Publications by authors named "Joel G DeKoven"

72 Publications

Patch Test Reactions Associated With Topical Medications: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2001-2018).

Dermatitis 2021 Sep 1. Epub 2021 Sep 1.

From the Department of Dermatology, Park Nicollet Health Services Department of Dermatology, University of Minnesota Department of Dermatology, Minneapolis Veterans Affairs Medical Center University of Minnesota Medical School, Minneapolis Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, Cleveland Clinic, OH Department of Dermatology, Duke University Medical Center, Durham, NC Associates in Dermatology, Fort Myers, FL Department of Dermatology, University of California San Francisco Department of Dermatology, Columbia University Irving Medical School, New York, NY Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC Division of Dermatology, CHU de Québec, Laval University, Canada Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH Division of Dermatology, University of Louisville, KY Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada Division of Dermatology, University of Ottawa, Ontario, Canada Department of Dermatology, University of Colorado, Boulder Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Background/objectives: Topical medications may lead to allergic contact dermatitis. This study characterized positive patch test reactions associated with medications in patients evaluated by the North American Contact Dermatitis Group (NACDG).

Methods: This study is a retrospective analysis of the NACDG data (2001-2018). Patients with at least 1 positive patch test reaction associated with a medication source were included. Allergens, reaction characteristics, clinical relevance, and source details were tabulated.

Results: Of 43,722 patients, 6374 (14.6%) had positive allergic patch test reactions associated with 1 or more topical medication sources. Patients with versus without allergic reactions to medications were more likely to be older than 40 years (P < 0.0001) and/or have primary sites of dermatitis on the legs, anal/genital region, or trunk (P < 0.0001). There were 8787 reactions to NACDG allergens; the most common were neomycin (29.4%), bacitracin (29.1%), propylene glycol 100% (10.6%), tixocortol-17-pivalate (10.0%), lidocaine (7.9%), budesonide (4.9%), and dibucaine (4.4%). Propylene glycol 100% was the most common inactive ingredient (10.6%). Current relevance was present in 61.0%. A total of 6.5% of the individuals with medication allergy would have had 1 or more positive patch test reactions missed if only tested to the NACDG screening series.

Conclusions: Positive patch test reactions associated with topical medications were common (14.6%), and most were clinically relevant. Patients with topical medication allergy were twice as likely to have anal/genital involvement. Active ingredients, especially neomycin, bacitracin, and tixocortol-17-pivalate, were frequent culprits.
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http://dx.doi.org/10.1097/DER.0000000000000777DOI Listing
September 2021

Patch testing with ammonium persulfate: The North American Contact Dermatitis Group Experience, 2015-2018.

J Am Acad Dermatol 2021 Aug 11. Epub 2021 Aug 11.

Department of Dermatology, University of Colorado, Boulder, Colorado.

Background: Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions, including allergic contact dermatitis.

Objective: To characterize positive patch test reactions to APS (2.5% petrolatum).

Methods: Retrospective analysis of patients tested to the North American Contact Dermatitis Group screening series from 2015 to 2018.

Results: Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared with APS-negative patients, APS-positive patients were significantly more likely to be male (43.2% vs 28.0%; P < .0001); have primary hand dermatitis (30.2% vs 22.0%; P = .0064), scattered generalized dermatitis (25.5% vs 17.9%; P = .0064), or trunk dermatitis (8.9% vs 4.9%; P = .0123); and have dermatitis that is occupationally related (22.2% vs 10.9%; P < .0001). More than half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially hairdressers (68.4%). Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common sources of APS.

Limitations: Immediate reactions and follow-up testing were not captured.

Conclusion: The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals were important sources of APS exposure.
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http://dx.doi.org/10.1016/j.jaad.2021.08.005DOI Listing
August 2021

Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018.

J Am Acad Dermatol 2021 Jul 24. Epub 2021 Jul 24.

