bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between size of test chamber and patch test reaction: a statistical reanalysis
Authors: Gefeller Olaf , Pfahlberg Annette , Geier Johannes , Brasch Jochen , Uter Wolfgang
Published: February 2007

A recent study by Brasch and co‐workers reported on the association between size of test chamber and patch test reaction. The investigators interpreted their data on 495 patients as having conclusively shown that standard preparations of fragrance mix, wool wax alcohols, Kathon CG and formaldehyde led to more positive test reactions when large Finn Chambers were used for patch testing. We have scrutinized the statistical aspects of this study and conclude that the authors should have adopted a statistical approach suitable to analyse dependent samples. After explaining the correct methodological way of dealing with quadratic contingency tables formed by 2 dependent samples, we reanalyze the data accordingly and compare the results to those of the original paper. Based on this reanalysis, the conclusions are more complex: the reaction pattern for the fragrance mix and wool wax alcohols is significantly different between small and large test chambers; however, this discrepancy arises primarily from changing weak positive reactions with small chambers to strong positive reactions with large chambers. For formaldehyde, no relationship between chamber size and patch test reaction was found in the data, while for Kathon CG, statistical evidence is borderline that more positive test reactions are yielded by large test chambers than by small ones.
Structure‐activity relationships in allergic contact dermatitis induced by methacrylates
Authors: Kanazawa Yukiko , Yoshida Takemi , Kojima Kohichi
Published: February 2007

Some methacrylates are known to be strong contact sensitizers. To determine the effect of side‐chain length on sensitizing potential, we examined 11 derivatives with linear side chains from C1 to C18 in an experimental sensitization test in guinea pigs. The results showed an increase in the sensitizing potential with increasing length of the alkyl side chain from Q to C12. The C12 derivative, lauryl methacrylate, showed the strongest sensitizing potential. Further elongation of the alkyl side chain of methacrylates resulted in a decrease in the potential. With respect to the side‐chain‐length‐dependent sensitizing potential, the present results correspond well with the findings obtained with other compounds like primin, catechols, phenols, hydroquinones, and gallates.
Influence of patch‐test application tape on reactions to sodium dodecyl sulfate
Authors: Fischer Torkel , Dahlen Åsa , Bjarnason Bolli
Published: February 2007

There remains much room for improvement in the accuracy of the patch test procedure. There has been a lack of knowledge regarding the possible relationship between the intensity of test reactions and the quality of the tape used to apply patch tests. Using different brands of tape, patches coated with 2 mg/cm2 sodium dodecyl sulfate (SLS) were applied for 24 h to the backs of 10 volunteers. The tape specimens varied in terms of manufacture, elasticity, adhesive strength, and water permeability. The intensity of patch test reactions, evaluated visually and objectively with both the high resolution laser Doppler perfusion imaging technique (HR‐LDPI) and transepidermal water loss measurements (TEWL), varied significantly with the different brands of tape. Observed variations in the intensity of reactions to the patch tests could not be explained by any of the 4 tape parameters investigated. In order to attain optimal test quality in the future, both the tape and patches used in the testing system should be standardized and clearly labelled.
In vitro testing of tensides employing monolayer cultures: a comparison with results of patch tests on human volunteers
Authors: Benassi Luisa , Bertazzoni Giorgia , Seidenari Stefania
Published: February 2007

Evaluation of the irritant potential of new products or ingredients prior to human testing is generally performed in vivo on animals. However, according to the 6th amendment and following updates of the European Community directive on cosmetic products (93/35/EEC), animal testing will be banned when suitable substitutes will be available. To know whether in vitro tests for assessment of skin irritancy provide results approaching human conditions, comparisons have to be made between data deriving from in vitro tests and skin response in humans. The aim of our study was to assess the validity of the monolayer culture system of normal human keratinocytes as a model for the evaluation of the irritant effects of detergents, by comparing in vitro cell culture data to in vivo acute skin irritancy effects of cocamidopropyl betaine (CAPB), an amphoteric compound, Tween 20 (TW20) (polysorbate 20) and Tween 80 (TW80) (polysorbate 80), representing nonionic compounds, applied to the skin of 24 healthy volunteers at a concentration similar to that employed in commercial products. As parameters for cytotoxicity, cell proliferation, cell membrane integrity and cell metabolism were assessed by cell counts, thymidine incorporation, MTT conversion, and Neutral Red uptake. In order to increase the sensitivity of the in vivo evaluation, bioengineering methods for assessment of the effects of test products on the skin were employed. Whereas all 4 in vitro methods ranked the tensides according to their toxicity in the following order: CAPB>SLS>TW20>TW80, both in vivo methods agreed in identifying SLS as the most irritating substance. Moreover, as compared with the irritation potential on human skin, all 4 in vitro tests overestimated the toxicity of CAPB. This suggests that the keratinocyte monolayer cell culture technique cannot directly replace in vivo methods, and that data obtained by this method should be interpreted cautiously.
Delayed contact hypersensitivity to non‐steroidal anti‐inflammatory drugs
Authors: Gniazdowska Beata , Ruëff Franziska , Przybilla Bernhard
Published: February 2007

