Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review.

BACKGROUND: Prolonged wear of facial protective equipment can lead to occupational dermatoses. OBJECTIVE: To identify important causes of occupational dermatoses from facial protective equipment. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both. RESULTS: We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare. LIMITATIONS: Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies. CONCLUSION: This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.

Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society.

The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.

Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler.

PURPOSE OF REVIEW: The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6-18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined. RECENT FINDINGS: Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients. This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.

Metal hypersensitivity in the context of connective tissue disease - An opportunity for practice prevention.

Metal hypersensitivity reactions (MHR) are not associated with metal containing orthodontic implants unless there is a positive history of dermatitis from a high nickel-release item (piercing post, earring, watch). We wish to present this letter to highlight evidence surrounding orthodontic-related nickel hypersensitivity and to bring to the readers attention current American Contact Dermatitis Society (ACDS) guidelines that endorse the importance of addressing metal hypersensitivity reactions in the setting of implantable dental devices.

Approach to the jewelry aficionado.

Children's and teens' frequent use of inexpensive "costume" jewelry exposes them to a variety of contact allergens. Greater use heightens the risk of developing allergic contact dermatitis, especially in the setting of body piercings. Several clinical pearls, prevention strategies, and avoidance alternatives are provided in this article to guide clinicians and patients in the management of jewelry-related allergic contact dermatitis.

Current Knowledge on Skin Cancer Prevention in Liver Transplant Recipients.

The improved survival of liver transplant recipients (LTRs) has been accompanied by a concomitant rise in long-term liver transplantation complications, including skin cancer. A recent study found that the prevalence of skin cancer among LTRs is 13.5%, a rate equivalent to that observed among kidney transplant recipients. Given the morbidity associated with skin cancer in LTRs, an individualized, multidisciplinary approach to skin cancer prevention that incorporates patient education, encourages consistent use of primary prevention methods, and ensures routine dermatologic screening should be universally adopted in this population. Chemopreventative measures should be considered in LTRs with a high skin cancer burden. Furthermore, additional studies should be performed in order to systematize these recommendations.

Diagnosis and management of allergic contact dermatitis in children: common allergens that can be easily missed.

PURPOSE OF REVIEW: Contact dermatitis is an economically burdensome pediatric disease, and it is important to know the top allergens that have remained as top offenders for over the last decade. RECENT FINDINGS: A comparative analysis of the 20-allergen screen was done against the current top 40 pediatric allergens, and it revealed that the 20-allergen screening series would have theoretically only captured 47.5% of the relevant contact allergens (52.5% failure to detect rate). In addition, the T.R.U.E. Test (SmartPractice, Phoenix, Arizona, USA) would have revealed 60% of the top 40 allergens (40% failure to detect rate). SUMMARY: Patch testing in children has become a more common practice, and management requires the identification and avoidance of the offending allergen from the sensitized person's environment.

Appropriate Testing of Isothiazolinones in Children.

BACKGROUND/OBJECTIVE: The isothiazolinones methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are prevalent pediatric contact sensitizers. MI allergic contact dermatitis (ACD) is underreported in the literature. The objective of the current study was to use a database of provider-reported U.S. pediatric patch test cases to evaluate the positive patch test (PPT) prevalence rates of the combined preservative test substrate MCI/MI and of MI alone. METHODS: U.S. pediatric patch test providers in all 50 states who had joined the registry were invited to submit deidentified cases to the database. More than 1100 logged cases in the database were evaluated for PPTs to MCI/MI combination, MCI/MI and MI, and MI alone. RESULTS: Within 1 year of data collection, 96 cases with a PPT for MCI/MI, MCI/MI and MI, and MI alone were identified; 37 of these were positive to MCI/MI, with MI alone not tested or negative, and 39 were positive to MI only, with MCI/MI and MI tested. Fifteen (41%) of the MCI/MI cases were detected using an epicutaneous patch test alone and 22 cases (59%) using comprehensive patch testing. Only one case (3%) of MI alone sensitization was detected using T.R.U.E. plus a supplemental panel of tests; the remaining 38 cases (97%) were detected using comprehensive testing. Testing with only the combined MCI/MI preservative substrate may miss 51% of MI allergies. CONCLUSION: Appropriate testing of isothiazolinones is needed to clarify the true prevalence of sensitization to these allergens and the burden of pediatric ACD. Patch testing for MI alone in addition to MCI/MI combination is warranted in children with recalcitrant dermatitis.

Cinnamon Sugar Scrub Dermatitis: "Natural" Is Not Always Best.

Children are at risk of developing allergic contact dermatitis to fragrances. Personal hygiene products, even those labeled hypoallergenic or considered all natural, may be a significant source of fragrance exposure in this population.

Contact Alopecia: Improvement of Alopecia with Discontinuation of Fluocinolone Oil in Individuals Allergic to Balsam Fragrance.

Inflammatory scalp dermatoses can be associated with alopecia, which is nonscarring and reversible in its early stages. This association has been described in seborrheic dermatitis, psoriasis, and atopic dermatitis. We describe three girls with alopecia aggravated by contact allergy to balsam fragrances. All three had complete resolution with avoidance of balsam of Peru and other balsam derivatives (including discontinuation of fluocinolone oil, which contains balsam of pine).

Practice Patterns of Dermatologists in the Pediatric Contact Dermatitis Registry.

