Occupational contact dermatitis in blue-collar workers: results from a multicentre study from the Danish Contact Dermatitis Group (2003-2012).

BACKGROUND: Blue-collar workers have a high risk of occupational contact dermatitis, but epidemiological studies are scarce. OBJECTIVES: To investigate allergic contact dermatitis in blue-collar workers with dermatitis registered by the Danish Contact Dermatitis Group. METHODS: A retrospective analysis of patch test data from 1471 blue-collar workers and 1471 matched controls tested between 2003 and 2012 was performed. A logistic regression was used to test for associations. RESULTS: The blue-collar workers often had occupational hand dermatitis (p < 0.001). Atopic dermatitis was less commonly observed among blue-collar workers (19.6%) than among controls (23.9%) (p = 0.005). Allergens with a statistically significant association with the occupational group of blue-collar workers were epoxy resins, methyldibromo glutaronitrile, 2-bromo-2-nitro-1,3-propanediol, potassium dichromate, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI). The following occupations were additionally identified as risk factors for contact sensitization to MCI/MI and MI, epoxy resins, and potassium dichromate, respectively: painting, construction work, and tile setting/terrazzo work. CONCLUSION: Contact allergy is a major problem among blue-collar workers. The data indicate a healthy worker effect among blue-collar workers diagnosed with dermatitis, as blue-collar workers were diagnosed significantly less often with atopic dermatitis than were controls.

Occupational contact dermatitis in hairdressers: an analysis of patch test data from the Danish contact dermatitis group, 2002-2011.

BACKGROUND: Occupational contact dermatitis among hairdressers is frequent, owing to daily exposure to irritants and allergens. OBJECTIVES: To identify sensitization to the most common allergens associated with the occupation of hairdressing. METHODS: Patch test results of 399 hairdressers and 1995 matched controls with contact dermatitis, registered by the Danish Contact Dermatitis Group between January 2002 and December 2011, were analysed. All patients were patch tested with the European baseline series, and hairdressers were additionally tested with the hairdressing series. RESULTS: Occupational contact dermatitis (p < 0.001) and hand eczema (p < 0.001) were observed significantly more often among hairdressers than among controls. Atopic dermatitis was less commonly observed among hairdressers (21.3%) than among controls (29.4%) (p < 0.01). Allergens from the European baseline series with a statistically significant association with the occupation of hairdressing were p-phenylenediamine, thiuram mix, and benzocaine. Frequent sensitizers from the hairdressing series were ammonium persulfate, toluene-2,5-diamine, 3-aminophenol, and 4-aminophenol. Cysteamine hydrochloride and chloroacetamide emerged as new sensitizers. CONCLUSIONS: These results indicate a healthy worker effect among hairdressers diagnosed with eczema. Ammonium persulfate and p-phenylenediamine remain frequent sensitizers in hairdressers with contact dermatitis. Cysteamine hydrochloride and chloroacetamide should be included in future surveillance studies.

Contact allergy to epoxy resin: risk occupations and consequences.

BACKGROUND: Epoxy resin monomers are strong skin sensitizers that are widely used in industrial sectors. In Denmark, the law stipulates that workers must undergo a course on safe handling of epoxy resins prior to occupational exposure, but the effectiveness of this initiative is largely unknown. OBJECTIVES: To evaluate the prevalence of contact allergy to epoxy resin monomer (diglycidyl ether of bisphenol A; MW 340) among patients with suspected contact dermatitis and relate this to occupation and work-related consequences. PATIENTS/METHODS: The dataset comprised 20 808 consecutive dermatitis patients patch tested during 2005-2009. All patients with an epoxy resin-positive patch test were sent a questionnaire. RESULTS: A positive patch test reaction to epoxy resin was found in 275 patients (1.3%), with a higher proportion in men (1.9%) than in women (1.0%). The prevalence of sensitization to epoxy resin remained stable over the study period. Of the patients with an epoxy resin-positive patch test, 71% returned a questionnaire; 95 patients had worked with epoxy resin in the occupational setting, and, of these, one-third did not use protective gloves and only 50.5% (48) had participated in an educational programme. CONCLUSION: The 1% prevalence of epoxy resin contact allergy is equivalent to reports from other countries. The high occurrence of epoxy resin exposure at work, and the limited use of protective measures, indicate that reinforcement of the law is required.

Occupational contact dermatitis in painters: an analysis of patch test data from the Danish Contact Dermatitis Group.

