Occupational Contact Dermatitis in North American Production Workers Referred for Patch Testing: Retrospective Analysis of Cross-Sectional Data From the North American Contact Dermatitis Group 1998 to 2014

N-Methyl-(2S,4R)-trans-4-hydroxy-L-proline isolated Sideroxylon obtusifolium attenuates TPA-induced irritant contact dermatitis in mice

Dermatitis is defined as a set of inflammatory diseases that affect the skin, with varied causes. Among the different types of dermatitis, contact dermatitis is the most prevalent. Although the current therapy is often effective, it is associated with adverse effects and the possibility of drug tolerance. N-Methyl-(2S, 4R)-trans-4-hydroxy-L-proline is a L-proline amino acid derivative found in the leaves of Sideroxylon obtusifolium, a species traditionally used to treat inflammatory diseases. The aim of this study was to investigate the topical anti-inflammatory effect of N-methyl-(2S, 4R)-trans-4-hydroxy-L-proline (NMP) in 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced irritant contact dermatitis in mice. Topically administered NMP, at doses of 0.03 - 0.50 mg/ear, reduced TPA-induced ear edema and neutrophil migration, as evidenced by low tissue myeloperoxidase activity and verified by histological examination. In addition, NMP (0.06 mg/ear) reduced tissue levels of pro-inflammatory cytokines (TNF-α, IL-6, IL-1β, INF-γ and MCP-1) and of the anti-inflammatory cytokine IL-10, and reduced gene expression of TNF-α, IL-6 and IL-1β increased by TPA. The data suggest that N-methyl-(2S, 4R)-trans-4-hydroxy-L-proline acts as a topical anti-inflammatory agent that decreases the expression of inflammatory cytokines, making it useful for the treatment of skin inflammation. Further investigations are necessary for its development as a therapeutic agent.

Prevalence and risk factors of work-related contact dermatitis symptoms among healthcare cleaners during the COVID-19 pandemic in Northwest Ethiopia: a multicentre cross-sectional survey

OBJECTIVE

This study was aimed to explore the prevalence and risk factors of work-related contact dermatitis (WRCD) symptoms among cleaners working in healthcare institutions in Gondar city, Northwest Ethiopia, during the COVID-19 pandemic.

DESIGN

A multicentre cross-sectional study was conducted from September to October 2021. An interviewer-administered standardised Nordic Occupational Skin Questionnaire, V.2002 (NOSQ-2002) was used to assess WRCD. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. The association between dependent and independent variables was computed with a binary logistic regression. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted in Gondar city healthcare institutions, Northwestern Ethiopia.

PARTICIPANTS

A total of 409 cleaners participated in this study.

OUTCOME MEASURES

The primary outcome is the prevalence of WRCD symptoms, which was measured using the NOSQ-2002.

RESULTS

The response rate was 95.6%. The majority, 302 (73.8%), of the study participants were female. The mean age (±SD) was 31 (±7.87) years old. The overall prevalence of self-reported WRCD during the last 12 months was 213 (52.1%) (95% CI (47.1% to 57.0%)). The highest symptoms reported were skin redness, 51.6% (n=110), and the most affected skin body sites were hands (hand dermatitis), 74.2% (n=158). Hand washing frequency more than 20 times per day (AOR=1.73, 95% CI (1.03 to 2.92)), personal history of eczema (AOR=1.46, 95% CI (1.01 to 2.42)) and lack of training on skin hazards (AOR=2.06, 95% CI (1.16 to 3.63)) were factors influencing the occurrence of WRCD.

CONCLUSIONS

This study revealed the prevalence of WRCD is common during the COVID-19 pandemic. Adjusting hand washing frequency per day, educating people with atopy about the avoidance of exposure to skin irritants and providing training on skin hazards were recommended to minimise the condition.

Occupational respiratory and skin diseases among workers exposed to metalworking fluids

PURPOSE OF REVIEW

To examine respiratory and skin diseases that occur among workers exposed to metalworking fluids (MWFs) used during machining processes.

RECENT FINDINGS

Five cases of a severe and previously unrecognized lung disease characterized by B-cell bronchiolitis and alveolar ductitis with emphysema (BADE) were identified among workers at a machining facility that used MWFs, although MWF exposure could not be confirmed as the etiology. In the United Kingdom, MWF is now the predominant cause of occupational hypersensitivity pneumonitis (HP). Under continuous conditions associated with respiratory disease outbreaks, over a working lifetime of 45 years, workers exposed to MWF at 0.1 mg/m3 are estimated to have a 45.3% risk of acquiring HP or occupational asthma under outbreak conditions and a 3.0% risk assuming outbreak conditions exist in 5% of MWF environments. In addition to respiratory outcomes, skin diseases such as allergic and irritant contact dermatitis persist as frequent causes of occupational disease following MWF exposure.

