Healthcare workers (HCWs) need to wear personal protective equipment (PPE) during the COVID-19 pandemic Studies from China report high rates of irritant dermatitis in frontline HCWs (Pei S, Xue Y, Zhao S et al Occupational skin conditions on the front line: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients J Eur Acad Dermatol Venereol 2020;Epub ahead of print) The British Society of Cutaneous Allergy conducted an audit of occupational dermatoses in HCWs Eleven centres in the U K and Ireland organized occupational skin disease clinics to treat PPE-related dermatoses A standardized proforma was completed, which included information about site, dermatological history, occupation, working environment, shift pattern, sick leave, PPE and handwashing practices Diagnosis and treatment were advised during a virtual consultation Each participating unit entered anonymized audit data into a spreadsheet Data from 200 HCWs were collected in May and June 2020 Forty-three per cent (n = 86) worked in England;30 5% (n = 61) in Scotland, 13 5% (n = 27) in Ireland and 13 0% (n = 26) in Wales Median age was 36 years Ninety per cent (n = 180) were female;67 0% (n = 134) had nursing roles The face was affected in 46 5% (n = 93) and hands in 46 0% (n = 92) In 94 0% of cases (n = 188) the clinical findings were felt to be occupational or partially occupational, with the most common diagnosis being irritant contact dermatitis: 59 0% of patients (n = 118) Seventeen per cent (n = 35) had required time off work (292 5 days in total;range 0 5-28) The mean number of hours of PPE wear per shift was 6 9 [median 7 5, interquartile range (IQR) 4-10] Those who wore PPE for longer periods had more time off;each hour of wearing PPE during a shift increased the time off by 0 2 days [95% confidence interval (CI) 0 002-0 344;P = 0 048] The mean number of handwashes with soap per day was 22 7 (median 20, IQR 10-30) Each handwash increased the expected number of days off by 0 03 (95% CI -0 013 to 0 069;P = 0 174) The mean number of uses of alcohol gel per day was 19 2 (median 10, IQR 5-30) There was an inverse association with use of alcohol gel and time off;each use of alcohol gel per day reduced the expected number of days off by 0 03 (95% CI 0 002-0 066;P = 0 04) These data indicate that the duration of wearing PPE, frequency of handwashing and use of alcohol gel have a significant effect on the time off work for HCWs

Clinical and Experimental DermatologyVolume 45, Issue 4 p. 473-476 Viewpoints in dermatology ● Correspondence A service evaluation between 2-week wait (2WW) skin cancer referrals via teledermatology and the standard face-to-face pathway at a teaching hospital W. T. N. Hunt, Corresponding Author W. T. N. Hunt huntwtn@doctors.org.uk orcid.org/0000-0002-7680-0624 Dermatology Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this authorL. Ali, L. Ali Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorH. Marder, H. Marder Cancer Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorJ. E. Sansom, J. E. Sansom Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorD. A. R. de Berker, D. A. R. de Berker Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this author W. T. N. Hunt, Corresponding Author W. T. N. Hunt huntwtn@doctors.org.uk orcid.org/0000-0002-7680-0624 Dermatology Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UKSearch for more papers by this authorL. Ali, L. Ali Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorH. Marder, H. Marder Cancer Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorJ. E. Sansom, J. E. Sansom Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this authorD. A. R. de Berker, D. A. R. de Berker Bristol Dermatology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UKSearch for more papers by this author First published: 06 November 2019 https://doi.org/10.1111/ced.14137Citations: 2 Conflict of interest: the authors declare that they have no conflicts of interest. WTNH and LA contributed equally to this work and should be considered joint first authors. Read 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 Citing Literature Volume45, Issue4June 2020Pages 473-476 RelatedInformation

