Patch testing in patients with suspected cosmetic dermatitis: A retrospective study

Characteristics of Litigations Involving Contact Dermatitis: An Exploratory Analysis

Background: Contact dermatitis (CD) is one of the most common skin disorders, occurring in >20% of patients worldwide. Estimated cost burden for CD in the United States approaches $1 billion annually. Objective: To describe characteristics of litigation among patients with CD. Methods: Westlaw legal database for U.S. lawsuits was queried for lawsuits between the years 1983 and 2021 containing the keywords "dermatitis or eczema." Each lawsuit associated with CD was analyzed by plaintiff demographics, verdict, prosecution reason, payouts, and allergen implicated. Results: Of 98 cases, 61 met the inclusion criteria. Verdicts issued favored plaintiffs (42.6%) more than defendants (32.8%) with the remaining cases decided through settlements. If payout occurred, the mean was $246,310 (standard deviation [SD] = $798,536), the median was $20,000 (Q1 = $8,500, Q3 = $88,725, interquartile range = $80,225). The top reason for litigation was toxic exposure (n = 38, 62.2%), and common contact allergens associated with lawsuits were latex (n = 4, 20%), surgical tape (n = 4, 20%), and beauty products (n = 4, 20%). Conclusion: Common allergens associated with lawsuits include latex, surgical tape, and beauty products. Most CD cases adjudicated in the United States since 1983 are associated with toxic exposures.

Quaternary Ammonium Compounds and Contact Dermatitis: A Review and Considerations During the COVID-19 Pandemic

The recent global pandemic has resulted in increased use of quaternary ammonium compounds (QACs). Currently, QACs are active ingredients in 292 disinfectants recommended by the US EPA for use against SARS-CoV-2. Among QACs, benzalkonium chloride (BAK), cetrimonium bromide (CTAB), cetrimonium chloride (CTAC), didecyldimethylammonium chloride (DDAC), cetrimide, quaternium-15, cetylpyridinium chloride (CPC), and benzethonium chloride (BEC) were all identified as potential culprits of skin sensitivity. Given their widespread utilization, additional research is needed to better classify their dermal effects and identify other cross-reactors. In this review, we aimed to expand our knowledge about these QACs to further dissect its potential allergic and irritant dermal effects on healthcare workers during COVID-19.

Skin Toxicity of Selected Hair Cosmetic Ingredients: A Review Focusing on Hairdressers

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.

Facial contact dermatitis caused by cosmetic-relevant allergens

BACKGROUND

Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge.

OBJECTIVES

To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic-related allergens and a new test series with cosmetic-relevant natural ingredients (CRNIs).

METHODS

This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic-relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life).

RESULTS

Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic-induced FD. The most common cosmetic-related allergens were fragrances and preservatives. The most common patch test-positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test-positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life.

CONCLUSIONS

Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life.

Development of Biodegradable Cosmetic Patch Using a Polylactic Acid/Phycocyanin-Alginate Composite

The usage of non-degradable polymer as the main matrix for a cosmetic patch raises concern, as it can cause environmental pollution when discarded in landfill. Thus, biodegradable polylactic acid (PLA) was chosen in this study, as PLA has non-toxic properties and similar mechanical properties to conventional plastic materials. An active ingredient in a cosmetic patch serves the purpose of providing beneficial ingredients to the skin; therefore, phycocyanin, an extract from spirulina, was chosen, as it possesses antioxidant and anti-inflammatory properties. Alginate was also incorporated with the phycocyanin for fabrication onto the PLA matrix. A preliminary study was first carried out to identify the antioxidant properties and cytotoxic effect of the phycocyanin on skin cells. It was observed that phycocyanin had no cytotoxic effect on the skin and showed good antioxidant activity. PLA/phycocyanin-alginate composite was fabricated using a solvent casting method, and optimization of preparation conditions (phycocyanin/alginate ratio, stirring time, and temperature) were carried out using the one-factor-at-a-time (OFAT) method with responses of elongation at break and releasing properties. Attenuated total reflectance (ATR)-FTIR analysis was also conducted to further analyze the functional group of the composites. Surface morphologies were observed for samples before and after the releasing test. From the analyses conducted, PLA/phycocyanin-alginate composite prepared at a phycocyanin/alginate ratio of 40/60 for 20 h at 20 °C gave the best properties in terms of flexibility of film and releasing properties of phycocyanin.

Patch test in Chinese in Shanghai with cosmetic allergy to cosmetic series and products

BACKGROUND

There are increasing cosmetic adverse reactions in China, mostly cosmetic contact dermatitis, with the development of its cosmetics industry.

AIMS

To identify the allergens and cosmetics products responsible for cosmetic allergic contact dermatitis (CACD) in Shanghai.

METHODS

Five hundred and sixty patients, including 342 suspected CACD patients from dermatological clinic and 218 cosmetics consumers with an allergic history, were patch tested with a cosmetic series (C-1000 series). And 154 patients patched with possible culprit cosmetics.

RESULTS

Two hundred and forty-six subjects showed positive reaction to C-1000 series. Clinic patients had much higher positive rate than that of cosmetics consumers. Leading allergens were methylisothiazolinone (MI), methylisothiazolinone + methylchloro-isothiazolinone (MCI/MI), thimerosal, and the positive rates were significantly higher in patients than in cosmetic consumers (P < .001 for all). MCI/MI elicited positive patch test reactions in 73.5% of MI-positive patients. Of those patched with cosmetic products, 19 patients had 31 positive reactions, including 22 skin care products and 5 color decorating.

