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Guarneri F, Belloni Fortina A, Corazza M, Cristaudo A, Foti C, Parodi A, Pigatto P, Stingeni L, DE Pità O. Topical non-pharmacological treatment of eczema: an Italian consensus. Ital J Dermatol Venerol 2022; 157:402-413. [PMID: 36213968 DOI: 10.23736/s2784-8671.22.07283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.
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Affiliation(s)
- Fabrizio Guarneri
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Caterina Foti
- Department of Biomedical Sciences and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paolo Pigatto
- Unit of Dermatology, Department of Surgical and Odontoiatric Biomedical Sciences, Galeazzi IRCCS Orthopedic Institute, Milan, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ornella DE Pità
- Unit of Clinical Pathology, Inflammatory and Autoimmune Skin Diseases, Cristo Re Hospital, Rome, Italy
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Feng X, Long R, Wang L, Liu C, Bai Z, Liu X. A review on heavy metal ions adsorption from water by layered double hydroxide and its composites. Sep Purif Technol 2022. [DOI: 10.1016/j.seppur.2021.120099] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tramontana M, Bianchi L, Hansel K, Agostinelli D, Stingeni L. Nickel Allergy: Epidemiology, Pathomechanism, Clinical Patterns, Treatment and Prevention Programs. Endocr Metab Immune Disord Drug Targets 2021; 20:992-1002. [PMID: 31994473 DOI: 10.2174/1871530320666200128141900] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 01/19/2023]
Abstract
Nickel is the most common cause of contact allergy in the general population and the most frequently detected allergen in patients patch tested for suspected allergic contact dermatitis (ACD). ACD from nickel is a typical type IV hypersensitivity. Nickel allergy is mostly caused by nonoccupational exposure, such as jewelry and clothing decorations, metal tools, medical devices (mainly orthopedic and orthodontic implants, cardiovascular prosthesis), eyeglasses, utensils, keys, pigment for paint, cosmetics, and food (mainly legumes, chocolate, salmon, peanuts). Occupational exposure can involve several workers (mechanics, metalworkers, platers, hairdressers, jewelers, workers in the constructions and electronic industries), classically involving hands and forearms. The classic clinical pattern of ACD caused by nickel is characterized by eczematous dermatitis involving the sites of direct contact with the metal. Non-eczematous-patterns are reported, including lichenoid dermatitis, granuloma annulare, vitiligo-like lesions, dyshidrosiform dermatitis, and vasculitis. In the case of systemic exposure to nickel, sensitized patients could develop systemic contact dermatitis. Patch testing represents the gold standard for the diagnosis of ACD from nickel. Treatment includes avoidance of contact with products containing nickel and the patient's education about the possible use of alternative products. A recent EU nickel directive, regulating the content and release of nickel from products, has caused a decrease of nickel contact allergy in some European countries. Nickel allergy is a relevant issue of public health with significant personal, social, and economic impact. This review summarizes epidemiology, pathomechanism, clinical patterns, treatment, and prevention programs.
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Affiliation(s)
- Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Daniela Agostinelli
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
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Gergovska M, Darlenski R, Kazandjieva J. Nickel Allergy of the Skin and Beyond. Endocr Metab Immune Disord Drug Targets 2021; 20:1003-1009. [PMID: 32108006 DOI: 10.2174/1871530320666200228124453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/25/2020] [Accepted: 03/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypersensitization to nickel is one of the most common contact allergies in the modern world and it is considered to be a major cause of contact dermatitis, especially for hand eczema. OBJECTIVE The aim of this paper is to describe many faces of the nickel allergy and to find out different diagnostic, potential strategies for treatment and prevention in hypersensitized patients. A personal clinical experience with practical clinical cases of contact dermatitis to nickel has also been presented. METHODS Electronic databases on this topic was carried out using PubMed-Medline. RESULTS The literature review identified many articles reporting for nickel contact allergy and pointing the metal as number one allergen in the frequency of positive skin patch test reactions in a large population worldwide. Herein, a summary of the current understanding and evidence on nickel allergy with practical approach and proposed recommendations to the dermatologist, general practitioner, and the allergist were prepared. CONCLUSION The prevalence of nickel allergy represents an important socio-economical and health issue. Metal is one of the most common sensitizing agents worldwide. The morbidity due to this metal represents the allergic contact dermatitis and it is constantly growing in many countries. There are also cases of systemic allergic contact dermatitis, where they could be easily misdiagnosed as adverse drug reactions, which lead to delay of the correct diagnosis and inappropriate treatment.
