Gender differences in allergic contact dermatitis to common allergens

BACKGROUND

Gender-based differences in skin structure, physiology, and allergen exposure can influence contact dermatitis development.

OBJECTIVE

This study investigated the differences and trends in contact sensitizers, focusing on the top 10 allergens and personal care product (PCP) contact allergies from a gender perspective.

METHODS

We conducted a retrospective chart review of 5998 patients undergoing patch testing at an occupational and contact dermatitis clinic in a Thai, university-based, tertiary referral hospital from January 2001 to December 2021. Patients' characteristics and patch test results were collected.

RESULTS

Females had a higher positive patch test rate than males (71.8% vs. 65%, p < 0.001). However, males showed a greater prevalence of occupationally related allergic contact dermatitis (15.9%). Multivariate analysis revealed associations between being female and allergies to colophonium (aOR 1.46, 95% CI 1.07-1.99, p = 0.019), formaldehyde (aOR 1.97, 95% CI 1.17-13.31, p = 0.010), fragrance mix I (aOR 1.66, 95% CI 1.34-2.07, p < 0.001), MCI/MI (aOR 2.55, 95% CI 1.90-3.44, p < 0.001), neomycin (aOR 4.15, 95% CI 2.54-6.80, p < 0.001), and nickel (aOR 2.62, 95% CI 2.17-3.15, p < 0.001). Conversely, being male correlated with allergies to carba mix (aOR 0.51, 95% CI 0.41-0.64, p < 0.001), epoxy resin (aOR 0.26, 95% CI 0.14-0.47, p < 0.001), n-isopropyl-n-phenyl-4-phenylenediamine (aOR 0.41, 95% CI 0.20-0.83, p = 0.014), paraben mix (aOR 0.42, 95% CI 0.32-0.56, p < 0.001), and potassium dichromate (aOR 0.70, 95% CI 0.58-0.84, p < 0.001). Positive reactions to PCPs stood at 13% overall (males 17.1%, females 12.2%, p < 0.001).

CONCLUSIONS

Gender plays a pivotal role in contact dermatitis. This work emphasises the importance of considering gender-specific factors when diagnosing and managing contact allergies.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence and causative allergens of contact cheilitis in Thailand

BACKGROUND

Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown.

OBJECTIVES

To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital.

METHODS

A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021.

RESULTS

Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources.

CONCLUSIONS

ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.

Efficacy of panthenol- and bisabolol-containing lip care as monotherapy for mild-to-moderate cheilitis

BACKGROUND

Cheilitis is a chronic inflammatory condition of the lips, and frequent or prolonged use of topical corticosteroids may lead to various adverse events. Therefore, alternative therapies with fewer side effects are beneficial for the treatment of this condition.

AIM

To evaluate the efficacy of a lip care formulation containing both panthenol and bisabolol as a monotherapy for mild-to-moderate cheilitis.

METHODS

This single-centre prospective pilot open-label study included 20 patients with mild-to-moderate cheilitis who were treated with the tested lip care for 8 weeks and evaluated by physician and patient assessments before the final efficacy was determined using the Visioscan score.

RESULTS

Of the 20 patients, 13 (65.0%) presented with moderate cheilitis with dry and chapped lips. All parameters, including physician and patient clinical scores and bioengineering measurements, showed significant improvements as early as week 2 and sustained until week 8 following the application of the tested lip care. The frequency of cheilitis flareups also decreased significantly. The tested product was well tolerated without any adverse effects.

CONCLUSIONS

Lip care with panthenol and bisabolol was safe and effective. It can be used as monotherapy for the treatment of mild-to-moderate cheilitis.

