Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study

Bio-fabricated bismuth-based materials for removal of emerging environmental contaminants from wastewater

Although rapid industrialization has made life easier for humans, several associated issues are emerging and harming the environment. Wastewater is regarded as one of the key problems of the 21st century due to its massive production every year and requires immediate attention from all stakeholders to protect the environment. Since the introduction of nanotechnology, bismuth-based nanomaterials have been used in variety of applications. Various techniques, such as hydrothermal, solvo-thermal and biosynthesis, have been reported for synthesizing these materials, etc. Among these, biosynthesis is eco-friendly, cost-effective, and less toxic than conventional chemical methods. The prime focuses of this review are to elaborate biosynthesis of bismuth-based nanomaterials via bio-synthetic agents such as plant, bacteria and fungi and their application in wastewater treatment as anti-pathogen/photocatalyst for pollutant degradation. Besides this, future perspectives have been presented for the upcoming research in this field, along with concluding remarks.

Bikini textile contact dermatitis: A Sherlockian approach revealing 2.4-dichlorophenol as a potential textile contact allergen

BACKGROUND

Different textile constituents may act as allergens and/or irritants and provoke textile contact dermatitis (TCD).

OBJECTIVES

To report a case of TCD caused by ethylene glycol monododecyl ether and 2.4-dichlorophenol, present in a bikini.

METHODS

A woman presented with an eczematous, pruritic rash in the area of the bikini straps and back. Patch testing was performed with the European baseline, textile, sunscreen, and photo-patch series, the bikini "as is", and ethanol and acetone extracts of the bikini. Thin-layer chromatography (TLC) of the extracts and gas chromatography-mass spectrometry (GC-MS) analysis were used to elucidate the culprit agents.

RESULTS

Positive reactions were found to the bikini "as is" and to the ethanol and acetone extracts. Patch testing with TLC strips showed a strong reaction to spots-fractions 3 and 4. GC-MS was performed to identify substances in each fraction and those suspected to be skin sensitisers were patch tested. On day (D) 4 positive reactions to ethylene glycol monododecyl ether (irritant reaction) and 2.4-dichlorophenol (++) were observed.

CONCLUSION

A myriad of chemical compounds can be found in clothing. Ethylene glycol monododecyl ether and 2.4-dichlorophenol were identified as the potential culprits of this bikini TCD.

HIGHLIGHTS

We have combined chemical analyses (thin-layer chromatography and gas chromatography-mass spectrometry) to study a case of textile contact dermatitis. As such, the presence of a myriad of chemical compounds was found in a bikini, suggesting that clothing in general may become impregnated or contaminated by a wide range of external substances that may be harmful to the skin. Textile contact dermatitis could in this case be attributed to ethylene glycol monododecyl ether (CAS No. 4536-30-5) and 2.4-dichlorophenol (CAS No. 120-83-2), the latter not yet previously described as a textile contact allergen.

Occupational Contact Dermatitis: An Update

Occupation contact dermatitis (CD) is a common inflammatory skin condition impacting every professional industry in the United States. It is associated with significant personal and professional distress, loss of revenue, and decreased productivity. Occupational CD is further subdivided into irritant CD and allergic CD. Frequently, workers may suffer from a combination of both types. Numerous workplace exposures are implicated, but there are several themes across professions, such as CD related to frequent handwashing and wet work. A detailed occupational history, physical examination, and patch testing can help to make the diagnosis. Treatment includes identification of the substance and avoidance, which often is quite challenging.

Contact sensitivity to textile dyes in patients with pigmented purpuric dermatosis

