Gender differences in allergic contact dermatitis to common allergens.

BACKGROUND: Gender-based differences in skin structure, physiology, and allergen exposure can influence contact dermatitis development. OBJECTIVE: This study investigated the differences and trends in contact sensitizers, focusing on the top 10 allergens and personal care product (PCP) contact allergies from a gender perspective. METHODS: We conducted a retrospective chart review of 5998 patients undergoing patch testing at an occupational and contact dermatitis clinic in a Thai, university-based, tertiary referral hospital from January 2001 to December 2021. Patients' characteristics and patch test results were collected. RESULTS: Females had a higher positive patch test rate than males (71.8% vs. 65%, p < 0.001). However, males showed a greater prevalence of occupationally related allergic contact dermatitis (15.9%). Multivariate analysis revealed associations between being female and allergies to colophonium (aOR 1.46, 95% CI 1.07-1.99, p = 0.019), formaldehyde (aOR 1.97, 95% CI 1.17-13.31, p = 0.010), fragrance mix I (aOR 1.66, 95% CI 1.34-2.07, p < 0.001), MCI/MI (aOR 2.55, 95% CI 1.90-3.44, p < 0.001), neomycin (aOR 4.15, 95% CI 2.54-6.80, p < 0.001), and nickel (aOR 2.62, 95% CI 2.17-3.15, p < 0.001). Conversely, being male correlated with allergies to carba mix (aOR 0.51, 95% CI 0.41-0.64, p < 0.001), epoxy resin (aOR 0.26, 95% CI 0.14-0.47, p < 0.001), n-isopropyl-n-phenyl-4-phenylenediamine (aOR 0.41, 95% CI 0.20-0.83, p = 0.014), paraben mix (aOR 0.42, 95% CI 0.32-0.56, p < 0.001), and potassium dichromate (aOR 0.70, 95% CI 0.58-0.84, p < 0.001). Positive reactions to PCPs stood at 13% overall (males 17.1%, females 12.2%, p < 0.001). CONCLUSIONS: Gender plays a pivotal role in contact dermatitis. This work emphasises the importance of considering gender-specific factors when diagnosing and managing contact allergies.

Allergic contact dermatitis to footwear in Thailand: Prevalence, clinical characteristics and common allergens.

BACKGROUND: Footwear contact allergy is caused by exposure to allergens in shoes. The prevalence and common allergens vary by region and time due to differences in customs and lifestyle. OBJECTIVES: To determine the clinical characteristics and common allergens of patients with footwear-related allergic contact dermatitis (ACD) who attended Siriraj Hospital in Bangkok, Thailand, between 2001 and 2020. METHODS: The medical records of 247 patients with clinically suspected footwear dermatitis who underwent patch testing were reviewed. RESULTS: The prevalence of ACD to footwear was 1.8%. Females were predominant (71.6%). The three most common allergens were carba mix (7.7%), mercapto mix (6.9%) and potassium dichromate (6.9%). According to the allergens found, rubber (14.2%), adhesives (7.7%) and leathers (6.9%) were the three most common groups. Dorsal-limited skin lesions were significantly associated with footwear ACD. CONCLUSION: Rubber and leather allergens were still the most common culprit allergens. Dermatologists should keep up-to-date on common allergens in footwear and emerging allergens to include in patch test series.

Efficacy of panthenol- and bisabolol-containing lip care as monotherapy for mild-to-moderate cheilitis.

BACKGROUND: Cheilitis is a chronic inflammatory condition of the lips, and frequent or prolonged use of topical corticosteroids may lead to various adverse events. Therefore, alternative therapies with fewer side effects are beneficial for the treatment of this condition. AIM: To evaluate the efficacy of a lip care formulation containing both panthenol and bisabolol as a monotherapy for mild-to-moderate cheilitis. METHODS: This single-centre prospective pilot open-label study included 20 patients with mild-to-moderate cheilitis who were treated with the tested lip care for 8 weeks and evaluated by physician and patient assessments before the final efficacy was determined using the Visioscan score. RESULTS: Of the 20 patients, 13 (65.0%) presented with moderate cheilitis with dry and chapped lips. All parameters, including physician and patient clinical scores and bioengineering measurements, showed significant improvements as early as week 2 and sustained until week 8 following the application of the tested lip care. The frequency of cheilitis flareups also decreased significantly. The tested product was well tolerated without any adverse effects. CONCLUSIONS: Lip care with panthenol and bisabolol was safe and effective. It can be used as monotherapy for the treatment of mild-to-moderate cheilitis.

