Textile dye dermatitis. A review

Textiles and Human Skin, Microclimate, Cutaneous Reactions: An Overview

This article overviews research in the interdisciplinary area of textile/skin interaction and related cutaneous intolerance. Microclimate in the skin/clothing system and especially the skin responses relates to the moisture and heat transfer within this system and plays a critical role in skin irritation from textiles. A discussion is then given on skin irritation reactions to textiles, including intolerance caused by chemicals (dyes and finishes) and physical contact/friction. Finally, two skin injuries, blisters and pressure ulcers, which are caused by physical contact, pressure, and friction, are documented. Despite the prevalent problems caused by ill textile/skin interactions, minimal efforts have been devoted to this field. In addition, the in vivo experimental studies infrequently lead to a solid conclusion. The cause may lie in the dramatic variation of skin conditions among individuals as well as among different anatomic sites of the same person. Another reason might be the lack of communications between researchers in the areas of textiles and dermatology.

Sensitising potential of four textile dyes and some of their metabolites in a modified local lymph node assay

We studied the sensitising and allergenic potentials of the textile dyes disperse yellow 3, disperse orange 30, disperse red 82, disperse yellow 211 and two metabolites of disperse yellow 3, 4-aminoacetanilide and 2-amino-p-cresol, using modified protocols of the murine "local lymph node assay" (LLNA). Test substances were applied either to the dorsum of the mice ears (sensitisation protocol) or they were first applied to the skin of their backs and 2 weeks later to their ears (sensitisation-challenge protocol). In addition to the endpoints weight and cell number of the draining ear lymph nodes we analysed lymphocyte subpopulations by flow cytometry. In the sensitisation protocol, disperse yellow 3 and its metabolite 4-aminoacetanilide did not induce significant effects, whereas in the sensitisation-challenge protocol cell number and lymph node weight increased significantly indicating a sensitising potential in NMRI mice. Hence, two-phase treatment (skin of the back, ear) increased the sensitivity of this assay. The second metabolite of disperse yellow 3, 2-amino-p-cresol, showed distinct effects in both treatment protocols; this applied mainly to the parameters cell number and lymph node weight. The dye disperse red 82 caused ambiguous increases in lymph node weight and cell number in the sensitisation protocol which were not reproduced in the sensitisation-challenge protocol, ruling out a relevant sensitising potential for this dye in NMRI mice. Disperse yellow 211 and disperse orange 30 did not induce relevant changes under our experimental conditions. Phenotyping of lymphocytes did not influence the assessment of these dyes.

Textile dye allergic contact dermatitis following paraphenylenediamine sensitization from a temporary tattoo

Textile dye allergy is frequently caused by azo dyes, which can cross-react with structurally similar compounds, including paraphenylenediamine. A case of allergic contact dermatitis to azo textile dyes, presenting principally as a sock dermatitis, is presented. The patient also gave a history of an episode of scalp dermatitis consistent with contact allergy to paraphenylenediamine in hair dye. It is proposed that paraphenylenediamine sensitization from a temporary skin tattoo may have been the primary sensitizing event for these reactions.

Foot dermatitis caused by the textile dye Basic Red 46 in acrylic blend socks

17 male subjects are described with foot dermatitis in association with positive patch test reactions to the textile dye Basic Red 46. Chromatographic analysis of the socks of 2 affected patients confirmed the presence of Basic Red 46. Withdrawal of the acrylic blend socks suspected of having been dyed with Basic Red 46 resulted in the improvement of symptoms in 12 of 17 patients (70.6%). However, equivocal or negative patch test results to their own socks were frequently noted in those patients. A highly significant association between the presence of foot dermatitis and a positive Basic Red 46 patch test reaction was noted in 555 patients from a patch test clinic population (P < 0.001). The prevalence of positive patch test reactions to Basic Red 46 was 1.2%. We suggest that patients with foot dermatitis be routinely patch tested for textile dyes. In particular, testing with Basic Red 46 should be considered in those with a history of use of dark-coloured acrylic and/or acrylic blend socks.

