Publications by authors named "Amber Reck Atwater"

44 Publications

Contact Dermatitis of the Hands: Is It Irritant or Allergic?

Cutis 2021 Mar;107(3):129-132

Mr. Patel and Dr. Reeder are from the University of Wisconsin School of Medicine and Public Health, Madison. Dr. Reeder is from the Department of Dermatology. Dr. Atwater is from the Department of Dermatology, Duke University School of Medicine, Durham, North Carolina.

Hand contact dermatitis is common, and irritant contact dermatitis (ICD) is more likely than allergic contact dermatitis (ACD) in both occupational and nonoccupational settings. Irritant contact dermatitis can have acute and chronic presentations, and hand hygiene products can contribute. The most common relevant hand contact allergens in North American patch test populations are methylisothiazolinone (MI), nickel, formaldehyde, quaternium-15, and fragrance mix I. In health care workers, rubber accelerators often are relevant as potential contact allergens. Clinically, it can be difficult to differentiate between ICD and ACD, and patch testing often is required for definitive diagnosis. When patch testing is indicated, supplemental allergen series in addition to a screening series often are needed. Management of hand contact dermatitis requires gentle skin care, avoidance of irritants and/ or allergens when appropriate, and prescription topical or systemic therapies or phototherapy when indicated.
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http://dx.doi.org/10.12788/cutis.0204DOI Listing
March 2021

Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016.

J Am Acad Dermatol 2021 Apr 9;84(4):965-976. Epub 2021 Feb 9.

Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.

Background: Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited.

Objective: To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group.

Methods: We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016.

Results: A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time.

Limitations: Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias.

Conclusions: This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016.
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http://dx.doi.org/10.1016/j.jaad.2020.07.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087451PMC
April 2021

Patch testing 101, part 2: after the patch test.

Cutis 2020 Dec;106(6):292-296

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, USA.

After the patch test, the physician must interpret positive reactions in the clinical context of the patient's dermatitis. Relevance can be graded as current, past, or unknown. Counseling the patient on allergen avoidance is the most important step, and resources such as allergen information sheets and physician-generated safe lists from product databases can be used to help the patient both understand their allergens and avoid further exposure.
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http://dx.doi.org/10.12788/cutis.0138DOI Listing
December 2020

Facial Personal Protective Equipment: Materials, Resterilization Methods, and Management of Occupation-Related Dermatoses.

Dermatitis 2021 Mar-Apr 01;32(2):78-85

Duke Dermatology, Duke University Medical Center, Durham, NC.

Background: The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods.

Objectives: The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses.

Methods: Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored.

Results: Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed.

Conclusions: There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.
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http://dx.doi.org/10.1097/DER.0000000000000699DOI Listing
May 2021

Allergen Content of Best-Selling Ethnic Versus Nonethnic Shampoos, Conditioners, and Styling Products.

Dermatitis 2021 Mar-Apr 01;32(2):101-110

Department of Dermatology, Duke University Medical Center, Durham, NC.

Background: Hair products are a potential cause of allergic contact dermatitis. There are limited data on the allergen content of ethnic hair products.

Objective: To identify allergens unique to ethnic hair products (shampoos, conditioners, styling products) and provide a resource for low allergen hair care products for patients with ethnic hair types.

Methods: The top 100 best-selling shampoos, conditioners, and styling products for ethnic and nonethnic hair products were determined from 3 major online retailers (Walmart, Target, Walgreens). Allergen was defined as presence on the 2017 American Contact Dermatitis Society Core 80 allergen list.

Results: The 2017 American Contact Dermatitis Society Core 80 allergens were tabulated for ethnic and nonethnic shampoos, conditioners, and styling products. A list of low-allergen shampoos, conditioners, and styling products was identified. Fragrance was the most common allergen for ethnic shampoos, conditioners, and styling products. Other notable allergens included methylchloroisothiazolinone/methylisothiazolinone, formaldehyde releasers, cetyl steryl alcohol, tocopherol, decyl glucoside, sodium benzoate, and phenoxyethanol.

Conclusions: This study identifies important differences in allergens found in products marketed for ethnic hair compared with those marketed for nonethnic hair.
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http://dx.doi.org/10.1097/DER.0000000000000668DOI Listing
December 2020

Fragrance- and Botanical-Related Allergy and Associated Concomitant Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 2007-2016.

Dermatitis 2021 Jan-Feb 01;32(1):42-52

Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.

