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Sadrolvaezin A, Pezhman A, Zare I, Nasab SZ, Chamani S, Naghizadeh A, Mostafavi E. Systemic allergic contact dermatitis to palladium, platinum, and titanium: mechanisms, clinical manifestations, prevalence, and therapeutic approaches. MedComm (Beijing) 2023; 4:e386. [PMID: 37873514 PMCID: PMC10590457 DOI: 10.1002/mco2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T-cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work-related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.
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Affiliation(s)
- Ali Sadrolvaezin
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Arezou Pezhman
- School of MedicineZahedan Azad University of Medical SciencesZahedanIran
| | - Iman Zare
- Research and Development DepartmentSina Medical Biochemistry Technologies Co. Ltd.ShirazIran
| | - Shima Zahed Nasab
- Department of Life Science EngineeringFaculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Sajad Chamani
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ebrahim Mostafavi
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. S1-Leitlinie Kontaktekzem. J Dtsch Dermatol Ges 2022; 20:711-734. [PMID: 35578429 DOI: 10.1111/ddg.14734_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster
| | - Vera Mahler
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen
| | | | | | | | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Johannes Geier
- Zentrale des IVDK, Universitätsmedizin Göttingen, Göttingen
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20:712-734. [DOI: 10.1111/ddg.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum Bochum Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Randolf Brehler
- Department of Dermatology University Hospital Münster Münster Germany
| | - Vera Mahler
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Hans F. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - Irena Neustädter
- Department of Pediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | | | - Thomas Werfel
- Department of Dermatology Allergology and Venereology Hannover Medical School Hannover Germany
| | - Margitta Worm
- Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Johannes Geier
- Center of IVDK University Medical Center Göttingen Göttingen Germany
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Saldan I, Dobrovetska O, Makota O. Nanotechnologies for Preparation and Application of Metallic Nickel. CHEMISTRY & CHEMICAL TECHNOLOGY 2022. [DOI: 10.23939/chcht16.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nanostructured nickel exhibits substantial surface area per unit volume and adjustable optical, electronic, magnetic, and biological properties, that makes nanofabricated nickel highly attractive as regards to its practical application in different fields of chemistry. Technologies on nickel nanomaterials including their simple preparation and modern application are summarized in this review.
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Tramontana M, Bianchi L, Hansel K, Agostinelli D, Stingeni L. Nickel Allergy: Epidemiology, Pathomechanism, Clinical Patterns, Treatment and Prevention Programs. Endocr Metab Immune Disord Drug Targets 2021; 20:992-1002. [PMID: 31994473 DOI: 10.2174/1871530320666200128141900] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 01/19/2023]
Abstract
Nickel is the most common cause of contact allergy in the general population and the most frequently detected allergen in patients patch tested for suspected allergic contact dermatitis (ACD). ACD from nickel is a typical type IV hypersensitivity. Nickel allergy is mostly caused by nonoccupational exposure, such as jewelry and clothing decorations, metal tools, medical devices (mainly orthopedic and orthodontic implants, cardiovascular prosthesis), eyeglasses, utensils, keys, pigment for paint, cosmetics, and food (mainly legumes, chocolate, salmon, peanuts). Occupational exposure can involve several workers (mechanics, metalworkers, platers, hairdressers, jewelers, workers in the constructions and electronic industries), classically involving hands and forearms. The classic clinical pattern of ACD caused by nickel is characterized by eczematous dermatitis involving the sites of direct contact with the metal. Non-eczematous-patterns are reported, including lichenoid dermatitis, granuloma annulare, vitiligo-like lesions, dyshidrosiform dermatitis, and vasculitis. In the case of systemic exposure to nickel, sensitized patients could develop systemic contact dermatitis. Patch testing represents the gold standard for the diagnosis of ACD from nickel. Treatment includes avoidance of contact with products containing nickel and the patient's education about the possible use of alternative products. A recent EU nickel directive, regulating the content and release of nickel from products, has caused a decrease of nickel contact allergy in some European countries. Nickel allergy is a relevant issue of public health with significant personal, social, and economic impact. This review summarizes epidemiology, pathomechanism, clinical patterns, treatment, and prevention programs.
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Affiliation(s)
- Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Daniela Agostinelli
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
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Gergovska M, Darlenski R, Kazandjieva J. Nickel Allergy of the Skin and Beyond. Endocr Metab Immune Disord Drug Targets 2021; 20:1003-1009. [PMID: 32108006 DOI: 10.2174/1871530320666200228124453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/25/2020] [Accepted: 03/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema. OBJECTIVE The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented. METHODS Electronic databases on this topic was carried out using PubMed-Medline. RESULTS The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared. CONCLUSION The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.