CD-1 Preservative sensitivity in the United Kingdom (2004-2005) C.T. Jong, C.M. Green,* C.M. King, D.J. Gawkrodger, J.E. Sansom,§ J.S.C. English,– S.M. Wilkinson,** A.D. Ormerod, M.M.U. Chowdhury and B.N. Statham§§ Department of Dermatology, Singleton Hospital, Swansea; *Department of Dermatology, Ninewells Hospital and Medical School, Dundee; Department of Dermatology, Royal Liverpool Hospital, Liverpool; Department of Dermatology, Roayl Hallamshire Hospital, Sheffield; §Department of Dermatology, Bristol Royal Infirmary, Bristol; –Department of Dermatology, Queens Medical Centre, Nottingham; **Department of Dermatology, Leeds General Infirmary, Leeds; Department of Dermatology, Aberdeen Royal Infirmary, Aberdeen; Department of Dermatology, University Hospital of Wales, Cardiff and §§Department of Dermatology, Singleton Hospital, Swansea, U.K. Using the British Contact Dermatitis Society (BCDS) database, we evaluated the positive rates of sensitivity to preservatives during 2004 and 2005. We compared these data with the British and European data collected 5 years ago. The latter showed a rapidly increasing level of sensitivity to methyldibromoglutaronitrile (MDBGN), leading to the withdrawal of this biocide in leave-on products by the European Union in 2003. Data were collected from patients attending patch test clinics within the dermatology departments of nine centres across the U.K., five in England, two in Scotland and two in Wales. Complete data on 10 preservatives in the BCDS battery from 2004 to 2005 were analysed. The positive rate is defined as the sum of all positive tests (of current or past relevance or where relevance is unknown) over that of all patch tests for an allergen, expressed as percentage. A total of 6478 patch tests using the BCDS standard battery were performed to investigate suspected contact allergies from January 2004 to December 2005. The female to male ratio was 2 : 1. The median age group was 40–49 years old. Nationally, only formaldehyde 1% aq and chloromethylisothiazolinone/methylisothiazolinone 0Æ01% aq have a positive rate of >2% at 2Æ13% and 2Æ10% respectively. The range of positive rates varies from 2Æ13% (formaldehyde 1% aq) to 0Æ23% (2,4-chloro-3,5-xylenol 0Æ5% pet). A difference in the positive rates between centres is noted. The positive rate of MDBGN 0Æ3% pet ranges from 0Æ33% to 2Æ20%; the average is 1Æ14%. These rates are lower than the U.K. rate of 2Æ4% (Britton JE, Wilkinson SM, English JS et al. The British standard series of contact dermatitis allergens: validation in clinical practice and value for clinical governance. Br J Dermatol 2003; 148:259–64) in 2000 and the European level of 3Æ5% in 2000 (Wilkinson JD, Shaw S, Andersen KE et al. Monitoring levels of preservative sensitivity in Europe. Contact Dermatitis 2002; 46:207–10). The site most commonly affected by preservative allergy in both sexes is the hand. Formaldehyde is the commonest preservative allergen in both female (18Æ7% of all preservative allergy) and male (15Æ9% of all preservative allergy) patients. From the data, formaldehyde is the preservative with the highest positive rate. The positive rates of MDBGN, although they vary widely among centres, seem to be lower than the previously reported British and European levels. Conflicts of interest: none