Importance: When fragrance- and botanical-related (F/BR) allergy is identified, concomitant reaction (CR) frequencies can help direct avoidance recommendations.

Objective: This study aimed to determine the CR rates for F/BR allergens.

Design: A retrospective cross-sectional analysis of the North American Contact Dermatitis Group data 2007-2016 was conducted. Frequencies of demographics, positive reactions, strength of reactions, trends, and CR rates were calculated.

Results: A total of 5504 (22.7%) of 24,246 patients had F/BR allergic reactions. The F/BR-sensitive patients were more likely to be female, older than age 40 years, and White and have face, leg, or anal/genital dermatitis. Top allergens included fragrance mix I (FMI, 10.6%), Myroxylon pereirae (balsam of Peru [BOP], 8%), and fragrance mix II (FMII, 4.9%). There were increasing trends for FMI, FMII, cinnamic aldehyde, and Compositae mix and decreasing trends for BOP and propolis. When patients were positive to any F/BR allergen, they were likely to be positive to FMI, FMII, and BOP. Concomitant reactions were bidirectional between multiple fragrance allergens and propolis, colophony, and Compositae mix.

Conclusions: Concomitant reactions were identified between fragrances, between fragrances and BR allergens, and between BR allergens and fragrances. If CRs of greater than 10% suggest cross-reactivity, then all patients with fragrance sensitivity should avoid BR allergens and vice versa.
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http://dx.doi.org/10.1097/DER.0000000000000661DOI Listing
December 2020

Patch testing 101, part 1: performing the test.

Cutis 2020 Oct;106(4):165-167

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Understanding the basics of patch testing is essential to caring for patients with contact dermatitis. Several screening or standard series are available, and additional allergens or series may be necessary based on the patient's history. A delayed reading should be performed 72 to 144 hours after patch placement. Certain oral medications, phototherapy, or topical products may interfere with patch test results.
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http://dx.doi.org/10.12788/cutis.0093DOI Listing
October 2020

Cutaneous Reactions to Aluminum.

Dermatitis 2020 Nov/Dec;31(6):335-349

From the Park Nicollet Contact Dermatitis Clinic.

: Cutaneous exposure to aluminum may occur via contact with metal items, medications, and personal care products. Despite the widespread use of aluminum, allergic contact dermatitis is relatively rare. Sensitization is often incidentally identified during patch testing with aluminum-based chambers. This article presents several cases along with a literature review summarizing prevalence and clinical manifestations of cutaneous reactions to aluminum, recommendations for patch testing, sources of aluminum, and reproducibility of aluminum allergy over time.
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http://dx.doi.org/10.1097/DER.0000000000000633DOI Listing
November 2020

Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review.

J Am Acad Dermatol 2021 Feb 1;84(2):486-494. Epub 2020 Oct 1.

Duke Dermatology, Duke University Medical Center, Durham, North Carolina. Electronic address:

Background: Prolonged wear of facial protective equipment can lead to occupational dermatoses.

Objective: To identify important causes of occupational dermatoses from facial protective equipment.

Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both.

Results: We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare.

Limitations: Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies.

Conclusion: This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.
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http://dx.doi.org/10.1016/j.jaad.2020.09.074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528888PMC
February 2021

Tattoo hypersensitivity reactions: inky business.

Cutis 2020 Aug;106(2):64-67

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, USA.

Hypersensitivity reactions can occur in both temporary and permanent tattoos. Traditional temporary tattoos consist of red henna or black henna; paraphenylenediamine is the most common allergen and usually is present in black henna. Contact allergy to genipin in jagua temporary tattoos also has been reported. Permanent tattoo inks traditionally contain black pigment of amorphous carbon or black iron oxides or metals. Modern permanent tattoo ink is a blend of pigments, including metals, as well as carbon, azo, diketopyrrolopyrrole, quinacridone, anthraquinone, dioxazine (purple), or quinophthalone (yellow) dyes. Patch testing for temporary and permanent tattoos is complex and challenging.
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http://dx.doi.org/10.12788/cutis.0028DOI Listing
August 2020

Isobornyl acrylate and diabetic devices steal the Show for the 2020 American Contact Dermatitis Society Allergen of the Year.