Several non‐steroidal anti‐inflammatory drugs (NSAIDs) are available for topical treatment of acute soft tissue trauma or degenerative musculoskeletal disorders; the NSAID bufexamac is mainly used for therapy of chronic inflammatory skin diseases. In order to assess the occurrence of contact allergy to NSAIDs in 371 consecutive patients presenting for diagnosis of presumed contact allergy, patch tests were performed with a standard series and additionally with a series of NSAIDs, comprising acetylsalicylic acid, bufexamac, diclofenac, etofenamate, felbinac, flufenamic acid, ibuprofen, indomethacin, and piroxicam. 17 individuals (4.6%) exhibited delayed hypersensitivity to one of the NSAID preparations: 12 patients (3.2%) had patch test reactions to bufexamac, 2 (0.5%) to etofenamate, 2 (0.5%) to indomethacin, and 1 patient (0.3%) to flufenamic acid. These patch test results corresponded well to the individual history in 11 individuals (including 10 patients with reactions to bufexamac), and in 2 patients the clinical relevance of the reactions was probable. In view of the high frequency of allergic contact reactions to bufexamac, we propose to test this drug particularly in patients with atopic eczema or other chronic eczematous diseases.
Contact allergy to calcipotriol does exist
Authors: Frosch Peter J. , Rustemeyer Thomas
Published: February 2007

A 64‐year‐old woman developed an itchy papulovesicular dermatitis at the periphery of psoriatic plaques on the lower legs after the daily application of calcipotriol ointment (Psorcutan® Salbe) for 2 weeks. She had used the same ointment for 4 weeks 6 months before. Patch testing revealed strongly positive reactions to the marketed product and to the active ingredient calcipotriol in a concentration series (2.0, 10.0 and 50.0 μg/ml in isopropyl alcohol). A repeated open application test (ROAT) on the forearms showed a vesicular dermatitis after 4 days on the side that received the calcipotriol ointment, whereas the control with the placebo ointment remained completely negative. Histologic examination of the ++ patch test reaction was in line with the picture of contact allergy. Retesting after 6 months confirmed the hyper sensitivity, with a positive reaction even at 0.4 μg/ml. For comparison, the ROAT with calcipotriol ointment was performed for 2 weeks on both forearms of 15 volunteers never exposed to calcipotriol before. Only 2 subjects developed a slight reaction on days 5 and 11, respectively. Based on this case and on previous reports in the literature, calcipotriol must now be regarded as both a contact allergen and an irritant. For patch testing, a concentration of 2 μg/ml in isopropyl alcohol is the most suitable. If the reaction is only weakly positive and not reproducible after some time, it might be of the irritant type. In unclear cases, a ROAT should be performed. A severe papulovesicular dermatitis within 1 week will confirm the presence of contact allergy.
Patch testing with natural rubber latex
Authors: Wakelin S. H. , Jenkins R. E. , Rycroft R. J. G. , McFadden J. P. , White I. R.
Published: February 2007

Immediate‐type hypersensitivity to natural rubber latex (NRL) may be associated with chronic eczema, and it has recently been suggested that NRL should be used as a patch‐test allergen. However, a standardized preparation does not exist, and experience of patch testing with this substance is extremely limited. The aims of our study were to investigate the patch‐test response to different preparations of NRL amongst patients with suspected contact dermatitis. 608 patients were patch tested with a latex series which included wet and dry preparations of undiluted high‐ammonia (HA) NRL and low‐ammonia thiuram‐containing NRL. Cutaneous reactions to 1 or more NRL patches were noted in 24 patients. None of these were strong allergic reactions (> +), and in 15 patients, the responses were only doubtful (?+). Positive patch tests were observed in 9 patients, and were probably due to concurrent thiuram allergy in 6. In the remaining 3 patients, the reactions had subsided by the 2nd reading and may have represented false positives. None of the patients showed consistent allergic reactions to all NRL patches, and most of the doubtful readings had resolved within 4 days, suggesting that they were irritant rather than weak allergic responses. Patch testing to dry HA latex was associated with the least number of reactions. We conclude that allergic patch test reactions to NRL are uncommon, and as reactions are usually weak and difficult to interpret, we suggest that patch testing with NRL should remain experimental until further studies have been undertaken.
Sensitization to thimerosal in atopic children
Authors: Patrizi Annalisa , Rizzoli Laura , Vincenzi Colombina , Trevisi Pompilio , Tosti Antonella
Published: February 2007

Thimerosal is an organic mercurial compound widely used as a preservative in vaccines, eyedrops, and contact lens cleaning and storage solutions. 5 infants, 2 female and 3 male, ranging in age from 7 to 28 months and affected by atopic dermatitis (AD) diagnosed according to the Hanifin and Rajka criteria, experienced an exacerbation of their clinical condition 2–10 days after mandatory vaccinations with vaccines containing thimerosal. Cutaneous lesions of nummular eczema appeared on the trunk, limbs and face. All patients were patch tested with serial dilutions of thimerosal in petrolatum. A positive patch test reaction to thimerosal 0.1% pet. was observed in all 5 children. 3 of them also showed a positive reaction at 0.01% and 0.05% pet. Despite their thimerosal‐hypersensitivity, all children completed the entire series of mandatory vaccinations, care being taken to use different needles for injection and aspiration of the vaccine. The 2‐year follow‐up did not reveal other episodes of exacerbation of the AD after vaccination. The present study confirms the high frequency of sensitization to thimerosal in atopic children and suggests that vaccination can cause clinical symptoms in sensitized children. Nevertheless, sensitization to thimerosal does not prevent children from continuing with mandatory vaccinations.
Biophysical characterization of skin damage and recovery after exposure to different surfactants
Authors: Bárány Ebba , Lindberg Magnus , Lodén Marie
Published: February 2007

