bluuebunny/crossref_metadata_2025 huggingface dataset:
P13 Results of patch testing with patients’ own cosmetics and toiletries
Authors: Uter Wolfgang , Balzer C , Schnuch A
Published: August 2010

Patch testing with materials brought in by the patient is useful to identify the cause(s) of current allergic contact dermatitis (ACD). However, little is known (i) on the contribution of such tests to diagnostic success and (ii) on the spectrum of contact allergens associated with ACD to certain product categories. Between 1998 and 2002, 5911 out of 48381 patients patch tested in the centres of the IVDK (http://www.ivdk.org) have been tested with own cosmetics and toiletries in addition to commercial allergens. These were manually assigned to 26 categories, based on a EU classification (annex I to 76/768/EEC), which was further refined. As illustrative example, data on “Bath and shower preparations” are presented: out of 1333 patients tested with a total of 2336 single patches (1102 with 1%, 391 with 10% and 280 with 0.1% in water, remainder with other preparations, depending on the actual kind of product), 71 had positive reactions at the D3 reading. Only in 46 of these, reactions to potential cosmetic ingredients, tested as commercially available allergens, were observed. Among these, fragrance mix (30.0% vs. 12.9% in those not reacting positively to this product category), Myroxylon Pereirae resin (18.6% vs. 8.4%) and some biocides like MCI/MI (11.4% vs. 1.8%) and methyldibromo glutaronitrile + phenoxyethanol (12.1% vs. 5.3%) were the most common allergens. In conclusion, patch testing own products – although not without pitfalls – may (i) help to correctly diagnose ACD and (ii) give important hints on the occurrence of allergens in a particular type of (cosmetic) product.
P17 Allergic contact dermatitis from hydrolyzed wheat protein
Authors: Bordalo Olivia
Published: August 2010

Allergic Contact Dermatitis (ACD) from hydrolysed wheat protein (HWP) is rarely reported in the literature. We describe 2 cases of ACD to this new allergen. Case1‐ A 39‐year‐old non atopic woman presented with a dermatitis of the face, mainly eyelids and neck. She had been using a new cosmetic cream for 2 months. The lesions subsided with topical corticosteroids. Patch tests with the standard, cosmetic, fragrance series and with her own products gave positive reactions only to the new cosmetic cream. We also tested all the components of this cream and only HWP gave a doubtful reaction with occlusive tests and positive reaction with ROAT. Case 2 – A 48‐year‐old atopic woman presented with a dermatitis of the face and hands for 1 month. She had been using a new cosmetic cream for 11 months and kept using the product without any suspicion. The dermatitis subsided with cetirizine and topical corticosteroids. Patch tests with the standard, cosmetic, fragrance series and her own products revealed positive reactions to the cosmetic cream. Again, testing all the components of the cream, only HWP gave doubtful reactions with occlusive tests and positive reactions with ROAT.

Discussion:  In recent years, a number of protein hydrolysates have been introduced into cosmetic manufacture. HWP is being used in cosmetic creams for its moisturizing properties. As far as we know, there is only one previously reported case of ACD induced by this allergen. More cases may be expected.
P71 Metabolism of delta‐3‐Carene by human cytochrom 450 enzymes
Authors: Duisken Mike , Peiffer TH , Blömeke B , Hollender J
Published: August 2010

Occupational exposure to monoterpenes occurs in saw mills, particle‐board plants, carpentry shops and other types of wood‐treating industries. The bicyclic monoterpene delta‐3‐Carene, one of the components of turpentine, may irritate the skin and muceous membranes and prolonged exposure may result in allergic contact dermatitis or chronic lung function impairment. The effects of low concentrations of delta‐3‐Carene on alveolar macrophages in vitro were examined and a dose‐dependent relationship between the cell viability and the delta‐3‐Carene concentration was found. Little is known about the metabolism of delta‐3‐Carene in mammalians. In order to determine the toxic potential of this monoterpene we studied the human metabolism of delta‐3‐Carene in vitro. Therefore we used pooled human liver S9 and human liver microsomal cytochrome P450 enzymes. By using GC‐MS analysis we found one main metabolite produced at high rates. The structure was identified by its mass spectra. The mass fragmentation indicated hydroxylation in allyl position. After synthesis of the assumed product in a four step reaction, it was characterized as delta‐3‐Carene‐10‐ol. There was a clear correlation between the concentration of the metabolite production, incubation time and enzyme concentration, respectively. Kinetic analysis showed that Km and Vmax values for the oxidation of delta‐3‐Carene by human liver microsomes were 0.39 μM and 0.2 nmol/min/nmol P450. It is the first time that delta‐3‐Carene‐10‐ol is described as human metabolite of delta‐3‐Carene.
P73 The magnitude of contact allergy responses can be quantified with imaged perfusion
Authors: Bjarnason Bolli , Xu H , Elmets CA
Published: August 2010

Objective:  The objective of this study was to determine whether the magnitude of the perfusion of the contact hypersensitivity response as measured by the laser Doppler perfusion imaging (LDPI) technique was associated with immunological parameters implicated in the pathogenesis of the disease.

Methods:  Urushiol was applied on one of the forearms of volunteers for 48 hours while the other forearm served as a control. Twenty‐four hours later, measurements of perfusion of the patch test sites were performed with the LDPI technique. To determine whether there was a correlation with immunological parameters associated with human contact hypersensitivity, suction blisters were produced at the test sites. Blister fluid was removed and examined for the cytokine interleukin‐8 (IL‐8).

