Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action.

Objectives: Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. Methods: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. Results: Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. Conclusions: Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.

Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action.

OBJECTIVES: Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. METHODS: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. RESULTS: Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. CONCLUSIONS: Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.

Characterization of Tattoo Aftercare Products: Allergenic Ingredients and Marketing Claims.

BACKGROUND: Common recommendations for tattoo aftercare to ensure proper healing include application of topical products. Little is known about tattoo aftercare products. METHODS: Tattoo aftercare products were identified from a previous study and a search on Amazon.com using the phrase "tattoo aftercare." Duplicates and products without complete ingredient lists were excluded. Marketing claims were tabulated. All ingredients were entered in Excel and grouped according to Contact Allergen Management Program categories. Comparison of ingredients to North American Contact Dermatitis Group (NACDG) screening and American Contact Dermatitis Society (ACDS) Core allergens was conducted. RESULTS: A total of 84 tattoo aftercare products from 52 distinct brands were found. Forty-eight distinctive market claims were identified; the use of "natural ingredient(s)" (42.9%) was most common. There were 4 to 28 ingredients per product (mean = 11.8 ± 5.5) with a total of 369 distinct ingredients listed. Products contained an average of 7.9 ± 3.9 ACDS Core allergens per product and 7.0 ± 3.7 NACDG allergens per product. Most common allergens included fragrance/botanicals (n = 529), vitamin E derivatives (n = 43), and vitamin B5 derivatives (n = 11). CONCLUSIONS: This review of 84 products found that tattoo aftercare products contain an average of 8 ACDS Core and 7 NACDG allergens. Clinicians should be aware of potential allergens in tattoo aftercare products.

Allergic Contact Dermatitis to Pramoxine (Pramocaine).

Prescription and over-the-counter topical anesthetics are commonly used. Although allergy to amide and ester anesthetics is known, little has been reported on the nonamide, nonester pramoxine (pramocaine). This article briefly reviews allergy to topical anesthetics, provides detailed information on pramoxine, and describes characteristics of multiple patients with positive, relevant reactions to pramoxine.

Men's Facial Moisturizers in the Metrosexual Era.

BACKGROUND: Manufacturers are increasingly branding personal care products (PCPs) specifically for men. OBJECTIVE: The aim of the study was to characterize ingredients and claims of facial moisturizers marketed to men. METHODS: Men's facial moisturizers from 7 different online retailers were identified in June-September 2018. Ingredients were grouped and identified per the Ingredient Database of the Personal Care Products Council. Potential allergens were identified using the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series and 2017-2018 North American Contact Dermatitis Group Screening Series. RESULTS: Sixty-five men's facial moisturizers were identified with a total of 1930 ingredients. On average, there were 12 ACDS Core and 9 North American Contact Dermatitis Group Screening allergens per product. A total of 70.8% of products contained between 6 and 15 ACDS Core allergens. The most notable allergens were fragrances (present in 98.5% of products), propylene glycol/derivatives (32.3%), parabens (29.2%), and alkyl glucosides (26.2%). Interestingly, less than 10% of products contained the most common allergenic preservatives in PCPs: formaldehyde releasers and methylisothiazolinone. CONCLUSIONS: Men's facial moisturizers commonly contain fragrances, emulsifiers, and glucosides but relatively few allergenic preservatives. This may reflect changes in modern PCP preservation. These findings are important for modern dermatologists to be aware, especially in a new era of male skincare.

Allergenic Ingredients in Health Care Hand Sanitizers in the United States.

BACKGROUND: Health care workers with occupational contact dermatitis often attribute their symptoms to frequent use of alcohol-based hand sanitizers. However, ingredient lists are difficult to obtain, and safe alternatives typically must accommodate brands utilized by a particular hospital system. OBJECTIVE: The aims of this study were to investigate allergenic ingredients present within health care hand sanitizers and to provide a comprehensive product list to assist with allergen avoidance. METHODS: Five major hospitals in Minnesota and 20 hospitals across the United States were called to obtain a product list. The National Library of Medicine's DailyMed Web site was searched to retrieve ingredients. Ingredients were compared with the American Contact Dermatitis Society 2017 Core Allergen Series and cross-reactors. RESULTS: The most common brands included Purell, Ecolab, DebMed, and Avagard. Active ingredients consisted of ethyl alcohol (85.0%), benzalkonium chloride (8.8%), or isopropyl alcohol (2.5%). Top 5 allergens included tocopherol (51.3%), fragrance (40.0%), propylene glycol (27.5%), benzoates (25.0%), and cetyl stearyl alcohol (12.5%). Four sanitizers were free of all American Contact Dermatitis Society allergens; 15 products contained only tocopherol or propylene glycol as allergens. CONCLUSIONS: We identified 19 low-allergen hand sanitizers within the most common brands utilized by US hospital systems. This product list will be useful for patients and health care workers seeking allergen avoidance.

Isothiazolinone Detection in Dish Soap and Personal Care Products: Comparison of Lovibond Isothiazolinone Test Kit and Ultrahigh-Performance Liquid Chromatography-Tandem Mass Spectrometry.