The majority of adverse skin reactions to personal‐care products are presumed to be caused by irritant substances, like surfactants. In this study, different aspects of the irritant reaction after a single exposure to 8 surfactants were characterized during 2 weeks. Solutions of 2% sodium lauryl sulfate, 5% sodium C12‐15 pareth sulfate, 5% sodium cocoyl isethionate, 10% disodium laureth sulfosuccinate, 10% sodium cocoamphoacetate, 10% cocamide DEA, 10% cocamidopropyl betaine and 10% lauryl glucoside, respectively, were applied to the forearm of 12 volunteers. Clinical assessment, an evaporimeter, a laser Doppler flowmeter and a corneometer were used for evaluation. The surfactants induced different degrees of irritation. Erythema, transepidermal water loss and skin blood flow exhibited a similar time course, which seemed to be inversely related to the delayed scaling and reduced skin capacitance. The mechanism of the damaging effect of the surfactants seems to be similar, although some minor differences were noted.
Increase in occupational skin diseases of dental personnel
Authors: Kanerva Lasse , Lahtinen Aira , Toikkanen Jouni , Forss Helena , Estlander Tuula , Susitaival Pàivikki , Jolanki Rlitta
Published: February 2007

Occupational diseases of dentists and dental nurses were compiled from the Finnish Register of Occupational Diseases. The cases were recorded during 3 3‐year observation periods, namely 1982–1984, 1986–1988, and 1992–1994 (i.e., 9 observation years). The relative risk of developing occupational allergic contact dermatitis in different occupations was calculated from the statistics of the years 1986–1991, and was expressed as the age‐standardized rate ratio (SRR). During the 9 observation years, the majority of registered occupational diseases of dentists and dental nurses were skin diseases (221/312; 70.8%), followed by occupational repetitive strain injuries (61/312; 19.6%) and occupational respiratory diseases (20/312; 6.4%). The incidence rate (IR) for allergic contact dermatoses/10,000 workers (contact urticaria included) increased from 26 (95% confidence interval (CI) 16–40) in 1982–1984 to 79 (95% CI 64–97) in 1992–1994. The IR/10 000 of allergic contact dermatoses increased especially for dentists, from 5.4 (95% CI 0.7–19) in 1982 to 67 (95% CI 45–95) in 1992–1994. The increase of the IR/10 000 dental nurses was smaller: from 43 (95% CI 26–66) in 1982–1984 to 87 (95% CI 67–111) in 1992–1994. There was no increase in the IR/10 000 cases of irritant dermatoses. The most common causes of allergic contact dermatitis were plastics, disinfectants and antimicrobials, rubber chemicals, and mercury/mercury salts. The most common causes of irritant contact dermatitis were detergents, wet and dirty work, plastic chemicals and antimicrobials. Currently, Finnish dentists have the highest risk and dental nurses have the 4th highest risk of any occupation for developing occupational allergic contact dermatitis: the risk was 6.4‐fold (SRR 6.4) in dentists and 6.1‐fold in dental nurses, as compared to the general working population. It is evident that safer acrylics and protective gloves, better product declarations and material safety data sheets, as well as more information about protective measures, including non‐touch working techniques, are needed.
Patch test reactions at D4, D5 and D6
Authors: Geier Johannes , Gefeller Olaf , Wiechmann Kirsten , Fuchs Thomas
Published: February 2007

In this retrospective study, patch test reactions in 3 groups of patients were analysed, in order to obtain information on the best day for the 2nd patch‐test reading after day 2 (D2), on the usefulness of additional readings after D3, and on the dependence of patch‐test reactions at D4, D5, or D6 on allergen and/or patient characteristics. In the years 1990 to 1995, patch tests were routinely read at D3 and D4 in 1096 patients, at D3 and D5 in 1243 patients, and at D3 and D6 in 1136 patients. In all of the 3 groups, significantly more positive reactions diminished than appeared de novo from D3 to the later reading. Virtually identical results were observed in subgroups of patients formed by sex, age or atopy. However, men might possibly react more slowly than women on patch testing, showing more increasing than diminishing reactions in the D3/D4‐ and the D3/ D5‐comparison. Reactions to individual allergens showed wide differences in this connection. Neo‐mycin sulfate, cobalt salts, and p‐phenylenediamine can be characterized as slow allergens, with more reactions increasing than diminishing from D3 to the later readings. With fragrance mix and balsam of Peru, the opposite pattern occurred. In all subgroups of patients, and with most allergens, the gain in positive reactions was biggest when an additional reading was performed at D5. We conclude that for a single 2nd patch test reading after D2, D3 is the best day, and especially better than D4. If a 3rd reading is performed, it should be done at D5 to get the maximum information out of patch testing. However, this extends the test procedure to at least 1 day of the weekend.
Are contact allergens stable in patch test preparations? Investigation of the degradation of d‐limonene hydroperoxides in petrolatum
Authors: Nilsson Ulrika , Magnusson Kerstin , Karlberg Olof , Karlberg Ann‐Therese
Published: February 2007

