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Atwater AR, Bembry R, Green CL, Warshaw EM, Belsito DV, DeKoven JG, Reeder MJ, Silverberg JI, Taylor JS, DeLeo VA, Sasseville D, Pratt MD, Zug KA, Dunnick C, Houle MC. Nonmedical Adhesive Allergens: Retrospective Analysis of Cross-Sectional Data From the North American Contact Dermatitis Group, 2001-2018. Dermatitis 2024. [PMID: 38593448 DOI: 10.1089/derm.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Raina Bembry
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Park Nicollet Health Services, University of Minnesota, Minneapolis, MN, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Cory Dunnick
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Canada
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Ehlert B, Coerdt K, Taylor JS, Hsieh F, Anthony JS. Insulin Allergy Presenting as Protein Contact Dermatitis: Letter. Dermatitis 2024. [PMID: 38502840 DOI: 10.1089/derm.2023.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Brittany Ehlert
- Ohio University Heritage College of Osteopathic Medicine Cleveland, OH USA
| | - Kathleen Coerdt
- Department of Dermatology Cleveland Clinic Cleveland, OH USA
| | - James S Taylor
- Department of Dermatology Cleveland Clinic Cleveland, OH USA
| | - Fred Hsieh
- Department of Allergy and Immunology Cleveland Clinic Cleveland, OH USA
| | - John S Anthony
- Department of Dermatology Cleveland Clinic Cleveland, OH USA
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Reeder MJ, Nihal A, Aravamuthan SR, Warshaw EM, DeKoven JG, Atwater AR, Houle MC, Adler BL, Silverberg JI, Taylor JS, Pratt MD, Belsito DV, Yu J, Botto NB, Mowad CM, Dunnick CA, DeLeo VA. Allergic or Not: Final Interpretation of Doubtful Patch Test Reactions From the North American Contact Dermatitis Group, 2019-2020. Dermatitis 2024; 35:138-143. [PMID: 38320244 DOI: 10.1089/derm.2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background: Doubtful patch test reactions generally do not meet criterion for positivity in patch testing. However, the North American Contact Dermatitis Group (NACDG) allows for doubtful reactions to be coded with a final determination of "allergic/positive" based on the temporal pattern, appearance, known characteristics of the allergen, and/or other supportive patch test reactions. Objectives: To analyze NACDG data from the 2019-2020 patch test cycle to identify patterns in the interpretation and relevance of doubtful reactions. Methods: The frequency and proportions of doubtful reactions were tabulated and analyzed for patterns. Statistical analyses were limited to allergens with ≥30 doubtful reactions to ensure adequate sample size. Results: Of patch-tested patients, 31.9% (1315/4121) had ≥1 doubtful reaction. Of 2538 total doubtful reactions, 46% (n = 1167) had a final interpretation of "allergic/positive." The allergens with the highest proportion of doubtful reactions at the final visit were hydroperoxides of linalool 1% (4.5%), fragrance mix I 8.0% (3.9%), and cetrimonium chloride 0.5% (3.4%). Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) 0.02% (P < 0.001), MI 0.2% (P < 0.001), nickel sulfate hexahydrate 2.5% (P = 0.001), and neomycin sulfate 20.0% (P = 0.003) doubtful reactions were more likely to be interpreted as allergic than nonallergic. Methyldibromoglutaronitrile/phenoxyethanol 0.2% (P < 0.001), oleamidopropyl dimethylamine 0.1% (P < 0.001), formaldehyde 2.0% (P < 0.001), cetrimonium chloride 0.5% (P < 0.001), benzophenone-4 (sulisobenzone) 10% (P < 0.001), iodopropynyl butylcarbamate 0.5% (P < 0.001), cocamidopropyl betaine 1.0% (P = 0.002), and benzisothiazolinone 0.1% (P = 0.012) doubtful reactions were less likely to be interpreted as allergic. Of the 1167 doubtful reactions interpreted as allergic, 84.9% had current relevance. Conclusions: Doubtful reactions were common and approximately one half were coded with a final interpretation of "allergic/positive." Of those, most were clinically relevant. MCI/MI, MI, nickel, and neomycin were more likely to be interpreted as allergic.
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Affiliation(s)
- Margo J Reeder
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aman Nihal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Srikanth R Aravamuthan
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina B Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; and
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Silverberg JI, Patel N, Warshaw EM, DeKoven JG, Belsito DV, Atwater AR, Taylor JS, Sasseville D, Reeder MJ, Houle MC, DeLeo VA, Maibach HI, Fowler JF, Zug KA, Pratt MD, Yu J, Mowad CM, Botto NC, Adler BL. Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis. Dermatitis 2024; 35:152-159. [PMID: 38052041 DOI: 10.1089/derm.2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background: Allergic contact dermatitis is frequently caused by metals, including multiple metals simultaneously. Objectives: To assess characteristics and associations of positive and clinically relevant patch test (PT) reactions with solitary and concurrent metal sensitization. Methods: A retrospective analysis of PT results for nickel, cobalt, and/or chromium from the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,522). Results: 18.0% had a positive/allergic reaction to nickel sulfate hexahydrate, 7.3% to cobalt chloride hexahydrate, and 3.0% to potassium dichromate. 87.9% patients had a currently relevant reaction to 0, 9.4% to 1, and 2.7% to multiple metals tested. Patients with 1 versus no currently relevant reactions to metal were more likely to have a primary dermatitis site of trunk, feet, and ears; patients with currently relevant reactions to multiple metals had more dermatitis affecting the trunk and ears. Metal sources varied by co-reacting metal, especially for patients with cobalt and chromium allergy. Jewelry was the most commonly identified source of nickel and cobalt for both solitary and concurrent metal allergy. Conclusions: Sensitization to multiple metals occurred in 6% of patients. Allergen sources varied between patients with sensitivity to 1 metal versus those who had concurrent sensitivity to cobalt and/or chromium.
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Affiliation(s)
- Jonathan I Silverberg
- From the Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nisha Patel
- From the Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Canada
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christen M Mowad
- Division of Dermatology, Geisinger Health System, Danville, Pennsylvania, USA; and
| | - Nina C Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Brandon L Adler
- Department of Dermatology, University of Southern California, Lost Angeles, California, USA
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Reeder MJ, Zhang D, Aravamuthan SR, Warshaw EM, DeKoven JG, Silverberg JI, Adler BL, Atwater AR, Taylor JS, Houle MC, Belsito DV, Yu J, Botto N, Mowad CM, Dunnick CA, DeLeo VA, Pratt MD. More than just methylisothiazolinone: Retrospective analysis of patients with isothiazolinone allergy in North America, 2017-2020. J Am Acad Dermatol 2024; 90:319-327. [PMID: 37879460 DOI: 10.1016/j.jaad.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Isothiazolinones are a common cause of allergic contact dermatitis. OBJECTIVE To examine the prevalence of positive patch test reactions to isothiazolinones from 2017-2020 and characterize isothiazolinone-allergic (Is+) patients compared with isothiazolinone nonallergic (Is-) patients. METHODS Retrospective cross-sectional analysis of 9028 patients patch tested to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) 0.02% aqueous, MI 0.2% aqueous, benzisothiazolinone (BIT) 0.1% petrolatum, and/or octylisothiazolinone (OIT) 0.025% petrolatum. Prevalence, reaction strength, concurrent reactions, clinical relevance, and source of allergens were tabulated. RESULTS In total, 21.9% (1976/9028) of patients had a positive reaction to 1 or more isothiazolinones. Positivity to MI was 14.4% (1296/9012), MCI/MI was 10.0% (903/9017), BIT was 8.6% (777/9018), and OIT was 05% (49/9028). Compared with Is-, Is+ patients were more likely to have occupational skin disease (16.5% vs 10.3%, P <.001), primary hand dermatitis (30.2% vs 19.7%, P <.001), and be >40 years (73.1% vs 61.9%, P <.001). Positive patch test reactions to >1 isothiazolinone occurred in 44.1% (871/1976) of Is+ patients. Testing solely to MCI/MI would miss 47.3% (611/1292) of MI and 60.1% (466/776) of BIT allergic reactions. LIMITATIONS Retrospective cross-sectional study design and lack of follow-up data. CONCLUSION Sensitization to isothiazolinones is high and concurrent sensitization to multiple isothiazolinone allergens is common.