Purpose: The aetiology of pigmented purpuric dermatoses is unclear. Recent studies speculate about contact sensitivity to play a role in the aetiology of the disease. In most patients, the lesions begin and stay limited on the lower extremities as textile products are in tight contact with the skin. Also, textile dyes can cause contact dermatitis of purpuric type. This study was conducted in order to understand whether the contact sensitivity plays a critical role in the aetiology of pigmented purpuric dermatoses. Materials and methods: Patients with diagnosis of pigmented purpuric dermatoses were included in the study. Patch tests were applied at the back of all patients with textile series (Chemotechnique Diagnostics TF-1000) which have 33 allergens containing textile dyes, material and protectors by IQ Ultra Chamber. Test sites were evaluated at 48, 72, 96. h and on the 7th day according to the criteria of the International Contact Dermatitis Research Group. The evaluation results were recorded in patient files and the results were statistically compared. Results: Eighteen males (60%) and 12 females (40%), a total of 30 patients were included in the study. Schamberg disease in 23 patients (76.7%), lichen aureus in 5 patients (16.7%) and Majocchi disease in 2 patients (6.7%) were described out of total 30 patients. No contact sensitivity was detected in any of the patients. Conclusion: Contact sensitivity to textile dyes was not found as an etiologic factor in our study group.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Contact allergy to compression stockings: Is this possible?

In der Therapie der chronisch venösen Insuffizienz oder des Lymphödems sind Kompressionsstrümpfe ein Standard der Therapie. Trotzdem ist die Akzeptanz der Patienten relativ gering. Ein Grund dafür sind unter anderem auch Symptome wie Juckreiz, Brennen oder Rötung, die vom Patienten, aber auch häufig vom behandelnden Arzt als Allergie auf die Kompressionsstrümpfe gewertet werden. Die Übersichtsarbeit geht auf die Grundlagen der Kontaktallergien ein, zeigt wie häufig Allergien auf Kompressionsstrümpfe auftreten, welche Auslöser dafür in Frage kommen und beschreibt kurz die häufigen Differenzialdiagnosen, ihre Auslöser und Prävention.

Symptoms related to new flight attendant uniforms

BACKGROUND

Flight attendants at Alaska Airlines reported health symptoms after the introduction of new uniforms in 2011. The airline replaced the uniforms in 2014 without acknowledging harm. To understand possible uniform-related health effects, we analyzed self-reported health symptoms in crew who participated in the Harvard Flight Attendant Health Study between 2007 and 2015, the period before, during, and after the introduction of new uniforms.

METHODS

We calculated a standardized prevalence of respiratory, dermatological and allergic symptoms at baseline, as well as during and after uniform changes in 684 flight attendants with a varying number of surveys completed across each time point. We used Generalized Estimating Equations (GEE) to model the association between symptoms at baseline versus the exposure period after adjusting for age, gender and smoking status and weighting respondents for the likelihood of attrition over the course of the study period.

RESULTS

We found the following symptom prevalence (per 100) increased after the introduction of new uniforms: multiple chemical sensitivity (10 vs 5), itchy/irritated skin (25 vs 13), rash/hives (23 vs 13), itchy eyes (24 vs 14), blurred vision (14 vs 6), sinus congestion (28 vs 24), ear pain (15 vs 12), sore throat (9 vs 5), cough (17 vs 7), hoarseness/loss of voice (12 vs 3), and shortness of breath (8 vs 3). The odds of several symptoms significantly increased compared to baseline after adjusting for potential confounders.

CONCLUSION

This study found a relationship between health complaints and the introduction of new uniforms in this longitudinal occupational cohort.

Survey of Occupational Allergic Contact Dermatitis and Patch Test among Clothing Employees in Beijing

Occupational population-based epidemiological data relating to occupational contact allergies in the Chinese clothing industry are limited. To investigate the prevalence of occupational allergic contact dermatitis (OACD) and to identify the causative allergens among clothing employees in China, a cross-sectional study was conducted in 529 clothing employees at 12 clothing factories in Beijing. All employees were subjected to an interview using self-administered questionnaire and skin examination, and those who were diagnosed with occupational contact dermatitis (OCD) were patch tested. In the present survey, we found that the overall 1-year prevalence of OACD among the clothing employees was 8.5%. The 1-year prevalence of OACD among workers (10.8%) was significantly higher than that among managers (3.2%). The lesions were primarily on the hands and wrists in workers, but the face and neck in managers. The major allergens were nickel sulfate and cobalt dichloride in workers and colophony and p-tert-butylphenol formaldehyde resin in managers. In conclusion, workers are at a higher risk of OACD compared with managers in the Chinese clothing industry. In addition to hand dermatitis in workers, airborne contact dermatitis on the face and neck should be also addressed in managers.