Several of the products formed after oxidation of d‐limonene exhibit strong contact allergenic properties. Some, e.g., the hydroperoxides, are unstable compounds. In this study, we have examined whether the limonene hydroperoxides are chemically stable in white petrolatum used for patch testing. We found that the stability of the hydroperoxides was strongly dependent on whether or not the petrolatum was stabilized with α‐tocopheryl acetate. In the presence of this antioxidant, the hydroperoxides were degraded to a greater extent. The hydroperoxides were shown to be directly reduced to the corresponding alcohols by this agent. On the other hand, the compounds where shown to be stable in non‐stabilized petrolatum throughout clinical patch testing for a period of 6 weeks, provided that the preparations were stored in a refrigerator when not used. Thus, it is recommended that vehicles without α‐tocopheryl acetate are used when peroxy or hydroperoxy compounds are patch tested or used in sensitization experiments. However, it is important to limit the storage time so that optimal conditions are at hand. A fast method was developed to enable isolation and quantification of the hydroperoxides in white petrolatum. This analytical method may also be applicable to other compositions of patch test preparations.
A hand immersion test under laboratory‐controlled usage conditions: the need for sensitive and controlled assessment methods*
Authors: Paye M. , Gomes G. , Zerweck C. R. , Piérard G. E. , Grove G L.
Published: February 2007

Exaggerated test conditions were frequently used to investigate the cutaneous tolerance of detergent products in the past. As the sensitivity of newly designed biometric methods is steadily improving, the trend towards more realistic test conditions should be encouraged. A hand immersion test under laboratory‐controlled usage conditions is presently described, fulfilling such principles. Panelists soaked their hands in 2 different hand dishwashing liquids, 2× daily for 10 min each (with successive in‐solution/out‐of‐solution cycles) for 4 consecutive days. Products were at usual dilution for dishwashing liquids and were randomized between the dominant and non‐dominant hands of panelists. Visual scoring of erythema and dryness developing on the whole hands (scoring scales including interdigital areas and joints) during the week did not allow discrimination between the 2 products. However the dominant hands were significantly more susceptible to alterations than the non‐dominant hands, regardless of product attribution. In contrast, skin electrical measurements (Corneometer® CM800 and Skicon® 200) on the dorsum of the hands (muscle mass between thumb and index) and squamometry analysis of tape stripping (harvested from the same site) yielded significant differences between the 2 products. In conclusion, a hand immersion test under realistic conditions has been described, which discriminates between products when sensitive assessment methods are used to explore skin sites partially protected from daily‐life skin aggressions.
Does sodium lauryl sulfate concentration vary with time?
Authors: Sugár M. , Schnetz E. , Fartasch M.
Published: February 2007

When performing skin irritation tests with sodium lauryl sulfate (SLS), the quality of the test solution is of major importance for the reproducibility and comparability of the results. The influence of 4 different storage parameters (concentration, duration, temperature, material of the storage vials) on the stability of aqueous SLS solutions was investigated under non‐sterile conditions. SLS solutions at 5 different concentrations (0.001%, 0.01%, 0.1%, 0.5%, 1%) were analysed by mobile phase ion chromatography. Analyses were performed after a storage time of 3 h, 1 week, and 4 weeks. Storage was carried out at different temperatures: −18°C, 6°C, and 23°C. The storage containers were of 2 different materials (glass and polypropylene). After a storage of 1 week, no decrease in SLS concentration was observed, regardless of the chosen conditions. After 4 weeks at 6°C and 23°C, the SLS concentration was found to be significantly decreased for the 2 lowest concentrations (0.001% and 0.01%). At higher concentrations and lower temperatures, no decrease in SLS concentration had occurred. In parallel to the loss of SLS, contamination with bacteria was found in the solutions, especially at the 2 lowest concentrations. Bacterial growth was not observed at higher concentrations. The possibility of biodegradation of SLS has to be taken into account, especially when dealing with low concentrations of SLS.
Skin sensitization risk assessment: a comparative evaluation of 3 isothiazolinone biocides
Authors: Basketter David A. , Rodford Rosemary , Kimber Ian , Smith Ian , Wahlberg Jan E.
Published: February 2007

Many of the chemicals in common use possess, to some degree, a capacity to cause skin sensitization. Consequently, it is important to conduct a thorough and accurate risk assessment when it can be anticipated that such chemicals are likely to come into contact with human skin. Such risk assessments must consider the nature and extent of dermal exposure together with the sensitizing potency of the chemical. Whilst the exposure elements of the risk assessment process are often well understood, or can at least be reasonably predicted on the basis of the proposed usage of the chemical, the determination of skin sensitizing potency may be problematic. In this paper, we describe an approach to the determination of relative potency of 3 isothiazolinone biocides. Initially, the local lymph node assay (LLNA) provides an estimate of relative sensitizing potency. Where appropriate, this can be followed by confirmatory testing in the human repeat insult patch test (HRIPT). The data generated reveal that (chloro)methyl isothiazolinone (CMI) is a significantly stronger sensitizer than either methyl trimethylene isothiazolinone (MTI) or benzisothiazolinone (BIT). Furthermore, both the LLNA and the HRIPT data show consistently that BIT is a somewhat weaker skin sensitizer than MTI. As an important additional component of the safety evaluation, the ability of these sensitizing isothiazolinones to cross‐react has been considered; the data indicate that the more weakly sensitizing isothiazolinones do not elicit allergic reactions in subjects sensitized to MCI. The implications for use of these biocides in various product types are discussed.
Screening patch tests for pigmented contact dermatitis in Israel
Authors: Trattner Akiva , Hodak Emmilia , David Michael
Published: February 2007

