Patch test results of hand eczema patients: relation to clinical types

Hand dermatitis: a 6-year experience in a tertiary referral Brazilian hospital

BACKGROUND

Hand dermatitis (HD) is a prevalent inflammatory skin disease with a significant socioeconomic impact.

OBJECTIVES

To characterize the population of HD patients followed up at the Department of Dermatology of a tertiary hospital.

METHODS

A cross-sectional, retrospective and descriptive study was carried out through the analysis of medical records of HD patients assisted at the Allergy Clinic of the Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, between March 1, 2016 and August 31, 2022.

RESULTS

Of the 175 patients, 73.3% were women, and the mean age at the onset of the condition was 41.7 years. There was a statistically significant association between occupation categories and the presence of occupational dermatitis. Cases were classified as irritant contact dermatitis (49.7%), allergic contact dermatitis (57.1%) and endogenous vesicular HD (3.4%). It was observed a statistically significant higher frequency of patch tests positivity for methylchloroisothiazolinone and methylisothiazolinone (MCI/MI) and nickel sulfate in women and for potassium bichromate and carba mix in men. DLQI was assessed in 77 patients, and the average score was 7.8 points.

STUDY LIMITATIONS

As limitations, the authors point out data collection from medical records, which lacked some information. Furthermore, as this was a cross-sectional study, it was not possible to assess cause-and-effect relationships between the variables.

CONCLUSIONS

The present data reinforces the importance of patch tests in HD investigation and highlights the high sensitivity rates to MCI/MI and nickel sulfate in Brazilian women and to potassium bichromate and carba mix in Brazilian men patients.

Clinical Characteristics and Patch Test Results in 57 Patients with Contact Dermatitis in Southern Taiwan

Background/Objectives: Patch testing is a valuable clinical tool for identifying the causes of allergic contact dermatitis (ACD). This study aimed to identify common allergens in southern Taiwan. Methods: A retrospective review of patch test data from April 2019 to May 2023 was conducted at a tertiary medical center. The European Baseline Series of allergens was utilized to evaluate and identify the causes of dermatitis. The prevalence rates of contact sensitization to each allergen were calculated. Results: A total of 57 patients (mean age 41.8 years) with contact dermatitis who underwent patch testing were included. The most common allergens were cobalt chloride (24.6%), followed by fragrance mix I (19.3%), Peru balsam (17.5%), nickel (II) sulfate hexahydrate (15.8%), benzisothiazolinone (15.8%), 4-Phenylenediamine (PPD) base (10.5%), and methyldibromo glutaronitrile (10.5%). Patients with positive patch test results frequently had a history of allergic rhinitis (26.3%), atopic dermatitis (24.6%), urticaria (21.1%), and elevated immunoglobulin E (IgE) levels (28.1%). The hairdressing profession was associated with a higher risk of hand eczematous dermatitis. Conclusions: Positive patch test results were observed in 86% of patients diagnosed with contact dermatitis. This study found that cobalt, rather than nickel, was the most prevalent allergen in patients with contact dermatitis. Elevated IgE levels were observed in ACD patients, with the hands being the most frequently affected area. Occupations as accountants, secretaries, and in the hairdressing and cosmetics industries were strongly associated with hand eczematous dermatitis. The early identification of allergens and appropriate treatment strategies significantly reduced recurrence rates and improved outcomes. For individuals with specific allergies, ongoing avoidance of identified allergens is crucial to managing and preventing allergic reactions. Further research is needed to elucidate the mechanisms and responses to novel therapies, including biologic agent- and nanotechnology-based treatments.

