Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends. / Vigilancia epidemiológica en los últimos 4 años del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea: situación actual y tendencias.

BACKGROUND: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process. OBJECTIVES: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022. METHODS: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend). RESULTS: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend. CONCLUSIONS: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone.

[Translated article] Medical Devices in Patients With Diabetes and Contact Dermatitis.

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.

Dermoscopy in Patch Testing: How Can It Help? / Uso del dermatoscopio en la lectura de pruebas epicutáneas: ¿qué puede aportar?

Interpreting patch test reactions is not easy. It requires experience and is characterized by high intraobserver and interobserver variability. It can sometimes be truly difficult to discern between a weak allergic reaction and an irritant reaction. A number of recent studies have investigated the dermoscopic features of patch test reactions. Homogeneous erythema is the main feature observed in patients with a positive allergic reaction, although dotted vessels, vesicles, crusts and yellow-orange areas may also provide clues. These features are somewhat similar to those observed in inflammatory conditions, such as eczema. In patients with an irritant reaction, the most common dermoscopic findings are the pore reaction pattern and perifollicular erythema. Dermoscopy could be useful for establishing a diagnosis in the case of doubtful patch test reactions.

Haptens, Proteins, and Atopic Dermatitis. / Haptenos, proteínas y dermatitis atópica.

Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.

Contact Allergy to Shellac. Retrospective Cross-Sectional Study With Data From the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC).

INTRODUCTION: Shellac is a known allergen present mainly in cosmetics used on the eyelids and lips, although new sources of exposure have recently been described. Our objective was to assess the use of shellac as a contact allergen in Spain and the clinical profile of patients allergic to shellac. METHODS: This retrospective cross-sectional study included patients patch tested for shellac between 2018 and 2021 from the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC). RESULTS: A total of 980 patients were patch tested for shellac (20% in ethanol), and 37 (3.77%, 95% confidence interval [CI], 2.58-3.97%) showed positive results. Most of these patients were tested for shellac due to a suspicion of cosmetic contact dermatitis. Seven patients with present relevance were found, five with relation to cosmetics, and the other two with an occupational background of food handling. The reaction index for shellac was 0.51 and the positivity ratio was 67.56% (95% CI, 52.48-82.65%). CONCLUSIONS: Shellac appears to be a prevalent allergen in patients with suspected contact dermatitis related with cosmetics or foodstuff. However, further studies are needed to validate its use in other patients.

Contact Allergy to Shellac. Retrospective Cross-Sectional Study With Data From the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy (REIDAC). / [Artículo traducido] Alergia de contacto a shellac. Estudio transversal retrospectivo con datos del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (REIDAC).

INTRODUCTION: Shellac is a known allergen present mainly in cosmetics used on the eyelids and lips, although new sources of exposure have recently been described. Our objective was to assess the use of shellac as a contact allergen in Spain and the clinical profile of patients allergic to shellac. METHODS: This retrospective cross-sectional study included patients patch tested for shellac between 2018 and 2021 from the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC). RESULTS: A total of 980 patients were patch tested for shellac (20% in ethanol), and 37 (3.77%, 95% confidence interval [CI], 2.58-3.97%) showed positive results. Most of these patients were tested for shellac due to a suspicion of cosmetic contact dermatitis. Seven patients with present relevance were found, five with relation to cosmetics, and the other two with an occupational background of food handling. The reaction index for shellac was 0.51 and the positivity ratio was 67.56% (95% CI, 52.48-82.65%). CONCLUSIONS: Shellac appears to be a prevalent allergen in patients with suspected contact dermatitis related with cosmetics or foodstuff. However, further studies are needed to validate its use in other patients.

Contact Allergy in Patients with Rosacea. / Sensibilización alérgica de contacto en pacientes con rosácea.

