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Kaur A, Higgins CL, Nixon RL. Allergic contact dermatitis to Flexi-Trak™ dressing. Contact Dermatitis 2024; 91:429-430. [PMID: 39001655 DOI: 10.1111/cod.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/15/2024] [Accepted: 06/23/2024] [Indexed: 10/05/2024]
Affiliation(s)
- Amreeta Kaur
- Occupational Dermatology Research and Education Centre (ODREC), Skin Health Institute, Carlton, Victoria, Australia
| | - Claire L Higgins
- Occupational Dermatology Research and Education Centre (ODREC), Skin Health Institute, Carlton, Victoria, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre (ODREC), Skin Health Institute, Carlton, Victoria, Australia
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2
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Cegolon L, Larese Filon F. Sensitization to Lanolin in North-Eastern Italy, 1997-2021: Prevalence, Risk Factors and the Impact of Occupation. Life (Basel) 2024; 14:916. [PMID: 39202659 PMCID: PMC11355248 DOI: 10.3390/life14080916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 09/03/2024] Open
Abstract
Background: Direct skin contact with items containing lanolin can induce sensitization and development of contact dermatitis (CD). This multi-centric study investigated prevalence of lanolin sensitization among 30,269 outpatients from North-Eastern Italy patch tested during 1997-2021. Methods: European baseline and extended Triveneto series were applied on the upper part of patients' back and removed after 48 h. Risk factors for lanolin sensitization were investigated by multiple logistic regression analysis, reporting adjusted odds ratios (aOR) with 95% confidence interval (95%CI). Results. Overall lanolin patch test positive ratio (PTPR) was 1.64% (=501/30,629), with variability over time and by research center. The body area most frequently affected by CD were hands (36.32%), followed by face (19.52%) and legs (8.09%), with a lanolin PTPR of 1.68%, 1.37% and 3.07%, respectively. Prevalence of occupational CD was 8.24%, and 1.83% patients with occupational CD patch tested positive against lanolin. Lanolin sensitization was significantly higher in males (aOR = 1.34; 95%CI: 1.08; 1.65) and among patients with leg CD aged 49-60 years (aOR = 2.34; 95%CI: 1.20; 4.57) or older than 60 (aOR = 4.21; 95%CI: 2.59; 6.85). Sub-group analysis confirmed the significantly higher sensitization rate of older patients with leg CD, with much stronger effect size in females 61+ years old (aOR = 5.33; 95%CI 2.87; 9.89) than males in the same age group (aOR = 2.92; 95%CI: 1.34; 6.39). Moreover, female house painters were more likely to test positive to lanolin. Conclusions: The variability of lanolin PTPR over time and by research center endorsed the ongoing debate on the relevance of the respective skin reaction. Clinicians assessing patients with dermatitis should collect information on potential risk factors for lanolin sensitization, particularly use of skin care products containing the hapten. Occupational exposure to lanolin-containing varnishes should also be considered.
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Affiliation(s)
- Luca Cegolon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34128 Trieste, Italy;
- Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34148 Trieste, Italy
| | - Francesca Larese Filon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34128 Trieste, Italy;
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34148 Trieste, Italy
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3
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Cherian P, Bergfeld WF, Belsito DV, Cohen DE, Klaassen CD, Rettie A, Ross D, Slaga TJ, Snyder PW, Tilton S, Fiume M, Heldreth B. Sodium Dehydroacetate and Dehydroacetic Acid. Int J Toxicol 2024:10915818241260276. [PMID: 38913451 DOI: 10.1177/10915818241260276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The Expert Panel for Cosmetic Ingredient Safety (Panel) first published a safety assessment of Sodium Dehydroacetate and Dehydroacetic Acid in 1985. The Panel previously concluded that Sodium Dehydroacetate and Dehydroacetic Acid are safe as used in the present practices of use and concentration, as stated in that report. Upon re-review in 2003, the Panel reaffirmed the original conclusion, as published in 2006. The Panel reviewed updated frequency and concentration of use data again in 2023, in addition to any newly available, relevant safety data. Considering this information, as well as the information provided in the original safety assessment and the prior re-review document, the Panel reaffirmed the 1985 conclusion.
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Affiliation(s)
- Priya Cherian
- Cosmetic Ingredient Review Senior Scientific Analyst/Writer
| | | | | | | | | | - Alan Rettie
- Expert Panel for Cosmetic Ingredient Safety Member
| | - David Ross
- Expert Panel for Cosmetic Ingredient Safety Member
| | | | | | - Susan Tilton
- Expert Panel for Cosmetic Ingredient Safety Member
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4
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Pesqué D, Borrego L, Zaragoza-Ninet V, Sanz-Sánchez T, Miquel-Miquel FJ, González-Pérez R, Silvestre JF, Córdoba-Guijarro S, Carrascosa JM, Gatica-Ortega ME, Ruiz-González I, Mercader-García P, Tous-Romero F, Ortiz de Frutos FJ, Serra-Baldrich E, Pastor-Nieto MA, Rodríguez-Serna M, Sánchez-Pérez J, Sánchez-Gilo A, Melé-Ninot G, Sánchez-Pedreño Guillén P, Pujol RM, Giménez-Arnau AM. Polysensitization in the Spanish Contact Dermatitis Registry (REIDAC): A 2019-2022 prospective study with cluster and network analysis. J Eur Acad Dermatol Venereol 2024. [PMID: 38411353 DOI: 10.1111/jdv.19934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND There is still limited clinical-practice data on specific clinical and patch test features, as well as on allergen clusters in polysensitization (PS). OBJECTIVES To determine the frequency, relevance, symptoms duration and risk factors in polysensitized patients and to assess possible allergen aggregation. METHODS Prospective multicentric study (January 2019-December 2022) conducted in setting of the Spanish Contact Dermatitis Register (REIDAC). Clinical and patch test data of polysensitized and oligosensitized patients were compared, and risk factors of PS were investigated with logistic multivariate regression. Unsupervised hierarchical clustering and network analysis were used to study allergen aggregation in PS. RESULTS A total of 10,176 patients were analysed. PS was found in 844 (8.3%). Current relevance was significantly higher in polysensitized patients (p < 0.01). Risk factors for PS were atopic dermatitis (OR: 1.58, 95% CI: 1.24-2.02), age (≥60 years vs. ≤24 years, OR: 1.75, 95% CI: 1.25-2.44) and some special locations (legs vs. face OR: 1.54, 95% CI: 1.05-2.25, hands vs. face OR: 1.46, 95% CI:1.15-1.85, arms vs. face OR: 1.49, 95% CI:1.01-2.20, trunk vs. face OR: 1.40, 95% CI:1.06-1.85). Cluster and network analyses revealed specific-allergen clusters and significant associations, including allergens belonging to metals group, fragrances and botanicals group, topical drugs group, rubber allergens and biocides. CONCLUSIONS This study confirms that PS is structured by discernible patterns of specific-allergen clusters and reinforces significant allergen associations in PS. Cross-reactivity and/or concomitant sensitization could explain the formation of allergen clusters in PS.