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Affiliation(s)
- Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Donglin Zhang
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Srikanth R Aravamuthan
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Botto
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Christen M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Canada
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Szvalb AD, Marten C, Cain K, Taylor JS, Huang SY, Jiang Y, Raad II, Viola GM. Percutaneous nephrostomy catheter-related infections in patients with gynaecological cancers: a multidisciplinary algorithmic approach. J Hosp Infect 2023; 141:99-106. [PMID: 37696471 DOI: 10.1016/j.jhin.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Percutaneous nephrostomy catheters (PCNs) are commonly utilized in patients with gynaecological cancers due to intrinsic or extrinsic urinary obstruction. Unfortunately, these foreign medical devices may be associated with several infectious complications, including: pyelonephritis, renal abscess, and bacteraemia, which may lead to further delay of life-saving cancer therapy. AIM To evaluate the performance of our multidisciplinary algorithm for diagnosis and treatment of PCN-related infections (PCNIs) and identify risk factors for recurrent urinary device-related infections. METHODS Patients with gynaecological cancers having PCNIs were prospectively evaluated at our institution from July 2019 to September 2021. All patients were managed by our standardized algorithm and followed-up until reinfection or routine PCN exchange. FINDINGS Of 100 consecutive patients with PCNIs, 74 had adequate follow-up, and were analysed in three groups according to clinical outcome: reinfection with the same organism (26%), reinfection with a different organism (23%), and no reinfection (51%). Their median age was 54 years, and the most common cancers were cervical (65%), and ovarian (19%) with 53% being metastatic. The most frequently recovered micro-organisms were Pseudomonas (32%), Enterococcus (27%), and Escherichia (24%) species. The main risk factors for recurrent PCNI with the same organism were pelvic radiation therapy (P=0.032), pelvic fistulas (P=0.014), and a PCNI with the same pathogen within the previous year (P = 0.012). CONCLUSIONS Our algorithm has allowed for accurate diagnosis, staging, and treatment of and identification of several key risk factors for recurrent PCNIs. These results may lead to further preventive measures for these infections.
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Affiliation(s)
- A D Szvalb
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Marten
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Cain
- Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J S Taylor
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G M Viola
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Warshaw EM, Han J, Kullberg SA, DeKoven JG, Adler BL, Silverberg JI, Houle MC, Pratt MD, Belsito DV, Yu J, Botto NC, Reeder MJ, Taylor JS, Atwater AR, Dunnick CA, DeLeo VA, Mowad CM. Patch Testing to Chlorhexidine Digluconate, 1% Aqueous: North American Contact Dermatitis Group Experience, 2015-2020. Dermatitis 2023; 34:501-508. [PMID: 37279017 DOI: 10.1089/derm.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. Objectives: To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. Methods: This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Group, 2015-2020. Results: Of 14,731 patients tested to chlorhexidine digluconate, 107 (0.7%) had an allergic reaction; of these, 56 (52.3%) reactions were currently clinically relevant. Most (59%) reactions were mild (+), followed by strong (++, 18.7%) and very strong (+++, 6.5%). Common primary dermatitis anatomic sites in chlorhexidine-positive patients were hands (26.4%), face (24.5%), and scattered/generalized distribution (17.9%). Compared with negative patients, chlorhexidine-positive patients were significantly more likely to have dermatitis involving the trunk (11.3% vs 5.1%; P = 0.0036). The most commonly identified source category was skin/health care products (n = 41, 38.3%). Only 11 (10.3%) chlorhexidine reactions were occupationally related; of these, 81.8% were in health care workers. Conclusions: Chlorhexidine digluconate allergy is uncommon, but often clinically relevant. Involvement of the hands, face, and scattered generalized patterns was frequent. Occupationally related reactions were found predominantly in health care workers.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joohee Han
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
| | - Sara A Kullberg
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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8
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Warshaw EM, Peterson MY, Atwater AR, DeKoven JG, Pratt MD, Taylor JS, Belsito DV, Silverberg JI, Reeder MJ, DeLeo VA, Houle MC, Dunnick CA, Yu J, Adler B, Mowad C, Botto NC. Patch Testing to Paraphenylenediamine: The North American Contact Dermatitis Group Experience (1994-2018). Dermatitis 2023; 34:536-546. [PMID: 37523239 DOI: 10.1089/derm.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018). Demographics and dermatitis site(s) were compared between PPD-allergic and PPD-negative patients. PPD reactions were analyzed by reaction strength, clinical relevance, occupational relatedness, and source as well as coreactivity with structurally related compounds. Results: Of 54,917 patients tested to PPD, 3095 (5.6%) had an allergic patch test reaction. Compared with PPD-negative patients, PPD-allergic patients had significantly greater odds of age >40 years (odds ratio [OR] 1.55 [95% confidence interval; CI 1.43-1.69]) and female gender (OR 1.52 [95% CI 1.41-1.66]), but lower odds of being White (OR 0.66 [95% CI 0.60-0.71]). The most common primary anatomic sites of dermatitis were face (25.5%), hands (21.9%), and scattered/generalized pattern (15.5%). Over half (55.3%) of PPD reactions were ++ or +++ at the final reading and 60.9% were currently relevant. Common exposure sources included hair dye (73.5%) and clothing/shoes/apparel (3.9%). Occupationally related reactions occurred in 8.3%, most commonly in hairdressers/cosmetologists (72.8%). The most common coreactions were benzocaine (11.3%), N-isopropyl-N'-phenyl-p-phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). Conclusions: The 24-year percentage of allergic reactions to PPD was 5.6%. PPD allergy was associated with female gender and age >40 years. PPD allergic patients were less likely to be White. Allergic reactions were usually clinically relevant and hair dye was the most frequently identified source.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Malina Yamashita Peterson
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christen Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Nina C Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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9
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Yu J, Johnson H, DeKoven JG, Warshaw EM, Taylor JS, Belsito DV, Adler BL, Silverberg JI, Atwater AR, Reeder MJ, Botto N, Houle MC, Mowad CM, Pratt MD, Dunnick CA. Patch Test Results Among Older Adults: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2009-2020). Dermatitis 2023. [PMID: 37590477 DOI: 10.1089/derm.2023.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Background: Allergic contact dermatitis (ACD) in older adults (OA) represents a significant health burden, but few studies examine the prevalence and characteristics of contact allergy and ACD in this population. Objective: To compare positive and clinically relevant patch test results in OA versus younger adults (YA) and children. Methods: Retrospective analysis of patch test results obtained in OA (≥65 years), YA (19-64 years), and children (≤18 years) by the North American Contact Dermatitis Group, 2009 to 2020. Results: Of 28,177 patients patch tested, 5366 (19.0%) were OA. OA were more likely to have a final primary diagnosis of ACD as compared with YA (50.8% vs 49.2%, P = 0.035) and children (44.6%, P < 0.0001). The primary site of dermatitis also differed by age group, with OA having a higher proportion of dermatitis affecting the trunk, scalp, anogenital region, and "under clothing," and a lower proportion of dermatitis affecting the face, lips, and feet. Limitations: Retrospective design, lack of follow-up, and referral population. Conclusion: OA were as likely and were statistically even more likely to have a final primary diagnosis of ACD compared with YA and children. Anatomic site of dermatitis also differed by age group. This underscores the need for patch testing in OA when ACD is suspected.
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Affiliation(s)
- JiaDe Yu
- From the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hadley Johnson
- From the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical College, New York, New York, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada; and
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
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10
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Silverberg JI, Patel N, Warshaw EM, DeKoven JG, Belsito DV, Atwater AR, Taylor JS, Sasseville D, Reeder MJ, Houle MC, DeLeo VA, Maibach HI, Fowler JF, Zug KA, Pratt MD. Patch Testing With Cobalt in Adults: A North American Contact Dermatitis Group Experience, 2001-2018. Dermatitis 2023; 34:209-217. [PMID: 37205858 DOI: 10.1097/der.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background: Cobalt is a recognized cause of allergic contact dermatitis (ACD); however, detailed information on patient characteristics, sites, and sources is lacking. Objective: The aim of the study is to assess trends in patch test reactions to cobalt and associated patient characteristics, common sources, and body sites affected. Methods: The study used a retrospective analysis of adult patients who were patch tested to cobalt by the North American Contact Dermatitis Group between 2001 and 2018 (n = 41,730). Results: Overall, 2986 (7.2%) and 1362 (3.3%) had allergic or currently relevant patch test reaction to cobalt, respectively. Patients with versus without an allergic patch test reaction to cobalt were more likely to be female, employed, have a history of eczema or asthma, be Black, Hispanic, or Asian, and have occupational-related dermatitis. The most commonly identified sources of cobalt in allergic patients included jewelry, belts, and cement, concrete, and mortar. Affected body site(s) varied by cobalt source among patients with currently relevant reactions. Occupational relevance was found in 16.9% of patients with positive reactions. Conclusions: Positive patch test reactions to cobalt were common. The most common body sites were the hands, and affected site varied by the source of cobalt.