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Affiliation(s)
- Malena Gergovska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Pleven, Bulgaria
| | - Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Jana Kazandjieva
- Department of Dermatology and Venereology, Faculty of Medicine, Sofia, Bulgaria
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Can the Reactivity to Chromate Be Changed in Patch Testing Using a Barrier Cream? Dermatitis 2020; 31:373-377. [PMID: 33186332 DOI: 10.1097/der.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The persistent, difficult-to-treat, allergic contact dermatitis from hexavalent chromium in European construction workers has diminished significantly since the legislative measurements that came into force in January 2005. However, sensitization to hexavalent chromium continues to be a problem. Barrier creams have been tried for various allergens with divergent results. OBJECTIVE The aim of the study was to investigate the protective capacity of barrier cream candidates against hexavalent chromium in a patch test situation. METHODS An experimental study was performed to investigate the reductive properties of glutathione and iron sulfate on the patch test reactivity in chromium-allergic individuals when exposed to hexavalent chromium. In this study, we also investigated the protective properties of a commercially available barrier cream. CONCLUSIONS A higher number of volunteers (16/18) showed reactions on the skin treated with the commercially available barrier cream, compared with the untreated skin (13/18) on test reading day 3/4 or day 7. The skin treated with petrolatum or Essex cream showed fewer and less prominent allergic reactions than the skin treated with the commercially available barrier cream.
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Thyssen JP, Ahlström MG, Bruze M, Rustemeyer T, Lidén C. Metals. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_35-1] [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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Abstract
We discuss a case of razor-associated dermatitis to highlight a potential source of nickel exposure in allergic patients.
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Affiliation(s)
- Shehla Admani
- Division of Dermatology, University of California, San Diego, Rady Children's Hospital, San Diego, California
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Gumienna-Kontecka E, Nurchi VM, Szebesczyk A, Bilska P, Krzywoszynska K, Kozlowski H. Chelating Agents as Tools for the Treatment of Metal Overload. Z Anorg Allg Chem 2013. [DOI: 10.1002/zaac.201300064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Hypersensitivity reactions to nickel are one of the most common in the modern world. Nickel allergy prevalence is constantly growing in many countries and represents a major health and socioeconomic issue. Herein the current understanding on nickel allergy is summarized with a practical approach to the dermatologist, allergist, and general practitioner. The personal experience with some practical clinical cases of nickel dermatitis is shared. A special emphasis is put on the possible strategies for treatment and prevention of the disease.
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Thyssen JP, Menné T. Metal allergy--a review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol 2010; 23:309-18. [PMID: 19831422 DOI: 10.1021/tx9002726] [Citation(s) in RCA: 247] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1-3% are allergic to cobalt and chromium. Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.
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Affiliation(s)
- Jacob P Thyssen
- National Allergy Research Centre and Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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Torres F, das Graças M, Melo M, Tosti A. Management of contact dermatitis due to nickel allergy: an update. Clin Cosmet Investig Dermatol 2009; 2:39-48. [PMID: 21436967 PMCID: PMC3047925 DOI: 10.2147/ccid.s3693] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nickel is the major cause of allergic contact dermatitis in the general population, both among children and adults, as well as in large occupational groups. This metal is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life. Nickel contact dermatitis can represent an important morbidity, particularly in patients with chronic hand eczema, which can lead to inability to work, a decrease in quality of life and significant healthcare expenses. Therefore, its management is of great importance. This article reviews diagnostic, preventive and therapeutic strategies in this field.
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Affiliation(s)
- Fernanda Torres
- Department of Dermatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Lu LK, Warshaw EM, Dunnick C A. Prevention of Nickel Allergy: The Case for Regulation? Dermatol Clin 2009; 27:155-61, vi-vii. [DOI: 10.1016/j.det.2008.11.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Scheman A, Jacob S, Zirwas M, Warshaw E, Nedorost S, Katta R, Cook J, Castanedo-Tardan MP. Contact Allergy: Alternatives for the 2007 North American Contact Dermatitis Group (NACDG) Standard Screening Tray. Dis Mon 2008; 54:7-156. [DOI: 10.1016/j.disamonth.2007.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kosboth M, Chin-Loy A, Lyons R, Wesson SK, Reeves WH. Malar rash caused by metal allergy in a patient with systemic lupus erythematosus. ACTA ACUST UNITED AC 2007; 3:240-5. [PMID: 17396110 DOI: 10.1038/ncprheum0464] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 02/08/2007] [Indexed: 11/08/2022]
Abstract
BACKGROUND A 61-year-old woman with an 8-year history of systemic lupus erythematosus presented with a non-pruritic, erythematous, malar rash. Previously, she had tested positive for antinuclear antibody and autoantibodies to double-stranded DNA and Ro/SSA, and had an elevated erythrocyte sedimentation rate. She wore eyeglasses with metal frames and had recently gained weight, which caused the eyeglasses to have increased contact area with her face. INVESTIGATIONS Physical examination, autoantibody testing, measurement of complement C3 and C4 levels, measurement of erythrocyte sedimentation rate, hypersensitivity patch testing, dimethylglyoxime test of the patient's eyeglass frames. DIAGNOSIS Delayed-type hypersensitivity reaction to nickel and possibly to cobalt dichloride in the patient's eyeglass frames, which caused a malar rash that mimicked acute cutaneous lupus erythematosus. MANAGEMENT The rash resolved completely with contact avoidance with the eyeglass frames.