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Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Leopoldo Borrego
- Department of Dermatology, Hospital Universitario Insular de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Ricardo González-Pérez
- Department of Dermatology, Hospital Universitario Araba, Universidad del País Vasco, Vitoria-Gasteiz, Spain
| | | | | | - José Manuel Carrascosa
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | | | | | - Pedro Mercader-García
- Department of Dermatology, Hospital General Universitario José María Morales Meseguer, Murcia, Spain
| | | | | | | | - María Antonia Pastor-Nieto
- Department of Dermatology, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Department of Dermatology, Hospital Fundación Jiménez-Díaz, Madrid, Spain
| | | | | | - Araceli Sánchez-Gilo
- Department of Dermatology, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Gemma Melé-Ninot
- Department of Dermatology, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, Barcelona, Spain
| | | | - Ramon Maria Pujol
- Department of Dermatology, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana María Giménez-Arnau
- Department of Dermatology, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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5
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Wistner SC, Rashad L, Slaughter G. Advances in tissue engineering and biofabrication for in vitro skin modeling. BIOPRINTING (AMSTERDAM, NETHERLANDS) 2023; 35:e00306. [PMID: 38645432 PMCID: PMC11031264 DOI: 10.1016/j.bprint.2023.e00306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The global prevalence of skin disease and injury is continually increasing, yet conventional cell-based models used to study these conditions do not accurately reflect the complexity of human skin. The lack of inadequate in vitro modeling has resulted in reliance on animal-based models to test pharmaceuticals, biomedical devices, and industrial and environmental toxins to address clinical needs. These in vivo models are monetarily and morally expensive and are poor predictors of human tissue responses and clinical trial outcomes. The onset of three-dimensional (3D) culture techniques, such as cell-embedded and decellularized approaches, has offered accessible in vitro alternatives, using innovative scaffolds to improve cell-based models' structural and histological authenticity. However, these models lack adequate organizational control and complexity, resulting in variations between structures and the exclusion of physiologically relevant vascular and immunological features. Recently, biofabrication strategies, which combine biology, engineering, and manufacturing capabilities, have emerged as instrumental tools to recreate the heterogeneity of human skin precisely. Bioprinting uses computer-aided design (CAD) to yield robust and reproducible skin prototypes with unprecedented control over tissue design and assembly. As the interdisciplinary nature of biofabrication grows, we look to the promise of next-generation biofabrication technologies, such as organ-on-a-chip (OOAC) and 4D modeling, to simulate human tissue behaviors more reliably for research, pharmaceutical, and regenerative medicine purposes. This review aims to discuss the barriers to developing clinically relevant skin models, describe the evolution of skin-inspired in vitro structures, analyze the current approaches to biofabricating 3D human skin mimetics, and define the opportunities and challenges in biofabricating skin tissue for preclinical and clinical uses.
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Affiliation(s)
- Sarah C. Wistner
- Center for Bioelectronics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Layla Rashad
- Center for Bioelectronics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Gymama Slaughter
- Center for Bioelectronics, Old Dominion University, Norfolk, VA, 23508, USA
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23508, USA
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Xu J, Hao F, Wang C, Zhao Z, Zhang M, Chen X, Zhang Y. Sodium dehydroacetate-induced disorder of coagulation function in broiler chickens and the protective effect afforded by vitamin K. Poult Sci 2023; 102:102482. [PMID: 36706663 PMCID: PMC10014351 DOI: 10.1016/j.psj.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Sodium dehydroacetate (S-DHA) is used widely as a preservative in several products, including poultry feed. The anticoagulation effect of 200 mg/kg S-DHA in rats has been reported to accompany a reduction in hepatic expression of vitamin K epoxide reductase complex 1 (VKORC1). Poultry and mammals have different physiology and coagulation systems, and species differences in VKORC1 expression have been found. The effect of S-DHA on blood clotting of poultry has not been studies deeply. S-DHA was given to yellow-plumage broilers (YBs) as single and multiple administrations. Vitamin K3 (VK3) was injected into YBs 2 wk after S-DHA administration. Then, the prothrombin time (PT), partial activated prothrombin time (APTT), plasma levels of vitamin K (VK), factor IX (FIX), and S-DHA, and hepatic expression of VKORC1 were obtained. Chicken hepatocellular carcinoma (LMH) cells were also exposed to S-DHA, and the cell activity, VK level, and FIX level were measured. S-DHA prolonged the PT or APTT significantly, decreased levels of VK and FIX in blood, and inhibited hepatic expression of VKORC1. The maximum changes were 1.15-fold in the PT, 1.42-fold in the APTT, 0.8-fold in the VK level, 0.7-fold in the FIX level, and 0.35-fold in VKORC1 expression compared with controls. The cell activity, VK level, FIX level, and VKORC1/VKORC1L1 expression of LMH cells were reduced significantly at S-DHA doses of 2.0 to 10.0 mM. Prolongation of the PT/APTT and lower levels of VK/FIX in YBs or the lower cell activity and VK/FIX levels in LMH cells induced by S-DHA therapy were resisted significantly by VK3 treatment. We demonstrated that S-DHA could induce a disorder in coagulation function in YBs or in LMH cells via reduction of VKORC1/VKORC1L1 expression, and that VK could resist this anticoagulation effect.
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Affiliation(s)
- Jinge Xu
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China; Guizhou Animal Husbandry and Veterinary Institute, Guiyang, Guizhou, China
| | - Fuxing Hao
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Agri-Animal Husbandry Vocational College, Taizhou, China
| | - Cunkai Wang
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China
| | - Zeting Zhao
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China
| | - Meng Zhang
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China
| | - Xin Chen
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yumei Zhang
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, Jiangsu, China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou, Jiangsu, China.
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7
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Zhou Z, Chen B, Zhang M, Chen X, Zhang Y. Mechanism of VKORC1 and VKORC1L1 signaling in the effects of sodium dehydroacetate on coagulation factors in rat hepatocytes. Toxicol In Vitro 2023; 87:105518. [PMID: 36403723 DOI: 10.1016/j.tiv.2022.105518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/02/2022] [Accepted: 11/14/2022] [Indexed: 11/20/2022]
Abstract
Sodium dehydroacetate (Na-DHA) is widely used as an antibacterial and preservative additive in food and cosmetics. Previously, we reported that repeated oral administration of Na-DHA induces coagulation disorders, and inhibited liver vitamin K epoxide reductase complex subunit 1 (VKORC1) and VKORC1-like protein 1 (VKORC1L1) in rats. However, the effects of Na-DHA on coagulation factors in rat hepatocytes and the mechanism of VKORC1 and VKORC1L1 signaling in that process are unclear. Here, we constructed stable Vkorc1 and Vkorc1l1 overexpressing cell lines using lentiviruses and transfected small interfering RNAs into buffalo rat liver BRL3A cells for Vkorc1 and Vkorc1l1 overexpression and silencing, respectively. After treatment with 5 mmol/L Na-DHA for 24 h, VKORC1 and VKORC1L1 expression levels were detected by real-time PCR and western blotting. Vitamin K (VK) and factor IX (FIX) contents were detected using enzyme linked immunosorbent assays. We observed that Na-DHA inhibited VKORC1 and VKORC1L1 expression levels and reduced VK and FIX levels in rat hepatocytes. Overexpression or silencing of Vkorc1 and Vkorc1l1 increased or decreased, respectively, the production and secretion of VK and FIX in rat hepatocytes, and alleviated or aggravated the inhibitory effects of Na-DHA on VKORC1 and VKORC1L1 expression levels. Taken together, the results indicated that both VKORC1 and VKORC1L1 signaling play regulatory roles in the effects of Na-DHA on coagulation factors in rat hepatocytes.
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Affiliation(s)
- Zhiqiang Zhou
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Hunan Key Laboratory of Pharmacodynamics and Safety Evaluation of New Drugs & Hunan Provincial Research Center for Safety Evaluation of Drugs, Changsha 410329, PR China
| | - Binlin Chen
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China
| | - Meng Zhang
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China
| | - Xin Chen
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou 225009, PR China
| | - Yumei Zhang
- Laboratory of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, PR China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, PR China; Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education of China, Yangzhou University, Yangzhou 225009, PR China.
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8
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Shawa H, Wu PA, Dahle S, Isseroff RR, Sood A. Potential Allergens in Wound Care Products. Dermatitis 2023; 34:51-55. [PMID: 36705648 DOI: 10.1089/derm.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Patients with chronic wounds have an increased risk of developing allergic contact dermatitis (ACD). Reports of ACD to wound care products are not uncommon. To minimize contact sensitization in patients with chronic wounds, allergenic ingredients should be avoided when possible. Objective: With more than 5000 wound care products available in the United States, it is essential to understand which products can be chosen to minimize allergen exposures. Methods: Ingredients in wound care products in 5 wound care clinics across 2 institutions were cross-referenced with the American Contact Dermatitis Society core allergen series 2020. Results: Of the 267 wound care products included, 97 (36.3%) contained at least one allergen, including 31 dressings/wraps (22.3%), 25 medications (69.4%), 12 cleaning supplies (36.3%), 16 tapes/glues (80%), 2 instruments (14.3%), 8 emollients and vehicles (61.5%), 1 ostomy product (11.1%), and 2 odor-eliminating products (66.7%). Thirty-four different allergens were identified across all products. The most common allergens present in the included items were acrylates and propylene glycol, followed by parabens, cetyl stearyl alcohol, tocopherol, fragrance, and phenoxyethanol. Conclusions: Many wound care products contain at least one contact allergen, highlighting the importance of clinician education on ACD in the context of wound care product selection.