A Review of Hand Eczema Subtypes: Clinical Features, Biomarkers and Treatment Strategies

Hand eczema is a common dermatological condition that significantly impairs quality of life. The classification of hand eczema has been considered an essential step for its management. The diagnosis of hand eczema relies on the aetiological and clinical features of hand lesions, a process complicated by the heterogeneous presentations and the considerable overlap among its subtypes. However, the investigation of hand eczema biomarkers and the advent of targeted therapies have shed light on the underlying pathogenic mechanisms. This review adopts a subtype-specific approach to hand eczema, addressing clinical, pathogenic and therapeutic factors, with the aim of providing a comprehensive understanding of this heterogeneous condition from the perspective of its subtypes.

Microbial assisted alleviation of nickel toxicity in plants: A review

Nickel (Ni) is required in trace amounts (less than 500 µg kg-1) in plants to regulate metabolic processes, the immune system, and to act as an enzymatic catalytic cofactor. Conversely, when nickel is present in high concentration, it is considered as a toxic substance. Excessive human nickel exposure occurs through ingestion, inhalation, and skin contact, ultimately leading to respiratory, cardiovascular, and chronic kidney diseases. Due to anthropogenic activities, the nickel concentrations in various environmental scenarios have progressively risen to levels as high as 26,000 ppm in soil and 0.2 mg L-1 in water; surpassing the established safety threshold limits of 100 ppm for soil and 0.005 ppm for surface water. Nickel is required by various plant species for facilitating biological processes; in the range of 0.01-5 µg g-1 (dry weight). When present in excess, nickel toxicity in plants (10-1000 mg kg-1 dry weight mass) causes many disrupted metabolic processes; leading to lower growth, altered development, hindered seed germination, chlorosis, and necrosis. To tackle any metal-linked pollution issues, various remediation approaches are employed to remove heavy metals (especially nickel) and metalloids including physicochemical, and biological methods. Based on literature, the physicochemical methods are not commonly used due to their costly nature and the potential for producing secondary pollutants. Interestingly, bioremediation is considered by many practitioners as an easy-to-handle, efficient, and cost-effective approach, encompassing techniques such as phytoremediation, bioleaching, bioreactors, green landforming, and bio-augmentation. Operationally, phytoremediation is widely utilized for cleaning up contaminated sites. To support the phytoremediative processes, numerous nickel hyperaccumulating plants have been identified; these species can absorb from their surroundings and store high concentrations of nickel (through various mechanisms) in their biomass, thereby helping to detoxify nickel-contaminated soils via phytoextraction. The microbe-assisted phytoremediation further optimizes the nickel detoxification processes by fostering beneficial interactions between microbes and the nickel-hyperaccumulators; promoting enhanced metal uptake, transformation, and sequestration. Microbe-assisted phytoremediation can be categorized into four subtypes: bacterial-assisted phytoremediation, cyanoremediation, mycorrhizal-assisted remediation, and rhizoremediation. These diverse approaches are likely to offer more effective and sustainable remediative strategy to ecologically restore the nickel-contaminated environments.

Hand eczema

Hand eczema is a highly prevalent skin disease and one of the most common work-related disorders. In up to two-thirds of individuals affected by hand eczema, the disease becomes chronic and results in substantial personal and occupational disability. Manifestations of chronic hand eczema vary in severity and appearance over time, and people with eczema typically experience itch, pain, and a burning sensation. The pathophysiology of chronic hand eczema is multifactorial. Major risk factors are current or past atopic dermatitis and excessive or prolonged exposure to irritants or allergens. Based on the suspected main causes, chronic hand eczema is commonly classified into irritant, allergic, and atopic hand eczema. Diagnosis and assessment can be complex, and management is often challenging. Strategies include structured education, avoidance of trigger factors, primary to tertiary prevention, topical anti-inflammatory treatment with glucocorticosteroids, calcineurin inhibitors, or januskinase inhibitors, phototherapy, systemic retinoids, and off-label use of immunosuppressive drugs. Topical and systemic immunomodulatory therapies approved for atopic dermatitis could be used in severe atopic hand eczema and some of them are under clinical development for chronic hand eczema. Additional research is needed to better understand chronic hand eczema subtypes and underlying mechanisms, and the comparative effectiveness and safety of therapies. This Review combines established knowledge with ongoing changes in our understanding of the disease and their implications for prevention, management, and future research.

