bluuebunny/crossref_metadata_2025 huggingface dataset:
FS03.1 The hand eczema severity index (HECSI). A study of inter‐ and intraobserver reliability
Authors: Held Elisabeth , Skoet R , Agner T , Johansen J Duus , Skovgaard L Theil
Published: August 2010

In clinical studies on hand eczema (HE) an objective and accurate assessment of the severity of the disease is needed. The present study was undertaken in order to develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE. Twelve dermatologists (observers) assessed 15 HE patients (11 women and 4 men) twice with an interval of 30 min. To minimise recall bias only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC). ICC for total HECSI score was 0.79 at time 1 and 0.85 at time 2 respectively. When looking at ICC for the different items in the scoring system (extent of lesions, anatomical location and intensity of clinical signs) best agreement was found for extension followed by anatomical location and least agreement was found for the scoring of clinical signs. ICC for intraobserver agreement was 0.90. A regression correlation coefficient of 0.993 was found (simple linear regression analysis of time 1 scores against time 2 scores) indicating high reproducibility. Overall good agreement existed for both inter‐ and intraobserver reliability although some inter‐ and intraobserver variation existed.
FS03.4 Irritant dermatitis following tape stripping
Authors: Nybæk Hanne , Knudsen DB , Nielsen LF , Karlsmark T , Jemec GBE
Published: August 2010

Repeated tape stripping of the skin associated with e.g. the use of stoma care products can cause irritant dermatitis. This experimental study in 12 healthy volunteers was designed to assess the effects of 3 chemically and physically different adhesives commonly used in stoma care products. Two different frequencies of stripping (daily vs twice weekly) were tested, and the various parameters of inflammation and barrier integrity were studied with established non‐invasive methods (Measurement of erythema, conductance, and Trans Epidermal Water Loss (TEWL)) on day 0, 4, 6, 10, 16, 22 and 28. All adhesives caused increases in all the studied parameters during the 28 day period compared to the corresponding non‐stripped values. Furthermore, daily stripping caused significantly greater inflammation and barrier disruption than stripping twice weekly. In conclusion, it was possible by measuring skin erythema, conductance and TEWL to detect different patterns of inflammatory changes and barrier disruption in areas treated with the 3 adhesives. As expected, more frequent stripping caused greater changes. These differences did however appear at different times during the study period, suggesting that the chemical and mechanical properties of the adhesives may affect the skin differently.
FS03.6 Efficacy of MAS063D (‘Atopiclair’) in irritant contact dermatitis
Authors: Zhai Hongbo , Villarama I , Hafeez Z Hasan , Maibach HI
Published: August 2010

Objective:  To determine the efficacy of a topical, MAS063D, in managing the clinical signs and symptoms of experimentally induced irritant contact dermatitis (ICD).

Methods:  Two patches of ICD were created using sodium lauryl sulfate (SLS) in 20 consenting volunteers. MAS063D was applied to one patch and a vehicle‐only control to the other. Measurements were taken at baseline, 24, 48 and 72 hours as follows: blood flow volume (BFV); skin color (a*); transepidermal water loss (TEWL); patient’s view of itch and visual scoring. Results: The objective measurements of BFV, a* and TEWL all showed statistically significant benefits of MAS063D over the vehicle‐only control. BFV and a* were significantly better at all time points (p = 0.046, p = 0.045 respectively at 72 hours) and TEWL at 48 and 72 hours (p = 0.02 at 72 hours). MAS063D demonstrated benefit in the visual scoring of irritant contact dermatitis that was not statistically significant. Patient‐assessed itch was low at baseline; significant improvement was neither expected nor demonstrated although a small benefit of MAS063D over vehicle was seen in the mean values.

Conclusions:  BFV and a* are both good indicators of local erythema. TEWL is a good indicator of skin integrity. MAS063D therefore demonstrated statistically significant benefit over vehicle on three clinically meaningful outcomes of SLS‐induced ICD, and therefore may benefit irritant contact dermatitis.
FC02.2 Patch tests with gluten and gliadin in children with coeliac disease
Authors: Giusti Francesca , Amarri S , Seidenari S
Published: August 2010

Atopy patch tests (ATPs) are believed to be a useful diagnostic procedure for atopic dermatitis (AD), aiming at the detection of delayed reactions to aeroallergens and food allergens. Our aim was to investigate immune responses to gluten and gliadin in children affected by coeliac disease by performing APTs, and to compare these data to the ones observed in AD patients. 31 children, 15 males and 16 females (mean age ± s.d. = 5,5 ± 3,8 years) affected by coeliac disease underwent APTs with gluten and gliadin. Among these, 15 children were on gluten‐free diet at the moment of our examination and 3 patients were affected by AD. 83 AD children not affected by celiac disease, were used as controls. 19,4% and 12,9% of children with coeliac disease proved positive to APTs with gluten and gliadin, respectively. No difference in the frequency and intensity of APT responses were present between the patients on gluten‐free diet and the children not on diet. Among AD patients 12% reacted to gluten, whereas no positive reactions to gliadin were observed. Going on these findings, the cellular‐mediated reactivity to gliadin in patients with coeliac disease may show a clinical expression by positive APT reactions to gliadin. These represent a specific finding in subjects with coeliac disease when compared to AD children.
FC02.3 Thimerosal‐ is it really irrelevant?
Authors: Ingber Arieh , Slodownik D
Published: August 2010

Objective:  Recently, several investigators claimed that thimerosal is one of the most irrelevant allergens existing in screening for contact dermatitis.