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Affiliation(s)
- Jonathan Ian Silverberg
- From the Department of Dermatology, George Washington University School of Medicine, Washington, DC
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nisha Patel
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services
- Department of Dermatology, University of Minnesota
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, MN
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | | | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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11
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Silverberg JI, Chaubal M, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Houle MC. Prevalence and trend of allergen sensitization in patients with cheilitis referred for patch testing, North American Contact Dermatitis Group data, 2001-2018. Contact Dermatitis 2023; 88:300-314. [PMID: 36502370 DOI: 10.1111/cod.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND An updated understanding of allergic contact cheilitis is needed. OBJECTIVES To characterize clinical characteristics and allergen relevance in patients with cheilitis referred for patch testing. METHODS Retrospective analysis of 43 772 patients patch tested with the North American Contact Dermatitis Group (NACDG) screening series from 2001 to 2018. RESULTS Overall, 2094 patients (4.8%) had lips as one of three sites of dermatitis, 1583 (3.6%) had lips as the primary site and 1167 (2.7%) had lips as the sole site of dermatitis. Prevalences of cheilitis at any, primary, and sole sites significantly increased throughout the study cycle from 2001-2002 (2.7%, 2.2% and 1.7%) to 2017-2018 (7.8%, 5.2% and 3.7%). Approximately 60% of patients with any, a primary, or a sole site of cheilitis had one or more positive allergic patch-test reactions compared to 65% of those without cheilitis. CONCLUSION Patients with cheilitis who were referred for patch testing had high rates of positive and relevant allergens. More than one in four patients with any, primary, or sole cheilitis had a positive reaction to non-NACDG screening allergens (28.0%, 26.8%, 31.1% vs. 21.6%) compared to patients without cheilitis, emphasizing the need for expanded patch test series in cheilitis.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Manotri Chaubal
- Department of Dermatology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - 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, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Quebec City, Quebec, Canada
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12
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DeKoven JG, Warshaw EM, Reeder MJ, Atwater AR, Silverberg JI, Belsito DV, Sasseville D, Zug KA, Taylor JS, Pratt MD, Maibach HI, Fowler JF, Adler BL, Houle MC, Mowad CM, Botto N, Yu J, Dunnick CA. North American Contact Dermatitis Group Patch Test Results: 2019-2020. Dermatitis 2023; 34:90-104. [PMID: 36917520 DOI: 10.1089/derm.2022.29017.jdk] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2019, to December 31, 2020. Methods: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 80 allergens, and, as indicated, supplemental allergens. Results: Overall, 4121 patients were tested; 2871 (69.7%) had at least 1 positive/allergic patch test reaction and 2095 patients (51.2%) had a primary diagnosis of ACD. The most commonly positive allergens were nickel (18.2%), methylisothiazolinone (MI) (13.8%), fragrance mix (FM) I (12.8%), hydroperoxides of linalool (HPL) (11.1%), and benzisothiazolinone (BIT) (10.4%). Compared with that of 2017-2018, prevalence of top 20 allergens statistically increased for FM I, HPL, BIT, propolis, and hydroperoxides of limonene (3.5%). For the first time, MI positivity did not increase between reporting periods. Approximately one-fifth of patients (20.3%) had ≥1 clinically relevant reaction(s) to allergens/substances not on the NACDG series. Conclusions: The epidemic of MI contact allergy in North America may have reached a plateau. Patch testing using a robust screening series, and supplemental allergens as indicated, is necessary for comprehensive evaluation of ACD.
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Affiliation(s)
- Joel G DeKoven
- From the *Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Division of Occupational Health, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical College, New York, New York, USA
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montréal, Canada
| | - Kathryn A Zug
- Department of Dermatology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, Nebraska, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
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13
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Reeder MJ, Warshaw E, Aravamuthan S, Belsito DV, Geier J, Wilkinson M, Atwater AR, White IR, Silverberg JI, Taylor JS, Fowler JF, Maibach HI, DeKoven JG, Buhl T, Botto N, Giménez-Arnau AM, Gallo R, Mowad C, Lang CCV, DeLeo VA, Johnston G, Pratt MD, Brockow K, Adler BL, Houle MC, Dickel H, Schuttelaar MLA, Yu J, Spiewak R, Dunnick C, Filon FL, Valiukeviciene S, Uter W. Trends in the Prevalence of Methylchloroisothiazolinone/Methylisothiazolinone Contact Allergy in North America and Europe. JAMA Dermatol 2023; 159:267-274. [PMID: 36652228 PMCID: PMC9857829 DOI: 10.1001/jamadermatol.2022.5991] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance The common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US. Objective To compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) combination and MI alone in North America and Europe from 2009 to 2018. Design, Setting, and Participants This retrospective analysis of North American Contact Dermatitis Group, European Surveillance System on Contact Allergies (ESSCA), and the Information Network of Departments of Dermatology (IVDK) databases included data from patients presenting for patch testing at referral patch test clinics in North America and Europe. Exposures Patch tests to MCI/MI and MI. Main Outcomes and Measures Prevalence of allergic contact dermatitis to MCI/MI and MI. Results From 2009 to 2018, participating sites in North America and Europe patch tested a total of 226 161 individuals to MCI/MI and 118 779 to MI. In Europe, positivity to MCI/MI peaked during 2013 and 2014 at 7.6% (ESSCA) and 5.4% (IVDK) before decreasing to 4.4% (ESSCA) and 3.2% (IVDK) during 2017 and 2018. Positive reactions to MI were 5.5% (ESSCA) and 3.4% (IVDK) during 2017 and 2018. In North America, the frequency of positivity to MCI/MI increased steadily through the study period, reaching 10.8% for MCI/MI during 2017 and 2018. Positive reactions to MI were 15.0% during 2017 and 2018. Conclusions and Relevance The study results suggest that in contrast to the continued increase in North America, isothiazolinone allergy is decreasing in Europe. This trend may coincide with earlier and more stringent government regulation of MI in Europe.