Results:  There was an extremely close correlation between the magnitude of the contact hypersensitivity response as measured by the imaged perfusion and the level of IL‐8 in the blister fluid (r = 1.00). Compared to subjects with visually positive urushiol reactions, patients who failed to develop urushiol contact hypersensitivity despite repeated exposures to that substance had both greatly diminished perfusion and blister fluid IL‐8 levels.

Conclusion:  The results indicate that LDPI is a sensitive method of quantifying contact hypersensitivity reactions in humans and that the magnitude of the measurements with this technique correlates extremely well with cutaneous cytokine levels that have been implicated in the immunopathogenesis of contact hypersensitivity.
P75 Molecular screening for skin sensitisation hazard in vitro using proteomics techniques
Authors: Divkovic Maja , Basketter D , Pease C , Panico M , Morris H , Dell A
Published: August 2010

Covalent binding of hapten to skin protein is required for sensitisation. It has long been postulated that only sensitising chemicals will modify skin protein(s), whereas non‐sensitisers and irritants do not. To pinpoint the amino acid residues involved in such modifications, we employed mass spectrometry (MS) based proteomics techniques. Known sensitisers, non‐sensitisers and irritants were incubated with human serum albumin (HSA). Modified HSA samples were digested by trypsin and matrix assisted laser desorption/ionisation (MALDI‐MS) analyses were conducted on the digests. Nano‐electrospray tandem mass spectrometry (ES‐MS/MS) analyses were conducted on modified peptides purified by high performance liquid chromatography (HPLC). The HSA sequence was mapped and modified peptides identified. In HSA samples incubated with non‐sensitisers and irritants there was no change compared to HSA incubated without chemical. Modified peptides were purified by HPLC and sequenced using ES‐MS/MS. Lysine, histidine and cysteine were found to be involved in covalent modifications by the sensitising chemicals used. A double adduct of one sensitiser (MCI) on His 338 of HSA molecule was also identified. More sensitisers need to be investigated to establish similarities between covalent protein modifications of chemically related compounds. The aim is to develop an assay for protein binding ability of chemicals which could form part of a battery of tests needed to replace animal testing for sensitisation potential.
P76 Allergic contact dermatitis vs. psoriasis
Authors: Fernandez‐Redondo Virginia , Rodriguez‐Blanco I , Toribio J
Published: August 2010

Background:  Psoriasis prevalence in the Spanish population is around 1.4%(2000). The last epidemiological enquire of the GEIDC (2001) showed that 55.11% of the patients revised in specialized units presented Allergic Contact Dermatitis (ACD). Concomitance of both processes has been widely studied being the opinions of the different authors controversial. Palmo‐plantar psoriasis seems to be the most frequent type in patients presenting delayed hypersensitivity.

Aim and methods:  A retrospective study (2002–2003) of the incidence of ACD in patients previously diagnosed of psoriasis was performed in the allergy unit of our hospital. The aim of our study was to investigate the delayed hypersensitivity among psoriatic patients as well as its clinical relevance in our influence area. 604 consecutive patients were studied. Standard batteries of the GEIDC as well as complementary series (True‐Test and Chemotecnique) were performed. Allergen application and posterior evaluation were done according to the ICDRG rules.

Results:  We studied 26 patients affected of Psoriasis, (4,3% of total). In contrast to the general population, 9 were female (mean age 49 years) and 17 male (mean age 48,4 years). ACD suggestive lesions were located in the hands of 15 patients, feet in three of them and in 4 patients both. Patch test was negative in 8 cases. The most detected allergens were Nickel and Fragrance‐mix. Occupational origin was discussed in 6 cases. Sensitivity to formaldehyde resins was demonstrated in several patients. Medicamentous origin due to ethylendiamine and Peru Balsam was also demonstrated.

Comments:  Several revisions about the relationship of ACD and psoriasis have been published in the last years and most of the authors think that there are no differences between healthy, psoriatic and atopic subjects. These studies have focused on adverse drug reactions or standard series of allergens, taking not in consideration an occupational origin. We suggest epicutaneous tests as a reliable method to diagnose ACD in psoriatic patients with chronic and/or refractory lesions in hands.
P78 Frequency and development of atopic dermatitis in Norway
Authors: Selvaag Edgar , Loeb M
Published: August 2010

Investigations in several western countries, especially european, have shown an increase in the frequency of atopic disease. To investigate these trends in Norway, the following procedure was followed.

Using four standardized interview‐reports the development and the frequency of atopic dermatitis was determined.

The questionnaires were conducted in the years 1968, 1975, 1985 and 1995. The results were registred electronically, and made available on the Statistical Package for the Social Sciences (SPSS) in Windows version.

In 1968 420 out of 11101 persons suffered from a skin disease.

The diagnosis atopic dermatitis was not recorded in 1968, in 1975 0.7% of all skin disease considered atopic dermatitis, in 1985 1.3% and in 1995 10.1%.

The results show an increased incidence of atopic dermatitis in Norway, comparable to other western countries.

Connections to air pollution, indoor environment, especially smoking are at present under investigation.
Contact allergy caused by air oxidation of common materials – diagnosis and prevention
Authors: Karlberg Ann‐Therese
Published: August 2010

When considering the allergenic activity of a compound not only the possibility of bioactivation by skin metabolism but also air activation by autoxidation must be taken into account.