BACKGROUND AND OBJECTIVE: Rosacea is a chronic acneiform skin disorder in which impaired skin barrier function can lead to sensitization to allergens. We aimed to analyze contact allergies in our patients with rosacea. MATERIAL AND METHODS: Retrospective cohort study of all patients who underwent patch testing in our skin allergy clinic between May 1991 and May 2019. RESULTS: A total of 200 patients with rosacea were referred to our clinic for patch testing during the study period; they represented 2.1% of all patch tested patients in the period. Eighty-one percent were women (mean age, 44.7years). At least 1positive patch test was recorded for 46.5%; 15% were of current relevance. The most frequent positive reaction was to nickel (26%), followed by cobalt chloride (6.5%), isothiazolinones (6%), p-phenylenediamine (5.5%), fragrance mixII (5%), and thimerosal (3.5%). The most common currently relevant patch test reactions were to isothiazolinones in 10 of the 200 patients (5%); to phenylenediamine, fragrance mixII, and toluensulfonamide formaldehyde resin in 4 patients (2%) each; and to tixocortol and fragrance mixI in 2 patients (1%) each. The allergen groups most often implicated were metals (of current relevance in 12.6%) and drugs (of current relevance in 25.8%). Preservatives and fragrances were the next most common allergen groups, and 70.8% and 43.7% of the positive reactions in these groups, respectively, were of current relevance. Cosmetics were the most frequent source of sensitization, followed by topical medications - notably corticosteroids and antifungal agents. CONCLUSIONS: We emphasize the high prevalence of allergic contact dermatitis in patients with rosacea, a finding which supports patch testing, especially if eruptions worsen when these patients use cosmetics and topical medications.

Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria. / Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria.

BACKGROUND AND OBJECTIVES: Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. MATERIAL AND METHODS: Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. RESULTS: Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). CONCLUSIONS: Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Pediatric Allergic Contact Dermatitis: Clinical and Epidemiological Study in a Tertiary Hospital. / Dermatitis alérgica de contacto pediátrica. Estudio clínico-epidemiológico en un hospital terciario.

BACKGROUND: Few epidemiological studies have investigated the incidence of allergic contact dermatitis in children. Underdiagnosis has been observed in some studies, with many cases in which the condition is not suspected clinically and patch tests are not performed. However, the prevalence of pediatric sensitization to allergens has been reported to be as high as 20%, and the diagnosis should therefore be contemplated as a possibility in this age group. MATERIAL AND METHODS: We performed a retrospective analysis of the skin allergy database of the Dermatology Department of Consorcio Hospital General Universitario de Valencia. Children between 0 and 16 years of age diagnosed with allergic contact dermatitis in the previous 15 years (between 2000 and 2015) were included in the analysis. Epidemiological (age, sex, history of atopy) and clinical (site of the lesions, allergen series applied, positive reactions, and their relevance) variables were gathered. RESULTS: Patch tests had been performed on 4,593 patients during the study period. Of these, 265 (6%) were children aged between 0 and 16 years. A positive reaction to at least one of the allergens tested was observed in 144 (54.3%) patients in that group. The allergens most frequently identified were the following (in decreasing order of frequency): thiomersal, cobalt chloride, colophony, paraphenylenediamine, potassium dichromate, mercury, and nickel. The sensitization was considered relevant in 177 (61.3%) cases. CONCLUSIONS: More than half of the children studied showed sensitization to 1 or more allergens, with a high percentage of relevant sensitizations. All children with a clinical suspicion of allergic contact dermatitis should be referred for patch testing. As no standardized test series have been developed for this age group, a high level of clinical suspicion and knowledge of the allergens most commonly involved are required when selecting the allergens to be tested.

Hipersensitivity Reactions to Corticosteroids.

Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice.

Corticosteroid hypersensitivity studies in a skin allergy clinic.

INTRODUCTION: Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic. MATERIAL AND METHODS: Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period. RESULTS: We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction. CONCLUSIONS: The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids.

Descriptive study of sensitization to methylchloroisothiazolinone and methylisothiazolinone in a skin allergy unit.

BACKGROUND: Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are heterocyclic compounds used as preservatives in cosmetic and industrial products. They continue to be common allergens, causing positive patch test reactions in 2% to 4% of patients tested. MATERIAL AND METHODS: We searched the database at our skin allergy unit for all cases of sensitization to MCI/MI and MI diagnosed between January 1980 and March 2013. RESULTS: Patch tests were performed with MCI/MI in 8705 patients and with MI in 404 patients. In total, 222 patients (2.55%) were sensitized to MCI/MI and 21 (5.19%) were sensitized to MI. The incidence of MCI/MI cases peaked between 1998 and 2005 and again between 2009 and 2013. Of the 222 patients with MCI/MI sensitization, 142 were women (64%) and 49 were men (36%); the mean age was 43 years. The most frequently affected areas were the hands (54% of cases), the arms (36%), and the face (35%); 75.67% of cases were due to cosmetics and 2.25% were due to paint. Of the 21 patients with MI sensitization (mean age, 50 years), 12 were women (57%) and 9 were men (43%). The most common site of involvement in this group was the face (71% of cases), followed by the arms (38%) and the hands (29%). All the cases were due to cosmetics. CONCLUSIONS: Our data show that sensitization to the combination of MCI and MI and MI alone has increased in recent years. It would appear to be necessary to add MI to the baseline patch test series, although the test concentration has yet to be determined.

