Potassium dichromate sensitivity presenting as tefillin dermatitis: A retrospective cohort study.

BACKGROUND: Tefillin are a religious article worn by Jewish men during daily prayer. Tefillin dermatitis secondary to potassium dichromate sensitivity is recognised, but data remain sparse. OBJECTIVE: To investigate the prevalence and clinical characteristics of tefillin dermatitis. METHODS: Patients who underwent patch testing with the European baseline series in a tertiary dermatology clinic in 2009-2023 and were diagnosed with tefillin dermatitis were identified by file review and their clinical data recorded. RESULTS: Of 1679 consecutive male patients tested, 25 (1.49%) were diagnosed with tefillin dermatitis, accounting for 15.34% of all potassium-dichromate-positive patients (163/1679). Mean pre-symptomatic duration of tefillin use was 38 ± 16.9 years, and mean follow-up time, 3.1 ± 2.9 years. Patients presented with an eczematous rash on body areas in direct contact with the leather box or straps of the tefillin. An id reaction was noted in 32%, and sensitivity to other leather accessories, in 44%. Fourteen patients (56%) switched to chromate-free tefillin: symptoms resolved completely in 11 (79%) and partially in 2. LIMITATIONS: Retrospective cohort design. CONCLUSION: This is the largest study to date of tefillin dermatitis caused by sensitivity to potassium dichromate used in leather production. Prognosis after switching to chromate-free tefillin was good-to-excellent. Tefillin dermatitis may be more prevalent than previously thought.

Idiopathic Papular Dermatitis in the Spectrum of Chronic Papular Eruptions (Subacute Prurigo): Reappraisal and Diagnostic Algorithm.

BACKGROUND: The clinical diagnosis of papular eruptions is common but poorly characterized in the literature and the etiology is often unknown. OBJECTIVE: To characterize the entity of idiopathic papular dermatitis in the spectrum of chronic papular eruptions. METHODS: The cohort consisted of patients who presented at a tertiary medical center in 2005-2014 with a papular eruption of at least 4 months' duration. Findings on histological analysis and thorough clinical investigation, performed in all cases, were collected. The patients completed a questionnaire on disease course and outcome. RESULTS: Sixty-five patients were included. Sixteen patients showed morphological changes over time and were excluded. Investigations in the remaining 49 patients with a consistent papular morphology yielded a well-defined diagnosis in 23 (46%). Twenty-six patients (54%; 14 male) were diagnosed with idiopathic papular dermatitis. Their mean age at onset was 61.6 ± 14.4 years and the mean duration of disease 3.11 ± 2.726 years. In 60%, the rash resolved with conservative treatment during follow-up (mean 4.35 ± 2.53 years). CONCLUSIONS: Chronic papular eruptions encompass a wide range of skin diseases. In more than half of the cases, the etiopathogenesis remains unclear. On the basis of our results, we propose a diagnostic algorithm for idiopathic papular dermatitis.

Patch testing in Israeli children with suspected allergic contact dermatitis: A retrospective study and literature review.

BACKGROUND/OBJECTIVES: Childhood allergic contact dermatitis is recognized as a significant clinical problem. The objective was to evaluate the rate of positive patch tests in Israeli children with clinically suspected allergic contact dermatitis, identify possible sex and age differences, compare results with those in Israeli adults, and review pediatric studies in the literature. METHODS: The study sample included 343 children and adolescents (197 female, 146 male; 1-18 years of age, mean age 11.8 years) with clinically suspected allergic contact dermatitis who underwent patch testing with a standard pediatric series of 23 allergens at a tertiary medical center from 1999 to 2012. Data on clinical characteristics and test results were collected retrospectively from the medical files. RESULTS: Ninety-eight subjects (28.6%) (75 girls [38.1%], 23 boys [15.8%]) had at least one positive reaction. The most frequent reactions were to nickel sulfate, followed by potassium dichromate and cobalt chloride. Nickel sulfate sensitivity was more common in girls, especially those younger than 3 years and older than 12 years. The prevalence of contact sensitization was similar in subjects with and without atopic dermatitis (50% and 51%, respectively). CONCLUSION: Nickel is the most common allergen in Israeli children, especially girls. Patch testing should be performed in children with clinically suspected allergic contact dermatitis regardless of atopic background.

Luminex LiquiChip System for the Evaluation of Cytokine Levels in Patients with Contact Dermatitis to Potassium Dichromate.

