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Fuller J, Palmer A, Nixon R. An update on the performance of the Australian Baseline Series in detecting allergic contact dermatitis. Contact Dermatitis 2024. [PMID: 39137894 DOI: 10.1111/cod.14673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Affiliation(s)
- James Fuller
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
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2
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Burnett C, Bergfeld WF, Belsito DV, Klaassen CD, Liebler DC, Marks JG, Shank RC, Slaga TJ, Snyder PW, Fiume M, Heldreth B. Imidazolidinyl Urea. Int J Toxicol 2023; 42:53S-55S. [PMID: 37776363 DOI: 10.1177/10915818231204614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
The Expert Panel for Cosmetic Ingredient Safety reviewed updated information that has become available since their original assessment from 1980, along with updated information regarding product types, and frequency and concentrations of use, and reaffirmed their original conclusion that Imidazolidinyl Urea is safe as a cosmetic ingredient in the practices of use and concentration as described in this report.
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Affiliation(s)
- Christina Burnett
- Cosmetic Ingredient Review Senior Scientific Analyst/Writer, Washington, DC, USA
| | | | | | | | | | - James G Marks
- Expert Panel for Cosmetic Ingredient Safety Former Member
| | - Ronald C Shank
- Expert Panel for Cosmetic Ingredient Safety Former Member
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3
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Paulsen E. The sesquiterpene lactone mix: A review of past, present and future aspects. Contact Dermatitis 2023; 89:434-441. [PMID: 37820718 DOI: 10.1111/cod.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
The sesquiterpene lactones (SLs) are secondary plant metabolites, which are widespread in the Compositae/Asteraceae plant family. The first SLs were detected more than 100 years ago, and allergic contact dermatitis from Compositae has been reported since the beginning of the 1900s, but it was not until the late 1960s and early 1970s that a collaboration between dermatologists, chemists and botanists led to the detection of SLs as the main allergens of Compositae plants. In the 1980s, the SL mix, consisting of equimolar amounts of alantolactone, costunolide and dehydrocostus lactone, was developed as a screening agent for Compositae sensitisation. Today, after inclusion of SL mix in the baseline series, the mean prevalence of reactions in Europe is around 1%, and in North America 0.8%. In countries outside Europe and North America, the prevalence ranges between 0% and 10.7%. The detection rate of SL mix is lower than that of some plant extracts, and ideally, SL mix should be supplemented with a mix of SLs from locally prevalent allergenic plants. The prevalence of positive reactions to SL mix suggests continued baseline testing in most European countries, North America, New Zealand, Australia and probably some Chinese centres.
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Affiliation(s)
- Evy Paulsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense C, Denmark
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4
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de Groot AC, Rustemeyer T. 2-Hydroxyethyl methacrylate (HEMA): A clinical review of contact allergy and allergic contact dermatitis-Part 1. Introduction, epidemiology, case series and case reports. Contact Dermatitis 2023; 89:401-433. [PMID: 37752620 DOI: 10.1111/cod.14405] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023]
Abstract
2-Hydroxyethyl methacrylate (HEMA) has been increasingly recognised as a contact allergen and was added to the European baseline series in 2019. In this article (2 parts), the results of an extensive literature review of the clinical aspects of contact allergy/allergic contact dermatitis to HEMA are presented. In part 1, the epidemiology of HEMA contact allergy is discussed and detailed information on published case series and case reports presented. HEMA is an important cause of contact allergy/allergic contact dermatitis in North America and Europe with recent prevalences of >3% in the USA + Canada and 1.5%-3.7% in Europe. Currently, most cases are caused by nail cosmetics, both in consumers and professional nail stylists. In our literature review, we have found 24 studies presenting case series of patients with allergic contact dermatitis attributed to HEMA and 168 case reports. However, the presence of HEMA in the products causing ACD was established in only a minority. Part 2 will discuss cross- and co-sensitisation, and other skin reactions to HEMA, will assess whether HEMA is the most frequent (meth)acrylate allergen and how sensitive HEMA as a screening agent is, investigate the presence of HEMA in commercial products and provide practical information on patch testing procedures.
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Affiliation(s)
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, AZ, The Netherlands
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5
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Patel K, Palmer A, Nixon R. Allergic contact dermatitis from propylene glycol: A case series from Australia. Contact Dermatitis 2023. [PMID: 37100088 DOI: 10.1111/cod.14325] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Propylene glycol (PG) is used in a variety of cosmetics, food and pharmaceuticals. PG is a known sensitizer but also irritating when patch tested (PT). OBJECTIVES The aims were to investigate the frequency of contact sensitization to PG and to identify cases of allergic contact dermatitis (ACD). METHODS A retrospective study was performed on patients PT at the Skin Health Institute (SHI), Victoria, Australia to PG 5% pet. and PG 10% aq. between 1 January 2005 and 31 December 2020. RESULTS In all, 6761 patients were PT to PG and 21 (0.31%) reacted. Of those 21 individuals, 9 (42.9%) had a relevant reaction. 75% of relevant positive reactions were in patients PT to PG 10% aq. The most common source of PG exposure was topical medicaments (77.8% of relevant reactions) and moisturizers, with the largest group being topical corticosteroids. CONCLUSION Contact sensitization to PG in the patch test population remains uncommon, although it is possible that testing with concentrations of 5%-10% PG did not identify all reactions. Topical corticosteroids were the most important cause. Patients with suspected contact dermatitis to topical corticosteroids should be PT to PG.
