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Jasly K, Goyal S, Ashwini PK, Kanthraj GR, Chethana SG, Ranugha S. Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study. Indian J Dermatol Venereol Leprol 2024; 90:575-580. [PMID: 38594974 DOI: 10.25259/ijdvl_118_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 04/11/2024]
Abstract
Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aim To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitation A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.
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Affiliation(s)
- Kuttiali Jasly
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Sakshi Goyal
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - P K Ashwini
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Garehatty Rudrappa Kanthraj
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - S Gurumurthy Chethana
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Subramaniam Ranugha
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
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Foti C, Rosato WA, Cassano N, Vena GA, Fanigliulo G, Castronovi C, Ambrogio F, Bonamonte D, Romita P. Usefulness of telemedicine with digitized grid reconstruction to improve the value of photo assessment in late patch test readings. Contact Dermatitis 2023; 89:292-294. [PMID: 37421162 DOI: 10.1111/cod.14376] [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: 05/02/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Caterina Foti
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - William Andrew Rosato
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Gabriele Fanigliulo
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Cosimo Castronovi
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Ambrogio
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Bonamonte
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Romita
- Department of Precision and Regenerative Medicine and Jonian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
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Christiansen AG, Carstensen O, Sommerlund M, Clausen PA, Bønløkke JH, Schlünssen V, Isaksson M, Schmidt SAJ, Kolstad HA. Prevalence of skin sensitization and dermatitis among epoxy-exposed workers in the wind turbine industry. Br J Dermatol 2022; 187:988-996. [PMID: 35972390 PMCID: PMC10087335 DOI: 10.1111/bjd.21830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A high prevalence of skin sensitization and dermatitis has been reported among workers exposed to epoxy components. OBJECTIVES To estimate the risk of skin sensitization and dermatitis among workers exposed to epoxy components during production of wind turbine blades while using comprehensive safety measures. METHODS A cross-sectional study of 180 highly epoxy-exposed production workers and 41 nonexposed office workers was conducted at two wind turbine blade factories in Denmark. Participants underwent a skin examination, were tested with a tailored patch test panel including epoxy-containing products used at the factories, and answered a questionnaire. RESULTS Sixteen production workers (8·9%) were sensitized to an epoxy component compared with none of the office workers. Skin sensitization was more frequent within the first year of exposed employment. Strong selection bias by atopic status was indicated. Among nonatopic workers, the prevalence of dermatitis was higher among production workers (16·4%) than among office workers [6·5%, odds ratio (OR) 2·3, 95% confidence interval (CI) 0·6-9·1] and higher among the sensitized workers (43·8%) than the nonsensitized workers (14·6%, OR 4·5, 95% CI 1·6-12·7). Resins based on diglycidyl ether of bisphenol A and F were the most frequent sensitizers. One of the four workers sensitized to epoxy components used at the factories did not react to the epoxy resin of the TRUE test® panel. CONCLUSIONS Despite comprehensive skin protection, sensitization and dermatitis are prevalent among highly epoxy-exposed workers in the wind turbine industry in Denmark. Our findings document the need for intensified preventive efforts and emphasize the importance of tailored patch testing. What is already known about this topic? Epoxy components are well-known sensitizers of the skin. A high prevalence of skin sensitization and dermatitis has been reported among workers exposed to epoxy components. Comprehensive protective equipment is recommended when working with epoxy components. What does this study add? Despite comprehensive skin protection, skin sensitization and dermatitis are prevalent among epoxy-exposed workers. We found that 40% of workers sensitized to epoxy products had dermatitis. Only 75% of the sensitized workers were detected by the epoxy resin of the TRUE test® , which emphasizes the importance of tailored testing.