A cross-sectional study of clinical characteristics and risk factors for hand eczema in the general Chinese population

In the general population, there is limited evidence for the associations between hand eczema (HE) and lifestyle factors, and between the severity of HE and quality of life. This study aimed to estimate the risk factors for the incidence of HE in the general population and the risk factors for the severity of HE. A cross-sectional questionnaire was administered to 121 HE patients in a hospital from December 2018 to December 2019 in Wuhan. The severity of HE was significantly associated with working with wet hands more than 5 h per day and chapped skin. Sixty-seven patients have positive patch test results. Working with wet hands for more than 5 h per day and chapped skin were the most common and significant risk factors for HE. Working hours with wet hands per day was an independent risk factor for the hand eczema severity index and dermatology life quality index, and there was a significant positive correlation between chapped skin and the severity of hand eczema and higher transepidermal water loss (TEWL). The results also revealed a significant positive correlation between the severity of HE and the impact on quality of life and the severity of TEWL. Prolonged wet hand work can lead to a higher rate of severe hand eczema in the general population. HE can be relieved by reducing the wet hand working time and hand moisturizing.

Th1 and Th2 cytokine expression in hyperkeratotic chronic hand eczema and the role of Tofacitinib a oral JAK inhibitor

Tissue cytokines in chronic hand eczema (CHE) can predict targeted therapy with novel drugs including JAK inhibitors. Our primary objective was to assess the tissue expression of cytokines of Th1 and Th2 cell lines in CHE patients and to study the efficacy of oral tofacitinib. We recruited patients presenting with recalcitrant CHE. Lesional and non-lesional tissue samples were assessed for Th1(IFN-γ, TNF-α) and Th2 related cytokines (IL-4, IL-13, IL-2,) using real time PCR. Tofacitinib 5 mg twice daily was initiated with 4 weekly assessment and we also noted relapses post therapy.Of 21 refractory hyperkeratotic CHE patients, cytokine analysis was performed in 11 patients which showed upregulation of IL-4 [n = 5/11, 1.87-fold increase], TNF-α (n = 5/11, 5.13-fold) and IFN-γ (n = 6/11, 1.98-fold) as compared to uninvolved skin. All patients (100%) had used topical corticosteroids (TCS) and 4/21 (19%) had failed methotrexate and 2/21 (9.5%) had failed acitretin. Tofacitinib 5 mg twice daily was given in 15/21 patients. The mean time to achieve hand eczema severity index 90 (HECSI 90) was 4 weeks (mean duration of treatment:5.8 months, n = 12). Side effects were observed in 4/12 (33.3%) patients and relapse was noted in 3/12 (25%) patients after a mean duration of 7 months after discontinuation of tofacitinib. Tofacitinib (pan-JAK inhibitor) showed an excellent response in refractory CHE patients with predominant tissue Th1/Th2 cells related cytokine expression.

[Molecular diagnosis of hand eczema]

BACKGROUND

Because hand eczema is a diagnostic challenge even for experienced dermatologists, a correct diagnosis is essential to ensure success of specific therapies.

OBJECTIVES

Prerequisites for successful molecular diagnostics in general and in hand eczema in particular are discussed.

MATERIALS AND METHODS

Basic research and opinion statement on new developments in molecular diagnostics are considered with a special focus on hand eczema.

RESULTS

The first molecular classifier to distinguish psoriasis from (hand) eczema signature has been introduced as CE-marked in vitro diagnostics (CE-IVD); many more biomarkers associated with diagnostics, theranostics, or natural course of the disease are currently being investigated.

CONCLUSIONS

Diagnosis of hand eczema will be supported by molecular diagnostics in the near future; we are at the beginning of the molecular era in dermatology.