Contact DermatitisVolume 54, Issue 4 p. 215-216 Delayed hypersensitivity following intravenous lidocaine James R. Hickey, Corresponding Author James R. Hickey Bristol Dermatology CentreDr James R Hickey Bristol Dermatology Centre Bristol Royal Infirmary Bristol BS2 8HWSearch for more papers by this authorStuart D. Cook, Stuart D. Cook Bristol Eye Hospital, Bristol, UKSearch for more papers by this authorGary Gutteridge, Gary Gutteridge Bristol Eye Hospital, Bristol, UKSearch for more papers by this authorJane E. Sansom, Jane E. Sansom Bristol Dermatology CentreSearch for more papers by this author James R. Hickey, Corresponding Author James R. Hickey Bristol Dermatology CentreDr James R Hickey Bristol Dermatology Centre Bristol Royal Infirmary Bristol BS2 8HWSearch for more papers by this authorStuart D. Cook, Stuart D. Cook Bristol Eye Hospital, Bristol, UKSearch for more papers by this authorGary Gutteridge, Gary Gutteridge Bristol Eye Hospital, Bristol, UKSearch for more papers by this authorJane E. Sansom, Jane E. Sansom Bristol Dermatology CentreSearch for more papers by this author First published: 06 April 2006 https://doi.org/10.1111/j.0105-1873.2006.0775c.xCitations: 6Read 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 Citing Literature Volume54, Issue4April 2006Pages 215-216 RelatedInformation

Journal Article Delayed onset of bullous reaction with severe deep skin necrosis in association with sertraline Get access M.E. Kirkup, M.E. Kirkup Departments of Dermatology and Histopathology, Bristol Royal Infirmary, Bristol BS2 8HW Search for other works by this author on: Oxford Academic Google Scholar E.A. Sheffield, E.A. Sheffield Departments of Dermatology and Histopathology, Bristol Royal Infirmary, Bristol BS2 8HW Search for other works by this author on: Oxford Academic Google Scholar L.J. Sacks, L.J. Sacks Department of Plastic Surgery, Frenchay Hospital, Bristol BS16 1ND, U.K. E‐mail: maggie.kirkup@btinternet.com Search for other works by this author on: Oxford Academic Google Scholar J.E. Sansom J.E. Sansom Departments of Dermatology and Histopathology, Bristol Royal Infirmary, Bristol BS2 8HW Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 150, Issue 1, 1 January 2004, Pages 164–166, https://doi.org/10.1111/j.1365-2133.2004.05736.x Published: 01 January 2004

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.

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.

Contact DermatitisVolume 51, Issue 2 p. 95-96 Allergic contact dermatitis from tetracaine in the beauty industry M. Connolly, Corresponding Author M. Connolly Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andDr Maureen Connolly Bristol Dermatology Centre Bristol Royal Infirmary Bristol BS2 8HW UK Tel: +44 0117 9230000 Fax: +44 0117 9282845 e-mail: [email protected]Search for more papers by this authorA. Mehta, A. Mehta Department of Dermatology, Royal Cornwall Hospital, Truro TR1 3LJ, UKSearch for more papers by this authorJ. E. Sansom, J. E. Sansom Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andSearch for more papers by this authorM. G. S. Dunnill, M. G. S. Dunnill Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andSearch for more papers by this author M. Connolly, Corresponding Author M. Connolly Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andDr Maureen Connolly Bristol Dermatology Centre Bristol Royal Infirmary Bristol BS2 8HW UK Tel: +44 0117 9230000 Fax: +44 0117 9282845 e-mail: [email protected]Search for more papers by this authorA. Mehta, A. Mehta Department of Dermatology, Royal Cornwall Hospital, Truro TR1 3LJ, UKSearch for more papers by this authorJ. E. Sansom, J. E. Sansom Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andSearch for more papers by this authorM. G. S. Dunnill, M. G. S. Dunnill Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol BS2 8HW, andSearch for more papers by this author First published: 16 September 2004 https://doi.org/10.1111/j.0105-1873.2004.0396h.xCitations: 3Read 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 onEmailFacebookTwitterLinkedInRedditWechat References 1 Condé-Salazar L, Llinás M G, Guimaraens D, Romero L. Occupational allergic contact dermatitis from amethocaine. Contact Dermatitis 1988: 19: 69–70. 10.1111/j.1600-0536.1988.tb02879.x PubMedWeb of Science®Google Scholar 2 García Pérez A, Condé Salazar L, Guimaraens D et al. La sensibilidad de contacto a ametocaina. Actas Dermosifiliogr 1981: 72: 441–448. CASPubMedGoogle Scholar 3 Rebandel P, Rudzki E. Occupational contact sensitivity in oculists. Contact Dermatitis 1986: 15: 92. 10.1111/j.1600-0536.1986.tb01284.x PubMedWeb of Science®Google Scholar 4 Dawe R S, Watt D, O'Neill S, Forsyth A. A laser-clinic nurse with allergic contact dermatitis from tetracaine. Contact Dermatitis 2002: 46: 306.DOI: 10.1034/j.1600-0536.2002.460515.x 10.1034/j.1600-0536.2002.460515.x CASPubMedWeb of Science®Google Scholar 5 Lodi A, Ambonati A, Coassini A et al. Contact allergy to ‘caines’ caused by anti-hemorrhoidal ointments. Contact Dermatitis 1999: 41: 221–222. 10.1111/j.1600-0536.1999.tb06136.x CASPubMedWeb of Science®Google Scholar 6 Sánchez-Pérez J, Córdoba S, Feal C et al. Allergic contact balanitis due to tetracaine (amethocaine) hydrochloride. Contact Dermatitis 1998: 39: 268. 10.1111/j.1600-0536.1998.tb05930.x CASPubMedWeb of Science®Google Scholar Citing Literature Volume51, Issue2August 2004Pages 95-96 ReferencesRelatedInformation