Sensitizer contained in heat-decomposed dye

Recently a new resorbable P(LA/CL) monofilament suture made of L-lactide and epsilon-caprolactone was developed. The sensitization test was carried out using a guinea pig maximization test according to the Japanese Guidelines. As a result of this test, it was revealed that the methanol extract of P(LA/CL) suture contains a skin sensitizer. It was suggested that the D&C Violet No. 2 contained in P(LA/CL) sutures is decomposed during the melt-spinning process and that the decomposed dye induces skin sensitization. To characterize the sensitizer (the decomposed dye) it was separated and collected by HPLC. To determine the molecular formula of the sensitizer, MS, IR, and NMR spectra were obtained. The molecular weight of the sensitizer was estimated as 240 by measuring the MS. Considering the chemical structure of the dye and the molecular weights, it was determined that the sensitizer was 1,4-dihydroxyanthraquinone (quinizarin). The D&C Violet No. 2 contained in P(LA/CL) sutures was decomposed by the melt-spinning procedure to form quinizarin, one type of anthraquinone dye, and the sensitizer was identified to be, indeed, quinizarin. To evaluate the sensitizing potential of quinizarin, we tested skin sensitization using the maximization test method. Quinizarin induced skin sensitization in guinea pigs, and the minimum sensitizing concentration was approximately 100 ppm. The concentration of quinizarin contained in the P(LA/CL) suture was 1-5 ppm, a value that is lower than the minimum sensitizing concentration of quinizarin. This suggests that P(LA/CL) suture has a low risk with regard to contact dermatitis.

Allergic contact dermatitis from azo dyes

Contact allergy to textile dyes usually occurs with disperse dyes of the azo or anthraquinone groups. A case is reported of a woman with clinical features of contact allergy to coloured nylon stockings who had multiple sensitivities to dyes of different azo groups.

Cross-sensitizations between azo dyes and para-amino compound. A study of 236 azo-dye-sensitive subjects

Combined sensitizations to different azo dyes, probably based both on true cross-sensitization and on simultaneous positive reactions, have frequently been described. However, since azo dyes are included in the standard series in a minority of countries, the case studies considered comprise, with few exceptions, a small number of subjects. The aim of our study was to investigate cross-reactions between different azo dyes and para-amino compounds in azo-dye-sensitive subjects, to study the clinical aspects of azo dye dermatitis, to assess the relevance of sensitization to azo dyes, and to relate the pattern of cross-sensitizations to the chemical structure of the different dyes. Out of 6203 consecutively tested patients, 236 were sensitized to at least 1 of 6 azo compounds employed as textile dyes, included in our standard series. 107 subjects reacted to Disperse Orange 3 (DO3), 104 to Disperse Blue 124 (DB124), 76 to p-aminoazobenzene (PAB), 67 to Disperse Red 1 (DR1), 42 to Disperse Yellow 3 (DY3), and 31 to p-dimethylaminoazobenzene (PDAAB). Co-sensitizations to para-phenylenediamine were present in most subjects sensitized to DO3 (66%) and PAAB (75%), in 27% and 36% of DR1 and DY3-sensitive subjects, and only in 16% of subjects sensitized to DB124. Apart from the hands and the face, the neck and the axillae were the most frequently involved skin sites. Whereas the involvement of flexural areas was mainly connected with sensitization to DB124, in patients with hand dermatitis and in those working as hairdressers, sensitization to DO3 and PAAB was more frequent. Moreover, in the former patient group, a history of textile dye allergy was most frequently obtained. Out of 33 patients tested with an additional textile dye series, only 5 subjects reacted to anthraquinone dyes. Cross-sensitizations between azo dyes and para-amino compounds can partially be explained on the basis of structural affinities.