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Affiliation(s)
- Malena Gergovska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Pleven, Bulgaria
| | - Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Jana Kazandjieva
- Department of Dermatology and Venereology, Faculty of Medicine, Sofia, Bulgaria
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Can the Reactivity to Chromate Be Changed in Patch Testing Using a Barrier Cream? Dermatitis 2020; 31:373-377. [PMID: 33186332 DOI: 10.1097/der.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The persistent, difficult-to-treat, allergic contact dermatitis from hexavalent chromium in European construction workers has diminished significantly since the legislative measurements that came into force in January 2005. However, sensitization to hexavalent chromium continues to be a problem. Barrier creams have been tried for various allergens with divergent results. OBJECTIVE The aim of the study was to investigate the protective capacity of barrier cream candidates against hexavalent chromium in a patch test situation. METHODS An experimental study was performed to investigate the reductive properties of glutathione and iron sulfate on the patch test reactivity in chromium-allergic individuals when exposed to hexavalent chromium. In this study, we also investigated the protective properties of a commercially available barrier cream. CONCLUSIONS A higher number of volunteers (16/18) showed reactions on the skin treated with the commercially available barrier cream, compared with the untreated skin (13/18) on test reading day 3/4 or day 7. The skin treated with petrolatum or Essex cream showed fewer and less prominent allergic reactions than the skin treated with the commercially available barrier cream.
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Lejding T, Engfeldt M, Bruze M, Isaksson M, Svedman C, Zimerson E, Verma K, Mowitz M. Skin application of glutathione and iron sulfate can inhibit elicitation of allergic contact dermatitis from hexavalent chromium. Contact Dermatitis 2019; 82:45-53. [PMID: 31584201 DOI: 10.1111/cod.13409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) caused by hexavalent chromium, Cr(VI), is often severe and difficult to treat. The most common source of exposure to Cr(VI) in Sweden used to be cement, and more recently leather. The contact allergy can be diminished or inhibited if the exposure is decreased or ceases. Barrier creams against different kinds of allergens have been investigated for their protective properties which may offer protection against Cr(VI) exposure. OBJECTIVES To investigate the capacity of formulas containing glutathione (GSH) and iron sulfate to inhibit elicitation of ACD in Cr(VI)-allergic individuals when exposed to Cr(VI). METHODS In 18 Cr(VI)-allergic volunteers the back was divided into eight patch test areas which were treated with preparations of possible barrier creams, prior to patch testing with a dilution series of potassium dichromate and a buffered extract of cement. RESULTS A significant reduction in reactivity to Cr(VI) and cement extract on skin treated with formulas containing GSH or iron sulfate was noticed, compared with untreated skin. CONCLUSION Formulas containing GSH or iron sulfate in barrier creams inhibit ACD in individuals allergic to Cr(VI) when applied before exposure to Cr(VI) and cement extract.
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Affiliation(s)
- Tina Lejding
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Malin Engfeldt
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Erik Zimerson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Kaushal Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Ramesan V, Jain S. Chitosan-Glycerol Gel as Barrier Formulation for Metal Allergy. ACS OMEGA 2019; 4:5900-5903. [PMID: 31459738 PMCID: PMC6648679 DOI: 10.1021/acsomega.9b00326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
Metal-induced allergic contact dermatitis, particularly nickel, affects over 10% of the general population. Herein, chitosan-glycerol gel as protective barrier formulation was synthesized by neutralization reaction with an aim to reduce metal-ion diffusion into the skin to prevent allergy. Active functional groups in chitosan-glycerol gel were able to capture allergenic metal ions present in artificial sweat solution. The efficacy of the barrier formulation against nickel-ion penetration was evaluated ex vivo using pig skin. We found that the percutaneous absorption of nickel ion reduced by ∼98% when chitosan-glycerol gel was used as a barrier formulation.
