Disfiguring angioedema-like airborne dermatitis from methylisothiazolinone in paints: About time to regulate?

Severe Allergic Contact Dermatitis From Octylisothiazolinone in Over-Ear Headphones: A Case Series

BACKGROUND

Octylisothiazolinone (OIT; CAS 26530-20-1) is used as a biocide in leather products.

OBJECTIVES

To report several cases of allergic contact dermatitis (ACD) from the use of headphones containing OIT, and to highlight the strong allergic potential of this preservative.

PATIENTS AND METHODS

Four patients with ACD from headphones were patched tested using the European baseline, cosmetic, rubber, plastics/glues and acrylates series. Patients were also tested to different parts of their own headphones ('as is'). Chemical analyses of the headphones was additionally performed with Ultra Performance Liquid Chromatography-tandem mass spectrometry (UPLC-MS/MS).

RESULTS

All patients had developed localised ACD to the contact sites of the headphones, except for one patient who developed 'angioedema-like' dermatitis. All patients were shown to have been primarily sensitised to OIT. UPLC-MS/MS analysis confirmed OIT in the leather ear pads of the headphones.

CONCLUSIONS

OIT is a relevant and strong sensitizer in leather, and may cause severe ACD. Safer use concentrations (limits) of OIT, as well as product labelling in the leather industry, may be required to ensure a better protection of consumers.

Differential diagnosis of contact dermatitis: A practical-approach review by the EADV Task Force on contact dermatitis

The diagnosis of eczema ('dermatitis') is mostly clinical and depends on the clinical history and exploratory objective findings (primary lesions, patterns). Contact dermatitis remains as an important condition in the group of eczematous disorders, with important socioeconomic and occupational relevance. Although irritant and allergic contact dermatitis have a different pathogenesis, both are characterized by a rather typical morphology, are triggered by external factors and tend to occur primarily in the area of contact with the exogenous agent. In addition, allergic and irritant dermatitis may also co-exist. The importance of diagnosing contact dermatitis, especially when allergic in nature, is both due to the possibility of avoiding the trigger, and due to its role in aggravating other skin conditions. Nevertheless, the heterogeneity of clinical presentations in daily practice may pose an important challenge for the suspicion and correct diagnosis of contact dermatitis. Furthermore, other conditions, with different pathogenesis and treatment, may clinically simulate contact dermatitis. The Task Force aims to conduct a review of the unifying clinical features of contact dermatitis and characterize its main clinical phenotypes, and its simulators, in order to contribute to an early suspicion or recognition of contact dermatitis and enable a correct differential diagnosis.

Wenn es kein Angioödem ist, was dann? Diagnostisches Vorgehen bei Gesichtsödemen

Gesichtsödeme sind ein relativ häufiges Symptom bei Patienten allergologischer und dermatologischer Kliniken. Die Differentialdiagnose ist breit gefächert und die endgültige Diagnose kann manchmal eine Herausforderung für den Kliniker sein. Das faziale Angioödem selbst umfasst verschiedene Ätiopathologien (histaminerg, bradykinininduziert und weitere), die von anderen Ursachen des Gesichtsödems differenziert werden sollten, etwa allergischer Kontaktdermatitis, granulomatösen Erkrankungen, inflammatorischen Ursachen, Infektionen, Neoplasmen oder paraneoplastischen Syndromen, Autoimmunerkrankungen und anderen Entitäten, die hier als „Sonstige“ bezeichnet werden. Um die richtigen Untersuchungen anzuordnen und eine gezielte Therapie zu verordnen, ist ein angemessener diagnostischer Ansatz ausschlaggebend. Diese Übersicht konzentriert sich auf Entitäten, die mit Gesichtsödem einhergehen, und fasst ihre klinischen Charakteristika zusammen.

If not angioedema, what is it? Diagnostic approach to facial edema

Facial edema is a relatively frequent clinical presentation encountered in patients seen in allergology and dermatology clinics. The differential diagnosis is broad, and sometimes the definitive diagnosis can be a challenge for the clinician. Facial angioedema itself encompasses different etiopathologies (histaminergic, bradykinergic, etc.) that must be distinguished from other causes of facial edema, such as allergic contact dermatitis, granulomatous conditions, inflammatory causes, infections, neoplasms or paraneoplastic syndromes, autoimmune diseases, among other entities hereby referred as miscellanea. A proper diagnostic approach is essential to order the appropriate tests, as well as to prescribe a targeted treatment. This review focuses on entities that present with facial edema and summarize their characteristic clinical features.