Postsurgical contact dermatitis due to povidone iodine: a diagnostic dilemma.

We present 7 cases of postsurgical contact dermatitis due to povidone iodine. The diagnosis was based on the clinical manifestations, the history of exposure, the site of the lesions, and the results of patch tests. This type of dermatitis can develop in the area of surgery or at distant sites exposed to povidone iodine during the surgical intervention. Patch tests with 10% povidone iodine in petrolatum were positive in all patients. Based on the results of the same tests in a control group, we recommend the use of petrolatum rather than water as the vehicle for the diagnosis of this form of contact dermatitis. Repeated open application tests with a commercially available solution of povidone iodine were negative. We conclude that the presence of the solution under occlusion during surgery is necessary both for the symptoms to develop and for the diagnosis to be made. This condition may be underdiagnosed.

Candidate Allergens for Inclusion in the Spanish Standard Series Based on Data from the Spanish Contact Dermatitis Registry. / Alérgenos candidatos para ser incluidos en la serie estándar española a partir de los datos del Registro Español de Dermatitis de Contacto.

BACKGROUND: Standard patch test series must be updated using objective data on allergen sensitization. The Spanish standard series was last updated in 2016 and the European series in 2019, and the inclusion of several emerging allergens needs to be evaluated. MATERIAL AND METHODS: We conducted a prospective, observational, multicenter study of consecutive patients from the registry of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) who were patch tested in 2019 and 2020 with linalool hydroperoxide, limonene hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, octylisothiazolinone, textile dye mix (TDM), sodium metabisulfite, propolis, bronopol, Compositae mix II, diazolidinyl urea, imidazolidinyl urea, decyl glucoside, and lauryl glucoside. RESULTS: We analyzed data for 4654 patients tested with diazolidinyl urea, imidazolidinyl urea, and bronopol, and 1890 tested with the other allergens. The values for the MOAHLFA index components were 30% for male, 18% for occupational dermatitis, 15% for atopic dermatitis, 29% for hand, 6.5% for leg, 23% for face, and 68% for age > 40 years. Sensitization rates above 1% were observed for 7 allergens: linalool hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, limonene hydroperoxide, TDM, sodium metabisulfite, and propolis. Three allergens had a current relevance rate of over 1%: linalool hydroperoxide, 2-hydroxyethyl-methacrylat, and limonene hydroperoxide. Benzisothiazolinone and TDM had a relevance rate of between 0.9% and 1%. CONCLUSIONS: Our results indicate that 7 new allergens should be considered when extending the Spanish standard patch test series. The data from our series could be helpful for guiding the next extension of the European baseline series.

Patch Testing During the COVID-19 Pandemic: Recommendations of the AEDV's Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC). / Recomendaciones del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC) de la AEDV en relación con la realización de pruebas epicutáneas durante la pandemia por SARS-CoV-2 (COVID-19).

As the COVID-19 pandemic gradually comes under control, the members of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) have drawn up a proposed list of the requirements, limitations, and conditioning factors affecting the resumption of work in contact dermatitis units. The assumption is that the severe acute respiratory syndrome coronavirus2 is still circulating and that occasional or seasonal outbreaks will occur. They recommend that the first step should be to assess how many patch tests each clinic can handle and review the waiting list to prioritize cases according to disease severity and urgency. Digital technologies can, where possible, be used to send and receive the documentation necessary for the patch test (information, instructions, informed consent, etc.). If the necessary infrastructure is available, patients can be offered the option of a remote initial consultation. Likewise, in selected cases, the patch test results can be read in a virtual visit using photographs taken by the patient or a video visit can be scheduled to allow the physician to evaluate the site of application remotely. These measures will reduce the number of face-to-face visits required, but will not affect the time spent on each case, which must be scheduled in the normal manner. All of these recommendations are suggestions and should be adapted to the needs and possibilities of each health centre.