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Affiliation(s)
- Harrison Shawa
- From the ∗Department of Dermatology, University of California, Davis.,Section of Dermatology
| | - Peggy A Wu
- From the ∗Department of Dermatology, University of California, Davis.,Section of Dermatology
| | - Sara Dahle
- From the ∗Department of Dermatology, University of California, Davis.,Section of Podiatry, Veterans Affairs Northern California Healthcare System, Sacramento
| | - R Rivkah Isseroff
- From the ∗Department of Dermatology, University of California, Davis.,Section of Dermatology
| | - Apra Sood
- From the ∗Department of Dermatology, University of California, Davis.,Section of Dermatology
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9
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Jenkins BA, Belsito DV. Lanolin. Dermatitis 2023; 34:4-12. [PMID: 36917502 DOI: 10.1089/derm.2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its emollient properties. The purification of crude lanolin into lanolin wax and the processing of this wax into various derivatives began in 1882 and continue to this day with newer highly purified anhydrous lanolins. Controversy as to lanolin's allergenicity began in the 1920s and remains an issue. The most appropriate patch test preparation(s) for detecting allergy remain disputed. Detection of lanolin-induced contact dermatitis in diseased skin by patch testing on normal skin may lead to false negative results. Patients with a positive patch test to lanolin may tolerate use of lanolin on normal skin. Although lanolin is a weak sensitizer and the frequency of contact allergy to it in the European population reportedly is 0.4%, there are high-risk concomitant conditions: stasis dermatitis, leg ulcers, perianal/genital dermatitis, and atopic dermatitis (AD). Children and the elderly are also at greater risk of developing contact allergy to lanolin, partly because of comorbidities (AD and stasis dermatitis/leg ulcers, respectively). Finally, in the United States, non-Hispanic white patients are more likely than their non-Hispanic black counterparts to be lanolin allergic.
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Affiliation(s)
- Blair A Jenkins
- From the Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Donald V Belsito
- From the Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA.,D.V.B. is a member of the expert panel for cosmetic ingredient safety, Washington, DC, and the expert panel for fragrance safety, Woodcliff Lake, NJ
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Shawa H, Wu PA, Dahle S, Isseroff RR, Sood A. Potential Allergens in Wound Care Products. Dermatitis 2022; Publish Ahead of Print:01206501-990000000-00064. [PMID: 36136000 DOI: 10.1097/der.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with chronic wounds have an increased risk of developing allergic contact dermatitis (ACD). Reports of ACD to wound care products are not uncommon. To minimize contact sensitization in patients with chronic wounds, allergenic ingredients should be avoided when possible. OBJECTIVE With more than 5000 wound care products available in the United States, it is essential to understand which products can be chosen to minimize allergen exposures. METHODS Ingredients in wound care products in 5 wound care clinics across 2 institutions were cross-referenced with the American Contact Dermatitis Society core allergen series 2020. RESULTS Of the 267 wound care products included, 97 (36.3%) contained at least one allergen, including 31 dressings/wraps (22.3%), 25 medications (69.4%), 12 cleaning supplies (36.3%), 16 tapes/glues (80%), 2 instruments (14.3%), 8 emollients and vehicles (61.5%), 1 ostomy product (11.1%), and 2 odor-eliminating products (66.7%). Thirty-four different allergens were identified across all products. The most common allergens present in the included items were acrylates and propylene glycol, followed by parabens, cetyl stearyl alcohol, tocopherol, fragrance, and phenoxyethanol. CONCLUSIONS Many wound care products contain at least one contact allergen, highlighting the importance of clinician education on ACD in the context of wound care product selection.
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Peyneau M, de Chaisemartin L, Gigant N, Chollet-Martin S, Kerdine-Römer S. Quaternary ammonium compounds in hypersensitivity reactions. FRONTIERS IN TOXICOLOGY 2022; 4:973680. [PMID: 36211198 PMCID: PMC9534575 DOI: 10.3389/ftox.2022.973680] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Quaternary ammonium compounds (QAC) are commonly used disinfectants, antiseptics, preservatives, and detergents due to their antibacterial property and represent the first used biocides before phenolic or nitrogen products. Their common structure consists of one or more quaternary ammonium bound with four lateral substituents. Their amphiphilic structure allows them to intercalate into microorganism surfaces which induces an unstable and porous membrane that explains their antimicrobial activity towards bacteria, fungi, and viruses. QAC are thus found in many areas, such as household products, medicines, hygiene products, cosmetics, agriculture, or industrial products but are also used in medical practice as disinfectants and antiseptics and in health care facilities where they are used for cleaning floors and walls. QAC exposure has already been involved in occupational asthma in healthcare workers or professional cleaners by many authors. They also have been suggested to play a role in contact dermatitis (CD) and urticaria in workers using cosmetics such as hairdressers or healthcare workers, inciting reglementary agencies to make recommendations regarding those products. However, distinguishing the irritant or sensitizing properties of chemicals is complex and as a result, the sensitizing property of QAC is still controverted. Moreover, the precise mechanisms underlying the possible sensitization effect are still under investigation, and to date, only a few studies have documented an immunological mechanism. Besides, QAC have been suggested to be responsible for neuromuscular blocking agents (NMBA) sensitization by cross-reactivity. This hypothesis is supported by a higher prevalence of quaternary ammonium (QA)-specific IgE in the professionally exposed populations, such as hairdressers, cleaners, or healthcare workers, suggesting that the sensitization happens with structurally similar compounds present in the environment. This review summarizes the newest knowledge about QAC and their role in hypersensitivities. After describing the different QAC, their structure and use, the most relevant studies about the effects of QAC on the immune system will be reviewed and discussed.
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Affiliation(s)
- Marine Peyneau
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
- *Correspondence: Marine Peyneau,
| | - Luc de Chaisemartin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Nicolas Gigant
- CNRS, BioCIS, Université Paris-Saclay, Châtenay-Malabry, France
| | - Sylvie Chollet-Martin
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
- Department « Autoimmunité, Hypersensibilités et Biothérapies », DMU BioGeM, APHP, Hôpital Bichat, Paris, France
| | - Saadia Kerdine-Römer
- Université Paris-Saclay, Inserm, Inflammation microbiome immunosurveillance, Châtenay-Malabry, France
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Rippon MG, Rogers AA, Ousey K, Atkin L, Williams K. The importance of periwound skin in wound healing: an overview of the evidence. J Wound Care 2022; 31:648-659. [PMID: 36001708 DOI: 10.12968/jowc.2022.31.8.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
| | | | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, Department of Nursing and Midwifery, University of Huddersfield.,Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia.,Visiting Professor, RCSI, Dublin, Ireland
| | | | - Kate Williams
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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13
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Barbaud A, Garvey LH, Arcolaci A, Brockow K, Mori F, Mayorga C, Bonadonna P, Atanaskovic‐Markovic M, Moral L, Zanoni G, Pagani M, Soria A, Jošt M, Caubet J, Carmo A, Mona A, Alvarez‐Perea A, Bavbek S, Benedetta B, Bilo M, Blanca‐López N, Bogas HG, Buonomo A, Calogiuri G, Carli G, Cernadas J, Cortellini G, Celik G, Demir S, Doña I, Dursun AB, Eberlein B, Faria E, Fernandes B, Garcez T, Garcia‐Nunez I, Gawlik R, Gelincik A, Gomes E, Gooi JHC, Grosber M, Gülen T, Hacard F, Hoarau C, Janson C, Johnston SL, Joerg L, Kepil Özdemir S, Klimek L, Košnik M, Kowalski ML, Kuyucu S, Kvedariene V, Laguna JJ, Lombardo C, Marinho S, Merk H, Meucci E, Morisset M, Munoz‐Cano R, Murzilli F, Nakonechna A, Popescu F, Porebski G, Radice A, Regateiro FS, Röckmann H, Romano A, Sargur R, Sastre J, Scherer Hofmeier K, Sedláčková L, Sobotkova M, Terreehorst I, Treudler R, Walusiak‐Skorupa J, Wedi B, Wöhrl S, Zidarn M, Zuberbier T, Agache I, Torres MJ. Allergies and COVID-19 vaccines: An ENDA/EAACI Position paper. Allergy 2022; 77:2292-2312. [PMID: 35112371 DOI: 10.1111/all.15241] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. METHOD Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. RESULTS No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. CONCLUSIONS These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.
