Background: Concern was raised within the International Contact Dermatitis Research Group (ICDRG) regarding the scoring of weak allergic versus doubtful patch test reactions. Objective: To investigate the degree of uniformity in patch test reading. Methods: Five series of fictive contact dermatitis cases were written up by the study organizer and presented to expert participants. Each series was sent electronically to participants one by one. All dermatitis cases underwent patch testing, and the test result was a reaction characterized by erythema and infiltration. Within each case series, there were 5 subcases that differed only in the size of the test area showing erythema and infiltration. Three nearly identical case series had 1 crucial difference: the result of a repeated open application test (ROAT), both in the cases and controls. The experts had to determine whether the patch test reaction indicated contact allergy, defined as an immunologically acquired delayed hypersensitivity. All other reactions (negative, doubtful, and irritant) were classified as no contact allergy. Results: There was a big intra- and inter-individual variation in the patch test reading. Nobody read according to any of the 2 existing ICDRG classifications. The ROAT results sometimes influenced the scoring. Conclusion: A new ICDRG classification is needed.

BACKGROUND:Since its inception in 1980, the MOHL index (% patients who are male, have occupational, hand, or leg dermatitis, respectively) and its later evolutions until the presently used MOAHLFA(P) index (adding % patients with atopic dermatitis, face dermatitis, age 40+ years and positive reaction(s) to ≥ 1 baseline series allergen) have been intended to convey important demographic and clinical information on the patients patch tested in a certain area and time, aiding the interpretation of the observed spectrum of sensitisation. OBJECTIVES:To examine the current usage of the MOAHLFA(P) index and suggest consolidated definitions for its single items. METHODS:A title/abstract search in Medline identified publications mentioning the evolving acronyms. A Delphi-like survey among contact dermatitis experts collected agreement with suggested definitions. RESULTS:The search term 'MOAHLFA' was used in 35 publications from a broad geographical origin. More than 80% of the 24 participants of the survey (65% response) agreed on maintaining to use (i) sex for the 'M' criterion, (ii) occupation-related dermatitis irrespective of medicolegal definitions for the 'O', (iii) atopic dermatitis (but not rhinitis or asthma) for the 'A'. The possibility to use more than one site among 'H', 'L' and 'F' and a more detailed description of age distribution were favoured, and the difficult interpretability of the 'P' measure was highlighted. CONCLUSIONS:The 'classical' MOAHLFA(P) index may be extended. Some aspects, notably atopic dermatitis, need further standardisation.

Background: The textile dye mix (TDM) 6.6% in petrolatum contains Disperse Blue (DB) 35, Disperse Yellow 3, Disperse Orange (DO) 1 and 3, Disperse Red 1 and 17, and DB 106 and 124. The most frequent allergen in TDM-positive patients is DO 3. Around 85% of para-phenylenediamine (PPD)-allergic dermatitis patients have been positive to DO 3. There has been a discussion to exclude DO 3 from TDM 6.6% because of strong simultaneous reactions to TDM and PPD. Objective: To study if DO 3 can be excluded from TDM 6.6%. Methods: Patch tests were performed on 2951 dermatitis patients with TDM 6.6%, TDM 7.0% (without DO 3 but with the other disperse dyes at 1.0% each), DO 3 1.0%, and PPD 1.0% pet. Results: Contact allergy to TDM 6.6% was 4.3% and to TDM 7.0% was 3.5%. Sixty-three out of 69 DO 3-positive patients were positive to PPD. The 102 patients positive to TDM 7.0% plus the 28 patients positive to PPD and TDM 6.6% but negative to TDM 7.0% were 130, outnumbering the 127 positive to TDM 6.6%. Conclusion: TDM 7.0% can replace TDM 6.6% in the International Contact Dermatitis Research Group baseline series, since TDM 7.0% together with PPD 1.0% will detect patients with textile dye allergy.

Eugenol is a known contact sensitiser included in fragrance mix I.