Cutis 2020 Jun;105(6):283-285

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Diabetic devices including glucose monitoring systems and insulin pumps are used worldwide and are increasingly recognized as a source of irritant contact dermatitis and allergic contact dermatitis (ACD). Isobornyl acrylate is a chemical used in the glue of some of these devices and has been implicated as a frequent culprit allergen in patients who become sensitized to their device. Patch testing with isobornyl acrylate 0.1% in petrolatum is not necessary in standard screening panels but should be considered in patients with suspected ACD to glucose sensors or insulin pumps.
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June 2020

Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society.

J Am Acad Dermatol 2020 Dec 22;83(6):1730-1737. Epub 2020 Jul 22.

Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado. Electronic address:

The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.
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http://dx.doi.org/10.1016/j.jaad.2020.07.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373692PMC
December 2020

Orthopedic Implant Hypersensitivity Reactions: Concepts and Controversies.

Dermatol Clin 2020 Jul 25;38(3):361-369. Epub 2020 Apr 25.

Duke Dermatology, 5324 McFarland Road #210, Durham, NC 27707, USA. Electronic address:

Orthopedic implant hypersensitivity reactions (IHRs) are known to occur but are uncommon. Clinical presentations include local and generalized cutaneous reactions and noncutaneous complications. Pathogenesis traditionally was believed a type IV delayed hypersensitivity reaction, but there is evidence that innate immunity plays a role. Orthopedic implants are made predominantly of metals, and nonmetal components, such as bone cement, plastics, and ceramics, also may be utilized. Several diagnostic tests are available, and patch testing is considered the gold standard. Diagnostic criteria for IHRs have been developed and can help with determination as to whether orthopedic implant symptoms are due to IHRs.
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http://dx.doi.org/10.1016/j.det.2020.02.005DOI Listing
July 2020

Essential oils debunked: separating fact from myth.

Cutis 2020 Apr;105(4):174-176

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Essential oils (EOs) are present in products we use at home, at work, and in our environment. In recent years, there has been an increasing trend to use EOs rather than products containing chemicals perceived as harmful by consumers. In this review, we separate the facts from the myths surrounding EOs and provide scientifically sound answers to common questions.
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April 2020

Duration of Dermatitis Before Patch Test Appointment Is Associated With Distance to Clinic and County Poverty Rate.

Dermatitis 2020 Jul/Aug;31(4):259-264

Department of Dermatology, Duke University Medical Center, Durham, NC.

Background: Contact dermatitis is a common disease that is associated with impaired quality of life.

Objective: We examined the effect of travel distance and other socioeconomic factors on duration of dermatitis before presentation at the Duke Contact Dermatitis and Patch Testing Center.

Methods: This is a retrospective study of patients who underwent patch testing from March 1, 2012, to August 1, 2018. Associations between duration of dermatitis, distance to clinic, and socioeconomic factors (age, race, payor group, county poverty rate, rural-urban status) were examined.

Results: The median duration of dermatitis was 14 months (Q1 = 7 months; Q3 = 36 months), and the median distance to clinic was 18 miles (Q1 = 7 miles; Q3 = 45.9 miles). For a 50-mile increase in the distance from the patient's zip code to the clinic, the median duration of dermatitis increased by 17.9% (P < 0.001). For every 5% increase in the county poverty rate, the median duration of dermatitis increased by 16.3% (n = 29; P = 0.032). Trends were noted for a longer duration of dermatitis based on insurance payor, rural-urban status, and race.

Conclusions: Distance to patch test provider and county poverty status are important measures of access for patients with dermatitis.
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http://dx.doi.org/10.1097/DER.0000000000000581DOI Listing
May 2021

Hypersensitivity reactions to orthopedic implants: what's all the hype?

Cutis 2020 Feb;105(2):68-70

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, USA.

Hypersensitivity reactions to orthopedic implanted materials exist but are rare. Potential allergens include metals and bone cement components. Clinical presentation can include localized or generalized cutaneous reactions and noncutaneous reactions. Preimplant patch testing for implant hypersensitivity reactions (IHRs) is only recommended if metal allergy is strongly suspected; postimplant patch testing to relevant allergens can be completed if symptoms are concerning for implant hypersensitivity. The decision to remove or revise an orthopedic implant should be made as a joint decision between the surgeon and patient.
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February 2020

A comparison of knowledge acquisition and perceived efficacy of a traditional vs flipped classroom-based dermatology residency curriculum.

Cutis 2020 Jan;105(1):36-39

Duke University Medical Center, Durham, North Carolina, USA.