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Affiliation(s)
- Meghavi Kosboth
- Division of Rheumatology & Clinical Immunology and Center for Autoimmune Disease, University of Florida, Gainesville, FL 32610-0221, USA
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Hostynek JJ. Sensitization to nickel: etiology, epidemiology, immune reactions, prevention, and therapy. REVIEWS ON ENVIRONMENTAL HEALTH 2006; 21:253-80. [PMID: 17243350 DOI: 10.1515/reveh.2006.21.4.253] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nickel is a contact allergen causing Type I and Type IV hypersensitivity, mediated by reagins and allergen-specific T lymphocytes, expressing in a wide range of cutaneous eruptions following dermal or systemic exposure. As such, nickel is the most frequent cause of hypersensitivity, occupational as well as among the general population. In synoptic form, the many effects that nickel has on the organism are presented to provide a comprehensive picture of the aspects of that metal with many biologically noxious, but metallurgically indispensable characteristics. This paper reviews the epidemiology, the prognosis for occupational and non-occupational nickel allergic hypersensitivity, the types of exposure and resulting immune responses, the rate of diffusion through the skin, and immunotoxicity. Alternatives toward prevention and remediation, topical and systemic, for this pervasive and increasing form of morbidity are discussed. The merits and limitations of preventive measures in industry and private life are considered, as well as the effectiveness of topical and systemic therapy in treating nickel allergic hypersensitivity.
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Affiliation(s)
- Jurij J Hostynek
- UCSF School of Medicine, Department of Dermatology, San Francisco, CA 94143-0989, USA
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Filon FL, Boeniger M, Maina G, Adami G, Spinelli P, Damian A. Skin Absorption of Inorganic Lead (PbO) and the Effect of Skin Cleansers. J Occup Environ Med 2006; 48:692-9. [PMID: 16832226 DOI: 10.1097/01.jom.0000214474.61563.1c] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the percutaneous penetration of lead oxide (PbO) powder and the effect of rapid skin decontamination with two different detergents. METHODS Franz cells were used to study in vitro PbO skin penetration through human skin during a 24-hour period. The tests were performed without or with decontamination using either Ivory Liquid soap or a new experimental cleanser 30 minutes after the start of exposure. RESULTS We confirm that PbO can pass through the skin with a median penetration of 2.9 ng/cm (25-75th percentiles 0.35-6). The cleaning procedure using Ivory Liquid soap significantly increased skin penetration with a median value of 23.6 ng/cm (25-75th percentiles 12-47.1; Mann-Whitney U test, P = 0.0002), whereas the new experimental cleanser only marginally increased penetration (7.1 ng/cm). CONCLUSIONS Our results indicate that it is necessary to prevent skin contamination from occurring because a short contact can increase skin content and penetration even if quickly followed by washing. This study demonstrated that PbO powder can pass through the skin and that skin decontamination done after 30 minutes of exposure did not decrease skin absorption occurring over 24 hours and stresses the need to prevent skin contamination when using toxic substances.
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Affiliation(s)
- Francesca Larese Filon
- Unità Clinico Operativa di Medicina del Lavoro, Dipartimento di Scienze di Medicina Pubblica, Università di Trieste, Trieste, Italy.
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Skin Penetration. Contact Dermatitis 2006. [DOI: 10.1007/3-540-31301-x_11] [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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Affiliation(s)
- Linh K Lu
- Department of Dermatology, University of Colorado Health Sciences Center, Denver, Co, USA
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Abstract
This article reviews the current information surrounding the efficacy of barrier creams as a protective measure against contact dermatitis. The principles of the proposed effects of barrier creams on the skin and the experimental and clinical data regarding their efficacy in the prevention of irritant and allergic contact dermatitis are discussed.