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Affiliation(s)
- Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Erin 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
| | - Srikanth Aravamuthan
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Johannes Geier
- Information Network of Departments of Dermatology, Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Mark Wilkinson
- Department of Dermatology, Leeds Teaching Hospitals National Health Service Trust, Chapel Allerton Hospital, Leeds, England
| | - Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London, England
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany
| | - Nina Botto
- Department of Dermatology, University of California, San Francisco
| | | | - Rosella Gallo
- Clinica Dermatologica, IRCCS-AOU San Martino-IST and Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Christen Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Claudia C V Lang
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Graham Johnston
- Department of Dermatology, Leicester Royal Infirmary, Leicester, England
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University Munich, Munich, Germany
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec, Quebec, Canada
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Marie Louise A Schuttelaar
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Cory Dunnick
- Department of Dermatology, University of Colorado, Denver
| | - Francesca Larese Filon
- Department of Public Health, Occupational Medicine, University of Trieste, Trieste, Italy
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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14
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Warshaw EM, Xiong M, Belsito DV, Adler BL, Atwater AR, DeKoven JG, Taylor JS, Reeder MJ, Houle MC, Silverberg JI, Pratt MD, Dunnick CA, Botto N, DeLeo VA, Mowad CM, Maibach HI, Yu J, Fowler JF. Patch Testing With Benzophenone-3 and -4: The North American Contact Dermatitis Group Experience, 2013-2020. Dermatitis 2023; 34:105-112. [PMID: 36917534 DOI: 10.1089/derm.2022.29013.ewa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Benzophenone (BZP)-3 and BZP-4 are ultraviolet (UV) absorbers used in sunscreens and personal care products (PCPs) and may cause allergic contact dermatitis. Objective: To characterize positive patch test reactions to BZP-3 (10% in petrolatum [pet]) and BZP-4 (2% pet) in a screening allergen series. Methods: Retrospective analysis of patients tested to BZP-3 and BZP-4 was conducted by the North American Contact Dermatitis Group from 2013 to 2020. Results: Of 19,618 patients patch tested to BZP-3 and BZP-4, 103 (0.5%) and 323 (1.6%) had positive reactions, respectively: 413 (2.1%) reacted to at least 1 BZP (BZP-positive patient). As compared with BZP-negative patients, BZP-positive patients were significantly more likely to have a history of hay fever (39.3% vs 33.4%, P = 0.0134), history of atopic dermatitis (39.8% vs 30.7%, P = 0.0001), and facial involvement (37.4% vs 32.2%, P = 0.0272). Most reactions were currently clinically relevant (BZP-3: 90.4%; BZP-4: 65.8%). Common identified sources included PCPs and sunscreens. Coreactivity between BZP-3 and BZP-4 was low: 13.5% (14/104) of BZP-3-positive patients were allergic to BZP-4 and 4.3% (14/322) of BZP-4-positive patients were allergic to BZP-3. Conclusions: Eight-year prevalence of BZP positivity was 2.1%. Reactions were frequently clinically relevant and linked to PCPs and sunscreens.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Xiong
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Vincent A DeLeo
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
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15
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Warshaw EM, Xiong M, DeKoven JG, Taylor JS, Belsito DV, Reeder MJ, Adler BL, Pratt MD, Atwater AR, Maibach HI, Silverberg JI, Yu J, Botto N, Fowler JF, Houle MC, Mowad CM, Dunnick CA, DeLeo VA. Co-reactivity of glucosides: Retrospective analysis of North American Contact Dermatitis Group Data 2019-2020. Contact Dermatitis 2023; 88:153-156. [PMID: 36268749 DOI: 10.1111/cod.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Xiong
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec City, Quebec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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16
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Silverberg JI, Patel N, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Houle MC. Patch testing with Cobalt in Children and Adolescents: North American Contact Dermatitis Group experience, 2001 to 2018. Contact Dermatitis 2022; 87:420-429. [PMID: 35801686 DOI: 10.1111/cod.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) to cobalt is more common in children and adolescents than adults. However, detailed information on sites and sources of cobalt ACD are limited. OBJECTIVES To assess trends in positive and clinically relevant patch test reactions to cobalt in children and associated patient characteristics, common sources, and body sites affected. METHODS A retrospective analysis of children (<18 years) patch tested to cobalt by the North American Contact Dermatitis Group between 2001-2018. RESULTS Of 1,919 children patch tested, 228 (11.9%) and 127 (6.6%) had a positive/allergic or currently relevant patch test reaction to cobalt, respectively. The most common primary body sites affected were scattered generalized (30.0%), face, not otherwise specified (NOS, 10.6%), and trunk (10.1%). Patients with allergic and currently relevant allergic patch test reactions were more likely to have a primary site of trunk (P=.0160 and P=.0008) ears (P=.0005 and P<.0001). Affected body site(s) varied by cobalt source among patients with currently relevant reactions, especially for less common sources. The most commonly identified sources of cobalt included jewelry, belts, and clothing. CONCLUSIONS Positive patch test reactions to cobalt were common in children. Most common body site was scattered generalized and the sources of cobalt varied by body site. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington D.C., USA; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nisha Patel
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN.,Department of Dermatology, University of Minnesota, Minneapolis, MN.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire (CHU) de Québec, Laval University, Quebec, Canada
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17
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Warshaw EM, Xiong M, Atwater AR, DeKoven JG, Pratt MD, Maibach HI, Taylor JS, Belsito DV, Silverberg JI, Reeder MJ, Zug KA, Sasseville D, Fowler JF, DeLeo VA, Houle MC, Dunnick CA. Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018. J Am Acad Dermatol 2022; 87:1033-1041. [PMID: 35551968 DOI: 10.1016/j.jaad.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products. OBJECTIVE To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018). METHODS Retrospective analysis of patients tested by the North American Contact Dermatitis Group. RESULTS Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside. LIMITATIONS The cohort predominantly reflects a referral population, and follow-up after testing was not captured. CONCLUSION Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Michelle Xiong
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota; Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - 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
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire Québec, Laval University, Laval, Québec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado
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18
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Atwater AR, Bembry R, Liu B, Warshaw EM, DeKoven JG, Silverberg JI, Taylor JS, Zug KA, Houle MC, Belsito DV, Maibach HI, Reeder MJ, Sasseville D, Dunnick C, Fowler JF, Pratt MD, DeLeo VA. Medical Adhesive Allergens: Retrospective Analysis of Cross-Sectional Data from the North American Contact Dermatitis Group, 2001-2018. J Am Acad Dermatol 2021; 87:1024-1032. [PMID: 34875303 DOI: 10.1016/j.jaad.2021.11.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Identification of allergens causing medical adhesive contact allergy is difficult. OBJECTIVE Characterize the demographics, clinical characteristics, patch test results and occupational data for North American Contact Dermatitis Group (NACDG) patients with medical adhesive contact allergy. METHODS Retrospective study of 43,722 NACDG patients patch-tested 2001-2018, with: 1) medical adhesive (tapes/band aids/adhesive aids/suture glue) source, 2) positive patch test, and 3) final primary diagnosis of allergic contact dermatitis. RESULTS 313 (0.7%) patients met inclusion criteria. Compared to other patients with final primary diagnosis of allergic contact dermatitis, medical adhesive allergy patients were less likely male (odds ratio 0.58, 95% confidence interval [0.45-0.77]) and/or age >40 (0.76 [0.6-0.96]). The most common NACDG screening series allergens were colophony (80.7%), balsam of Peru (3.9%), 2-hydroxyethyl methacrylate (2.7%) and carba mix (2.7%). One-fourth (79/313, 25.2%) had positive patch test reactions to supplemental allergens/materials, and 17.3% (54/313) only had reactions to supplemental allergens/materials. LIMITATIONS Results of comprehensive patch testing may be prone to referral population selection bias and may not be representative of the general dermatology population. CONCLUSION Colophony was the most common allergen. Supplemental allergens and materials should be tested in the evaluation of suspected medical adhesive contact allergy.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
| | - Raina Bembry
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Erin M Warshaw
- Departments of Dermatology, Minneapolis Veterans Affairs Medical Center, Park Nicollet Health Services, and University of Minnesota, Minneapolis, MN
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Howard I Maibach
- Department of Dermatology, University of California Medical School, San Francisco, CA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Cory Dunnick
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, KY
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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19
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Silverberg JI, Hou A, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Zirwas MJ, Marks JG, Dunnick CA, Houle MC. Allergens in patients with a diagnosis of seborrheic dermatitis, North American Contact Dermatitis Group data, 2001-2016. J Am Acad Dermatol 2021; 86:460-463. [PMID: 34582838 DOI: 10.1016/j.jaad.2021.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/04/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - 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, Wisconsin
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada
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21