Predictive Model for Allergic Contact Dermatitis in Patients With Hand Eczema. / Modelo predictivo de dermatitis alérgica de contacto en pacientes con eccema de manos.

INTRODUCTION: Patch tests are only indicated for hand eczema when it is diagnosed as chronic. A positive reaction of current relevance requires a change in treatment strategy. Knowing which clinical factors are associated with current relevance would allow tests to be performed sooner. OBJECTIVE: To develop a model for predicting currently relevant patch test positivity in patients with hand eczema only. MATERIAL AND METHODS: Retrospective study of patients with hand eczema only. We collected data on age, sex, time since onset, occupation, and history of atopic dermatitis. We built a predictive logistic regression model and assessed discrimination by computing the area under the receiver operating characteristic curve. RESULTS: We included 262 patients; 66.03% had positive patch tests (28.6% of current relevance). Univariate analysis detected significant associations between positivity of current relevance and employment as a hairdresser-aesthetician, a personal history of atopy, male sex, and a time since onset of over 6 months. Multivariate analysis confirmed employment as a hairdresser-aesthetician as an independent risk factor and male sex and a personal history of atopy as protective factors. The score suggested by the predictive model was 2.316(hairdresser-aesthetician)-1.792(atopic dermatitis)-0.601(male sex). CONCLUSIONS: Occupation, sex, and a history of atopy influence the likelihood of patch test positivity of current relevance in patients with hand eczema in Spain. Our model suggests that a diagnosis of chronic eczema is not necessarily an indication for patch testing. Future studies with larger samples are needed to determine the true usefulness of predictive models in this setting.

Vigilancia epidemiológica en los últimos 4 años del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea: situación actual y tendencias / Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends

Antecedentes: El Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea tiene entre sus objetivos la vigilancia epidemiológica de la dermatitis de contacto. Para ello es importante conocer si se producen alteraciones en el tiempo de las prevalencias de las positividades a los distintos alérgenos. Objetivos: Describir las variaciones en las tendencias temporales en positividades a alérgenos en la serie estándar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022. Métodos: Estudio observacional multicéntrico de pacientes estudiados consecutivamente mediante pruebas epicutáneas dentro del estudio de un posible eczema alérgico de contacto recogidos de forma prospectiva en el seno del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. Se analizaron los datos mediante 2 pruebas estadísticas: una de homogeneidad (para ver si hay cambios en los diferentes años) y otra de tendencia (para ver si los cambios siguen una tendencia lineal). Resultados: Se incluyeron un total de 11.327 pacientes en el periodo de estudio. Los alérgenos en los que de forma global se detectó una sensibilización mayor fueron sulfato de níquel, metilisotiazolinona, cloruro de cobalto, metilcloroisotiazolinona/metilisotiazolinona y mezcla de fragancias i. Se detectó una disminución estadísticamente significativa en el porcentaje de positividades de metilisotiazolinona a lo largo de años de estudio con una tendencia ordenada. Conclusiones: Si bien se pueden apreciar diferentes cambios en las tendencias a sensibilizaciones a varios de los alérgenos de la batería estándar, se observa que persiste una alta sensibilización al níquel, a la metilcloroisotiazolinona/metilisotiazolinona y a la mezcla de fragancias i. Solo se aprecia una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona.(AU)

Background: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process. Objectives: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022. Methods: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend). Results: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend. Conclusions: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone.(AU)

[Translated article] Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends / Vigilancia epidemiológica en los últimos 4 años del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea: situación actual y tendencias

Antecedentes: El Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea tiene entre sus objetivos la vigilancia epidemiológica de la dermatitis de contacto. Para ello es importante conocer si se producen alteraciones en el tiempo de las prevalencias de las positividades a los distintos alérgenos. Objetivos: Describir las variaciones en las tendencias temporales en positividades a alérgenos en la serie estándar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022. Métodos: Estudio observacional multicéntrico de pacientes estudiados consecutivamente mediante pruebas epicutáneas dentro del estudio de un posible eczema alérgico de contacto recogidos de forma prospectiva en el seno del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. Se analizaron los datos mediante 2 pruebas estadísticas: una de homogeneidad (para ver si hay cambios en los diferentes años) y otra de tendencia (para ver si los cambios siguen una tendencia lineal). Resultados: Se incluyeron un total de 11.327 pacientes en el periodo de estudio. Los alérgenos en los que de forma global se detectó una sensibilización mayor fueron sulfato de níquel, metilisotiazolinona, cloruro de cobalto, metilcloroisotiazolinona/metilisotiazolinona y mezcla de fragancias i. Se detectó una disminución estadísticamente significativa en el porcentaje de positividades de metilisotiazolinona a lo largo de años de estudio con una tendencia ordenada. Conclusiones: Si bien se pueden apreciar diferentes cambios en las tendencias a sensibilizaciones a varios de los alérgenos de la batería estándar, se observa que persiste una alta sensibilización al níquel, a la metilcloroisotiazolinona/metilisotiazolinona y a la mezcla de fragancias i. Solo se aprecia una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona.(AU)