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Affiliation(s)
- Kajal Patel
- Skin Health Institute, Carlton, Victoria, Australia
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6
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Midander K, Werner P, Isaksson M, Wisgrill L, Lidén C, Fyhrquist N, Julander A. Cobalt nanoparticles cause allergic contact dermatitis in humans. Br J Dermatol 2023; 188:278-287. [PMID: 36637098 DOI: 10.1093/bjd/ljac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cobalt (Co) causes allergic contact dermatitis (ACD) and the emerging use of Co nanoparticles (CoNPs) warrants gaining further insight into its potential to elicit ACD in sensitized individuals. OBJECTIVES The aims of the study were to clarify to what extent CoNPs may elicit ACD responses in participants with Co contact allergy, and to evaluate whether the nanoparticles cause a distinct immune response compared with cobalt chloride (CoCl2) in the skin reactions. METHODS Fourteen individuals with Co contact allergy were exposed to CoNPs, CoCl2, a Co-containing hard-metal disc (positive control), and an empty test chamber (negative control) by patch testing. Allergic responses were evaluated clinically by a dermatologist at Days 2, 4 and 7. At Day 2, patch-test chambers were removed, and remaining test-substance and skin-wipe samples were collected for inductive-coupled plasma mass spectrometry (ICP-MS) analysis. Additionally, skin biopsies were taken from patch-test reactions at Day 4 for quantitative real-time polymerase chain reaction analysis, histopathology and ICP-MS analysis of Co skin penetration. RESULTS Patch testing with CoNPs elicited allergic reactions in Co-sensitized individuals. At all timepoints, clinical assessment revealed significantly lower frequencies of positive patch-test reactions to CoNPs compared with CoCl2 or to the positive control. CoNPs elicited comparable immune responses to CoCl2. Chemical analysis of Co residues in patch-test filters, and on skin, shows lower doses for CoNPs compared with CoCl2. CONCLUSIONS CoNPs potently elicit immune responses in Co-sensitized individuals. Even though patch testing with CoNPs resulted in a lower skin dose than CoCl2, identical immunological profiles were present. Further research is needed to identify the potential harm of CoNPs to human health.
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Affiliation(s)
- Klara Midander
- IVL Swedish Environmental Research Institute, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paulina Werner
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marléne Isaksson
- Lund University, Department of Occupational and Environmental Dermatology, Skane University Hospital Malmö, Malmö, Sweden
| | - Lukas Wisgrill
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Carola Lidén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anneli Julander
- IVL Swedish Environmental Research Institute, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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7
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Uter W, Strahwald J, Hallmann S, Johansen JD, Havmose MS, Kezic S, van der Molen HF, Macan J, Babić Ž, Franić Z, Macan M, Turk R, Symanzik C, Weinert P, John SM. Systematic review on skin adverse effects of important hazardous hair cosmetic ingredients with a focus on hairdressers. Contact Dermatitis 2023; 88:93-108. [PMID: 36254351 DOI: 10.1111/cod.14236] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The burden of occupational hand eczema in hairdressers is high, and (partly strong) allergens abound in the hair cosmetic products they use. OBJECTIVES To systematically review published evidence concerning contact allergy to an indicative list of active ingredients of hair cosmetics, namely, p-phenylenediamine (PPD), toluene-2,5-diamine (PTD), persulfates, mostly ammonium persulfate (APS), glyceryl thioglycolate (GMTG), and ammonium thioglycolate (ATG), concerning the prevalence of sensitization, particularly in terms of a comparison (relative risk; RR) between hairdressers and non-hairdressers. METHODS Following a PROSPERO-registered and published protocol, eligible literature published from 2000 to February 2021 was identified, yielding 322 publications, and extracted in standardized publication record forms, also considering risk of bias. RESULTS Based on 141 publications, the contact allergy prevalence to PPD was 4.3% (95% CI: 3.8-4.9%) in consecutively patch tested patients. Other ingredients were mostly tested in an aimed fashion, yielding variable, and partly high contact allergy prevalences. Where possible, the RR was calculated, yielding an average increased sensitization risk in hairdressers of between 5.4 (PPD) and 3.4 (ATG). Additional evidence related to immediate-type hypersensitivity, experimental results, exposures, and information from case reports was qualitatively synthesized. CONCLUSIONS An excess risk of contact allergy is clearly evident from the pooled published evidence from the last 20 years. This should prompt an improvement in working conditions and product safety.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Germany
| | - Julia Strahwald
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Germany
| | - Sarah Hallmann
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen/Nürnberg, Erlangen, Germany
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
| | - Martin S Havmose
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark
| | - Sanja Kezic
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jelena Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Željka Babić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Zrinka Franić
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Marija Macan
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Rajka Turk
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
