Contact Dermatitis Associated With Skin Cleansers: Retrospective Analysis of North American Contact Dermatitis Group Data 2000–2014

Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018

BACKGROUND

Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products.

OBJECTIVE

To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018).

METHODS

Retrospective analysis of patients tested by the North American Contact Dermatitis Group.

RESULTS

Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside.

LIMITATIONS

The cohort predominantly reflects a referral population, and follow-up after testing was not captured.

CONCLUSION

Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.

Impact of Water Exposure and Temperature Changes on Skin Barrier Function

The frequency of hand hygiene has increased due to the COVID-19 pandemic, but there is little evidence regarding the impact of water exposure and temperature on skin. The aim of this study is to evaluate the effect of water exposure and temperature on skin barrier function in healthy individuals. A prospective observational study was conducted. Temperature, pH, transepidermal water loss (TEWL), erythema and stratum corneum hydration (SCH) were measured objectively before and after hot- and cold-water exposure and TempTest® (Microcaya TempTest, Bilbao, Spain) contact. Fifty healthy volunteers were enrolled. Hot-water exposure increased TEWL (25.75 vs. 58.58 g·h^-1·m^-2), pH (6.33 vs. 6.65) and erythema (249.45 vs. 286.34 AU). Cold-water immersion increased TEWL (25.75 vs. 34.96 g·h^-1·m^-2) and pH (6.33 vs. 6.62). TEWL (7.99 vs. 9.98 g·h^-1·m^-2) and erythema (209.07 vs. 227.79 AU) increased after being in contact with the hot region (44 °C) of the TempTest. No significant differences were found after contact with the cold region (4 °C) of the TempTest. In conclusion, long and continuous water exposure damages skin barrier function, with hot water being even more harmful. It would be advisable to use cold or lukewarm water for handwashing and avoid hot water. Knowing the proper temperature for hand washing might be an important measure to prevent flares in patients with previous inflammatory skin diseases on their hands.

The History of Surfactants and Review of Their Allergic and Irritant Properties

Surfactants, many of which are used as detergents, can be found in many common household items, such as shampoos, conditioners, soaps, and cosmetics. One should recognize the multitude of surfactants that are used in today's products to identify any potential allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). Given their abundance in everyday products, it is understandable that many cases of occupational contact dermatitis that arise can be attributed to surfactants. The products most connected with ACD are cocamidopropyl betaine, oleamidopropyl dimethylamine, decyl glucoside, 3-dimethylaminopropylamine, amidoamine, and cocamide diethanolamine. Similarly, the most common surfactant-related causes of ICD are sodium lauryl sulfate and benzalkonium chloride. It is important for dermatologists to identify the causes and differentiate between the two, to adjust treatments and products accordingly. Here, the most frequently used surfactants, as well as their correlation between ACD and ICD, will be reviewed.

Characterization of Tattoo Aftercare Products: Allergenic Ingredients and Marketing Claims

BACKGROUND

Common recommendations for tattoo aftercare to ensure proper healing include application of topical products. Little is known about tattoo aftercare products.

METHODS

Tattoo aftercare products were identified from a previous study and a search on Amazon.com using the phrase "tattoo aftercare." Duplicates and products without complete ingredient lists were excluded. Marketing claims were tabulated. All ingredients were entered in Excel and grouped according to Contact Allergen Management Program categories. Comparison of ingredients to North American Contact Dermatitis Group (NACDG) screening and American Contact Dermatitis Society (ACDS) Core allergens was conducted.

RESULTS

A total of 84 tattoo aftercare products from 52 distinct brands were found. Forty-eight distinctive market claims were identified; the use of "natural ingredient(s)" (42.9%) was most common. There were 4 to 28 ingredients per product (mean = 11.8 ± 5.5) with a total of 369 distinct ingredients listed. Products contained an average of 7.9 ± 3.9 ACDS Core allergens per product and 7.0 ± 3.7 NACDG allergens per product. Most common allergens included fragrance/botanicals (n = 529), vitamin E derivatives (n = 43), and vitamin B5 derivatives (n = 11).

CONCLUSIONS

This review of 84 products found that tattoo aftercare products contain an average of 8 ACDS Core and 7 NACDG allergens. Clinicians should be aware of potential allergens in tattoo aftercare products.