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Affiliation(s)
- Annick Barbaud
- Sorbonne UniversitéINSERMInstitut Pierre Louis d’Epidémiologie et de Santé PubliqueAP‐HP.Sorbonne Université, Hôpital TenonDépartement de dermatologie et allergologie Paris France
| | - Lene Heise Garvey
- Allergy ClinicCopenhagen University Hospital at Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Denmark
| | - Alessandra Arcolaci
- Immunology UnitUniversity Hospital of VeronaPoliclinico G.B. Rossi Verona Italy
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Francesca Mori
- Allergy Unit Department of Pediatrics Meyer Children’s University Hospital
| | - Cristobalina Mayorga
- Allergy Clinical Unit Hospital Regional Universitario de Málaga‐Instituto de Investigación Biomédica de Málaga‐IBIMA ARADyAL, Málaga Spain
| | | | | | - Luis Moral
- Moral Luis. Pediatric Allergy and Respiratory Unit Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL) Alicante Spain
| | - Giovanna Zanoni
- Giovanna Zanoni, Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona Italy
| | - Mauro Pagani
- Medicine Department Medicine Ward Mantova HospitalASST di Mantova Italy
| | - Angèle Soria
- Sorbonne UniversitéINSERM 1135 Cimi‐ParisHôpital TenonAssistance Publique‐Hôpitaux de ParisDepartement de dermatologie et d'allergologie Paris France
| | - Maja Jošt
- University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Jean‐Christoph Caubet
- Department of Women‐Children‐Teenagers University Hospital of Geneva Geneva Switzerland
| | - Abreu Carmo
- Allergy and Clinical Immunology Unit Centro Hospitalar de Trás‐os‐Montes e Alto DouroVila Real and Allergy and Clinical Immunology UnitCentro Hospitalar do Baixo Vouga Aveiro Portugal
| | - Al‐Ahmad Mona
- Microbiology Department Faculty of MedicineKuwait University Kuwait
| | | | - Sevim Bavbek
- School of Medicine Department of Pulmonary Diseases Division of Allergy FAAAIAnkara University Ankara Turkey
| | - Biagioni Benedetta
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Disease IRCCS Azienda Ospedaliero‐Universitaria di Bologna Italy
| | - M.Beatrice Bilo
- Department of Clinical and Molecular Sciences Università Politecnica delle Marche Ancona Italy
- Allergy Unit ‐ Department of Internal Medicine University Hospital Ospedali Riuniti di Ancona Italy
| | | | - Herrera Gádor Bogas
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA, and Allergy UnitHospital Regional Universitario de Málaga‐HRUM Málaga Spain
| | - Alessandro Buonomo
- Allergy Unit ‐ Fondazione Policlinico Gemelli IRCCS ‐ Largo Gemelli Rome Italy
| | | | - Giulia Carli
- SOS Allergologia e ImmunologiaAzienda USL Toscana CentroOspedale S. Stefano Prato Italy
| | - Josefina Cernadas
- Allergy and Clinical Immunology Department Centro Hospitalar Universitário de S. JoãoPorto and Allergy UnitHospital Lusíadas Porto Portugal
| | - Gabriele Cortellini
- Allergy Unit Departments of Internal Medicine Azienda Sanitaria della RomagnaRimini, Hospital Rimini Italy
| | - Gülfem Celik
- Department of Chest Diseases Division of Immunology and allergy Ankara University School of Medicine cebeci Hospital Ankara Turkey
| | - Semra Demir
- Istanbul UniversityIstanbul Faculty of MedicineInternal MedicineImmunology and Allergic Diseases Istanbul Turkey
| | - Inmaculada Doña
- Allergy Research Group Allergy UnitHospital Regional Universitario de MálagaInstituto de Investigación Biomédica de Málaga‐IBIMAPlaza del Hospital Civil s/n Málaga Spain
| | | | - Bernadette Eberlein
- Faculty of Medicine Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Emilia Faria
- Allergy and Clinical Immunology Unit Centro Hospitalar E Universitário de Coimbra Coimbra Portugal
| | | | - Tomaz Garcez
- Immunology Department Manchester University NHS Foundation Trust Manchester UK
| | | | - Radoslaw Gawlik
- Department of Internal Diseases, Allergology and Clinical Immunology Medical University of Silesia Katowice Poland
| | - Asli Gelincik
- Istanbul UniversityIstanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases Istanbul Turkey
| | - Eva Gomes
- Allergy Department Centro Hospitalar Universitário do Porto Porto Portugal
| | - Jimmy H. C. Gooi
- Department of Clinical Immunology King’s College Hospital London UK
| | - Martine Grosber
- Department of Dermatology Universitair ZiekenhuisVrije Universiteit Brussel Brussel Belgium
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy Department of Medicine Karolinska University Hospital HuddingeKarolinska Institutet Stockholm Sweden
| | - Florence Hacard
- Allergology and Clinical Immunology Department Centre Hospitalier Lyon‐Sud Pierre‐Bénite France
| | - Cyrille Hoarau
- Service transversal d'allergologie et immunologie clinique CHR de Tours Tours France
| | | | | | - Lukas Joerg
- Division of Allergology and Clinical Immunology Department of Pneumology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - Seçil Kepil Özdemir
- Department of Chest Diseases Division of Allergy and Immunology Chest Diseases and Surgery Training and Research Hospital Izmir Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | | | - Marek L. Kowalski
- Department of Immunology and Allergy Medical University of Lodz Poland
| | - Semanur Kuyucu
- Faculty of Medicine Dpt of Pediatric Allergy and Immunology Mersin University Mersin Turkey
| | - Violeta Kvedariene
- Institute of Biomedical Sciences Department of Pathology Faculty of Medicine Vilnius UniversityInstitute of Clinical Medicine, Clinic of Chest diseases, Immunology and Allergology, Faculty of Medicine Vilnius Lithuania
| | - Jose Julio Laguna
- Allergy Unit, Allergo‐Anaesthesia Unit Faculty of Medicine Hospital Central de la Cruz RojaAlfonso X El Sabio University Madrid Spain
| | | | - Susana Marinho
- Allergy Centre Wythenshawe HospitalManchester University NHS Foundation Trust and University of Manchester Manchester UK
| | | | - Elisa Meucci
- SOS Allergologia ed Immunologia clinicaAzienda USL Toscana CentroOspedale San Giovanni di Dio Firenze Italy
| | | | | | | | - Alla Nakonechna
- Allergy and Clinical Immunology Department University of LiverpoolRoyal Preston HospitalLancashire Teaching HospitalsNHS Foundation Trust UK
| | - Florin‐Dan Popescu
- Department of Allergology Carol Davila University of Medicine and PharmacyNicolae Malaxa Clinical Hospital Bucharest Romania
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland
| | - Anna Radice
- SOS Allergologia ed Immunologia clinicaAzienda USL Toscana CentroOspedale San Giovanni di Dio Firenze Italy
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology Unit Centro Hospitalar E Universitário de Coimbra Coimbra Portugal
- Institute of Immunology Faculty of Medicine University of Coimbra Coimbra Portugal
- ICBR ‐ Coimbra Institute for Clinical and Biomedical ResearchCIBBFaculty of MedicineUniversity of Coimbra Coimbra Portugal
| | - Heike Röckmann
- Department of Dermatology University Medical Centre Utrecht‐Heidelberglaan 100 Utrecht The Netherlands
| | | | - Ravishankar Sargur
- Clinical Immunology and Allergy Unit Northern General HospitalSheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Joaquin Sastre
- Allergy Department Fundación Jiménez DiazUniversidad Autonoma de MadridCIBERESInstituto de Salud Carlos III Spain
| | | | | | - Marta Sobotkova
- Department of Immunology Motol University Hospital and 2nd Faculty of Medicine Charles University Prague Czech Republic
| | | | - Regina Treudler
- Department of Dermatology, Venerology and Allergology Universitätsmedizin Leipzig Leipzig Germany
| | - Jolanta Walusiak‐Skorupa