A comparative study of chemical constituents and safety of Thai herbal medicated oil formula and traditional medicated oil

OBJECTIVES

Medicated oil has been traditionally used as an analgesic medicine to relieve pain by applying to the skin over painful muscles, and has been established in The National List of Essential Medicines (2556 B.E.). Traditional Medicated oil (TMO) consists of cassumunar ginger, Wan En Lueang, and Wan Ron Thong. It is prepared by frying herbs in coconut oil which is a traditional method. Thai Herbal Medicated oil formula (MOF) comprises cassumunar ginger, sweet flag, lesser galangal, wild turmeric, Wan En Lueang, and Wan Ron Thong. Its preparation by maceration with methyl salicylate is modified method to avoid the heat in the traditional preparation. Since both recipes have different methods of extraction and compositions, it is necessary to determine the chemical constituents and acute skin irritation potential of MOF and TMO.

METHODS

This study applied Gas Chromatography-Mass Spectrometry (GC-MS) for quality assessment of MOF extract and TMO extract. The mass spectra of the compounds matched with authentic standards from the NIST library. The compounds were identified by comparing their retention time and peak area, and the percentage of matched factor was more than 80%. The safety assessment on acute skin irritation used the 4 h human patch test (4 h HPT) in 36 healthy subjects.

RESULTS

The 37 compounds were found in MOF extract. The most common chemical constituents were terpene derivatives; monoterpenes and sesquiterpenes, and others, namely benzene derivatives, ester, phenylpropanoid, and other compounds. The 33 compounds were found in TMO extract and the chemical groups were similar to MOF extract. The 4 h HPT demonstrated that the MOF extract, TMO extract, methyl salicylate solvent, and coconut oil solvent, did not induce skin irritation. However, the vehicle of the formulae and the whole formulae as MOF and TMO clinically induced skin irritation and accorded with rubefacient. The characteristic as mild erythema or dryness, but not erythema with edema, could appear after the use of rubbing skin products.

CONCLUSIONS

The chemical constituents found in MOF and TMO extracts were partially different and their acute skin irritation reactions were not significantly different. A study on the efficacy of both remedies should be performed in the future, as well as a study on active chemical constituents. This study provides scientific evidences of quality and safety, including GC-MS condition for poly-herbal medicated oil standardization.

A 30-year Patch Testing Experience at Siriraj Dermatology

Objective:  To identify trends of contact allergy and patch testing amendments at the Contact Dermatitis Clinic, Department of Dermatology, Siriraj Hospital. Materials and Methods: Medical records of 6,862 patients referred to our clinic between January 1992 and December 2021for patch testing were reviewed. Results: The number of patients patch tested increased and reached a peak of 600 patients/year in 2019 before the COVID-19 pandemic.  The most frequently used series was baseline, while the most used specific series was cosmetics. The overall positivity rate was 69%. The highest positivity rate was in the cosmetics series (70.2%). Nickel sulfate was the most common contact allergen found (24.2%). Conclusion:  Our patch test service has been growing in the last 30 years.  The series of allergens used for patch testing has been amended every few years to be up-to-date with current global trends of contact allergies. Continual surveillance of contact prevalence and periodic updating of those series are necessary to enhance our ability to detect culprit contact allergens, which could help us improve care of our patients.

Characteristics and common ultraviolet filter usage of sunscreens purchased online: Cross-cultural analysis across 5 continents

BACKGROUND

A wide range of sunscreen products are available globally. Designed to meet various customer needs, they differ in formulations type, textures, ingredients, ultraviolet (UV) protection capabilities, and other properties. Knowing the factors influencing the purchase of sunscreens and the UV filters commonly used in each global region would be beneficial for dermatologists, consumers, and regulators.

METHODS

Data on 50 best-selling sunscreens from each of 20 countries on 5 continents (1000 products in all) were retrieved from Amazon Marketplace during the period from January to July 2021.

RESULTS

Among the 5 continents, Asia had the highest proportion of consumers (71.1%) choosing high sun protection factor (SPF) sunscreens (SPF ≥50). In contrast, Europe had the highest percentage (11.8%) purchasing <30 SPF sunscreens. The lack of standard UVA protection labeling was significantly highest in South America. The use of inorganic-based sunscreen was highest in North America, and across all continents, those products were significantly more expensive than organic-based sunscreens. Globally, lotions were the most favored formulation type. "Nongreasy/dry touch" (45.1%) and "lightweight texture" (40.4%) were the most common promotional terms used. The most common UV filters differed among regions. Iron oxide, which can function as a visible light filter, was most frequently found in sunscreens in South America (20%) and North America (19.3%).