BACKGROUND:All centres use an empirically determined set of 'standard' test allergens for patch testing that contain the commoner environmental sensitizers. Objectives To assess the validity of the British standard series of 12 allergens used in addition to the 23 already in the European standard series.PATIENTS AND METHODS:Results for 3062 consecutive patients patch tested in seven centres across the United Kingdom during the year 2000 were analysed.RESULTS:The additional allergens from the British series and positive rates were: methyl dibromoglutaronitrile 2.4%, carba mix 1.6%, tixocortol pivalate 1.5%, ethylenediamine 1.3%, cetearyl alcohol 0.8%, 2-bromo-2-nitropane-1,3-diol 0.8%, diazolidinyl urea 0.7%, chlorocresol 0.6%, budesonide 0.6%, fusidic acid 0.5%, imidazolidinyl urea 0.5%, and chloroxylenol 0.4%. The allergens with the lowest positive rate in the European standard series were primin at 0.6% and isopropyl-phenyl-para-phenylenediamine at 0.4%.CONCLUSIONS:The 12 allergens in the British series should continue being tested as a standard addition to the European series within the U.K. The collection of data in this manner to allow comparisons between centres shows differences that reflect selection criteria and interpretation of results, and offers a useful tool for audit and clinical governance. Testing fewer than 1 : 2150 population may indicate underprovision of service. Similarly, rates of sensitization for nickel contact allergy above 26% and for fragrance mix above 16% (the upper 95% confidence intervals) should stimulate inquiry into the reasons behind this.

A 33-year-old woman presented with a 2-month history of an intermittent itchy rash on the neck and around the eyes, associated with episodes of swelling of the eyelids. Each flare had settled to leave scaling. There was no history of atopy. She admitted to wearing cosmetics and applying nail varnish regularly. She worked in an office environment. On examination, there was mild erythema and scaling over the upper eyelids and neck. Patch testing was performed to the British standard series (1) and modified cosmetic (Chemotechnique) and modified plant (Chemotechnique) series as well as to her cosmetics and nail varnish. She had a positive reaction (π) to her nail varnish at 2 and 4days, which was applied to a Finn Chamber and allowed to dry before application. She did not react to tosylamide/formaldehyde resin in the facial series. Patch testing was performed with the nail varnish components provided by the manufacturer. She had a positive reaction (π π) to phthalic anhydride/trimellitic anhydride/glycols copolymer 1% pet. at 2 and 4days. Also, she had reactions (π) to the 5 colouring bases that also contained this ingredient. 12 control subjects were negative.