- Department of Occupational Diseases and Environmental Health Walusiak‐Skorupa JolantaNofer Institute of Occupational Medicine Lodz Poland
| | - Bettina Wedi
- Department of Dermatology & Allergy OE6600Comprehensive Allergy CenterHannover Medical School Hannover Germany
| | | | - Mihael Zidarn
- University Clinic of Respiratory and Allergic Diseases GolnikGolnik, and Internal Medicine, Faculty of MedicineUniversity of Ljubljana Ljubljana Slovenia
| | - Torsten Zuberbier
- Charité ‐ Universitätsmedizin BerlinKlinik für Dermatologie Berlin Germany
| | - Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Maria J. Torres
- Allergy Unit Regional University Hospital of MalagaIBIMA‐UMA‐ARADyAL Malaga Spain
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Dendooven E, Foubert K, Naessens T, Pieters L, Lambert J, Aerts O. Isocyanates may contribute to allergic contact dermatitis from diabetes devices and wound dressings. Contact Dermatitis 2022; 87:414-419. [PMID: 35815495 DOI: 10.1111/cod.14187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isocyanates are well-known occupational allergens, but can also be present in medical devices. OBJECTIVES To highlight that contact sensitization to isocyanates might contribute to allergic contact dermatitis (ACD) from polyurethane (PU)-containing diabetes devices and wound dressings. PATIENTS AND METHODS Nineteen patients with suspected allergic contact dermatitis (ACD) from diabetes devices and/or wound dressings were patch tested to an isocyanate series. Four wound dressings, 6 diabetes devices and 4 monomeric isocyanate patch test preparations were analysed with gas chromatography - mass spectrometry (GC/MS). RESULTS Eight patients reacted to isocyanates and corresponding amines: 3 to isophorone diisocyanate (IPDI), 4 to 4,4'-diaminodiphenylmethane (MDA), 4 to 2,4-toluene diisocyanate (TDI) and 1 to polymeric methylene diphenyl diisocyanate (PMDI). Three of 4 wound dressings contained isocyanates (MDI, TDI and/or IPDI), whereas 5 of 6 diabetes devices contained 4,4'-methylene diphenyl diisocyanate (MDI), and one of them also IPDI. None of the medical devices contained 1,6-hexamethylene diisocyanate (HDI). Contrary to IPDI, and especially MDI, only the concentration of the TDI patch test preparation corresponded approximately (80%) to its label. CONCLUSION Patch tests with isocyanates may be worth-while in patients with suspected ACD from PU-containing medical devices. Besides MDA, and PMDI, also TDI might potentially be a marker for MDI-sensitization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ella Dendooven
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kenn Foubert
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tania Naessens
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Luc Pieters
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Julien Lambert
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium
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Tramontana M, Bianchi L, Biondi F, Hansel K, Malatesta N, Marietti R, Stingeni L. A case of delayed allergy to polyethylene glycol 2000 and polysorbate 80 confirmed by patch test: Consequences for anti-SARS-CoV2 vaccination? Contact Dermatitis 2022; 87:209-210. [PMID: 35445750 DOI: 10.1111/cod.14131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicolò Malatesta
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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16
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Rizo-Potau D, Riera-Monroig J, Pomar Matias Á, Alsina Gibert M. Dermatitis de contacto en pacientes con úlceras crónicas en extremidades inferiores: serie de casos. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:439-441. [DOI: 10.1016/j.ad.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022] Open
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[Translated article] Contact Dermatitis in Patients With Chronic Leg Ulcers: A Case Series. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Baudy A, Dereure O, Du-Thanh A, Raison-Peyron N. Allergic contact dermatitis in response to cetearyl glucoside from a topical drug. Contact Dermatitis 2021; 86:125-127. [PMID: 34628676 DOI: 10.1111/cod.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Amandine Baudy
- Department of Dermatology, Université Montpellier, Montpellier, France
| | - Olivier Dereure
- Department of Dermatology, Université Montpellier, Montpellier, France
| | - Aurélie Du-Thanh
- Department of Dermatology, Université Montpellier, Montpellier, France
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Alavi A, Goldenberg A, Jacob S, Shelley A, Kirsner RS. Contact dermatitis: An important consideration in leg ulcers. Int J Womens Dermatol 2021; 7:298-303. [PMID: 34222587 PMCID: PMC8243149 DOI: 10.1016/j.ijwd.2020.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
The prevalence of chronic wounds is increasing with the aging population, with 1% to 2% of the worldwide population experiencing leg ulcers and positive patch tests reported in up to 75% of this population. With the introduction of modern dressings and compression therapies, clinicians should be cognizant of the potential risk of contact dermatitis in patients with leg ulcers. Contact dermatitis (both allergic and irritant) to wound products may present as maceration, pain, and overall impaired wound healing. Herein, we review the literature on contact dermatitis to wound-care products.
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Affiliation(s)
- Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alina Goldenberg
- Medical Group of North County, Scripps Affiliated Medical Group, Oceanside, CA, United States
| | - Sharon Jacob
- Department of Medicine and Pediatrics (Dermatology), University of California, Riverside, CA, United States
| | - Amanda Shelley
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Robert S Kirsner
- Department of Dermatology, University of Miami, Miami, FL, United States
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Monari P, Fusano M, Moro R, Baiguini I, Calzavara-Pinton P, Vascellaro A, Gualdi G. Allergic contact versus irritant contact dermatitis in patients with hard-to-heal leg ulcer: clinical and diagnostic approach. J Wound Care 2021; 30:394-398. [PMID: 33979220 DOI: 10.12968/jowc.2021.30.5.394] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dermatitis of surrounding skin may complicate hard-to-heal leg ulcers, delaying wound healing. The coexistence of hard-to-heal leg ulcers and irritant or allergic contact dermatitis may create difficulties for both diagnostic and therapeutic management. OBJECTIVE The aim of our study was to evaluate the incidence of dermatitis occurring in the surrounding skin in a population affected by hard-to-heal leg ulcers during treatment, and to differentiate between allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) with the use of a patch test. Furthermore, we investigated which medications were most probably related to these conditions. METHOD We conducted an observational study from 21 February to 21 July 2017, enlisting all patients affected by hard-to-heal leg ulcers who attended the Wound Care Service of the Dermatologic Department of ASST, Spedali Civili, Brescia, Italy. RESULTS We enrolled 95 patients; 81 patients did not develop dermatitis, while 14 patients developed dermatitis of the surrounding skin. These patients underwent a patch test which gave a positive result in seven patients, permitting the diagnosis of ACD. CONCLUSION Our study confirmed the incidence of dermatitis of the surrounding skin reported in the literature but reassessed the incidence of ACD as opposed to ICD.