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Taylor JS, Patel J, Otto E. 26519 Patient safety alert: Preventing infection from misuse of medication vials. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Warshaw EM, Ruggiero JL, DeKoven JG, Pratt MD, Silverberg JI, Maibach HI, Zug KA, Atwater AR, Taylor JS, Reeder MJ, Sasseville D, Fowler JF, Fransway AF, Belsito DV, DeLeo VA, Houle MC, Dunnick CA. Patch Testing with Ammonium Persulfate: The North American Contact Dermatitis Group Experience, 2015-2018. J Am Acad Dermatol 2021; 87:1014-1023. [PMID: 34390784 DOI: 10.1016/j.jaad.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions including allergic contact dermatitis. OBJECTIVE To characterize positive patch test reactions to APS (2.5% pet). METHODS Retrospective analysis of patients tested to the North American Contact Dermatitis Group (NACDG) screening series from 2015-2018. RESULTS Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared to negative patients, APS-positive patients were significantly more likely to be male (43.2% vs. 28.0%, p<0.0001), have primary hand (30.2% vs. 22.0%, p=0.0064), scattered generalized (25.5% vs. 17.9%, p=0.0064), or trunk dermatitis (8.9% vs. 4.9%, p=0.0123), and occupationally-related dermatitis (22.2% vs. 10.9%, p<0.0001). Over half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially (68.4%) hairdressers. Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common APS sources. LIMITATIONS Immediate reactions and follow-up testing not captured. CONCLUSIONS The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals are important sources of APS exposure.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, University of Minnesota, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center
| | - Jenna L Ruggiero
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center; University of Minnesota Medical School, Minneapolis, MN.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, NY
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
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23
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Warshaw EM, Shaver RL, DeKoven JG, Taylor JS, Zug KA, Pratt MD, Atwater AR, Houle MC, Maibach HI, Belsito DV, Silverberg JI, Dunnick CA, Reeder MJ, Sasseville D, Fowler JF, DeLeo VA. Patients with patch test reactions associated with eye care products: Retrospective analysis of North American contact dermatitis group data, 2001-2018. Contact Dermatitis 2021; 85:712-715. [PMID: 34314025 DOI: 10.1111/cod.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Rob L Shaver
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Québec, Québec, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
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24
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Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, Zug KA, Taylor JS, Sasseville D, Dunnick CA, Houle MC, Atwater AR, Reeder MJ, DeLeo VA, Pratt MD, Fowler JF, Zirwas MJ, Marks JG. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018. J Am Acad Dermatol 2021; 86:818-826. [PMID: 34314743 DOI: 10.1016/j.jaad.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND An updated understanding of allergic contact dermatitis is needed, particularly in children. OBJECTIVES To compare positive and clinically relevant reactions in children versus adults referred for patch testing. METHODS Retrospective analysis of 1871 children and 41,699 adults from the North American Contact Dermatitis Group (NACDG) from 2001-2018. RESULTS Both final diagnosis of allergic contact dermatitis (55.2% versus 57.3%; chi square, P = .0716) and prevalence of ≥ 1 currently relevant reaction to a NACDG screening allergen (49.2% vs 52.2%; P = .1178) were similar between children and adults. Currently in children, the most common relevant allergens were nickel sulfate (17.3%), hydroperoxides of linalool (7.8%), methylisothiazolinone (7.7%), cobalt chloride (7.0%), and fragrance mix I (4.9%). Approximately a fifth of children had a positive reaction to a non-NACDG allergen. CONCLUSION Over half of children referred for patch testing were diagnosed with allergic contact dermatitis. The most common relevant allergens in children were nickel sulfate, cobalt chloride, and hydroperoxides of linalool. Twenty percent of children had at least 1 positive reaction to allergens/substances not on the NACDG screening series, underscoring the need for comprehensive testing.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph F Fowler
- Division of Dermatology University of Louisville, Louisville, Kentucky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Hershey, Pennsylvania
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25
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Goodier MC, DeKoven JG, Taylor JS, Sasseville D, Fowler JF, Fransway AF, DeLeo VA, Marks JG, Zug KA, Hylwa SA, Warshaw EM. Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology. Contact Dermatitis 2021; 85:274-284. [PMID: 33837533 DOI: 10.1111/cod.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding teledermatology for patch testing are limited. OBJECTIVES Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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Affiliation(s)
- Molly C Goodier
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, Health Partners Institute Dermatology, St. Louis Park, Minnesota, USA
| | - Joel G DeKoven
- Department of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Department of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Department of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sara A Hylwa
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA
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26
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Silverberg JI, Hou A, DeKoven JG, Warshaw EM, Maibach HI, Atwater AR, Belsito DV, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Fowler JF, Zirwas MJ, Marks JG, Dunnick CA, Houle MC. Prevalence and trend of allergen sensitization in patients referred for patch testing with a final diagnosis of psoriasis: North American Contact Dermatitis Group data, 2001-2016. Contact Dermatitis 2021; 85:435-445. [PMID: 33931870 DOI: 10.1111/cod.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the relationship between psoriasis and allergic contact dermatitis (ACD). OBJECTIVE To examine the associations with ACD, related clinical characteristics, and common positive and clinically relevant allergens of patients with a final diagnosis of psoriasis who were referred for patch testing. METHODS Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group. RESULTS Patients with a final diagnosis of psoriasis had lower proportions of ACD than those without psoriasis (32.7% vs 57.8%). In multivariable logistic regression models, psoriasis was inversely associated with female sex, Black or Asian race, and history of atopic dermatitis and hay fever. Patients with a final diagnosis of psoriasis were less likely to have one or more positive allergic patch-test reactions or to have a current clinically relevant patch-test reaction to the majority of the most commonly positive and/or relevant allergens. The most clinically relevant allergens included nickel sulfate, methylisothiazolinone, and fragrance mix I. CONCLUSION Approximately one-third of patients who were referred for patch testing with a final diagnosis of psoriasis were also diagnosed with ACD. In select patients with suspected psoriasis who also have a clinical presentation suggestive of ACD, patch testing may be helpful.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - 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, Wisconsin, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec, Quebec, Canada
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27
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Warshaw EM, Buonomo M, DeKoven JG, Atwater AR, Reeder MJ, Belsito DV, Silverberg JI, Taylor JS, Maibach HI, Zug KA, Sasseville D, Fowler JF, Pratt MD, DeLeo VA, Zirwas MJ. Patch testing with sodium disulfite: North American Contact Dermatitis Group experience, 2017 to 2018. Contact Dermatitis 2021; 85:285-296. [PMID: 33843061 DOI: 10.1111/cod.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sodium disulfite (SD), also known as sodium metabisulfite, is an increasingly recognized cause of allergic contact dermatitis. OBJECTIVES The objective of this work was to characterize individuals with positive patch test reactions to SD as well as analyse reaction strength, clinical relevance, and sources. METHODS This is a retrospective analysis of patients patch tested with SD (1% petrolatum) by the North American Contact Dermatitis Group (NACDG), 2017 to 2018. RESULTS Of 4885 patients patch tested with SD, 132 (2.7%) had a positive reaction. Common primary anatomic sites of dermatitis were face (28.8%), hands (20.5%), and a scattered/generalized distribution (13.6%). Compared with SD-negative patients, SD-positive patients were more likely male (odds ratio 2.81, 95% confidence interval 1.98-4.00) and/or over 40 years (odds ratio 1.95, 95% confidence interval 1.30-2.94). Reactions were most commonly + (50.4%) or ++ (34.1%); 65.2% were considered currently relevant. About 15.2% were definitively confirmed in sources, commonly personal care products (18.9%, especially hair dye), and drugs/medications/alcoholic beverages (9.1%). Only 2.3% of positive reactions were linked to occupation. CONCLUSIONS Positive reactions to SD occurred in 2.7% of tested patients. Reactions were often clinically relevant and linked to personal care products and drugs/medications/alcoholic beverages.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Michele Buonomo
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Matt J Zirwas
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
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28
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Warshaw EM, Shaver RL, Atwater AR, Maibach HI, Sasseville D, Reeder MJ, DeKoven JG, Taylor JS, Belsito DV, Silverberg JI, Zug KA, Fowler JF, Pratt MD, Fransway AF, DeLeo VA, Houle MC, Dunnick CA. Contact dermatitis in music professionals referred for patch testing: North American Contact Dermatitis Group data, 1996-2018. Contact Dermatitis 2021; 85:359-362. [PMID: 33783009 DOI: 10.1111/cod.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Rob L Shaver
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,School of Medicine, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Toronto, Ontario, Canada
| | - Anthony F Fransway
- Department of Dermatology, Associates in Dermatology, Fort Myers, Florida, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Quebec City, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
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29
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Atwater AR, Petty AJ, Liu B, Green CL, Silverberg JI, DeKoven JG, Belsito DV, Reeder MJ, Sasseville D, Taylor JS, Maibach HI, Zirwas MJ, Marks JG, Zug KA, Fowler JF, Pratt MD, DeLeo VA, Warshaw EM. Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016. J Am Acad Dermatol 2021; 84:965-976. [PMID: 33579596 PMCID: PMC8087451 DOI: 10.1016/j.jaad.2020.07.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited. OBJECTIVE To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group. METHODS We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016. RESULTS A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time. LIMITATIONS Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias. CONCLUSIONS This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016.