Prevalence and causative allergens of contact cheilitis in Thailand.

BACKGROUND: Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown. OBJECTIVES: To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital. METHODS: A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021. RESULTS: Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources. CONCLUSIONS: ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.

Trends in formaldehyde and formaldehyde-releaser contact allergies as compared with market exposure in Thailand.

BACKGROUND: Formaldehyde and formaldehyde releasers (FRs) are common preservatives in cosmetics and household products. Their contact allergy trends are decreasing in Europe and America, but trend data for Asia are limited. OBJECTIVES: The first objective was to determine the prevalences of and trends in contact allergies to formaldehyde and FRs. The second objective was to establish how often formaldehyde and FRs were mentioned on the labels of products sold in the Thai market. METHODS: Twenty years of data on patch test results for formaldehyde and FRs were reviewed. Their frequency of mention on the labels of 5855 products was analysed. RESULTS: The trends in contact allergy to formaldehyde and FRs were decreasing. The overall prevalence of formaldehyde contact allergy was 2.5%. The most common FR to cause contact allergy was quaternium-15. Formaldehyde and FRs were identified as ingredients in 10.2% of the products surveyed. Dimethylol dimethyl hydantoin was the most common FR (5.2%). The highest use of formaldehyde and FRs (15.5%) was in hair care products. CONCLUSION: Although contact allergy trends in Thailand were decreasing, the proportion of products with FRs remained high. Comprehensive and universal legislation is needed to control the presence of formaldehyde and FRs.

Characteristics and common ultraviolet filter usage of sunscreens purchased online: Cross-cultural analysis across 5 continents.

BACKGROUND: A wide range of sunscreen products are available globally. Designed to meet various customer needs, they differ in formulations type, textures, ingredients, ultraviolet (UV) protection capabilities, and other properties. Knowing the factors influencing the purchase of sunscreens and the UV filters commonly used in each global region would be beneficial for dermatologists, consumers, and regulators. METHODS: Data on 50 best-selling sunscreens from each of 20 countries on 5 continents (1000 products in all) were retrieved from Amazon Marketplace during the period from January to July 2021. RESULTS: Among the 5 continents, Asia had the highest proportion of consumers (71.1%) choosing high sun protection factor (SPF) sunscreens (SPF ≥50). In contrast, Europe had the highest percentage (11.8%) purchasing <30 SPF sunscreens. The lack of standard UVA protection labeling was significantly highest in South America. The use of inorganic-based sunscreen was highest in North America, and across all continents, those products were significantly more expensive than organic-based sunscreens. Globally, lotions were the most favored formulation type. "Nongreasy/dry touch" (45.1%) and "lightweight texture" (40.4%) were the most common promotional terms used. The most common UV filters differed among regions. Iron oxide, which can function as a visible light filter, was most frequently found in sunscreens in South America (20%) and North America (19.3%). CONCLUSIONS: The regional factors influencing the purchase of sunscreen products differed. A considerable number of sunscreens may not provide adequate sun protection for consumers. Dermatologists should recommend sunscreens with sufficient UV protection that suit the skin of individual consumers.

A comparative study of chemical constituents and safety of Thai herbal medicated oil formula and traditional medicated oil.