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Affiliation(s)
- M S Alvarez
- Ronald O. Perelman Department of Dermatology, New York University, School of Medicine, Skin Institute of New York, 67 Perry Street, New York, NY 10014, USA
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Wöhrl S, Kriechbaumer N, Hemmer W, Focke M, Brannath W, Götz M, Jarisch R. A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals. Contact Dermatitis 2001; 44:224-8. [PMID: 11260238 DOI: 10.1034/j.1600-0536.2001.044004224.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chelating agents in protective barrier creams have often been used in the prevention of allergic contact dermatitis to nickel. In a pilot study, we demonstrated the preventive effect of 10% diethylenetriaminepentaacetic acid (DTPA) in an oil-in-water emulsion in nickel-sensitized patients. Now we reproduced these results in a randomized, double-blind study. Additionally, we investigated the efficacy of the barrier cream in other clinically relevant metal allergies. Individuals sensitized to various metals had a significant decrease in positive patch test reactions after pre-treatment with the DTPA-cream: 2.5% nickel sulfate (24/28 positive without pre-treatment versus 1/28 with pre-treatment; p<0.0001), 5% nickel sulfate (30/32 versus 15/32; p=0.0003), 1% cobalt chloride (19/20 versus 6/20; p=0.001) and 5% copper sulfate (13/14 versus 5/14; p=0.02). However, the cream had no protective effect with 1% palladium chloride (17/23 versus 16/23) and with 0.5% potassium dichromate (9/13 versus 7/13). We conclude that the DTPA-cream clearly abrogates positive patch test reactions in nickel-, cobalt- and copper-sensitized subjects and that it may therefore be helpful in the management of allergic contact dermatitis.
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Affiliation(s)
- S Wöhrl
- FAZ - Floridsdorf Allergy Centre, Franz-Jonas-Platz 816, A-1210 Vienna, Austria
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Andersen O. Principles and recent developments in chelation treatment of metal intoxication. Chem Rev 1999; 99:2683-710. [PMID: 11749497 DOI: 10.1021/cr980453a] [Citation(s) in RCA: 283] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- O Andersen
- Department of Life Sciences and Chemistry, Roskilde University, Postbox 260 4000, Roskilde, Denmark
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Zhai H, Chang YC, Singh M, Maibach HI. In vivo nickel allergic contact dermatitis: human model for topical therapeutics. Contact Dermatitis 1999; 40:205-8. [PMID: 10208508 DOI: 10.1111/j.1600-0536.1999.tb06035.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Techniques to determine efficacy of topical agents on allergic contact dermatitis (ACD) may benefit from refinement. The aim of this study was to develop an in vivo human model system for the bioengineering and visual quantification of the effect of topical agents on nickel ACD, and to correlate ACD parameters. 14 nickel patch-test-positive subjects were included in a placebo-controlled, double-blind study after a pre-screening procedure with a standard diagnostic patch test with nickel sulfate in 54 healthy human volunteers. 5% nickel sulfate in petrolatum in a Finn Chamber was applied on forearm skin for 48 h to create a standardized dermatitis. Thereafter, the dermatitis was treated with a model topical agent and a placebo control while recording endpoint parameters daily for 10 days. Resolution was quantified with 4 parameters: visual scoring (VS), transepidermal water loss (TEWL) (Tewameter), skin blood flow volume (BFV) (laser Doppler flowmeter), and skin color (a* value) (Colorimeter). The model agent reduced cutaneous allergic reactions, especially on day 8 to 10, in comparison with the placebo control. A highly significant linear relationship exists among all parameters, except between a* and BFV. This model may provide robust biometrics for determining the efficacy of topical therapeutics on experimentally induced ACD.