BACKGROUND/OBJECTIVES: U.S. adults and children are equally likely to have allergic contact dermatitis. Historically the narrow geographic location of data-reporting providers has quantitatively and qualitatively limited the pediatric contact dermatitis data. The Pediatric Contact Dermatitis Registry was used to evaluate self-identified pediatric patch test providers within the United States with regard to demographic characteristics, geographic location, and practice patterns. METHODS: A wide range of U.S. providers were invited to join the registry by completing a secure online 11-question registration survey. RESULTS: There were 252 respondents from 50 states and the District of Columbia; 28.6% were pediatric dermatologists and members of the Society for Pediatric Dermatology (SPD), and 38% were members of the American Contact Dermatitis Society. The cumulative range of pediatric patch-test evaluations performed each year was 1,726 to 4,613 children. SPD members had a significantly greater likelihood of performing a commercially available patch test (odds ratio 7.14 [95% confidence interval 5.11, 9.97], p < .001) than those who were not SPD members. SPD members also had significantly lower odds of performing North American Contact Dermatitis Group standard tests than nonmembers. CONCLUSIONS: The frequency of patch test evaluations in children is significantly underreported. This study provides insight into the practice patterns of various providers who are patch testing children and makes recommendations for evidence-based modifications regarding these practices. Limitations of the study include survey responder selection bias and small sample size.

Chemical Tattoo Treatment Leading to Systemic Cobalt Hypersensitivity.

An otherwise healthy 36-year-old Caucasian woman, without prior history of atopic dermatitis or eczema, presented to an outside dermatologist with a generalized, severely pruritic eruption involving the entire body except the face. One month previously, she had used a 50% trichloroacetic acid tattoo removal solution on a blue-colored tattoo on the medial aspect of the left ankle. The patient's eruption persisted for 7 months, and after several attempts to slowly taper her prednisone dose, she presented to our institution. On physical examination, there was a 3-cm erythematous, lichenified plaque surrounding the tattoo (Figure). On the trunk and upper regions of the arms, there were scattered, 1- to 2-cm, nummular patches and plaques. Biopsy of a truncal lesion revealed spongiotic pustules with a mixed dermal infiltrate and scattered eosinophils, consistent with subacute spongiotic dermatitis.

Shin-Guard Dermatitis-Detection and Protection.

With the popularity of soccer among American youth and the associated use of protective shin guards, dermatitis from the guard components has emerged. Awareness and protective measures may help prevent irritation and the development of contact sensitization from the guards.

Benzoate Allergy in Children--From Foods to Personal Hygiene Products.

Benzoate allergy may be an overlooked allergen in children and one that may be of increasing importance with its increasing role as a preservative in pediatric personal hygiene formulations. The cases herein report an association with cola and benzoate allergy and discusses the implications of replacement of formaldehyde by benzoates in personal hygiene products.

Countering Staphylococcus Overgrowth During Patch Testing in Children with Moderate to Severe Atopic Dermatitis.

BACKGROUND: Patients with moderate to severe atopic dermatitis (AD) often have a concurrent diagnosis of contact dermatitis, but patch testing in these patients presents a unique set of challenges. Barrier impairment and Staphylococcus aureus colonization and infection, along with the sealed occlusion that takes place during the patch testing procedure, can create an optimal environment for bacterial overgrowth. AIMS: To identify patients at risk for S. aureus overgrowth during patch testing and provide pre- and peripatch testing interventions to aid clinicians in obtaining the best possible patch test results in this complicated population. MATERIALS AND METHODS: A retrospective review was performed of five patients with moderate to severe AD for which S. aureus overgrowth and superinfection complicated patch test evaluation. RESULTS: All five patients were able to complete the patch test procedure and all had relevant positive patch test reactions. Complications during patch testing included erythema, oozing, foul odor under the patches, and purulent material at the patch sites. One patient had a culture performed during patch testing that showed methicillin-sensitive S. aureus. DISCUSSION: Patch testing can play an important role in the examination and management of patients with refractory AD. CONCLUSIONS: Moderate to severe AD and concern regarding S. aureus overgrowth should not preclude patch testing.

"Mint" Condition: Contact Dermatitis in an Adolescent Numismatist.

Allergic contact dermatitis (ACD) is common in children and adolescents. A history of persistent rash despite appropriate treatment should raise suspicion of ACD. We present the case of a 16-year-old boy with chronic dermatitis suspected of being a possible nickel allergy. He and his mother denied known common exposures. Patch testing confirmed allergies to multiple metals and several preservatives. A detailed social history revealed that the patient was an avid coin collector. Information about hobbies and activities should be elicited in any patient in whom ACD is suspected to determine exposures they may not initially have considered relevant. This case highlights the importance of pre- and posttest counseling and exposure history.

Use of Oral Polypodium Leucotomos Extract in Chronic Photoinduced Hypersensitivity Dermatitis.

A 52-year-old man with Fitzpatrick type V skin presented for evaluation of a photodistributed eruption of unknown origin. The patient reported a 20-year history of the dermatitis, with worsening severity during the past 6 years. He had required one hospital admission with intravenous methylprednisolone and two extended courses of oral prednisone (starting dose of 60 mg/d). He complained of pruritus and swelling localized to the sun-exposed areas of the forearms, face, and neck, with notable sparing of photoprotected areas of his skin. He denied new medications, and a systemic review of systems was noncontributory.

Easter egg hunt dermatitis: systemic allergic contact dermatitis associated with chocolate ingestion.

Pediatric systemic allergic contact dermatitis to nickel has previously been reported in association with cocoa. We present four clinical cases of hypersensitivity temporally associated with chocolate consumption at Easter. Clinicians should be aware of the potential for foods high in nickel to provoke patients with known nickel sensitivity and systemic dermatitis.

Nickel ferrule applicators: a source of nickel exposure in children.

Eye makeup has been investigated for nickel content and found to have no direct association with nickel allergy and cosmetic dermatitis. However, the tools used (e.g., eyelash curlers, hairdressing scissors, hair curlers, and eye shadow and makeup applicators) may be sources. Nickel is ubiquitous and a wide range of sources have been reported, and makeup applicators (ferrules) now join the list.