OBJECTIVES: Medicated oil has been traditionally used as an analgesic medicine to relieve pain by applying to the skin over painful muscles, and has been established in The National List of Essential Medicines (2556 B.E.). Traditional Medicated oil (TMO) consists of cassumunar ginger, Wan En Lueang, and Wan Ron Thong. It is prepared by frying herbs in coconut oil which is a traditional method. Thai Herbal Medicated oil formula (MOF) comprises cassumunar ginger, sweet flag, lesser galangal, wild turmeric, Wan En Lueang, and Wan Ron Thong. Its preparation by maceration with methyl salicylate is modified method to avoid the heat in the traditional preparation. Since both recipes have different methods of extraction and compositions, it is necessary to determine the chemical constituents and acute skin irritation potential of MOF and TMO. METHODS: This study applied Gas Chromatography-Mass Spectrometry (GC-MS) for quality assessment of MOF extract and TMO extract. The mass spectra of the compounds matched with authentic standards from the NIST library. The compounds were identified by comparing their retention time and peak area, and the percentage of matched factor was more than 80%. The safety assessment on acute skin irritation used the 4 h human patch test (4 h HPT) in 36 healthy subjects. RESULTS: The 37 compounds were found in MOF extract. The most common chemical constituents were terpene derivatives; monoterpenes and sesquiterpenes, and others, namely benzene derivatives, ester, phenylpropanoid, and other compounds. The 33 compounds were found in TMO extract and the chemical groups were similar to MOF extract. The 4 h HPT demonstrated that the MOF extract, TMO extract, methyl salicylate solvent, and coconut oil solvent, did not induce skin irritation. However, the vehicle of the formulae and the whole formulae as MOF and TMO clinically induced skin irritation and accorded with rubefacient. The characteristic as mild erythema or dryness, but not erythema with edema, could appear after the use of rubbing skin products. CONCLUSIONS: The chemical constituents found in MOF and TMO extracts were partially different and their acute skin irritation reactions were not significantly different. A study on the efficacy of both remedies should be performed in the future, as well as a study on active chemical constituents. This study provides scientific evidences of quality and safety, including GC-MS condition for poly-herbal medicated oil standardization.

Simultaneous patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes: An update from southern Sweden.

BACKGROUND: Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated. OBJECTIVES: To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs. METHODS: A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed. RESULTS: The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3-cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series. CONCLUSIONS: Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.

The Value of Patch Testing With Shoe Material Samples in Patients Suspected of Shoe Allergic Contact Dermatitis.

BACKGROUND: Patch testing is the standard diagnostic tool for shoe allergic contact dermatitis (ACD). As shoe materials change over time, utilizing commercial allergen series might be ineffective. However, because testing with patients' shoe samples is laborious, its value is questioned. OBJECTIVE: The aim of this study was to ascertain the benefits of patch testing with patients' shoes by comparing the frequencies of patch-test positivity of shoes and shoe-related allergens in baseline series for suspected shoe ACD patients. METHODS: A retrospective study was conducted of patients with clinically suspected shoe ACD who underwent patch testing with baseline series and shoe samples 2000 to 2019. RESULTS: Almost half of the cohort (77 of 178; 43.3%) was diagnosed with shoe ACD. Of those 77, 48 (62.3%) were positive to shoe-related allergens from the baseline series, whereas 53 (68.8%) were positive to their shoe materials. The prevalence of tests positive to shoe material but negative to shoe-related allergens was 29 of 77 (37.7%). The most common shoe-related allergens were potassium dichromate (7.9%), carba mix (6.8%), and mercapto mix (6.7%). CONCLUSIONS: Patch testing with shoe materials increased the diagnostic yield by 37.7 percent. To diagnose shoe ACD, testing of shoe materials may compensate for unknown, scarce, or novel allergens not in the baseline series.

Ultraviolet filters in sunscreens and cosmetic products-A market survey.

BACKGROUND: As several reports have raised a variety of environmental, health, and safety issues related to ultraviolet (UV) filters, it is crucial to understand the trends in the exposure of the population to UV filters. OBJECTIVE: To determine the frequency of UV filter usage in sunscreens and other cosmetic products in Thai market. METHODS: We surveyed the UV filter labelling on sunscreens and cosmetic products sold in the Thai market. In all, 312 sunscreens and 1350 other cosmetic products were investigated. RESULTS: Titanium dioxide was the most frequently used UV filter in both sunscreens (66.7%) and other cosmetic products (68.4%). Ethylhexyl methoxycinnamate was the most common organic UVB filter, whereas butyl methoxydibenzoylmethane was the most common organic UVA filter. In sunscreens aimed at children, bis-ethylhexyloxyphenol methoxyphenyl triazine was the most commonly used UV filter. The most frequent co-occurrence of UV filters was titanium dioxide and ethylhexyl methoxycinnamate. CONCLUSIONS: Titanium dioxide was the most commonly used UV filter, which differs from the findings of previous surveys. Knowing the availability and frequency of each UV filter provides valuable information about consumer exposure levels, facilitates refinements of the allergen series in patch testing, and enhances the monitoring of adverse effects of UV filters.