Pigmented contact dermatitis has been found to be caused by fragrances, cosmetics, washing powders, azo dyes in textiles, and rubber products in selected groups of patients. The aim of this study was to run screening patch tests in an unselected group of patients with pigmented contact dermatitis (n=29) encountered in our center over a 2‐year period. The test series included the European standard, cosmetics, fragrance, Scandinavian photo, and personal products. 21 patients had a positive reaction in at least 1 of the series (total, 29 reactions): 16 ‐ standard, 3 ‐ cosmetics, 1 ‐ fragrance, 9 ‐ photo, and 1 ‐ personal products; 16 (55%) had relevant results. We conclude that the highest yield for screening for pigmented contact dermatitis is achieved with the standard and photo series.
Classification criteria for skin‐sensitizing chemicals: a commentary
Authors: Basketter D. A. , Flyvholm M. A. , Menné T.
Published: February 2007

A formalized, standardized and effective mechanism for the identification of substances which possess significant skin sensitization potential is a necessary first step in the process of limiting the incidence of allergic contact dermatitis. Strategies to achieve such hazard identification are unified throughout the European Union and also have been publicised by the World Health Organization. Global harmonization of these and other approaches (e.g., in the USA) is being driven by the Organization for Economic Cooperation and Development. In this paper, the benefits and limitations of these classification systems are reviewed. A common element of all the systems is that they seek to distinguish important contact allergens from chemicals which are infrequent sensitizers. The European criteria are legal requirements in the EU member states and formal classification as a skin sensitizer leads to mandatory labelling. The most notable omission from current and proposed classification criteria relates to the relative potency of a classified skin sensitizer and the exposure dose. Such information is necessary for proper risk assessment and management measures to be implemented.
Squamometry: an evaluation method for a barrier protectant (tannic acid)
Authors: Sfflmizu Tomokazu , Maibach Howard I.
Published: February 2007

Squamometry for evaluating skin barrier substances is described. Forearms of 8 volunteers were dosed with 0, 0.25, 0.5, and 1% sodium lauryl sulfate (SLS) in distilled water (semi‐open method) for 24 h, to skin pretreated with distilled water and 5% tannic acid, a model barrier protectant. Squamometric evaluation indicated the skin damage increased with SLS concentration in a dose‐dependent manner, and that tannic acid reduced the damage (p<0.01). The results suggest that squamometry may be a useful method for determining efficacy of skin barrier substances.
Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases
Authors: Giordano‐Labadie F. , Rancé F. , Pellegrin F. , Bazex J. , Dutau G. , Schwarze H. P.
Published: February 2007

The aim of our study was the evaluation of contact sensitization in pediatric patients with atopic dermatitis (AD). It seems that the frequency of contact allergies in the course of AD, and also the frequency of contact allergies in children, is underestimated in general. Our study has been performed by investigating 137 children with AD. The childrens' history was taken according standardized consultation guidelines and followed by a physical examination. Patch testing was performed systematically, including the European standard series, together with tixocortol pivalate, budesonide and the applied emollient. If necessary, optional patch tests were performed according to the child's history. The results demonstrate contact sensitization in 43% of all children tested. The most frequent contact allergens are: metals (19.3%), fragrance (4.4%), balsam of Peru (2.6%), lanolin (4.4%), neomycin (2.6%) and emollients (2.6%). No contact sensitization to corticosteroids nor any induction of active sensitization were seen. Statistical analysis demonstrates that the risk of developing a contact allergy is significantly elevated in children after the age of 5 years. Female sex is a risk factor only for nickel. Age of onset of AD or its severity is not associated with the development of contact allergy. In conclusion, the results indicate the necessity of performing systematic patch testing in the investigation of allergies in children with AD. Preventive measures from an early age are suggested to avoid exposure to the most frequent contact allergens.
Identification of coumarin as the sensitizer in a patient sensitive to her own perfume but negative to the fragrance mix
Authors: Mutterer V , Arnau E. Giménez , Lepoittevin J.‐P. , Johansen J. D. , Frosch P. J. , Menné T. , Andersen K. E. , Bruze M. , Rastogi S. C. , White I. R.
Published: February 2007

