BACKGROUND:The number of commercially available plant allergens/extracts is limited and therefore patch testing with fresh/dried plant material may be a necessary supplement in diagnosing plant allergy. OBJECTIVES:To evaluate the usefulness of patch testing with plants "as is" compared to patch testing with commercial and in-house produced plant test materials and to report on species eliciting positive patch test reactions. PATIENTS/MATERIALS/METHODS:Consecutive eczema patients, who were patch tested between January 2019 and December 2023 and who had at least one positive reaction to a plant allergen and/or extract and/or plant "as is" were included in the study. RESULTS:A total 57 out of 1893 patients tested (3%) were sensitised to plants. Compositae plants were the most frequent sensitizers, followed by tomato, tulipalin A, falcarinol, and Philodendron plants. In 12 patients (21%), the diagnosis was based on patch testing with fresh plants only. Occupational sensitization occurred in 32%. Other sensitizers included Hydrangea, Pelargonium zonale, and Monstera. CONCLUSIONS:A large minority of plant-sensitised patients would have been undiagnosed without patch testing with plants "as is." Most of the culprit plants were known sensitizers, but not commercially available, and these and new species taken into cultivation makes patch testing with fresh plants unavoidable and worthwhile.

The authors declare no conflicts of interest.

The sesquiterpene lactones (SLs) are secondary plant metabolites, which are widespread in the Compositae/Asteraceae plant family. The first SLs were detected more than 100 years ago, and allergic contact dermatitis from Compositae has been reported since the beginning of the 1900s, but it was not until the late 1960s and early 1970s that a collaboration between dermatologists, chemists and botanists led to the detection of SLs as the main allergens of Compositae plants. In the 1980s, the SL mix, consisting of equimolar amounts of alantolactone, costunolide and dehydrocostus lactone, was developed as a screening agent for Compositae sensitisation. Today, after inclusion of SL mix in the baseline series, the mean prevalence of reactions in Europe is around 1%, and in North America 0.8%. In countries outside Europe and North America, the prevalence ranges between 0% and 10.7%. The detection rate of SL mix is lower than that of some plant extracts, and ideally, SL mix should be supplemented with a mix of SLs from locally prevalent allergenic plants. The prevalence of positive reactions to SL mix suggests continued baseline testing in most European countries, North America, New Zealand, Australia and probably some Chinese centres.

Isocyanates may contribute to allergic contact dermatitis from diabetes devices and wound dressings. Contact Dermatitis. 2022;87(5): 414-419. 10. Frick-Engfeldt M, Isaksson M, Zimerson E, Bruze M. How to optimize patch testing with diphenylmethane diisocyanate. Contact Dermatitis. 2007;57:138-151. How to cite this article: Enberg J, Hamnerius N, Mowitz M. Allergic contact dermatitis caused by a new insulin pump system containing isobornyl acrylate. Contact Dermatitis. 2023;88(4):326‐328. doi:10.1111/cod.14274

Contact DermatitisEarly View CONTACT POINT Occupational contact dermatitis from Senecio barbertonicus “Himalaya” Evy Paulsen, Corresponding Author Evy Paulsen evy.paulsen@rsyd.dk orcid.org/0000-0001-9738-6613 Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark Correspondence Evy Paulsen, Department of Dermatology and Allergy Centre, Odense University Hospital, J.B. Winsløws Vej 4, Entrance 1, 7th floor, DK-5000 Odense C, Denmark Email: evy.paulsen@rsyd.dkSearch for more papers by this authorKlaus E. Andersen, Klaus E. Andersen Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, DenmarkSearch for more papers by this authorLars P. Christensen, Lars P. Christensen Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, DenmarkSearch for more papers by this author Evy Paulsen, Corresponding Author Evy Paulsen evy.paulsen@rsyd.dk orcid.org/0000-0001-9738-6613 Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark Correspondence Evy Paulsen, Department of Dermatology and Allergy Centre, Odense University Hospital, J.B. Winsløws Vej 4, Entrance 1, 7th floor, DK-5000 Odense C, Denmark Email: evy.paulsen@rsyd.dkSearch for more papers by this authorKlaus E. Andersen, Klaus E. Andersen Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, DenmarkSearch for more papers by this authorLars P. Christensen, Lars P. Christensen Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, DenmarkSearch for more papers by this author First published: 09 April 2022 https://doi.org/10.1111/cod.14122Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

pyelogram. Dermatologica. 1985;171(6):463-468. 6. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. How to cite this article: Tsutsumi R, Yoshida Y, Goto H, Yamamoto O. Thyroid-shaped iododerma on the neck. Contact Dermatitis. 2022;86(2):132-134. doi:10.1111/cod.13991

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BACKGROUND:It is recommended that patch test readings include a day (D)7 reading. Substitution of the D7 reading with a photo may be a valid option.OBJECTIVES:To compare the sensitivity of digital photos at D7 to clinical readings, to assess the number of positive reactions appearing at D7 only (late reactions), and after D7 only (delayed reactions).METHODS:Patients patch tested in six European clinics were instructed to forward photos of the patch test reactions to the respective clinics at D7 (before attending the clinic) and at D21. Only allergens in the baseline series or TRUE Test were included in the data analysis.RESULTS:Two hundred ninety-three of 629 patients had a total of 599 positive reactions, with 6.3% occurring at D7 only. When substituting the D7 reading with a photo (90% submitted), 26.3% of late reactions were missed and nine false-positive reactions were found. Delayed reactions were detected in four patients at D21 (65.3% submitted).CONCLUSION:Our data show that if the D7 reading is not performed, 6.3% of positive reactions from the baseline series would be missed, and if substituting the D7 reading by digital photo, 26.3% late reactions would be missed. Delayed reactions seemed rare.