SUMMARY

Healthcare providers need to consider MWF exposure as a potential cause for work-related respiratory and skin diseases. Additional work is necessary to more definitively characterize any potential association between MWF exposures and BADE. Medical surveillance should be implemented for workers regularly exposed to MWF.

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

BACKGROUND

Hand eczema (HE) is a heterogeneous and burdensome disorder.

OBJECTIVE

To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing.

METHODS

Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113).

RESULTS

Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ², P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators.

LIMITATIONS

No data on HE phenotype.

CONCLUSION

HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.

Facial Dermatitis in Male Patients Referred for Patch Testing: Retrospective Analysis of North American Contact Dermatitis Group Data, 1994 to 2016

Importance

Facial dermatitis in women is well characterized. However, recent shifts in the men's grooming industry may have important implications for male facial dermatitis.

Objective

To characterize male patients with facial dermatitis.

Design, Setting, and Participants

A 22-year retrospective cross-sectional analysis (1994-2016) of North American Contact Dermatitis Group (NACDG) data, including 50 507 patients who underwent patch testing by a group of dermatology board-certified patch test experts at multiple centers was carried out. Facial dermatitis was defined as involvement of the eyes, eyelids, lips, nose, or face (not otherwise specified).

Main Outcomes and Measures

The main outcome was to compare characteristics (including demographics and allergens) between male patients with facial dermatitis (MFD) and those without facial dermatitis (MNoFD) using statistical analysis (relative risk, CIs). Secondary outcomes included sources of allergic and irritant contact dermatitis and, for occupationally related cases, specific occupations and industries in MFD.

Results

Overall, 1332 male patients (8.0%) were included in the MFD group and 13 732 male patients (82.0%) were included in MNoFD. The mean (SD) age of participants was 47 (17.2) years in the MFD group and 50 (17.6) years in the MNoFD group. The most common facial sites were face (not otherwise specified, 817 [48.9%]), eyelids (392 [23.5%]), and lips (210 [12.6%]). Participants in the MFD group were significantly younger than MNoFD (mean age, 47 vs 50 years; P < .001). Those in the MFD group were less likely to be white (relative risk [RR], 0.92; 95% CI, -0.90 to 0.95) or have occupationally related skin disease (RR, 0.49; 95% CI, -0.42 to 0.58; P < .001) than MNoFD. The most common allergens that were associated with clinically relevant reactions among MFD included methylisothiazolinone (n = 113; 9.9%), fragrance mix I (n = 27; 8.5%), and balsam of Peru (n = 90; 6.8%). Compared with MNoFD, MFD were more likely to react to use of dimethylaminopropylamine (RR, 2.49; 95% CI, -1.42 to 4.37]) and paraphenylenediamine (RR, 1.43; 95% CI, -1.00 to 2.04; P < .001). Overall, 60.5% of NACDG allergen sources were personal care products.

Conclusions and Relevance

Although many allergens were similar in both groups, MFD were more likely to react to use of dimethylaminopropylamine and paraphenylenediamine, presumably owing to their higher prevalence in hair products. Most sources of allergic and irritant contact dermatitis in MFD were personal care products. This study provides insight into the risks and exposures of the increasing number of grooming products used by male dermatology patients. This will enable clinicians to better identify male patients who would benefit from patch testing and treat those with facial dermatitis.

Occupationally Related Nickel Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 1998-2016

BACKGROUND

The epidemiology of nickel allergy in occupational settings is not well understood.

OBJECTIVE

The aim of the study was to characterize occupationally related nickel allergy (ORNA).

METHODS

This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2016. Characteristics of individuals with ORNA were compared with those with non-ORNA (NORNA).

RESULTS

A total of 7928 (18.2%) individuals were positive to nickel sulfate 2.5%. Two hundred sixty-eight (3.4%) had ORNA. As compared with NORNA, ORNA was statistically associated with the male sex (41.0% vs 12.9%, P < 0.001), a diagnosis of irritant contact dermatitis (22.4% vs 12.0%, P < 0.001), and no history of eczema (81.7% vs 75.7%, P = 0.0217). The most common sites of ORNA dermatitis were hand (39.9%) and arm (18.1%), which were significantly more common than in NORNA (P < 0.0001). Sixteen industry categories and 22 occupation categories were identified for ORNA; the most common industries were durable goods manufacturing (24.6%) and personal services (15.7%), and the most frequent occupations were hairdressers/cosmetologists/barbers (14.3%), machine operators (9.3%), and health care workers (7.1%). Overall 30% of ORNA occupations were in metalworking. Of 215 ORNA sources identified, instruments/phones/other equipment (16.3%), vehicles/machinery (15.8%), and tools (15.3%) were the most common.

CONCLUSIONS

Occupational nickel allergy is distinct from nonoccupational nickel allergy.

Occupational Dermatosis

PURPOSE OF REVIEW

The purpose of this review is to provide an update on occupational contact dermatitis including gaps in knowledge and practice. Occupational contact dermatitis is the most common occupational skin disease.

