Associated factors of widespread pattern of dermatitis among patch test population: 12-Year retrospective study.

BACKGROUND/OBJECTIVE: Widespread dermatitis is often associated with diagnostic and therapeutic challenges. Multiple factors influence this widespread pattern of dermatitis. We aim to study the associated factors in patch-tested patients who presented with widespread pattern of dermatitis. METHOD: This retrospective, case-control study was conducted on patients with dermatitis who were patch tested during January 2005 to December 2016. The demographic data, patient and family histories, diagnoses, and patch test findings were recorded and analyzed. RESULTS: Of the 3201 included patients, 645 (20.2%) had widespread pattern of dermatitis. Being male, age >60, and history of either atopic dermatitis (AD) or metal allergy were significantly associated with the widespread dermatitis pattern. A multivariate analysis demonstrated that preservatives were the significant offending allergens, especially methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), and methylisothiazolinone (MI) alone. CONCLUSION: Widespread pattern of dermatitis is associated with gender, age, underlying atopic dermatitis and a history of metal allergy. Preservatives are the significant offending allergens of widespread dermatitis, especially MCI/MI, and MI alone. A thorough history taking and patch testing, including preservatives, are necessary to determine the cause of widespread pattern of dermatitis.

Randomized investigator-blinded comparative study of moisturizer containing 4-t-butylcyclohexanol and licochalcone A versus 0.02% triamcinolone acetonide cream in facial dermatitis.

BACKGROUND: Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects. OBJECTIVE: To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis. METHODS: This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4. RESULTS: Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity. CONCLUSION: The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.

Amalgam Contact Allergy in Oral Lichenoid Lesions.

BACKGROUND: Oral lichenoid lesions (OLLs) cannot be distinguished from oral lichen planus (OLP) except that causative factors can be identified. Amalgam is one of the causative allergens, and replacement may lead to resolution. OBJECTIVES: The aim of this study was to determine the prevalence, prognosis, and aggravating factors of amalgam contact allergy in patients with OLLs. METHODS: A clinical retrospective and prospective cohort study was carried out at the Dermatology Department, Siriraj Hospital, Mahidol University. In cases with patch test positive for an amalgam component, patients were suggested to replace their amalgam restorations. RESULTS: Of 53 patients with OLLs, 39 (73.6%) had positive patch test results, and 31 (58.5%) reacted to at least one amalgam component. The most common causative allergen was mercury (35.8%). Lesions on bilateral buccal mucosa and gingiva tended to have negative patch test results (P < 0.05). Spicy food was the main aggravating factor. Amalgam replacements were performed in 10 patients. Clinical improvement was observed in all cases with complete healing in 3 cases. CONCLUSIONS: The prevalence of amalgam contact allergy in patients with OLLs was 58.5%. Mercury was the most common allergen, followed by copper sulfate. An association between clinical, topographic relation, and positive patch test results would be a useful predictor for favorable outcome after amalgam removal.

Contact sensitizers in commercial hair dye products sold in Thailand.

BACKGROUND: Hair dyes are known to contain potent contact allergens for which sensitization rates have increased over the last decade. OBJECTIVE: To examine the type and frequency of potent contact sensitizers labelled on hair dyes sold in metropolitan Bangkok, Thailand. METHODS: During the 2013-2014 study period, labelled ingredient information from home use and professional hair dye products was collected. RESULTS: Two hundred and fifty-two hair dye products were evaluated. One hundred and forty-nine products from 48 brands were domestically produced in Thailand, and 103 products were from 23 multinational brands produced in countries other than Thailand. Two hundred and fourteen of 252 (84.9%) hair dye products were found to contain strong skin sensitizers, with 118 (46.8%) being found in domestically produced products, and 96 (38.1%) being found in multinational brand products. Thirty-eight hair dye products (15.1%) were free of potent skin sensitizers. The number of domestically produced products (31, 20.8%) that were free of potent skin sensitizers was significantly higher (p = 0.002) than the number of multinational brand products (7, 6.8%). CONCLUSIONS: p-Phenylenediamine was the most prevalent potent sensitizer found among domestically produced hair dyes available on the market. Our findings indicate regional differences in hair dye allergen exposure.