Flipped and traditional classroom models were compared in the Duke University Medical Center (Durham, North Carolina) dermatology residency program for the 2014-2015 academic year. The residents participated in 12 lectures-6 traditional and 6 flipped-that were paired for similar content. Each lecture was followed by a survey comprised of 10 factual questions and 10 perception questions. Generalized linear regression models were used to study the differences in quiz scores between the 2 classroom models after adjusting for other baseline covariates. There was not a significant difference in mean factual quiz scores between the two classroom models. Results indicated significant perception differences in favor of the flipped classroom model, such as participation (P < .001), enjoyment (P=.038 and P=.026), efficiency (P=.033), and boards (P=.050) and clinical preparedness (P=.034).
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January 2020

Systemic contact dermatitis: sometimes it is the food.

Cutis 2019 Dec;104(6):337-340

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Systemic contact dermatitis (SCD) represents a unique pattern of allergic contact dermatitis that may cause a symmetric eruption involving intertriginous skin, genitals, eyelids, and/or hands. Common culprits known to elicit SCD for some patients include preservatives, metals, and fragrances. Certain medications including steroids and antihistamines can cause SCD. For patients who do not improve with skin allergen avoidance alone and who have a pattern of dermatitis suggestive of SCD, counseling on allergen avoidance through oral, parenteral, and inhaled routes is indicated.
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December 2019

Contact allergy to nickel: still #1 after all these years.

Cutis 2021 01;107(1):12-15

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Nickel is ubiquitous in our daily environment and remains the most common cause of contact allergy worldwide. Regulation of nickel release exists in Europe but unfortunately continues to be absent in the United States. Nickel contact allergy most often is associated with earrings and other jewelry; however, novel exposures to nickel through diet and electronic devices and other materials also occur. Once diagnosed, allergen avoidance is key for improvement of symptoms.
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http://dx.doi.org/10.12788/cutis.0156DOI Listing
January 2021

Patch testing in children: not just little adults.

Cutis 2019 Nov;104(5):288-290

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, USA.

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November 2019

Allergens in Medical Hand Skin Cleansers.

Dermatitis 2019 Nov/Dec;30(6):336-341

Department of Dermatology, Duke University Medical Center, Durham, NC.

Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of "low-allergen" medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time.
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http://dx.doi.org/10.1097/DER.0000000000000504DOI Listing
May 2020

Patch Test Practice Patterns of Members of the American Contact Dermatitis Society.

Dermatitis 2020 Jul/Aug;31(4):272-275

Department of Dermatology, Duke University Medical Center, Durham, NC.

Background: Patch testing is the criterion standard for diagnosis and management of allergic contact dermatitis. Limitations on the number of allergens tested can negatively impact patient care.

Objective: This study reports clinical practice patterns of American Contact Dermatitis Society (ACDS) members.

Methods: In October and November 2018, the US-based members of the ACDS received an electronic survey regarding their procedures and experiences with patch testing. We evaluated the type of practice, number of patients tested, type of screening and supplemental series, number of allergens tested, and billing and reimbursement concerns.

Results: There were 149 respondents; 62% use ACDS Core 80, 70% "sometimes" or "always" test with supplemental series, and 70% "sometimes" or "always" test patient products. Participants estimated that supplemental series identify relevant allergens 35% of the time. Approximately 66% most commonly test more than 81 allergens per patient, and 78% expressed concerns regarding fair reimbursement.

Conclusions: Most ACDS members routinely test more than 81 allergens per patient. Barriers to fair payment for beyond a fixed number of patches at any one visit may impede the diagnosis of allergic contact dermatitis, prolong suffering, and worsen outcomes.
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http://dx.doi.org/10.1097/DER.0000000000000513DOI Listing
May 2021

Methylisothiazolinone and isothiazolinone allergy.

Cutis 2019 Aug;104(2):94-96

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

Methylisothiazolinone (MI) is a preservative commonly used in water-based personal care products. Increases in the allowable concentration of MI alone in these products has led to an epidemic of allergic contact dermatitis (ACD). Although personal care products are the most common source of MI contact allergy, other novel exposures include household products, industrial chemicals, paint, slime, and adhesive agents. Other isothiazolinones such as benzisothiazoline (BIT) and octylisothiazolinone (OIT) are uncommon in personal care products but have been found in leather products, glue, industrial chemicals, paints, and cleaning products. There may be cross-reactivity between OIT and MI, and a minority of patients who are allergic to MI are cosensitized to BIT. In this article, we review MI and related isothiazolinone chemicals.
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August 2019

Trends in nail services may cause dermatitis: not your mother's nail polish.