Sensitization to reactive textile dyes in patients with contact dermatitis

Reactive dyes are used especially for colouring natural fibres (cotton, silk and wool) that are widely used in Western countries, particularly Italy, in the production of clothes. The aim of our study was to investigate sensitization to the most commonly used reactive textile dyes in patients undergoing patch tests, and to assess the clinical relevance of contact sensitization to these dyes. 1813 consecutive patients underwent patch tests with the GIRDCA standard series and an additional textile series of 12 reactive dyes. 18 of these patients were sensitized to reactive dyes (0.99%) (4 only to reactive dyes). The dyes most frequently responsible for positive patch tests were Red Cibacron CR and Violet Remazol 5R (respectively, 8 and 5 positivities). In 5 cases only was a history of intolerance to particular garments given; of 4 patch tests performed with pieces of garment, 2 were positive. In 1 occupationally-exposed patient, airborne contact dermatitis was suspected. Owing to the lack of up-to-date patch test series, some cases of allergic contact dermatitis from textile dyes are probably misdiagnosed: new colouring agents are continuously introduced to the market, so that a close relationship with textile industry is necessary to improve our diagnostic tools.

Multiple azo disperse dye sensitization mainly due to group sensitizations to azo dyes

A female patient, with a previous episode of contact dermatitis caused by a blue dress, developed similar dermatitis due to a navy-blue dress. Patch tests revealed multiple allergic positive reactions to paraphenylenediamine (PPD), the navy-blue dress, its extracts, 6 azo disperse dyes in a textile series, as well as 3 dye components, including Disperse (DP) Red 153, which were present in the dress; these were composed of 9 azo disperse dyes, all dyes being of a different chemical structure. On the basis of chemical similarities between these 16 azo dyes including PPD, these are classified into the following 4 groups: thiazol-azoyl-PPD group (including DP Blue 106, DP Blue 124 and 5 used dyes), aminoazobenzene group (DP Red 1, DP Red 17, DP Brown 1 and 2 used dyes), PPD group (PPD and DP Orange 3) and benzothiazol-azoyl-PPD group (2 dyes in DP Red 153). With few exceptions, cross-sensitizations between dyes in the same group have been reported by other authors, or are suggested by us, in the former 3 groups. Multiple azo disperse dye sensitization is therefore considered to be attributable mainly to group sensitizations to azo dyes.

Prevalence of contact allergy to non-disperse azo dyes for natural fibers: a study in 1814 consecutive patients

5 non-disperse azo dyes, used for colouring natural fibers, were added to the standard patch test series, as 5% pet. preparations. 1814 consecutive patients attending the patch test clinic were patch tested, of whom 16 (0.88%) reacted to the newly added dyes: 8 to Direct Orange 34, 5 to Acid Yellow 61, 2 to Acid Red 359 and 1 to Acid Red 118. On the basis of clinical history and results of patch tests with pieces of fabrics, contact sensitization to non-disperse azo dyes seemed to be related to the appearance of skin lesions at least in 8 subjects. We conclude that systematic exploration of the sensitizing potential of textile dyes, selected after careful investigation, can provide additional information on the frequency of occurrence of textile dye dermatitis, supporting individual investigation in sensitized subjects.

Textile dermatitis: an update. (I). Resins, additives and fibers

Cases of textile-related dermatitis reported in the medical literature after the mid-1980s are reviewed. Part I focuses on cases in which textile resins, fiber additives, or fibers were the causal agent. Studies which provide insight into understanding fabric-induced prickle and itch are included.

Textile dye dermatitis

The literature concerning textile dye dermatitis published during the last decade was reviewed. Sixty-one cases of dye-allergic contact dermatitis in which the presentation or course of the dermatitis was unusual or the dye allergen was one not previously reported have been described. The four new dye allergens discovered were Disperse Blue 106, Disperse Blue 85, Disperse Brown 1, and Basic Red 46. The incidence of dye dermatitis varied from 1% to 15.9% depending on the country, patient sample, and number of dyes in the patch test series. The 10 new dye allergens discovered in these studies were Disperse Blue 153, Disperse Orange 13, Basic Black 1, Basic Brown 1, the acid dyes Supramine Yellow and Supramine Red, the direct dye Diazol Orange, the basic dye Brilliant Green, Turquoise Reactive, and Neutrichrome Red. Disperse Blue 106 and Disperse Blue 124 were shown to be the strongest clothing dye sensitizers to date. Standard screening patch test series were found to be inadequate for the detection of textile dye sensitivity; therefore textile dye patch test series should be used. It is difficult to determine whether the incidence of dye dermatitis is increasing or decreasing because controlled epidemiologic studies are lacking, but data suggest that textile dye sensitivity is more common than previously believed.