Natural compounds (terpenes) easily oxidize at air exposure. They are found in products that are common causes of allergic contact dermatitis (ACD) i.e. colophony and fragrances.

The introduction of oxygen enables the molecules to form antigens with skin proteins via a nucleophilic‐ electrophilic interaction or via a radical reaction. The latter mechanism seems to be important since the primary oxidation products, the hydroperoxides, are the most potent sensitizers formed. Oxidative decomposition at air exposure resulting in allergenic oxidation products is observed also for other common compounds e.g. ethoxylated fatty alcohols used as surfactants.

It is important to test the patient with the offending compounds for diagnosis of ACD. A negative diagnosis can be due to failure in testing with the correct substances. In the case of air activated compounds, testing should not be performed with the pure substances but rather with the oxidation mixture or the most sensitizing oxidation products (the hydroperoxides). We have in multicenter‐studies shown that the common fragrance terpenes, limonene and linalool, are frequent sensitizers when oxidized. This is a challenge in clinical practice since such patch test materials are not easily standardized.

Compounds, easily activated at air exposure, should be prevented from oxidative decomposition by addition of antioxidants and proper handling and storage. More research is needed in this area.
Contact dermatitis and danger models
Authors: McFadden John P
Published: August 2010

Conventional models of the immune response are based on distinguishing self and non‐self. However, the more recently proposed ‘danger’ model may be an illuminating alternative for studying allergic contact dermatitis. In the presence of a ‘danger’ signal, which in some cases of allergic contact dermatitis could be cutaneous ‘irritancy’(ie cytokine release from non‐immune/keratinocyte cells in response to chemical stimulus in a non‐sensitising manner), the immune system would become activated, leading first to the induction of sensitisation and then subsequently to the elicitation of a contact hypersensitivity response. In most cases both the antigenic signal and signal for keratinocyte cytokine release will come from the hapten, although for example in an occupational setting, traumiterative dermatitis would be the source of the “danger” signal. A further prediction of this hypothesis is that reported animal experiments demonstrating low dose tolerance with contact allergens may be explained by the loss of the ‘irritant’ effect at lower dilutions whilst an antigenic stimulus remains present.
FS03.5 Evaluation of the irritancy potential of adapalene and tretinoin in volunteers of different ethnic origins
Authors: Goh Chee‐Leok , Goon A T‐J , Sorba V , Soto P , Kaoukhov A
Published: August 2010

Objectives:  To compare the cumulative irritancy potential of adapalene gel, 0.1% to that of tretinoin gel, 0.025% following repeated applications to the skin of human volunteers of different ethnic origins.

Methods:  Single center study, randomized, investigator blind, intra‐individual, comparison in healthy volunteers, 18 years of age and older. Volunteers were randomized to apply each product daily to one or the other half‐face for 21 days. On the forearms products were applied under occlusive conditions for 4 days. Criteria for evaluation were signs and symptoms (erythema, desquamation, dryness, stinging/ burning, pruritus) on the face and on the forearms (irritation, stinging/burning, pruritus, and biophysical measurements: colorimetry‐a* and Trans‐epidermal Water Loss (TEWL)). Overall safety evaluation was based on adverse events information collected throughout the study.

Results:  Seventy‐three (73) volunteers from 4 ethnic groups (Chinese, European, Indian and Malaysian volunteers) were randomized. On the face the between treatment differences in olerability parameters were similar in all ethnic groups, thus allowing to conclude that adapalene was significantly better tolerated than tretinoin in all ethnic groups. This also allowed us to compare overall irritation susceptibility of different ethnic groups using the sum of clinical sign scores. An overall ethnic effect could be shown (p < 0.001): Chinese being most susceptible (33.5), followed by Indians (26.9), Malaysians (23.6) and Europeans (14.1). Forearm evaluations showed significantly better tolerability for adapalene than for tretinoin. However in each patient TEWL measurements correlated poorly with clinical assessments. Throughout the study more treatment related adverse events occurred with tretinoin than with adapalene.

Conclusions:   Adapalene gel, 0.1%showed a better cutaneous tolerability and safety profile than tretinoin gel, 0.025% for all four ethnic groups. An interethnic difference in the irritation susceptibility could be shown.
FS03.7 Tape stripping procedure: influence of anatomic site, application pressure, duration and removal
Authors: Löffler Harald , Dreher F , Maibach HI
Published: August 2010

Background and Objectives:  Tape stripping is a common method for investigating stratum corneum (SC) physiology as well as bioavailability and bioequivalence of topical drugs. However, little is known concerning the influence of procedures (anatomic site, pressure, pressure duration, tape removal rate) inherent in each stripping protocol.

Methods:  Tape stripping was performed using tapes on the forearm, forehead and back. On the forearm different pressures (165 and 330 g cm−2), durations of pressure (2s and 10s), and removal rate (slow and rapid removal) was performed. Changes in skin physiology were evaluated by measurement of transepidermal water loss (TEWL) and hydration.

Results:  A significant influence of all parameters on the TEWL‐increase as a function of tape strip number was observed. The fastest increase was demonstrated on the forehead, followed by the back and, lastly, the forearm. Rapid removal produced a protracted increase in comparison to the slow removal. 10s pressure induced a faster increase of TEWL than 2s pressure. Likewise, the 330 g cm−2 pressure induced an earlier increase than the 165 g cm−2. Skin hydration was not influenced by the variables tested.