Department of Dermatology, Pennsylvania State University, State College, Hershey, Pennsylvania.

Background: An updated understanding of allergic contact dermatitis is needed, particularly in children.

Objectives: To compare positive and clinically relevant reactions in children versus adults referred for patch testing.

Methods: Retrospective analysis of 1871 children and 41,699 adults from the North American Contact Dermatitis Group (NACDG) from 2001-2018.

Results: Both final diagnosis of allergic contact dermatitis (55.2% versus 57.3%; chi square, P = .0716) and prevalence of ≥ 1 currently relevant reaction to a NACDG screening allergen (49.2% vs 52.2%; P = .1178) were similar between children and adults. Currently in children, the most common relevant allergens were nickel sulfate (17.3%), hydroperoxides of linalool (7.8%), methylisothiazolinone (7.7%), cobalt chloride (7.0%), and fragrance mix I (4.9%). Approximately a fifth of children had a positive reaction to a non-NACDG allergen.

Conclusion: Over half of children referred for patch testing were diagnosed with allergic contact dermatitis. The most common relevant allergens in children were nickel sulfate, cobalt chloride, and hydroperoxides of linalool. Twenty percent of children had at least 1 positive reaction to allergens/substances not on the NACDG screening series, underscoring the need for comprehensive testing.
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http://dx.doi.org/10.1016/j.jaad.2021.07.030DOI Listing
July 2021

Occupational contact dermatitis: Return to work using a multidisciplinary clinic model.

Contact Dermatitis 2021 Jul 22. Epub 2021 Jul 22.

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Background: Occupational contact dermatitis often results in work disruption. Return-to-work (RTW) is an important outcome.

Objective: The objective of this study was to determine RTW outcomes and factors associated with such outcomes using a multidisciplinary clinic model.

Methods: Chart abstraction was performed for 194 workers who received RTW assistance over a 6-year period. Elements abstracted included demographic and diagnostic information and information about the RTW program including principles, program components, barriers, and facilitators.

Results: Of the 902 workers seen for dermatologic assessment, 194 received RTW assistance. At initial assessment, 37% were not working because of their skin disease, and at follow-up, 7% were not working because of their skin disease. The RTW plan components included a graduated or trial of RTW, specific recommendations for avoiding exposure, personal protective equipment, skin management, and ongoing skin monitoring. Principles associated with successful RTW included good communication and the availability of modified work and a worker adherence to the plan. Barriers included lack of modified work, unresponsive employers, and ongoing skin problems.

Conclusions: Specific approaches are important to identify if RTW is to be successful for workers with occupational contact dermatitis.
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http://dx.doi.org/10.1111/cod.13945DOI Listing
July 2021

Contact Allergy in Canada Versus United States: Analysis of the North American Contact Dermatitis Group Data 2005-2016.

Dermatitis 2021 Jul 7. Epub 2021 Jul 7.

From the Departments of Dermatology Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC Department of Dermatology, Minneapolis Veterans Affairs Medical Center; Department of Dermatology, University of Minnesota, Minneapolis Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC Department of Dermatology, Cleveland Clinic Lerner College of Medicine, OH Department of Dermatology, Columbia University Irving Medical Center, New York, NY Division of Dermatology, University of Louisville, KY Department of Dermatology, University of California Medical School, San Francisco Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ontario, Canada Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.

Differences in consumer product availability, distribution, and use may lead to national differences in contact sensitization frequencies.

Objective: The aim of the study was to describe the differences in contact allergy between the United States (US) and Canada.

Methods: This is a retrospective cross-sectional analysis of the North American Contact Dermatitis Group data from 2005 to 2016. Frequencies of demographics, clinical characteristics, positive reactions, trends, and occupations were calculated.