Contact dermatitis from textile dyes

6 female patients with allergic contact dermatitis from textile dyes are described. Lesions were confined to areas in direct contact with the offending garment, mainly where friction and/or pressure occurred. Patch tests were positive to 2 or more disperse dyes. Thin-layer chromatography was carried out on the dyes extracted from fabrics of 3 patients, for the identification of textile dyes.

Sensitization to azo dyes: negative patch tests to yellow and red azo dyes in printed paper

An over 2 x fold increase in para-aminoazobenzene allergy was observed in patients with allergic contact dermatitis during the years 1990-1991. Presuming that an increase in colour-printed newspapers might be a new unrecognized source of clinical allergy to azo dyes, patch tests were performed in 32 patients with an established p-aminoazobenzene allergy using a series of important azo dyes used in offset printing ink (Pigment Yellow 12, Pigment Yellow 13, Pigment Red 53, Pigment Red 57), as well as with dye-containing inks and specimens of colour-printed newspaper containing these azo dyes. In 25 out of the 32 patients (78%), positive patch tests were seen to textile azo dyes, in particular to Disperse Orange 3 (24 patients). In none of the 32 patients were reactions observed to the azo dyes used in printing ink, to the inks used or to the colour-printed paper specimens, indicating that these products were apparently not a cause of contact dermatitis in our group of patients with azo dye sensitization.

Contact sensitization to textile dyes: description of 100 subjects

We have described 100 subjects sensitized to textile dyes. Of these, 16 had clinically been suspected of having a textile dermatitis from among 1145 patients referred for patch testing. 41 patients were identified from among 861 consecutive subjects tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series supplemented with 4 disperse dyes (Disperse Blue 124, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3). The remaining 43 patients were identified from among 746 subjects tested with the GIRDCA standard series, supplemented with the 4 disperse dyes mentioned above and a further series of 12 other textile dyes. The clinical picture was extremely variable: most patients had a typical eczematous dermatitis, but we also observed persistent erythematous-wheal-type reactions, a transient urticarial dermatitis and an erythema-multiforme-like eruption. Among these textile dyes, Disperse Blue 124 caused most reactions. With the addition of the 4 disperse dyes to the GIRDCA standard series, we identified 4.8% sensitized to textile dyes, a much higher figure than the 1.4% observed among patients being patch tested on the basis of their history and the clinical findings; the addition of a further 12 textile dyes to the series further increased the detection rate to 5.8%. We stress the importance of routinely patch testing with textile dyes, which can help to elucidate the cause of certain kinds of atypical dermatitis.

Allergic dermatoses and respiratory diseases from reactive dyes

5 cases of occupational eczema, urticaria and respiratory disease from reactive dyes, occurring during 1977-1987, are reported. The patients, 4 men and 1 woman, were 24-52 years old when examined. They had been working in dye houses or textile plants, and had been exposed to reactive dyes for 8 months to 4 years before symptoms developed. Only 1 of the patients has been able to continue in the same occupation. On patch testing, the 4 patients with eczema reacted positively to 9 commercial dye powders. 2 patients reacted to the same dye, Remazol Schwarz B. On scratch and/or prick testing, the 2 patients who also had respiratory symptoms and/or urticaria reacted positively to the same dyes as on patch testing. The 5th patient, who had urticaria and respiratory symptoms, reacted positively to a dye, Remazol Gold Gelb RNL, but the patch test with that dye was negative. None of the patients was patch-test-positive to para-phenylenediamine (PPD) or to textile dye allergens in a series of organic dyes. Thus, the series of organic dyes has little value in the screening of allergy to reactive dyes. A 1% pet. dilution of commercial dye powder for patch testing and the same concentration in distilled water for prick testing seem to be suitable for the screening of allergy to reactive dyes.

Textile chemical finish dermatitis

Chemicals used on fabrics to improve 10 different performance characteristics have resulted in irritant or allergic contact dermatitis. The most significant problem is due to formaldehyde and N-methylol compounds to produce durable press fabrics. Little is known about incidence of finish dermatitis or mode and amount of transfer of chemicals from fabric to skin.