Conclusion:  Tape stripping results are influenced dramatically by all investigated parameters. A standardized procedure is necessary for a comparable study design. A dynamic SC stress test to more closely investigate SC cohesion is proposed based on the present observations.
FS04.8 The U.S. Cosmetic Ingredient Review: process and products
Authors: McEwen Gerald
Published: August 2010

The U.S. Cosmetic Ingredient Review (CIR) program has evaluated safety in use data on approximately 1300 ingredient since 1976. The review process, which relies on open public meetings and the active participation of the public, the U.S. Food and Drug Administration, and the cosmetics and chemical industries, has identified many cosmetic ingredients that should only be used under limited conditions. Adhearance to the limitations on use in the conclusions of the CIR reports, in the U.S., appears to have limited exposure and patient population sensitivity to some widely used cosmetic ingredients that have produced high rates of reactions in Europe. The advantages of the CIR process for the public and the medical community; the deliberations leading to the use limitations on two example ingredients, and sources for attendees to locate CIR Reports and conclusions will be presented.
FC01.1 Occupational contact dermatitis from methylisothiazolinone
Authors: Isaksson Marléne , Gruvberger B , Bruze M
Published: August 2010

Background:  The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) has been used extensively in various products since the 1980s. Recently, a biocide containing only MI and not MCI has been launched on the Swedish market for use in industrial settings, paints and glues.

Objectives:  To describe sensitization to the unchlorinated isothiazolinone 2‐methyl‐4‐isothiazolin‐3‐one (MI) in 2 workers, a technician after a chemical burn and a painter, both exposed to a preservative containing MI. Methods: Patch testing with serial dilutions of MCI/MI, MCI, MI, 2‐n‐octyl‐4‐isothiazolin‐3‐one (OIT) and a commercial preservative containing MI in the 2 workers.

Results:  The patients reacted positively to MCI/MI and to the separate active ingredients (MCI, MI). The patch test reactivity to MI was higher than the reactivity to MCI, which is a reversed pattern to what is usually seen in patients sensitized to MCI/MI. Both patients also had positive test reactions to OIT.

Conclusion:  MI may sensitize on it’s own, and in patients allergic to MI, cross‐reactions are also seen to MCI.
FC01.3 The Finnish Machinist Study – new results
Authors: Suuronen Katri Maria , Makela EA , Alanko K , Susitaival P , Luukkonen R , Tuomi T , Jolanki R
Published: August 2010

Objective:  The aim of the study was to get information on the chemical exposure and the prevalence of skin and respiratory symptoms among Finnish machinists.

Methods:  A cross‐sectional study was carried out on a population of 961 Finnish machinists. Skin and respiratory symptoms, atopy, exposure at work, etc. were inquired by a telephone interview. Working conditions were assessed and the data were combined with the data from the interview. Technical office personnel in the same companies were used as a control group.

Results:  A third of the interviewees reported prolonged rhinitis. A fifth had continuous or relapsing hand or forearm dermatitis, cough, phlegm production or eye symptoms. Wheezing, dyspnea, laryngeal symptoms, or relapsing low fever were reported by 8–2%. 5% reported having asthma. In total, 35% of the machinists considered the skin or respiratory symptoms as work‐related.

Conclusion:  This study shows that work‐related skin and respiratory symptoms are common among machinists in Finland. Those reporting symptoms have been examined in more detail at FIOH. New results of the statistical analysis and medical investigations will be presented.
FC01.5 Occupationally based type IV hypersensitivity in dental professionals
Authors: Hogan Daniel , Hamman C , Rodgers P , Siew C
Published: August 2010

The study’s objective was to determine the frequency of type IV hypersensitivity in dentists, dental hygienists, dental assistants or dental students attending annual Health Screenings at the 1997, 1998, 2000, 2002 and 2003 American Dental Association (ADA) Annual Sessions held in various major American cities. We patch tested: 1997–59 dentists and 21 non‐dentists; 1998–40 and 13; 2000–21 and 7; 2002–33 and 6; 2003–25 and 4. We patch‐tested participants using T.R.U.E. Test panels and/or Finn chambers containing Trolab allergens. Due to the time constraints of the ADA meeting dates, patches were placed for 48 hours and skin reactions read at 0 and/or 24 hours after patch removal. Overall, 49% of patch‐testing participants tested positive to at least one allergen. The most prominent dental‐related allergens were rubber compounding agents and methacrylates. Positive reactions in the former were due to thiurams (10%) and carbamates (12%). Positive reactions to acrylates were most frequent to ethylene glycol dimethacrylate. All acrylate allergies were in dentists; typically theses dentists had chronic fingertip dermatitis. Preservative allergies were also common, including thimerosal (31%) and benzoyl peroxide (11%). Glutaraldehyde and formaldehyde each produced 3.5% of positive reactions with no evidence of cross‐reactivity Common allergies that may be occupationally related were nickel (20%) in tools and orthodontic appliances and fragrance mix (16%) containing eugenol and cinnamates. These results indicate that allergies other than type I hypersensitivity to NRL proteins occur in dental professionals with current or past dermatitis.
FS05.6 New standardized allergens: the experimental TRUE Test® Panel
Authors: Hoeck Ulla , Lehmann S , Bjarnoe H , Meldgaard J , Laugesen L Holm
Published: August 2010