BACKGROUND: Isothiazolinones are commonly used preservatives, which may cause allergic contact dermatitis. The Lovibond Isothiazolinone Test Kit (LITK) has been reported to successfully identify clinically relevant, occult isothiazolinones in patient personal care products. OBJECTIVE: The aim of the study was to analyze dish soaps and personal care products that do not declare isothiazolinones ("no-ISO") for the presence of isothiazolinones via 2 methods: LITK and ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). METHODS: No-ISO dish soaps (n = 9), a convenience sample of patient products (n = 6), and controls (positive [isothiazolinone declared], n = 5; negative, n = 2) were tested with LITK (X3) and UHPLC-MS/MS. RESULTS: Several no-ISO dish soaps and personal products were positive for isothiazolinones (LITK, n = 12; UHPLC-MS/MS, n = 3). Ultrahigh-performance liquid chromatography-tandem mass spectrometry specifically identified methylisothiazolinone alone in 1 no-ISO dish soap, methylchloroisothiazolinone in another, and both in a third. Using UHPLC-MS/MS as the criterion standard, we observed the accuracy of LITK for 9 dish soaps was poor (sensitivity, 66.7%; specificity, 20%) and very poor for 6 personal care products (sensitivity, 0%; specificity, 0%). CONCLUSIONS: Personal products may contain undeclared isothiazolinones. The current study found that LITK had poor accuracy for testing dish soap and personal care products. Clinicians should be aware of these factors when managing patients with contact allergy to isothiazolinones.

Contact dermatitis to personal care products is increasing (but different!) in males and females: North American Contact Dermatitis Group data, 1996-2016.

BACKGROUND: Personal care products (PCPs) are commonly responsible for allergic contact dermatitis and irritant contact dermatitis. PCP use was historically associated with females, but male-targeted PCPs are increasingly being marketed. OBJECTIVE: To characterize and compare males with PCP-related contact dermatitis (MPCPs) and females with PCP-related contact dermatitis (FPCPs). METHODS: This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). RESULTS: Four thousand six hundred eighty of 16,233 men (28.8%) and 12,730 of 32,222 (39.5%) women had a PCP identified as a source of irritant contact dermatitis or a positive patch test reaction. The proportion of PCP-related dermatitis in both sexes significantly increased (>2.7-fold) over the decade of study. Compared with FPCPs, a larger proportion of MPCPs were older or had trunk or extremity dermatitis (P < .0001). MPCPs were twice as likely to have soaps as a source while FPCPs were twice as likely to have hair care products (P < .0001). The most common PCP-related North American Contact Dermatitis Group allergens for both sexes were methylisothiazolinone (MPCP 28.8% and FPCP 21.5%), fragrance mix I (MPCP 22.3% and FPCP 20.1%), balsam of Peru (MPCP 18.5% and FPCP 14.1%), quaternium-15 (MPCP 16.1% and FPCP 12.3%), and paraphenylenediamine (MPCP 11.5% and FPCP 11.1%). LIMITATIONS: Patient population referred for suspected contact dermatitis. CONCLUSIONS: PCP-related dermatitis is increasing. Sites of involvement and relevant PCP sources are distinct between sexes. Male and female variation in exposure history may explain differences in reactivity to some allergen groups.

Characterizing online searches in pediatric dermatology.

The use of online medical information is a common trend but little is known about these searches and implications in pediatric dermatology. Through a convenience sample of 95 parents/guardians and patients in pediatric dermatology at the University of Minnesota, 38.9% of participants reported that they had used an online search tool prior to their appointment. Google was the most common tool used (91.4%), and eczematous conditions were the most common patient-suspected diagnosis (32.4%). Of interest, 13.9% of individuals became more concerned and 16.7% made an appointment earlier because of their online findings.

Examination of use and barriers for five sun protection strategies in parents and their children.

BACKGROUND/OBJECTIVES: Sun protection starting in childhood is an important means of skin cancer prevention. Factors associated with sunscreen use have been previously described. However, less is known about factors associated with children's utilization of non-sunscreen sun protection strategies. We sought to examine parent and child characteristics, parental use of sun protection, and barriers associated with children's use of five sun protection strategies: sunscreen, shirts with sleeves, wide-brimmed hats, sunglasses, and shade. METHODS: A cross-sectional survey of parents of children entering kindergarten through grade 8. Survey participants were recruited at the 2016 Minnesota State Fair. RESULTS: A total of 409 parents were surveyed. The most common sun protection strategies parents reported for their child were wearing a shirt with sleeves (69.9%) and using sunscreen (61.9%), while protection via shade, wide-brimmed hats, and sunglasses were reported by less than one-quarter of parents. For each individual strategy, parents' own use of that strategy was strongly associated with that strategy in their children. Lack of child cooperation was associated with decreased use of sunscreen, shirts with sleeves, and wide-brimmed hats. CONCLUSION: Significant room for improvement exists in childhood sun protection. Parents should especially be encouraged to use shade, wide-brimmed hats, and sunglasses as methods of protection for their children. Advising parents to model seeking shade, applying sunscreen, and choosing appropriate clothing and hats may improve sun safety practices.