BACKGROUND: Allergic contact dermatitis (ACD) is associated with increased production of cytokines. The patch test is the "gold-standard" diagnostic method, but it poses a risk of false results. OBJECTIVE: To evaluate a novel laboratory technique, the Luminex LiquiChip, which simultaneously measures blood levels of multiple cytokines, as a diagnostic tool in patients with chrome-induced ACD. METHODS: The study group included 20 patients with ACD and relevant patch test results for potassium dichromate and 19 patients with ACD for nickel or fragrance as control. Peripheral blood mononuclear cells (PBMCs) were cultured in the presence and absence of potassium dichromate. The Luminex LiquiChip was used to measure levels of the following cytokines: granulocyte-macrophage colony-stimulating factor, interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, interferon-γ, and tumor necrosis factor (TNF)-α. RESULTS: Potassium dichromate-stimulated PBMCs secreted significantly higher amounts of all cytokines except TNF-α than nonstimulated PBMCs. PBMCs from patients with ACD to chromium secreted significantly higher amounts of all cytokines tested, except IL-4, compared to PBMCs from patients with ACD to nickel or fragrance. CONCLUSIONS: Potassium dichromate stimulates the production of both Th1- and Th2-type cytokines in patients with chrome allergy. The Luminex LiquiChip is a promising in vitro method and may serve as a diagnostic tool for ACD.

Occupational contact dermatitis due to essential oils.

BACKGROUND: Allergic contact dermatitis induced by the occupational use of products containing essential oils has not been studied comprehensively. OBJECTIVES: The aim of the present report was to describe the characteristics, diagnosis, and outcome of 5 patients with occupational contact dermatitis because of essential oils attending our outpatient dermatology clinics over a 2-year period. PATIENTS: These patients are added to the 11 cases reported thus far in the literature. RESULTS: The research shows that for proper diagnosis, patch tests with the standard series and the fragrance series should be performed, in addition to tests with the specific oils to which the patients were exposed. CONCLUSIONS: Patients should be instructed to avoid the allergens identified. Sensitization to essential oils has important implications for the occupational future of affected individuals.

[Pemphigus vulgaris--an alternative for steroid treatment?].

Pemphigus vulgaris is an autoimmune disease with a well-established immunological basis. Treatment is based on high dose and maintenance systemic corticosteroids. We report on a patient with a recurrence of full-blown pemphigus vulgaris after a trial of alternative hypnosis therapy to replace the corticosteroids.

Tefillin dermatitis.

Tefillin (phylacteries) are a religious article worn by observant Jewish men. Only two cases of allergic contact dermatitis from tefillin have been reported previously. We describe 7 new cases of tefillin contact dermatitis and review the literature on contact allergy caused by religious objects and practices. All our patients had contact allergy to potassium dichromate, which was the only allergen relevant to tefillin .

Transient idiopathic primary penoscrotal edema.

We present the case of a male born prematurely at 32 weeks gestation by cesarean section following overt symptoms of maternal preeclampsia. He developed severe penoscrotal edema anew one month from birth. No remarkable exposure or trauma was identified. This unexplained swelling remained uniform till 4 months of age, while the penile edema resolved spontaneously. A small benign hydrocele remained unchanged, since onset of the edema and continued after the edema subsided. This is the first report of persistent, but transient penoscrotal edema resolving in a 3 months course, without any apparent explanation, a possible pathogenetic mechanism was suggested.

Toothpaste allergy as a cause of cheilitis in Israeli patients.

BACKGROUND: Allergic contact cheilitis may appear after exposure to different substances, including dental materials, toothpastes, cosmetics, foods and medications. OBJECTIVE: To compare the rate of toothpaste allergy between patients with and without cheilitis and to examine the yield of our proposed toothpaste patch test kit for use in patients with cheilitis. METHODS: A patch test kit containing 11 substances used in toothpastes was formed. The study sample consisted of 44 patients, 24 with cheilitis (study group) and 20 with contact dermatitis but without cheilitis (control group). RESULTS: Eleven patients in the study group (45%) were found to be allergic to toothpaste, compared to only one patient (5%) in the control group (p < .05). CONCLUSION: The rate of toothpaste allergy among patients with cheilitis might be higher than previously reported. Patch-testing with our toothpaste series is recommended in the evaluation of cheilitis.

Questionnaire study of the prevalence of allergic contact dermatitis from cosmetics in Israel.

BACKGROUND: The prevalence of cosmetics-related contact dermatitis is rising, owing mainly to the wider use of cosmetics by the public and the routine diagnostic use of patch tests. OBJECTIVE: To determine the prevalence of cosmetics allergy in Israel. METHODS: A questionnaire was distributed to a random sample of 360 female customers of pharmacies and beauty salons in two areas of the country. Items included general health profile, family history of atopy, occurrence of rash due to patch-test-proven cosmetics allergy, anatomic sites of the rash, subjective aspects regarding the rash, and cosmetics consumption habits. RESULTS: Patient age ranged from 15 to 89 years. Eleven subjects (3.1%) had patch-test-proven cosmetics allergic contact dermatitis. There was a correlation between proven cosmetics allergy and subjective sensitivity to facial cream (p = .03). CONCLUSIONS: The 3.1% prevalence rate of cosmetics contact allergic dermatitis in a randomly selected population in Israel is similar to values reported in the literature (about 2%). The higher-than-expected rate of subjective sensitivity to facial cream among patients with proven cosmetics allergy may be explained by the wide use of facial cream, facial skin susceptibility to insult, and the relatively long duration of contact of facial cream (a leave-on product) with the skin.