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Affiliation(s)
- Alexandra G Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Carstensen
- Department of Occupational Medicine, The Regional Hospital Goedstrup, University Research Clinic, Herning, Denmark
| | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Per A Clausen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jakob H Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Lund University, Skane University Hospital Malmö, Malmö, Sweden
| | - Sigrun A J Schmidt
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Forkel S, Schubert S, Dickel H, Gina M, Schröder‐Kraft C, Vieluf D, Brans R, Kreft B, Wurpts G, Geier J, Buhl T. The benefit of late readings in patch testing depends both on allergen and patient characteristics. Allergy 2022; 77:1477-1485. [PMID: 34687560 DOI: 10.1111/all.15149] [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: 06/09/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patch test (PT) readings are recommended after 48 h and 72 h (D3). An additional day 7 (D7) reading has been suggested by some, although data on efficient patient selection are scarce. We investigated positive D7 reactions regarding (i) allergens in the baseline series and additional PT series of the German Contact Dermatitis Research Group (DKG) and (ii) characteristics of the patients tested. METHODS Retrospective, multicentre analysis of 190 allergens derived from 17 DKG test series in 4687 patients with an additional D7 reading. Patients were patch tested with the baseline series and additional series, if required. Occurrence of novel D7 reactions as well as increasing skin reactions from D3 to D7 was analysed separately. RESULTS Depending on the allergen tested, waiving D7 readings would have missed 4.4-26.8% of positive PT results. Patch test series with the highest number of novel D7 reactions were baseline series, metal series, and leather/shoe series. New positive reactions on D7 were associated with age over 50 years and with a negative irritant control containing sodium lauryl sulphate. Of note, application of the PT allergens for 48 h instead of 24 h was positively associated with late PT reactions. CONCLUSION Within the most frequently tested allergens, without late readings, on average 11.7% of sensitizations would have been missed. Novel late reacting allergens were identified. This study comprehensively dissects patient-, allergen- and test-dependent parameters in support for D7 readings. We propose to always consider late readings individually based on effort-benefit considerations.
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Affiliation(s)
- Susann Forkel
- Department of Dermatology, Venereology and Allergology University Medical Center Göttingen Göttingen Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology Institute at the University Medical Center Göttingen Göttingen Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum (UK RUB) Bochum Germany
| | - Michal Gina
- Department of Occupational Dermatology BG Hospital Falkenstein Falkenstein Germany
| | - Claudia Schröder‐Kraft
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) BG Hospital Hamburg Hamburg Germany
| | - Dieter Vieluf
- Department of Allergology, Photodermatology and Occupational Dermatology Dermatologikum Hamburg Hamburg Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück Osnabrück Germany
- Department of Dermatology, Environmental Medicine and Health Theory University of Osnabrück Osnabrück Germany
- Lower Saxony Institute of Occupational Dermatology University of Osnabrück Osnabrück Germany
| | - Burkhard Kreft
- Department of Dermatology, Venereology and Allergology University Medical Center Halle Martin Luther University Halle‐Wittenberg Halle (Saale) Germany
| | - Gerda Wurpts
- Department of Dermatology, Venereology and Allergology University Medical Center Aachen Aachen Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology Institute at the University Medical Center Göttingen Göttingen Germany
- Lower Saxony Institute of Occupational Dermatology University of Göttingen Göttingen Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology University Medical Center Göttingen Göttingen Germany
- Lower Saxony Institute of Occupational Dermatology University of Göttingen Göttingen Germany
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Tupker RA, Stapper WGC, Kelder JC. Predictive factors for Day 7 positive patch test readings at a secondary referral centre. SKIN HEALTH AND DISEASE 2022; 2:e79. [PMID: 35665214 PMCID: PMC9060153 DOI: 10.1002/ski2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022]
Abstract
Background Based on studies at tertiary centres it is known that patch test reading on Day (D) 7 may show additional positive reactions. Female gender, higher age and allergen groups of topicals and corticosteroids were identified as predictive factors. Objectives The first aim was to study the value of reading patch tests on D2, D3 and D7 at a secondary referral centre. The second aim was to investigate the predictive potential of the factors sex, age, atopic dermatitis, body location, allergen group and clinical relevance for a positive reaction only on D7. Methods Retrospective data from patients tested between 2013 and 2016 were evaluated. The factors sex, age, atopic dermatitis, body location, allergen group and clinical relevance were tested by regression analysis. Results Two hundred and sixty-three out of a total of 396 patients had a positive reaction only on D2, D3 and D7 in 14 (2.5%), 152 (27.5%) and 61 (11.0%) occasions, observed in 10 (2.5%), 108 (27.3%) and 51 (12.9%) patients, respectively. These reactions were deemed relevant in 0 (0%), 12 (2.2%) and 9 (1.6%) occasions, observed 0 (0%), 11 (2.8%) and 9 (2.3%) patients, respectively. Higher age and allergen groups of metals, fragrances and resins were predictive for late positive reactions. Conclusions D7 patch test reading should also be routinely adopted at secondary referral centres. D7 positive reactions were associated with higher age and sensitization to metals, fragrances and resins.