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Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
| | - Amy J Petty
- Duke University School of Medicine, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Medical Center, New York, New York
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montréal General Hospital, Montréal, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Howard I Maibach
- Department of Dermatology, University of California Medical School, San Francisco, California
| | - Matthew J Zirwas
- Probity Medical Research, Dermatologists of the Central States, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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30
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Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, Taylor JS, Zug KA, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Fowler JF, Zirwas MJ, Marks JG, Atwater AR. Prevalence and Trend of Allergen Sensitization in Adults and Children with Atopic Dermatitis Referred for Patch Testing, North American Contact Dermatitis Group Data, 2001-2016. J Allergy Clin Immunol Pract 2021; 9:2853-2866.e14. [PMID: 33781959 DOI: 10.1016/j.jaip.2021.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The association between atopic dermatitis (AD) and allergic contact dermatitis (ACD) is controversial. OBJECTIVE To analyze the prevalence, reaction strength, and trends of the most commonly positive and relevant allergens in patients with AD referred for patch testing. METHODS This was a retrospective analysis of 38,482 patients from the North American Contact Dermatitis Group, 2001 to 2016. RESULTS Most adults (56.0%) and children (52.8%) with a history of AD had a final diagnosis of ACD. Adults (66.5% vs 65.6%; χ2, P = .1459) and children (61.4% vs 62.3%, P = .7074) with or without a history of AD had similar proportions of one or more allergic patch test reactions. Adults with a history of AD had a greater number of allergic patch test positive reactions than those without it (2.0 ± 2.4 vs 1.9 ± 2.3; t test, P < .0001), whereas children did not (1.5 ± 1.8 vs 1.4 ± 1.6; P = .3839). Nickel sulfate, methylisothiazolinone, formaldehyde, fragrance mix I, sodium gold thiosulfate, and thimerosal were the most common allergens in adults and children with a history of AD. In multivariable logistic regression models, adults with versus without a history of AD had increased odds of reacting to 10 of the top 25 North American Contact Dermatitis Group screening allergens. Most allergens had similar strengths of reaction in adults or children with and without a history of AD or a current AD diagnosis; cobalt, fragrance mix I, and propylene glycol had weaker reactions. In multivariable logistic regression, adults with versus without an AD history had increased odds of relevance for 10 of the 25 most currently relevant allergens, whereas children with an AD history did not have increased relevance for any specific allergens. CONCLUSIONS Most patients referred for patch testing with AD history had a final diagnosis of ACD. Patients with AD history had a similar likelihood of having a positive patch test reaction as those without an AD history. Adults with an AD history had a higher number of positive patch test reactions.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minn; Department of Dermatology, University of Minnesota, Minneapolis, Minn; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minn
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | | | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, QC, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, Calif
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Joseph F Fowler
- Division of Dermatology University of Louisville, Louisville, Ky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pa
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
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DeKoven JG, DeKoven BM, Warshaw EM, Mathias CGT, Taylor JS, Sasseville D, Belsito DV, Fowler JF, Pratt MD, Zug KA, Maibach HI, DeLeo VA, Silverberg JI, Atwater AR, Reeder MJ, Holness DL. Occupational contact dermatitis: Retrospective analysis of North American Contact Dermatitis Group Data, 2001 to 2016. J Am Acad Dermatol 2021; 86:782-790. [PMID: 33753252 DOI: 10.1016/j.jaad.2021.03.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings. OBJECTIVE Provide an overview of occupational skin disease (OSD) and an analysis of occupational ACD in North American patients undergoing patch testing between 2001and 2016. METHODS Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded. RESULTS Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators. LIMITATIONS Our cohort may not reflect the general working population. CONCLUSION This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis.
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Affiliation(s)
- Joel G DeKoven
- Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, Unity Health, University of Toronto, Toronto, Ontario, Canada.
| | - Benjamin M DeKoven
- Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, Unity Health, University of Toronto, Toronto, Ontario, Canada
| | - Erin M Warshaw
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | | | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - D Linn Holness
- Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, Unity Health, University of Toronto, Toronto, Ontario, Canada
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Silverberg JI, Hou A, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Zirwas MJ, Marks JG. Prevalence and trend of allergen sensitization in patients with nummular (discoid) eczema referred for patch testing: North American Contact Dermatitis Group data, 2001-2016. Contact Dermatitis 2021; 85:46-57. [PMID: 33634511 DOI: 10.1111/cod.13824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD). OBJECTIVE To examine trends, associations, and clinical relevance of ACD in patients with NE who were referred for patch testing. METHODS Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group. RESULTS Overall, 748 patients (1.9%) were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001 and 2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE increased steadily with age and was associated with male sex and Asian and other race/ethnicity, and inversely associated with a history of atopic dermatitis (AD) and hay fever. Patients with NE had lower proportions of one or more positive allergic reactions and lower odds of a positive reaction in multiple individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium 15, fragrance mix I, and propylene glycol. CONCLUSION NE is a heterogeneous disorder with distinct subsets of lesional distributions and a profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly one in four patients with NE had ACD, supporting the role of patch testing in patients with NE.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - 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, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
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Patel J, Otto E, Taylor JS, Mostow EN, Vidimos A, Lucas J, Khetarpal S, Regotti K, Kaw U. Patient safety in dermatology: a ten-year update. Dermatol Online J 2021; 27:13030/qt9cp0t2wt. [PMID: 33865273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE We update and expand our 2010 article in this journal, Patient safety in dermatology: A review of the literature [4][DH1]. METHODS PubMed at the National Center for Biotechnology Information (NCBI), United States National Library of Medicine (NLM) was searched September 2019 for English language articles published between 2009 and 2019 concerning patient safety and medical error in dermatology. Potentially relevant articles and communications were critically evaluated by the authors with selected references from 2020 added to include specific topics: medication errors, diagnostic errors including telemedicine, office-based surgery, wrong-site procedures, infections including COVID-19, falls, laser safety, scope of practice, and electronic health records. SUMMARY Hospitals and clinics are adopting the methods of high-reliability organizations to identify and change ineffective practice patterns. Although systems issues are emphasized in patient safety, people are critically important to effective teamwork and leadership. Advancements in procedural and cosmetic dermatology, organizational and clinical guidelines, and the revolution in information technology and electronic health records have introduced new sources of potential error. CONCLUSION Despite the growing number of dermatologic patient safety studies, our review supports a continuing need for further studies and reports to reduce the number of preventable errors and provide optimal care.
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Affiliation(s)
| | | | - James S Taylor
- Department of Dermatology, Dermatology Plastic Surgery Institute, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland OH.
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Silverberg JI, Warshaw EM, Maibach HI, DeKoven JG, Taylor JS, Atwater AR, Sasseville D, Zug KA, Reeder MJ, Fowler JF, Pratt MD, Fransway AF, Zirwas MJ, Belsito DV, Marks JG, DeLeo VA. Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016. Br J Dermatol 2021; 185:185-194. [PMID: 33454963 DOI: 10.1111/bjd.19818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE). OBJECTIVES To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing. METHODS A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed. RESULTS Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ2 -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone. CONCLUSIONS Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens.