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Kairey L, Agnew T, Bowles EJ, Barkla BJ, Wardle J, Lauche R. Efficacy and safety of Melaleuca alternifolia (tea tree) oil for human health-A systematic review of randomized controlled trials. Front Pharmacol 2023; 14:1116077. [PMID: 37033604 PMCID: PMC10080088 DOI: 10.3389/fphar.2023.1116077] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/04/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: Leaves of the Australian tea tree plant Melaleuca alternifolia were used traditionally by First Nations Australians for treating wounds, burns, and insect bites. Tea tree oil, the essential oil steam-distilled from M. alternifolia, is well-known for its medicinal properties, the evidence for most applications however is limited. This review aimed to critically appraise evidence from clinical trials examining the therapeutic efficacy and safety of tea tree oil on outcomes. Methods: Randomized controlled trials with participants of any age, gender, or health status, comparing tea tree oil to any control were included, without limit on publication date. Electronic databases were searched on 12 August 2022 with additional records sourced from article reference sections, reviews, and industry white papers. Risk of bias was assessed by two authors independently using the Cochrane risk-of-bias 1.0 tool. Results were summarized and synthesized thematically. Results: Forty-six articles were eligible from the following medical fields (Dentistry n = 18, Dermatology n = 9, Infectious disease n = 9, Ophthalmology n = 6, Podiatry n = 3; and Other n = 1). Results indicate that oral mouthwashes with 0.2%-0.5% tea tree oil may limit accumulation of dental plaque. Gels containing 5% tea tree oil applied directly to the periodontium may aid treatment of periodontitis as an adjunctive therapy to scaling and root planing. More evidence is needed to confirm the benefits of tea tree oil for reducing acne lesions and severity. Local anti-inflammatory effects on skin, if any, also require further elucidation. Topical tea tree oil regimens show similar efficacy to standard treatments for decolonizing the body from methicillin-resistant Staphylococcus aureus, although intra-nasal use of tea tree oil may cause irritation to mucous membranes. Tea tree oil with added iodine may provide an effective treatment for molluscum contagiosum lesions in young children. More evidence on efficacy of tea tree oil-based eyelid wipes for Demodex mite control are needed. Side effects were reported in 60% of included studies and were minor, except where tea tree oil was applied topically in concentrations ≥ 25%. Discussion: Overall, the quality of research was poor to modest and higher quality trials with larger samples and better reporting are required to substantiate potential therapeutic applications of tea tree oil. Systematic Review Registration: PROSPERO, identifier [CRD42021285168].
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Affiliation(s)
- Lana Kairey
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Tamara Agnew
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Esther Joy Bowles
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Bronwyn J. Barkla
- Southern Cross Plant Science, Faculty of Science and Engineering, Southern Cross University, Lismore, NSW, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Romy Lauche
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
- *Correspondence: Romy Lauche,
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9
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Symanzik C, Weinert P, Babić Ž, Hallmann S, Havmose MS, Johansen JD, Kezic S, Macan M, Macan J, Strahwald J, Turk R, van der Molen HF, John SM, Uter W. Skin Toxicity of Selected Hair Cosmetic Ingredients: A Review Focusing on Hairdressers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7588. [PMID: 35805241 PMCID: PMC9265752 DOI: 10.3390/ijerph19137588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022]
Abstract
The safety assessment of cosmetics considers the exposure of a 'common consumer', not the occupational exposure of hairdressers. This review aims to compile and appraise evidence regarding the skin toxicity of cysteamine hydrochloride (cysteamine HCl; CAS no. 156-57-0), polyvinylpyrrolidone (PVP; CAS no. 9003-39-8), PVP copolymers (CAS no. 28211-18-9), sodium laureth sulfate (SLES; CAS no. 9004-82-4), cocamide diethanolamine (cocamide DEA; CAS no. 68603-42-9), and cocamidopropyl betaine (CAPB; CAS no. 61789-40-0). A total of 298 articles were identified, of which 70 were included. Meta-analysis revealed that hairdressers have a 1.7-fold increased risk of developing a contact allergy to CAPB compared to controls who are not hairdressers. Hairdressers might have a higher risk of acquiring quantum sensitization against cysteamine HCl compared to a consumer because of their job responsibilities. Regarding cocamide DEA, the irritant potential of this surfactant should not be overlooked. Original articles for PVP, PVP copolymers, and SLES are lacking. This systematic review indicates that the current standards do not effectively address the occupational risks associated with hairdressers' usage of hair cosmetics. The considerable irritant and/or allergenic potential of substances used in hair cosmetics should prompt a reassessment of current risk assessment practices.
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Affiliation(s)
- Cara Symanzik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, 49076 Osnabrueck, Germany; (P.W.); (S.M.J.)
| | - Patricia Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, 49076 Osnabrueck, Germany; (P.W.); (S.M.J.)
| | - Željka Babić
- Institute for Medical Research and Occupational Health, HR 10001 Zagreb, Croatia; (Ž.B.); (M.M.); (J.M.); (R.T.)
| | - Sarah Hallmann
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen, 91054 Erlangen, Germany; (S.H.); (J.S.); (W.U.)
| | - Martin Stibius Havmose
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, 2900 Copenhagen, Denmark; (M.S.H.); (J.D.J.)