Results: A total of 28,640 patients underwent patch testing. At least 1 positive patch test was observed in 18,599 patients (US, 11,641 [66.5%]; Canada, 6958 [62.5%]). When comparing the 2 groups, US positive reactions were more likely to occur in male patients (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.31-1.49), older than 40 years (OR = 1.30, 95% CI = 1.22-1.38), Black (OR = 2.67, 95% CI = 2.24-3.19) or Hispanic race (OR = 3.53, 95% CI = 2.61-4.78), and/or patients with scattered generalized dermatitis (OR = 1.96, 95% CI = 1.80-2.13). They were less likely to occur in patients with eczema (OR = 0.61, 95% CI = 0.57-0.65) and Asian race (OR = 0.50, 95% CI = 0.44-0.56). Nickel (US, 16.0%; Canada, 22.4%) and methylisothiazolinone (US, 13.4%; Canada, 11.0%) were the top allergens. The third most frequent was neomycin (US, 11.7%) and fragrance mix I (Canada, 10.2%).

Conclusions: National differences in allergen prevalence and trends exist in North America.
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http://dx.doi.org/10.1097/DER.0000000000000701DOI Listing
July 2021

Patch Testing With Tocopherol and Tocopherol Acetate: The North American Contact Dermatitis Group Experience, 2001 to 2016.

Dermatitis 2021 Sep-Oct 01;32(5):308-318

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

Background: Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis.

Objective: The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate.

Methods: This is a retrospective analysis of North American Contact Dermatitis Group patch test data to tocopherols (dl-α-tocopherol 100% and/or dl-α-tocopherol acetate 100%) from 2001 to 2016.

Results: Of the 38,699 patients patch tested to tocopherol and/or tocopherol acetate, 349 (0.9%) had positive reactions; of these, 87.6% were currently relevant. Most (51.4%) were weak (+) and/or not related to occupation (99.1%). Compared with tocopherol-negative patients, tocopherol-positive individuals were more likely to be female (72.5% vs 67.2%, P = 0.0355), have a final primary diagnosis of allergic contact dermatitis (74.2% vs 52.6%, P < 0.0001), and have dermatitis in a scattered generalized distribution (23.8% vs 18.2%, P = 0.0072); they were also less likely to have hand involvement (16.6% vs 22.3%, P = 0.0064). The most common source of tocopherol was personal care products, especially moisturizers.

Conclusions: Positive patch test reactions to tocopherols were relatively rare given their widespread use. When positive, current clinical relevance was high. Tocopherol-positive patients were more likely to be female and presented with dermatitis on the face or in a scattered generalized pattern.
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http://dx.doi.org/10.1097/DER.0000000000000706DOI Listing
July 2021

Contact Dermatitis Associated With Musical Instruments: North American Contact Dermatitis Group Data, 2001-2018.

Dermatitis 2021 Jun 29. Epub 2021 Jun 29.

Department of Dermatology Park Nicollet Health Services Minneapolis, MN. Department of Dermatology University of Minnesota, MN Department of Dermatology Minneapolis Veterans Affairs Medical Center, MN Department of Dermatology Park Nicollet Health Services Minneapolis, MN. Department of Dermatology Minneapolis Veterans Affairs Medical Center. University of Minnesota Medical School Minneapolis Division of Dermatology Sunnybrook Health Sciences Centre University of Toronto Ontario, Canada. Department of Dermatology Cleveland Clinic, OH Department of Dermatology Duke University Medical Center Durham, NC Department of Dermatology Columbia University Irving Medical School New York Department of Dermatology The George Washington University School of Medicine and Health Sciences Washington, DC. Department of Dermatology University of Wisconsin School of Medicine and Public Health, Madison. Department of Dermatology Dartmouth-Hitchcock Medical Center Lebanon, NH. Division of Dermatology Montreal General Hospital McGill University Quebec, Canada. Department of Dermatology University of California San Francisco Division of Dermatology University of Louisville, KY Division of Dermatology University of Ottawa Ontario, Canada. Associates in Dermatology Fort Myers, FL. Department of Dermatology Keck School of Medicine Los Angeles, CA. Division of Dermatology CHU de Québec Laval University Quebec, Canada. Department of Dermatology University of Colorado Boulder.