The Role of the Skin Barrier in Occupational Skin Diseases.

Occupational skin diseases (OSDs) are the second most common occupational diseases worldwide. Occupational contact dermatitis (OCD) is the most frequent OSD, and comprises irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), contact urticaria and protein contact dermatitis. There are many endogenous and exogenous factors which affect the development of OCD, including age, sex, ethnicity, atopic skin diathesis, certain occupations and environmental factors. One of the most important contributing causes is skin barrier dysfunction. The skin provides a first-line defense from environmental assaults and incorporates physical, chemical and biological protection. Skin barrier disturbance plays a crucial role in various skin diseases such as atopic dermatitis (AD), ichthyosis, ICD and ACD. Genetic factors, such as filaggrin gene (FLG) mutations, and external factors, such as skin irritants interfering with stratum corneum structure and composition, may lead to abnormalities in skin barrier function and increased vulnerability to skin diseases. FLG encodes the cornified envelope protein, filaggrin, which is involved in skin barrier function. FLG mutation is associated with the development of OCD. High-risk occupations for OCD include health care workers, hairdressers and construction workers. There are often multiple contributing causes to OCD, as workers are exposed to both irritants and allergens. AD is also associated with skin barrier disruption and plays an important role in OCD. ICD often precedes and facilitates the development of ACD, with impairment of the skin barrier contributing to the concurrence of ICD and ACD in many workers with OCD.

Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause - a comparative study.

BACKGROUND: Standardized skin surface biopsy (SSSB) is considered to be the gold standard technique to evaluate the density of Demodex mites for the diagnosis of demodicidosis. Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superficial skin. OBJECTIVE: To evaluate the reliability of potassium hydroxide preparation of skin scrapings as compared to the standard skin biopsy technique with regard to capacity to detect Demodex mites, time consumed and technician satisfaction. METHODS: One hundred outpatients presenting with facial erythema of uncertain cause were enrolled. Standardized skin surface biopsy and potassium hydroxide preparation of skin scrapings were undertaken in adjacent areas on the patients' right cheek. LIMITATION: Patients with normal facial skin were excluded from the study. RESULTS: The accuracy of Demodex mite detection by potassium hydroxide preparation of skin-scrapings when compared to the standard procedure is 82%. The sensitivity, specificity, positive and negative predictive values of this method are 75%, 84.2%, 60% and 91.43%, respectively. There was no statistically significant difference between the standard and skin scraping techniques (P = 0.238) with regard to mite detection. Mean preparation time while using the skin scraping technique was 6 times less than that of the standard technique. For interpretation also, skin scraping technique (3.6 min) consumed much less time than the biopsy technique (9.8 min). Moreover, experienced technicians were more satisfied with skin scraping. CONCLUSION: Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method.

Cosmetic preservative labelling on the Thai market.

BACKGROUND: Preservatives are added to cosmetics and other consumer products to prevent microbial growth and product degradation. Many cosmetic preservatives are skin sensitizers and frequent causes of contact dermatitis. The use of preservatives may vary by country and/or region, according to legislation, and may be reflected in differences in the prevalence rates of preservative allergy worldwide. OBJECTIVE: To examine the type and frequency of preservative use in cosmetics sold in Thai markets in metropolitan Bangkok, Thailand. METHODS: Preservatives contained in 1000 different cosmetics sold in Thai markets were documented and analysed, based on the labelling of ingredients. RESULTS: Most of the cosmetic and skincare products sold in Thai markets were international brands, with only a small proportion of cosmetic products being produced in Thailand. International brand cosmetics were more likely to contain non-formaldehyde-releasing preservatives than domestically produced brands. Isothiazolinone-based preservatives, which are responsible for the current increase in the prevalence of contact allergy, were found at a significant frequency in domestically produced, leave-on cosmetic products. CONCLUSION: Preservatives in cosmetics were significantly different according to source of production and type of cosmetics.