Background: The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process. Objectives: To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31, 2022. Methods: This was a multicenter, observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy. The data was analyzed using 2 statistical tests: one homogeneity test (to describe the changes seen over time) and one trend test (to see whether the changes described followed a linear trend). Results: A total of 11327 patients were included in the study. Overall, the allergens associated with a highest sensitization were nickel sulfate, methylisothiazolinone, cobalt chloride, methylchloroisothiazolinone/methylisothiazolinone, and fragrance mix i. A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend. Conclusions: Although various changes were seen in the sensitizations trends to several allergens of the standard testing, it became obvious that a high sensitization to nickel, methylchloroisothiazolinone/methylisothiazolinone and fragrances mix i remained. Only a significant downward trend was seen for methylisothiazolinone.(AU)

Foot Eczema in a Skin Allergy Unit: Retrospective Study of 13 Years. / Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años.

INTRODUCTION: Foot eczema is a common complaint encountered by skin allergists. OBJECTIVE: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. MATERIAL AND METHODS: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. RESULTS: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). CONCLUSION: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.

Dispositivos médicos en pacientes diabéticos y dermatitis de contacto / Medical Devices in Patients With Diabetes and Contact Dermatitis

El desarrollo y comercialización de los sensores de glucosa y las bombas de insulina han supuesto una revolución en el control de los pacientes diabéticos. En los últimos años se han detectado múltiples casos de dermatitis de contacto relacionados con estos dispositivos médicos, con el creciente interés sobre los alérgenos responsables de la sensibilización. Isobornil acrilato fue sin duda el alérgeno principal del dispositivo FreeStyle, motivando al fabricante a modificar la composición eliminando este alérgeno. Curiosamente, este alérgeno está presente en casi todos los sensores comercializados. La colofonia y derivados del ácido abiético desempeñan un papel relevante en cuanto al adhesivo. Recientemente aparecen nuevos componentes identificados como alérgenos, no comercializadas, como el dipropilene glicol diacrilato, la N,N-dimetilacrilamida, o el metacrilato de trietilenglicol, que están siendo foco de estudio. El impacto positivo que tiene el uso de estos dispositivos puede verse mermado por la sensibilización a uno de sus ingredientes, obligando en ocasiones a abandonar el dispositivo, y por ende, restando calidad de vida. El dermatólogo debe posicionarse respecto al estudio dirigido de estos pacientes, dando soporte a los servicios de endocrinología, con la finalidad de orientar tanto el cuidado de la piel como las alternativas posibles, especialmente con la colaboración de los fabricantes.(AU)

The development and commercialization of glucose sensors and insulin pumps has revolutionized the management of diabetes. These devices have been linked to multiple cases of contact dermatitis in recent years, however, giving rise to a growing interest in identifying the sensitizing allergens. Isobornyl acrylate was clearly identified as one of the main allergens responsible for contact dermatitis among users of the FreeStyle glucose sensor and was subsequently removed from the product ingredients. Remarkably, however, it is still used in most other sensors on the market. The common adhesive ingredients colophony and abietic acid derivatives have also been shown to be sensitizing agents. New components under study, such as dipropylene glycol diacrylate, N,N-dimethylacrylamide, and triethylene glycol methacrylate have recently been identified as allergens, though they are not commercially available for clinical testing. The benefits offered by glucose sensors and insulin pumps may be offset by sensitization to product ingredients, in some cases forcing discontinuation and diminishing quality of life. Dermatologists should play a role in this clinical and research scenario, offering case-by-case guidance to endocrinologists on skin care and possible alternatives for patients with glucose sensors and insulin pumps who develop contact dermatitis. They should also collaborate with the manufacturers developing these devices.(AU)