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BACKGROUND:Compositae plant sensitization in children is relatively frequent. From 1995-2006, we found a prevalence of 1.8% sesquiterpene lactone (SL) mix/parthenolide patch test positives among consecutive eczema patients <18 years.OBJECTIVES:To report the results of patch test screening for Compositae sensitization in patients <18 years in the last 13 years.METHODS:Children and adolescents <18 years, diagnosed with Compositae sensitization between 2007 and 2019, were included.RESULTS:Among 388 children tested, 12 (3%) were Compositae-sensitized, and 11 (2.8%) had positive reactions to SL mix. Compositae mix 5% pet. elicited positive reactions in six of seven patients tested, and dandelion extract 2.5% pet. in six of 10 patients tested. The mean age of the five girls and seven boys was 9.4 years and 11.7 years, respectively. Eleven children had a personal and one a family history of atopy, and 11 children had hand eczema. Only two were mono-sensitized to Compositae.CONCLUSIONS:SL mix is a suitable screening agent among children and adolescents in our area, well supplemented with Compositae mix 5% and dandelion extract. The study emphasizes the importance of Compositae screening in children with a personal and/or family history of atopy, hand eczema or widespread airborne dermatitis, summer exacerbation, and plant exposure.

Classic pyoderma gangrenosum (PG) is an ulcerative skin disease that belongs to the neutrophilic dermatoses (1). Although the disease may be idiopathic, it has traditionally been associated with an array of conditions, notably inflammatory bowel disease and rheumatoid arthritis. The pathogenesis of PG is not fully clarified, but recent research suggests a pivotal role of proinflammatory cytokines, such as interleukin (IL)-1-β and IL-17 and tumour necrosis factor alpha (TNF-α), as in the monogenic autoinflammatory diseases (1). IL1-β is also an atherogenic cytokine, and, in accordance with this, a recent clinical study showed evidence of more generalized inflammation in patients with PG: Jockenhöfer et al. (3) detected a stronger association between PG and the occurrence of metabolic syndrome than between PG and inflammatory bowel disease and rheumatic conditions (2, 3). As might be expected from the pathogenesis, topical and/or systemic immunosuppressive or immunomodulating drugs are necessary for the healing of PG lesions. Despite this, the ulcers are sometimes quite recalcitrant to treatment. A keratin-rich gel has been reported to be an effective topical treatment in ulcers and wounds of different origin (4–7). We report here our experience with this gel in a patient with PG ulcers.

Background Since the 1990s, gold has been recognized as an important contact allergen. Objectives Based on our results with gold sodium thiosulfate (GST) in the TRUE Test patch test system in the baseline series, the aims of the study were to evaluate baseline testing with gold salts worldwide and to discuss relevance. Methods Patients with positive patch test reactions to GST were questioned on exposure at day 7 reading. Results In a 1-year period, 89 (18.5%) of 480 patients tested positive to GST, making this the most frequent contact allergy. The 89 patients comprised 18 males and 71 females. The reaction was considered relevant in 21%; this is a minimum figure because 2 patients were withdrawn because of unknown relevance and because clinical features suggestive of gold contact allergy at distant sites, such as the face, were not taken into account. Altogether, 88% had been exposed. Worldwide, the prevalence of gold sensitization ranges between 0.78% and 30.7%, and relevance, in larger studies, has been between 15% and 20% of patients. The use of earrings and the presence of dental gold were important sources of exposure. Conclusions Because it may be difficult to diagnose gold allergy, screening may be recommended when history taken suggests gold exposure.

Systemic allergic dermatitis arises if an individual sensitised via the skin is exposed to the same allergen or a cross reacting allergen by a different route1 . It is rarely elicited by cutaneous contact with an allergen2 , although transepidermal rechallenge has been reported3 . We report a case of systemic allergic dermatitis caused by patch testing. This article is protected by copyright. All rights reserved.

BACKGROUND:Tree moss (Pseudevernia furfuracea [L.] Zopf.), a lichen growing on conifers, is a frequent fragrance sensitizer. Previous studies have shown two subgroups of tree moss-allergic patients: a group sensitized to common allergens of tree and oak moss (Evernia prunastri), and another group sensitized to colophonium-derived allergens, which may contaminate tree moss extract.OBJECTIVES:To report the results of including tree moss extract in the baseline series and discuss the clinical implications.METHODS:Tree moss extract was included in the baseline series and sensitized patients were assessed for concomitant allergy to colophonium and oak moss, and the relevance of these reactions was analyzed.RESULTS:Altogether, 22 of 632 patients (3.5%) had positive reactions to tree moss. Eight patients were sensitized to tree moss only (among fragrance allergens) and 75% had relevant reactions to colophonium. Fourteen patients were sensitized to other fragrance allergens as well and 28.5% had relevant colophonium reactions.CONCLUSIONS:The prevalence of positive tree moss reactions is high enough to justify its inclusion in the baseline series. If tree moss is not included, patients with positive colophonium reactions should be informed of possible (false) cross-reactivity to tree moss to avoid this labeled fragrance allergen.