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Parra C, Montero-Silva F, Gentil D, Del Campo V, Henrique Rodrigues da Cunha T, Henríquez R, Häberle P, Garín C, Ramírez C, Fuentes R, Flores M, Seeger M. The Many Faces of Graphene as Protection Barrier. Performance under Microbial Corrosion and Ni Allergy Conditions. MATERIALS 2017; 10:ma10121406. [PMID: 29292763 PMCID: PMC5744341 DOI: 10.3390/ma10121406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022]
Abstract
In this work we present a study on the performance of CVD (chemical vapor deposition) graphene coatings grown and transferred on Ni as protection barriers under two scenarios that lead to unwanted metal ion release, microbial corrosion and allergy test conditions. These phenomena have a strong impact in different fields considering nickel (or its alloys) is one of the most widely used metals in industrial and consumer products. Microbial corrosion costs represent fractions of national gross product in different developed countries, whereas Ni allergy is one of the most prevalent allergic conditions in the western world, affecting around 10% of the population. We found that grown graphene coatings act as a protective membrane in biological environments that decreases microbial corrosion of Ni and reduces release of Ni2+ ions (source of Ni allergic contact hypersensitivity) when in contact with sweat. This performance seems not to be connected to the strong orbital hybridization that Ni and graphene interface present, indicating electron transfer might not be playing a main role in the robust response of this nanostructured system. The observed protection from biological environment can be understood in terms of graphene impermeability to transfer Ni2+ ions, which is enhanced for few layers of graphene grown on Ni. We expect our work will provide a new route for application of graphene as a protection coating for metals in biological environments, where current strategies have shown short-term efficiency and have raised health concerns.
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Affiliation(s)
- Carolina Parra
- Laboratorio de Nanobiomateriales, Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Francisco Montero-Silva
- Laboratorio de Nanobiomateriales, Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Dana Gentil
- Laboratorio de Nanobiomateriales, Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Valeria Del Campo
- Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | | | - Ricardo Henríquez
- Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Patricio Häberle
- Departamento de Física, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Carolina Garín
- Instituto de Química, Pontificia Universidad Católica de Valparaíso, Valparaíso 3100000, Chile.
| | - Cristian Ramírez
- Departamento de Ingeniería Química y Ambiental, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Raúl Fuentes
- Departamento de Industrias, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
| | - Marcos Flores
- Laboratorio de Superficies y Nanomateriales, Departamento de Física, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago 8370448, Chile.
| | - Michael Seeger
- Departamento de Química, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile.
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Mostosi C, Simonart T. Effectiveness of Barrier Creams against Irritant Contact Dermatitis. Dermatology 2016; 232:353-62. [DOI: 10.1159/000444219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
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Fage SW, Faurschou A, Thyssen JP. Copper hypersensitivity. Contact Dermatitis 2014; 71:191-201. [DOI: 10.1111/cod.12273] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/13/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Simon W. Fage
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Annesofie Faurschou
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; National Allergy Research Centre, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
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Vemula PK, Anderson RR, Karp JM. Nanoparticles reduce nickel allergy by capturing metal ions. NATURE NANOTECHNOLOGY 2011; 6:291-295. [PMID: 21460828 DOI: 10.1038/nnano.2011.37] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 02/18/2011] [Indexed: 05/30/2023]
Abstract
Approximately 10% of the population in the USA suffer from nickel allergy, and many are unable to wear jewellery or handle coins and other objects that contain nickel. Many agents have been developed to reduce the penetration of nickel through skin, but few formulations are safe and effective. Here, we show that applying a thin layer of glycerine emollient containing nanoparticles of either calcium carbonate or calcium phosphate on an isolated piece of pig skin (in vitro) and on the skin of mice (in vivo) prevents the penetration of nickel ions into the skin. The nanoparticles capture nickel ions by cation exchange, and remain on the surface of the skin, allowing them to be removed by simple washing with water. Approximately 11-fold fewer nanoparticles by mass are required to achieve the same efficacy as the chelating agent ethylenediamine tetraacetic acid. Using nanoparticles with diameters smaller than 500 nm in topical creams may be an effective way to limit the exposure to metal ions that can cause skin irritation.
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Affiliation(s)
- Praveen Kumar Vemula
- Center for Regenerative Therapeutics and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Thyssen JP, Menné T. Metal allergy--a review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol 2010; 23:309-18. [PMID: 19831422 DOI: 10.1021/tx9002726] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1-3% are allergic to cobalt and chromium. Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.
