Periocular dermatitis: a report of 401 patients

Experimental study for inorganic and organic profiling of toy makeup products: Estimating the potential threat to child health

Inorganic elements are added to toys as impurities to give desired stability, brightness, flexibility, and color; however, these elements may cause numerous health issues after acute or chronic exposure. In this study, the inorganic profile of 14 elements (Al, As, Ba, Cd, Co, Cr, Cu, Hg, Mn, Ni, Se, Sb, Pb, and Zn) in 63 toy makeup products was identified by inductively coupled plasma-mass spectrometry after microwave acid digestion method. Additionally, organic allergen fragrance was investigated by gas chromatography-mass spectrometry. The systemic exposure dosage (SED), margin of safety (MoS), lifetime cancer risk (LCR), hazard quotient (HQ), and hazard indices were used to assess the safety evaluation. Then, 57 out of 63 samples (90.48%) exceeded the limits at least for one toxic element with descending order Ni > Cr > Co > Pb > Sb > Cd > As > Hg. The SED values were compared with tolerable daily intake values and remarkably differences were found for Al and Pb. The MoS values for 57.15% of samples exceeded the limit value for Al, As, Cd, Co, Hg, Mn, Sb, and Zn elements. The LCR values were observed at 100% (n = 63), 79.37% (n = 50), 85.71% (n = 54), 77.78% (n = 49), and 18.87% (n = 10) for Cr, Ni, As, Pb, and Cd, respectively. Also, the skin sensitization risks were obtained for Cr and Ni at 26.980% (n = 17) and 9.52% (n = 6), respectively. The HQ values for 80% of samples were found to be ≥ 1 at least for one parameter. The investigation of fragrance allergens in samples did not show any significant ingredients. As a result, toy makeup products marketed in local stores were found to be predominantly unsafe. Children should be protected from harmful chemicals by regular monitoring and strict measures.

Delayed periocular dermatitis as a rare side-effect of topical anti-glaucoma eyedrop instillation in two Shih-Tzu dogs with atopic dermatitis

Two Shih-Tzu dogs with atopic dermatitis presented with delayed periocular dermatitis (PD) following the instillation of dorzolamide and dorzolamide/timolol combination eyedrops; the development of dermatologic signs took 94 and 104 d in cases 1 and 2, respectively. Hypersensitivity to anti-glaucoma eyedrops was highly suspected, and treatment was discontinued. Delayed PD was significantly relieved in cases 1 and 2, at days 155 and 64 after discontinuation, respectively. In this study, the clinical characteristics and progression of delayed PD were described to inform clinicians who may encounter this rare side effect.

Determination of Metallic Impurities by ICP-MS Technique in Eyeshadows Purchased in Poland. Part I

Eye shadows, which are products willingly and frequently used by women and even children, have been reported in literature to contain toxic metals. In this work, a total of 94 eye shadows samples available on the Polish market were collected. Eye shadow products have been selected in order to include several parameters important from the point of view of the typical consumer such as: product type (mat/pearl), consumer group (for adults and children), price range (very cheap, medium price, expensive and very expensive), color (twelve different colors were tested), manufacturer (eight brands were investigated) or country of production (four countries were included). The concentration of selected metals (Ag, Ba, Bi, Cd, Pb, Sr, Tl) was determined by ICP-MS technique after the sample extraction with a mixture of nitric acid and hydrogen peroxide in a microwave closed system. For Ag, Cd and Tl, some results were below the established limit of quantification for the employed technique. The presence of strontium, barium, lead and bismuth was confirmed in all studied samples. The obtained results for analyzed elements were, in general, quite comparable with the data reported by other authors. A small number of samples exceeding the permissible values (two samples were beyond the limit value for Cd of 0.5 mg/kg and one exceed the acceptable concentration for Pb of 10 mg/kg) also proves a relatively good condition of the Polish cosmetics market and suggests insubstantial risk for the potential consumers. The results gathered for some of the eye shadows intended for children turned out to be alarmingly high, in particular for elements such as Cd. The highest concentration of Cd reached almost 4 mg/kg, while of Pb amounted to 16 mg/kg. The presence of the statistically significant differences was confirmed for all included parameters with an exception of the color of the eye shadow. Considering the results acquired only for Cd and Pb with respect to the country of origin, the least contaminated cosmetics by metallic impurities seem to be the one produced in Canada, while the ones presenting the highest health risk among all studied eye shadows are make-up cosmetics originating from Poland and Italy. Multivariate analysis of a large data set using CA methods and PCA provided valuable information on dependencies between variables and objects.

Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016

BACKGROUND

Eyelid dermatitis is a common dermatologic complaint.

OBJECTIVE

To characterize patients with eyelid dermatitis.

METHODS

Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data.

RESULTS

Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group.

LIMITATIONS

Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data.

CONCLUSION

Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.

Eyelid Dermatitis and Contact Sensitization to Nickel: Results from an Italian Multi-Centric Observational Study

BACKGROUND

Due to the sensitizing constituents of eye cosmetics, allergic contact dermatitis is considered a frequent cause of eyelid dermatitis. An association between eyelid dermatitis and nickel contained in make-ups remains controversial.