A comprehensive summary of disease variants implicated in metal allergy

Allergic disease represents one of the most prominent global public health crises of the 21^st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.

Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas

This is a comprehensive and current guide for the diagnosis, differential diagnosis, treatment, and management of eczematous dermatitis, with a focus on atopic dermatitis, irritant and allergic contact dermatitis, hand dermatitis including recurrent vesicular and hyperkeratotic types, asteatotic dermatitis, and nummular or discoid dermatitis. Diagnostic options highlighted are clinical history, physical examination, and patch testing. Therapeutic options highlighted are moisturizers, topical corticosteroids, topical calcineurin inhibitors, crisaborole, phototherapy, and systemic medications including biologics.

Nickel Allergy: Epidemiology, Pathomechanism, Clinical Patterns, Treatment and Prevention Programs

Nickel is the most common cause of contact allergy in the general population and the most frequently detected allergen in patients patch tested for suspected allergic contact dermatitis (ACD). ACD from nickel is a typical type IV hypersensitivity. Nickel allergy is mostly caused by nonoccupational exposure, such as jewelry and clothing decorations, metal tools, medical devices (mainly orthopedic and orthodontic implants, cardiovascular prosthesis), eyeglasses, utensils, keys, pigment for paint, cosmetics, and food (mainly legumes, chocolate, salmon, peanuts). Occupational exposure can involve several workers (mechanics, metalworkers, platers, hairdressers, jewelers, workers in the constructions and electronic industries), classically involving hands and forearms. The classic clinical pattern of ACD caused by nickel is characterized by eczematous dermatitis involving the sites of direct contact with the metal. Non-eczematous-patterns are reported, including lichenoid dermatitis, granuloma annulare, vitiligo-like lesions, dyshidrosiform dermatitis, and vasculitis. In the case of systemic exposure to nickel, sensitized patients could develop systemic contact dermatitis. Patch testing represents the gold standard for the diagnosis of ACD from nickel. Treatment includes avoidance of contact with products containing nickel and the patient's education about the possible use of alternative products. A recent EU nickel directive, regulating the content and release of nickel from products, has caused a decrease of nickel contact allergy in some European countries. Nickel allergy is a relevant issue of public health with significant personal, social, and economic impact. This review summarizes epidemiology, pathomechanism, clinical patterns, treatment, and prevention programs.

Topical 0.05% clobetasol cream in the treatment of chronic hand eczema: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic hand eczema (CHE) is a recurrent, frequently disabling skin condition that requires daily skin care to prevent transepidermal water loss, posing a significant burden of society and economy. In recent years, topical 0.05% clobetasol cream is widely used for the treatment of CHE for its efficacy, tolerability and safety. Whereas, no systematic review and meta-analysis has been updated up to now. Therefore, this work aims to assess the effectiveness and safety of topical 0.05% clobetasol cream in patients with CHE.

METHODS

Study on topical 0.05% clobetasol cream for CHE will be searched from their inception to December, 2020 with the language restrictions of English and Chinese in 8 databases (PubMed, Cochrane Library, Embase, the web of science, VIP, CNKI, CBM, and WAN FANG). According to the heterogeneity test, a fixed or random-effect model will be used to synthesize data. The primary outcome is the proportion of patients achieving more than 75% reduction in signs and symptoms according to the Hand Eczema Severity Index (HECSI). The secondary outcomes include: scored for 4 different characteristics of the lesions (redness, scaling, lichenification, and pruritus), QoL questionnaire, adverse events, and recurrence events. STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. Two or more reviewers will independently conduct the selection of studies, data extraction, and data analysis.

RESULTS

The results of the study expect to provide a high-quality, evidence-based recommendation on topical 0.05% clobetasol cream in the treatment of CHE for clinicians.

CONCLUSION

The study will provide scientific and useful evidence for better use of topical 0.05% clobetasol cream in treating CHE.

ETHICS AND DISSEMINATION

This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/SPHVZ.