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Affiliation(s)
- Jacob P Thyssen
- National Allergy Research Centre and Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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Torres F, das Graças M, Melo M, Tosti A. Management of contact dermatitis due to nickel allergy: an update. Clin Cosmet Investig Dermatol 2009; 2:39-48. [PMID: 21436967 PMCID: PMC3047925 DOI: 10.2147/ccid.s3693] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nickel is the major cause of allergic contact dermatitis in the general population, both among children and adults, as well as in large occupational groups. This metal is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life. Nickel contact dermatitis can represent an important morbidity, particularly in patients with chronic hand eczema, which can lead to inability to work, a decrease in quality of life and significant healthcare expenses. Therefore, its management is of great importance. This article reviews diagnostic, preventive and therapeutic strategies in this field.
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Affiliation(s)
- Fernanda Torres
- Department of Dermatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Lu LK, Warshaw EM, Dunnick C A. Prevention of Nickel Allergy: The Case for Regulation? Dermatol Clin 2009; 27:155-61, vi-vii. [DOI: 10.1016/j.det.2008.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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17
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Almeida IF, Valentão P, Andrade PB, Seabra RM, Pereira TM, Amaral MH, Costa PC, Bahia MF. In vivo skin irritation potential of a Castanea sativa (Chestnut) leaf extract, a putative natural antioxidant for topical application. Basic Clin Pharmacol Toxicol 2008; 103:461-7. [PMID: 18793273 DOI: 10.1111/j.1742-7843.2008.00301.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Topical application of natural antioxidants has proven to be effective in protecting the skin against ultraviolet-mediated oxidative damage and provides a straightforward way to strengthen the endogenous protection system. However, natural products can provoke skin adverse effects, such as allergic and irritant contact dermatitis. Skin irritation potential of Castanea sativa leaf ethanol:water (7:3) extract was investigated by performing an in vivo patch test in 20 volunteers. Before performing the irritation test, the selection of the solvent and extraction method was guided by the 1,1-diphenyl-2-picryl hydrazyl (DPPH) free radical scavenging test and polyphenols extraction (measured by the Folin Ciocalteu assay). Iron-chelating activity and the phenolic composition (high performance liquid chromatography/diode array detection) were evaluated for the extract obtained under optimized conditions. The extraction method adopted consisted in 5 short extractions (10 min.) with ethanol:water (7:3), performed at 40 degrees. The IC(50) found for the iron chelation and DPPH scavenging assays were 132.94 +/- 9.72 and 12.58 +/- 0.54 microg/ml (mean +/- S.E.M.), respectively. The total phenolic content was found to be 283.8 +/- 8.74 mg GAE/g extract (mean +/- S.E.M.). Five phenolic compounds were identified in the extract, namely, chlorogenic acid, ellagic acid, rutin, isoquercitrin and hyperoside. The patch test carried out showed that, with respect to irritant effects, this extract can be regarded as safe for topical application.
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Affiliation(s)
- Isabel F Almeida
- Department of Pharmaceutical Technology, São Marcos Hospital, Braga, Portugal
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Final Report on the Safety Assessment of Pentasodium Pentetate and Pentetic Acid as Used in Cosmetics. Int J Toxicol 2008; 27 Suppl 2:71-92. [DOI: 10.1080/10915810802244546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pentasodium Pentetate and Pentetic Acid function as chelating agents in cosmetics. Pentasodium Pentetate is readily soluble in water, but the corresponding free acid is not. Pentasodium Pentetate is used in almost 400 cosmetic products over a wide range of product categories, although it is mostly used in hair dyes and colors at use concentrations of 0.1% to 1.0%. Pentetic Acid is used in 150 cosmetic products, mostly in hair dyes and colors. Chelating agents are used in cosmetics to remove calcium and magnesium cations, which impede foaming and cleansing performance and which can cause a haze in clear liquids. The acute oral LD50 of Pentasodium Pentetate in rats was >5 g/kg. The acute dermal LD50 of Pentapotassium Pentetate using rats was reported to be >2 g/kg. The intraperitonal LD50 of Pentetic Acid was reported to be 585 mg/kg. Short-term studies of the calcium and sodium salts of Pentetic Acid in male mice demonstrated no dose-related toxicity over the dose range of 10, 100, and 250 mg/kg. In a 4-week dermal toxicity study, daily topical application of 0.05% Pentasodium Pentetate to shaved and abraded rabbit skin produced moderate erythema after the first week and throughout the study, but no systemic tox-icity. Pentasodium Pentetate or Pentapotassium Pentetate applied to intact albino rabbit skin were not