CONCLUSIONS

The regional factors influencing the purchase of sunscreen products differed. A considerable number of sunscreens may not provide adequate sun protection for consumers. Dermatologists should recommend sunscreens with sufficient UV protection that suit the skin of individual consumers.

Impact of the COVID-19 Pandemic on Tertiarycare University Dermatology Outpatient Clinic and Dermatology Procedures

Objective: This study aimed to determine the changes in patient characteristics, disease prevalence, and dermatology procedures during the COVID-19 pandemic. Materials and Methods: We retrospectively reviewed the demographic data, diagnoses, and dermatology procedures of the patients who visited an outpatient dermatology clinic between March 1, 2018, and December 31, 2021. Changes in the number of patients, the patterns of diagnosis, and the dermatology procedures were analyzed. Results: The number of patients decreased at the start of each of the 4 COVID-19 waves that occurred during the study period. Older adults increased their dermatology visits during the pandemic. The skin disease with the highest proportional increase in the frequency of visits was cutaneous T-cell lymphoma. The proportion of noncosmetic procedures significantly increased, in contrast to a decrease in the proportion of cosmetic procedures. Conclusion: The COVID-19 pandemic significantly affected outpatient dermatology by changing the setting and frequency of patient visits to the outpatient clinic, the pattern of the diseases, and the dermatology procedures.

Trends in formaldehyde and formaldehyde-releaser contact allergies as compared with market exposure in Thailand

BACKGROUND

Formaldehyde and formaldehyde releasers (FRs) are common preservatives in cosmetics and household products. Their contact allergy trends are decreasing in Europe and America, but trend data for Asia are limited.

OBJECTIVES

The first objective was to determine the prevalences of and trends in contact allergies to formaldehyde and FRs. The second objective was to establish how often formaldehyde and FRs were mentioned on the labels of products sold in the Thai market.

METHODS

Twenty years of data on patch test results for formaldehyde and FRs were reviewed. Their frequency of mention on the labels of 5855 products was analyzed.

RESULTS

The trends in contact allergy to formaldehyde and FRs were decreasing. The overall prevalence of formaldehyde contact allergy was 2.5%. The most common FR to cause contact allergy was quaternium-15. Formaldehyde and FRs were identified as ingredients in 10.2% of the products surveyed. Dimethylol dimethyl hydantoin was the most common FR (5.2%). The highest use of formaldehyde and FRs (15.5%) was in hair care products.

CONCLUSIONS

Although contact allergy trends in Thailand were decreasing, the proportion of products with FRs remained high. Comprehensive and universal legislation is needed to control the presence of formaldehyde and FRs. This article is protected by copyright. All rights reserved.

Simultaneous patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes ‐ an update from southern Sweden

Background

Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated.

Objectives

To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs.

Methods

A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed.

Results

The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3‐cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series.

Conclusions

Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.

Ultraviolet filters in sunscreens and cosmetic products-A market survey

BACKGROUND

As several reports have raised a variety of environmental, health, and safety issues related to ultraviolet (UV) filters, it is crucial to understand the trends in the exposure of the population to UV filters.

OBJECTIVE

To determine the frequency of UV filter usage in sunscreens and other cosmetic products in Thai market.

METHODS

We surveyed the UV filter labelling on sunscreens and cosmetic products sold in the Thai market. In all, 312 sunscreens and 1350 other cosmetic products were investigated.

RESULTS

Titanium dioxide was the most frequently used UV filter in both sunscreens (66.7%) and other cosmetic products (68.4%). Ethylhexyl methoxycinnamate was the most common organic UVB filter, whereas butyl methoxydibenzoylmethane was the most common organic UVA filter. In sunscreens aimed at children, bis-ethylhexyloxyphenol methoxyphenyl triazine was the most commonly used UV filter. The most frequent co-occurrence of UV filters was titanium dioxide and ethylhexyl methoxycinnamate.