BACKGROUND: Painters are among the occupational groups that most commonly experience occupational contact dermatitis, but few investigations exist concerning this occupation. OBJECTIVES: To characterize painters with contact dermatitis and identify the most common allergens associated with the occupation. Materials and methods. All patch test results of 219 painters and 1095 matched controls registered by the Danish Contact Dermatitis Group between 2001 and 2010 were analysed. RESULTS: Hand eczema (p < 0.0001) and occupational contact dermatitis (p < 0.0001) were observed significantly more often in the painters than in the group of controls. Sensitizations to the following allergens from the European baseline series were associated with the occupation and were statistically significant: methylchloroisothiazolinone/methylisothiazolinone, epoxy resin, formaldehyde, and quaternium-15. Three different isothiazolinones emerged as the most frequent sensitizers of the allergens tested in addition to the baseline series. CONCLUSIONS: The results indicate that painters have an increased risk of developing occupational hand eczema. Isothiazolinones and epoxy resin proved to be the two most frequent sensitizers in painters.

Classification of hand eczema: clinical and aetiological types. Based on the guideline of the Danish Contact Dermatitis Group.

BACKGROUND: No generally accepted classification scheme for hand eczema exists. The Danish Contact Dermatitis Group recently developed a guideline defining common clinical types and providing criteria for aetiological types. OBJECTIVES: To test the concepts of this guideline in a group of hand eczema patients. METHODS: Seven hundred and ten hand eczema patients were included from seven dermatology clinics in Denmark. The hand eczema was classified into one of five clinical types, with standard photographs as reference. The severity was scored by the physician, who also made a final aetiological diagnosis. RESULTS: Irritant contact dermatitis was most frequent in chronic, dry fissured hand eczema (44.3%), pulpitis (41.7%), and nummular hand eczema (40.9%), whereas allergic contact dermatitis dominated in vesicular types of hand eczema, with recurrent (35%) and few (24.2%) eruptions. Hyperkeratotic palmar hand eczema was the only clinical type that constituted a distinct subgroup; it was found most frequently in older men and had the strongest relationship, although not significant, with non-specific dermatitis. CONCLUSIONS: The relationship between clinical type of hand eczema and aetiological diagnosis fitted with general experience, but no simple relationship was found. This emphasizes that patch testing and exposure analysis are mandatory. Hyperkeratotic palmar hand eczema was identified as a distinct clinical subtype.

Deodorants are the leading cause of allergic contact dermatitis to fragrance ingredients.

BACKGROUND: Fragrances frequently cause contact allergy, and cosmetic products are the main causes of fragrance contact allergy. As the various products have distinctive forms of application and composition of ingredients, some product groups are potentially more likely to play a part in allergic reactions than others. AIM: To determine which cosmetic product groups cause fragrance allergy among Danish eczema patients. METHOD: This was a retrospective study based on data collected by members of the Danish Contact Dermatitis Group. Participants (N = 17,716) were consecutively patch tested with fragrance markers from the European baseline series (2005-2009). RESULTS: Of the participants, 10.1% had fragrance allergy, of which 42.1% was caused by a cosmetic product: deodorants accounted for 25%, and scented lotions 24.4%. A sex difference was apparent, as deodorants were significantly more likely to be listed as the cause of fragrance allergy in men (odds ratio 2.2) than in women. Correlation was observed between deodorants listed as the cause of allergy and allergy detected with fragrance mix II (FM II) and hydroxyisohexyl 3-cyclohexene carboxaldehyde. CONCLUSION: Deodorants were the leading causes of fragrance allergy, especially among men. Seemingly, deodorants have an 'unhealthy' composition of the fragrance chemicals present in FM II.

Fragrance mix II in the baseline series contributes significantly to detection of fragrance allergy.

BACKGROUND: Fragrance mix II (FM II) is a relatively new screening marker for fragrance contact allergy. It was introduced in the patch test baseline series in Denmark in 2005 and contains six different fragrance chemicals commonly present in cosmetic products and which are known allergens. AIM: To investigate the diagnostic contribution of including FM II in the baseline series by comparing it with other screening markers of fragrance allergy: fragrance mix I (FM I), Myroxylon pereirae and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC). METHOD: Retrospective study of 12 302 patients consecutively patch tested with FM II by members of the Danish Contact Dermatitis Group 2005-2008. RESULTS: FM II gave a positive patch test in 553 patients (4.5%), and in 72.2% of these patients the reaction was judged to be clinically relevant. FM II ranked second in detecting fragrance allergy, after FM I. If FM II had not been included as a screening marker in the baseline series, 15.6% (n = 202) of individuals with fragrance allergy would not have been identified by the other fragrance screening markers (FM I, M. pereirae or HICC). CONCLUSION: FM II contributes substantially to detecting fragrance allergy. It ranked second among the fragrance screening markers tested in the baseline series and detects individuals with an allergy who otherwise would not have been identified.

Characteristics of nickel-allergic dermatitis patients seen in private dermatology clinics in Denmark: a questionnaire study.