irritating. A 40% solution of Pentapotassium Pentetate was not sensitizing in a guinea pig maximization test. The no observed adverse effect level (NOAEL) for rats given 40% Pentapotassium Pentetate by oral gavage was reported to be 83 mg/kg day-1. Subchronic inhalation evaluation of a bath freshener containing 0.05% or 0.09% Pentasodium Pentetate using albino rats determined that there was no cumulative systemic toxicity attributable to the ingredient at either concentration. The no observed effect level (NOEL) for maternal toxicity in pregnant rats was 400 mg/kg body weight and for fetal toxicity was 100 mg/kg body weight. Another reproductive toxicity study evaluated Pentetic Acid–Zn with and without sodium chloride in pregnant C57/B1 Dougherty mice. No toxicity was found without added sodium chloride. Pentapotassium Pentetate was not muta-genic in an Ames test, with or without metabolic activation. The same material tested in Chinese hamster ovary cells was not clas-togenic. Calcium Pentetate at 1.351 µg/ml produced a statistically significant increase in the number of sister-chromatid exchanges. Pentasodium Pentetate is nonirritating to moderately irritating, but not a sensitizer in clinical tests. A human comedogenicity (acne promotion) test using Pentasodium Pentetate found no effect. Although data are lacking on the dermal penetration of these two ingredients, other chelating agents such as EDTA do not penetrate the skin, so it is likely that Pentasodium Pentetate and Pentetic Acid also would not penetrate. The high water solubility of Pentasodium Pentetate and the low water solubility of Pentetic Acid also support that their dermal penetration will be low. Other chelating agents, including EDTA and its salts, have been determined to be safe in the current practices of use in cosmetics. Meta-, Tri-, and Hexam-etaphosphate salts are chelating agents determined to be safe in the current practices of use in cosmetics. Metasilicate salts were found to be safe as chelating agents in cosmetics when formulated to avoid irritation. Overall, these data were considered sufficient to support the safety of Pentesodium Pentetate and Pentetic Acid as used in cosmetics.
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Scheman A, Jacob S, Zirwas M, Warshaw E, Nedorost S, Katta R, Cook J, Castanedo-Tardan MP. Contact Allergy: Alternatives for the 2007 North American Contact Dermatitis Group (NACDG) Standard Screening Tray. Dis Mon 2008; 54:7-156. [DOI: 10.1016/j.disamonth.2007.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jacob SE, Castanedo-Tardan MP. Pharmacotherapy for allergic contact dermatitis. Expert Opin Pharmacother 2007; 8:2757-74. [DOI: 10.1517/14656566.8.16.2757] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Sharon E Jacob
- University of Miami, Leonard M. Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Florida 33124, USA
| | - Mari Paz Castanedo-Tardan
- University of Miami, Leonard M. Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, Florida 33124, USA
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Hostynek JJ. Sensitization to nickel: etiology, epidemiology, immune reactions, prevention, and therapy. REVIEWS ON ENVIRONMENTAL HEALTH 2006; 21:253-80. [PMID: 17243350 DOI: 10.1515/reveh.2006.21.4.253] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nickel is a contact allergen causing Type I and Type IV hypersensitivity, mediated by reagins and allergen-specific T lymphocytes, expressing in a wide range of cutaneous eruptions following dermal or systemic exposure. As such, nickel is the most frequent cause of hypersensitivity, occupational as well as among the general population. In synoptic form, the many effects that nickel has on the organism are presented to provide a comprehensive picture of the aspects of that metal with many biologically noxious, but metallurgically indispensable characteristics. This paper reviews the epidemiology, the prognosis for occupational and non-occupational nickel allergic hypersensitivity, the types of exposure and resulting immune responses, the rate of diffusion through the skin, and immunotoxicity. Alternatives toward prevention and remediation, topical and systemic, for this pervasive and increasing form of morbidity are discussed. The merits and limitations of preventive measures in industry and private life are considered, as well as the effectiveness of topical and systemic therapy in treating nickel allergic hypersensitivity.
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Affiliation(s)
- Jurij J Hostynek
- UCSF School of Medicine, Department of Dermatology, San Francisco, CA 94143-0989, USA
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Saary J, Qureshi R, Palda V, DeKoven J, Pratt M, Skotnicki-Grant S, Holness L. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2006; 53:845. [PMID: 16243136 DOI: 10.1016/j.jaad.2005.04.075] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Revised: 03/23/2005] [Accepted: 04/22/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention. METHODS Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence. RESULTS In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications. CONCLUSIONS A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.