CONCLUSIONS

Titanium dioxide was the most commonly used UV filter, which differs from the findings of previous surveys. Knowing the availability and frequency of each UV filter provides valuable information about consumer exposure levels, facilitates refinements of the allergen series in patch testing, and enhances the monitoring of adverse effects of UV filters.

Prevalence, concomitant reactions, and factors associated with fragrance allergy in Thailand

BACKGROUND

Fragrances are the most common cause of cosmetic contact allergy. Up-to-date information on contact allergy frequencies and relevance aids primary and secondary preventive measures.

OBJECTIVES

To determine the prevalence, associated factors, and concomitant reactions in fragrance allergy among Thais.

METHODS

This retrospective study collected data from 2012 to 2019. The patient characteristics of fragrance and nonfragrance allergy groups were compared. Concurrent positive reactions to fragrance allergens (fragrance mix [FM] I, FM II, Myroxylon pereirae resin and hydroxyisohexyl 3-cyclohexene carboxaldehyde) and other baseline-series allergens were analysed.

RESULTS

Of 1032 patients, 175 (17.0%) had fragrance allergy, with 57.7% of clinical relevance. FM I showed the highest prevalence (9.4%). The associated factors were being elderly, lesions on the extremities, metal allergy history, and long dermatitis duration. Contact allergies to epoxy resin and Compositae plants were significantly associated with fragrance allergy with an odds ratio of 5.95 (95% confidence interval [CI]: 5.21-6.80) and an odds ratio of 4.42 (95% CI: 1.58-12.36), respectively. No significant associations between colophonium (previously proposed as a fragrance marker) and fragrance allergens were found.

CONCLUSIONS

The prevalence of fragrance contact allergy remains high and should be considered in old patients presenting with long-standing eczema on the extremities. Unlike reports from other countries, varied, significant, concomitant reactions were observed.

Photopatch testing in a tropical country, Thailand: 20 years' experience

BACKGROUND

Photoallergic contact dermatitis is one of the important parts of photodermatoses. The investigation of choice is photopatch testing. However, reports with photopatch test results from Asian countries are scarce. The objective of this study was to determine the prevalence of positive photopatch test reactions and to ascertain the common photoallergens among Thai patients during 1998-2018.

METHODS

We retrospectively reviewed the records of 339 patients who were clinically suspected of having photoallergic contact dermatitis and had undergone photopatch testing.

RESULTS

A total of 44 photoallergic contact reactions in 38 patients (11.2%) were found. The positive photoallergic reactions were mainly found with organic ultraviolet filters and fragrances.

CONCLUSIONS

Organic ultraviolet filter chemicals especially benzophenone-3 and fragrances were found to have a high prevalence of photoallergic contact reactions. Monitoring of the photoallergens employed in photopatch tests should be conducted periodically to provide the best patient care.

Pediatric contact allergy: A comparative study with adults

BACKGROUND

Pediatric allergic contact dermatitis is increasing. The patch test allergens included in pediatric baseline series vary globally. The worldwide prevalence of pediatric reactions to allergens needs clarification.

OBJECTIVES

Identify the prevalence, associated factors, and culprit allergens for contact allergy among patch-tested Thai children, and compare with those for adults.

METHODS

Baseline series patch test results from 2010-2019 were collected for patients younger than 18 years of age. As a control group, sex-matched adult patients were randomly selected. The results and characteristics of the two groups were compared.

RESULTS

The median age of 112 patch tested pediatric patients was 16 (range 2-17) years. Of the children, 35.5% had at least one positive reaction, significantly less than the 56.6% for adults. The five most common pediatric allergens were nickel sulfate (12.1%), potassium dichromate (8.0%), methylisothiazolinone (7.1%), fragrance mix II (6.0%), and carba mix (5.4%). Although similar, the 10 most common allergens of the groups differed in order. Positive reactions to cosmetic allergens were significantly less frequent among the children. Many allergens remained entirely negative.