Cutis 2019 Jun;103(6):315-317

Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, USA.

The advent of acrylate-based nail treatments-known as gels, dips, or shellac-has resulted in an uptick in nail-related acrylate allergy. Acrylate dermatitis related to nail services can affect both clients and technicians and can present on the hands, fingers, and wrists, as well as on the face and neck. Nail acrylate allergy occurs from sensitization to acrylate monomers; 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate, ethyl cyanoacrylate, and others have been identified as relevant allergens. Patch testing with HEMA and ethyl cyanoacrylate can screen for nail acrylate allergy. Avoidance is key, and we recommend less-permanent, acrylate-free nail polishes as alternatives.
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June 2019

Parabens: the 2019 nonallergen of the year.

Cutis 2019 Apr;103(4):192-193

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA.

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April 2019

Shifting Paradigms in Allergic Contact Dermatitis: The Role of Innate Immunity.

J Invest Dermatol 2020 01 14;140(1):21-28. Epub 2019 May 14.

Duke University Medical Center, Department of Dermatology, Duke University Medical Center, DUMC 3135, Durham, North Carolina, USA. Electronic address:

The role of the innate immune system in allergic contact dermatitis (ACD) has traditionally been confined to the initial antigen sensitization phase. However, more recent findings have shown the role of innate immunity in additional aspects of ACD, including the effector phase of the classic type IV hypersensitivity reaction. As a result, the precise immunologic mechanisms mediating ACD are more complex than previously believed. The aim of this review is to provide insight into recent advances in understanding the role of the innate immune system in the pathogenesis of ACD, including novel mechanistic roles for macrophages, innate lymphoid cells, natural killer cells, innate γδ T cells, and other signaling molecules. These insights provide new opportunities for therapeutic intervention in ACD.
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http://dx.doi.org/10.1016/j.jid.2019.03.1133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854274PMC
January 2020

Anaphylactoid reaction to benzophenones, with recurrence during patch testing.

Contact Dermatitis 2019 Oct 9;81(4):303-304. Epub 2019 Jun 9.

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina.

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http://dx.doi.org/10.1111/cod.13293DOI Listing
October 2019

Frequency of Contact Allergy to Implanted Cardiac Devices.

JAMA Dermatol 2019 06;155(6):749-752

Department of Dermatology, Duke University School of Medicine, Durham, North Carolina.

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http://dx.doi.org/10.1001/jamadermatol.2019.0036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563555PMC
June 2019

Biased agonists of the chemokine receptor CXCR3 differentially control chemotaxis and inflammation.

Sci Signal 2018 11 6;11(555). Epub 2018 Nov 6.

Department of Biochemistry, Duke University, Durham, NC 27710, USA.

The chemokine receptor CXCR3 plays a central role in inflammation by mediating effector/memory T cell migration in various diseases; however, drugs targeting CXCR3 and other chemokine receptors are largely ineffective in treating inflammation. Chemokines, the endogenous peptide ligands of chemokine receptors, can exhibit so-called biased agonism by selectively activating either G protein- or β-arrestin-mediated signaling after receptor binding. Biased agonists might be used as more targeted therapeutics to differentially regulate physiological responses, such as immune cell migration. To test whether CXCR3-mediated physiological responses could be segregated by G protein- and β-arrestin-mediated signaling, we identified and characterized small-molecule biased agonists of the receptor. In a mouse model of T cell-mediated allergic contact hypersensitivity (CHS), topical application of a β-arrestin-biased, but not a G protein-biased, agonist potentiated inflammation. T cell recruitment was increased by the β-arrestin-biased agonist, and biopsies of patients with allergic CHS demonstrated coexpression of CXCR3 and β-arrestin in T cells. In mouse and human T cells, the β-arrestin-biased agonist was the most efficient at stimulating chemotaxis. Analysis of phosphorylated proteins in human lymphocytes showed that β-arrestin-biased signaling activated the kinase Akt, which promoted T cell migration. This study demonstrates that biased agonists of CXCR3 produce distinct physiological effects, suggesting discrete roles for different endogenous CXCR3 ligands and providing evidence that biased signaling can affect the clinical utility of drugs targeting CXCR3 and other chemokine receptors.
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http://dx.doi.org/10.1126/scisignal.aaq1075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329291PMC
November 2018