RECENT FINDINGS

New sources of exposure for known allergens and new allergens are continually being reported. Through clinical databases and surveillance systems, effects of prevention efforts or introduction of new allergens or new uses of known allergens can be monitored. Though the diagnostic process is clear, there are delays in workers seeking care. As early detection and intervention improves outcomes, screening should be implemented. Gaps in primary prevention in the workplace are identified and should be addressed to reduce the burden of disease. Surveillance systems support the prevention mandate. Understanding limitations of our knowledge and identifying gaps in practice can lead to initiatives to address research and practice needs and improve prevention of occupational dermatoses.

Isothiazolinone Content of US Consumer Adhesives: Ultrahigh-Performance Liquid Chromatographic Mass Spectrometry Analysis

BACKGROUND

There are limited data regarding the prevalence and concentration of isothiazolinone preservatives in consumer adhesives.

OBJECTIVES

The aim of this study was to determine the prevalence and concentration of 5 specific isothiazolinones (methylisothiazolinone [MI], methylchloroisothiazolinone [MCI], benzisothiazolinone [BIT], butyl BIT, and octylisothiazolinone) in US adhesives.

METHODS

Thirty-eight consumer adhesives were analyzed using ultrahigh-performance liquid chromatographic-mass spectrometry. Fisher exact tests were used to test for isothiazolinone content and: 1) glue format (2) application purpose and 3) extraction method.

RESULTS

Nineteen adhesives (50%) had at least 1 isothiazolinone, and 15 contained 2 isothiazolinones. Frequencies and concentrations were as follows: MI (44.7%; 4-133 ppm), MCI (31.6%; 7-27 ppm), BIT (15.8%; 10-86 ppm), and octylisothiazolinone (2.6%; 1 ppm). Butyl BIT was not detected in any of the adhesives. Format (stick vs liquid) was not statistically associated with isothiazolinone presence. At least half of adhesives in the following application purposes had at least 1 isothiazolinone: shoe, craft, fabric, and school. All-purpose glues had a statistically significant lower concentration of MI and MCI, whereas craft glues were associated with higher concentrations of MI and MCI. Compared with other glues, fabric adhesives were associated with a higher risk of containing BIT.

CONCLUSIONS

Half of the tested adhesives contained at least 1 isothiazolinone. Methylisothiazolinone and MCI were the most common. Consumers and dermatologists should be aware of adhesives as a source of isothiazolinones.

Skin Biophysical Parameters and Patch Test Results in People Predisposing to Xiaotong Tiegao Induced Irritant Contact Dermatitis

Background

Xiaotong Tiegao (XTT) is an ancient topical Tibetan medicine plaster which is widely used in China. Irritant contact dermatitis (ICD) caused by XTT is very common. It is still unclear why some people are more prone to develop ICD. The aim of this study is to study the baseline skin biophysical parameters and patch test results in individuals predisposing to XTT induced ICD.

Methods

During a four-month period, 149 healthy volunteers with ICD and 50 volunteers without ICD after applying XTT were recruited. The skin biophysical parameters were measured, and contact allergy to 20 common allergens was patch tested, at two weeks after the ICD was recovered.

Results

There were no significant differences in age and sex between ICD and control groups. It was found that skin median melanin value (176.50 vs 189.50, P < 0.05, Mann-Whitney U-test) and erythema value (319.90 ± 70.49 vs 347.93 ± 84.55, P < 0.05, Independent-Samples T test) were much lower in ICD than control group. Overall patch test results were not different, but the positivity rate of nickel sulfate (15.44% vs 4.00%, P < 0.05, Fisher's exact test) was significantly higher in ICD group.

Conclusions

In conclusion, people with nickel allergy, lower values of skin melanin, and erythema are predisposing to develop ICD.

Elevation of Circulating Th17/Th22 Cells Exposed to Low-Level Formaldehyde and Its Relevance to Formaldehyde-Induced Occupational Allergic Contact Dermatitis

OBJECTIVES

The aim of this study was to investigate the effects of formaldehyde exposure on Th17 and Th22 cells and its relevance to human occupational allergic contact dermatitis (OACD).

METHODS

Circulating IL17-/IL22-secreting cells and serum IL17/IL22 levels in formaldehyde-exposed workers at Occupational Exposure Limit and nonexposed controls were assessed.

RESULTS

The IL17 and IL22 cell population were detected in both CD3CD8 and CD3CD8 cells. The percentages of circulating IL17 and IL22 T cells in the workers with and without ACD history were all elevated, which were more remarkable in the ones with ACD history. Serum levels of IL17 and IL22 between the workers and controls were not significantly different.

CONCLUSIONS

Low-level formaldehyde exposure may increase circulating IL17-/IL22-producing T cells (CD8 and CD8), possibly involved in the development of human OACD. But it may not alter serum levels of IL17/IL22 before the appearance of OACD symptoms.