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Affiliation(s)
- Paola Monari
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Marta Fusano
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Ruggero Moro
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Ilaria Baiguini
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | | | - Annalisa Vascellaro
- Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, Italy
| | - Giulio Gualdi
- Dermatology Department, University of Chieti and Pescara, Italy
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21
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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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22
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Contact Allergy to Topical Drugs. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_38] [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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23
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Gardeen S, Hylwa S. A review of acrylates: Super glue, nail adhesives, and diabetic pump adhesives increasing sensitization risk in women and children. Int J Womens Dermatol 2020; 6:263-267. [PMID: 33015283 PMCID: PMC7522914 DOI: 10.1016/j.ijwd.2020.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022] Open
Abstract
Allergic contact dermatitis (ACD) is a cutaneous type IV hypersensitivity immune reaction mounted against substances in contact with the skin to which the patient has been sensitized. ACD is common, affecting approximately 72 million Americans per year, and is more common in women. One common contact allergen group is acrylates, which are monomers that are polymerized in the making of glues, adhesives, and plastic materials. It is the monomers that are sensitizing, whereas the final polymers are inert. Acrylates were the 2012 Contact Allergen of the Year with the specific acrylate, isobornyl acrylate, being the 2020 Contact Allergen of the Year. This article reviews the history of acrylate use, epidemiology, and both known and emerging sources of acrylates resulting in ACD.
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Affiliation(s)
- Samantha Gardeen
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Sara Hylwa
- Department of Dermatology, Hennepin County Medical Center, Minneapolis, MN, United States
- Park Nicollet Contact Dermatitis Clinic, Health Partners Institute, Minneapolis, MN, United States
- Department of Dermatology, University of Minnesota, Minneapolis, MN, United States
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Surrounding skin management in venous leg ulcers: A systematic review. J Tissue Viability 2020; 29:169-175. [PMID: 32151489 DOI: 10.1016/j.jtv.2020.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/21/2019] [Accepted: 02/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Chronic venous insufficiency may lead to the development of venous leg ulcers, the most common form of chronic wounds in the lower extremity. Key to venous leg ulcer care is the maintenance of healthy skin surrounding the ulcer, as failure to maintain skin integrity may influence the healing outcome. We thus reviewed the scientific literature looking for assessment and management instruments regarding this common but often neglected issue. METHOD The search included all studies published between 2000 and May 2019. Keywords used were: "peri-wound skin care", "surrounding skin venous ulcers", "surrounding skin management leg ulcers", and "peri-lesional skin management". RESULTS Management of moisture-balance with the selection of appropriate dressings is the most important target in surrounding-wound skin care. Moreover, contact dermatitis related to products and the dressings themselves is a neglected problem in patients with chronic leg ulcers which clinicians increasingly have to manage. The literature search revealed that there is an increasing interest in the use of noninvasive assessment tools in the field of wound care, and focusing on the surrounding-wound skin plays a role in assessing the potential of wound healing. Transepidermal water loss measurement (TEWL) and ultrasonography are two of the measurement techniques available. CONCLUSION The integrity of the surrounding skin is necessary for wound healing, and appropriate management is needed to address this aspect which is part of an overall approach to treating wounds.
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Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-1] [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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26
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Goossens A, Gonçalo M. Contact Allergy to Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-2] [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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Contact Sensitization in Patients with Chronic Leg Ulcers: Results of a 5-Year Retrospective Analysis. Adv Skin Wound Care 2019; 32:558-562. [DOI: 10.1097/01.asw.0000582628.52901.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hyry HSI, Liippo JP, Virtanen HM. Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients. Contact Dermatitis 2019; 81:161-166. [DOI: 10.1111/cod.13337] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Heli S. I. Hyry
- Dermatology and AllergologyUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jussi P. Liippo
- Department of Dermatology and Allergy UnitUniversity of Turku, Turku University Hospital Turku Finland
| | - Hannele M. Virtanen
- Dermatology and AllergologyUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
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Practical Advice to Correctly Perform Patch Test. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Keller JJ. Leg Ulcers: Expanding the Differential. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Mestach L, Huygens S, Goossens A, Gilissen L. Allergic contact dermatitis caused by acrylic-based medical dressings and adhesives. Contact Dermatitis 2018; 79:81-84. [PMID: 29888412 DOI: 10.1111/cod.13044] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/05/2018] [Accepted: 05/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acrylates and methacrylates are acrylic resin monomers that are known to induce skin sensitization as a result of their presence in different materials, such as nail cosmetics, dental materials, printing inks, and adhesives. Allergic contact dermatitis resulting from the use of modern wound dressings containing them has only rarely been reported. OBJECTIVES To describe 2 patients who developed allergic contact dermatitis caused by acrylic-based modern medical dressings and/or adhesives. METHODS The medical charts of patients consulting since 1990 were retrospectively reviewed for (meth)acrylate allergy resulting from contact with such materials, and their demographic characteristics and patch test results were analysed. RESULTS Two patients were observed in 2014 and 2016 who had presented with positive patch test reactions to several acrylic-based dressings and/or adhesive materials, and to several (meth)acrylates, that is, hydroxyethyl acrylate, hydroxyethyl methacrylate, ethyleneglycol dimethacrylate, bisphenol A-glycidyl methacrylate/epoxy-acrylate, urethane diacrylate, and/or penta-erythritol acrylate. CONCLUSIONS Allergic contact dermatitis needs to be considered in patients with eczematous reactions or delayed healing following the use of acrylic-based modern dressings or adhesives. However, identification of the culprit allergen is hampered by poor cooperation from the producers, so adequate labelling of medical devices is an urgent necessity.
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Affiliation(s)
- Lien Mestach
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Sara Huygens
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - An Goossens
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
| | - Liesbeth Gilissen
- Department of Dermatology, University Hospitals KU Leuven, Leuven, Belgium
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Kerre S, Strobbe T, Naessens T, Theunis M, Foubert K, Aerts O. Alkyl glucosides: Newly identified allergens in foam wound dressings. Contact Dermatitis 2018; 79:191-193. [DOI: 10.1111/cod.13026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tine Strobbe
- Imelda ziekenhuis, Department Dermatology; Bonheiden Belgium
| | - Tania Naessens
- Research Group Natural Products and Food-Research and Analysis (NatuRA), Department of Pharmaceutical Sciences; University of Antwerp (UA); Antwerp Belgium
| | - Mart Theunis
- Research Group Natural Products and Food-Research and Analysis (NatuRA), Department of Pharmaceutical Sciences; University of Antwerp (UA); Antwerp Belgium
| | - Kenn Foubert
- Research Group Natural Products and Food-Research and Analysis (NatuRA), Department of Pharmaceutical Sciences; University of Antwerp (UA); Antwerp Belgium
| | - Olivier Aerts
- Department of Dermatology; University Hospital Antwerp (UZA) and University of Antwerp (UA); Antwerp Belgium
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Garval E, Plee J, Lesage C, Grange-Prunier A, Bernard P, Perceau G. [Frequency of contact sensitization to modern dressings used to treat chronic leg ulcer]. Ann Dermatol Venereol 2018; 145:339-346. [PMID: 29673752 DOI: 10.1016/j.annder.2018.01.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/03/2017] [Accepted: 01/15/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Allergic contact dermatitis around chronic leg ulcers (CLU) is a common complication in patients presenting CLU and prolongs healing times. The aim of this study was to describe the rate of sensitization to modern dressings (MD) used in these patients and to assess whether there is a relation between the number of sensitizations and ulcer type, the time from onset of the ulcer, and patient age and gender. PATIENTS AND METHODS We conducted a retrospective study at Reims University Hospital between 2010 and 2014 that included all patients with CLU of vascular etiology surrounded by eczematous lesions, and who had one of the patch-tests in the following 3 series: European baseline±leg ulcers±corticosteroids. RESULTS Among the 73 patients included, 43 % were polysensitized. Thirty-three patients (45 %) were sensitized to MD (38 % to hydrocolloids, 18 % to hydrogels, 7 % to hydrocellular dressings, 7 % to hydrofiber dressings, 5 % to contact layers and 3 % to alginates). Median age and sex did not differ between "polysensitized" patients and "non-polysensitized" patients (P=0.84 and P=0.25, respectively). Polysensitization was more frequent among patients presenting ulcers for more than 5 years (P=0.032). CONCLUSION Practically half of all patients presenting CLU with surrounding contact dermatitis had sensitization to modern dressings (mostly hydrocolloids and hydrogels). The rate of sensitization increased with the length of presence of CLU.