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Affiliation(s)
- J I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Dermatology, The Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - E M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - J G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - J S Taylor
- Department of Dermatology, Cleveland Clinic, OH, USA
| | - A R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - D Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, QC, Canada
| | - K A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - M J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J F Fowler
- Division of Dermatology, University of Louisville, KY, USA
| | - M D Pratt
- Division of Dermatology, University of Ottawa, ON, Canada
| | | | - M J Zirwas
- Department of Dermatology, Ohio State University, Columbus, OH, USA
| | - D V Belsito
- Department of Dermatology, Columbia University, New York, NY, USA
| | - J G Marks
- Department of Dermatology, Pennsylvania State University, State College, PA, USA
| | - V A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA, USA
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Taylor JS. Cleveland Clinic Journal of Medicine: Evolution and a look ahead. Cleve Clin J Med 2021; 88:11-13. [PMID: 33384306 DOI: 10.3949/ccjm.88a.20187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James S Taylor
- Clinical Assistant Professor of Dermatology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Editor in Chief Emeritus, Cleveland Clinic Journal of Medicine 1982-1992
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Patel J, Otto E, Taylor JS, Mostow EN, Vidimos A, Lucas J, Khetarpal S, Regotti K, Kaw U. Patient safety in dermatology: a ten-year update. Dermatol Online J 2021. [DOI: 10.5070/d3273052763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Goossens A, Taylor JS. Contact Allergy to Shoes. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Warshaw EM, Schlarbaum JP, Maibach HI, Silverberg JI, Taylor JS, Atwater AR, Reeder MJ, DeKoven JG, Pratt MD, DeLeo VA, Zug KA, Fransway AF, Belsito DV, Mathias T, Fowler JF, Marks JG, Sasseville D, Zirwas MJ. Facial Dermatitis in Male Patients Referred for Patch Testing: Retrospective Analysis of North American Contact Dermatitis Group Data, 1994 to 2016. JAMA Dermatol 2020; 156:79-84. [PMID: 31774459 DOI: 10.1001/jamadermatol.2019.3531] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Facial dermatitis in women is well characterized. However, recent shifts in the men's grooming industry may have important implications for male facial dermatitis. Objective To characterize male patients with facial dermatitis. Design, Setting, and Participants A 22-year retrospective cross-sectional analysis (1994-2016) of North American Contact Dermatitis Group (NACDG) data, including 50 507 patients who underwent patch testing by a group of dermatology board-certified patch test experts at multiple centers was carried out. Facial dermatitis was defined as involvement of the eyes, eyelids, lips, nose, or face (not otherwise specified). Main Outcomes and Measures The main outcome was to compare characteristics (including demographics and allergens) between male patients with facial dermatitis (MFD) and those without facial dermatitis (MNoFD) using statistical analysis (relative risk, CIs). Secondary outcomes included sources of allergic and irritant contact dermatitis and, for occupationally related cases, specific occupations and industries in MFD. Results Overall, 1332 male patients (8.0%) were included in the MFD group and 13 732 male patients (82.0%) were included in MNoFD. The mean (SD) age of participants was 47 (17.2) years in the MFD group and 50 (17.6) years in the MNoFD group. The most common facial sites were face (not otherwise specified, 817 [48.9%]), eyelids (392 [23.5%]), and lips (210 [12.6%]). Participants in the MFD group were significantly younger than MNoFD (mean age, 47 vs 50 years; P < .001). Those in the MFD group were less likely to be white (relative risk [RR], 0.92; 95% CI, -0.90 to 0.95) or have occupationally related skin disease (RR, 0.49; 95% CI, -0.42 to 0.58; P < .001) than MNoFD. The most common allergens that were associated with clinically relevant reactions among MFD included methylisothiazolinone (n = 113; 9.9%), fragrance mix I (n = 27; 8.5%), and balsam of Peru (n = 90; 6.8%). Compared with MNoFD, MFD were more likely to react to use of dimethylaminopropylamine (RR, 2.49; 95% CI, -1.42 to 4.37]) and paraphenylenediamine (RR, 1.43; 95% CI, -1.00 to 2.04; P < .001). Overall, 60.5% of NACDG allergen sources were personal care products. Conclusions and Relevance Although many allergens were similar in both groups, MFD were more likely to react to use of dimethylaminopropylamine and paraphenylenediamine, presumably owing to their higher prevalence in hair products. Most sources of allergic and irritant contact dermatitis in MFD were personal care products. This study provides insight into the risks and exposures of the increasing number of grooming products used by male dermatology patients. This will enable clinicians to better identify male patients who would benefit from patch testing and treat those with facial dermatitis.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis
| | - Jamie P Schlarbaum
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,University of Minnesota Medical School, Minneapolis
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco
| | | | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin Medical School, Madison
| | - 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
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Kathryn A Zug
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York
| | - Toby Mathias
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | | | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania
| | - Denis Sasseville
- Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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Warshaw EM, Kimyon RS, Silverberg JI, Belsito DV, DeKoven JG, Maibach HI, Zug KA, Atwater AR, Mathias T, Sasseville D, Fowler JF, Marks JG, Reeder MJ, DeLeo VA, Pratt MD, Zirwas MJ, Taylor JS, Fransway AF. Evaluation of Patch Test Findings in Patients With Anogenital Dermatitis. JAMA Dermatol 2020; 156:85-91. [PMID: 31774454 DOI: 10.1001/jamadermatol.2019.3844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Contact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008. Objectives To characterize patients with anogenital dermatitis referred for patch testing by the North American Contact Dermatitis Group, to identify common allergens, and to explore sex-associated differences between anogenital dermatitis and allergens. Design, Setting, and Participants A retrospective, cross-sectional analysis was conducted of the North American Contact Dermatitis Group database among 28 481 patients who underwent patch testing from January 1, 2005, to December 31, 2016, at outpatient referral clinics in the United States and Canada. Exposure Patch testing for allergens. Main Outcomes and Measures Currently relevant allergic patch test reactions in patients with anogenital dermatitis. Results Of 28 481 patients tested during the study period, 832 patients (336 men and 496 women; mean [SD] age, 50.1 [26.5] years) had anogenital involvement and 449 patients (177 men and 272 women; mean [SD] age, 49.6 [17.4] years) had anogenital dermatitis only. Compared with those without anogenital involvement, there were significantly more male patients in the group with anogenital dermatitis (177 [39.4%] vs 8857 of 27 649 [32.0%]; relative risk, 1.37; 95% CI, 1.14-1.66; P < .001). In the group with anogenital involvement, female patients were significantly less likely than male patients to have allergic contact dermatitis as a final diagnosis (130 [47.8%] vs 107 [60.5%]; relative risk, 0.78; 95% CI, 0.64-0.94; P = .01), whereas a final diagnosis of other dermatoses (eg, lichen planus, lichen sclerosus, or lichen simplex chronicus) was more frequent for female patients than for male patients (67 [24.6%] vs 28 [15.8%]; relative risk, 1.54; 95% CI, 1.02-2.31; P = .03). Of the 449 patients in the group with anogenital involvement only, 227 (50.6%) had 1 or more relevant reaction with patch testing. Allergens that were statistically significantly more common in patients with anogenital involvement compared with those without anogenital involvement included medicaments such as dibucaine (10 of 250 patients tested [4.0%] vs 32 of 17 494 patients tested [0.2%]; relative risk, 22.74; 95% CI, 11.05-46.78; P < .001) and preservatives such as methylchloroisothiazolinone and methylisothiazolinone (30 of 449 patients tested [6.7%] vs 1143 of 27 599 patients tested [4.1%]; relative risk, 1.61; 95% CI, 1.14-2.41; P = .008). A total of 152 patients met the definition for anogenital allergic contact dermatitis, which is defined as anogenital involvement only, allergic contact dermatitis as the only diagnosis, and 1 or more positive reaction of current clinical relevance. Conclusions and Relevance For patients with anogenital involvement only who were referred for patch testing, male patients were more likely to have allergic contact dermatitis, whereas female patients were more likely to have other dermatoses. Common allergens or sources consisted of those likely to contact the anogenital area. For individuals with anogenital involvement suspected of having allergic contact dermatitis, reactions to preservatives, fragrances, medications (particularly topical anesthetics), and topical corticosteroids should be tested.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis
| | - Rebecca S Kimyon
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,University of Minnesota Medical School, Minneapolis
| | - Jonathan I Silverberg
- Feinberg School of Medicine, Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Toby Mathias
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Denis Sasseville
- Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin Medical School, Madison
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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Warshaw EM, Kullberg SA, Atwater AR, DeKoven JG, Silverberg JI, Belsito DV, Fowler JF, Fransway AF, DeLeo VA, Maibach HI, Zug KA, Reeder MJ, Taylor JS, Sasseville D, Pratt MD. Currently relevant p-phenylenediamine patch test reactions associated with hair dye and nonscalp anatomic areas: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 2001 to 2016. J Am Acad Dermatol 2020; 84:e175-e177. [PMID: 33157175 DOI: 10.1016/j.jaad.2020.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Sara A Kullberg
- 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, Minnesota.