Methods:  508 patients who were suspected to have allergic contact dermatitis were patch tested at our clinic. They completed a questionnaire including medical, demographic and occupational details. We used the standart tray of Chemotechniqe Diagnostics (MalmÖ, Sweden) and additional series which were case relevant. The relevance of the allergic reaction to thimerosal was scored from 1–6.

Results:   19 patients (3.7%) had an allergic reaction to thimerosal. Six (31.5%) had a definite relevance and eight (42.1%) had a probable relevance. Only three patients (15.8%) had an irrelevant reaction. SPIN value was 2281. We found a high proportion of mechanics (42.1%) among the patients who had positive reaction to thimerosal (P < 0.0001).

Conclusion:  Although previous reports found thimerosal highly irrelevant, our daily experience being supported by the above data, indicates that positive reactions to thimerosal could be relevant for many patients.
PCS.02 Risk assessment in practice – clinical problems in ACD. Consumer perspectives
Authors: White Ian R
Published: August 2010

That a cosmetic product must not cause damage to human health is enshrined in European legislation. Within the EU, the Scientific Committee for Cosmetic and Non‐food Products (SCC NFP) of the Directorate General for Consumer Safety & Health Protection provides independent risk assessments of certain cosmetic ingredients. The evaluations depend largely on the completeness of dossiers submitted by industry. Requirements for submissions are published by the SCC NFP http://europa.eu.int/comm/health/ph_risk/committees/sccp/documents/
out242_en.pdf) and cutaneous toxicology, including contact allergy, is only a part of the overall assessment.

Opinions adopted by the SCC NFP are published in full (http://europa.eu.int/comm/health/ph_risk/committees/sccp/sccp_opinions_en.htm), presented to the Directorate General responsible for the legislation (Enterprise), who are risk managers, and discussed with Member States before the recommendations are included in the annexes of the Cosmetics Directive, if appropriate.

The Cosmetics Directive (http://pharmacos. eudra.org/F3/cosmetic/pdf/vol_1en.pdf) contains positive lists of certain ingredient types (including preservatives, UV filters) and only those substances listed may be used. Annex 3 lists substances that may be used under certain conditions (concentration, exposure sites, warnings, age).

Increasingly, revision of assessments of risks related to contact allergy have been brought about by epidemiological and robust clinical data (elicitation studies) submitted by dermatologists. As illustrated with the examples of methyldibromo glutaronitrile and Lyral®, rapid responses to protect the consumer are possible when the Commission is provided with appropriate information. Similar examples illustrate failures to predict risks for the induction of contact allergy before the consumer was excessively exposed.

In contrast to the above, some permanent hair dye chemicals (for which there is, as yet, no positive list) are important and potent allergens and are permitted only because of the absence of acceptable alternatives and social need. Warnings and recommendations for testing before use have not been validated despite the long history of complaints. The ‘damage’ experienced by the consumer with an adverse reaction to a hair dye must be balanced against their possible carcinogenic potential.

The consumer expects products to be safe. Why do risk assessments fail?
FS05.1 Treatment of hand eczema
Authors: Veien Niels K
Published: August 2010

Hand eczema is a common skin disease that often becomes chronic, and treatment of the disease is often challenging. Skin protection is of great importance for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Emollients have been shown to be successful in the primary prevention of hand eczema as well as in reducing eczema activity. Topical corticosteroids are still the mainstay of treatment, but randomised controlled trials of their efficacy are needed. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid‐associated side‐effects. UV‐therapy and Grenz rays can also suppress hand eczema. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Treatment possibilities for hand eczema, indications and side effects will be discussed.
FS06.2 Autoxidation of linalool and impact on the sensitizing capacity and allergenicity
Authors: Sköld Maria , Börje A , Harambasic E , Matura M , Karlberg A‐T
Published: August 2010

Linalool is one of the most frequently used fragrance chemicals in scented products and a large population is exposed to it. It is therefore important to study the allergenic properties of linalool, and the effect of autoxidation.

Objectives:  To study the autoxidation of linalool and identify formed oxidation products, to investigate the impact of autoxidation on the sensitizing capacity and to study the frequency of contact allergy to oxidized linalool among consecutive dermatitis patients.

Methods:  Linalool was air‐exposed and the degradation followed with GC. Oxidation products were identified with GC‐MS and NMR. Pure linalool, 2 different states of oxidized linalool and 3 oxidation products were tested for their sensitizing capacity in the local lymph node assay (LLNA). Consecutive dermatitis patients were patch‐tested with oxidized linalool and a fraction of oxidized linalool.

Results:  Linalool started to decompose immediately when air‐exposed. Several oxidation products were identified among which 3 (2 hydroperoxides and an alpha, beta‐unsaturated aldehyde) contain structural features that make them potential allergens. LLNA showed that the 3 oxidation products were moderate allergens, and that the sensitizing potential of linalool increased with longer air‐exposure times. In the patch‐test study positive reactions were observed to oxidized linalool in 1.65% of the patients.