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Skin and Allergy, University of Copenhagen, Gentofte Hospital, 2900 Copenhagen, Denmark; (M.S.H.); (J.D.J.)
| | - Sanja Kezic
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.K.); (H.F.v.d.M.)
| | - Marija Macan
- Institute for Medical Research and Occupational Health, HR 10001 Zagreb, Croatia; (Ž.B.); (M.M.); (J.M.); (R.T.)
| | - Jelena Macan
- Institute for Medical Research and Occupational Health, HR 10001 Zagreb, Croatia; (Ž.B.); (M.M.); (J.M.); (R.T.)
| | - Julia Strahwald
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen, 91054 Erlangen, Germany; (S.H.); (J.S.); (W.U.)
| | - Rajka Turk
- Institute for Medical Research and Occupational Health, HR 10001 Zagreb, Croatia; (Ž.B.); (M.M.); (J.M.); (R.T.)
| | - Henk F. van der Molen
- Amsterdam UMC, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.K.); (H.F.v.d.M.)
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) and Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, 49076 Osnabrueck, Germany; (P.W.); (S.M.J.)
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen, 91054 Erlangen, Germany; (S.H.); (J.S.); (W.U.)
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10
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Cheng HS, Konya J, Lobel E, Fernandez-Penas P. Australian baseline series allergens in assessment of allergic contact dermatitis in New South Wales. Australas J Dermatol 2021; 63:e78-e80. [PMID: 34751435 DOI: 10.1111/ajd.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/23/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Harriet Sara Cheng
- The Skin Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Konya
- The Skin Hospital, Sydney, New South Wales, Australia
| | - Edmund Lobel
- The Skin Hospital, Sydney, New South Wales, Australia
| | - Pablo Fernandez-Penas
- The Skin Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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11
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Warshaw EM, Ruggiero JL, DeKoven JG, Pratt MD, Silverberg JI, Maibach HI, Zug KA, Atwater AR, Taylor JS, Reeder MJ, Sasseville D, Fowler JF, Fransway AF, Belsito DV, DeLeo VA, Houle MC, Dunnick CA. Patch Testing with Ammonium Persulfate: The North American Contact Dermatitis Group Experience, 2015-2018. J Am Acad Dermatol 2021; 87:1014-1023. [PMID: 34390784 DOI: 10.1016/j.jaad.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions including allergic contact dermatitis. OBJECTIVE To characterize positive patch test reactions to APS (2.5% pet). METHODS Retrospective analysis of patients tested to the North American Contact Dermatitis Group (NACDG) screening series from 2015-2018. RESULTS Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared to negative patients, APS-positive patients were significantly more likely to be male (43.2% vs. 28.0%, p<0.0001), have primary hand (30.2% vs. 22.0%, p=0.0064), scattered generalized (25.5% vs. 17.9%, p=0.0064), or trunk dermatitis (8.9% vs. 4.9%, p=0.0123), and occupationally-related dermatitis (22.2% vs. 10.9%, p<0.0001). Over half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially (68.4%) hairdressers. Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common APS sources. LIMITATIONS Immediate reactions and follow-up testing not captured. CONCLUSIONS The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals are important sources of APS exposure.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, University of Minnesota, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center
| | - Jenna L Ruggiero
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center; University of Minnesota Medical School, Minneapolis, MN.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, NY
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
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12
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Seine AJ, Baird EA, Chan L, Davis A, Greig D, Judd LE, Mahon C, Oakley A, Rademaker M, Reiche L, Stanway AD, Cheng HS. A baseline patch test series for New Zealand. Australas J Dermatol 2021; 62:489-495. [PMID: 34293187 DOI: 10.1111/ajd.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patch testing is the gold standard diagnostic test for allergic contact dermatitis and needs to be relevant to the region and the population being tested. The aim of this study was to develop a specific New Zealand baseline series (NZBS). METHOD We performed a retrospective case note review of patients attending four regional patch test centres between 2008 and 2020. Demographic and diagnostic information was collected for each patient along with results of patch testing. Using the results of this review, a group of 11 dermatologists with an interest in contact dermatitis agreed on a core group of allergens for inclusion in an NZBS, based on the frequency of positive reactions and allergens of interest. The remaining potential allergens were ranked by each dermatologist using an online questionnaire, with inclusion in the final NZBS by consensus. RESULTS Results from 2402 patients (67% female, mean age 44 years) from Auckland, Wellington, Palmerston North and Christchurch were collated. The 10 most frequent positive (relevant and non-relevant) allergens were nickel sulfate (22.0%), fragrance mix I (8.6%), cobalt chloride (7.3%), Myroxylon pereirae (5.6%), colophonium (5.1%), p-phenylenediamine (4.9%), methylisothiazolinone/methylchloroisothiazolinone (4.1%), fragrance mix II (3.9%), potassium dichromate (3.5%) and methylisothiazolinone (3.4%). Based on these results, a core series of 30 allergens was developed, with an additional 30 allergens added to form the extended series (total 60 allergens). CONCLUSION The baseline series of patch test allergens for routine use in New Zealand (NZBS) is based on national patch test data and expert consensus.
