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  • 1
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  The frequency of sensitivity to the cosmetic preservative methyldibromoglutaronitrile (MDBGN) has increased significantly in Europe. Most cases of allergic contact dermatitis from MDBGN are caused by leave-on cosmetic products. The risk of developing allergic contact dermatitis from rinse-off products has been less studied.Objectives  To investigate the allergic response elicited in presensitized individuals from exposure to a rinse-off product preserved with the maximum permitted level of MDBGN.Methods  Nineteen contact allergic individuals and nine controls participated in a double-blind, randomized repeated open application test (ROAT) using two coded liquid soaps with and without MDBGN. Areas of 50 cm2 on the lower arms were washed with the soaps twice a day for up to 28 days; two of the subjects continued for 34 days. The subjects were also patch tested with a dilution series of MDBGN to determine their patch test threshold values.Results  Seven presensitized individuals (37%) developed allergic contact dermatitis from the soap containing MDBGN. The mean dose of MDBGN per application was 2·2 µg cm−2 and the reactions appeared between days 6 and 34. All nine controls had negative ROATs. The difference in reactivity between test subjects and controls was significant (one-sided Fisher's exact test, P = 0·04). Patch test threshold values ranged from 〈 0·001% to 0·2% MDBGN in ethanol/water.Conclusions  This study shows that the exposure to a rinse-off product containing the maximum permitted level of MDBGN can easily elicit an allergic response in presensitized individuals. Along with reported cases of induction and elicitation caused by MDBGN in rinse-off products the study indicates that the permitted level of MDBGN in rinse-off products is too high. We recommend that this level should be re-evaluated.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis.Objectives  To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups.Methods  Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job.Results  The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19·9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27·2%) compared with those in wet occupations (20·1%) and other occupations (16·5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations.Conclusions  Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job.
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  • 3
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  The rapidly increasing level of contact allergy to methyldibromoglutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50–100 p.p.m.Objectives  To determine whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized individuals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content.Methods  Eighteen volunteers with contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with two moisturizers with a high and a low lipid content, respectively, both containing MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left and the right side of the neck for 14 days, or until a positive reaction was seen. If a positive reaction did not develop within the first 14 days, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a further 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed.Results  Eleven of 18 (61%) subjects developed dermatitis on the test area, of whom 10 developed a positive reaction to the 50 p.p.m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to the low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs.Conclusions  Even 50 p.p.m. cannot be regarded as a safe concentration for use and the prohibition of MDBGN is scientifically well founded.
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  • 4
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Contact allergy to fragrances is a common problem world-wide. The currently used fragrance mix (FM) for patch testing has only eight constituents and does not identify all fragrance-allergic patients. As perfumes may contain 100 or more substances, the search for markers for allergy continues. The synthetic fragrance 4-(4-hydroxy-4-methylpentyl)-3-cyclohexene carboxaldehyde (Lyral®) was tested together with the FM and 11 other fragrance substances on consecutive patients in six European departments of dermatology. All patients were carefully questioned regarding a history of reactions to scented products in the past and were grouped into four categories: ‘certain’, ‘probable’, ‘questionable’ and ‘none’. Lyral® (5% in petrolatum) gave a positive reaction in 2·7% of 1855 patients (range 1·2–17%) and ranked next to 11·3% with FM allergy. Twenty-four patients reacted to both Lyral® and FM, but 21 (1·1%) reacted positively only to Lyral®. Of 124 patients with a ‘certain’ history, 53·2% reacted to the FM and a further 7·2% to Lyral® only. If any kind of history of fragrance intolerance was given, 80% (40 of 50) of Lyral® positive patients had a ‘positive’ history while only 58·6% (123 of 210) of FM positive patients had such a history; this difference was significant at P 〈 0·01. Lyral® was identified by gas chromatography–mass spectrometry in some products which had caused an allergic contact dermatitis in four typical patients who showed a patch test positive to Lyral® and negative or doubtful to FM. In conclusion, we recommend the testing of 5% Lyral® (in petrolatum) in patients suspected of contact dermatitis.
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  • 5
    ISSN: 0022-328X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The frequency of contact allergy to the 10 best-selling women's perfumes was studied in 335 consecutive female eczema patients by patch testing. The diagnostic ability of the fragrance mix, in relation to these products, was evaluated. Of eczema patients, 6.9% had a positive patch test to one or more of the perfumes, and 56.5% of these had a concurrent positive reaction to the fragrance mix. Hence, testing with the patients’ own cosmetics is a significant part of diagnosing perfume allergy. The clinical relevance of the patch-test reactions to the commercial perfumes was equal to that of the fragrance mix, as judged from the patient's history and use testing with one of the perfumes. At least three of the chemically defined sensitizers in the fragrance mix were detected in all the perfumes by gas chromatography-mass spectrometry, which indicates that the fragrance mix is a good imitation of actual exposure.