The use of nickel in certain consumer goods has been regulated in Denmark since 1990. The aim of this study was to reveal the clinical characteristics of nickel-allergic patients seen in seven private dermatology clinics and to identify current sources of nickel that may elicit nickel dermatitis. During 2006 to 2007, 634 patients with dermatitis aged 17-91 years were patch-tested and completed a questionnaire including a question about the occurrence of dermatitis following skin contact with ear-rings or ear-pins, watches, buttons or metal clasps (i.e. metal dermatitis). chi2 tests were applied to test for statistical significant differences. Analysis revealed a lower prevalence of nickel allergy among women in the youngest age group (17-22 years) in comparison with older age groups (23-34 years and 35-46 years) (p < 0.03). Most patients experienced metal dermatitis on the first occurrence be-tween 1975 and 1985. No new cases of metal dermatitis were identified after 1985. We conclude that nickel allergy has decreased among young females with dermatitis due to the nickel regulation.

Decreasing trends in methyldibromo glutaronitrile contact allergy--following regulatory intervention.

BACKGROUND: The preservative methyldibromo glutaronitrile (MDBGN) has been banned, first from stay-on, and later from rinse-off cosmetics, in the EU countries because of increasing rates of contact allergy. OBJECTIVES: To evaluate the frequency of contact allergy to MDBGN among patients patch tested by the Danish Contact Dermatitis Group just before and following regulatory decisions. PATIENTS/METHODS: The data set comprised 19 279 consecutive eczema patients patch tested from 2003-2007 with MDBGN 0.3% in petrolatum (pet.) or, in a minority of patients, with Euxyl K 400 1.5% in pet. RESULTS: A significantly decreasing trend in the frequency of positive patch tests to MDBGN was found from 4.6% in 2003 to 2.6% in 2007 (P < 0.001). The decreasing trend was seen for both men and women. A significantly decreasing proportion of cases with a current relevance of contact allergy to MDBGN was also seen from 51.3% in 2003 to 29% in 2007 (P < 0.001). CONCLUSIONS: Regulatory interventions have already had a major effect on allergic disease due to MDBGN in Denmark. The same trends are likely to be seen in other EU countries.

Trisomy 14 mosaicism: clinical and cytogenetic findings in an adult.

Trisomy 14 mosaicism is a well-known but rare chromosomal defect with most frequently reported features being growth retardation, psychomotor retardation, broad nose, dysplastic and/or apparently low set ears, micrognathia, short neck, congenital heart disease and, in males, micropenis and cryptorchidism. Other frequent findings are prominent forehead, hyperteleorism, narrow palpebral fissures, large mouth, cleft or highly arched palate, body asymmetry and abnormal skin-pigmentation (Fujimoto et al., 1992). To the best of our knowledge, only one adult patient with trisomy 14 mosaicism has been described so far (Fujimoto et al., 1992). We present the clinical findings in a 27-year-old woman to add to the knowledge of the adult phenotype of trisomy 14 mosaicism and to demonstrate the findings on fibroblast culture.

Contact allergy to methyldibromo glutaronitrile--data from a 'front line' network.

The preservative methyldibromo glutaronitrile (MDBGN) has caused an epidemic of contact allergy in Europe. However, most data concerning contact allergy comes from hospital departments of dermatology. As a part of the primary health care sector, Danish dermatologists in private practice provide the front line of care for patients with skin diseases. Data from this source may therefore better reflect trends in the general population than material from hospital departments of dermatology. In this study, the frequency of MDBGN allergy and the characteristics of patients seen by dermatologists in private practice were studied. In 1 year, 2146 patients were patch tested by the participating dermatologists from 4 clinics in various parts of Denmark. 5% (110) had positive patch tests to MDBGN, with no difference between the sexes. After adjustment was made for other background variables, multivariate analysis using logistic regression showed a significant association between hand eczema and MDBGN allergy (OR 2.5, P < 0.001). In 53 cases (52.4%), the patch test reaction to MDBGN was judged to be of current relevance. Creams and lotions accounted for 31% of the identified causative products and liquid soaps for 23%. It is concluded that contact allergy to MDBGN is frequent among patients seen by dermatologists in private practice. This is consistent with results from hospital departments of dermatology in Europe and indicates a general trend and ongoing epidemic in the general population. The significant relationship between hand eczema and MDBGN allergy is of concern, and the finding that wash-off products, especially liquid soaps, play a significant role in MDBGN allergy calls for a revision of the safety assessment of MDBGN in wash-off products.

Airborne allergic contact dermatitis from 3-iodo-2-propynyl-butylcarbamate at a paint factory.

3-Iodo-2-propynyl-butylcarbamate (IPBC) is a fungicide used in both industrial products and cosmetics. We report the first case of allergic contact dermatitis from airborne exposure to this preservative. A 34-year-old female production worker at a paint factory developed dermatitis on air-exposed skin areas. Patch testing showed a ++ reaction to the preservative IPBC 0.01% in petrolatum. The compound was used as a preservative in wood treatment products manufactured at her work place. Based on animal studies, IPBC is considered safe as a cosmetic preservative. However, widespread use of the chemical might lead to increasing levels of contact allergy, and therefore, close monitoring of IPBC is recommended.