Risk factors and common contact allergens in facial allergic contact dermatitis patients.

BACKGROUND: Facial dermatitis is commonly encountered in dermatologic practice. It is sometimes difficult to manage because its causative factors may be multiple and difficult to diagnose. OBJECTIVES: This study was designed to identify the characteristics, patch test results, and final diagnoses of facial dermatitis patients who were referred to a contact dermatitis clinic and to identify factors associated with facial allergic contact dermatitis (ACD). METHODS: We retrospectively reviewed case records of facial dermatitis patients who underwent patch testing at the clinic during the period from July 2006 to June 2011. RESULTS: Of the 891 patients patch-tested, 244 (27.4%) had facial dermatitis. Female patients were 9.1 times more predominant than male patients. The mean ± standard deviation age of patients was 37.3 ± 14.8 years. A total of 199 (81.6%) patients demonstrated at least one positive reaction to a patch test, 66.7% of which were clinically relevant. Allergic contact dermatitis was diagnosed in 45.5% of patients. Independent factors predisposing towards facial dermatitis were female sex, having a previous history of cosmetic allergy, a positive patch test reaction to hairdressing product-related allergens, and a positive allergic reaction to preservative allergens. CONCLUSIONS: The prevalence of facial dermatitis was 27.4%. Almost half of all patients with facial dermatitis demonstrated ACD. Factors associated with facial ACD were female gender, a history of cosmetic allergy, and positive patch test reactions to hairdressing product-related allergens and preservatives.

Assessment of nickel and cobalt release from jewelry from a non-nickel directive country.

BACKGROUND: A directive restricting nickel release from jewelry and other skin-contact products has not been initiated in Thailand or in the United States. The prevalence of nickel and cobalt allergies is increasing, and the main cause of sensitization seems to be jewelry. OBJECTIVES: We aimed to investigate nickel and cobalt release from jewelry available in Thai marketplaces and to study the factors associated with nickel and cobalt release. METHODS: Used costume jewelry items were collected from volunteers. They were tested with the dimethylglyoxime and cobalt tests. RESULTS: Five hundred fifty-one items, including belt buckles, bracelets, earrings, necklaces, rings, and watches, were tested; 216 (39.2%) gave positive dimethylglyoxime tests, and 206 (37.4%) gave positive cobalt tests. The factors that determined nickel or cobalt release were shopping location and jewelry price. Cobalt-containing jewelry could be identified by its dark color. CONCLUSIONS: A large proportion of the jewelry sold in Thai markets release nickel or cobalt.

Risk assessment for nickel contact allergy.

Nickel is one of the most common allergens causing allergic contact dermatitis worldwide. The aim of the study was to evaluate the contributing factors to nickel contact allergy (NiCA) in Asians who have a unique culture and lifestyle. We randomly selected 324 previously patch-tested patients, 162 nickel patch test (PT)-positive patients and 162 nickel PT-negative patients. The patients were telephone interviewed for their lifestyle information. Most of the nickel PT-positive patients (93.2%) were female with a mean age of 38.9 ± 13.3 years compared with the other group of nickel PT-negative patients who had a smaller proportion of females (76.5%) with an older mean age of 44.1 ± 14.9 years (P = 0.001). Multivariate analysis was able to establish that the significant risk factors for NiCA were female sex (odds ratio [OR], 6.38; 95% confidence interval [CI], 2.15-18.94), young age (OR, 0.98; 95% CI, 0.96-1.00), occupation with long periods of exposure to metal (OR, 3.08; 95% CI, 1.18-8.02), seafood (OR, 1.96; 95% CI, 1.17-3.27) and canned food consumption (OR, 3.12; 95% CI, 1.17-8.33) (P < 0.05). The adjusted factors found to associate with NiCA were female sex, young age, occupation with long periods of exposure to metal, seafood and canned food consumption.