OBJECTIVE

The study aimed to assess the association between nickel allergy, the use of pigmented makeup products and self-reported eyelid dermatitis.

METHOD

This multi-centric, cross-sectional study enrolled 165 women sensitized to nickel (patients) and 103 women without intolerance to metals (controls). We recorded: demographics, atopy, use of pigmented eye cosmetics (mascara, eyeshadow, eyeliner, eyebrow pencil), and previous eyelid dermatitis. Among the patients, any co-sensitization to cosmetics or metals was recorded.

RESULTS

87.3% of the patients and 91.3% of the controls reported their use of eye make-up; 44.9% and 52.4%, respectively, reported previous episodes of eyelid dermatitis, without significant differences. The occurrence of eyelid dermatitis was significantly associated with the use of eye make-up products, both in general and considering each product separately. Age, atopy, or co-sensitization to other metals or cosmetics did not affect the occurrence of eyelid dermatitis.

CONCLUSION

Nickel allergy should not be considered the main risk factor for eyelid dermatitis. The use of pigmented eye make-up may be a triggering factor for eyelid dermatitis, probably due to an irritant action.

Non-glaucoma periocular allergic, atopic, and irritant dermatitis at an academic institution: A retrospective review

PURPOSE

To better understand the nature of periocular dermatitis (PD) patient presentation, treatment, time-to-cure, and referral pattern for allergy testing in an ophthalmic academic center.

METHODS

A retrospective chart review of 344 patients diagnosed with PD between January 1, 2000 and November 30, 2016 at the Edward S. Harkness Eye Institute was performed. Eighty patients were eligible for the study. The primary endpoint was the time-to-cure. Cox proportional hazards regression was performed to assess if there was a significant difference between time-to-cure in patients treated with: 1) combination topical steroid/antibiotic (n = 6) vs. topical steroid alone (n = 40) and 2) combination topical steroid and oral antihistamine (n = 5) vs. topical steroid alone (n = 40).

RESULTS

The median age of eligible patients was 57.69 years old, 66.25% of patients were female, and 41.25% had a history of atopy. Seven patients in total were referred for allergy testing. A significant difference was found in likelihood of cure when comparing combination topical steroid and oral antihistamine versus topical steroid alone, adjusting for age and gender (aHR = 3.97, 95% CI: 1.40-11.25). No significance was found when comparing combination topical steroid/antibiotic versus topical steroid alone (aHR = 1.96, 95% CI: 0.72-5.27).

CONCLUSION

Patients treated with topical steroid and oral antihistamine were approximately 4 times more likely to experience cure in comparison to patients treated with topical steroids alone. While the majority of patients were not referred for formal allergy testing, this would likely be of benefit.

Contact dermatitis: a practice parameter-update 2015

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Contact blepharoconjunctivitis due to black henna — A case report

Para-phenylenediamine (PPD) can induce immediate or — more often — delayed hypersensitivity. We report the case of 48-year old female admitted to the out-patient allergy clinic a day after her visit in a beauty parlour, where she had her eyelashes and eyebrows dyed with henna. Physical examination revealed prominent edema of the upper part of the face including forehead, cheeks and eyes causing severe narrowing of the palpebral chink. Skin prick tests (SPT) with common allergens were positive for Dermatophagoides pteronyssinus, Dermatophagoides farinae and moulds, while the SPT with PPD was negative. Patch test to PPD was positive. Further investigations revealed eosinophilia in the tear fluid. To our knowledge, this is the first case of PPD-induced contact blepharoconjunctivitis (CB) with concomitant increased eosinophilia in the tear fluid.

Periorbital contact sensitization

PURPOSE

To identify frequency and pattern of contact sensitization among patients with periorbital dermatitis.

DESIGN

Cross-sectional retrospective investigation of 1247 patients referred for patch testing over a 17-year period.

METHODS

Data were collected for patients undergoing patch testing to the standard and customized trays between January 1990 and December 2006 at the Massachusetts General Hospital, Contact Dermatitis Clinic. Our study group consisted of 266 patients affected by periorbital dermatitis. Findings were compared to 981 referrals without periorbital dermatitis (controls). Patch test results were read after 48 and 72 hours and classified as allergic, questionable, irritant, or negative. Statistical analyses were carried out by using chi(2) test and Fisher exact test.

RESULTS

General epidemiologic data among periorbital dermatitis patients showed significant predominance of female gender (87.6%) and of individuals aged 40 to 59 years (45.9%). Nickel (16.5%) and fragrance mix (13.2%) were the top-ranking sensitizers. Ingredients of topical ophthalmologic products did not result in significant sensitization. Comparison of the periorbital dermatitis group to the controls did not reveal significant differences in sensitization pattern. Patch testing confirmed the likelihood of allergic contact dermatitis in 50.8% of the periorbital dermatitis patients tested.

CONCLUSIONS

Allergic contact dermatitis is a common cause of periorbital dermatitis. Patch testing should be considered in all patients with periorbital dermatitis when suspecting contact allergy in order to identify and avoid offending allergens.