Conclusions:  The extensively used fragrance chemical linalool is not allergenic in itself. The autoxidation process that takes place at air‐exposure leads to the formation of sensitizing oxidation products. The frequency of consecutive patients reacting to oxidized linalool shows that the experimental findings are clinically important.
FS06.3 Chloroatranol – clinical studies and exposure analysis
Authors: Johansen Jeanne Duus , Rastogi SC , Andersen KE , Bernard G , Svedman C , Bruze M , Bossi R , Gimenez‐Arnau E , Lepoittevin J‐P , Menné T
Published: August 2010

Objectives:  To investigate the elicitation potency of chloroatranol – a newly identified allergen in the natural fragrance extract: oak moss absolute. Further to compare chloroatranol and atranol and relate the findings to exposure assessed by chemical analysis.

Methods:  A serial dilution patch and repeated open application test was performed in 13 chloroatranol sensitized patients and in 10 healthy controls. Further the relative potency between chloroatranol and atranol in equimolar patch test concentrations was studied and exposure assessed by chemical analysis (liquid chromatographic‐tandem mass spectrometry) of perfumes on the European Market.

Results:  Elicitation occurred in 92%(12/13) to the repeated open application of 5 ppm chloroatranol in ethanol within 14 days of exposure and in none of the controls (p < 0.001). Patch testing with eqimolar concentrations of chloroatranol and atranol indicated almost similar elicitation potency. Exposure assessment showed that chloroatranol and atranol were widespread in perfumes. Chloroatranol was found at 10 ppm and atranol 74 ppm (90% percentiles).

Conclusions:  Chloroatranol and atranol are strong elicitors. The current exposure to these fragrance allergens in perfumes is likely to cause clinical symptoms in sensitised individuals.
FS06.7 The new fragrance mix II – test results of a multicentre European Study
Authors: Frosch Peter , Pirker C , Rastogi S , Andersen KE , Bruze M , Goossens A , White IR , Uter W , Johansen J Duus , Menné T
Published: August 2010

A new fragrance mix (FM II) with 6 frequently used chemicals was evaluated in consecutive patients patch tested in 6 dermatological centres in Europe. 28% FM II contained 5% Lyral, 1% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10% alpha‐hexyl cinnamic aldehyde (AHCA); in 14% FM II the single constituents’ concentrations was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable and none. The frequency of positive reactions to the currently used 8% fragrance mix (FM I) and the new mix in 1703 patients was as follows: FM I, 6.6%; 2.8% FM II, 1.3%; 14% FM II, 2.9%; 28% FM II, 4.1%. The number of doubtful/irritant reactions was 7.2% for FM I and ranged from 1.8% to 10.6% for FM II.

8.7% of tested patients had a certain fragrance history. Of these 25.2% were positive to FM I, reactivity to FM II was dose‐dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history – certain and none – values for sensitivity (sens) and specificity (spec) were calculated. Sens: FM I, 27.2%; 2.8% FM II, 8.7%; 14% FM II, 15.9%; 28% FM II, 21.5%. Spec: FM I, 96.3%; 2.8% FM II, 99.5%; 14% FM II, 98.7%; 28% FM II, 97.9%. 31/70 (44.3%) patients positive to 28% FM II were negative to FM I. In the group of patients with a certain history a total of 6 patients was found reacting only to FM II. Simultaneous break‐down testing with the single constituents produced positive reactions in 54.3% for 28% FM II and 48% for 14% FM II. Lyral was the dominating single constituent with positive reactions (37.1% for 28% FM II, 36% for 14% FM II), followed by citral, farnesol, citronellol, AHCA and coumarin. Chemical analysis for the 6 constituents of FM II was performed on 25 products used by 12 patients being patch test positive to FM II. Lyral was detected in 76% of these products, citral in 16% and AHCA in 8%. In conclusion, the new FM II detects additional patients with contact allergy to fragrances missed by the currently used FM I. The medium concentration, 14% FM II, is probably the most useful one for diagnostic screening.
FS07.2 Occupational contact dermatitis and workers’ compensation
Authors: Frowen Kathryn , Cromie J , Nixon R
Published: August 2010

Statistics for occupational contact dermatitis (OCD) in Australia are gathered from workers’ compensation (WC) data and research has indicated that occurrence is underestimated by as much as 400%. This study investigated reasons which might influence decisions whether to claim WC or not. A questionnaire was posted to 168 individuals diagnosed with significantly work related OCD at a specialised occupational dermatology clinic, therefore fulfilling valid claim criteria under the WC scheme operating in the state of Victoria. 70 completed responses were analysed. Ages ranged from 18–65 and only 40% had claimed workers’ compensation, with those under 45 y less likely to claim. Females were significantly (P < 0.05) less likely to claim, as were respondents who had dermatitis present for less than 6 months. At the time of diagnosis, 37% of respondents were health care workers, 10% hairdressers, 7% food handlers, and 29% worked in hospitals, 24% manufacturing, 10% hairdressing salons, and 7% each vehicle maintenance, food service and trades. 31% no longer worked for the same employer, however 90% of respondents were still employed. Those who did not claim WC lost less time from work than those who claimed, but more non‐claimants still had skin problems quite often or constantly than did claimants. 28.6% of non‐claimants had all or some of their medical and/or lost time costs paid by their employer, and only 18% of claimants had all of their costs paid by their employer or WC insurer. Although the sample size was small, interesting data was also obtained from the qualitative responses.
FS08.2 Gender, race, age & occupation effect quality of life (QoL) in ACD
Authors: Belsito Donald , Kadyk D , Hall S
Published: August 2010

Objectives:  This study was conducted to investigate the relationship between QoL scores for patients with ACD and confounders, such as gender, race, age, and occupation.

Methods:  A total of 428 subjects with ACD were, at varying times after diagnosis, mailed a QoL questionnaire modified from Skindex‐16 to include an additional 5 items pertaining to occupational impact. The QoL scores were analyzed by gender, race, age, and occupation to ascertain factors that impact QoL in subjects with ACD.

Results:  Three of the four confounders examined have a significant connection with QoL in patients with ACD. Non‐Caucasians had significantly worse QoL scores than Caucasians within the functioning scale, and had more emotional distress secondary to their disease. There were no statistically significant gender‐related differences in QoL scores, although females felt a higher degree of embarrassment and depression. Age significantly impacted items within the functioning and occupational scales, with subjects nearing retirement age and older reporting better QoL. In contrast, younger subjects, especially those in the 5th decade, were more likely to have difficulty pursuing daily activities, have more fear that they might need to leave their jobs, and have more concern for their financial futures. Office workers, students, and homemakers were primarily diagnosed with non‐occupational ACD, while more industrial, health care and other wet workers suffered from occupationally related ACD. In the analyses of QoL by occupation, industrial workers reported significantly more impaired QoL than subjects in other professions.
FS08.5 Does childhood atopic dermatitis influence the future working life?
Authors: Nyrén Miruna , Lindberg M , Stenberg B , Svensson Å , Svensson M , Meding B
Published: August 2010

Aim:  To investigate the risk of adult hand eczema and possible influence on later working life in persons with childhood atopic dermatitis.

Method:  After reviewing medical records from the school healthcare in Stockholm regarding individuals born 1960–69, 600 individuals where signs of atopic dermatitis were noted (“cases”) and 600 matched controls without eczema or allergic disease (“controls”) were identified. 405 cases and 378 controls answered a questionnaire regarding past and present skin disease, choice of job, exposure at work and possible change of job due to eczema.

Results: Hand eczema was more than 3 times more common among cases, 42%, compared to controls, 13%(p < 0.001). Hand eczema during the past 12 months was reported by 24% of the cases and 9% of the controls (p < 0.001). The proportion of individuals working in jobs with high‐risk for hand eczema was equal between the groups, as well as exposure to water, detergents, chemicals and hand washing. Among the cases 9% reported change of job due to eczema compared to 2% of controls (p < 0.001) and sick leave 10% compared to 2%(p < 0.001).

Conclusions: Childhood atopic dermatitis is a risk factor for hand eczema. As the proportion of individuals in jobs with high‐risk for hand eczema and the exposure was the same in cases and controls measures preventive measures are important to reduce consequences like sick leave and change of job.
FS09.1 Diacetylmorphine (heroin) allergy
Authors: Hogen Esch Aliet J , Heide S van der , Brink W van den , Bruynzeel DP , Coenraads PJ
Published: August 2010

Since heroin is delivered to a selected group of drug addicts under supervision of nurses in the Netherlands, we reported about several nurses who presented with work‐related eczema and positive patch tests to heroin. To investigate the prevalence of heroin contact allergy among all workers in this heroin delivery project, a study was started using questionnaires. Altogether 31 nurses reported work‐related complaints out of 100 who returned questionnaires. Besides reports of eczema, mainly of eyelids (probably airborne) and hands, there were mucosal and respiratory complaints. Patch tests were performed in 25 nurses with complaints; in 9 of them a heroin contact allergy could be confirmed. In 6 out of these 9 nurses this was combined with mucosal or respiratory complaints. There were also 6 nurses with mucosal or respiratory complaints without a contact allergy. Contact dermatitis from opioids, such as morphine and codeine, has been documented among opioid industry workers, nurses, doctors, pharmacists, and in patients. In conclusion heroin appears to be a potent contact allergen, causing contact dermatitis. Mucosal and respiratory complaints however, cannot be explained by this contact allergy; they might be caused by a type‐1‐allergy to heroin, or by a direct histamine liberating effect. Opioids are known histamine liberators causing urticaria, rhinitis and anaphylactoid reactions; therefore intracutaneous tests with heroin are unreliable. In an ongoing research project it will be attempted to detect specific IgE to heroin in the 12 workers with mucosal or respiratory complaints; within the next few months results will be available.
FS10.4 Colophony allergy as a cause of occupational dermatitis
Authors: Lammintausta Kaija , Alanko K , Jolanki R
Published: August 2010

Objective and methods:  To evaluate the importance of occupational colophony exposure among occupational dermatitis patients we analyzed data of occupational dermatitis caused by colophony on the basis of the Finnish Register of Occupational Diseases (FROD) and among the colophony allergic patients studied in the Finnish Institute of Occupational Health (FIOH)in 1993–2002. Finnish physicians are obligated to report cases of occupational diseases to the FROD. Insurance companies remit patients to FIOH, mainly recommended by company doctors or dermatologists.

Results:  Altogether 128 cases (68 females and 60 males) of occupational dermatitis caused by colophony were reported to the FROD since 1993 to 2002 accounting for 3.4% of all occupational allergic contact dermatitis cases and another 67 had it as a second diagnosis. Mean age of the patients was 42 years, being lowest among engineering workers (34 years) Among colophony allergic patients studied in FIOH 46/89 had an occupational dermatitis caused by colophony; 14 of them as a second diagnosis. Engineering, metal working, wood working, agricultural or medical work were most common occupations. Among colophony allergic patients without an occupational dermatitis (22) or an occupational dermatitis caused by other causes (21)working with food materials and agricultural work were most common. Principal causative agents of occupational allergic contact dermatitis from colophony were cutting fluids, soldering fluxes, tall soft soap, adhesives and varnishes. Variable individual sources were occasionally detected. Mean exposure time was 12 years.

Conclusion:  Occupational dermatitis caused by colophony is difficult to diagnose, since non‐occupational colophony exposure is common.
FS11.4 Garlic‐fingered chefs – a study of contact dermatitis to garlic in curry chefs
Authors: Hubbard Viginia , Goldsmith P
Published: August 2010

Allergic contact dermatitis to garlic is described in caterers and can be an important occupational hazard.

Our department serves an area with a large Bengali population. We noted a relatively high number of curry chefs and housewives have hand dermatitis. We wanted to see whether garlic was an important sensitiser in this group.

We use diallyl disulphide to test for garlic sensitisation. We reviewed the notes of all patients who had been patch tested to this over a 12 month period. We recruited further curry chefs by visiting local restaurants. We also asked local GPs to refer suitable patients for patch testing.

We identified 26 patients who were patch tested to diallyl disulphide. Of this group, 13 were curry chefs and 11 housewives. 4 patients were found to have an allergic reaction to diallyl disulphide – all were chefs. All had presented with dermatitis of the non‐dominant hand. 1 was atopic.

Advice was given on avoidance of contact with garlic and onion (a cross‐reactant). Unfortunately this proved difficult in practice. 1 patient required acitretin with a good result. 1 patient responded well to hand PUVA.

Previous studies have shown a high incidence of occupational garlic dermatitis but some of these have tested with garlic plant or extract which can be a powerful irritant and produce misleading Results: Diallyl disulphide, allylpropyl disulphide and allicin have been identified as the allergens in garlic. Diallyl disulphide is considered the main allergen. This study shows the importance of testing for garlic allergy in caterers.
PCS.04 Establishment of safe exposure limits for the induction of allergy. Theory
Authors: Gerberick G Frank , McNamee P , Kern PS , Ryan CA , Basketter DA
Published: August 2010

For new chemicals introduced into the workplace or marketplace, and which come into contact with the skin, it is necessary, to conduct a thorough skin safety testing and risk assessment program to be certain that the exposures will be well tolerated. One vital risk assessment process involves the determination of allergic skin reactions, referred to as skin sensitization, the clinical manifestation of which is allergic contact dermatitis. The process by which low molecular weight chemicals induce and elicit skin sensitization is dependent on many factors including the ability of the chemical to penetrate the skin, react with protein, and trigger a cell‐mediated immune response. Based on our chemical, cellular and molecular understanding of allergic contact dermatitis, it is possible to carry out a quantitative risk assessment. It has been well known for years that chemical allergens display dose‐response characteristics regardless of whether the sensitization is induced in an experimental system or in humans. Moreover, it is well known that the critical exposure determinant for evaluating skin sensitization risk is dose per unit area of skin exposed. The skin sensitization testing and risk assessment process for new ingredients and consumer products generally follows a step‐wise approach that may involve structure‐activity evaluations, analytical assessments, preclinical skin sensitization testing (e.g., the mouse local lymph node assay), confirmatory clinical testing (e.g., the human repeat insult patch test), and benchmarking of resulting data against similar ingredients and product types. Essential elements for conducting a sound risk assessment involve the development of an understanding of the sensitization potential of the contact allergen and the likely dose, nature, extent and duration of exposure. With an understanding of the exposure and potency of the chemical one can assess whether the chemical, under the specific conditions of exposure, ould pose an acceptable or unacceptable risk of induction of skin sensitization. As with any test method or risk assessment approach, it is critical to understand the strengths and limitations so that one can conduct the best assessment possible and assure the skin safety of the chemical under evaluation.
FS12.1 Allergic contact dermatitis from plastic gloves
Authors: Aalto‐Korte Kristiina , Alanko K , Henriks‐Eckerman ML , Estlander T , Jolanki R
Published: August 2010

Plastic gloves are made of polymers including polyvinylchloride, polyvinylalcohol, polyethylene and polyvinylacetate. Additives such as plasticizers, stabilizers, UV light absorbers, fungicides, bactericides, flame retardants and colourants are added to the polymer, and these are potential allergens. Contact allergy to plastic gloves is rare. The allergen responsible for the sensitization usually remains unknown. An organic pigment, Irgalite Orange F2G, and bisphenol A have both caused contact allergy from household‐type PVC gloves. 1 patient with allergic contact dermatitis from his PVC gloves reacted also to tricresyl phosphate and triphenyl phosphate, chemicals known to be used as plasticizers in PVC. A plasticizer, di(2‐ethylhexyl) phthalate (DOP), caused 1 case of contact urticaria from the vinyl chloride slip guard of cotton gloves. 1 patient with contact urticaria from his polyethylene gloves reacted to 3 antioxidants, octadecanoic acid methyl ester and di‐tertiary butyl phenol of the gloves on scratch testing. We report 3 additional cases of allergic contact dermatitis from PVC gloves due to bisphenol A. 2 of the patients reacted also to para‐tertiary butyl catechol, a polymerization inhibitor in PVC. In chemical analysis, the connection between sensitization to para‐tertiary butyl catechol and the use of vinyl gloves could not be proven. We analysed 16 brands of disposable PVC gloves for medical use, covering at least 80% of the Finnish market. We found a very small amount of bisphenol A in 1 brand, and no para‐tertiary butyl catechol in any of the gloves. However, bisphenol A should be remembered as a possible allergen in PVC gloves.
FS12.3 Occupational contact dermatitis to phenol formaldehyde resins
Authors: Beck Michael H
Published: August 2010

Phenol formaldehyde resins were the first synthetic plastics to be used commercially, being patented as Bakelite in 1907.There are two main types of phenol formaldehyde resin [PFR], resols [phenol reacted with excess formaldehyde in alkaline conditions] and novolacs [formaldehyde reacting with excess phenol in acid conditions]. Novolac resins may require cross‐linking agents to cure them but resol can be hardened by heat alone. Usually sensitisation occurs when the resins are handled in partially condensed form. Modifications and additives to these resin systems increase the range of potential allergens. PFRs have electrical resistance and binding properties resulting in their widespread use in electrical appliances, glues, laminated floorboards, plywood, fibreglass including insulation, brake linings, clutch facings, grinding wheels, foundry sand moulds, abrasive cloths and papers, plastic moulds, telephones and steering wheels.

Study aim:  To analyse retrospectively the causes, occupations and investigations of patients demonstrated to have dermatitis from occupational contact with PFRs.

Summary of Results:  27 dermatitis cases were identified (4 irritant and 23 allergic). The commonest causes were from contact with PFR used in fibreglass materials, in binders e.g. brakes, foundry sand, and from adhesives.

Conclusions:  Patients should be investigated for contact allergy by patch testing them with their own resins. PFR‐2 identified by M. Bruze was the best commercially available allergen to screen for contact allergy. Concomitant allergy to formaldehyde and PTBP formaldehyde resin is rare. The possibility of allergy to reactive diluents should be considered in those exposed to epoxy novolac systems.
FS12.5 Chemical analysis of MDI in petrolatum patch test preparations
Authors: Frick Malin , Zimerson E , Karlsson D , Mar Å , Skarping G , Isaksson M , Bruze M
Published: August 2010

Objectives:  Diphenylmethane‐4,4’‐diisocyanate (MDI) is a very common isocyanate which is used in the plastics industry in its’ polymeric form in the production of polyurethane products such as rigid and flexible foams, elastomers (rubbers) and coatings. Previous reports on MDI‐related contact allergy have shown a pattern where patients seem to react to their own MDI‐based work material but not to the commercial patch test preparations of MDI. Therefore, we performed chemical analysis of 14 commercial patch test preparations of MDI.

Materials and Methods:  MDI preparations from 8 European and 4 American dermatology departments as well as preparations obtained from 2 major European suppliers of patch test allergens were analyzed with respect to MDI content using liquid chromatography mass spectrometry (LC‐MS).

Results:  None of the preparations obtained from dermatology departments contained more than 12% of the concentration stated on the label. In most cases the MDI content was only a few percentages or less of the concentration stated. In only 1 commercial preparation the MDI content came close to the declared concentration.

Conclusion:  7 of the 14 preparations were analyzed before the expiry date. Yet, only 1 of them contained a concentration that came close to that stated on the label. Thus, using these preparations patients will be tested with a much lower concentration than intended leading to a high risk of false‐negative reactions and thereby underdiagnosis of allergic contact dermatitis from MDI.
FC03.2 Cumulative incidence of self reported skin disease in hydrotherapists working in swimming pools
Authors: Lazarov Aneta , Navo K , Pardo A , Froom P
Published: August 2010

Objective:  To assess the cumulative incidence and characteristics of self reported skin disease in hydrotherapists.

Methods:  Hydrotherapists, who had completed a hydrotherapy training course answered a questionnaire in reference to newly appeared skin disease. Data were analyzed statistically.

Results:  190 subjects presently working as hydrotherapists were studied. Of them 75.8% were female and 24.2% were male. 80% of the hydrotherapists worked up to 10 000 cumulative hours defined by the formula: working hours per weeks × number of weeks per year × years of work in the pool. 85 of the subjects (45%) reported on the development of skin disease for the first time after starting work at the swimming pool. 21 (11.8%) had a preexisting skin disease. The most frequent symptoms included pruritus, burning, stinging, erythematous patches and xerotic skin on the extremities, trunk and folds. A statistically significant relationship between the cumulative working time and the incidence of dermatological pathology compatible with contact dermatitis was found.

Conclusions:  The incidence of self reported skin diseases, developing for the first time or due to exacerbation of preexisting dermatological conditions, in hydrotherapists working in swimming pools is high. Statistically significant relationship between the cumulative hours of immersion in the pool and the incidence of the dermatological pathology was observed suggesting a dose response relationship between exposure and effect.
FS13.4 Prevention of occupational hand eczema by skin‐care management – results of an intervention study
Authors: Diepgen Thomas L
Published: August 2010

Objectives:  In the prevention of occupational contact dermatitis the usage of personal skin protection measures have a high priority, however there is a lack of intervention field studies to demonstrate its efficacy. Therefore we conducted a field study in a plant of the metal‐working industry and investigated the efficacy of an established skin protection programme.

Methods:  First, a professional dermatological appraisal of the current status and a skin‐protection analysis were carried out for 180 company employees, and a dermatological evaluation of each workplace from the aspect of prevention was conducted. Using the information obtained a skin protection programme for the whole company was devised and subsequently set up. The follow‐up examination was performed eight months later.

Results:  At the beginning of the study 26% of the employees were found to have skin problems related to the work they were doing. In 50% of the cases skin protection was never or only rarely used, with the right kind of skin protection almost never being applied. There was no skin protection programme in place meeting today’s professional dermatological requirements, or at the most there were just the first signs of one. After the programme had been set up and suitable instruction and information given there was a follow‐up observation period of eight months, during which several professional dermatological examinations of the employees were carried out and further instruction (individual prevention) was given. In the final examination only 8.7% of the employees were found to have work related skin problems.

Conclusions:  We could demonstrated that the occurrence of occupationally‐related hand eczema can be significantly reduced by setting up and providing instruction in a skin protection concept matched to the hazards the skin is exposed to at work. Additionally, valuable knowledge and experience were gained on implementing industrial skin protection programmes and performing intervention studies.
P29 Interleukin‐8 in patch‐test blisters is chemotactic and detects allergy
Authors: Bjarnason Bolli , Xu H , Elmets CA
Published: August 2010

Objective:  To investigate interleukin‐8 (IL‐8) as a chemokine for T‐lymphocytes and as a marker of magnitude of contact allergy.

Subjects, Materials and Methods:  Urushiol, the contact allergen of poison ivy, was applied to allergic and anergic volunteers. Suction blisters of urushiol exposed and non‐exposed skin were produced 48 h later and the fluids were analyzed for chemotactic activity for T‐lymphocytes using modified Boyden chambers. Anti‐IL‐8‐antibodies were added to the fluids to investigate their effect on the chemotactic activity. IL‐8 protein concentration of the fluids was determined by ELISA and its correlation with visible test responses was investigated.

Results:  Significant chemotactic activity for T‐lymphocytes was only present in blister fluid from urushiol exposed skin and only from the allergic subjects. The chemotactic activity could be neutralized with the anti‐IL‐8 antibodies. There was an excellent correlation between the IL‐8 protein concentration in blister fluids and the clinical appearance of the inflammatory reactions at the skin test sites.

Conclusions:  The results support the hypothesis that IL‐8 in blister fluid is both chemotactic for T‐lymphocytes and is a sensitive marker of an inflammatory response. Determination of the concentration of IL‐8 proteins in blister fluid of patch tests may be of future use for objective assessment of clinically important contact allergies.
P31 Patch test reactions in the elderly
Authors: Connolly Maureen , Kirkup M , Sansom JE
Published: August 2010

The incidence of patch test reactivity depends on prior exposure, with few studies evaluating elderly

Subjects:
The aim of our study was to address this issue. We reviewed results of elderly patients, (defined ¡Ý 65 years) who attended for patch testing over a five‐year period from January 1999 to December 2003. Patients were patch tested to an extended European standard series and additional series depending on clinical presentation. Results showed 322 (16.4%) of 1968 patients patch tested were elderly, 196 women (60%) and 126 men (40%). Balsam of Peru (Myroxylon pereirae) was the commonest sensitizer among men 21/126 (16.7%), followed by fragrance mix in 10 subjects (7.9%) neomycin in 7 (5.6%) and carba mix in 7 (5.6%). Nickel was the most frequently occurring contact allergen in women, 32/126 (16.3%), followed by fragrance mix in 19 (9.7%), thiuram mix in 19 (9.7%), carba mix in 15 (7.7%) and Balsam of Peru in 14 (7.1%). Investigation of ACD in a multicentre study of all age groups in the UK reported nickel as the commonest allergen at 18.6%, followed by fragrance mix (10.7%) and Balsam of Peru (6.7%). Our study shows nickel and fragrance mix reactions to be lower in this elderly population at 11.5% and 9% respectively, Balsam of Peru positivity being higher at 10.9%. This study suggests that patch testing in elderly patients remains a worthwhile investigation yielding significant positive results.
P42 Cutaneous reactions from non‐steroidal anti‐inflammatory drugs: follow‐up of 4 years
Authors: Galindo Esther Cuerda , Buján J Goday , Jorge B Fernández , Lozano J Rodríguez , Fonseca E
Published: August 2010

Introduction:  Cutaneous reactions due to use of non‐steroidal anti‐inflammatory drugs (NSAID) are frequently described. In the Contact Unit from the Department of Dermatology of Juan Canalejo Hospital, we compiled all cases studied during 4 years (from 2000 to 2003) to analyze the incidence, frequency and type of reactions derived from NSAIDs use.

Material and methods:  We used a NAIDs battery (Aristegui lab.Ò) on 55 patients with clinical suspicion of adverse reaction from NSAIDs. We performed epicutaneous study on 17 and additional photoallergic study, after UVA irradiation (from 5 to 7,5 J/cm2), on 38 cases. In some cases we patched the drug used by patient as is and/or the active substance provided by the laboratory if it was not included on NSAIDs battery. Readings were done following ICDRG criteria at 48 and 96 hours on patch tests and 24 and 72 hours on photopatch tests. Healthy controls were patched.