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Affiliation(s)
- Adrian J Seine
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand
| | | | - Lydia Chan
- Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand
| | | | - Deborah Greig
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand.,Department of Dermatology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Caroline Mahon
- Department of Dermatology, Canterbury District Health Board, Christchurch, New Zealand.,University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Amanda Oakley
- Department of Dermatology, Waikato District Health Board, Hamilton, New Zealand.,Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences Hamilton, Hamilton, New Zealand
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland's Faculty of Medical and Health Sciences Hamilton, Hamilton, New Zealand
| | | | | | - Harriet S Cheng
- Department of Dermatology, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Scheinman PL, Vocanson M, Thyssen JP, Johansen JD, Nixon RL, Dear K, Botto NC, Morot J, Goldminz AM. Contact dermatitis. Nat Rev Dis Primers 2021; 7:38. [PMID: 34045488 DOI: 10.1038/s41572-021-00271-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
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Affiliation(s)
- Pamela L Scheinman
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marc Vocanson
- CIRI - Centre International de Recherche en Infectiologie, INSERM, U1111; Univ Lyon; Université Claude Bernard Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR, 5308, Lyon, France
| | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rosemary L Nixon
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Kate Dear
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Johanna Morot
- CIRI - Centre International de Recherche en Infectiologie, INSERM, U1111; Univ Lyon; Université Claude Bernard Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR, 5308, Lyon, France
| | - Ari M Goldminz
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
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14
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Patch Testing to Methyldibromoglutaronitrile/Phenoxyethanol: North American Contact Dermatitis Group Experience, 1994-2018. Dermatitis 2021; 32:256-266. [PMID: 33675328 DOI: 10.1097/der.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) is a broad-spectrum preservative mixture used in consumer and industrial products. OBJECTIVES The aims of the study were (1) to characterize the prevalence and clinical relevance of patch test reactions to MDBGN/PE and the epidemiology of positive patients and (2) to determine the frequency of concomitant reactions of MDBGN/PE and its components. METHODS This study used a retrospective analysis of cross-sectional data compiled by the North American Contact Dermatitis Group from 1994 to 2018. RESULTS Of 55,477 tested patients, 2674 (4.8%) had positive patch test reactions to MDBGN/PE (1.0%-2.5% petrolatum [pet]); most were + (63.3%) or ++ (22.3%). Clinical relevance was considered definite in 3.0% and probable in 19.3% of reactions. Common dermatitis sites included the hands (26.4%), scattered/generalized distribution (24.7%), and the face (18.3%). Patients with a positive reaction to MDBGN/PE and/or MDBGN and/or PE were significantly more likely to be male and older than 40 years and/or had hand dermatitis (P ≤ 0.0033). Positivity to MDBGN/PE 2.0% pet decreased significantly over time (from 6.0% in 1998-2000 to 2.5% in 2017-2018, P < 0.0001). Personal care products were the most common exposure source (53.2%). CONCLUSIONS Over time, positivity to MDBGN/PE 2.0% pet decreased significantly from 6.0% (in 1998-2000) to 2.5% (in 2017-2018). The high proportion of weak (63.3%) reactions underscore the need for careful interpretation of patch test sites. Important demographic associations included male sex and age older than 40 years.
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15
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Dear K, Palmer A, Nixon R. Contact allergy and allergic contact dermatitis from benzalkonium chloride in a tertiary dermatology center in Melbourne, Australia. Contact Dermatitis 2021; 85:146-153. [PMID: 33656745 DOI: 10.1111/cod.13826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer. OBJECTIVE To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients. METHODS We conducted a single-center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019. RESULTS Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear. CONCLUSION Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID-19) pandemic is likely to further expose people to BAK.
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Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
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16
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Aerts O, Rustemeyer T, Wilkinson M. Comments on Various Baseline Series for Patch Testing. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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The Chinese Baseline Series. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Mizutani H, Nixon RL. The Australian Baseline Series. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016. Dermatitis 2020; 32:232-244. [PMID: 33273233 DOI: 10.1097/der.0000000000000675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population. METHODS The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure. RESULTS A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively). CONCLUSIONS Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.
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20
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Felmingham C, Davenport R, Palmer A, Nixon RL. Vulval allergic contact dermatitis: Medicaments are a common cause. Australas J Dermatol 2020; 61:388-390. [PMID: 32940345 DOI: 10.1111/ajd.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Claire Felmingham
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Vic, Australia
| | - Rachael Davenport
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Vic, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Vic, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Vic, Australia
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21
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Thetkathuek A, Yingratanasuk T, Ekburanawat W, Jaidee W, Sa-Ngiamsak T. The risk factors for occupational contact dermatitis among workers in a medium density fiberboard furniture factory in Eastern Thailand. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:255-265. [PMID: 32924862 DOI: 10.1080/19338244.2020.1819185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to determine the occupational exposure to formaldehyde on the medium-density fiberboard (MDF) dust and allergic contact dermatitis among the workers at a furniture factory. Data were collected from 439 subjects using questionnaires and patch testing to evaluate allergic contact dermatitis resulting from formaldehyde on wood dust exposure in the workplace. The geometric mean concentration of formaldehyde on MDF dust that the workers in the production department were exposed to was 2.07 ppm (GSD 4.54). Patch test results revealed that some subjects developed allergy to various substances, including epoxy resin (16.7%) and formaldehyde (5.6%). The odds ratios (95% CI) for contact dermatitis were 3.6 (1.7-7.3) among those with a history of metal allergy, 1.8 (0.6-5.2) whose family members having a history of allergic contact dermatitis. Exposure to MDF dust in the workplace should be reduced, as the current levels of exposure exceed the permissible OSHA standard.