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http://dx.doi.org/10.1097/DER.0000000000000758DOI Listing
June 2021

Contact Dermatitis Associated With Hair Care Products: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001-2016.

Dermatitis 2021 Jun 19. Epub 2021 Jun 19.

From the Department of Dermatology, Park Nicollet Health Services Department of Dermatology, University of Minnesota Department of Dermatology, Minneapolis Veterans Affairs Medical Center University of Minnesota Medical School, Minneapolis, MN Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, University of California San Francisco Department of Dermatology, Duke University Medical Center, Durham, NC Department of Dermatology, Cleveland Clinic, OH Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada Division of Dermatology, University of Louisville, KY Associates in Dermatology, Fort Myers, FL Division of Dermatology, University of Ottawa, Ontario, Canada Department of Dermatology, Columbia University Irving Medical School, New York, NY Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Background: Hair care products (HCPs) may cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD).

Objectives: The aims of the study were to determine the prevalence of HCP-associated ICD/ACD and to characterize relevant allergens.

Methods: This study is a retrospective analysis of North American Contact Dermatitis Group (NACDG) patch test data, 2001-2016.

Results: Of 38,775 patients tested, 3481 (9.0%) had positive patch test reactions associated with HCPs. The HCP-positive patients were significantly more likely to be female (79.9% vs 66.0%) and/or have primary sites of dermatitis on the face (32.0% vs 27.8%) or scalp (15.4% vs 2.2%) compared with the HCP-negative patients (P < 0.0001). Of 4908 HCP-associated positive patch test reactions, 86.9% (n = 4263) were due to allergens on the NACDG screening series; p-phenylenediamine (35.8%), methylisothiazolinone (9.7%), methylchloroisothiazolinone/methylisothiazolinone (8.7%), and cocamidopropyl betaine (5.9%) were the most frequent. Most reactions (87.7%, 3736/4263) were currently clinically relevant. The most common job associated with 366 occupationally related NACDG HCP-associated allergens was hairdresser/cosmetologist (71.9%). Two hundred eighty-two patients (0.7%) had ICD associated with HCPs. Shampoo/conditioners were the most frequent source of NACDG HCP-associated reactions (47.3%) and HCP-associated ICD (45.0%).

Conclusions: Of the HCP-positive patients, 18.5% had HCP reactions to allergens not on the NACDG screening series, underscoring the importance of patch testing to expanded series in patients suspected of HCP allergy.
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http://dx.doi.org/10.1097/DER.0000000000000760DOI Listing
June 2021

North American Contact Dermatitis Group Patch Test Results: 2017-2018.

Dermatitis 2021 Mar-Apr 01;32(2):111-123

Division of Dermatology, University of Louisville, KY.

Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD).

Objective: This study documented the North American Contact Dermatitis Group (NACDG) patch testing results from March 1, 2017, to December 31, 2018.

Methods: At 14 centers in North America, patients with dermatitis were tested in a standardized manner with a screening series of 70 allergens and supplemental allergens as clinically indicated. Data were manually verified and entered into a central database. Descriptive statistics were estimated, and trends were analyzed using χ2 test.