Dermatitis®Vol. 34, No. 6 LettersOleyl Alcohol May Be an Overlooked Allergen in Pimecrolimus CreamKlaus Ejner AndersenKlaus Ejner AndersenDepartment of Dermatology, Institute of Clinical Research, University of Southern Denmark, Odense 5000, Denmark E-mail Address: [email protected]https://orcid.org/0000-0002-6181-824XSearch for more papers by this authorPublished Online:16 Nov 2023https://doi.org/10.1089/derm.2022.0082AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Oleyl Alcohol May Be an Overlooked Allergen in Pimecrolimus Cream." Dermatitis®, 34(6), p. 564FiguresReferencesRelatedDetails Volume 34Issue 6Dec 2023 Information© 2023 American Contact Dermatitis Society. All Rights Reserved.To cite this article:Klaus Ejner Andersen.Oleyl Alcohol May Be an Overlooked Allergen in Pimecrolimus Cream.Dermatitis®.Dec 2023.564-564.http://doi.org/10.1089/derm.2022.0082Published in Volume: 34 Issue 6: November 16, 2023Online Ahead of Print:January 19, 2023PDF download

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

Background: Allergic contact dermatitis (ACD) caused by hexavalent chromium (Cr(VI)) is often severe and difficult to treat. The content of Cr(VI) in cement can be reduced by, for example, addition of iron(II) sulfate. Since 2005 the content of Cr(VI) in cement is regulated in the EU Directive 2003/53/EC and must not exceed 2 ppm. Since this regulation came into force, ACD caused by cement has markedly been reduced. Objective: To investigate Cr(VI) and total chromium content in samples of cement from countries within and outside the EU. Methods: The members of the International Contact Dermatitis Research Group (ICDRG) were invited to participate in the study with the aim to collect cement samples from geographically different areas. The content of Cr(VI) in the samples was estimated by the diphenyl carbazide spot test, atomic absorption spectroscopy was used to assess the total chromium content. Results: Forty-five cement samples were analyzed, containing amounts of Cr(VI) from <0.1 to >70 ppm. Twenty-one samples contained >2 ppm Cr(VI), 24 contained less. Four of 17 samples from within the EU contained >2 ppm Cr(VI), that is, higher amounts than stipulated in the EU directive, as compared with 17 samples from countries outside the EU. Conclusion: In countries outside the EU, significantly more cement samples contained >2 ppm Cr(VI).

BACKGROUND:Prophylactic vaccination against influenza and other epidemic viruses is recommended for citizens above 65 years. Several vaccines may contain traces of formaldehyde and are contra-indicated in patients hypersensitive (in the broadest possible meaning) to formaldehyde. Thorough knowledge on the various subtypes of hypersensitivity is sparse among non-dermatologists and non-allergists, and therefore many patients are prevented from vaccination based on a positive patch test to formaldehyde. The purpose of this retrospective study was to investigate whether patients with positive patch test to formaldehyde subsequently receiving a formaldehyde-containing vaccine and developed a severe adverse reaction.METHODS/MATERIALS:From January 2000 to June 2021, 169 patients (>50 years) had a positive formaldehyde patch test at the Department of Dermatology and Allergy Center, Odense University Hospital and were included into this retrospective study. The electronic medical record was assessed for receipt of a formaldehyde-containing vaccine after patch test and for subsequent contact with the Acute Ward in the Region of Southern Denmark within 14 days after vaccination.RESULTS:Of the 158 patients residing in the Region of Southern Denmark, 130 patients were vaccinated with one or more formaldehyde-containing vaccines of whom 123 received an influenza vaccine. No contacts to the acute wards were identified.DISCUSSION:Although prospective studies would be beneficial, patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines.

Background Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. Objectives To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. Method The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. Results Consensus was achieved for several statements and management strategies. Conclusion The updated guideline should improve management of hand eczema.

Patient adherence to topical antipsoriatic drugs is often poor, leading to poor efficacy. Use of long‐term support delivered by dermatological nurses to patients treated with topical drugs may improve outcome.