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Affiliation(s)
- Anamai Thetkathuek
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Tanongsak Yingratanasuk
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Wiwat Ekburanawat
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Wanlop Jaidee
- Department of Public Health Foundations, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Teerayuth Sa-Ngiamsak
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
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Dear K, Bala H, Palmer A, Nixon RL. How good is the Australian baseline series at detecting allergic contact dermatitis? Australas J Dermatol 2020; 62:51-56. [DOI: 10.1111/ajd.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Rosemary Louise Nixon
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
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23
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Hedberg YS. Chromium and leather: a review on the chemistry of relevance for allergic contact dermatitis to chromium. JOURNAL OF LEATHER SCIENCE AND ENGINEERING 2020. [DOI: 10.1186/s42825-020-00027-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
As other causes decline in importance, chromium-tanned leather has become a more important source for chromium allergy, which affects around 1% of the general population. The aim of this review is to give suggestions on how to minimize the risk of leather-related allergic contact dermatitis, which can be elicited in chromium-allergic persons by hexavalent and trivalent chromium released from leather. Hexavalent chromium is the more potent chromium form and requires a lower skin dose to elicit allergic reactions. It is formed on the surface of some, antioxidant-free, leathers at dry conditions (< 35% relative humidity) and is influenced by the tanning process and other conditions, such as UV irradiation, contact with alkaline solutions, and leather age. Trivalent chromium is the dominant form released from chromium-tanned leather and its released amount is sufficient to elicit allergic reactions in some chromium-allergic individuals when they are exposed repetitively and over longer time (days – months). A low initial test result (< 3 mg/kg) for hexavalent chromium with the current standard test (ISO 17075) does not guarantee a low release of chromium from the leather or a low release of hexavalent chromium under typical exposure conditions during the service life of the leather. Information, labels, and certificates regarding leather products are often insufficient to protect chromium-allergic individuals. Correct labelling and information on the possible content of different allergens, as well as different tanning alternatives for certain leather products, are crucial.
Graphical abstract
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24
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Smart C, Cheng HS. Poor correlation of patient‐reported skin contact reactions with patch testing. Australas J Dermatol 2020; 61:90-92. [DOI: 10.1111/ajd.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Charlotte Smart
- Department of Dermatology Auckland District Health Board Auckland New Zealand
| | - Harriet Sara Cheng
- Department of Dermatology Auckland District Health Board Auckland New Zealand
- Department of Medicine The University of Auckland Auckland New Zealand
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An N, Pourzal S, Luccioli S, Vukmanović S. Effects of diet on skin sensitization by nickel, poison ivy, and sesquiterpene lactones. Food Chem Toxicol 2020; 137:111137. [PMID: 31982450 DOI: 10.1016/j.fct.2020.111137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/20/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
Skin contact or exposure to sensitizers often occurs as a consequence of occupational exposures (e.g. poison ivy in forestry), wearing jewelry (e.g. nickel), or use of cosmetics (e.g. fragrances). However, many of the known skin sensitizers or their chemical variants are also consumed orally through foods or other sources. Since oral exposure to antigenic substances can lead to tolerance, consumption of sensitizers may impact the development and potency of skin sensitization, especially if the sensitizer is consumed early in life, prior to the first skin contact. To address this issue, we have reviewed human clinical and epidemiological literature relevant to this subject and evaluated whether early oral exposures to relevant sensitizers, or their chemical variants, are associated with reduced prevalence of skin sensitization to three main allergic sensitizers - nickel, urushiols of poison ivy, and sesquiterpene lactones of chrysanthemum and other plants.
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Affiliation(s)
- Nan An
- Cosmetics Division, Office of Cosmetics and Colors (OCAC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | - Selma Pourzal
- Cosmetics Division, Office of Cosmetics and Colors (OCAC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | - Stefano Luccioli
- Office of Compliance (OC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA
| | - Stanislav Vukmanović
- Cosmetics Division, Office of Cosmetics and Colors (OCAC), Center for Food Safety and Applied Nutrition (CFSAN), Food and Drug Administration (FDA), USA.
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Veverka KK, Davis MDP. Dubiously Doubtful: An Exploration of the Literature Concerning Doubtful, Macular Erythema, “?+,” and “+/−” Patch Test Reactions. Dermatitis 2020; 31:36-41. [DOI: 10.1097/der.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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The Australian Baseline Series. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_68-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Comments on Various Baseline Series. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_95-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Comments on Various Baseline Series for Patch Testing. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_95-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Felmingham C, Davenport R, Bala H, Palmer A, Nixon R. Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series. Australas J Dermatol 2019; 61:33-38. [PMID: 31630402 DOI: 10.1111/ajd.13169] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing. METHODS We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch-testing centres in Melbourne, Victoria. RESULTS A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium. CONCLUSION Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.
