylisothiazolinone 8.6%, p-phenylenediamine 6.0% and potassium dichromate 4.7%).

CONCLUSIONS

HE patients, and particularly those with exclusive hand involvement, show a particular profile in terms of demographic and clinical characteristics, etiologies and relevant positive patch test reactions.

Contact allergy to and allergic contact dermatitis from formaldehyde and -releasers: A clinical review and update

This review aims to provide a clinically useful update regarding the role of formaldehyde (FA) and its five main releasers (FRs) quaternium-15, diazolidinyl urea, DMDM hydantoin, imidazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol (bronopol) in contact allergy and allergic contact dermatitis. These ubiquitous preservatives are still often, and sometimes undeclared, present in cosmetics, pharmaceuticals, medical devices, household detergents and chemical (industrial) products. In Europe, the use of free FA and quaternium-15 in cosmetics is forbidden and contact allergy rates have been found to be stable to decreasing. However, FA/FRs still readily provoke localized (e.g., facial/hand), airborne and generalized dermatitis, and may also complicate atopic and stasis dermatitis, or result in nummular dermatitis. Seborrheic-, rosacea- and impetigo-like dermatitis have recently been reported. For a correct diagnosis, FA 2% aq. (0.60 mg/cm² ) should be used, and particularly the FRs bronopol 0.5% pet. and diazolidinyl urea 2% should be patch tested separately in a baseline series. If sensitization to FA occurs, both FA and FRs should preferably be avoided, except perhaps for bronopol in case it tests negatively. If a patient reacts to one or more FRs (such as bronopol, or diazolidinyl/imidazolidinyl urea), but not to FA, then the specific FR(s) should be avoided. This article is protected by copyright. All rights reserved.

Cosmetic preservative labelling in philippine products in accordance with philippine regulations

BACKGROUND

Preservatives are usually added to a wide array of consumer products to prevent growth of microbes and to prevent product destabilization and degradation. However, many of these preservatives are common skin sensitizers and may cause allergic contact dermatitis. The amount of preservatives may vary per country or region according to their respective legislation, and may be reported in differences in prevalence rates of contact dermatitis.

OBJECTIVE

To examine and identify preservatives in consumer products in accordance with Philippine legislation. To verify the accuracy of the list of ingredients of Philippine cosmetic products as legislated by the Philippine Bureau of Food and Drug Administration.

METHODS

A total of 65 commonly used Philippine consumer products ranging from liquid facial and body washes, bar soaps, laundry detergents, feminine hygiene washes and wipes, shampoos and conditioners, sunblock, and moisturizers were selected. Ingredients noted on labels were documented. Products were subsequently investigated chemically for the presence of either methylchloroisothiazolinone, methylisothiazolinone, and formaldehyde.

RESULTS

The preservatives most commonly used in cosmetic products in the Philippine market are: methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), and/or formaldehyde. In accordance with Philippine legislation, almost all products provided a detailed ingredient list as printed on the packaging. Measurements of MCI/MI ranged from less than 1 ppm to 16 ppm, and MI only ranged from less than 1 ppm to 66 ppm, whereas formaldehyde was noted to range from less than 2.5 ppm to greater than 40 ppm in the products tested. Most products are manufactured by international brands with a few products being manufactured locally.

CONCLUSIONS

The preservatives found in cosmetic products were MCI, MI and formaldehyde. There were discrepancies found in the preservatives and labelling of these products, with a majority of investigated Philippine products labelled inaccurately with varying concentrations of preservatives. This article is protected by copyright. All rights reserved.

Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020

Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child's current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians' decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines.