bluuebunny/crossref_metadata_2025 huggingface dataset:
FS11.3 Contact allergy to the sesquiterpene lactone calocephalin
Authors: Hindsén Monica , Christensen LP , Paulsen E
Published: August 2010

Background:  A 63‐year old female gardener developed eczema on her hands, arms and face. She suspected cushion bush, Calocephalus brownii F. Muell., a plant introduced in Sweden by her. This plant belongs to the Asteraceae family.

Methods:  Patch testing with our standard series, plant series and acetone extract of cushion bush. The predominating sesquiterpene lactone (SL) calocephalin identified in the plant extract was patch tested in the patient and 20 controls. Calocephalin was isolated from the plant extract of cushion bush by column chromatography and preparative high‐performance liquid chromatography (HPLC) and identified by mass spectrometry and nuclear magnetic resonance (NMR) spectroscopy.

Results:  The patient was negative to the standard series but positive to parthenolide and to the cushion bush extract. Likewise, positive reactions to cushion bush extracts were seen in SL‐mix positive but not in negative patients. Parthenolide was not present in the plant extract as shown by gas chromatography‐mass spectrometry (GC‐MS) analysis, while the guaianolide calocephalin was identified as the major SL. The patient tested positively to calocephalin while the controls tested negatively.

Conclusion:  The plant cushion bush can cause occupational allergic contact dermatitis and the major contact sensitizer in the plant is the SL calocephalin.
FS12.2 Occupational allergic contact dermatitis from UV‐cured adhesive
Authors: Francalanci Stefano , Giorgini S , Gola M , Sestini S , Moretti S
Published: August 2010

A 35‐year‐old woman presented with a 8‐month history of scaling, hyperkeratotic and fissured lesions of the fingertips of the first three fingers of both the hands. She referred the healing of the dermatitis during the summer holidays. She was employed in a small firm where she was used to glue together silver components with glass ones of decorative pieces. For this aim, she applied a glue (Loxeal UV 30–20) cured by exposition to UV light coming from a proper lamp. The material safety data sheet (MSDS) indicated that the glue contained hydroxyethyl methacrylate (HEMA) and hydroxypropyl methacrylate (HPMA). Patch tests performed with the standard SIDAPA series gave negative results; patch tests carried out with an additional one (acrylic adhesive series) showed positive reactions towards glue components (HEMA,HPMA) and towards other acrylates (possible cross‐reacting). An inspection performed in the work‐place showed that the patient was in contact with the glue not only when she applied it on the components, but particularly when she handled the bottle cap (splashed with the glue) in its opening and closing. After the changing of her occupation, the patient has not presented relapse of the dermatitis. The UV‐cured acrylic resins are known for some time to be a frequent cause of occupational allergic contact dermatitis in dentists and in printing industry. The case reported shows a different exposition source towards these resins, i.e. from UV‐cured acrylate adhesive employed for sticking metal pieces with glass ones.
FC03.4 Eczema, skin symptoms and risk factors among hospital employees
Authors: Bach Bodil , Flyvholm M‐A , Villadsen E
Published: August 2010

Hospital employees and especially nurses have a high frequency of work‐related skin diseases. The purpose of the present study was to collect baseline data in order to plan an intervention project with focus on skin problems among different hospital job groups reporting high frequencies of work related skin problems or eczema. Self‐administered questionnaires based on a standardized questionnaire for work‐related skin diseases and exposure (NOSQ‐2002) were used. A total of about 1.900 employees from all job groups at the hospital where invited to participate. Due to anonymous distribution of the questionnaires it was not possible to administer reminders. The overall response rate was 65%. Among the 1.246 respondents the frequency of self‐reported eczema within the last year varied between different departments from 7% to 44%. Assessed by job group the eczema frequency varied from 8% to 31%, with the highest frequency found among nurses and assistant nurses.
FC04.1 Some new and unexpected allergens in cosmetics
Authors: Goossens An
Published: August 2010

Labels on cosmetics with statements such as ‘recommended by dermatologists’, ‘allergy‐tested’, ‘hypo‐allergenic’, and more recently ‘for use on intolerant’ or for ‘sensitive skin’ have become very popular. Indeed, many ingredients are used precisely because of their low irritancy potential. However, this does not preclude the occurrence of contact allergic reactions from such cosmetic products. During the last few months several of these substances have been identified as allergens. Examples are: – Alkylglucosides, e.g. coco‐, decyl‐, and laurylglucosides, which are condensation products of the corresponding fatty alcohols with glucose, are widely used as emulsifiers in skin‐care products, mild surfactants and cleansing agents, as well as in fragrance products, hair dyes, sunscreens and tanning products. – Ethylhexylglycerin (syn.: octoxyglycerin) is used as a skin conditioning agent (and for miscellaneous purposes). – Methoxy PEG‐17 and PEG‐22/dodecyl glycol copolymers, which are alkoxylated alcohols and synthetic polymers, are used as emulsion stabilizers and suspending and viscosity‐increasing agents, and also as skin‐conditioning agents. – Butylene glycol and pentylene glycol are aliphatic alcohols with applications similar to those of propylene glycol, which is considered to be more irritant and allergenic. These agents are widely used in a wide variety of cosmetic products because of their solvent, humectant and antibacterial effects. Butylene glycol is also usd as a fragrance ingredient and as a skin conditioner.
FS13.2 Intervention on work‐related skin problems among gut cleaners
Authors: Flyvholm Mari‐Ann , Mygind K , Jensen A , Jepsen KF , Sell L , Villadsen E
Published: August 2010

Work‐related skin problems are frequent in the food processing industry. A randomised intervention study with a one‐year follow up was carried out among gut cleaners in order to prevent work‐related skin problems due to wet work. The effects of the intervention were primarily measured by telephone interviews using questionnaires based on a standardized questionnaire for work‐related skin diseases and exposure (NOSQ‐2002).* The intervention activities included an evidence‐based prevention program and an evidence‐based method for implementation. Six of the 18 participating departments were randomly assigned to the intervention group and the remaining 12 departments to the comparison group. A total of 644 employees responded in the baseline interview and 622 in the follow‐up interview carried out a year later. The participation rates were 87,5% and 71,6% respectively. Among the 495 participants answering in both interviews the frequency of eczema on hands or forearms within the past 3 months was reduced significantly by more than 25% in the intervention departments. A minor increase was observed in the comparison departments. This study has shown that even in jobs without the possibility to reduce high exposure to wet work work‐related skin problems can be reduced by proper preventive measures.

*) Susitaival P, Flyvholm M‐A, Meding B, Kanerva L, Lindberg M, Svensson Å, Ólafsson JH. Contact Dermatitis 2003;49:70–76.
PCS.05 Establishment of safe exposure limits for the induction of allergy. Practical examples
Authors: Menné Torkil
Published: August 2010

The WHO criteria for drug allergy can be adapted as guidelines for primary sensitisation from consumer products or occupational exposures. In case a person with a formerly healthy skin, develops allergic contact dermatitis after a specific exposure (a product or occupational exposure) has a positive patch test to specific chemical present in the product and ideally a positive either patch test or use test to the product during re‐exposure primary sensitisation is likely.

Allergic contact sensitisation is a unique toxicological event (e.g. compared to cancer) as there is a direct (time and skin area) correlation between exposure and disease and the basic damage on the individual can be identified by the diagnostic patch test. Primary sensitisation may occur after single exposure to potent allergens, experimental from DNCB, in the US poison ivy, occupational accidental exposure to isothiazolones (in%) or from hair dying with PPD and its derivatives as a flare‐up reaction occurring 1–2 weeks after the original exposure.

The ongoing epidemic caused by methyldibromo glutaronitrile (MDGN) provides unique options for studying primary sensitisation from consumer products as the clinical reactions are often very severe and patch test reaction with the products often exceeds the strength of the standard patch test response. Chemical analysis of the products involved uniformly illustrates the presence of MDGN within the legal permitted concentration. At the start of the epidemic, primary sensitisation was mostly seen from leave on products. After EU actions in 2002 against the use of MDGN in leave on products primary sensitisation from this preservative is now caused by wash off products. This observation is significant as it underscores the effect of specific exposures for primary sensitisation from consumer products but also the fact that primary sensitisation from a moderate to strong hapten is possible from wash off products. The MDGN story has illustrated that human data are pivotal for the current risk assessment – risk management. No new chemical should be permanently permitted in consumer products before significant post marketing data, collected after stringent criteria, are public available and scrutinised by an independent scientific committee.

Human sensitisation data has successfully been used to introduce regulation of nickel exposure from consumer items. The year 2000 EU regulation has been in use in Denmark for more than 10 years. A significant decline in both induction and elicitation of dermatitis from nickel releasing items has been observed. Health economists have calculated that the direct savings from the regulation amount to 1.2 bill Euro over a 20‐year period in a population of 5.2. mio individuals.

Translated to the whole EU‐region substantial gains can be achieved by improving the contact allergy risk assessment – risk management process.
PCS.06 Establishment of safe exposure limits for the elicitation of allergy – fragrances
Authors: Johansen Jeanne Duus
Published: August 2010

Safe exposure limits for the elicitation of fragrance contact allergy have been a subject of research in several EU‐funded studies, against the background of high frequencies of contact allergy to certain fragrance ingredients. Elicitation studies can be easily performed in already sensitised individuals, they bear no ethical problems and by using simulated realistic exposures, safe thresholds relevant for exposure can be determined. The challenge in establishing safe thresholds for fragrance ingredients is the many different applications and thus potential exposures to fragrances. Deodorant exposures have been regarded a worst case assumption model for safety assessment and the fragrance ingredients: isoeugenol, hydroxycitronellal and cinnamic aldehyde, have been studied, showing that current exposure to these ingredients in some deodorants exceeds the safe limits for elicitation. Recent investigations show that the impact of fragrance allergy on hand eczema may need to be looked at a different angle, as it appears that it is more the combined exposures to several allergens and irritants that matters than the action of a single ingredient. At the moment, studies are being performed to elucidate whether dose‐response patch test data can be used more systematically as the basis of safety assessments. This will make studies even easier and it will be possible to provide data on more allergens than at the present time.
P20 Red tattoo reactions
Authors: Connolly Maureen , Archer CB , Dunnill GS , Kennedy CT , Sansom JE
Published: August 2010

Tattoos are becoming increasingly popular, although reactions to tattoos remain relatively uncommon. We describe 4 patients with a variety of red tattoo reactions, one responding well to intralesional steroid therapy.

Case 1:  A 50‐year‐old man presented with a florid, inflammatory reaction confined to the red area of his forearm tattoo. Biopsy showed a dense lymphocytic and focal macrophage response to tattoo pigment. Mass spectrometry of biopsy tissue revealed high concentrations of titanium and iron. Patch testing was negative. Intralesional steroid injection has produced a marked improvement.

Case 2:  A 42‐year‐old man presented with an inflammatory reaction affecting the red area of his leg tattoo. Biopsy revealed a florid lymphoid reaction.

Case 3:  A 30‐year‐old man presented with an eczematous reaction within the red/brown pigmented areas of his tattoos, which was exacerbated by sun exposure. Patch testing showed a (+) positive reaction to cadmium after 96 hours. Photo patch testing was negative. The reaction settled spontaneously within 12 months.

Case 4:  A 37‐year‐old woman presented with a florid, indurated inflammatory reaction involving the red area of a shoulder tattoo. Patch testing revealed a (++) and (+) positive reaction to nickel and cobalt respectively with a doubtful (?+) reaction to mercury 0.5% in petrolatum after 96 hours. Tattoo reactions, especially red tattoo reactions can present with a spectrum of histological changes, including lichenoid, granulomatous, hypersensitivity, nodular, pseudolymphomatous or sarcoidal reactions. One of our cases responded well to intralesional steroid injection and one case resolved spontaneously.
P22 Patch testing with p‐toluene diamine (PTD) preparations of different ages
Authors: Geier Johannes , Lessmann H , Uter W , Hildebrandt S , Schnuch A
Published: August 2010

Background:  PTD, a component of oxidative hair dyes, is a frequent sensitizer in hairdressers. Investigations on the stability of the patch test preparation PTD 1% pet. revealed a decline of the PTD concentration to 0.1% within 6 months, possibly due to a reaction of PTD molecules to dye complexes. This raises the question if the long‐term diagnostic quality of the PTD preparation is hampered by chemical changes.

Objective:  To systematically compare intra‐individually patch test results obtained with three PTD patch test preparations of different age, tested synchronously in a multicenter study of the German Contact Dermatitis Research Group (DKG).

Methods:  3 PTD preparations, produced in January 2002 (batch A), August 2001 (batch B), and April 2001 (batch C), were patch tested in 177 patients from March to December 2002. Patch testing was performed blinded, with respect to the production date.

Results:  There were 150 concordant reactions to batch A, B, and C, i.e. 133 negative, 1 doubtful (?), 11 weak positive (+), 3 strong positive (++ and +++), and 2 irritant reactions. In 27 patients, discordant reactions to batch A, B, and C had been observed. Altogether, 22 positive reactions were noted to batch A, and 19 to batch B and C, respectively (difference not significant). There was no clear cut time trend concerning the occurrence of positive or discordant reactions.

Conclusions:  Reproducibility of patch test reactions was within a normal range. The chemical changes mentioned above apparently do not affect the diagnostic quality of the PTD patch test preparation.
P23 Allergic contact sensitization in Spanish patch‐tested patients in 2001
Authors: Sanchez‐Perez Javier , De Frutos J Ortiz , Bravo B García , Salazar L Conde , Muntañola A Alomar , De la Cuadra Oyanguren J , Fernandez‐Redondo V , Juanena D Guimaraens , Vozmediano JM Fernandez , Manrique P , Romero A Miranda , Alvarez B Piñeiro , Serna M Rodriguez , Sagrera C Romaguera , Pedreño P Sanchez , Baldrich E Serra , Silvestre JF , Vilaplana J Vilaplana
Published: August 2010

Objective:  The first Spanish patch‐test study of patients with contact dermatitis was performed in 1977. We aimed to determine the prevalence of hypersensitivity for Spanish standard allergens in patients suspected of contact dermatitis in 2001.

Methods:  A total of 3832 patients of 13 dermatological centers were patch‐tested with Spanish standard series. Age, gender, occupation, dermatitis site and type, and positive patch test were tabulated.

Results:  2300 female and 1532 male patients, aged 0 to 70 years were observed with contact dermatitis. Origin of eczema was occupational in 16.66% of patients. Eczema was located on hands in 54.34% of cases. Allergic contact dermatitis in 31.02% and irritative contact dermatitis in 15.88% were the most frequent diagnosis. Positive patch tests was observed in 55.11% of patients. Prevalence of positives reaction was obtained with nickel (26.64%), cobalt (9.89%), chrome (8.66%), PPDA (5.27%), thimerosal (5.21%), fragance mix (5.03%), Kathon CG (4.04%) and thiuram mix (2.87%).

Conclusions:  The results emphasize that nickel, cobalt, chrome are by far the most common allergens. A increase in the frequency of allergic patch test reactions to nickel has been noted (18,78 in 1977; 26,64 in 2001). However the contact sensitivity to cobalt, chrome and thiuram mix has decreased. Currently, allergy to cosmetics constitutes a significant portion of the cases of contact dermatitis.
P24 Increasing prevalence of sensitization to preservatives in children
Authors: Giusti Francesca , Mondino M , Seidenari S
Published: August 2010

The aim of this study was to evaluate the frequency of contact sensitization to preservatives in a pediatric population and to compare the data to our previous findings referring to the period 1988–1994. From January 1995 to December 2002, 1255 patients aged 7 months‐12 years, 583 boys and 672 girls, with suspected allergic contact dermatitis underwent patch testing with our pediatric series of 30 allergens including 5 different preservatives: methyldibromoglutaronitrile, methyl(chloro)isothiazolinone, imidazolidinyl urea, paraben mix, and formaldehyde. Of the 1255 children tested, 108 (8.6%), 52 boys and 56 girls, showed positive reactions to 1 or more of the preservatives listed above. In particular, 55 subjects reacted to methyl(chloro)isothiazolinone, 22 to methyldibromoglutaronitrile, 20 to paraben mix, 17 to formaldehyde, and 13 to imidazolidinyl urea. Among our preservative‐positive children, 77% of patients reacted to other haptens of the series, and 44% were affected by atopic dermatitis. In comparison with our previous data referring to the period 1988–1994, a significant increase has been observed in the frequency of positive reactions to methyldibromoglutaronitrile, paraben mix, and formaldehyde. Our findings confirm the importance of patch testing children with preservatives since the wider and wider use of cosmetics in the pediatric age.
P25 Accuracy of serial dilution concentrations for intradermal skin testing: a neglectable problem?
Authors: Bircher Andreas , Figueiredo V , Scherer K , Surber C
Published: August 2010

Skin tests are important diagnostic tools. To establish reactivity, a single allergen test concentration is considered to be sufficient. To diagnose sensitivity serial dilution or endpoint titration is recommended. Skin testing in drug allergy is complex, since pathogenetic mechanisms are diverse, and for many drugs cut‐off skin test concentrations have not been established. Therefore, after a negative prick/puncture test with the stock solution, intradermal tests with serial (ten‐fold) dilutions are recommended. Surprisingly in most publications dealing with serial skin test dilution, the technique is not described in detail.

Aim:  Comparison of the variability of test substance concentrations produced with two serial dilution techniques conducted by experienced allergy nurses.

Methods:  Two allergy nurses produced dilution series. Isosulfane blue was chosen as test substance, since it enabled easy and sensitive detection. Dilution series of isosulfan blue (aqueous solution of 10 mg/ml) from 1:10 to 1:10’000 were produced under sterile conditions by two dilution techniques: 1) Dilution in vials: 0.5 ml isosulfane blue solution was serially transferred with 1 ml tuberculine syringes to vials containing exactly 4.5 ml NaCl 0.9% 2) Dilution in syringes: 0.1 ml isosulfane blue solution with the higher concentration was aspirated into 1 ml tuberculine syringes followed by 0.9 ml NaCl 0.9%. These procedures were compared with a controlled experiment carried out using piston‐stroke pipettes. The concentrations of isosulfan blue in all dilutions were determined by UV/VIS‐spectroscopy and external standard calibration.

Results:  In almost all samples the concentrations were higher than expected. In vials the concentrations varied from 83 to 360%, in syringes from 83 to 711% of the expected values. The dilution in vials gave consistently better results than dilution in syringes. A considerable interindividual variability was observed between the conducting nurses, however variability over time was smaller.

Conclusions:  In routinely performed serial dilutions of allergen test preparation considerable deviations from the expected allergen test concentration have been observed. This might be of minor importance for an individual patient, however, in establishing e.g. cut‐off concentrations for non‐irritant drug concentrations or in multicenter studies such variations may result in major errors. Quality management of skin testing should not only include the recording, injection technique and test reactivity evaluation, but also the exact description of the preparation of test dilutions. In clinical routine dilution techniques should be applied, which give more accurate results.
P30 Transparent plastic foils allow a short patch‐test application time
Authors: Bjarnason Bolli , Fischer T , Elmets CA , Flosadottir E
Published: August 2010

Objective:  To investigate whether application of allergic patch tests with transparent semi‐occlusive adhesive plastic foils yields higher test sensitivity than when tapes are used. To study whether such foils compared to tapes allow a shorter application time of tests.

Methods:  We applied different doses of budesonide printed on polyester squares and vehicle control squares to budesonide allergic subjects for 4 days. Each subject was tested with a set of tests both with a tape and a foil. We assessed all tests when they had been detached and additionally those applied with foils at earlier time points. All assessments were performed both visually and with a laser Doppler perfusion imaging technique.

Results:  Test sensitivity is higher with foil applications than when tapes are used and the perfusion is higher with the foils in many cases. The foils allow detachment of visually positive tests before 48 hours in some subjects, regardless of dose.

Conclusions:  Test applications with transparent semi‐occlusive adhesive plastic foils is sensitive and should be considered for application of patch tests when a short application time is important as when tests are carried out with occupationally hazardous allergens or when test substances containing allergens are expected to be irritating.
P34 Reproducibility of the positive patch test reactions with the TRUE Test
Authors: Jensen Charlotte Devantier , Andersen KE
Published: August 2010

The patch test results of patients tested at least twice at our clinic during a period of 11 years were analyzed with regard to reproducibility of the positive patch test reactions found in the first patch testing session.

A retrospective analysis of 257 patients who have been tested with the TRUE Test at least twice between 1991 and 2002 and had a minimum of one positive reaction in the first testing session was done. Test reactions were read routinely after 3 and 5–7 days.

In the first testing session a total of 299 positive reactions were found. Of these allergens, 151 (51%) stayed positive in the second test, 31 (10%) produced a doubtful reaction, 67 (22%) a negative response, and 50 (17%) were not retested because of strong positive reactions in the first test. Of the individual allergens, positive reactions from thiuram‐mix, kathon CG and colophony were the most reproducible.

If it is assumed that allergens which were not retested because of strong positive reactions would have shown positive reactions in a retest, a total of 68% of positive reactions were reproduced. A multitude of factors, such as: avoidance of relevant allergens between tests, diminished sensitivity, retesting within a period of more or less active dermatitis, different observers, methodological error, and prior false‐positive responses, influence the reproducibility of patch tests. The results will be put in perspective.
P35 Photo‐, phyto‐ and frostbite‐ provoked cases of contact dermatitis cured with o3
Authors: Krivatkin Sergey L , Krivatkina EV
Published: August 2010

Objectives:  To show cases of contact dermatitis (CD) provoked by different factors and possibility of their treatment with ozone application.

Methods:  Description of clinical cases:

Patient S., female, 17 years old, came to dermatologist with complaints on erythema and vesicles, sense of burning on the face during two weeks. The patient works on the market, exposures by sun. As a result of a talk with the patient, new perfume as a possible reason of photoallergic reaction was suspected. The patient was successfully treated by use of ozone therapy: 6 autochemotherapy minor (AHTmin) treatments were applied. By the end of the course crusts and hyperpigmentation only were observed.

Patient T., male, 36 years old, suffered from erythema and vesicles, itching and sense of burning on both hands and arms for 3 days. During weekend he had contact with cow‐parsnip plant. The patient got 5 AHT minor treatments: clinical recovery was registered.

Patient S., 36 years old, frosted his hands two weeks ago. When he came to dermatologist, erythema, vesicles, erosions and crusts on the backs of the hands were observed. Ozone therapy (AHTmin – 5 treatments plus ozonized water externally) was successfully applied: full recovery was registered.

Summary of results:  Different cases of CD were successfully treated by ozone therapy use.

Conclusions:  CD provoked by different factors can be cured with ozone.
P39 The accuracy of material safety data sheets: reporting of skin irritants and skin sensitisers
Authors: Keegel T , Saunders H , Nixon Rosemary
Published: August 2010

Objectives:  In Australia the National Occupational Health and Safety Commission (NOHSC) requires that manufacturers provide Material Safety Data Sheets (MSDS) for all hazardous materials. However the accuracy of MSDS has not previously been assessed, utilizing the specified NOHSC criteria for hazardous substances.

Methods:  100 consecutive product MSDS were collected from workers with potential work‐related cutaneous exposure, attending an occupational dermatology clinic. Manufacturers were contacted to verify the ingredients of each product. MSDS were evaluated using for skin irritants and skin sensitisers, and for compliance with the NOHSC criteria for hazardous substances (sensitisers present at a concentration >=1%, irritants present at a concentration >=20%). All sensitisers were checked for clinical significance (relevant positive patch test result) to the worker’s dermatitis.

Results:  On manufacturer follow‐up, 58% of the MSDS satisfied the NOHSC criteria. However, 3 products omitted sensitisers, present at <1%. Importantly, one sensitiser was clinically significant. 19% failed to meet the NOHSC criteria. 17 MSDS omitted sensitisers at >=1%, two omitted irritants at >=1%. Irritants were specified correctly in 19/22 cases, whereas sensitisers were specified correctly in only 30/71 cases (p = 0.0003). Non‐compliant MSDS may have been as high as 42%, as insufficient information to enable assessment was provided on manufacturer follow‐up regarding the percentage concentration of 1 unlisted irritant and 22 unlisted sensitisers.

Conclusion:  MSDS are significantly inaccurate with respect to skin sensitisers. Sensitisers and percentage concentration are frequently omitted from MSDS, thereby providing inadequate information for the prevention of skin sensitisation for workers.
P40 A case of contact dermatitis to polyethylene glycol
Authors: Tanaka Shin , Matsumo Y , Tamada Y
Published: August 2010

A 58‐year‐old female presented with a rash around an ulcer of livedo vasculitis. She had applied ActosinTM ointment (Bucaladesine Sodium) on the ulcer 1 month before. A patch test with ActocinTM ointment (as is) resulted in a ?+ reaction on D2 and + on D3. Polyethyleneglycol (10%pet.) gave a + reaction on D2 and + on D3. A skin biopsy of the positive reaction showed contact dermatitis. Patch tests to Bucaladesine Sodium and other components of ActosinTM ointment were negative. The eruption disappeared after 2 weeks of treatment with a topical corticosteroid.
P41 Contact allergy to clindamycin
Authors: Sinovich Vania , Powell S
Published: August 2010

A 42‐year–old non‐atopic lady was treated with twice daily 2% clindamycin vaginal cream (Dalacin®) and ster‐zac (bath antiseptic) for hidradenitis of the groins. She also had mild facial acne.

She developed genital pruritus and erythema which quickly became generalised which she related to the use of ster‐zac. However, when she applied clindamycin to her face a few weeks later, she developed a severe reaction which became generalised.

The patient was patch tested with an extended European series, the clindamycin cream, ster‐zac 1:100 and E45 which had also been used. Initially she developed an angry back picture which was difficult to assess but the standard testing was negative.

Repeat patch testing to the constituents of the topical preparations used produced a reaction to clindamycin 1%, 5% and to dalacin cream ‘as is’.

Discussion:
Coskey1 first described contact allergy to clindamycin in 1978. Since then there have been 6 further case reports. Mild local adverse reactions to topical clindamycin preparations such as burning, excessive dryness, itching and erythema are not uncommon, but more serious adverse events should prompt exclusion of a contact allergic component. Despite topical clindamycin being used for more than 25 years, sensitisation appears uncommon.
P45 Neomycine sulfate patch tests
Authors: Bjarnason Bolli , Flosadottir Ellen
Published: August 2010

Objective:  The purpose of this study is to investigate if patients with neomycin sulfate allergy may develop test responses that are unclassifiable by commonly used assessment scales but which should be considered positive.

Materials:  16 patients who tested positive to neomycin sulfate patch tests are retested with different dose levels and application times. Test areas are assessed visually up to 11 days.

Results:  Three types of reactions were observed. The first type was characterized by erythema and diffuse infiltrate. Some of these had in addition either discrete papules or both papules and vesicles on their surface. The second type of reaction initially developed large perifollicular papules which later developed into coalescent erythema and diffuse infiltrate. The third type of reaction exhibited perifollicular papules only which declined over time. This type was unclassifiable by commonly used assessment scales. All types of reactions were of clinical significance.

Conclusion:  The results support that universal assessment scales for patch‐test responses due to different test agents may be inappropriate for assessment of neomycin sulfate patch tests. The clinician should only consider assessment scales as an aid in the assessment of test responses and be aware that morphology of test responses may differ between test agents and test techniques.
P50 Occupational dermal exposure to permanent hair dyes in hairdressers
Authors: Lind Marie‐Louise , Boman A , Sollenberg J , Johnsson S , Hagelthorn G , Meding B
Published: August 2010

Objective:  To assess occupational dermal exposure to permanent hair dyes in hairdressers.

Methods:  Dermal exposure was assessed in 31 hairdressers using a previously evaluated method, hand wash sampling with bag rinsing. The measurements were performed in hairdressing saloons during working hours. Hand wash samples were collected from each hand before start of the hair dyeing process, after application of the hair dye and after cutting the newly dyed hair. 13 of the hairdressers did not use gloves during application of the hair dye, and during cutting of the dyed hair no one used gloves. The samples were analysed for aromatic amines and resorcinol using an HPLC‐method.

Results:  After application of the hair dye PPD (p‐phenylenediamine) was found in samples from 1 hairdressers (148–185 nmol/hand), TDA (toluenediamine) in samples from 12 hairdressers (range 10–735 nmol/hand) and resorcinol in 22 individuals (range 19–769 nmol/hand). In the samples taken after cutting the dyed hair PPD was found in 2 hairdressers (range 36–358 nmol/hand), TDA in 14 (range 8–361 nmol/hand) and resorcinol in 20 (range 10–725 nmol/hand.

Conclusion:  Skin exposure to aromatic amines and resorcinol was detected in more than half of the hairdressers after application of hair dye and also after cutting newly dyed hair. To reduce exposure improved skin protection is important.
P52 Contact dermatitis due to computer’s mouse
Authors: Fernandez‐Redondo Virginia , Suarez Amor O , Toribio J
Published: August 2010

Background:  Introduction of informatics has facilitated the apparition of lesions affecting the hand responsible of mouse movement. Different cases of contact dermatitis related to the use of personal computers have been published in the last years and two new morphologic patterns within cutaneous pathology affecting hands have been described in direct relationship with professional occupation, named generally “computer fingers” and “computer palms”.

Case report:  We present a 7‐patient series presenting lesions suggesting contact dermatitis after continued use (min 8 hours/day) of personal computer from a total of 700 patients revised. Patch tests including standard series of the GEIDC, series for plastics and glues and others related to specific details of each patient were performed in all cases. Six of our patients presented lesions in the 2, 3 and 4 fingers of the right hand while the other one was affected in the right hand palm. In our patients, all the epicutaneous tests were negative or without relevance, suggesting a mechanical cause to the occupational dermatitis presented.

Comments:  Products used in the fabrication of ABS plastics, employed to make personal computers mouse, such as ftalates, cobalt salts and resorcinol monobenzoate have been described as possible allergens. However, concentration of these allergens is too small to ensure a causal relationship. Pressure or an excessive sweating could facilitate these reactions. Wide use of informatics nowadays obliges us to consider those factors in patients presenting chronic dermatoses in their hands. Furthermore, better ergonomics in work places could prevent this kind of occupational dermatitis.
P53 Hand contact dermatitis in jewellwery 2 cases
Authors: Sanchez‐Politta Sabrina , Piletta P
Published: August 2010

The production of jewellery is currently mostly industrial and the jewellers perform only one or two stages in the manufacturing process. The jewellers make jewellery by hand in small workshops and are more polyvalent: they shape the metal with pliers or hand tools or cast it in moulds, assemble the individual parts with glues, carve metal, diamonds and other stones, clean metals with soaps and ultrasonic baths. The occupational dermatitis is of irritant nature (acid and alkalis in metal cleaners, soaps, detergents, metal dust, abrasions from polishing wheels and emery paper, heat, adhesives, etc) and allergic nature (potassium dichromate, 2‐mercaptobenzothiazole, ammoniated mercury, carba mix, epoxy resin, mercapto mix, formaldehyde, nickel, colophony). We report the cases of two jewellers working in workshops.

A 47 year old atopic woman already known for a sensitivity to metals (nickel, potassium dichromate and cobalt) developed recurrent vesiculo‐pustular erythematous lesions of both palms with occasional infections treated with systemic antibiotics and topical steroids. Patch tests were performed for the European standard series, woods, and personal series. There were positive + reactions at 96 h to colophony, palladium, and personal waxes. Information obtained through the manufacturer revealed colophony in the waxes frequently used by jewellers to fix the precious stones to woods and metal allowing the stones to be carved. A 47 years old atopic man working as a jeweller for 32 years developed recurrent eczematous lesions of the fingers of the right hand. Patch tests were performed for the European standard series, preservatives, plastics, acrylates and personals series and were positive + + at 96 h for urea formaldehyde, diethylenetriamine, araldite hardener and the soap used to clean the jewels. Uncommonly this contact allergy is not due to the epoxy resins themselves but to the hardener. The urea formaldehyde and the diethylenetriamine are in fact used as epoxy resins hardeners. There were no reactions to the araldite resin but there was one to its hardener.

In conclusion we report two unusual cases of hand contact dermatitis in jewellers. Because jewellers are exposed to a variety of substances, to detect the allergens the inquiry must be accurate and extensive patch testing may be required. Common allergens are compounds of uncommon substances and tools and uncommon allergens are compounds of well‐known sensitizers.
P57 Allergic contact dermatitis to compositae mix in children
Authors: Fortina Anna Belloni , Romano I , Marciani Magno F , Peserico A , Zacchello F
Published: August 2010

Background and aim:  Recent studies have demonstrated that contact sensitization to Compositae is not uncommon in adults. However, to our knowledge, no data are available in children. Our purpose was to investigate the prevalence of contact sensitization to Compositae in a pediatric population.

Methods:  434 consecutive pediatric patients (205 M; 229 F; mean age 6,7„,,b3,4 years) with suspected allergic contact dermatitis were patch tested with 30 haptens comprising Composite mix 5%(Tenacetum volgare, Arnica montana, Partenolide, Chamomilla recutitia, Achillea millefolium) at the Dermatology Unit of the Department of Pediatrics in Padua.

Results:  11 patients (7 M; 4 F; mean age 5,6„,,b2,8 years) had a positive patch test reaction to Compositae mix. In all these patients dermatitis was localized on the face and/or on the hands. Most of them had more than one positive reaction. 6 were affected by atopic dermatitis, 2 had a personal history of mucosal atopy and one had both. In 8 patients (5 with atopic dermatitis, 2 with mucosal atopy) the reaction was considered clinically relevant.

Conclusion: It might be useful to add Compositae mix to the pediatric screening series, when investigating dermatitis of air‐exposed areas in children with atopic diseases.
P61 EPOX 2002: concomitant sensitizations to epoxy resin components
Authors: Geier Johannes , Lessmann H , Jappe U , Hillen U , Uter W , Schnuch A
Published: August 2010

Objective:  The study EPOX 2002 is performed to detect the most frequent allergens in epoxy resin systems (ES) currently in use. In particular, concomitant test reactions are analysed to identify possible ‘indicator’ allergens for a future ES test series.

Methods:  Multicenter study within the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK) with 27 ES components.

Results:  From Oct. 2002 to Nov. 2003, 120 patients have been tested with the preliminary ES series. Of the 49 patients reacting to epoxy resin based on diglycidylether of bisphenol F (DGEBF), 44 also reacted to the standard epoxy resin based on diglycidylether of bisphenol A (DGEBA), i.e., 90%(95%‐CI [confidence interval]: 78%‐97%).

Out of 21 patients positive to 1,4‐butanediol diglycidylether (BDDGE), 18 also reacted to 1,6‐hexanediol diglycidylether (HDDGE)(86%; 95%‐CI: 64%‐97%). All 8 patients with allergic reaction to cresyl glycidylether (CGE) also reacted to phenyl glycidylether (PGE). Concomitant reactions to PGE and p‐tert butylphenyl glycidylether (PTBPGE) occured in 9 patients, while 5 patients reacted to PGE without reaction to PTBPGE and 6 patients vice versa.

Conclusions:  Immunological cross sensitization as well as frequent concomitant exposure to DGEBA and DGEBF epoxy resins is well known. Our data support testing a DGEBA resin as an indicator. HDDGE might serve as an indicator allergen for BDDGE; however, the sample size is too small yet to make a final decision. PGE obviously is a valuable tool to detect sensitization to CGE, but not to PTBPGE.
P64 Shoe contact dermatitis
Authors: Pereira Ofélia , Araújo A , Ribeira S , Rozeira J
Published: August 2010

Because of its numerous etiologies, foot dermatitis can be difficult to diagnose despite of thorough history and physical examination. The differential diagnoses are challenging and include allergic contact dermatitis, dyshidrosis, juvenile plantar dermatosis, atopic dermatitis, lichen planus.

Methods:  In the Cutaneous Allergology Unit of the Department of Dermatovenereology of Pedro Hispano Hospital, between 1999 and 2003, 804 patients were observed with suspicion of contact dermatitis. In 9,3% there was a history of recurrent foot dermatitis. All these patients were patch tested with GPEDC standard and shoe series and shoe fragments.

Results:  Twenty‐five patients revealed shoe contact dermatitis with positive reactions to the series tested, with an average age of 40 years. The dermatitis involved the dorsal aspect of the foot in 20 patients and the volar aspect in 8, the lateral aspects in 4, typically sparing the instep and flexural creases of the toes. The most common allergen were para‐tertiary‐butylphenol formaldehyde resin – PTBFR (12 patients‐48%), mercapto mix (7 patients‐28%), potassium dichromate (24%), mercaptobenzothiazole (24%).

Conclusions:  The most common causes of shoe contact dermatitis were glues, followed by rubber components and chromated leather. As in other studies the most common allergen in shoe dermatitis in Portugal is PTBFR in neoprene adhesives. Rubber components (accelerators) were the second more frequent allergen in this study, probably a direct result of improved fixation of chrome and a change in footwear style and chrome sensitivity explains leather allergy. Other causes of foot contact dermatitis are iatrogenic complication, clothing (socks), cosmetics, adhesive tape and professional etiology.
P66 Occupational contact dermatitis from glues
Authors: Hillen Uwe , Geier J
Published: August 2010

Objective:  Exposure to adhesives and glues is common in occupation. We here analyse the data of patients with suspected contact dermatitis (CD) from glues recorded within the Information Network of Departments of Dermatology (IVDK).

Methods:  Data recorded between 1996 and 2001 within the IVDK were searched for patients who underwent patch testing because of suspected contact dermatitis from glues.

Results:  Overall data of 829 patients were found, among them 336 with occupational skin disease. Allergic CD was diagnosed in 171/336 patients (50.9%), irritant CD in 24.7%. CD was mostly localized on the hands (72.6%), followed by the face (13.4%) and arms (3.9%). By far the most common cause of an allergic patch‐test reaction was epoxy resin (EP): 18.2%(age‐ and sex‐standardized proportion of sensitization) reacted to the standard EP based on diglycidylether of bisphenol A. reactive diluents and hardeners which elicited a positive patch‐test reaction in > 5% of the patients were phenyl glycidylether and 4,4′diamino diphenylmethane respectively. Cresyl glycidylether was positive in 4.9%. (Meth‐)acrylates which showed an allergic patch‐test reaction in >= 5% of the patients were 2‐hydroxypropyl methacrylate, hydroxyethyl acrylate, 2‐hydroxyethyl methacrylate, ethyleneglycol dimethacrylate, BIS GMA and triethyleneglycol dimethacrylate. Colophony was positive in 8.3% and p‐tert‐butylphenol formaldehyde resin in 4.1% of the patients respectively.

Conclusion:  In our collective allergic CD was nearly 2‐fold more frequent than irritant CD in patients with occupational CD from glues, epoxy resin components being the most important allergens.
P68 Atopy and contact sensitisation: relationship reassessed
Authors: Spiewak Radoslaw
Published: August 2010

Background:  Throughout medical literature, there are conflicting data on the relationship between atopy and contact sensitisation. Some authors believe that atopy is a protective factor against contact allergy, whereas others say it is a risk factor. Facing this contradiction, this study was undertaken to reassess the possible relationship.

Study design:  In 5 vocational schools, 1 randomly selected class in each was invited to participate. Altogether 135 students were tested, 73 females and 62 males aged 18–19 years. As markers of atopy, positive skin prick tests, Phadiatop and elevated total IgE (>120 kU/l) were selected. Patch tests were used for the detection of contact sensitivity. Skin tests included 10 contact allergens and 16 aeroallergens relevant for this population. The tests were carried out and scored according to the ICDRG and EAACI guidelines. Statistical analysis of the relationships included Fisher’s chi‐square test and odds ratios.

Results:  Positive patch tests (at least 1+ reaction) were found in 28.1% of the study subjects, positive prick test (wheal diameter at least 3 mm) in 23.7%, positive Phadiatop in 20.0%, and elevated total IgE in 23.7%. No statistically significant relationship between atopy markers and patch test results could be found. For each analysed feature, odds ratios remained close to the value of 1. As a “positive control” for the study design, the known relationship between female gender and positive patch test could be reconfirmed (for nickel: p = 0.003, OR = 12.0, 95%CI: 2.7–54.1).

Conclusion:  In general population, there is no (or little) correlation between atopy and contact sensitisation.
P69 A practical approach to the selection and use of gloves for workplace protection against chemical hazards
Authors: Leonard Packham Christopher
Published: August 2010

Millions of chemical protective gloves are used every day in Europe. Unfortunately, many are not achieving the level of performance needed to protect the health of the worker, although neither employer nor user are aware of this. The way in which such gloves perform is complex and affected by a whole range of factors. A method of integrating these into a simple method for selection and use has proved to be extremely difficult. This presentation will review the many factors that affect glove performance under actual working conditions and show how a system for the selection and use of gloves for chemical protection might be developed. A novel method for testing gloves under actual working conditions so as to correctly identify performance will be proposed.
PCS.09 Risk assessment versus risk management – is there a role for legislation? No
Authors: Laroche Charles
Published: August 2010

Abstract not available at the time of printing.