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Affiliation(s)
- E Garval
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France.
| | - J Plee
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - C Lesage
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - A Grange-Prunier
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - P Bernard
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - G Perceau
- Service de dermatologie, CHU, avenue du Général-Koenig, 51100 Reims, France
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Müller CSL, Burgard B, Zimmerman M, Vogt T, Pföhler C. On the significance of negative-pressure wound therapy with instillation in dermatology. J Dtsch Dermatol Ges 2018; 14:786-95. [PMID: 27509412 DOI: 10.1111/ddg.13038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Methods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative-pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well-known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure.
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Affiliation(s)
| | - Barbara Burgard
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Monika Zimmerman
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Allergology, and Venereology, University Hospital of Saarland, Homburg/Saar, Germany
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Price A, Stone NM, Harding KG. An unusual presentation of a common condition: Allergic contact dermatitis. Int Wound J 2018; 15:645-648. [PMID: 29600821 DOI: 10.1111/iwj.12908] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022] Open
Abstract
Allergic contact dermatitis commonly affects patients with chronic venous leg ulcers and can contribute to impaired wound healing. Many allergens have been identified, and despite the use of advanced dressings, the incidence of allergy has remained high. We discuss an unusual presentation of allergic contact dermatitis in a patient with a chronic wound. The patient's history was consistent with a recurrent venous leg ulcer, but on this occasion, the wound continued to deteriorate despite optimal treatment. This prompted further investigation, which included patch testing. Although the clinical features were not suggestive of allergy, the patch test was positive for several allergens, including Atrauman® dressings, which the patient was using at the time. This case highlights the importance of regular reassessment and accurate diagnosis for the management of chronic wounds. It also demonstrates that allergic contact dermatitis can contribute to delayed wound healing without causing the classical clinical features of inflammation of the surrounding skin, and even hypoallergenic, non-adherent dressings can be sensitising.
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Affiliation(s)
- Annie Price
- Wound Healing Research Unit, Cardiff University, Cardiff, UK
| | - Natalie M Stone
- Dermatology Department, Aneurin Bevan University Health Board, Newport, UK
| | - Keith G Harding
- Wound Healing Research Unit, Cardiff University, Cardiff, UK
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Rai R, Shenoy MM, Viswanath V, Sarma N, Majid I, Dogra S. Contact sensitivity in patients with venous leg ulcer: A multi-centric Indian study. Int Wound J 2018; 15:618-622. [PMID: 29600560 DOI: 10.1111/iwj.12905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 01/19/2023] Open
Abstract
Venous leg ulcers are the most common form of non-healing leg ulcers. They are subjected to treatments such as topical medications, dressings, and compression therapies. This can lead to exposure to a number of allergens with subsequent sensitisation and contact dermatitis of the regional skin. This may contribute to the poor ulcer healing. To detect the various contact sensitisers in patients with venous leg ulcers through patch testing, patients from 6 centres across India with venous leg ulcers of longer than 6 weeks duration were enrolled for the study. They were patch tested using a special parch test kit with 27 antigens. A total of 172 patients were included in the study; 82 (48.2%) tested positive for at least 1 antigen. Among them, polyvalent sensitisation was noted in 71% of patients. Wood tar mix (10.4%) and the framycetin (8.7%) were the most common allergens. There is a high frequency of allergic sensitisation to various ingredients of topical therapies used in the venous ulcer management, which may interfere with wound healing. Avoiding them can help obtain a better therapeutic outcome.
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Affiliation(s)
- Reena Rai
- Department of Dermatology, Venereology & Leprosy, PSG Institute of Medical Sciences & Research, Coimbatore, India
| | - Manjunath M Shenoy
- Department of Dermatology, Venereology & Leprosy, Yenepoya Medical College, Mangalore, India
| | - Vishalakshi Viswanath
- Department of Dermatology, Venereology & Leprosy, Rajiv Gandhi Medical College & CSMH, Thane, India
| | - Nilendu Sarma
- Department of Dermatology, Venereology & Leprosy, Dr B C Roy Institute of Pediatric Science, Kolkata, 700054, India
| | - Imran Majid
- Department of Dermatology, Venereology & Leprosy, Govt Medical College, Srinagar, India
| | - Sunil Dogra
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Abstract
PURPOSE To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. ABSTRACT Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.
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Liu H, Han L, Xie J, Wu Y, Xie Y, Zhang Y. The tissue residues of sodium dehydroacetate used as feed preservative in swine. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2018; 98:787-791. [PMID: 28677852 DOI: 10.1002/jsfa.8526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sodium dehydroacetate (Na-DHA) is a food and feed additive with antimicrobial effects. There is little information on Na-DHA residue levels in foods derived from animals. In this study, Na-DHA residue levels in swine tissues were determined by HLPC, and the pharmacokinetics of Na-DHA in tissues were determined. RESULTS The Na-DHA residue levels in swine tissues were <1.2 mg kg-1 at different withdrawal time after thirty-two Duroc × Landrace × Yorkshire pigs were administered 200 mg Na-DHA kg-1 through the feed for 30 days. In decreasing order of Na-DHA residue levels, the tissues were kidney > liver > muscle > fat. The pharmacokinetics of Na-DHA followed a binomial regression model, and the half-time of Na-DHA in swine tissues was 9.07 days for kidney, 7.19 days for liver, 6.66 days for muscle, and 5.39 days for fat tissue. The accuracy of the HPLC method for Na-DHA determination ranged from 80.18% to 91.33% recovery, with coefficients of variation <6.4%, limit of detection of 0.08 mg kg-1 , and limit of quantification of 0.2 mg kg-1 . CONCLUSION Na-DHA included at 200 mg kg-1 in a swine diet is a safe feed additive based on residue elimination and ADI values reported. © 2017 Society of Chemical Industry.
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Affiliation(s)
- Hao Liu
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Lingling Han
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Jiayu Xie
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Yingchao Wu
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Yang Xie
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Yumei Zhang
- Department of veterinary pharmacology and toxicology, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, P.R. China
- Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou, P.R. China
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Erfurt-Berge C, Geier J, Mahler V. The current spectrum of contact sensitization in patients with chronic leg ulcers or stasis dermatitis - new data from the Information Network of Departments of Dermatology (IVDK). Contact Dermatitis 2017; 77:151-158. [PMID: 28194803 DOI: 10.1111/cod.12763] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with lower leg dermatitis, chronic venous insufficiency or chronic leg ulcers have a high prevalence of contact sensitization. OBJECTIVES To identify the current spectrum of contact allergens in these patients. PATIENTS AND METHODS Data of the Information Network of Departments of Dermatology on 5264 patients with the above diagnoses from the years 2003 to 2014 (study group) were compared with data on 4881 corresponding patients from 1994 to 2003 (historical control group) and with a current control group without these diagnoses (n = 55 510). RESULTS Allergic contact dermatitis was diagnosed less frequently in the study group than in the historical control group (25.9% versus 16.9%; p < 0.001), and contact sensitization to most allergens had declined. The allergen spectrum, however, was largely unchanged. Important allergens are Myroxylon pereirae (balsam of Peru) (14.8% positive reactions), fragrance mix I (11.4%), lanolin alcohol (7.8%), colophonium (6.6%), neomycin sulfate (5.0%), cetearyl alcohol (4.4%), oil of turpentine (3.1%), and paraben mix (2.6%). Patch testing with additional series showed sensitization to Amerchol L-101 (9.7%), tert-butyl hydroquinone (8.7%), framycetin sulfate (5.0%), and gentamicin sulfate (3.1%). CONCLUSIONS Topical preparations for treating the above-mentioned conditions should not contain fragrances, Myroxylon pereirae, and colophonium. The special allergen spectrum has to be considered in patch testing.
