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Skin Toxicity of Selected Hair Cosmetic Ingredients: A Review Focusing on Hairdressers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137588. [PMID: 35805241 PMCID: PMC9265752 DOI: 10.3390/ijerph19137588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022]
Abstract
The safety assessment of cosmetics considers the exposure of a ‘common consumer’, not the occupational exposure of hairdressers. This review aims to compile and appraise evidence regarding the skin toxicity of cysteamine hydrochloride (cysteamine HCl; CAS no. 156-57-0), polyvinylpyrrolidone (PVP; CAS no. 9003-39-8), PVP copolymers (CAS no. 28211-18-9), sodium laureth sulfate (SLES; CAS no. 9004-82-4), cocamide diethanolamine (cocamide DEA; CAS no. 68603-42-9), and cocamidopropyl betaine (CAPB; CAS no. 61789-40-0). A total of 298 articles were identified, of which 70 were included. Meta-analysis revealed that hairdressers have a 1.7-fold increased risk of developing a contact allergy to CAPB compared to controls who are not hairdressers. Hairdressers might have a higher risk of acquiring quantum sensitization against cysteamine HCl compared to a consumer because of their job responsibilities. Regarding cocamide DEA, the irritant potential of this surfactant should not be overlooked. Original articles for PVP, PVP copolymers, and SLES are lacking. This systematic review indicates that the current standards do not effectively address the occupational risks associated with hairdressers’ usage of hair cosmetics. The considerable irritant and/or allergenic potential of substances used in hair cosmetics should prompt a reassessment of current risk assessment practices.
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Abstract
BACKGROUND The patch test is the standard for diagnosing allergic contact dermatitis. Standardized trays allow the examination of the most prevalent allergens, whereas customized trays are more appropriate for addressing specific allergens and require expertise. They are therefore usually performed in specialized clinics. METHODS We assessed the results of 4355 patch tests performed between 2012 and 2020 in a contact dermatitis clinic located in a large tertiary medical center. All patients were tested using the European baseline series and additional trays as clinically indicated. We assessed the frequency of relevant positive reactions outside the European baseline series. We then examined the added value and number of tests (NNTs) that need to be performed to elicit one relevant positive reaction per tray and common allergens. RESULTS Nine hundred fifty-four patients (21.9%) had 1 or more positive relevant reactions; 43.3% tested positive for an allergen outside the European baseline series (OEBS). The acrylate and fragrance trays were highly represented among the positive and relevant reactions OEBS with NNTs of 4.4 and 6.8, respectively. 2-Hydroxyethyl methacrylate is the most prevalent allergen OEBS and is considered a marker for acrylate sensitivity with a high rate of cross-reactions and concordance rate of 85%, justifying its addition to the EBS in 2018. Other highly represented allergens include chloramphenicol, 2-hydroxyethyl acrylate, and Amerchol L-101, a lanolin derivative. The cosmetics and textile trays, although often tested, have relatively low added values of 3.7% and 2.3%, respectively. Surprisingly, the cutaneous adverse drug reaction series tray (CAD-1000) yielded no positive reactions, whereas testing the patients' medication yielded positive results in 10.9% of the cases. CONCLUSIONS Expanded patch testing is crucial to accurately diagnose allergic contact dermatitis and almost doubles the number of patients with relevant positive reactions. Acrylate sensitivity is an emerging epidemic with a high positive reaction rate and low NNT, as is sensitivity to the allergens in the fragrance tray. 2-Hydroxyethyl methacrylate is a reliable marker for acrylate sensitivity with a concordance rate of 85%. Chloramphenicol is a common culprit and should be added to the standard tray in countries with a high usage rate. A low NNT was also observed when testing the patients' own cosmetics and medications; this should, therefore, be encouraged. The textile tray yielded a relatively high NNT; however, it should be performed when clinically indicated in the absence of a reliable marker in the EBS.