The aim of this study was to identify the chemicals responsible for the sensitivity of a 44‐year‐old woman to her own perfume, but showing negative patch test results to the fragrance mix. For this purpose, the perfume concentrate from the eau de toilette was chemically fractionated. Each fraction obtained was afterwards tested on the patient using a ROAT and/or a patch test. Only 1 fraction gave a positive ROAT result. This fraction was analyzed and found to contain coumarin and ethyl vanillin. Coumarin, one of the most widely used fragrance compounds that is not present in the fragrance mix, was confirmed as being the sensitizer.
The allergens of Dendropanax trifidus Makino and Fatsia japonica Decne. et Planch. and evaluation of cross‐reactions with other plants of the Araliaceae family
Authors: Oka Keiko , Saito Fumio , Yasuhara Tadashi , Sugimoto Akiko
Published: February 2007

cis‐9,17‐Octadecadiene‐12,14‐diyne‐1,16‐diol (I), an analog of falcarinol has been identified in our previous report as an active component of Dendropanax trifidus and a strong sensitizer. In this report, 16‐hydroxy‐cis‐9,17‐octadecadiene‐12,14‐diynoic acid (II) and cis‐9, trans‐16‐octadecadiene‐12,14‐diynoic acid (III) were elucidated as 2 other active components of the plant. Compound I, however, presented with the highest concentration and showed a stronger reaction on patch testing. The leaves of Fatsia japonica Decne. et Planch. were also found to contain compound I, but the amount was found to be 7× more in Dendropanax trifidus than in Fatsia japonica. 5 subjects with hypersensitivity to Dendropanax trifidus and compound I showed positive reactions when patch tested with the leaves of Hedera helix L. and Schefflera arboricola. 1 of these also showed a positive reaction to the extract of Panax ginseng root powder diluted 1% in ethanol. There was cross‐reaction among these plants, which all belong to the Araliaceae family.
Usefulness of the European standard series for patch testing in children A 3‐year single‐centre study of 337 patients
Authors: Roul S. , Ducombs G. , Taieb A.
Published: February 2007

Results of patch tests in 337 children aged 1 to 15 performed in our paediatric unit during the past 3 years have been analysed retrospectively in order to optimize the patch test series and to assess their relevance. This study represents the most important single‐centre study reported so far over a short period. We found a positive patch test rate of 66%, with a peak incidence among children less than 3 years of age (88% versus 58.9%). The most common allergens were metals, especially nickel, fragrances and, less frequently, rubber chemicals. Concerning nickel, positive reactions rarely correlated with a relevant exposure and were difficult to interpret, especially in patients with atopic dermatitis, who are probably more likely to have irritant or false‐positive reactions to metals. Based on the results and their relevance, we propose a shortened standard series of patch tests for paediatric patients.
Contact sensitivity to cigarettes and matches
Authors: Dawn G. , Fleming C. J. , Forsyth A.
Published: February 2007

The results of patch testing with a series containing components of cigarettes and matches were reviewed. 2 years were reviewed, 1987 and 1997. 314 patients were patch tested to this series, 203 in 1987 and 111 in 1997. 31 patients had clinically relevant positive reactions to the series, 25 in 1987 and 6 in 1997. 26 patients had relevant positive tests to cigarette components in the series. There were 14 relevant positive reactions to phosphorus sesquisulfide in 1987 and one in 1997. All patients with relevant positive reactions to red match tips also had reactions to phosphorus sesquisulfide. There was a significant association between cigarette and fragrance hypersensitivity. The eczema in 3 of 4 patients who stopped smoking improved. A series containing match heads, smoked cigarette filters and remnants of tobacco from smoked cigarettes may be useful in smokers with eczema of the face, neck or hands.
Skin susceptibility of atopic individuals
Authors: Löffler Harald , Effendy Isaak
Published: February 2007

The relevance of the irritant skin reaction of individuals with an atopic history (atopic dermatitis, rhinoconjunctivitis or atopic asthma) to sodium lauryl sulfate (SLS), a widely used irritant, is still controversial. The aim of this study was to evaluate transepidermal water loss (TEWL) as an indicator of stratum corneum integrity, before and after SLS patch testing, in various groups of atopic individuals with and without atopic dermatitits. 95 volunteers were divided into 4 groups: (1) individuals with active atopic dermatitis; (2) individuals with a history of atopic dermatitis but without active skin lesions; (3) individuals with rhinoconjunctivitis or atopic asthma without any symptoms at the time of testing; (4) healthy individuals serving as controls. The volunteers were patch‐tested at the unaffected volar side of the forearm with aqueous SLS 0.5% for 48 h. TEWL was measured before application and after removal of the patch. Individuals with active atopic dermatitis showed a significantly higher TEWL value after SLS and a tendency to a higher basal TEWL as compared to the 3 other groups. There were no significant differences in TEWL between individuals who were classified as atopic but without active dermatitis, individuals with rhinoconjunctivitis or atopic asthma and healthy controls, either at the basal or at the post‐SLS measurement. Enhanced skin susceptibility is only present in individuals with active dermatitis. The skin susceptibility of atopic individuals might therefore be increased as soon as the skin becomes ec‐zematous, suggesting a reduced epidermal integrity probably caused by the endogenous atopy and/ or respiratory allergens. When interpreting the atopy score in relation to skin susceptibility, the actual condition of the skin should hence be taken into consideration.
Intra‐ and inter‐individual variations in transepidermal water loss on the face: facial locations for bioengineering studies
Authors: Schnetz E. , Kuss O. , Schmitt J. , Diepgen T. L. , Kuhn M. , Fartasch M.
Published: February 2007

