Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis.

BACKGROUND: Occupational skin diseases, including allergic contact dermatitis (ACD), irritant contact dermatitis, and allergic contact urticaria (ACU), occur commonly among health care workers (HCWs). PURPOSE: To evaluate the aetiology of the various skin diseases afflicting HCWs evaluated for suspicion of ACD and/or ACU and to identify the most common allergens among HCWs found to have ACD and/or ACU. METHODS: A total of 1434 patients underwent patch testing. The demographic data and most common allergens for HCWs (n = 100) and non-HCWS (n = 1334) were compared. RESULTS: HCWs were statistically more likely than non-HCWS to be female, have hand dermatitis, and have a history of atopy. HCWs were also more likely to have work-related ACD especially to quaternium-15, thiuram, carba mix, glutaraldehyde and benzalkonium chloride, and to have ACU to latex. LIMITATIONS: This study was retrospective and is subject to the resultant biases of all such investigations. Only patients suspected of having ACD and who underwent patch testing are included in our database. The prevalence of ACD and ACU is likely to be higher than that seen in the general HCW population. CONCLUSIONS: Our results underscore the importance of thoroughly evaluating HCWs for ACD and ACU with the use of expanded standard allergen series and prick or radioallergosorbent testing to latex.

Blue-jean button nickel: prevalence and prevention of its release from buttons.

BACKGROUND: Nickel is a common cause of allergic contact dermatitis and is associated with metal buttons and snaps on blue jeans. OBJECTIVE: To determine the prevalence of nickel-positive metal buttons on blue jeans and the efficacy of nail polish in the prevention of nickel release. METHODS: We collected 62 pairs of new and preworn blue jeans. The metal buttons were tested for nickel with a dimethylglyoxime test kit, and one coat of clear nail polish was applied to nickel-positive buttons. Painted buttons were dried for 24 hours, and the jeans were washed on delicate cycle and retested for nickel. The jeans underwent a second wash/dry cycle and were retested. RESULTS: The prevalence of nickel-positive metal buttons on blue jeans was 16%. Ten pairs of jeans tested positive for nickel. All 10 pairs tested negative for nickel after the application of one coat of clear nail polish. Of these 10 pairs, seven pairs underwent two wash/dry cycles, and all seven tested negative for nickel after each cycle. CONCLUSION: The presence of nickel-positive blue-jean buttons is greater in new jeans than in preworn jeans. One clear coat of nail polish can prevent nickel release through two wash/dry cycles in a test environment.

Elastosis perforans serpiginosa.

A 41-year-old white man with Down syndrome presented with a slightly pruritic, papular eruption on bilateral forearms of several years' duration. Physical examination revealed multiple 2- to 3-mm keratotic, umbilicated pink papules in an annular configuration distributed symmetrically on the flexural surfaces of the forearms (Figure 1). The skin surrounding these papules was noted to be hyperpigmented and somewhat atrophic. The remainder of his skin examination was unremarkable. A shave biopsy of 1 papule was performed and stained with hematoxylin-eosin. Hematoxylin-eosin-stained sections showed clumps of bright red fibers being extruded through an acanthotic epidermis with a central invagination (Figure 2). Verhoeff-van Gieson stain confirmed these fibers to be elastin (Figure 3). Elastosis perforans serpiginosa was diagnosed.