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Affiliation(s)
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), University Medical Centre Göttingen, 37075, Göttingen, Germany
| | - Vera Mahler
- Department of Dermatology, University Hospital Erlangen, 91054, Erlangen, Germany
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Zelga PJ, Górnicz MM, Głuszkiewicz JM, Piasecka-Zelga J. Outcomes of acute dermal irritation and sensitisation tests on active dressings for chronic wounds: a comparative study. J Wound Care 2016; 25:722-729. [DOI: 10.12968/jowc.2016.25.12.722] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P. J. Zelga
- Medical University of Lodz, Department of General and Colorectal Surgery, Pl. Hallera 1, 91-647 Lodz, Poland
| | - M. M. Górnicz
- Institute of Occupational Medicine, Research Laboratory for Medicine and Veterinary Products in the GMP Head of Research Laboratory for Medicine and Veterinary Products
| | - J. M. Głuszkiewicz
- Institute of Occupational Medicine, Research Laboratory for Medicine and Veterinary Products in the GMP Head of Research Laboratory for Medicine and Veterinary Products
| | - J. Piasecka-Zelga
- Institute of Occupational Medicine, Research Laboratory for Medicine and Veterinary Products in the GMP Head of Research Laboratory for Medicine and Veterinary Products
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41
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Gilissen L, Goossens A. Frequency and trends of contact allergy to and iatrogenic contact dermatitis caused by topical drugs over a 25-year period. Contact Dermatitis 2016; 75:290-302. [DOI: 10.1111/cod.12621] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Liesbeth Gilissen
- Department of Dermatology; University Hospitals KU Leuven; 3000 Leuven Belgium
| | - An Goossens
- Department of Dermatology; University Hospitals KU Leuven; 3000 Leuven Belgium
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42
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Lazareth I. [When to worry about before a vascular chronic leg ulcer?]. ACTA ACUST UNITED AC 2016; 41:307-14. [PMID: 27622980 DOI: 10.1016/j.jmv.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022]
Abstract
Leg ulcers are a chronic condition. Healing can be long for venous ulcers and the risk of complications is significant. Infection is the most severe complication and can occur in the form of easily diagnosed acute bacterial dermohypodermitis that generally responds well to antibiotic treatment if given at an appropriate dose or in the form of localized infection that is more difficult to diagnosis. Indeed, no consensus has been reached in the literature on the clinical criteria to retain for the diagnosis of localized infection. Similarly, the most appropriate treatment remains to be established. Local care would be a logical starting point, followed by systemic antibiotics if this approach is unsuccessful. Individual conditions also should be taken into consideration (immunodepression, severe arteriopathy warranting more rapid use of systemic antibiotics). The second most frequent complication is an allergic reaction to a topical agent used for wound care. The rate of sensitivization in patients with leg ulcers is high (60 %), although the rate is declining with modern dressings. No product can be considered perfectly safe for these polysensitized patients. Dermocorticoid therapy can be very effective. Allergology tests are needed. Certain leg ulcers require special care from diagnosis. An arterial origin must be suspected for deep, or necrotic ulcers. Arterial supply must be explored rapidly, followed by a revascularization procedure when necessary. Highly painful superficial extensive necrotic ulcers due to necrotic angiodermitis require hospital care for skin grafts that will control the antiodermitis and provide pain. Carcinoma should be suspected in cases of leg ulcers with an atypical localization exhibiting excessive budding. A biopsy is mandatory for leg ulcers with an unusual course (absence of healing despite well-conducted care).
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Affiliation(s)
- I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
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43
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D'Erme AM, Iannone M, Dini V, Romanelli M. Contact dermatitis in patients with chronic leg ulcers: a common and neglected problem: a review 2000–2015. J Wound Care 2016; 25 Suppl 9:S23-9. [DOI: 10.12968/jowc.2016.25.sup9.s23] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - M. Iannone
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - V. Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M. Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
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44
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Müller CSL, Burgard B, Zimmerman M, Vogt T, Pföhler C. Zum Stellenwert der Unterdruck-Instillationstherapie in der Dermatologie. J Dtsch Dermatol Ges 2016; 14:786-96. [PMID: 27509413 DOI: 10.1111/ddg.13038_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Die Methoden zur Behandlung akuter und chronischer Wunden unterliegen einer steten Weiterentwicklung, Reevaluierung und Anwendung innovativer Therapieformen. Die Vakuumtherapie zur Wundbehandlung gehört zu den etablierten Behandlungsmodalitäten. Ein innovatives Verfahren kombiniert die Vakuumtherapie mit der automatisierten, kontrollierten Zufuhr und Drainage wirkstoffhaltiger Lösungen zur topischen Wundbehandlung im Wundbett und auch wirkstofffrei durch Instillation physiologischer Kochsalzlösung (Unterdruck-Instillationstherapie). Hierdurch können die Effekte der konventionellen Vakuumtherapie mit denen der lokalen Antisepsis kombiniert werden. Hierdurch kommt es zu einer Reduktion der Wundfläche, einer Induktion von Granulationsgewebe sowie einer Reduktion der Keimbesiedelung der Wunden. Bisher publizierte Studien konzentrieren sich auf die Anwendung dieses Therapieverfahrens zur Behandlung orthopädisch-chirurgischer Krankheiten. Die Datenlage bezüglich der Vakuum-Instillationstherapie in der Dermatochirurgie beschränkt sich derzeit auf Fallberichte und Einzelfallerfahrungen. Randomisierte, prospektive Studien zum Vergleich der Vakuum-Instillationstherapie zur Behandlung dermatologischer Krankheitsbilder existieren bislang nicht. Ziele des vorliegenden Artikels sind die Vorstellung der Vakuumtherapie mit Instillation einschließlich ihres Wirkprinzips, deren mögliche Komplikationen, die Diskussion erdenklicher Kontraindikationen sowie eine Übersicht über die aktuell verfügbare Datenlage. Zusammenfassend scheint sich die Evidenz zu verdichten, dass mittels Unterdruck-Instillationstherapie sowohl einfache als auch komplizierte Wunden effizient behandelt werden können, was sich in einer deutlichen Beschleunigung der Wundgranulation mit konsekutiv früher möglichem Defektverschluss äußert.
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Affiliation(s)
| | - Barbara Burgard
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Monika Zimmerman
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Claudia Pföhler
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
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Spencer A, Gazzani P, Thompson DA. Acrylate and methacrylate contact allergy and allergic contact disease: a 13-year review. Contact Dermatitis 2016; 75:157-64. [PMID: 27402324 DOI: 10.1111/cod.12647] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ashley Spencer
- Birmingham Skin Centre; Sandwell and West Birmingham Hospitals NHS Trust; Birmingham B18 7QH UK
| | - Paul Gazzani
- Birmingham Skin Centre; Sandwell and West Birmingham Hospitals NHS Trust; Birmingham B18 7QH UK
| | - Donna A. Thompson
- Birmingham Skin Centre; Sandwell and West Birmingham Hospitals NHS Trust; Birmingham B18 7QH UK
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Foti C, Romita P, Ettorre G, Angelini G, Bonamonte D. Allergic contact dermatitis caused by resorcinol and sodium dehydroacetate in a patient with leg ulcers. Contact Dermatitis 2016; 74:383-4. [DOI: 10.1111/cod.12575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; 70124 Bari Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; 70124 Bari Italy
| | - Grazia Ettorre
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; 70124 Bari Italy
| | - Gianni Angelini
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; 70124 Bari Italy
| | - Domenico Bonamonte
- Department of Biomedical Science and Human Oncology, Dermatological Clinic; University of Bari; 70124 Bari Italy
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Abstract
Compression therapy and treating venous insufficiency is the standard of care for venous leg ulcers. The need for debridement on healing venous leg ulcers is still debated. Dressings are often used under compression bandages to promote faster healing and prevent adherence of the bandage to the ulcer. A wide range of dressings is available, including modern dressings with different kinds of biological activity. Microbial burden is believed to underlie delayed healing, but the exact role of microbiofilm in wound healing is uncertain. Before choosing a specific wound dressing, four main functions should be considered: (1) cleaning, (2) absorbing, (3) regulating or (4) the necessity of adding medication. There is no clear evidence to support the use of one dressing over another, as demonstrated by many Cochrane review studies. In addition, the prescriber should enquire about contact allergies that may also develop during wound treatment. It is shown that early intervention and early investment may reduce the cost of treatment. The choice of wound dressings should be guided by cost, ease of application and patient and physician preference and be part of the complete strategy. The role of the medical specialist is evident. Wound dressings matter as part of the optimal treatment in VLU patients.
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