CONCLUSIONS

The prevalence of positive reactions was lower in children, varying by population and region. The top-10 pediatric and adult causative allergens were almost identical. We recommend using the same baseline patch test series for children and adults in our region.

Methylchloroisothiazolinone and/or Methylisothiazolinone Contact Allergies in Thailand

BACKGROUND

Methylchloroisothiazolinone, in combination with methylisothiazolinone (MCI/MI), and MI alone are common preservatives. The incidences of MCI/MI and MI-alone contact allergies have risen markedly worldwide, leading to changes in their use in products.

OBJECTIVES

The aim of the study was to determine the incidences of positive patch test reactions and factors associated with MCI and/or MI contact allergies during the recent decade in Thailand.

METHODS

Medical records of patients who underwent patch testing at Siriraj Hospital from 2009 to 2018 were retrospectively reviewed. The incidences of positive reactions, histories, and clinical data of MCI/MI and MI-alone contact allergy patients were analyzed.

RESULTS

Of 2789 patients undergoing patch testing, most were female (76.1%). The mean ± SD age was 42.7 ± 15.7 years. Positive reactions to MCI/MI increased from 2009 to 2016 before declining. The MCI/MI contact allergy was most common in females, middle-aged patients, and those with metal allergy histories, with the hands and arms being the predominant sites. However, MI-alone contact allergy was more common in males and mainly at the trunk. Its incidence significantly declined for the last 5 years.

CONCLUSIONS

The incidences of MCI/MI and MI-alone contact allergies began to decline because the Food and Drug Administration Thailand regulations restricted their use. The risk factors for the allergies reported in this study provide important information for patient care.

Assessment of the quality of life (QoL) of patients with dermatitis and the impact of patch testing on QoL: A study of 519 patients diagnosed with dermatitis

BACKGROUND

Dermatitis can impair the quality of life (QoL) of patients. Knowledge of the QoL-associated factors and the impact of patch testing on QoL is limited.

OBJECTIVES

To identify demographic and clinical factors affecting QoL, and to measure the impact of patch testing on QoL of dermatitis patients.

METHODS

The data and Dermatology Life Quality Index (DLQI) questionnaires of 519 dermatitis patients were analyzed. Of these, 107 underwent patch testing and completed the questionnaires two times (once before testing and again 60 days afterward).

RESULTS

The overall mean (±standard deviation) DLQI was 9.5 (±6.4). Patients aged 20 to 59 years and those who had more frequent disease exacerbations demonstrated significantly higher DLQIs. For each DLQI question, being female and aged 20 to 59 years were associated with impairments of various aspects of life, whereas the anatomical site of dermatitis impacted each question differently. The DLQI scores of the patients undergoing patch testing decreased significantly, irrespective of whether the test results were positive or negative.

CONCLUSIONS

Being of a working age and having more frequent disease exacerbations had negative QoL impacts. In addition, patch testing improved almost every aspect of the DLQI.

Synthetic hair reactions and treatment of complications: Case reports

BACKGROUND

Synthetic hair fiber implantation first achieved widespread use in the 1970s, but in 1983, the US Federal Drug Administration banned the fibers due to its complications. Currently available synthetic fibers consist of polyamide material, which has been claimed to be effective and safe. Nevertheless, its use for hair restoration is controversial because of complications such as recurrent infections; the rejection and the faster-than-anticipated loss of fibers; frequent allergic reactions; fears about carcinogenicity; cicatricial alopecia; granulomatous hypersensitivity; and cyst formation.

AIMS

To report complications of synthetic hair implantation and treatments.

METHODS

We report the clinical data, pathological studies, and treatment outcomes of two patients who developed complications after a synthetic hair implantation.