TRUE Test® is the only standardized patch test system for the diagnosis of allergic contact dermatitis based on 24 fully stable and reproducible formulations. New standardized patches are in process of development for TRUE Test® Panel 3. The allergens chosen are well‐known sensitizers and include preservatives, steroids, metals and others. 14 new patches are included in an Experimental panel which is tested in several European clinics. 11 of the patches contain new allergens while 3 patches consist of improved TRUE Test® formulations with Neomycine sulphate, Fragrance mix and Potassium dichromate. A number of the patches from the Experimental panel will be selected for TRUE Test® Panel 3. The overall purpose with pharmaceutical development of patch test materials for TRUE Test® is to obtain a precise dose, bioavailability and stability in every single patch. The patches have to be chemically stable for at least 2 years at refrigerated temperature. The selected preservatives on the Experimental panel are Methyldibromoglutaronitrile, Germall 115, Germall II and Bronopol. All 4 patches have proven to be difficult to stabilize because of the natural reactivity of the allergenic substances. The steroids chosen are Budesonide, Tixocortol‐21‐pivalate and Hydrocortisone‐17‐butyrate. All 3 steroids are stable in TRUE Test® formulations. Other allergens on the Experimental panel are Ammoniated Mercury, Goldsodiumthiosulphate, Parthenolide and Disperse blue 106, where the latter consists of a complex mixture. Chemical stabilization of the patches as well as clinical studies will be presented.
FS07.1 A survey of occupational hand eczema in Denmark
Authors: Skoet Rikke , Mathiesen B , Johansen J Duus , Olsen J , Agner T
Published: August 2010

Background:  The need for prevention to reduce the number of occupational hand eczema is high. Occupational hand eczema is the most frequently recognised work‐related disease in Denmark. Previous findings have shown that almost half of all cases develop a chronic condition with persistent dermatitis, and the annual cost to society is immense.

Aims:  The aim of this study was to survey the trends and development of occupational hand eczema in Denmark and thereby help to ensure future successful prevention of chronic disabling occupational hand eczema.

Methods:  758 patients with recognised occupational hand eczema were included prospectively in the period October 2001‐ November 2002. Data on diagnoses, disease duration, severity, absence from work and occupation was obtained from The Danish National Board of Industrial Injuries and an additional questionnaire was administered by mail.

Results:  621 patients answered the questionnaire (response rate 82%). Irritant contact dermatitis was the most frequent diagnosis and the female/male ratio was 2:1. High prevalence was found in particularly wet occupations. 19 per cent had sick leave more than 5 weeks per year and the mean disease duration was 4.8 years (median 2.1 years). 68.2% had chronic changes.

Conclusion:  The results showed a marked gender difference in the pattern of diagnosis and occupation. The impact of occupational hand eczema is still high with prolonged absence from work and a high percentage of chronic disease. The results of the study give important suggestions for future preventive strategies for health authorities.
FS07.3 Skin sensitisation thresholds: a legislative perspective
Authors: Basketter David
Published: August 2010

Current EU legislation for skin sensitisers is a simple device, which crudely distinguishes between chemicals which possess significant sensitising potential and those which do not. Where a chemical is clearly positive in predictive tests or by human experience, it is classified and labelled R43: May cause sensitisation by skin contact. Use of such a chemical at ?1% in products would require appropriate labelling. Additional labelling requirements in relation to elicitation also exist, or are planned, which variously impact cosmetics, detergents and a wide range of other consumer products. Improvements to this basic system are presently under consideration and largely are focused on a consideration of options to categorise sensitising chemicals according to their potency. Central to this activity has been the demonstration of the utility of the local lymph node assay (LLNA) as a predictor of the human potency of skin sensitisers. Arising from this, both industry (ECETOC) and regulatory bodies in the EU have taken proactive steps to initiate improvement in the existing legislation. However, at a wider regulatory level, the debate currently centres on whether formal validation processes are required to progress potency categorisation at the OECD level, and if so how many categories and with what threshold levels. Political niceties here represent a barrier to progressing improvements in human health protection.
FS07.5 Sensitive skin: What is it? What strategies meet its challenge?
Authors: Engasser Patricia
Published: August 2010

Sensitive skin is a neolgism used by consumers for a self‐perceived intolerance to environmental factors including skin care products and cosmetics. Consumer complaints focused industry on this concept and dermatology has gradually recognized it also. Identified associations range from endogenous skin disorders to irritant (including sensory) and allergic reactions. Impaired barrier function has been implicated in some instances. The consumer with sensitive skin frequently experiences adverse reactions to cosmetics, but what information is available to help them choose products they can tolerate? To answer this question, a survey is being conducted among cosmetic manufacturers inquiring if they market products for consumers with sensitive skin. They are asked what steps they take in the design of these products to insure tolerance, and what testing is done on these products that may be unique. Does the post‐marketing data show these products fulfilled their goal and these cosmetics are well tolerated by this group? The manufacturers are surveyed as to what precautions they regard as important for ‘sensitive skin’ individuals in choosing and using cosmetics. The results of the survey are incorporated into patient recommendations.
FS08.3 Health‐related quality of life and hand eczema
Authors: Meding Birgitta , Wallenhammar L‐M , Lindberg M , Nyfjäll M
Published: August 2010

Aims:  The aims were to study health‐related quality of life (HRQL) in patients with hand eczema, and to compare two different instruments for assessment of HRQL.