Patch Testing to Methyldibromoglutaronitrile/Phenoxyethanol: North American Contact Dermatitis Group Experience, 1994-2018

BACKGROUND

Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) is a broad-spectrum preservative mixture used in consumer and industrial products.

OBJECTIVES

The aims of the study were (1) to characterize the prevalence and clinical relevance of patch test reactions to MDBGN/PE and the epidemiology of positive patients and (2) to determine the frequency of concomitant reactions of MDBGN/PE and its components.

METHODS

This study used a retrospective analysis of cross-sectional data compiled by the North American Contact Dermatitis Group from 1994 to 2018.

RESULTS

Of 55,477 tested patients, 2674 (4.8%) had positive patch test reactions to MDBGN/PE (1.0%-2.5% petrolatum [pet]); most were + (63.3%) or ++ (22.3%). Clinical relevance was considered definite in 3.0% and probable in 19.3% of reactions. Common dermatitis sites included the hands (26.4%), scattered/generalized distribution (24.7%), and the face (18.3%). Patients with a positive reaction to MDBGN/PE and/or MDBGN and/or PE were significantly more likely to be male and older than 40 years and/or had hand dermatitis (P ≤ 0.0033). Positivity to MDBGN/PE 2.0% pet decreased significantly over time (from 6.0% in 1998-2000 to 2.5% in 2017-2018, P < 0.0001). Personal care products were the most common exposure source (53.2%).

CONCLUSIONS

Over time, positivity to MDBGN/PE 2.0% pet decreased significantly from 6.0% (in 1998-2000) to 2.5% (in 2017-2018). The high proportion of weak (63.3%) reactions underscore the need for careful interpretation of patch test sites. Important demographic associations included male sex and age older than 40 years.

Changing trends of contact allergens: A 40-year retrospective study from a referral centre in northern Taiwan

BACKGROUND

The common contact allergens may change over time as the environmental exposure changes.

OBJECTIVES

To identify the prevalence rates and changing trends of contact allergens in Taiwan over a 40-year period.

MATERIALS & METHODS

The patch testing results of a referral centre from 1978 to 2018 were retrospectively reviewed. The study population was divided into four groups according to 10-year intervals. The prevalence rates of contact sensitization to each agent and the clinical relevance were analysed. For patients with positive reactions to relevant allergens, the occupations and sites of dermatitis were analysed.

RESULTS

From 1978 to 2018, a total of 4005 patients underwent patch testing. Successively increasing trends of positive reactions to cobalt, fragrance mix I, and para-phenylenediamine (PPD) were found. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was an emerging contact allergen. Hairdressers, cosmetologists, and aromatherapists became the occupations most commonly having positive reactions in the most recent 10 years. In the first two decades, the face and neck were the most commonly affected areas. Later, hands became the most commonly affected sites.

CONCLUSIONS

The prevalence rates of positive reactions to cobalt, fragrance mix I, and PPD increased successively. MCI/MI was an emerging contact allergen of special concern.

Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.

Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016

BACKGROUND

Hand eczema (HE) is a heterogeneous and burdensome disorder.

OBJECTIVE

To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing.

METHODS

Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113).

RESULTS

Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ², P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators.

LIMITATIONS

No data on HE phenotype.

CONCLUSION

HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.

A comprehensive study of nickel levels in everyday items in Brazil

BACKGROUND

Nickel is a ubiquitous element used in many everyday items. In recent decades nickel has become a leading allergen, which has become a public health problem.

OBJECTIVE

To evaluate frequently used nickel products in Brazil. We investigated if these objects release nickel that is capable of inducing sensitization or cause clinical manifestations in terms of allergic contact dermatitis (ACD).

METHODS

Dimethylglyoxime (DMG) spot tests assessed nickel release from several common utensils used in everyday life in São Paulo and Rio de Janeiro, Brazil.