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Affiliation(s)
- H Zhai
- Department of Dermatology, University of California, School of Medicine, San Francisco 94143-0989, USA
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Van den Broeke LT, Gräslund A, Nilsson JL, Wahlberg JE, Scheynius A, Karlberg AT. Free radicals as potential mediators of metal-allergy: Ni2+- and Co2+-mediated free radical generation. Eur J Pharm Sci 1998; 6:279-86. [PMID: 9795082 DOI: 10.1016/s0928-0987(97)10024-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The generation of free radicals by Ni(2+) and Co(2+) was studied at physiological pH in H(2)O(2)-containing solutions in the absence and presence of various radical-mediating ligands and in human peripheral blood mononuclear cell (PBMC) cultures. With ESR spectroscopy, free radical species were identified and quantitated by spin trapping with 5,5-dimethyl-1-pyrroline-N-oxide (DMPO). Co(2+) generated hydroxyl radicals from H(2)O(2) in PBS solutions containing glutathione (GSH) or histidine (His). Omission of GSH or His from the reaction mixture significantly reduced the ESR-signal, indicating the importance of metal-chelation in free radical generation. Carnosine did not significantly enhance the reactivity of Co(2+) toward H(2)O(2), whereas cysteine (Cys) and N-acetylcysteine (NAC) suppressed free radical generation. Under identical reaction conditions, Ni(2+) was markedly less reactive toward H(2)O(2) in comparison with Co(2+). GSH, His, Cys and NAC did not enhance free radical generation of Ni(2+) from H(2)O(2). However, in the presence of carnosine weak but significantly enhanced ESR intensities were found. Incubation of PBMC cultures from healthy subjects with Co(2+) (10-50 microM) yielded the DMPO-.OH adduct, suggesting Co(2+)-mediated hydroxyl radical generation. In contrast, incubation of PBMC cultures with Ni(2+) (10-50 microM) did not produce a detectable ESR-signal. Ascorbic acid efficiently inhibited Co(2+)-mediated free radical generation in PBS solutions and PBMC cultures. The observed difference in free radical generating capacity between Ni(2+) and Co(2+) is of interest with respect to the absence of cross-reactivity between the two metal-ions in experimental allergic contact dermatitis.
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Affiliation(s)
- L T Van den Broeke
- Dept. of Occupational Health, Occupational Dermatology, National Institute for Working Life, S-171 84 Solna, Sweden.
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Healy J, Johnson S, Little MC, MacNeil S. An in vitro study of the use of chelating agents in cleaning nickel-contaminated human skin: an alternative approach to preventing nickel allergic contact dermatitis. Contact Dermatitis 1998; 39:171-81. [PMID: 9817222 DOI: 10.1111/j.1600-0536.1998.tb05889.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to investigate the efficacy of organic ligands in cleaning human skin contaminated with nickel. 4 ligands were investigated, 5-chloro-7-iodoquinolin-8-ol (either as HL(1) or NaL(1)), ethylenediaminetetraacetic acid (either as H4L(2) or Na2H2L(2)), sodium diethyldithiocarbamate (NaL(3)) and L-histidine (HL(4)). The cytotoxicity of these ligands was assessed using HaCaT cells (a transformed human keratinocyte cell line). The cytotoxicity order of the ligands was NaL(1) >Na2H2L(2)>NaL(3)>HL(4). An in vitro methodology for examining nickel removal from viable human skin was developed. This methodology was then used to compare the efficiency of the ligands in removing nickel from skin, both alone and in combination with soap solutions. HL(1) and NaL(3) were no more effective than control solutions in removing nickel over the pH range 2-11. In contrast, both H4L(2) and HL(4) removed between 74 and 87% (mean=82+/-3%) of nickel from human skin over the same pH range. Nickel removal from skin by sodium lauryl ethoxy sulfate (SLES, the active ingredient in most liquid skin cleansers) was independent of concentration and no more effective than phosphate-buffered saline (PBS). The amount of nickel removed by PBS solutions of Na2H2L(2) and HL(4) was significantly greater than the amount removed by SLES and was concentration dependent. An evaluation of nickel removal from skin by commercial solid soap, liquid soap and PBS, both alone and with added Na2H2L(2) or HL(4), was conducted. Commercial liquid soap with added HL(4) was more effective than the untreated soap. PBS with either added Na2H2L(2) or HL(4) was more effective than PBS alone.
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Affiliation(s)
- J Healy
- Health and Safety Laboratory, Sheffield, UK
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Affiliation(s)
- W Wigger-Alberti
- Department of Dermatology, University Hospital, Zurich, Switzerland
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Burrows DD. Contact allergens--what's new? Metals. Clin Dermatol 1997; 15:505-9. [PMID: 9255457 DOI: 10.1016/s0738-081x(97)00054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- D D Burrows
- Department of Dermatology, Queen's University, Belfast, Northern Ireland
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Abstract
The field of cutaneous allergy has enjoyed dynamic research advances in epidemiology and clinical contact dermatitis. Studies regarding outcomes analysis, validity, predictive value, and sensitivity have allowed clinicians to better understand the importance of patch test results. In the clinical arena, new and clinically relevant allergens are being discovered, such as corticosteroids, metals, preservatives, surfactants, and glues. Continued epidemiologic surveillance of new allergens will enable manufacturers to develop safer products for patients to use.
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Affiliation(s)
- D E Cohen
- Department of Dermatology, New York University Medical Center, New York, USA
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Chapter III: Preventive activities. General aspects and the efficacy of emollients and moisturizers. Contact Dermatitis 1996. [DOI: 10.1111/j.1600-0536.1996.tb06259.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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