Contact allergy in Indonesian patients with foot eczema attributed to shoes

Contact allergy to rubber accelerators in consecutively patch tested Danish eczema patients: A retrospective observational study from 1990 to 2019

BACKGROUND

Rubber accelerators are used in the production of rubber gloves and may cause contact allergy.

OBJECTIVES

To estimate long-term trend and prevalence of contact allergy to rubber accelerators for a 30-year period in Denmark, high-risk occupations, and exposures.

METHODS

Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch-tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted.

RESULTS

The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12-years, followed by a stable frequency in the past 18-years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet-work occupations were most often affected and gloves the most frequent exposure.

CONCLUSIONS

Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention.

Allergic contact dermatitis to footwear in Thailand: Prevalence, clinical characteristics and common allergens

BACKGROUND

Footwear contact allergy is caused by exposure to allergens in shoes. The prevalence and common allergens vary by region and time due to differences in customs and lifestyle.

OBJECTIVES

To determine the clinical characteristics and common allergens of patients with footwear-related allergic contact dermatitis (ACD) who attended Siriraj Hospital in Bangkok, Thailand, between 2001 and 2020.

METHODS

The medical records of 247 patients with clinically suspected footwear dermatitis who underwent patch testing were reviewed.

RESULTS

The prevalence of ACD to footwear was 1.8%. Females were predominant (71.6%). The three most common allergens were carba mix (7.7%), mercapto mix (6.9%) and potassium dichromate (6.9%). According to the allergens found, rubber (14.2%), adhesives (7.7%) and leathers (6.9%) were the three most common groups. Dorsal-limited skin lesions were significantly associated with footwear ACD.

CONCLUSION

Rubber and leather allergens were still the most common culprit allergens. Dermatologists should keep up-to-date on common allergens in footwear and emerging allergens to include in patch test series.

The Value of Patch Testing With Shoe Material Samples in Patients Suspected of Shoe Allergic Contact Dermatitis

BACKGROUND

Patch testing is the standard diagnostic tool for shoe allergic contact dermatitis (ACD). As shoe materials change over time, utilizing commercial allergen series might be ineffective. However, because testing with patients' shoe samples is laborious, its value is questioned.

OBJECTIVE

The aim of this study was to ascertain the benefits of patch testing with patients' shoes by comparing the frequencies of patch-test positivity of shoes and shoe-related allergens in baseline series for suspected shoe ACD patients.

METHODS

A retrospective study was conducted of patients with clinically suspected shoe ACD who underwent patch testing with baseline series and shoe samples 2000 to 2019.

RESULTS

Almost half of the cohort (77 of 178; 43.3%) was diagnosed with shoe ACD. Of those 77, 48 (62.3%) were positive to shoe-related allergens from the baseline series, whereas 53 (68.8%) were positive to their shoe materials. The prevalence of tests positive to shoe material but negative to shoe-related allergens was 29 of 77 (37.7%). The most common shoe-related allergens were potassium dichromate (7.9%), carba mix (6.8%), and mercapto mix (6.7%).

CONCLUSIONS

Patch testing with shoe materials increased the diagnostic yield by 37.7 percent. To diagnose shoe ACD, testing of shoe materials may compensate for unknown, scarce, or novel allergens not in the baseline series.

Patch test results in patients with suspected contact allergy to shoes: Retrospective IVDK data analysis 2009-2018

BACKGROUND

Allergic contact dermatitis caused by shoes is common and new relevant allergens have been identified.

OBJECTIVES

To investigate the pattern of type IV sensitization in patients with suspected allergic contact dermatitis of the feet related to shoes as a presumed culprit trigger.

METHODS

Retrospective analysis of data of the Information Network of Departments of Dermatology (IVDK), 2009-2018.

RESULTS

Six hundred twenty-five patients with presumed shoe dermatitis were identified in a cohort of 119 417 patients. Compared to patients with suspected contact sensitization from other allergen sources (n = 118 792), study group patients were more frequently sensitized to potassium dichromate (10.8% vs 3.5%), colophony (7.2% vs 3.7%), mercaptobenzothiazole (MBT; 4.0% vs 0.6%), mercapto mix (4.6% vs 0.6%), and p-tert-butylphenol formaldehyde resin (1.6% vs 0.5%). Sensitizations to urea formaldehyde resin, melamine formaldehyde resin, glutaraldehyde, tricresyl phosphate, and phenyl glycidylether were rare. Moreover, reactions to compounds in the leather or textile dyes test series were scarce.