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Affiliation(s)
- Joan Saary
- Department of Occupational and Environmental Health, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Affiliation(s)
- Linh K Lu
- Department of Dermatology, University of Colorado Health Sciences Center, Denver, Co, USA
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Kütting B, Drexler H. Effectiveness of skin protection creams as a preventive measure in occupational dermatitis: a critical update according to criteria of evidence-based medicine. Int Arch Occup Environ Health 2003; 76:253-9. [PMID: 12684811 DOI: 10.1007/s00420-003-0437-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Accepted: 01/10/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study attempts to assess the evidence of the generally recommended three-step programme of skin protection in the prevention of occupational skin disease. METHODS The following clinical questions, representative of critical appraisal of this preventive measurement, were generated: (1) Can a skincare regimen effectively reduce or eliminate work-related poor skin conditions? (2) Do protective creams prevent harmful substances from penetrating and adhering to the skin? (3) Is the differentiation between pre-exposure and post-exposure products justified by reliable data? Answers were generated according to the method used in evidence-based medicine by searching the literature, critically appraising the results and applying the results to the clinical questions. For our search we decided to use PubMed as the most convenient access to Medline and because, in contrast to other databases, this access is available free of charge. RESULTS To investigate the efficacy of barrier creams as pre-exposure skin protectors various in vitro and in vivo test methods have been developed. Over the past years the test techniques have been improved in order to adopt a real workplace situation. Efforts for standardisation of evaluation criteria have been made, too. Nevertheless, there is a lack of placebo-controlled, randomised clinical trials evaluating the benefit of these products in the prevention of occupational contact dermatitis under real workplace conditions. The literature data are conflicting; some publications report on the positive aspects of skin protection, whereas others stress the negative ones. CONCLUSION Not enough data have been accumulated for one to prove the benefit of skin protection measures under real workplace condition. Up to now, it is almost unclear if the various in vitro and in vivo methods used are suitable to simulate real workplace conditions and if these test results can be related to real occupational exposure. For the evidence-based recommendation of skin protection, further studies, especially under daily working conditions evaluating the contribution of each single element of skincare programme (products, frequency of application and education programme) are needed.
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Affiliation(s)
- Birgitta Kütting
- Institute for Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Schillerstrasse 25/29, 91054 Erlangen, Germany.
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Abstract
20 patients with systemic contact dermatitis due to nickel are described. Of these patients, 15 were female and 5 were male. Their mean age was 24.8 years (16-51 years). All had experienced contact dermatitis in the umbilical area due to continual contact with metal belt-buckles or buttons. Then, with long- or short-term aggravation of such periumbilical dermatitis, commonly in summer, lesions spread to other sites such as the side of the neck, the flexures of the extremities, etc. All patients showed a positive patch test to nickel sulphate (2.5% in petrolatum) and the dimethylglyoxime test demonstrated the presence of free nickel on metal buttons or belt-buckles. Punch biopsies performed in 7 patients showed subacute dermatitis. After avoidance of continual exposure to objects containing nickel and foods rich in nickel, as well as treatment with oral antihistamines and topical corticosteroids, all patients improved or cleared. It has been reported that nickel can cause systemic contact dermatitis by some internal systemic route, such as oral intake, transfusion, inhalation, implantation of metal medical devices, etc. In our patients, we found that continual local skin contact could also elicit systemic contact dermatitis.
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Affiliation(s)
- Xia Dou
- Department of Dermatology, Peking University First Hospital, Beijing, China
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Abstract
BACKGROUND Positive patch tests to copper sulfate are regularly observed, although copper is reported as a rare allergen with a low sensitizing potential. Usually they are claimed to be irritant and unspecific. OBJECTIVE The aim of this study was to assess the relevance and the diagnostic value of positive reactions to copper. METHODS A total of 2660 routine patch tests were analyzed for positive reactions to copper and other metal allergens: copper, 3.53%; nickel, 21.02%; palladium, 5.90%; cobalt, 3.31%. RESULTS Reactions to copper and nickel were highly significantly associated with each other. Twenty-six patients with a positive routine test to copper were retested. The reproducibility was modest (38%), but again significantly associated with nickel sensitization. CONCLUSION These clinical data support a copper-nickel cross-reactivity concept on T-cell level based on recently published molecular data. We conclude that positive patch tests to copper are mostly specific; however, they are usually of low clinical relevance.
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Affiliation(s)
- S Wöhrl
- FAZ-Floridsdorf Allergy Centre, Vienna, Austria
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