The volar forearm is the favored location for bioengineering studies. However, transepidermal water loss (TEWL), which is an important indicator of the function of the epidermal barrier, shows regional variations, and for the evaluation of cosmetic formulations, facial skin would be more suitable. In this study, we have compared 10 facial locations with 1 test site on the volar forearm for absolute TEWL values, reproducibility, and correlation. Measurements were performed over 3 consecutive days. The TEWL values of the facial test sites were higher compared to forearm values and did not correlate with the forearm. On the face, there was a good correlation between the values of the right compared to the left side of the face. The sites superior to the nervus supraorbitalis, the medial borders of the musculus masseter, and the center of the chin proved to be locations with relatively stable TEWL values. There was a greater variability at the center of the forehead and at the center of the cheeks. It is recommended that TEWL measurements on facial locations with stable TEWL values are used for the evaluation of cosmetic formulations.
Comparison between 2 test models in evaluating the effect of a moisturizer on irritated human skin
Authors: Held Elisabeth , Agner Tove
Published: February 2007

The purpose of the present study was to compare 2 experimental models of moisturizer efficacy on the recovery of irritated skin on the hands and the volar forearms. 12 healthy volunteers had their hands immersed in sodium lauryl sulfate (SLS) 10 min 2° daily for 2 days, and at the same time the volunteers had patch tests with SLS (0.125%, 0.25% and 0.5%) applied on their forearms for 24 h. After irritation of the skin, the volunteers had a moisturizer applied on one arm/hand 3° daily for the following 9 days. The other arm/hand served as untreated control. Evaluation was done on days (D) 1, 3, 5, 8 and 12 by transepidermal water loss, electrical capacitance, laser Doppler flowmetry and DermaSpectrometry. Both models were found useful, and the moisturizer was found to accelerate regeneration of the skin barrier function in both the hands (D8, p<0.05) and the volar forearms (0.5% SLS, D5 and D8, p<0.01). When the forearm model is used in the present set‐up, a relatively high concentration of SLS (<0.25%) should be used and evaluation measurements are best performed on D5‐D8. The forearm model proved reliable and easy to handle and we suggest that this model is used in future studies on moisturizer evaluation.
Compositae mix is a more sensitive test for Compositae dermatitis than the sesquiterpene lactone mix
Authors: von der Werth J. M. , Ratcliffe J. , English J. S. C.
Published: February 2007

Over the past 2 decades, Compositae dermatitis has increasingly been recognized as a cause of exposure‐pattern dermatitis. The introduction of the sesquiterpene lactone (SL) mix as a screening test has contributed to this improved recognition. However, there is growing evidence that the SL mix fails to detect a substantial number of genuine Compositae allergies. We therefore investigated whether another screening reagent (the Compositae mix) might be more sensitive in detecting cases of Compositae allergy than the SL mix. Over a 1‐year period, we tested 656 consecutive unselected patch test patients to both SL mix and Compositae mix. 31 patients were found to have genuine Compositae allergies. Of these, 28 had reacted to the Compositae mix but only 13 had reacted to the SL mix. The Compositae mix failed to detect only 2 genuine Compositae allergies, whereas the SL mix missed 17 such allergies. On the other hand, the Compositae mix led to 9 irritant reactions, while there was only 1 irritant reaction with the SL mix. We conclude that Compositae dermatitis is still being underdiagnosed with the current screening method, and that the Compositae mix is significantly more sensitive in detecting Compositae allergy than the SL mix.
Gold – a controversial sensitizer
Authors: Bruze Magnus , Andersen Klaus E.
Published: February 2007

Until recently, gold allergy was considered to be extremely rare. Gold has been used and worshipped for thousands of years without any obvious complaints of skin problems, either in those participating in mining and other ways of prospecting, or in those wearing jewellery. When studies on contact allergy to gold sodium thiosulfate were published at the beginning of the 1990s, the allergic nature of the reported positive patch test reactions to gold was questioned. The major argument for such questioning was the lack of demonstrable clinical relevance in most positive reactors. A major reason for the questioning may have been confusion in differentiating between contact allergy and allergic contact dermatitis. To arrive at a diagnosis of allergic contact dermatitis, 3 steps have, in principle, to be fulfilled: (i) establishment of contact allergy; (ii) demonstration of present exposure; (iii) assessment of clinical relevance, i.e., causing or aggravating a contact dermatitis. In this paper, these steps are discussed with regard to gold. With our present knowledge of contact allergy – allergic contact dermatitis, we do not recommend including gold sodium thiosulfate in the standard series. It should be applied for scientific purposes and when allergic contact dermatitis from gold is suspected.
Isolation and quantification of tuliposides and tulipalins in tulips (Tulipa) by high‐performance liquid chromatography
Authors: Christensen Lars P. , Kristiansen Kell
Published: February 2007

The content of tuliposides and tulipalins were determined in Tulipa species and cultivars by reversed‐phase high‐performance liquid chromatography (RP‐HPLC), using a water:methanol gradient as mobile phase. The compounds were detected by a diode array detector employed at 208 nm. The investigation revealed, in addition to 1‐ and 6‐tuliposide A, tuliposide D and the lactonized aglycones tulipalin A and (‐)‐tulipalin B, the new tuliposide F and 6‐tuliposide B, the latter being a new acyl derivative of the known 1‐tuliposide B. All compounds were isolated by preparative RP‐HPLC and identified by NMR and mass spectroscopy. The predominant compounds were 6‐tuliposide A and B present in amounts up to 1.5% and 1.3% of fresh weight, respectively. 6‐Tuliposide A and tulipalin A seem to be the major allergens in tulips, although tuliposide D and F may also contribute to the allergenic properties. Tulipalin A and (‐)‐tulipalin B occur in intact tulips and are not only produced in response to fungal attack or after excision of the plants. A few species were found to have very low allergen content and a relatively high level of tuliposide B, indicating it should be possible to breed non‐allergenic and disease‐resistant tulips.
Contact allergy to cosmetics: testing with patients' own products
Authors: Held Elisabeth , Johansen Jeanne Duus , Agner Tove , Menné Torkil
Published: February 2007