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Affiliation(s)
- Claire Felmingham
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rachael Davenport
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia
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31
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Lyapina MG, Stoyanova Dencheva M. Contact sensitization to ingredients of dental materials and cosmetics in dental students: a pilot study. Cent Eur J Public Health 2019; 27:73-77. [PMID: 30927402 DOI: 10.21101/cejph.a4756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the rate of contact sensitization to selected cosmetic allergens, i.e. ingredients of dental materials, in students of dental medicine and dental patients. METHODS A total of 50 participants were included in the study: 40 students of dental medicine exposed to the studied allergens during the course of practical education; and 10 randomly selected dental patients without occupational exposure to the investigated substances served as a control group. All of them were patch-tested with colophonium, myroxylon pereirae resin, paraben mix, fragrance mix I, isopropyl myristate, triclosan, polysorbate 80, compositae mix II, and hydroperoxides of limonene. RESULTS The sensitization rates for colophonium and polysorbate 80 were the highest. For the group of dental students, we established significantly higher sensitization rate for colophonium compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ2 = 4.93; p = 0.026), paraben mix (χ2 = 3.6; p = 0.05), isopropyl myristate (χ2 = 6.56; p = 0.01), and triclosan (χ2 = 8.5; p < 0.001); and to polysorbate 80 compared to the ones for myroxylon pereirae resin and hydroperoxides of limonene (χ2 = 3.97; p = 0.046), isopropyl myristate (χ2 = 5.47; p = 0.02) and triclosan (χ2 = 7.34; p = 0.007). Significantly increased concomitant sensitization rate to compositae mix and to hydroperoxides of limonene was established (χ2 = 12.55; p < 0.001). Generally, the incidence of concomitant sensitization to the studied allergens in the whole studied population was high. CONCLUSIONS Colophonium and polysorbate 80 could be outlined as sensitizers of paramount importance for both dental students and dental patients. We consider the major importance of exposure to colophonium during the course of practical education in dentistry for the onset of the sensitization. Sensitization to compositae mix was observed only among dental students. We consider the leading role of consumer exposure for the onset of the sensitization to triclosan and to hydroperoxides of limonene. Unexpected and unreported reactions of concomitant sensitization were observed.
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Affiliation(s)
| | - Maria Stoyanova Dencheva
- Department of Oral and Image Diagnostic, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria
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Stingeni L, Tramontana M, Bianchi L, Foti C, Patruno C, Gallo R, Corazza M, Schena D, Milanesi N, Guarneri F, Bini V, Hansel K. Contact sensitivity to 2‐hydroxyethyl methacrylate in consecutive patients: A 1‐year multicentre SIDAPA study. Contact Dermatitis 2019; 81:216-218. [DOI: 10.1111/cod.13278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
| | - Marta Tramontana
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human OncologyUniversity of Bari Bari Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences DepartmentMagna Graecia University Catanzaro Italy
| | - Rosella Gallo
- Section of Dermatology, Department of Health Sciences (DiSSAL)University of Genoa, Ospedale Policlinico San Martino Genoa Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical SciencesUniversity of Ferrara Ferrara Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of MedicineUniversity of Verona Italy
| | - Nicola Milanesi
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational MedicineUniversity of Florence Verona Italy
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental MedicineUniversity of Messina Messina Italy
| | - Vittorio Bini
- Endocrine and Metabolic Sciences Section, Department of MedicineUniversity of Perugia Perugia Italy
| | - Katharina Hansel
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
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Bingham LJ, Tam MM, Palmer AM, Cahill JL, Nixon RL. Contact allergy and allergic contact dermatitis caused by lavender: A retrospective study from an Australian clinic. Contact Dermatitis 2019; 81:37-42. [DOI: 10.1111/cod.13247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mei M. Tam
- Skin and Cancer Foundation Inc. Carlton Victoria Australia
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de Groot AC. Myroxylon pereirae
resin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets. Contact Dermatitis 2019; 80:335-353. [DOI: 10.1111/cod.13263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
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Zou Y, Li LF. The Chinese Baseline Series. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_67-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Harris AG, Saikal SL, Scurry J, Relic J, Nixon RL, Chee P. Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia? Australas J Dermatol 2018; 60:53-56. [PMID: 30155971 DOI: 10.1111/ajd.12910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/22/2018] [Indexed: 11/28/2022]
Abstract
Despite being a well-recognised cause of allergic contact dermatitis with an embargo in many countries around the world, bufexamac is available over the counter in topical preparations in Australia. We present a series of patients who developed severe cutaneous eruptions after the topical application of bufexamac containing preparations to highlight the potential risks of this medication, as well as advocate for the reconsideration of its registration by the Therapeutic Goods Administration in Australia.
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Affiliation(s)
- Adam G Harris
- Department of Dermatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Samra L Saikal
- Department of Dermatology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jim Scurry
- Department of Anatomical Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - John Relic
- Department of Dermatology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
| | - Paul Chee
- Department of Dermatology, John Hunter Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Flury U, Palmer A, Nixon R. The methylisothiazolinone contact allergy epidemic in Australia. Contact Dermatitis 2018; 79:189-191. [DOI: 10.1111/cod.13025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/15/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ursula Flury
- Skin & Cancer Foundation Inc.; Carlton Victoria Australia
- Luzerner Kantonsspital (LUKS); Luzern Switzerland
| | - Amanda Palmer
- Skin & Cancer Foundation Inc.; Carlton Victoria Australia
| | - Rosemary Nixon
- Skin & Cancer Foundation Inc.; Carlton Victoria Australia
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38
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Wilkinson M, Gallo R, Goossens A, Johansen JD, Rustemeyer T, Sánchez-Pérez J, Schuttelaar ML, Uter W. A proposal to create an extension to the European baseline series. Contact Dermatitis 2017; 78:101-108. [PMID: 29194657 DOI: 10.1111/cod.12918] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/04/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current European baseline series consists of 30 allergens, and was last updated in 2015. OBJECTIVES To use data from the European Surveillance System on Contact Allergies (ESSCA) to propose an extension to the European baseline series in response to changes in environmental exposures. METHODS Data from departmental and national extensions to the baseline series, together with some temporary additions from departments contributing to the ESSCA, were collated during 2013-2014. RESULTS In total, 31689 patients were patch tested in 46 European departments. Many departments and national groups already consider the current European baseline series to be a suboptimal screen, and use their own extensions to it. The haptens tested are heterogeneous, although there are some consistent themes. Potential haptens to include in an extension to the European baseline series comprise sodium metabisulfite, formaldehyde-releasing preservatives, additional markers of fragrance allergy, propolis, Compositae mix, and 2-hydroxyethyl methacrylate. CONCLUSION In combination with other published work from the ESSCA, changes to the current European baseline series are proposed for discussion. As well as addition of the allergens listed above, it is suggested that primin and clioquinol should be deleted from the series, owing to reduced environmental exposure.