Tolerability of hair cleansing conditioners: a double-blind randomized, controlled trial designed to evaluate consumer complaints to the U.S. Food and Drug Administration.

Importance: Consumers have reported skin rash/irritation and hair loss/breakage with Wen by Chaz Dean Sweet Almond Mint Cleansing Conditioner (WCDSAMCC), however epidemiologic, toxicologic and clinical hair loss studies have not provided an explanation. Contact dermatitis has been hypothesized.Objective: To assess the tolerability of six products: WCDSAMCC, three other hair cleansing conditioners, and two controls [salicylic acid shampoo (SAS) and baby shampoo (BS)].Design: Double-blind, randomized, controlled trial.Setting: Single-site study.Population: General population volunteers.Intervention: Standard semi-open patch tests (SOPTs) and duration-escalation repeat open application tests (ROATs) over 5 weeks.Main Outcome Measures: Primary outcome measure was "stopping point" [ROAT total component score ≥6 (maximum 10) or global ≥4 (maximum 5)]. Secondary outcomes included "any reaction" (ROAT component score ≥1) and SOPT ≥ doubtful.Results: Two hundred of 298 volunteers were enrolled. There were no significant differences in the tolerability of WCDSAMCC and any of the other three hair cleansing conditioners as assessed by SOPT or ROAT. WCDSAMCC was significantly better tolerated than SAS ("stopping point", or "any reaction", p values<0.0001) as well as BS (p = 0.01). The frequency of doubtful SOPT reactions was lowest for WCD (2.2%) and highest for SAS (7.1%, p = 0.04).Conclusions: As assessed by both ROAT and SOPTs, WCDSAMCC was similar in tolerability to three other hair cleansing conditioners and significantly better tolerated than both controls (SAS and BS).Summary: This double-blind, randomized, controlled study found that WCDSAMCC was similar in tolerability to three other HCCs and was significantly better tolerated than both SAS and BS. This study provides critical clinical evidence on the comparative lack of cutaneous effects with use of WCDSAMCC.Trial Registration: NCT03483025 ClinicalTrials.gov.

Facial Dermatitis in Male Patients Referred for Patch Testing: Retrospective Analysis of North American Contact Dermatitis Group Data, 1994 to 2016.

Importance: Facial dermatitis in women is well characterized. However, recent shifts in the men's grooming industry may have important implications for male facial dermatitis. Objective: To characterize male patients with facial dermatitis. Design, Setting, and Participants: A 22-year retrospective cross-sectional analysis (1994-2016) of North American Contact Dermatitis Group (NACDG) data, including 50 507 patients who underwent patch testing by a group of dermatology board-certified patch test experts at multiple centers was carried out. Facial dermatitis was defined as involvement of the eyes, eyelids, lips, nose, or face (not otherwise specified). Main Outcomes and Measures: The main outcome was to compare characteristics (including demographics and allergens) between male patients with facial dermatitis (MFD) and those without facial dermatitis (MNoFD) using statistical analysis (relative risk, CIs). Secondary outcomes included sources of allergic and irritant contact dermatitis and, for occupationally related cases, specific occupations and industries in MFD. Results: Overall, 1332 male patients (8.0%) were included in the MFD group and 13 732 male patients (82.0%) were included in MNoFD. The mean (SD) age of participants was 47 (17.2) years in the MFD group and 50 (17.6) years in the MNoFD group. The most common facial sites were face (not otherwise specified, 817 [48.9%]), eyelids (392 [23.5%]), and lips (210 [12.6%]). Participants in the MFD group were significantly younger than MNoFD (mean age, 47 vs 50 years; P < .001). Those in the MFD group were less likely to be white (relative risk [RR], 0.92; 95% CI, -0.90 to 0.95) or have occupationally related skin disease (RR, 0.49; 95% CI, -0.42 to 0.58; P < .001) than MNoFD. The most common allergens that were associated with clinically relevant reactions among MFD included methylisothiazolinone (n = 113; 9.9%), fragrance mix I (n = 27; 8.5%), and balsam of Peru (n = 90; 6.8%). Compared with MNoFD, MFD were more likely to react to use of dimethylaminopropylamine (RR, 2.49; 95% CI, -1.42 to 4.37]) and paraphenylenediamine (RR, 1.43; 95% CI, -1.00 to 2.04; P < .001). Overall, 60.5% of NACDG allergen sources were personal care products. Conclusions and Relevance: Although many allergens were similar in both groups, MFD were more likely to react to use of dimethylaminopropylamine and paraphenylenediamine, presumably owing to their higher prevalence in hair products. Most sources of allergic and irritant contact dermatitis in MFD were personal care products. This study provides insight into the risks and exposures of the increasing number of grooming products used by male dermatology patients. This will enable clinicians to better identify male patients who would benefit from patch testing and treat those with facial dermatitis.