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Warshaw EM, Buonomo M, DeKoven JG, Pratt MD, Reeder MJ, Silverberg JI, Belsito DV, Maibach HI, Atwater AR, Houle MC, Taylor JS, Zug KA, DeLeo VA, Dunnick CA. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol 2021; 157:1456-1465. [PMID: 34730775 PMCID: PMC8567181 DOI: 10.1001/jamadermatol.2021.4314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens. OBJECTIVE To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances. DESIGN, SETTING, AND PARTICIPANTS A 17-year, retrospective cross-sectional analysis (January 1, 2001, to December 31, 2018) of North American Contact Dermatitis Group (NACDG) data from multiple centers in North America was conducted. A total of 43 417 patients with dermatitis underwent patch testing to the NACDG screening series in a standardized manner with 65 to 70 allergens and supplemental allergens as clinically indicated. Patients with 1 or more clinically relevant reactions to a supplemental (nonscreening) allergen/substance were analyzed between November 18, 2020, and March 12, 2021. MAIN OUTCOMES AND MEASURES The main outcomes were to assess the number of patients with clinically relevant reactions to supplemental (nonscreening) allergens and compare characteristics (including demographic characteristics and occupations) between patients with a clinically relevant patch test reaction to 1 or more supplemental allergens or substances (supplement-positive) and those without a reaction (supplement-negative) using odds ratios (ORs) and 95% CIs. Secondary outcomes included sources of allergic contact dermatitis and, for occupationally related cases, specific occupations and industries. RESULTS Of 43 417 patients included in the study who underwent patch testing to the NACDG screening series (65-70 allergens), 9507 individuals (21.9%) had currently relevant reactions to 1 or more supplemental allergens or substances. Of these, 6608 were women (69.5%) and the mean (SD) age was 47.2 (0.54) years. Compared with patients who had supplement-negative results, patients with supplement-positive findings were significantly less likely to be male (OR, 0.90; 95% CI, 0.85-0.94; P < .001) and/or have atopic dermatitis (OR, 0.89; 95% CI, 0.84-0.93; P < .001). Common primary sites of dermatitis in 9499 patients with supplement-positive findings included the face (2856 [30.1%]), hands (2029 [21.4%]), and scattered/generalized distribution (1645 [17.3%]). Frequent sources of supplemental allergens in 9235 patients included personal care products (4746 [51.4%]) and clothing/wearing apparel (1674 [18.1%]). Of 9362 patients with available data, supplemental allergens/substances were occupationally related in 1580 (16.9%); of those with identified occupations, 25.1% (384 of 1529) were precision production, craft, or repair workers. Of 9507 patients with supplement-positive findings, 2447 (25.7%) had no currently relevant reactions to NACDG screening allergens. CONCLUSIONS AND RELEVANCE This cross-sectional study found that 21.9% of patients who underwent patch testing to an allergen screening series of 65 to 70 allergens had at least 1 relevant reaction to supplemental allergens/substances. Of these, one-quarter reacted only to a supplemental allergen/substance. Screening series include common, important allergens, but these findings suggest that the addition of specialty allergens and personal or work products is critical for the successful diagnosis and management of allergic contact dermatitis.
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Affiliation(s)
- Erin M. Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota
- Department of Dermatology, University of Minnesota, Minneapolis
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Michele Buonomo
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
- University of Minnesota Medical School, Minneapolis
| | - Joel G. DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Melanie D. Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J. Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Donald V. Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | | | - Amber R. Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - James S. Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn A. Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Vincent A. DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
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Cheng HS, Konya J, Lobel E, Fernandez-Penas P. Australian baseline series allergens in assessment of allergic contact dermatitis in New South Wales. Australas J Dermatol 2021; 63:e78-e80. [PMID: 34751435 DOI: 10.1111/ajd.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/23/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Harriet Sara Cheng
- The Skin Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Konya
- The Skin Hospital, Sydney, New South Wales, Australia
| | - Edmund Lobel
- The Skin Hospital, Sydney, New South Wales, Australia
| | - Pablo Fernandez-Penas
- The Skin Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Wilkinson SM, Badulici S, Giménez-Arnau A, Dickel H, Gonçalo M, Hervella M, Isaksson M, Johansen JD, Mahler V, Thyssen JP, Uter W. The European baseline series: Criteria for allergen inclusion (with reference to formaldehyde releasers). Contact Dermatitis 2021; 85:125-128. [PMID: 33745196 DOI: 10.1111/cod.13836] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
Existing criteria for inclusion in the European baseline series are summarized. Additional criteria are developed to aid decision making where the current criteria do not yield an unequivocal result. These include a consideration of whether an allergen (hapten) is better placed in a special series and the frequency with which an allergen cross-reacts with existing markers in the baseline series.