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Affiliation(s)
- Mark Wilkinson
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, LS7 4SA, UK
| | - Rosella Gallo
- Clinica Dermatologica, Department of Health Sciences (DiSSAL), Università di Genova, Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, 3000, Leuven, Belgium
| | - Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900, Hellerup, Denmark
| | - Thomas Rustemeyer
- Department of Dermatology, Free University of Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | | | - Marie L Schuttelaar
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, 9713 GZ, Groningen, The Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054, Erlangen, Germany
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Ge L, O'Connor AA, Polcz MM, Sebaratnam DF. A cheeky diagnosis. Med J Aust 2016; 205:520. [PMID: 27927147 DOI: 10.5694/mja16.01002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 09/05/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ludi Ge
- Royal Prince Alfred Hospital, Sydney, NSW
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Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis 2016; 75:213-22. [PMID: 27436328 DOI: 10.1111/cod.12616] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD). OBJECTIVES To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic. METHODS A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014. RESULTS Of 685 HCWs assessed in the clinic over a period of 22 years, 555 (81.0%) were diagnosed with OSD. The most common diagnosis was irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). Natural rubber latex allergy was also relatively frequent (13.0%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulfide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred more frequently than ACD caused by alcohol-based hand rubs (ABHRs). Occupational ICD was mostly caused by water/wet work and hand cleansers, and environmental irritants such as heat and sweating. CONCLUSIONS Understanding the causes of OSD in HCWs is important in order to develop strategies for prevention. We suggest that skin care advice should be incorporated into hand hygiene education. The use of ABHRs should be encouraged, weak allergens in skin cleansers should be substituted, and accelerator-free gloves should be recommended for HCWs with OSD.
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Affiliation(s)
- Claire L Higgins
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
| | - Amanda M Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Jennifer L Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
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43
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de Groot AC, Schmidt E. Tea tree oil: contact allergy and chemical composition. Contact Dermatitis 2016; 75:129-43. [DOI: 10.1111/cod.12591] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/16/2023]
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Evaluation of Functionality and Biological Responses of Mytilus galloprovincialis after Exposure to Quaternium-15 (Methenamine 3-Chloroallylochloride). Molecules 2016; 21:144. [PMID: 26821003 PMCID: PMC6273939 DOI: 10.3390/molecules21020144] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 11/19/2022] Open
Abstract
Although the irritant effects of quaternium-15 have been established, little is known about the toxicological consequences induced by this xenobiotic on aquatic invertebrates. The present article reports toxicological, histological and physiological effects of quaternium-15 following the exposure of Mytilus galloprovincialis for 18 days at three different concentrations (0.1, 1.0 and 2.0 mg/L). The results demonstrate that at higher concentrations histological damages to M. galloprovincialis gills occur, like melanosis, light exfoliations, increase of mucus production and infiltrative inflammation. In addition digestive gland cells of M. galloprovincialis, were not able to perform the regulation volume decrease (RVD) owing to osmotic stress following the exposure to the preservative. Overall, this first study on quaternium-15 highlights that it can jeopardize both the morphology and vital physiological processes in marine invertebrates, depending on the duration of exposure and the concentration of the preservative, indicating that further studies are necessary to increase our knowledge about the effects of this substance, commonly added to our products of daily use.
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Tizi S, Nixon RL. Patch testing in Australia: Is it adequate? Australas J Dermatol 2015; 57:192-8. [DOI: 10.1111/ajd.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Stephanie Tizi
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
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Hammer KA. Treatment of acne with tea tree oil (melaleuca) products: a review of efficacy, tolerability and potential modes of action. Int J Antimicrob Agents 2014; 45:106-10. [PMID: 25465857 DOI: 10.1016/j.ijantimicag.2014.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 01/10/2023]
Abstract
Over-the-counter acne treatments containing tea tree oil from the plant Melaleuca alternifolia are widely available, and evidence indicates that they are a common choice amongst those self-treating their acne. The aims of this review were to collate and evaluate the clinical evidence on the use of tea tree oil products for treating acne, to review safety and tolerability and to discuss the underlying modes of therapeutic action.
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Affiliation(s)
- K A Hammer
- School of Pathology and Laboratory Medicine (M504), Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, Perth 6009, WA, Australia.
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