Results:  22 patients showed positive test: 15 cases were diagnosed as photoallergic dermatitis (etofenamate 5; dexketoprofen 4; ketoprofen 3; piroxicam 2; diclophenac 2 and aceclophenac 1). Five cases were explained as allergic contact dermatitis (etofenamate 2; fepradinol 2 and phenylbutazone 1) and two cases of fixed drug eruption from piroxicam were found.

Conclusion:  In this study we observed that cutaneous reactions due to ketoprofen and piroxicam are still high. It is important to note the high incidence of allergic and photoallergic reactions from dexketoprofen, a recently introduced NSAID, reporting always a cross reaction between ketoprofen and dexketoprofen.
P47 Contact dermatitis to peppermint and menthol in a transdermal therapeutic system
Authors: Foti Cataria , Conserva A , Antelmi A , Lospalluti L , Angelini G
Published: August 2010

A 60‐year‐old non atopic was referred to our Unit due to the onset of severe eczematous contact dermatitis on the lumbar region, following repeated applications of a transdermal therapeutic system (TTS) with flurbiprofen for lumbar pain. Patch testing with the SIDAPA (Italian Society of Allergological, Occupational and Environmental Dermatology) standard series, the TTS as is and the constituents of TTS, including flurbiprofen 2% pet., isopropyl myristate 5% pet., polysorbate 80 5% pet., sorbitan sesquioleate 20% pet., peppermint oil 2% pet. and menthol 1% pet. gave a strong positive reaction to TTS, peppermint oil and menthol and a weak reaction to fragrance mix. Allergic contact dermatitis to peppermint oil and its principal constituent (menthol) is rare. Isolated cases of patients with oral symptoms after the use of mentholated cigarettes, toothpaste flavours and fragrances have been reported. Peppermint oil and menthol are used in TTS with anti‐inflammatory activity for their anesthetic properties and their vasodilatation effects that aid topical drug penetration. Reapplication of the device to the same site, the irritant action of the vehicle or adhesive, the length of occlusion, associated with warm and humid climates, may promote sensitization to menthol otherwise rarely a cause of contact dermatitis, when used in products designed for a brief contact with the oral mucosa. In contact allergies induced by TTS‐treatment patch tests are needed to make a precise identification of the causative agent.
P55 Nordic Occupational Skin Questionnaire (NOSQ‐2002)
Authors: Flyvholm Mari‐Ann , Susitaival P , Meding B , Kanerva L , Lindberg M , Svensson Å , Ólafsson JH
Published: August 2010

Questionnaire‐tools for surveying occupational skin diseases and exposure are needed for comparable epidemiological research, workplace assessments, and evaluation of workplace interventions. The Nordic Occupational Skin Questionnaire Group supported by the Nordic Council of Ministers has developed a standardized questionnaire‐tool for surveys on work‐related skin diseases and skin exposures to environmental factors.

Nordic Occupational Skin Questionnaire (NOSQ‐2002) includes two questionnaires designed for separate purposes. NOSQ‐2002/short is a 4‐page questionnaire for screening skin problems at workplaces. NOSQ‐2002/long is an in‐depth survey tool for research purposes. The questionnaire covers occupational history, atopic symptoms, self‐reported hand or forearm eczema, exacerbating factors, consequences and life impact of dermatoses, self‐reported contact urticaria on hands or forearms, skin symptoms, skin tests, exposures, and protective glove use. For the time being, NOSQ‐2002 is available in English, Danish, Swedish, Finnish and Icelandic. Further translations are welcomed.

The NOSQ‐2002 report includes a review of pertinent literature on questionnaire methods for skin disease studies. Questions on work and exposure can be tailored to specific populations or occupational groups, according to the instructions and recommendations given in NOSQ‐2002/INFO version of the questionnaire.

The NOSQ‐2002 questionnaire files can be downloaded from http://www.ami.dk/NOSQ. The Nordic Council of Ministers has the copyright to the NOSQ‐2002 questionnaires. Use of the questionnaires is free of charge. The NOSQ‐2002 questionnaires and their present and possible future translations cannot be used commercially.
P58 Multisensitization to plants: clinical case
Authors: Santos António Luís , Cunha AP , Barros AM , Barros MA
Published: August 2010

We observed a 65 years old male patient with pruritus, scaling erythema and liquenification areas on the face, neck, forearms and hands. For six years he had a story of episodic crisis of exsudative erythema associated with farm work. The skin biopsy showed irregular acantosis with slight hyperkeratosis and a mild multifocal lymphohistiocytic infiltrate, with many eosinophils. The patch tests with the Contact Dermatitis Portuguese Group of Study standard tray were positive for colophony, perfume mix and lactone mix. The patch tests with plant series were positive to atranorin, usnic acid, alantolactone, Parthenolide, lichen mix, Frulania dilatata, Achillea millefolium and Tanacetum extracts. Treatment was started with oral prednisone and hydroxyzine plus topical hydrocortisone and emollient cream with great improvement. The patient was advised about the avoidance of possible allergens sources. This kind of multisensitization to plants is an uncommon finding and poses diagnostic and therapeutic problems. This patient had a sustained recovery by avoiding farm work and by removal of in house plants.