CONCLUSIONS

Preservatives, especially MI, MCI/MI, and thimerosal, were the most common cosmetic allergens, and skin care products occupied the most allergic reaction of CACD. Patch testing is highly recommended for suspected CACD patients. Future comparative investigation with large sample size should benefit cosmetovigilance surveillance.

Growth and physiological response of an endangered tree, Horsfieldia hainanensis merr., to simulated sulfuric and nitric acid rain in southern China

As nitrogen deposition increases, acid rain is gradually shifting from sulfuric acid rain (SAR) to nitric acid rain (NAR). Acid rain can severely affect plant growth, damage ecosystems, and reduce biodiversity. Thus, a shift in acid rain type presents another challenge to the conservation of endangered plant species. We investigated the effect of three acid rain types (SAR, mixed acid rain [MAR], and NAR) and pH on the growth of an endangered Chinese endemic tree, Horsfieldia hainanensis Merr., using simulated rain in a greenhouse environment. Over nine months, growth indices, chlorophyll content, antioxidant enzyme activity, malondialdehyde content, and chlorophyll fluorescence parameters were investigated for treated and control saplings. The results indicated that at a pH of 5.6, H. hainanensis could adapt to SAR and MAR, but NAR inhibited below-ground growth. At a pH of 2.5 and 4.0, SAR inhibited stem and leaf biomass accumulation, whereas NAR inhibited root biomass accumulation and altered root morphology. MAR had intermediary effects between those of SAR and NAR. Adverse effects on leaf physiology were reduced as the rain type shifted from SAR to NAR; however, roots were increasingly adversely affected. Our results suggest that conservation efforts for H. hainanensis should shift from an above-ground to a below-ground focus as acid rain transitions toward NAR.

Thimerosal induces skin pseudo-allergic reaction via Mas-related G-protein coupled receptor B2

BACKGROUND

Thimerosal has been used as a preservative in many products which may cause contact dermatitis. It is the second most common allergen in positive patch test reactions, though being a clinical irrelevant allergen. Thimerosal-induced contact dermatitis is generally considered to be a delayed-type hypersensitivity reaction, but it is difficult to explain the fact that most patients develop an allergic reaction upon first encounter with thimerosal. Recent studies have demonstrated the association between Mas-related G protein coupled receptor X2 (MRGPRX2) and pseudo-allergic reactions which occur at the first contact with stimulation. This suggests the possibility that thimerosal may cause contact dermatitis via MRGPRX2 mediated mechanism.

OBJECTIVES

To investigate the role of Mas-related G-protein coupled receptor B2 (MrgprB2)/MRGPRX2 in contact dermatitis induced by thimerosal.

METHODS

Thimerosal induced pseudo-allergic reactions via MrgprB2/ MRGPRX2 were investigated using a novel skin pseudo-allergic reaction mouse model, footpad swelling and extravasation assays in vivo and mast cell degranulation assay in vitro.

RESULTS

Thimerosal induced contact dermatitis in dorsal skin and footpad swelling in wild-type mice, but had no significant effect in MrgprB2-knockout mice. Thimerosal-induced dermatitis is characterized by infiltration of inflammatory cells and elevation of serum histamine and inflammatory cytokines, rather than elevation of serum IgE level. Thimerosal increased the intracellular Ca²⁺ concentration in HEK293 cells overexpressing MrgprB2/MRGPRX2. Downregulation of MRGPRX2 resulted in the reduced degranulation of LAD2 human mast cells.

CONCLUSIONS

MrgprB2 mediates thimerosal-induced mast cell degranulation and pseudo-allergic reaction in mice. MRGPRX2 may be a key contributor to human contact dermatitis.

Clinical Profile and Allergens in Pigmented Cosmetic Dermatitis and Allergic Contact Dermatitis to Cosmetics in India

BACKGROUND

Pigmented cosmetic dermatitis (PCD) is frequently encountered in dark-skinned individuals as gradual hyperpigmentation on the face without preceding erythema or itching. Little is known about the allergen profile in PCD.

OBJECTIVES

The aim of the study was to describe the clinical profile and common allergens in PCD and allergic contact dermatitis (ACD) to cosmetics in Delhi.

METHODS

Records of patients suspected of PCD and ACD to cosmetics were analyzed. All patients were patch tested with the Indian standard series, Indian cosmetic and fragrance series, and personal cosmetics and, in relevant cases, hairdresser series.

RESULTS

One hundred six patients were analyzed. Patch test was positive in 77 cases (72.6%). Cetrimonium, gallate mix, thiomerosal, and skin lightening creams were more frequently positive in cases of PCD (P = 0.019-0.003), whereas p-phenylenediamine, toluene-2,5 diamine sulfate, p-aminophenol, m-aminophenol, and nitro-p-phenylenediamine were predominantly positive in ACD to cosmetics (P < 0.001).

CONCLUSIONS

Preservatives, antioxidants, and skin lightening creams seem to play a role in causation of PCD, whereas hair dye allergens cause ACD to cosmetics in India.

Contact Allergy: A Review of Current Problems from a Clinical Perspective

Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline^® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.