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - 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 Center, New York, New York
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
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Warshaw EM, Schlarbaum JP, Silverberg JI, DeKoven JG, Fransway AF, Taylor JS, Maibach HI, Fowler JF, Atwater AR, Reeder MJ, Zug KA, Belsito DV, Sasseville D, DeLeo VA, Pratt MD. Contact Dermatitis to Personal Care Products is Increasing (but Different!) in Males and Females: North American Contact Dermatitis Group (NACDG) Data, 1996-2016. J Am Acad Dermatol 2020; 85:1446-1455. [DOI: 10.1016/j.jaad.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/12/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
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Warshaw EM, Kullberg SA, DeKoven JG, Maibach HI, Belsito DV, Silverberg JI, Fowler JF, Atwater AR, Sasseville D, Reeder MJ, Taylor JS, DeLeo VA, Pratt MD, Zug KA, Fransway AF. Scalp involvement in patients referred for patch testing: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 1996 to 2016. J Am Acad Dermatol 2020; 84:977-988. [PMID: 32822786 DOI: 10.1016/j.jaad.2020.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Scalp conditions are often multifactorial. OBJECTIVE To characterize patients with scalp involvement and patch-testing outcomes. METHODS Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (≤3 anatomic sites coded) with or without additional sites. RESULTS A total of 4.8% of patients (2331/48,753) had scalp identified as 1 of up to 3 affected anatomic sites. Approximately one-third of "scalp-only" individuals had a specific primary diagnosis of allergic contact dermatitis (38.6%), followed by seborrheic dermatitis (17.2%) and irritant contact dermatitis (9.3%). When adjacent anatomic sites were affected, allergic contact dermatitis was more frequently identified as the primary diagnosis (>50%). The top 5 currently clinically relevant allergens in scalp-only patients were p-phenylenediamine, fragrance mix I, nickel sulfate, balsam of Peru, and cinnamic aldehyde. Methylisothiazolinone sensitivity was notable when adjacent anatomic sites were involved. The top 3 specifically identified sources for scalp-only allergens were hair dyes, shampoo/conditioners, and consumer items (eg, hair appliances, glasses). LIMITATIONS Tertiary referral population. CONCLUSION Isolated scalp involvement was less likely to be associated with allergic contact dermatitis than when adjacent anatomic sites were involved. Overlap with multiple diagnoses was frequent, including seborrheic dermatitis, irritant dermatitis, other dermatoses, or all 3. p-Phenylenediamine was the most common allergen.
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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, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Sara A Kullberg
- 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, Minnesota.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Warshaw EM, Voller LM, Maibach HI, Zug KA, DeKoven JG, Atwater AR, Reeder MJ, Sasseville D, Taylor JS, Fowler JF, Pratt MD, Silverberg JI, Fransway AF, Zirwas MJ, Belsito DV, Marks JG, DeLeo VA. Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016. J Am Acad Dermatol 2020; 84:953-964. [PMID: 32679276 DOI: 10.1016/j.jaad.2020.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Eyelid dermatitis is a common dermatologic complaint. OBJECTIVE To characterize patients with eyelid dermatitis. METHODS Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data. RESULTS Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group. LIMITATIONS Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data. CONCLUSION Patch testing remains a critical tool in evaluating patients with eyelid 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, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Lindsey M Voller
- 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, Minnesota.
| | - Howard I Maibach
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Denis Sasseville
- Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Fowler
- Division of Dermatology University of Louisville, Louisville, Kentucky
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, Hershey, Pennsylvania
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
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Warshaw EM, Schlarbaum JP, Taylor JS, Silverberg JI, DeKoven JG, Atwater AR, Zug KA, Zirwas MJ, Reeder MJ, Fowler JF, Marks JG, DeLeo VA, Belsito DV, Maibach HI, Fransway AF, Sasseville D, Pratt MD, Mathias CT. Allergic reactions to tattoos: Retrospective analysis of North American Contact Dermatitis Group data, 2001-2016. J Am Acad Dermatol 2020; 82:e61-e62. [DOI: 10.1016/j.jaad.2019.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Goossens A, Taylor JS. Contact Allergy to Shoes. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_41-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Warshaw EM, Schlarbaum JP, Silverberg JI, DeKoven JG, Maibach HI, Sasseville D, Fowler JF, Marks JG, Belsito DV, Reeder MJ, Mathias T, Atwater AR, Taylor JS, Fransway AF, Pratt MD, DeLeo VA, Zirwas MJ, Zug KA. Safety equipment: When protection becomes a problem. Contact Dermatitis 2019; 81:130-132. [PMID: 30809819 DOI: 10.1111/cod.13254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Jamie P Schlarbaum
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Sasseville
- Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin Medical School, Madison, Wisconsin
| | - Toby Mathias
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | | | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Warshaw EM, Aschenbeck KA, DeKoven JG, Maibach HI, Taylor JS, Sasseville D, Belsito DV, Fowler JF, Zug KA, Zirwas MJ, Fransway AF, DeLeo VA, Marks JG, Pratt MD, Mathias T. Epidemiology of pediatric nickel sensitivity: Retrospective review of North American Contact Dermatitis Group (NACDG) data 1994-2014. J Am Acad Dermatol 2018; 79:664-671. [DOI: 10.1016/j.jaad.2018.02.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
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Ascha M, Irfan M, Bena J, Taylor JS, Sood A. Pediatric patch testing: A 10-year retrospective study. Ann Allergy Asthma Immunol 2017; 117:661-667. [PMID: 27979024 DOI: 10.1016/j.anai.2016.09.445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patch testing is the gold standard for diagnosing allergic contact dermatitis in children. OBJECTIVE To present a 10-year retrospective review of pediatric patch testing at our institution. METHODS Data from patients 18 years or younger who presented for patch testing from February 1, 2005, to May 31, 2015, were entered into a database. Patch testing was performed according to North American Contact Dermatitis Group standards. A positive reaction was defined as any allergen for which the patient had a 1+ or greater reaction and provided avoidance information. RESULTS A total of 157 patients with a mean (SD) age of 12.3 (4.1) years were evaluated. The 2 most frequent allergens were nickel and cobalt. Most patients were referred by dermatologists for suspected allergic contact dermatitis (72.3%). Dermatitis was present for more than 2 years in most cases (n = 67 [46.2%]), from 6 months to 2 years (n = 49 [33.8%]), and for less than 6 months (n = 29 [20.0%]). Males were more likely to have a positive reaction to fragrance mix 1 compared with females (P = .02). No significant association was found between age and allergen sensitivity. Those with a history of atopy were more likely to have a positive reaction to cobalt (P = .008) and chromium (P = .03). Sixty patients (38.2%) returned for follow-up, and 37 (60.7%) reported improvement; most (n = 54 [88.5%]) were being treated with topical corticosteroids. CONCLUSION Our study of pediatric patch testing can provide information regarding common allergens in children, which can enhance patient care. Primary care practitioners may benefit from awareness of patch testing as an alternative to prescribing systemic immunosuppressants.
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Affiliation(s)
- Mona Ascha
- Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Mahwish Irfan
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Apra Sood
- Department of Dermatology, Cleveland Clinic Foundation and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
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Affiliation(s)
- Sherry H. Yu
- Currently a medical student at Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Apra Sood
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - James S. Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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Siegel PD, Fowler JF, Law BF, Warshaw EM, Taylor JS. Concentrations and stability of methyl methacrylate, glutaraldehyde, formaldehyde and nickel sulfate in commercial patch test allergen preparations. Contact Dermatitis 2014; 70:309-15. [PMID: 24731086 DOI: 10.1111/cod.12169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epicutaneous patch tests are used to reproduce allergy and diagnose allergic contact dermatitis. Reliable allergen test preparations are required. OBJECTIVES The purpose of the present study was to measure the actual concentrations of nickel(II) sulfate hexahydrate (NiSO4 ), methyl methacrylate, formaldehyde, and glutaraldehyde, and to compare them with the labelled concentrations, in commercial patch test allergen preparations found in dermatology clinics where patch testing is routinely performed. MATERIALS AND METHODS The commercial in-date and out-of-date patch test allergen preparations concentrations of NiSO4 , methyl methacrylate, formaldehyde and glutaraldehyde from one to three participating clinics were analysed with chromatographic or wet chemical techniques. RESULTS NiSO4 and formaldehyde concentrations were at or above the labelled concentrations; however, formaldehyde loss occurred with storage. NiSO4 particulate was uniformly distributed throughout the petrolatum. 'In-use' methyl methacrylate reagent syringes all contained ≤ 56% of the 2% label concentration, with no observable relationship with expiration date. Lower methyl methacrylate cocentrations were consistently measured at the syringe tip end, suggesting loss resulting from methyl methacrylate's volatility. The concentrations of glutaraldehyde patch test allergen preparations ranged from 27% to 45% of the labelled (1% in pet.) concentration, independently of expiration date. CONCLUSIONS Some false-negative methyl methacrylate, formaldehyde or glutaraldehyde patch test results may be attributable to instability of the test preparations.
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Affiliation(s)
- Paul D Siegel
- Health Effects Laboratory Division, Allergy and Clinical Immunology Branch, National Institute for Occupational Safety and Health (NIOSH), Morgantown, WV 26505, USA
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