Methods:  100 consecutive hand eczema patients (51 females and 49 males) at an occupational dermatology clinic completed the generic questionnaire Short Form‐36 (SF‐36), and the dermatology specific Dermatology Life Quality Index (DLQI). To compare the instruments factor analysis, with a polychoric correlation matrix as input, was performed, thus taking the ordinal aspect of the data into account.

Results:  HRQL was affected by hand eczema, measured with both SF‐36 and DLQI. The mean (SD) sum scores of DLQI was 7.4 (5.8), no difference between genders. However, the SF‐36 showed more impaired HRQL for females than for males in the mental health dimension. There was a high correlation between the instruments for physical health, but lower for mental health.

Conclusions:  Hand eczema has an impact on HRQL, and both SF‐36 and DLQI are suitable instruments. Our conclusion from the factor analysis is that the SF‐36 measures mental health better than the DLQI. The choice of instrument to be used in a specific study depends on the purpose of the study. A generic instrument has the advantage of making comparisons with other diseases possible. The SF‐36 also appears suitable for use in hand eczema studies where gender differences in HRQL are of interest.
FS09.6 Capsaicin contact dermatitis
Authors: Giménez‐Arnau Ana , Gilaberte M , Serra‐Baldrich E , Pujol‐Vallverdú RM
Published: August 2010

Capsicum peppers are widespread both in and out the kitchen. “Human hand” is a contact dermatitis resulting from the direct handling of peppers. Capsaicin also is found in topical agents for treatment of postherpetic neuralgia, diabetic neuropathy and arthritis. The oleoresin of capsicum is considered a powerfull irritant capable to induce irritant contact dermatitis and non‐immunological contact urticaria. A 81 year‐old man with a severe itchy macular and papular rash induced by Capsidol® initially located over the shoulder and sudden spread over the thorax is presented. A dense dermal mononuclear cell infiltrate and spongiosis suggested the diagnosis of contact dermatitis. Negative open tests and a positive patch test reaction (++ 96 hours) using the trade cream Capsidol®(capsaicin 5%) led us to contact with the Pharmaceutical Company Viñas. They provided us the components of the cream: capsaicin, isopropyl myristate, estearic acid (DERVACID 3148), propylene glycol, glycerin monomyristate (ESTOL3650GMM), AMPHISOL K, Cetyl alcohol (NACOL 16–85), benzyl alcohol, diazolidinyl urea (GERMALL II), p‐hydroxybenzoate–methylsodium (NIPAGIN M sódic), p‐hydroxybenzoate propyl (NIPASOL M). Capsaicin in benzyl alcohol at 0,075% was open tested with negative results. Only patch test with capsaicin was positive (++) at 48/96 hours and the excipient components at the appropiate concentrations were all negative. Patch test biopsy showed an eczematous pattern. Twenty controls showed negative results. This case is probably an allergic reaction but shows how still remains difficult to distinguish among allergic and irritative cutaneous reactions.
FS09.8 Drug‐induced Baboon syndrome: SDRIFE at strife with systemic contact dermatitis?
Authors: Bircher Andreas , Häusermann P , Harr T , Lerch M
Published: August 2010

The term baboon syndrome was introduced 20 years ago. It was proposed for a particular eruption mimicking the red gluteal area of the baboon after systemic exposure either to the contact allergens nickel and mercury or to oral ampicillin. Previously this phenomen was e.g. termed flexural exanthema to mercury. Since then similar incidences have been reported after systemic exposure to betalactam antibiotics and other drugs, sometimes under different terms. Clinically sharp demarcation of a V‐shaped erythema is present in inguinal/genital and gluteal/perianal areas. Additionally papules, vesicles and hemorrhagic lesion may be found. In most patients presence of exanthema in other anatomical flexural regions (axilla, elbow, knee, ventral neck) has been identified. However, involvement of the plantar/palmar regions, face and mucosal sites has not been documented. Typically blood tests are normal and systemic symptoms are absent. Histological results vary but a predominance of superficial perivascular infiltrate with mononuclear cells has been reported. Occasional positive patch tests or stimulation of lymphocytes in the LTT may be suggestive for a type IV allergic reaction. Since the drug‐related baboon syndrome shows clinically and histologically different findings to systemic contact dermatitis and acute generalized exanthematous pustulosis (AGEP), it should be seen as a separate entity. The mainstay for the diagnosis of systemic contact dermatitis requires contact sensitization and elicitation by a contact allergen. In contrast in the baboon syndrome and AGEP history for sensitization is often negative, although sometimes positive patch and LTT results can be found. AGEP, on the other hand, requires a distinct score including systemic signs and leucocytosis. In all three symptoms typically occur within 1 to 2 days. The term baboon syndrome does not reflect the whole range of symptoms and signs. And, although it is easily remembered, the comparison to an animal may be insulting. Therefore, we suggest that drug‐induced baboon syndrome should be separated from the contact allergen‐induced form, and should be recognized as a separate entity within the spectrum of drug eruptions. For this reason we propose the acronym SDRIFE (symmetrical drug related intertriginous flexural exanthema). This refers to the distinctive clinical pattern of this drug eruption without implicating any pathomechanism, which has not been clearly elucidated. The following criteria are proposed: 1) Exposure to a systemically administered drug, 2) Sharply demarcated erythema of the gluteal/perianal area and/or V‐shaped erythema of the inguinal/perigenital area, 3) Involvement of at least one other intertriginous/flexural fold, 4) Bilaterally or symmetrically affected areas, and 5) Absence of systemic symptoms and signs.
FS10.5 Occupational allergic contact dermatitis from isothiazolines
Authors: Rustemeyer Thomas , Bruynzeel D
Published: August 2010