RESULTS

We tested 46 coins (two denominations) and 90 common utensils. Approximately 91.1% produced nickel-positive results using the DMG spot test.

CONCLUSIONS

The DMG limit of detection was 1.67 ppm of nickel. We observed that many objects in our test series released nickel above the DMG test limit. This observation suggests that nickel-sensitive individuals may be exposed to nickel, representing a public health issue.

Isothiazolinone Biocides: Chemistry, Biological, and Toxicity Profiles

The importance of isothiazole and of compounds containing the isothiazole nucleus has been growing over the last few years. Isothiazolinones are used in cosmetic and as chemical additives for occupational and industrial usage due to their bacteriostatic and fungiostatic activity. Despite their effectiveness as biocides, isothiazolinones are strong sensitizers, producing skin irritations and allergies and may pose ecotoxicological hazards. Therefore, their use is restricted by EU legislation. Considering the relevance and importance of isothiazolinone biocides, the present review describes the state-of-the-art knowledge regarding their synthesis, antibacterial components, toxicity (including structure–activity–toxicity relationships) outlines, and (photo)chemical stability. Due to the increasing prevalence and impact of isothiazolinones in consumer’s health, analytical methods for the identification and determination of this type of biocides were also discussed.

[Molecular diagnostics of hand eczema]

BACKGROUND

Using current diagnostic tools for hand eczema, namely clinical picture and histology, differential diagnoses such as psoriasis palmaris usually cannot be ruled out.

OBJECTIVES

Discussion of current diagnostic possibilities for hand eczema; presentation and critical evaluation of proposed biomarkers for molecular diagnostics and outlook how diagnostics in dermatology will change in the near future.

MATERIALS AND METHODS

In this article, we discuss basic research and provide a review of the literature.

RESULTS

Molecular diagnostics has the potential to substantially improve diagnosis of hand eczema; prerequisites are prospective validation of proposed markers and availability of valid and cost-effective diagnostics.

CONCLUSIONS

In the near future, the diagnosis of hand eczema will be complemented by software algorithms and artificial intelligence on the one hand and simple, precise, and economic molecular diagnostic devices on the other.

Using Patch Testing to Improve Therapeutic Outcome in the Treatment of Hand Eczema in Vietnamese Patients

BACKGROUND:

Hand eczema is a common chronic and relapsing skin disease with various clinical features. Hand eczema aetiology can be allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), atopic dermatitis (AD) and unknown or combination causes. If the causative agents are not detected treatment of hand eczema will be a failure. A patch test can be useful to detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema. In Vietnam, patch test has not been used before, so we conduct this study.

AIM:

To identify causative allergens by using patch test with 28 standard allergens in consecutive patients.

METHODS:

A group of 300 HE patients from the National Hospital of Dermatology and Venereology (NHDV) in Vietnam were enrolled in this study. They were divided into 4 groups-ACD, ICD, AD and unknown aetiology. The patient was patch tested with 28 standard allergens to identify the causative agents.

RESULTS:

Among the 300 HE enrolled patients, ACD accounted for 72.7%, AD and ICD had the same rate of 12.7%. 39.3% of the patients had a positive patch test. Reaction to nickel sulfate was the most common (10.3%), followed by potassium dichromate (9.7%), cobalt (4%) and fragrance mix (3.1%). About one-third of the cases had relevant clinical reactions correlated with the contact agents and clinical history. Males reacted to cement, thiuram mix and formaldehyde more than females, while females reacted to a nickel more than males.

CONCLUSIONS:

Hand eczema has variable clinical features and diverse aetiology. ACD is an important cause of hand eczema that can be managed with a patch test to detect causative allergens. Nearly 40% of HE cases had positive patch test. Relevant patch test reactions were seen in one-third of the patients. We propose using patch test detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema.