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  • 7
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  The benefit of alcohol-based disinfectant used on normal skin has been debated.Objectives  The objective of the present study was to compare the effects of repeated exposure to an alcohol-based disinfectant, a detergent and an alcohol-based disinfectant/detergent alternately for 10 days, including noninvasive measurements in the evaluation. Skin reactivity in irritated skin after a 4-week interval was also evaluated.Materials and methods  Detergent, disinfectant and alternate disinfectant and detergent were applied twice daily every 10 min for 1 h to the ventral upper arms and forearms of 17 healthy volunteers. A control area was included. After 4 weeks an SLS patch was applied to each area. Irritant reactions were quantified with a visual score recording and measurements of transepidermal water loss (TEWL) and skin colour were performed on days 1, 5, 11, 38 and 40.Results  On day 5 the detergent caused a higher visual score than either disinfectant applied alone or alternate disinfectant and detergent, P 〈 0·05. On day 11 detergent and alternate disinfectant and detergent caused a higher score than disinfectant, P 〈 0·05. An increased irritant response for detergent compared with disinfectant alone and alternate disinfectant and detergent was confirmed by TEWL evaluations on days 5 and 11, P 〈 0·001, while no significant difference was found by colour measurement. After 4 weeks, when evaluated by colour measurement, significantly less response to the SLS patch was found on the disinfectant-treated area compared with the control area and detergent area, and a similar trend was found for TEWL, although it was not statistically significant.Conclusion  Alcohol-based disinfectant caused less visible skin irritation and less skin barrier disruption than the use of detergent. The alternate use of detergent and disinfectant caused less irritation than the use of detergent, and a possible interaction between the two irritants was not indicated. After 4 weeks there was a tendency for decreased skin reactivity in the skin areas which had 4 weeks previously been exposed to disinfectant.
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  • 8
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  Contact allergy to hair dye ingredients is a well-known entity seen both in consumers using hair dyes and among hairdressers with occupational contact dermatitis. Surveys show that consumers with even severe adverse skin reactions to hair dyes only rarely contact the healthcare services. The frequency of hair dye-induced skin reactions in the consumer population is unknown.Objectives  An epidemiological investigation with the aim of establishing the proportion of hair dye-induced skin reactions was performed in a population-based sample.Methods  A representative random sample (n = 4000) was taken of the Danish adult population. Personal interview questions were asked regarding adverse skin reactions to hair dyes, either compatible with a classical allergic eczematous reaction with redness, scaling and itching or a severe allergic reaction with oedema of the forehead and face. The response rate was 65·2%.Results  A total of 18·4% of the male respondents and 74·9% of the female respondents had at some point dyed their hair. The median age at first hair dyeing was 16 years (range 1–80). Adverse skin reactions to hair dyes compatible with an allergic reaction were reported in 5·3% of individuals who had ever used hair dye. Of these, only 15·6% had been in contact with healthcare services after the hair dye reaction. Having had a temporary tattoo was not a significant risk factor for an adverse reaction to hair dyes.Conclusions  The rate of adverse allergic skin reactions to hair dyes was higher than expected from patch-test studies. Only by studying the clinical types of adverse reactions to hair dyes will it be possible to gather a complete epidemiological picture of the nature and extent of the problems related to hair dye ingredients.
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  • 9
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive clinical examinations.Objectives  To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE.Methods  Between October 2001 and November 2002 (58 weeks) we identified all new cases of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology and extent of eczema, and frequency of eruptions. All participants received a self-administered questionnaire and were asked to classify severity of their OHE on a visual analogue scale from 0 to 10. The relation between DNBII-assessed and self-rated severity was illustrated by a receiver operating characteristic analysis.Results  Of 758 patients included in the study, 621 returned the questionnaire and 602 (79%) provided information on self-rated severity. The proportion of severe cases was significantly higher among patients' assessments compared with the rating by the DNBII. Almost 18% were categorized as severe cases by the DNBII while 40% of patients had assessed themselves as having severe eczema. The optimal cut-off point had a sensitivity and specificity of self-rated severity according to the DNBII assessment of 65% and 66%, respectively. The positive predictive value was 29% and the negative predictive value was 90%.Conclusions  The low positive predictive value suggests major differences in the criteria for self-rated severity vs. DNBII-rated severity. We recommend researchers to include ratings from both patients and physicians in future investigations of severity. The methods may address different aspects of OHE.
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  • 10
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE).Objectives  To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Methods  Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and 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), which is the correlation between (single) ratings of the same patient.Results  ICC for total HECSI score was 0·79 at the first assessment and 0·84 at the second assessment. ICC for intraobserver agreement was 0·90.Conclusions  Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.
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