Several employees of a construction adhesives‐producing plant developed skin problems. Within few weeks, 4 out of 12 workers got itchy eczematous lesions at the face, lower arms and hands. All of them reported on a work‐relationship with recoveries during holidays and sick‐leaves. This prompted the responsible occupational physician to contact our occupational dermatological clinic for further examination. First, we got an overview of the chemicals and pathways used for the production of the highly specialized plastic products. After working place examination, extended medical histories of the employees were taken. All affected workers were patch tested with the European Standard series, epoxy resins, preservatives and own working materials. After an occlusion time of 48 hours, skin tests were read at day 2 and 4 according to the ICDRG guidelines. Examination of the plant revealed that all affected workers were employed at the blending unit where, in particular dusty, ingredients were mixed. Few months prior to the development of skin problems, 2‐n‐octyl‐4‐isothiazolin‐3‐one (OIT) preservative had been introduced in the production pathway in partial exchange for chloro/methylisothiazolin‐3‐one (CIT/MIT). Personal protection measures were rarely provided.

All 4 tested workers were found patch test positive to CIT/MIT, 3/3 positive to OIT and 1/3 positive to 1,2‐benzisothiazoloin‐3‐one (BIT) and methyldibromoglutaronitril. Industrial usage of preservatives can result in frequent sensitisation of exposed employees. Adequate protection and prevention advices are required. This study highlights the need for extended (occupational) medical histories and working place examination to identify individual risk factors and to trace potential hazards at the working place.
FS10.8 Prevention of occupational contact dermatitis
Authors: Diepgen Thomas L
Published: August 2010

Occupational contact dermatitis (OCD) take the first rank of all occupational diseases in many countries. The incidence rate is believed to be around 0.5 to 1.9 cases per 1000 full‐time workers per year. However, the true incidence of work‐related hand eczema (mostly irritant hand eczema) is highly underreported. The development of OCD is determined by a combination of individual susceptibility (endogenous factors) and exposure characteristics (exogenous factors). Skin contact with irritants and/or allergens is a necessary condition of contact dermatitis and the probability and severity of a reaction depend on the type and intensity of exposure. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. Occupational Contact Dermatitis (OCD) has become an issue of increasing importance world‐wide, not only due to cost‐ intensification for employers but also due to impairment of employees’ quality of life. This lecture summarizes some important causes of occupational contact dermatitis in Europe, demonstrates possibilities of prevention based on recently conducted epidemiological studies, and ends by highlighting important future health service and population research issues. The following questions will be discussed:

 • How common are OCD in different industries and what is the extent of underestimation

 • What kind of regulations are needed to prevent OCD

 • How to deal with high risk individuals (atopics)

Research into the causes and prevention of occupational contact dermatitis using an epidemiological approach is still in its infancy, yet already there are some pointers that OCD can be prevented effectively.
FS11.6 Contact dermatitis to Iris in a florist
Authors: Dejobert Yves , Arzur L , Thellart A S , Martin P , Torck M , Frimat P , Piette F , Thomas P
Published: August 2010

Objective:  To detect a possible allergen in a florist with occupational dermatitis. Patient and methods: a 27‐year‐old atopic female working in a greenhouse since 10 years presented with a 3 months history of severe eczema involving hands, face, eyelids and neck requiring a stop of the work. Tests were performed with European standard series (Trolab®), additional series, plant series, (Chemotechnique Diagnostics®) and flowers. Readings were performed at D2 and D3 according ICDRG criteria. Results: positive patch tests were parabens +/+ nickel sulphate ++/++ cobalt chloride −/++ palladium chloride ++/++ thiomersal ++/++, Iris petal ++/+. Then various colours of Iris were tested and pale blue, yellow and white petals were positive ++/++ but purple blue petal was negative. The proximal yellow part of purple blue petal and orange part of yellow petal were also positive ++/++. The leaf and pistil of Iris were negative. One control with a white Iris petal was negative. Then the patient presented flare up of her dermatitis in the presence of Iris, at home, without handling them, that could make suspect an airborne contact dermatitis. Even after examination by a botanist, the precise identificaton of these Iris was not possible. Positive patch tests to unspecified Iris (petal and leaf) have already been reported in a florist who was allergic to safflower (Van der Willigen A.H. and al, Contact Dermatitis, 1987, 17,184). Conclusion: this case could evoke the responsibility of anthocyans, which play a role in the colours, but essential oils or other components are also possible responsibles.
FS12.6 Sensitizing capacity and cross‐reactivity of phenyl glycidyl ether
Authors: Pontén Ann , Zimerson E , Bruze M
Published: August 2010