European Surveillance System on Contact Allergies (ESSCA): Contact allergies in relation to body sites in patients with allergic contact dermatitis

Background

Analyses of the European Surveillance System on Contact Allergies (ESSCA) database have focused primarily on the prevalence of contact allergies to the European baseline series, both overall and in subgroups of patients. However, affected body sites have hitherto not been addressed.

Objective

To determine the prevalence of contact allergies for distinct body sites in patients with allergic contact dermatitis (ACD).

Methods

Analysis of data collected by the ESSCA (www.essca‐dc.org) in consecutively patch tested patients, from 2009 to 2014, in eight European countries was performed. Cases were selected on the basis of the presence of minimally one positive patch test reaction to the baseline series, and a final diagnosis of ACD attributed to only one body site.

Results

Six thousand two hundred and fifty‐five cases were analysed. The head and hand were the most common single sites that ACD was attributed to. Differences between countries were seen for several body sites. Nickel, fragrance mix I, cobalt and methylchloroisothiazolinone/methylisothiazolinone were the most frequent allergens reported for various body sites.

Conclusions

Distinct allergen patterns per body site were observed. However, contact allergies were probably not always relevant for the dermatitis that patients presented with. The possibility of linking positive patch test reactions to relevance, along with affected body sites, should be a useful addition to patch test documentation systems.

The risk of developing a contact allergy to materials present in diving suits and diving equipment

Allergic contact eczema is the most common occupational skin disease caused by allergens. Thus far, no research has been conducted in Poland in relation to the development of contact allergies amongst divers resulting from particular diving suit components. A group of 86 divers were examined using allergy patch tests. Standard products of contact allergy diagnostics were used containing 40 allergens.

Patch Test as a Diagnostic Tool in Hand Eczema

INTRODUCTION

Allergic contact dermatitis is an important cause of hand eczema. Patch testing is the only investigation available to prove the diagnosis of allergic contact dermatitis. Exposures to allergens differ according to geographical, occupational, economic and social factors. Accordingly, patterns of allergic contact dermatitis differ in different parts of the world and different regions of the same country.

AIM

To study the causes of allergic contact dermatitis in adult patients with hand eczema with the help of patch testing.

MATERIALS AND METHODS

This was a cross-sectional study involving 54 hand eczema patients conducted between October 2013 and June 2015, at a tertiary care centre in Southern India. After a detailed history including history of occupational exposure and detailed examination, patch test was done on these patients with Indian standard series. The patches were removed after 48 hours. Another reading was taken after 72 hours. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data were summarized using mean and standard deviation for continuous variables and percentages for categorical and dichotomous variables. The test of association was done with Fisher's-exact test.

RESULTS

Hyperkeratotic hand eczema was the commonest morphological type (29%), followed by discoid eczema. Pompholyx was significantly more common among patients with history of atopy. A total of 20 patients (37%) showed patch test positivity to a total of 25 allergens. Nickel was the most common allergen (11.11%) followed by para-phenylenediamine (PPD) (7.4%). Nickel (6 patients) and cobalt (3 patients) were the common allergens among women, while potassium dichromate (3 patients) and parthenium (2 patients) were the common allergens among men. Potassium dichromate allergy was significantly more common among masons and PPD allergy was significantly more common among hair dye users. Discoid pattern of hand eczema was common among patients with allergy to potassium dichromate.

CONCLUSION

Majority of the cases of hand eczema are not due to allergic contact dermatitis. History of atopy is common among patients with pompholyx. Allergic contact dermatitis due to nickel remains a common cause of hand eczema.

Belt Buckles-Increasing Awareness of Nickel Exposure in Children: A Case Report

Children, especially those with atopic dermatitis, are at risk for nickel sensitization and subsequent dermatitis from metal-containing objects, namely belt buckles. We describe allergic contact dermatitis in 12 children with peri-umbilical nickel dermatitis (with and without generalized involvement) caused by dimethylglyoxime-positive belt buckles. The patients' symptoms resolved with avoidance of the nickel-containing products.