Synthetic and Bio-Derived Surfactants Versus Microbial Biosurfactants in the Cosmetic Industry: An Overview

This article includes an updated review of the classification, uses and side effects of surfactants for their application in the cosmetic, personal care and pharmaceutical industries. Based on their origin and composition, surfactants can be divided into three different categories: (i) synthetic surfactants; (ii) bio-based surfactants; and (iii) microbial biosurfactants. The first group is the most widespread and cost-effective. It is composed of surfactants, which are synthetically produced, using non-renewable sources, with a final structure that is different from the natural components of living cells. The second category comprises surfactants of intermediate biocompatibility, usually produced by chemical synthesis but integrating fats, sugars or amino acids obtained from renewable sources into their structure. Finally, the third group of surfactants, designated as microbial biosurfactants, are considered the most biocompatible and eco-friendly, as they are produced by living cells, mostly bacteria and yeasts, without the intermediation of organic synthesis. Based on the information included in this review it would be interesting for cosmetic, personal care and pharmaceutical industries to consider microbial biosurfactants as a group apart from surfactants, needing specific regulations, as they are less toxic and more biocompatible than chemical surfactants having formulations that are more biocompatible and greener.

Characterization and Cytotoxic Effect of Biosurfactants Obtained from Different Sources

In this work, five biosurfactant extracts, obtained from different sources, all of them with demonstrated antimicrobial properties, were characterized and subjected to a cytotoxic study using mouse fibroblast cells (NCTC clone 929). Biosurfactant extracts obtained directly from corn steep water (CSW) showed similar surfactant characteristics to those of the extracellular biosurfactant extract produced by Bacillus isolated from CSW and grown in tryptic soy broth, observing that they are amphoteric, consisting of viscous and yellowish liquid with no foaming capacity. Contrarily, cell-bound biosurfactant extracts produced from Lactobacillus pentosus or produced by Bacillus sp isolated from CSW are nonionic, consisting of a white powder with foaming capacity. All the biosurfactants possess a similar fatty acid composition. The cytotoxic test revealed that the extracts under evaluation, at a concentration of 1 g/L, were not cytotoxic for fibroblasts (fibroblast growth > 90%). The biosurfactant extract obtained from CSW with ethyl acetate, at 1 g/L, showed the highest cytotoxic effect but above the cytotoxicity limit established by the UNE-EN-ISO10993-5. It is remarkable that the cell-bound biosurfactant produced by L. pentosus, at a concentration of 1 g/L, promoted the growth of the fibroblast up to 113%.

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.

Increased occurrence of hand eczema in young children following the Danish hand hygiene recommendations during the COVID-19 pandemic

BACKGROUND

During the first wave of the COVID-19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen.

OBJECTIVES

To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare.

METHODS

The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center.

RESULTS

Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing.

CONCLUSION

Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well-established prophylactic skin care might have spared a proportion of the children from developing hand eczema.

Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society

The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.

Allergens in Medical Hand Skin Cleansers

Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of "low-allergen" medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time.

Study of biosurfactant extract from corn steep water as a potential ingredient in antiacne formulations

Background: This is a novel work that includes the use of a biosurfactant extract obtained from corn milling industry (named BS-CSW), with antimicrobial activity, as ingredient in formulations to treat acne vulgaris. Methodology: With this purpose, it was established an incomplete experimental design with 3 independent variables, based on the concentration of non-nano zinc oxide (ZnO) (0-2%), BS-CSW (0-5%) and salicylic acid (0-2%). Results: This design allowed to obtain a theoretical model that calculates the inhibitory effect on Cutibacterium acnes (also named Propionibacterium acnes) for any formulation carried with the ingredients appointed before. It was observed a clear synergetic effect on the inhibition of C. acnes between ZnO and BS-CSW, in absence of salicylic acid. This fact allowed to reduce the concentration of ZnO, giving more ecofriendly and biocompatible formulations. Conclusions: It was observed that the biosurfactant extract, in formulations with intermediate concentration of ZnO (1%), possess an inhibitory effect on C. acnes considerably higher than ZnO alone and similar to ZnO (1%) with salicylic acid (1%). This fact demonstrates the enormous potential of this bioactive extract in antiacne formulations.