In a 2‐year period, 1527 patients with contact dermatitis were investigated in the patch‐test clinic. In 531 patients, allergy to cosmetics was suspected from the history and they were tested with their own cosmetic products. 40 (7.5%) (of the 531 patients) had 1 or more positive reactions, 82 (15.4%) had doubtfully positive reaction(s) and 31 (5.8%) had irritant reaction(s). Skin‐care products were tested most frequently and were also found to cause most positive, doubtfully positive and irritant reactions. 80% of the patients with positive reactions to their own products had no history of contact dermatitis prior to the presenting attack, and in 92.5% of the cases, the positive reaction was considered relevant or partly relevant. In patients with a positive reaction, ingredients that could be responsible were found in 60% of the cases by testing with the European standard series and a series of common cosmetic ingredients. Fragrance mix and formaldehyde were found to be the ingredients most often responsible and were significantly more frequent in patients with positive reactions to their own products, compared to a control group of eczema patients also seen in the patch‐test clinic.
Irritancy ranking of anionic detergents using one‐time occlusive, repeated occlusive and repeated open tests
Authors: Tupker R. A. , Bunte E. E. , Fidler V. , Wlechers J. W. , Coenraads P. J.
Published: February 2007

Discrepancies between the one‐time patch test and the wash test regarding the ranking of irritancy of detergents have been found in the literature. The aim of the present study was to investigate the concordance of irritancy rank order of 4 anionic detergents tested by 3 different exposure methods, namely one‐time occlusive, repeated short‐time occlusive and repeated short‐time open tests. These detergents were sodium cocoyl isethionate (ISE), sodium lauryl sulfate (SLS), soap and disodium lauryl 3‐ethoxysulfosuccinate (SUC). The reactions were evaluated by visual scoring and by transepidermal water loss (TEWL) measurement. When scored visually, the rank order in the one‐time test was: SOAP≥SLS≥ISE>SUC. The other test methods yielded a different order: SLS>ISE≥SOAP>SUC. A similar rank order was obtained with TEWL measurement for all exposure methods. Generally, the concordance among the different exposure methods was high when evaluated by TEWL. The concordance was lower when evaluation was performed by visual scoring. The present study demonstrates that the choice of exposure model and evaluation method may be important variables influencing the outcome of irritancy testing. It is proposed that the repeated open test is the best way to simulate most in‐use situations where the uncovered skin is exposed to detergents. The repeated occlusive test or the one‐time patch test may be better to simulate situations in which the skin is occluded after irritation by detergents.
Laser Doppler perfusion imaging for the documentation of flare‐up in contact allergy to gold
Authors: MOÖLLER HALVOR , BJÖRKER BERT , BRUZE MAGU S , LUDQVIT KATARIA , WOLLNER PER
Published: February 2007

A healed or healing allergic contact dermatitis is easily reactivated to a flare‐up if the patient is provoked systemically with his particular allergen. 5 patients with contact allergy to gold were patch tested with a serial dilution of gold sodium thiosulfate. 1 to 2 months later, when positive test reactions were healed, the patients were given 1 intramuscular injection of gold sodium thiomalate. This resulted in a flare‐up of patch tests as well as a transient fever and toxicoderma‐like reactions. The flaring tests were registered by digital photographs and laser Doppler imaging (LDI). An increased cutaneous blood flow in the formerly positive patch tests was discernible within 1 h after provocation, increased to a vigorous maximum after 4–6 h, and subsided during the following few days. The earliest increase and the highest peak of blood flow were observed in the test areas of the strongest original test concentration. LDI provides a most suitable technique for studying the dynamics of this rapidly developing inflammation of a mainly dermal character.
Effects of various grit‐containing cleansers on skin barrier function
Authors: WIGGER‐ALBERTI WALTER , FISCHER TOBIAS , GREIF CATHLEEN , MADDERN PETER , ELSNER PETER
Published: February 2007

Products intended for individuals in contact with strongly adhering dirt often contain grit. Various clinical test methods have been developed for evaluating the potential of personal washing products to induce skin irritation. In the present study, differences in the irritant effects of washing products containing naturally‐derived grit and synthetic grit were investigated in a forearm wash test. The forearms of 16 test subjects were washed in a total of 18 treatments (4 per day for 4 days, with 2 treatments on the 5th day). Treatment consisted of continuous washing for 2 min by a technician, who gently slid his fingertips with the lather up and down the forearm. Non‐invasive instrumental measurements of skin barrier function were performed. Repetitive washing for 1 week lead to increased TEWL values, skin redness and decreased stratum corneum hydration. Results indicate differences in irritancy potential due to different types of grit, their surface and concentration. It is concluded that the repeated wash test seems to be adequate for rating personal washing products that contain grit.