Patch-test results of chemotechnique oil and cooling fluid series in patients with suspected occupational contact dermatitis in Israel.

BACKGROUND: There appear to be no published studies on the rates of positive allergic reactions to oil and cooling fluids. OBJECTIVE: To determine the yield of the oil and cooling fluid series from Chemotechnique Diagnostics in patients in Israel who are suspected to have occupational allergic contact dermatitis. METHODS: The authors reviewed the findings in 175 patients with suspected occupational contact dermatitis who worked with oil and cooling fluids and were patch-tested at two dermatologic clinics in Israel from 1999 to 2003. RESULTS: Forty-four patients (all male; mean age, 40.8 years) had 67 positive reactions to 27 of the 35 allergens (86.7% relevant). An occupational cause was established in 39 patients (88.6%). Thirty-seven of the patients with a positive reaction were also tested with the European Standard series. Of these, 22 (59%) had positive reactions to several allergens in the standard series as well. CONCLUSION: To the best of the authors' knowledge, this is the first study of the oil and cooling fluid patch-test series in this setting. The findings indicate that this series serves as an appropriate test for evaluating occupational contact dermatitis and that its composition should not be changed, pending further studies.

Exogenous factors in connective tissue diseases.

Exogenous factors implicated in or suspected of precipitating connective tissue diseases are reviewed. These include environmental agents, such as ultraviolet light, drugs, chemicals, pesticides, heavy metals, infectious viruses, and bacteria. The possible roles of occupational exposures and the environmental factors early in life are discussed as well.

Standard patch test results in patients with contact dermatitis in Israel: age and sex differences.

Previous studies have shown that the prevalence of specific allergens varies by geographic area, population, age and sex. The objective of the present study was to determine the relative frequency of positive reactions to different sensitizers in Israeli patients with clinically suspected contact dermatitis (CD) and to identify possible sex and age differences. A total of 943 consecutive patients were tested for CD using the European standard patch test series. The most frequent allergen was nickel sulfate followed by potassium dichromate and fragrance mix. Positive reactions to nickel sulfate were more common among women, especially those in the younger age group (younger than 40 years). Positive reactions to balsam of Peru were more common among men, especially those in the older age group (40 years or older). This study presents the result of the standard patch test in Israel with stratification according to age and sex. The findings of the present study, combined with reports on geographic/population differences in the prevalence of specific allergens in CD, indicate the need for further investigations to identify prominent local allergens for better adaptation of the standard patch test to local needs.

Comparison of reactivity to allergens using the TRUE Test and IQ chamber system.

The reproducibility of the patch test is of great importance to its diagnostic utility. The objective of this study was to quantitatively and qualitatively compare the reproducibility of patch test reactions between the manufacturer-loaded TRUE Test (TT) panel and the investigator-loaded IQ Chamber (IQC) system using the European Standard Series (ESS) (Chemotechnique Diagnostics, Malmö, Sweden). Consecutive patients were simultaneously patch tested with 21 allergens using the TT and IQC system. The concordance and discordance of the 2 methods were analysed. Testing was performed in 207 patients (85 men and 122 women) who yielded 317 positive reactions, 188 with the IQ system and 129 with the TT. A total of 204 tests were positive with both methods, showing a positive concordance rate of 64.4%, with IQC producing more positive results. A high concordance rate of positive results was achieved for Cl+ Me- isothiazolinone (81.5%), nickel sulfate (79%), formaldehyde (76.9%), and paraphenylenediamine (PPD) (72.7%); a moderate concordance was noted for quaternium 15 (66.7%), potassium dichromate (64.3%), and fragrance mix (58.1%); and a low concordance was noted for cobalt chloride (27.6%) and Balsam of Peru (18.2%). The IQC and the TT are similar in finding allergy to allergens with high concordance. The IQC system has an advantage in detecting clinically relevant reactions to allergens that have a moderate and a low concordance.

Shoe contact dermatitis in Israel.

BACKGROUND: Patch testing with the shoe series may be useful for the diagnosis of shoe contact dermatitis. OBJECTIVE: The aim of the study was to verify the usefulness of the shoe series and the association of fungal infection with positive results in the shoe series. METHODS: A total of 140 patients with suspected shoe contact dermatitis underwent patch testing with the standard series and shoe series; 41 underwent mycologic examination. RESULTS: Positive results in the shoe series were noted in 58 patients (41.4%). The most common allergens were potassium dichromate (27.2%), nickel sulfate (11.9%), Kathon CG (10.9%), and 4-tert-butylphenol formaldehyde resin (8.7%). Of the 41 patients with suspected tinea pedis, 13 (32%) had positive mycologic findings and 9 (69.2%) also had a positive response to the shoe series. Of the patients with a negative result on mycologic examination, only 10 (35.7%) had a positive result in the shoe series. CONCLUSION: Our study indicates that all patients with foot dermatitis should undergo patch testing with the shoe series. Positive results in the shoe series seem to be more prevalent in patients with a fungal infection.