Phenyl glycidyl ether (PGE) is an aromatic reactive diluent used in epoxy resin systems. The sensitizing capacity of PGE, as well as the cross‐reactivity between PGE and the most important contact allergens in epoxy resins based on bisphenol A and bisphenol F, i.e. diglycidyl ether of bisphenol A (DGEBA) and the 3 isomers of diglycidyl ether of bisphenol F (p,p′‐DGEBF, o,p′‐DGEBF, and o,o′‐DGEBF), were investigated in a guinea pig maximization test (GPMT). Statistical significance was calculated with one‐sided Fisher’s exact test. PGE was found to be a strong sensitizer (24/24 sensitized animals, p < 0.001). Induction with DGEBA resulted in a statistically significant number of animals reacting to PGE (p = 0.006), but when induced with PGE, the animals did not react significantly to DGEBA. When induced with PGE, significant numbers of animals reacted to p,p′‐DGEBF (13/24 animals, p = 0.0011) and o,p′‐DGEBF (11/24 animals, p = 0.004). Induction with p,p′‐DGEBF and o,p′‐DGEBF resulted in a high number of reacting animals when tested with PGE (23/24 animals, p < 0.001 for both isomers). No statistically significant cross‐reactivity between PGE and o,o′‐DGEBF was found.

Conclusion:
According to our results in the GPMT, sensitization to DGEBA, which is the main constituent in the most common epoxy resin, may result in contact allergy to PGE, whereas sensitization to PGE seldom causes contact allergy to DGEBA. Sensitization to PGE may cause contact allergy to epoxy resins based on bisphenol F.
FC03.3 Identification of subjects with atopic dermatitis in questionnaire studies
Authors: Frydendall Jepsen Karen , Flyvholm M‐A , Mygind K
Published: August 2010

The performances of three different questions from The Nordic Occupational Skin Questionnaire (NOSQ‐2002) were compared with respect to their ability to identify subjects with atopic dermatitis. NOSQ‐2002 was used in an intervention study on the prevention of work related skin diseases among gut cleaners. The questions were: “Have you ever had an itchy rash that has been coming and going for at least 6 months, and at sometime has affected skin creases?”(A1), “Have you ever had eczema on the fronts of the elbow or behind the knees?”(S5a), and “Have you ever had “childhood” eczema?”(S5b). Question A1 is the single UK‐working party question on atopic dermatitis; questions S5a & S5b are national atopic dermatitis questions previously used in different Nordic studies. A total of 255 of 622 (41%) gut cleaners answered “yes” to question A1. Questions S5a and S5b gave rise to 14% and 5% positive answers, respectively. The high frequency of positive answers to question A1 could be due to the occupational exposure of gut cleaners. Their working environment is wet and often involves both forearms and hands, hence often leading to eczema of elbow creases. In conclusion, compared to other Danish studies the UK question seems to lead to over‐reporting. Question S5a seems to give a reliable frequency of atopic dermatitis in adult populations at risk for work‐related skin diseases.
FC03.5 Characteristics of wet work in nurses
Authors: Jungbauer Frank , Steenstra F , Coenraads PJ
Published: August 2010

Background/objectives:  The health care sector is known for its high prevalence of hand dermatitis, mainly because of the high exposure to wet work in nursing activities. Wet work can be activities with wet skin and activities with glove use (skin occlusion). A prevention program to reduce wet work exposure should be based on knowledge about activities that are components of wet work. We observed the frequency and duration of skin exposures to irritants with nursing activities.

Method:  Duration and frequency wet work activities were assessed in parts of the health care sector: 53 randomly chosen nurses were observed during their morning shift. Hand skin exposure to water, soap/detergents and occlusion by using gloves were recorded during 112 different 8‐hour morning shifts.

Results:  In nursing wet work activities make up 9%(dialysis ward), 16%(regular ward) and 24%(I.C.‐unit) of the duration of one shift. On a regular ward duration of wet work is mainly divided into 34% patient washing, 31% glove use and 26% hand washing. These main wet work activities have a short exposure cycle of 1.4–3.6 minutes. Hand washing, excluding the use of hand alcohol, and patient washing (without gloves) form both one third of the frequency of wet work activities.

Conclusions:  Wet work activities take up a substantial portion of nursing activities and are characterised by frequent short‐term exposures. Effective prevention programs on reducing the risk of hand dermatitis in nursing should primarily focus on the high frequencies of hand washing and patient washing. Using gloves in the procedure of patient washing will reduce the frequency of exposure to water and soap with 24%, at the expense of increasing exposure to occlusion by these gloves.
FC04.2 Sensitization to propolis in 1255 children undergoing patch testing
Authors: Giusti Francesca , Miglietta R , Seidenari S
Published: August 2010

Propolis is an ancient remedy well known for its beneficial properties. The aim of our study was to estimate the frequency of sensitization to propolis in our pediatric patch test population. 1255 children, 583 boys and 672 girls, aged from 7 months to 12 years, were patch tested for suspected allergic contact dermatitis with our pediatric series of 30 allergens including propolis. Out of these, 37% were affected by atopic dermatitis. Among the 1255 children tested, 113 (9%), 60 boys and 53 girls reacted to propolis. In subjects reacting to propolis the dermatitis involved the face in 4% of cases, the trunk in 3%, the hands in 2,2%, and the flexural skin folds of the limbs in 1,7%. The wider and wider use of propolis in “natural products” and biocosmetics, even in the pediatric age, could explain the high frequency of positive patch test responses to propolis we observed.