Compensation for occupational skin diseases

The Korean list of occupational skin diseases was amended in July 2013. The past list was constructed according to the causative agent and the target organ, and the items of that list had not been reviewed for a long period. The revised list was reconstructed to include diseases classified by the International Classification of Diseases (10th version). Therefore, the items of compensable occupational skin diseases in the amended list in Korea comprise contact dermatitis; chemical burns; Stevens-Johnson syndrome; tar-related skin diseases; infectious skin diseases; skin injury-induced cellulitis; and skin conditions resulting from physical factors such as heat, cold, sun exposure, and ionized radiation. This list will be more practical and convenient for physicians and workers because it follows a disease-based approach. The revised list is in accordance with the International Labor Organization list and is refined according to Korean worker's compensation and the actual occurrence of occupational skin diseases. However, this revised list does not perfectly reflect the actual status of skin diseases because of the few cases of occupational skin diseases, incomplete statistics of skin diseases, and insufficient scientific evidence. Thus, the list of occupational diseases should be modified periodically on the basis of recent evidence and statistics.

Textile allergic contact dermatitis: current status

MATERIALS AND METHODS

We conducted a thorough review of Pubmed search results for "textile percutaneous penetration" and "textile absorption". We also determined relevant articles that discussed percutaneous penetration of textiles into the skin and their associated disease states.

LIMITATIONS

Due to limitations in current and past publications, we are uncertain of the extent of the clinical problem; however, for patients allergic to textile dye, it is of practical importance, both clinically and in their everyday life.

CONCLUSIONS

There are many challenges to correctly identifying the offending textile products in a patient with suspected textile dye dermatitis. Different populations may exhibit varying degrees of allergic contact dermatitis (ACD), but more studies must be done to draw further conclusions. This is further complicated when counseling the patient on how to avoid the textile products most likely to cause a recurrence of ACD skin lesions.

Allergic contact dermatitis induced by textile necklace

Allergic contact dermatitis to textile dyes is considered to be a rare phenomenon. A recent review reported a prevalence of contact allergy to disperse dyes between 0.4 and 6.7%. The relevance of positive patch testing was not reported in all studies. Textile dye allergy is easily overlooked and is furthermore challenging to investigate as textile dyes are not labelled on clothing. In this report, we present a case of allergic contact dermatitis to a textile necklace. The patch test showed strong reactions to the necklace and the azo dyes Disperse Orange 1 and Disperse Yellow 3. Despite the European legislation and the reduced use of disperse dyes in Third World countries, disperse azo dyes still induce new cases of allergic contact dermatitis.

Allergic contact dermatitis in children: which factors are relevant? (review of the literature)

Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children.

Determination of formaldehyde in formaldehyde-releaser patch test preparations

BACKGROUND

Positive patch test reactions to formaldehyde-releasers in patients co-reacting to formaldehyde are often ascribed to formaldehyde allergy. However, the formaldehyde content of patch test materials has not been investigated.

OBJECTIVES

To demonstrate and quantify free formaldehyde in commercial patch test materials and in prepared aqueous solutions of formaldehyde releasers.

MATERIALS

Free formaldehyde was measured by (13)C NMR Spectroscopy in (i) all formaldehyde-releasers in water available from Chemotechnique and Brial, (ii) 5 releasers in petrolatum, (iii) 12 prepared aqueous solutions of formaldehyde-releasers and (iv) water that had been in contact with petrolatum test samples.

RESULTS

In none of the five petrolatum test substances was free formaldehyde found. In all nine commercial aqueous patch test substances and 9 of the 12 prepared solutions, free formaldehyde was demonstrated with concentrations ranging from 0.019% to 0.37% (detection limit 0.01%). Contact of the petrolatum test samples with water resulted in the release of formaldehyde.

CONCLUSIONS

Most aqueous solutions of formaldehyde-releasers contain free formaldehyde. Petrolatum-based patch test materials with formaldehyde-releasers do not contain free formaldehyde, but probably start releasing it upon contact with water. Therefore, in future studies, determination of free and releasable formaldehyde may be preferable.