Methylchloroisothiazolinone and/or Methylisothiazolinone Contact Allergies in Thailand.

BACKGROUND: Methylchloroisothiazolinone, in combination with methylisothiazolinone (MCI/MI), and MI alone are common preservatives. The incidences of MCI/MI and MI-alone contact allergies have risen markedly worldwide, leading to changes in their use in products. OBJECTIVES: The aim of the study was to determine the incidences of positive patch test reactions and factors associated with MCI and/or MI contact allergies during the recent decade in Thailand. METHODS: Medical records of patients who underwent patch testing at Siriraj Hospital from 2009 to 2018 were retrospectively reviewed. The incidences of positive reactions, histories, and clinical data of MCI/MI and MI-alone contact allergy patients were analyzed. RESULTS: Of 2789 patients undergoing patch testing, most were female (76.1%). The mean ± SD age was 42.7 ± 15.7 years. Positive reactions to MCI/MI increased from 2009 to 2016 before declining. The MCI/MI contact allergy was most common in females, middle-aged patients, and those with metal allergy histories, with the hands and arms being the predominant sites. However, MI-alone contact allergy was more common in males and mainly at the trunk. Its incidence significantly declined for the last 5 years. CONCLUSIONS: The incidences of MCI/MI and MI-alone contact allergies began to decline because the Food and Drug Administration Thailand regulations restricted their use. The risk factors for the allergies reported in this study provide important information for patient care.

Photopatch testing in a tropical country, Thailand: 20 years' experience.

BACKGROUND: Photoallergic contact dermatitis is one of the important parts of photodermatoses. The investigation of choice is photopatch testing. However, reports with photopatch test results from Asian countries are scarce. The objective of this study was to determine the prevalence of positive photopatch test reactions and to ascertain the common photoallergens among Thai patients during 1998-2018. METHODS: We retrospectively reviewed the records of 339 patients who were clinically suspected of having photoallergic contact dermatitis and had undergone photopatch testing. RESULTS: A total of 44 photoallergic contact reactions in 38 patients (11.2%) were found. The positive photoallergic reactions were mainly found with organic ultraviolet filters and fragrances. CONCLUSIONS: Organic ultraviolet filter chemicals especially benzophenone-3 and fragrances were found to have a high prevalence of photoallergic contact reactions. Monitoring of the photoallergens employed in photopatch tests should be conducted periodically to provide the best patient care.

Pediatric contact allergy: A comparative study with adults.

BACKGROUND: Pediatric allergic contact dermatitis is increasing. The patch test allergens included in pediatric baseline series vary globally. The worldwide prevalence of pediatric reactions to allergens needs clarification. OBJECTIVES: Identify the prevalence, associated factors, and culprit allergens for contact allergy among patch-tested Thai children, and compare with those for adults. METHODS: Baseline series patch test results from 2010-2019 were collected for patients younger than 18 years of age. As a control group, sex-matched adult patients were randomly selected. The results and characteristics of the two groups were compared. RESULTS: The median age of 112 patch tested pediatric patients was 16 (range 2-17) years. Of the children, 35.5% had at least one positive reaction, significantly less than the 56.6% for adults. The five most common pediatric allergens were nickel sulfate (12.1%), potassium dichromate (8.0%), methylisothiazolinone (7.1%), fragrance mix II (6.0%), and carba mix (5.4%). Although similar, the 10 most common allergens of the groups differed in order. Positive reactions to cosmetic allergens were significantly less frequent among the children. Many allergens remained entirely negative. CONCLUSIONS: The prevalence of positive reactions was lower in children, varying by population and region. The top-10 pediatric and adult causative allergens were almost identical. We recommend using the same baseline patch test series for children and adults in our region.

Prevalence, concomitant reactions, and factors associated with fragrance allergy in Thailand.