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Affiliation(s)
- S Mark Wilkinson
- Department of Dermatology, Chapel Allerton CSU, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ana Giménez-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autónoma, Barcelona, Spain
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Bochum, Germany
| | - Margarida Gonçalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Marcos Hervella
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | | | - Jacob P Thyssen
- National Allergy Research Centre, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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Mizutani H, Nixon RL. The Australian Baseline Series. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dear K, Bala H, Palmer A, Nixon RL. How good is the Australian baseline series at detecting allergic contact dermatitis? Australas J Dermatol 2020; 62:51-56. [DOI: 10.1111/ajd.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Harini Bala
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
| | - Rosemary Louise Nixon
- Occupational Dermatology Research and Education Centre Skin Health Institute Melbourne Australia
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Cheraghlou S, Watsky KL, Cohen JM. Utilization, cost, and provider trends in patch testing among Medicare beneficiaries in the United States from 2012 to 2017. J Am Acad Dermatol 2020; 85:1218-1226. [PMID: 32387633 DOI: 10.1016/j.jaad.2020.04.163] [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: 03/21/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patch testing is the best diagnostic test for allergic contact dermatitis. However, there is presently a lack of data on the test's geographic availability and the characteristics of the providers offering this test across the United States. OBJECTIVE To evaluate the geographic variation in the availability of patch testing for the Medicare population and to characterize the temporal trends of patch testing cost, use, and provider specialty from 2012 to 2017. METHODS Retrospective cohort study of the Medicare Provider Utilization and Payment Data from 2012 to 2017. RESULTS As of 2017, patch testing was available in 20.3% of metropolitan counties and in 1.1% of nonmetropolitan counties. From 2012 to 2017 in metropolitan regions, the number of beneficiaries tested by dermatologists grew by an average annual growth rate of 1.84%, whereas those tested by allergists grew by an average annual growth rate of 20.31%. Most providers that averaged use of 80 or more patches per beneficiary were dermatologists (76.3%). LIMITATIONS Analysis was restricted to Medicare Part B claims; data were unavailable on individuals with commercial insurance. CONCLUSIONS Most of the increase in patch testing utilization from 2012 to 2017 has been in metropolitan regions. Although growth was especially prominent among allergists in metropolitan counties, the majority of providers performing comprehensive patch testing were dermatologists.
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Affiliation(s)
- Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kalman L Watsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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Wu PA. The Importance of Education When Patch Testing. Dermatol Clin 2020; 38:351-360. [PMID: 32475513 DOI: 10.1016/j.det.2020.02.004] [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: 10/24/2022]
Abstract
Education is the keystone of successful management of allergic contact dermatitis. This article outlines practical tips to manage patients' expectations of the patch test process and understand their results. The considerations are outlined in a stepwise fashion from before, during, and after patch testing. Resources for patient information are highlighted, and an update on provider education is also included.
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Affiliation(s)
- Peggy A Wu
- Department of Dermatology, University of California Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA.
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The Australian Baseline Series. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_68-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Wilbur Johnson
- Senior Scientific Writer/Analyst, Cosmetic Ingredient Review, Washington, DC, USA
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Tizi S, Nixon RL. Patch testing in Australia: Is it adequate? Australas J Dermatol 2015; 57:192-8. [DOI: 10.1111/ajd.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/12/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Stephanie Tizi
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation Inc; Melbourne Victoria Australia
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Wold L, Chen JK, Lampel HP. Hand dermatitis: an allergist's nightmare. Curr Allergy Asthma Rep 2014; 14:474. [PMID: 25228264 DOI: 10.1007/s11882-014-0474-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hand dermatitis is a common skin complaint. We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Patients with hand dermatitis may present to their allergist with this complaint. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute to the overall condition. Furthermore, the differential diagnosis of hand dermatitis is broad and the cause often multifactorial. Obtaining a thorough history and performing a focused examination may help the clinician differentiate between multiple causes of hand dermatitis. Numerous treatment options exist for hand dermatitis, and new potential treatments are in development as well. We aim to provide the allergist with a streamlined toolkit for help in the diagnosis and management of hand dermatitis.
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Affiliation(s)
- Lindsey Wold
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA,
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Aquino M, Fonacier L. The Role of Contact Dermatitis in Patients with Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:382-7. [DOI: 10.1016/j.jaip.2014.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 12/25/2022]
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Abstract
Evidence for the effectiveness of patch testing and the need for an expanded series that provides experience and evidence-based suggestions for an extended patch testing series are examined in this review. Many of those testing with shorter allergen series are interested in expanding the spectrum of patch testing. The American Contact Dermatitis Society (ACDS) Core Allergen Series Group has arranged a group of suggested allergen groups that can be logically scaled up or down depending on the needs of the patch tester and the community being tested. This is not an "ACDS 80 Standard." We suggest a core group of allergens similar to the TRUE Test (SmartPractice, Phoenix, Ariz) with subsequent trays providing a greater breadth of coverage in a logical fashion, with more likely allergens being higher in the tray. For more extensive testing, specialty trays (ie, cosmetics, metals, plant, etc) are recommended.
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