RESULTS

Our case reports showed significant moderate-to-severe adverse events, including recurrent folliculitis, scalp crusting, scarring, the matting and breakage of fibers, and granulomatous reactions. The onset of the reactions varied between 1 and 8 weeks. Pathological studies showed that the implantation of the synthetic hair into the scalp produced a hyperplastic proliferation of epidermal cells, foreign body granuloma, and persistent acute inflammation due to bacterial infections. In our study, definitive treatment was ineffective until the synthetic fibers were removed from the scalp.

CONCLUSION

These significant adverse reactions may limit the benefits of synthetic hair fiber implantation for some patients. Although the inflammations were initially controlled by oral and topical antibiotics, a variety of antibiotics were unable to control the folliculitis. The fibers were ultimately removed, following which, the inflammations improved.

Methylchloroisothiazolinone and/or methylisothiazolinone in cosmetic products-A market survey

BACKGROUND

There was a global epidemic of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics.

OBJECTIVE

To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive.

METHODS

The presence of MCI and/or MI in leave-on and rinse-off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed.

RESULTS

Before the implementation date, most leave-on products contained MCI/MI. After the regulations came into force, the only leave-on cosmetic subcategories that complied with the law were facial skin-care, sunscreen and make-up products. MCI/MI and MI alone were found on the labels of both leave-on and rinse-off products, the presence of each varying between product subcategories.

CONCLUSIONS

Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.

Associated factors of widespread pattern of dermatitis among patch test population: 12-Year retrospective study

BACKGROUND/OBJECTIVE

Widespread dermatitis is often associated with diagnostic and therapeutic challenges. Multiple factors influence this widespread pattern of dermatitis. We aim to study the associated factors in patch-tested patients who presented with widespread pattern of dermatitis.

METHOD

This retrospective, case-control study was conducted on patients with dermatitis who were patch tested during January 2005 to December 2016. The demographic data, patient and family histories, diagnoses, and patch test findings were recorded and analyzed.

RESULTS

Of the 3201 included patients, 645 (20.2%) had widespread pattern of dermatitis. Being male, age >60, and history of either atopic dermatitis (AD) or metal allergy were significantly associated with the widespread dermatitis pattern. A multivariate analysis demonstrated that preservatives were the significant offending allergens, especially methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), and methylisothiazolinone (MI) alone.

CONCLUSION

Widespread pattern of dermatitis is associated with gender, age, underlying atopic dermatitis and a history of metal allergy. Preservatives are the significant offending allergens of widespread dermatitis, especially MCI/MI, and MI alone. A thorough history taking and patch testing, including preservatives, are necessary to determine the cause of widespread pattern of dermatitis.

Randomized investigator-blinded comparative study of moisturizer containing 4-t-butylcyclohexanol and licochalcone A versus 0.02% triamcinolone acetonide cream in facial dermatitis

BACKGROUND

Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects.

OBJECTIVE

To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis.

METHODS

This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4.

RESULTS

Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity.

CONCLUSION

The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.

Meeting the Challenges of Acne Treatment in Asian Patients: A Review of the Role of Dermocosmetics as Adjunctive Therapy

Conventional acne treatment presents several challenges such as intolerable side effects and antibiotic resistance. Dermocosmetic products may be used to reduce these unwanted effects. Dermocosmetics include skin cleansers, topical sebum-controllers, skin antimicrobial/anti-inflammatory agents, moisturizers, sunscreens, and camouflage products. Appropriate use of these products may help augment the benefit of acne treatment, minimize side effects, and reduce the need for topical antibiotics. In Asia, there is currently limited scientific data on the application and recommendations for dermocosmetic use in acne vulgaris (AV). This article reviews the evidence on dermocosmetics for AV and provides practice recommendations as discussed during the 4^th Asia-Pacific Acne Leaders' Summit held in Bangkok, Thailand, on 7 and 8 February 2015. Through a premeeting survey, a series of plenary lectures, a stepwise program of discussion sessions, and Medline article review, the Expert Panel set forth relevant recommendations on the role of dermocosmetics as adjunct for treating AV in Asian patients.