BACKGROUND: Fragrances are the most common cause of cosmetic contact allergy. Up-to-date information on contact allergy frequencies and relevance aids primary and secondary preventive measures. OBJECTIVES: To determine the prevalence, associated factors, and concomitant reactions in fragrance allergy among Thais. METHODS: This retrospective study collected data from 2012 to 2019. The patient characteristics of fragrance and nonfragrance allergy groups were compared. Concurrent positive reactions to fragrance allergens (fragrance mix [FM] I, FM II, Myroxylon pereirae resin and hydroxyisohexyl 3-cyclohexene carboxaldehyde) and other baseline-series allergens were analysed. RESULTS: Of 1032 patients, 175 (17.0%) had fragrance allergy, with 57.7% of clinical relevance. FM I showed the highest prevalence (9.4%). The associated factors were being elderly, lesions on the extremities, metal allergy history, and long dermatitis duration. Contact allergies to epoxy resin and Compositae plants were significantly associated with fragrance allergy with an odds ratio of 5.95 (95% confidence interval [CI]: 5.21-6.80) and an odds ratio of 4.42 (95% CI: 1.58-12.36), respectively. No significant associations between colophonium (previously proposed as a fragrance marker) and fragrance allergens were found. CONCLUSIONS: The prevalence of fragrance contact allergy remains high and should be considered in old patients presenting with long-standing eczema on the extremities. Unlike reports from other countries, varied, significant, concomitant reactions were observed.

Assessment of the quality of life (QoL) of patients with dermatitis and the impact of patch testing on QoL: A study of 519 patients diagnosed with dermatitis.

BACKGROUND: Dermatitis can impair the quality of life (QoL) of patients. Knowledge of the QoL-associated factors and the impact of patch testing on QoL is limited. OBJECTIVES: To identify demographic and clinical factors affecting QoL, and to measure the impact of patch testing on QoL of dermatitis patients. METHODS: The data and Dermatology Life Quality Index (DLQI) questionnaires of 519 dermatitis patients were analyzed. Of these, 107 underwent patch testing and completed the questionnaires two times (once before testing and again 60 days afterward). RESULTS: The overall mean (±standard deviation) DLQI was 9.5 (±6.4). Patients aged 20 to 59 years and those who had more frequent disease exacerbations demonstrated significantly higher DLQIs. For each DLQI question, being female and aged 20 to 59 years were associated with impairments of various aspects of life, whereas the anatomical site of dermatitis impacted each question differently. The DLQI scores of the patients undergoing patch testing decreased significantly, irrespective of whether the test results were positive or negative. CONCLUSIONS: Being of a working age and having more frequent disease exacerbations had negative QoL impacts. In addition, patch testing improved almost every aspect of the DLQI.

Synthetic hair reactions and treatment of complications: Case reports.

BACKGROUND: Synthetic hair fiber implantation first achieved widespread use in the 1970s, but in 1983, the US Federal Drug Administration banned the fibers due to its complications. Currently available synthetic fibers consist of polyamide material, which has been claimed to be effective and safe. Nevertheless, its use for hair restoration is controversial because of complications such as recurrent infections; the rejection and the faster-than-anticipated loss of fibers; frequent allergic reactions; fears about carcinogenicity; cicatricial alopecia; granulomatous hypersensitivity; and cyst formation. AIMS: To report complications of synthetic hair implantation and treatments. METHODS: We report the clinical data, pathological studies, and treatment outcomes of two patients who developed complications after a synthetic hair implantation. RESULTS: Our case reports showed significant moderate-to-severe adverse events, including recurrent folliculitis, scalp crusting, scarring, the matting and breakage of fibers, and granulomatous reactions. The onset of the reactions varied between 1 and 8 weeks. Pathological studies showed that the implantation of the synthetic hair into the scalp produced a hyperplastic proliferation of epidermal cells, foreign body granuloma, and persistent acute inflammation due to bacterial infections. In our study, definitive treatment was ineffective until the synthetic fibers were removed from the scalp. CONCLUSION: These significant adverse reactions may limit the benefits of synthetic hair fiber implantation for some patients. Although the inflammations were initially controlled by oral and topical antibiotics, a variety of antibiotics were unable to control the folliculitis. The fibers were ultimately removed, following which, the inflammations improved.