Latex glove-related symptoms among health care workers: a self-report questionnaire-based survey.

BACKGROUND: The use of latex gloves by health care workers (HCWs) can lead to multiple symptoms: eczema, contact urticaria, rhinitis, conjunctivitis, asthma, and anaphylaxis. OBJECTIVES: The objectives of this study were to reveal the prevalence of latex glove-related symptoms of HCWs at Siriraj Hospital and to determine risk factors associated with those symptoms associated with the use of latex gloves. METHODS: Self-administered questionnaires were sent to 6880 HCWs who were working at Siriraj Hospital and using latex rubber gloves in their duty. RESULTS: The questionnaire response rate was 65.8%. Of 4529 respondents, the male-to-female ratio was 1:8.6 and the mean age was 34.3 years. The majority of respondents were nurses (83%). The prevalence of glove-related symptoms among the HCWs is 13.3%. Glove-related cutaneous and noncutaneous symptoms were found in 11.3% and 5.9% of the respondents. CONCLUSIONS: The hospital housekeepers emerged as the job with the significantly higher prevalence rate of glove-related symptoms than that of the other job categories. Factors associated with glove-related cutaneous symptoms are frequency and duration of glove use, history of atopy, and history of allergy to fruit cross-reacting with latex. The quantity of glove use, history of atopy, and allergy to fruits cross-reacting with latex are risk factors for the occurrence of glove-related noncutaneous symptoms.

Occupational contact dermatitis in tertiary university hospital: a 5-year retrospective study.

BACKGROUND: Thailand, an agricultural country developing into an industrial country, has diferences in work environment, substance exposure, and climate. These factors may lead to a distinct epidemiology of occupational contact dermatitis (OCD). OBJECTIVE: To study the prevalence of allergic and irritant occupational contact dermatitis in Thailand. MATERIAL AND METHOD: The records of patients diagnosed of OCD and patch tested between 2006 and 2010 at Siriraj University Hospital were retrospectively reviewed. RESULTS: From 885patch tested patients, 194 (21.9%) had OCD. Of those 194 patients, 76.8% were female and23.2% were male. Allergic contact dermatitis (ACD; 76.3%) wasfoundto be more common than irritant contact dermatitis (ICD; 24.2%). The common affectedpart was hands (51.5%). The mostfrequent occupation was wet work (35.1%), followed by office work (24.7%), industrial work (16%), and medical personnel (13.4%). The most common occupational allergens were nickel sulfate (33.1%), potassium dichromate (19.6%), and carba mix (15.5%). Water (56.1%), foods (4.9%), and oil/grease (2.4%) were the most common occupational irritants. CONCLUSION: In our setting, allergic OCD was more common than irritant OCD. Nickel sulfate was the most common occupational allergen. Occupational A CD and lCD are most commonly found in industrial work and wet works, respectively.

Cutaneous reactions to non-steroidal anti-inflammatory drugs.

We retrospectively reviewed the records of 195 patients with suspected cutaneous reactions from NSAIDs. Two hundred and six different non-steroidal anti-inflammatory drugs (NSAIDs) were suspected of causing cutaneous reactions, and the most frequent suspected causative NSAID was ibuprofen (25.7%). Angioedema and/or urticaria were the most frequent cutaneous reactions (54.4%), and the foremost suspected causative drug for these reactions was ibuprofen. The second most frequently found cutaneous reaction was maculopapular eruption (26.2%), and celecoxib was the most commonly suspected causative NSAID for it. The primary suspected NSAIDs causing fixed drug eruption were in enolic acid group. Furthermore, drug hypersensitivity syndrome was diagnosed in five patients, and Stevens-Johnson syndrome and toxic epidermal necrolysis were detected in five patients.