CONCLUSION

A distinct sensitization pattern was observed in patients with suspected allergy to shoe materials. Although substances with low sensitization rates should be removed from the leather and shoe patch test series, novel potential allergens should be added.

Assessment of Impairment of Quality of Life in Foot Eczema and Correlation thereof with Epidemiological Data of its Patients: A Cross-Sectional Study

Background:

Eczema of foot adversely impacts daily activities, work productivity, and interpersonal relationships.

Materials and Methods:

This cross-sectional, questionnaire-based study collated epidemiological data of 70 outpatients of foot eczema, evaluated their quality of life by 10-item dermatology life quality index (DLQI) questionnaire, and undertook the correlation thereof.

Results:

Cases were predominantly males (48; 68.5%); 26 (37.1%) belonged to fifth decade of life and 47 (67%) presented within 12 months of onset. Dorsa of feet was involved in most (59; 84.2%) cases. Itching was a universal complaint followed by scaling (51; 72.9%), dryness (22; 31.4%), and oozing (21; 30%). History of atopy was reported by 15 (21.4%) patients; tobacco and/or alcohol abuse 32 (45.7%) patients; past treatment was received by 37 (52.9%) patients; and winter aggravation in 9 (12.3%) patients. Mean DLQI score was 13.64; with very large effect (11–20) on QoL in 38 (54.3%) patients; moderate (6–10) in 15 (21.4%) patients; extremely large (21–30) in 9 (12.9%) patients; and small (2–5) in 8 (11.4%) patients. Mean scores of questions of DLQI tool were 2.46 in first question (symptoms), 1.99 in fifth (social activities); 1.81 in seventh (working/studying); and 0.17 in fourth (clothes) question. Significant (P < 0.05) impairment of quality of life emerged with respect of burning, scaling, oozing, history of atopy, seasonal variation, and past treatment.

Conclusion:

Our study reports significant association of atopy, winter aggravation, past treatment, burning, scaling, and oozing with adverse quality of life in our study on cases of foot eczema and appears to be first study from India.

Isothiazolinone derivatives and allergic contact dermatitis: a review and update

Allergic contact dermatitis (ACD) from isothiazolinones has frequently been described in the literature. Following an epidemic of sensitization to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) in the 1980s, and more recently to MI, the Scientific Committee on Consumer Safety of the European Commission banned their use in leave-on products, while restricting that in rinse-off cosmetics. Despite a decreasing prevalence of ACD from MCI/MI and MI, cases caused by occupational exposure and non-cosmetic isothiazolinone sources are on the rise. Moreover, sensitization to newer and lesser known isothiazolinones has been reported. This paper reviews the epidemiology of contact allergy to different isothiazolinones, clinical presentation of isothiazolinone-induced ACD, most relevant sensitization sources and potential cross-reactions between isothiazolinone derivatives. It also provides an update on recent legislative measures.

Foot contact dermatitis: nitrofurazone as the main cause in a retrospective, cross-sectional study over a 16-year period from Turkey

BACKGROUND

The major causative agents in allergic contact dermatitis of the foot may differ from country to country. Sufficient data on foot eczema in patients from Turkey are lacking.

OBJECTIVE

To identify the clinically relevant contact allergens in foot eczema and determine the role of patch test series and patients' own materials in the detection of the responsible allergens.

METHODS

Among 1753 patients patch tested between 1996 and 2012 in our clinic, 53 with suspected allergic foot eczema were enrolled in this retrospective, cross-sectional study. Forty nine patients were patch tested with the extended European baseline series, 49 with supplemental series including rubber, leather, topical drugs, textile, cosmetic series containing preservatives and emulgators and varnish/plastic/glue series, and 37 with their own substances.

RESULTS

Thirty of the 53 patch tested patients showing sensitization to at least one clinically relevant allergen were diagnosed with allergic foot eczema. The main eliciting agent was nitrofurazone (n = 8), followed by leather shoe allergens, ie, potassium dichromate (n = 6), p-tert-butylphenol formaldehyde resin and formaldehyde, in the second range. Rubber shoe allergens were less frequently observed (n = 3). In more than 1/3 of the patients, the causative agent could only be identified by testing the patient's own substances and/or supplemental series.

CONCLUSION

Nitrofurazone was the leading causative agent followed by leather shoe allergens. Pediatric patients were frequently sensitized with shoe allergens. Patch testing with patient's own substances had a critical value in the detection of the causative agent in a significant number of patients.