BACKGROUND:Insulin pumps and glucose monitoring devices improve diabetes mellitus control and enhance patients' quality of life. However, a growing number of adverse cutaneous reactions related to the use of these devices have been reported.OBJECTIVE:To investigate the culprits of localized contact dermatitis in paediatric patients with diabetes caused by insulin pumps and glucose monitoring devices.METHODS:Retrospective analysis of 15 paediatric patients patch tested as part of a clinical investigation for skin reactions associated with insulin pumps and glucose monitoring devices.RESULTS:Seven patients had positive patch test reactions to isobornyl acrylate (IBOA) and five had positive reactions to benzoyl peroxide (BP). Positive patch test reactions to materials from the glucose sensor and/or insulin pump were seen in 10 of the 15 patients. Three had positive reactions to adhesive remover wipe from Smith and Nephew Remove and four had reactions to EMLA plaster.CONCLUSION:A high share of patients showed positive reactions to IBOA and/or their medical devices (insulin pumps or glucose devices). A third of patients showed positive reactions to BP. The presence of additional unidentified allergens cannot be excluded, highlighting the importance of access to a full description of the chemical composition of the devices.

Background Nickel allergy is the most common contact allergy, and a nickel salt is, therefore, included in most baseline patch test series. In the baseline series of the International Contact Dermatitis Research Group and the American Contact Dermatitis Society, nickel sulfate hexahydrate (NSH) in petrolatum at 2.5% is included, whereas NSH at 5.0% is included in many other baseline series, such as the European and Swedish ones. Objective The aim of the study is to investigate whether NSH at 5.0% detects significantly more contact allergy than NSH 2.5% when both preparations are tested simultaneously in consecutive dermatitis patients. Patients and Methods Two thousand two hundred eighty-seven consecutive dermatitis patients were patch tested simultaneously with NSH in petrolatum at 2.5% and 5.0%. The allergy rates were compared for all clinics individually and combined using McNemar test, 2-sided. Results Contact allergy to NSH 5.0% and 2.5% was found in 20.3% and 16.8%, respectively (P < 0.0001). In 6 of 11 clinics, significantly more patients tested positive to the higher NSH concentration. For the 2 clinics in North America combined, significantly more patients tested positive to NSH 5.0%. Conclusions The NSH preparation in the International Contact Dermatitis Research Group baseline patch test series should be considered to be changed from NSH 2.5% (1 mg NSH/cm2) to 5.0% (2 mg NSH/cm2).

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

BACKGROUND:In the early 1980s, a preservative containing a mixture of methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) in a ratio of 3:1 was introduced. This mixture (mix) has been patch tested at 100 ppm (0.01%) worldwide and at 200 ppm (0.02%) in Sweden since 1986 and also in the European baseline series since 2014.OBJECTIVE:A new aqueous mix of MCI 0.015% and MI 0.2% was compared with patch testing with the 2 aqueous baseline preparations of MCI/MI 0.02% and MI 0.2%.METHODS:Four thousand three hundred ninety-seven patients with dermatitis in 12 International Contact Dermatitis Research Group dermatology departments from 3 continents were patch tested simultaneously with the 3 preparations.RESULTS:The frequency of positive patch tests to the allergens varied between 0% and 26.7% in the 12 test centers. The new mixture MCI/MI 0.215% in aqua (aq) detected significantly more patients with MCI/MI allergy than both MCI/MI 0.02% aq (P < 0.001) and MI 0.2% aq (P < 0.001) alone and combined.CONCLUSIONS:The results favor replacing the preparations MCI/MI 0.02% aq and MI 0.2% aq with the mixture MCI/MI 0.215% aq in the International Contact Dermatitis Research Group baseline series.

Background: Topical drugs are recommended first-line treatment for mild-to-moderate psoriasis. However, patient preferences for the topical drugs differ, since a wide variety of topical drugs and topical drug formulations are available. Objectives: The aim of this study was to investigate psoriasis patient preferences for topical drugs. Methods: A systematic literature search was performed for English-language articles in Embase, Medline, PsycINFO, Cinahl, Scopus, and the Cochrane Library. Results: Four surveys, six randomized controlled trials, and two prospective studies of mainly good quality were included. Seven of the studies investigated patient preferences for topical drug formulations, while five studies investigated their preferences for different topical drugs. Overall, patients preferred drugs that are easy to apply, less messy, and have a pleasant scent. Conclusion: Psoriasis patient preferences for topical drugs differ. There is no one topical drug or topical drug formulation that suits everyone, which shows the importance of individualized prescriptions for topical drugs that are based on shared decision-making between the prescriber and patient.