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Affiliation(s)
- R. A. Tupker
- Dermatology DepartmentSt. Antonius HospitalNieuwegeinThe Netherlands
| | - W. G. C. Stapper
- Dermatology DepartmentSt. Antonius HospitalNieuwegeinThe Netherlands
| | - J. C. Kelder
- Epidemiology DepartmentSt. Antonius HospitalNieuwegeinThe Netherlands
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Dendooven E, Foubert K, Naessens T, Pieters L, Lambert J, Goossens A, Aerts O. Allergic contact dermatitis from ("hypoallergenic") adhesives containing D-limonene. Contact Dermatitis 2021; 86:113-119. [PMID: 34786729 DOI: 10.1111/cod.14008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Besides being a potential component of (some species of) colophonium, D-limonene is also used as a tackifier in the production of adhesives. Hydroperoxides of limonene are well-known skin sensitizers. OBJECTIVES To show that D-limonene may be present in colophonium-containing but also colophonium-free ("hypoallergenic") adhesives, and that patients suffering from allergic contact dermatitis (ACD) from both types of adhesives might display positive patch test reactions to limonene hydroperoxides in this regard. METHODS Five patients with suspected ACD from adhesives were patch tested to the baseline series (containing limonene hydroperoxides 0.3 and 0.2% pet.), additional series and, if available, to the culprit adhesives. The adhesives labelled as containing colophonium (n = 3) or free from it (n = 2) were analysed with gas chromatography - mass spectrometry (GC-MS) for the presence of D-limonene. RESULTS All five patients sensitised to adhesives had (strong) positive patch test reactions to limonene hydroperoxides. The presence of D-limonene, and/or related components, could be demonstrated in all three colophonium-containing and, surprisingly, also in two colophonium-free ("hypoallergenic") tapes. CONCLUSIONS D-limonene may be present in both regular and "hypoallergenic" adhesives, with limonene hydroperoxides potentially contributing to ACD from such medical devices. The use of fragrance chemicals in adhesives deserves further research.
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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, Antwerp, Belgium
| | - Kenn Foubert
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Tania Naessens
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Pieters
- Research Group Natural Products & Food - Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Julien Lambert
- Department of Dermatology, University Hospital Antwerp (UZA) and Research group Immunology, INFLA-MED Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - An Goossens
- Department of Dermatology, University Hospitals K.U.Leuven, Leuven, 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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Goodier MC, DeKoven JG, Taylor JS, Sasseville D, Fowler JF, Fransway AF, DeLeo VA, Marks JG, Zug KA, Hylwa SA, Warshaw EM. Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology. Contact Dermatitis 2021; 85:274-284. [PMID: 33837533 DOI: 10.1111/cod.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding teledermatology for patch testing are limited. OBJECTIVES Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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Affiliation(s)
- Molly C Goodier
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, Health Partners Institute Dermatology, St. Louis Park, Minnesota, USA
| | - Joel G DeKoven
- Department of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Department of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Department of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sara A Hylwa
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA
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