Contact sensitizers in commercial hair dye products sold in Thailand

BACKGROUND

Hair dyes are known to contain potent contact allergens for which sensitization rates have increased over the last decade.

OBJECTIVE

To examine the type and frequency of potent contact sensitizers labelled on hair dyes sold in metropolitan Bangkok, Thailand.

METHODS

During the 2013-2014 study period, labelled ingredient information from home use and professional hair dye products was collected.

RESULTS

Two hundred and fifty-two hair dye products were evaluated. One hundred and forty-nine products from 48 brands were domestically produced in Thailand, and 103 products were from 23 multinational brands produced in countries other than Thailand. Two hundred and fourteen of 252 (84.9%) hair dye products were found to contain strong skin sensitizers, with 118 (46.8%) being found in domestically produced products, and 96 (38.1%) being found in multinational brand products. Thirty-eight hair dye products (15.1%) were free of potent skin sensitizers. The number of domestically produced products (31, 20.8%) that were free of potent skin sensitizers was significantly higher (p = 0.002) than the number of multinational brand products (7, 6.8%).

CONCLUSIONS

p-Phenylenediamine was the most prevalent potent sensitizer found among domestically produced hair dyes available on the market. Our findings indicate regional differences in hair dye allergen exposure.

Cosmetic preservative labelling on the Thai market

BACKGROUND

Preservatives are added to cosmetics and other consumer products to prevent microbial growth and product degradation. Many cosmetic preservatives are skin sensitizers and frequent causes of contact dermatitis. The use of preservatives may vary by country and/or region, according to legislation, and may be reflected in differences in the prevalence rates of preservative allergy worldwide.

OBJECTIVE

To examine the type and frequency of preservative use in cosmetics sold in Thai markets in metropolitan Bangkok, Thailand.

METHODS

Preservatives contained in 1000 different cosmetics sold in Thai markets were documented and analysed, based on the labelling of ingredients.

RESULTS

Most of the cosmetic and skincare products sold in Thai markets were international brands, with only a small proportion of cosmetic products being produced in Thailand. International brand cosmetics were more likely to contain non-formaldehyde-releasing preservatives than domestically produced brands. Isothiazolinone-based preservatives, which are responsible for the current increase in the prevalence of contact allergy, were found at a significant frequency in domestically produced, leave-on cosmetic products.

CONCLUSION

Preservatives in cosmetics were significantly different according to source of production and type of cosmetics.

Occupational contact dermatitis in tertiary university hospital: a 5-year retrospective study

BACKGROUND

Thailand, an agricultural country developing into an industrial country, has diferences in work environment, substance exposure, and climate. These factors may lead to a distinct epidemiology of occupational contact dermatitis (OCD).

OBJECTIVE

To study the prevalence of allergic and irritant occupational contact dermatitis in Thailand.

MATERIAL AND METHOD

The records of patients diagnosed of OCD and patch tested between 2006 and 2010 at Siriraj University Hospital were retrospectively reviewed.

RESULTS

From 885patch tested patients, 194 (21.9%) had OCD. Of those 194 patients, 76.8% were female and23.2% were male. Allergic contact dermatitis (ACD; 76.3%) wasfoundto be more common than irritant contact dermatitis (ICD; 24.2%). The common affectedpart was hands (51.5%). The mostfrequent occupation was wet work (35.1%), followed by office work (24.7%), industrial work (16%), and medical personnel (13.4%). The most common occupational allergens were nickel sulfate (33.1%), potassium dichromate (19.6%), and carba mix (15.5%). Water (56.1%), foods (4.9%), and oil/grease (2.4%) were the most common occupational irritants.

CONCLUSION

In our setting, allergic OCD was more common than irritant OCD. Nickel sulfate was the most common occupational allergen. Occupational A CD and lCD are most commonly found in industrial work and wet works, respectively.