Innovative management of severe hand dermatitis

The successful treatment of hand dermatitis (HD) depends less on the selection of the proper topical steroid or a particular systemic agent than on addressing any underlying cause or perpetuating factor. Thus, innovative treatment is based on comprehensively addressing the patient's problem. Aggressive approaches may be required for the most severe forms of HD.

Hand/face/neck localized pattern: sticky problems--resins

Plastic resin systems have an increasingly diverse array of applications but also induce health hazards, the most common of which are allergic and irritant contact dermatitis. Contact urticaria, pigmentary changes, and photoallergic contact dermatitis may occasionally occur. Other health effects, especially respiratory and neurologic signs and symptoms, have also been reported. These resin systems include epoxies, the most frequent synthetic resin systems to cause contact dermatitis, (meth)acrylics, polyurethanes, phenol-formaldehydes, polyesters, amino resins (melamine-formaldehydes, urea-formaldehydes), polyvinyls, polystyrenes, polyolefins, polyamides and polycarbonates. Contact dermatitis usually occurs as a result of exposure to the monomers and additives in the occupational setting, although reports from consumers, using the raw materials or end products periodically surface. Resin- and additive-induced direct contact dermatitis usually presents on the hands, fingers, and forearms, while facial, eyelid, and neck involvement may occur through indirect contact, eg, via the hands, or from airborne exposure. Patch testing with commercially available materials, and in some cases the patient's own resins, is important for diagnosis. Industrial hygiene prevention techniques are essential to reduce contact dermatitis when handling these resin systems.

European Standard Series patch test results from a contact dermatitis clinic in Israel during the 7-year period from 1998 to 2004

The results of a 7-year retrospective study (1998-2004) from patch testing with the European Standard Series (ESS) establishing the frequency of sensitization in a contact dermatitis clinic in Israel are presented. 23 allergens were patch tested on 2156 patients, 1462 females (67.8%) and 694 males (32.2%). Atopy and asthma were present in 21.9% of the patients. One or more allergic reactions were observed in 937 patients (43.5%). The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate (13.9%), fragrance mix (7.1%), potassium dichromate (3.8%), Balsam of Peru (3.6%), CL+Me-isothiazolinone (3.4%) and cobalt chloride (3.4%). Allergens which produced the least amount of positive results were primin and clioquinol. Allergic contact dermatitis (ACD) was established in 32.8%, whereas occupationally related allergic (8.0) and irritant contact dermatitis (5.6%) affected a total of 13.6% of the cases studied. The most common clinical forms of dermatitis were chronic dermatitis (47.7%) followed by acute dermatitis (22.8%), and lichenification and hyperkeratosis (7.9%). The hands (30.7%), face and neck (23.9%) and extremities (11.3%) were the most frequently affected areas. Four allergens in our study differed from the top 10 allergens in Europe namely: Cl+Me-isothiazolinone, formaldehyde, 4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure. Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel. In spite of the existing differences with Europe, we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel.

Fragrance allergy: assessing the risk from washed fabrics

The prevalence of contact allergy to fragrance ingredients increased during the last part of the 20th century with the consequence that a substantial number of individuals are at risk of experiencing allergic contact dermatitis (ACD) if they have a sufficient degree of skin exposure to the chemical to which they have become sensitized. Such exposure does not necessarily have to arise from the type of source that originally induced the sensitization. A number of sources of exposure are clearly associated with risk of elicitation of ACD, but the role of fragrance deposited on fabrics, for example as a result of laundry processes, also can be questioned. In this article, firstly, the risk of the induction of fragrance-related ACD from exposure to fragrance via fabric is considered. Using a quantitative risk-assessment approach, the risk appears to be extremely low. The possibility that fragrance residues on laundered fabrics might elicit reactions in those already sensitized by a different route is also discussed. Clinically, clothing pattern dermatitis associated with fragrance allergy is almost never observed, although this could be investigated clinically by exposing sensitized individuals to the relevant fragrance allergen.