Risk assessment for nickel contact allergy

Nickel is one of the most common allergens causing allergic contact dermatitis worldwide. The aim of the study was to evaluate the contributing factors to nickel contact allergy (NiCA) in Asians who have a unique culture and lifestyle. We randomly selected 324 previously patch-tested patients, 162 nickel patch test (PT)-positive patients and 162 nickel PT-negative patients. The patients were telephone interviewed for their lifestyle information. Most of the nickel PT-positive patients (93.2%) were female with a mean age of 38.9 ± 13.3 years compared with the other group of nickel PT-negative patients who had a smaller proportion of females (76.5%) with an older mean age of 44.1 ± 14.9 years (P = 0.001). Multivariate analysis was able to establish that the significant risk factors for NiCA were female sex (odds ratio [OR], 6.38; 95% confidence interval [CI], 2.15-18.94), young age (OR, 0.98; 95% CI, 0.96-1.00), occupation with long periods of exposure to metal (OR, 3.08; 95% CI, 1.18-8.02), seafood (OR, 1.96; 95% CI, 1.17-3.27) and canned food consumption (OR, 3.12; 95% CI, 1.17-8.33) (P < 0.05). The adjusted factors found to associate with NiCA were female sex, young age, occupation with long periods of exposure to metal, seafood and canned food consumption.

Cutaneous lymphoepithelioma-like carcinoma: report of three cases

BACKGROUND

Cutaneous lymphoepithelioma-like carcinoma (cutaneous LELC) is an extremely rare malignant neoplasm with unclear histogenesis. Its histopathologic features are like those of lymphoepithelioma-like carcinoma occurring in the nasopharynx and in visceral organs especially salivary glands.

MATERIAL AND METHOD

The authors reported on one male and two female patients of cutaneous LELC with immunohistochemical and electron microscopic study. All patients were of old age. All cutaneous LELCs in this report occurred on the patient's face, one of each on the eyelid, conjunctiva, and cheek.

RESULTS

All resection specimens showed the typical histopathologic features of those of LELC, i.e. well-defined tumor lobules mainly located in the dermis and extending into the panniculus. These tumor lobules typically displayed ill-defined clusters/nests of large epitheloid cells with pale eosinophilic cytoplasm, atypical vesicular nuclei possessing prominent nucleoli and were surrounded by dense lymphoplasmacytic infiltration. Immunocytohistochemically, these epitheloid cells showed epithelial differentiation by the expression of epithelial membrane antigen (EMA), P63, CK5/6 and CAM5.2 but were negative to CK20, CEA and Ebstein-Barr virus (EBV). Squamous cell differentiation by the presence of desmosomes by electron microscopic study was also noted in two patients (case 1 and 3).

CONCLUSION

The findings described above indicated that cutaneous LELC was a malignant neoplasm exhibiting squamous cell differentiation.

The pH of commonly available soaps, liquid cleansers, detergents and alcohol gels

BACKGROUND

The hydrogen ion concentration (pH) of a cleanser certainly has an impact on skin condition. Dermatologists always need to recommend a cleanser to patients with hand dermatitis or sensitive skin; particularly during the outbreak of swine (AH1N1 virus) influenza, frequent hand washing and alcohol gel cleansing were greatly recommended.

OBJECTIVES

The purpose of this study was to evaluate the pH of various commonly available cleansers and alcohol gels on the market to assess patient comfort in using such products and to make good recommendations to our patients.

METHODS

Multiple brands of liquid cleansers, dishwashing liquids, soaps, laundry detergents, and alcohol gels commonly available on the market were assessed for pH by using a pH meter and pH-indicator strips. The pH assessment imitated real-life conditions by diluting each cleanser with tap water and then comparing the changed pH.

RESULTS

The pH levels of liquid cleansers, dishwashing liquids, a beauty bar, and alcohol gels were acidic to neutral and compatible with normal skin pH. Most bar soaps, baby soaps, and powdered laundry detergents had a pH in the alkali range. The pH of concentrated cleansers was slightly different from that of their dissolved forms.

CONCLUSION

Regarding the antiseptic property and pH of the cleansers, alcohol gels with moisturizers appeared to be the best hand cleansers to recommend to our patients.