Results: Overall, 4947 patients were tested. There were 3235 patients (65.4%) who had at least 1 positive reaction and 2495 patients (50.4%) had a primary diagnosis of ACD. Five hundred eighty-one patients (11.7%) had occupationally related dermatitis. There were 10,122 positive patch test reactions. Nickel remained the most commonly detected allergen (16.2%), followed by methylisothiazolinone 0.2% aqueous (15.3%) and methylchloroisothiazolinone/methylisothiazolinone 0.02% aqueous (200 ppm, 11.0%). Compared with the previous reporting periods (2015-2016 and 2007-2016), the proportion of positive reactions for the top 20 screening allergens statistically increased for only 1 allergen, propolis (3.4%; risk ratios = 2.05 [confidence interval = 1.66-2.54] and 1.82 [confidence interval = 1.57-2.11]).Four newly added allergen preparations, hydroperoxides of linalool (8.9%), benzisothiazolinone (7.3%), sodium metabisulfite (2.7%), and hydroperoxides of limonene (2.6%), all had a prevalence of greater than 2%. Approximately 1 (19.7%) in 5 tested patients had 1 or more clinically relevant reactions to an allergen not on the NACDG screening series; 13.2% of these were occupationally related. T.R.U.E. TEST (SmartPractice Denmark, Hillerød, Denmark) would have hypothetically missed 30% to 40% of reactions detected by the NACDG screening series.

Conclusions: These results demonstrate the importance of a regularly updated screening allergen series. Methylisothiazolinone continues to be a significant allergen in North America. Patch testing with allergens beyond a screening tray is necessary for complete evaluation of occupational and non-occupational ACD.
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http://dx.doi.org/10.1097/DER.0000000000000729DOI Listing
May 2021

Widespread cutaneous eruption after aluminum-containing vaccination: A case report and review of current literature.

Pediatr Dermatol 2021 Jul 30;38(4):872-874. Epub 2021 Apr 30.

Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada.

Aluminum salts are adjuvants found in many vaccines. Although rare, patients have reported cutaneous reactions to aluminum salts including persistent pruritic subcutaneous nodules at the injection site. We report the case of an 11-year-old male who at the age of 5 years developed a generalized pruritic cutaneous eruption after receiving the aluminum-containing Quadracel vaccination. Patch testing at that time was positive to aluminum salts and again on repeat patch testing 6 years later. Our case highlights a delayed systemic cutaneous reaction to a vaccine containing aluminum salts. We review cutaneous allergic reactions to vaccines containing aluminum salts and vaccination advice for patients with aluminum contact allergy.
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http://dx.doi.org/10.1111/pde.14613DOI Listing
July 2021

Prevalence and trend of allergen sensitization in patients referred for patch testing with a final diagnosis of psoriasis: North American Contact Dermatitis Group data, 2001-2016.

Contact Dermatitis 2021 May 1. Epub 2021 May 1.

Division of Dermatology, CHU de Quebec, Laval University, Quebec, Quebec, Canada.

Background: Little is known about the relationship between psoriasis and allergic contact dermatitis (ACD).

Objective: To examine the associations with ACD, related clinical characteristics, and common positive and clinically relevant allergens of patients with a final diagnosis of psoriasis who were referred for patch testing.

Methods: Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group.

Results: Patients with a final diagnosis of psoriasis had lower proportions of ACD than those without psoriasis (32.7% vs 57.8%). In multivariable logistic regression models, psoriasis was inversely associated with female sex, Black or Asian race, and history of atopic dermatitis and hay fever. Patients with a final diagnosis of psoriasis were less likely to have one or more positive allergic patch-test reactions or to have a current clinically relevant patch-test reaction to the majority of the most commonly positive and/or relevant allergens. The most clinically relevant allergens included nickel sulfate, methylisothiazolinone, and fragrance mix I.

Conclusion: Approximately one-third of patients who were referred for patch testing with a final diagnosis of psoriasis were also diagnosed with ACD. In select patients with suspected psoriasis who also have a clinical presentation suggestive of ACD, patch testing may be helpful.
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http://dx.doi.org/10.1111/cod.13877DOI Listing
May 2021

Patch Testing to Carvone: North American Contact Dermatitis Group Experience, 2009 to 2018.

Dermatitis 2021 Apr 15. Epub 2021 Apr 15.

From the Department of Dermatology, Park Nicollet Health Services Department of Dermatology, University of Minnesota Department of Dermatology, Minneapolis Veterans Affairs Medical Center University of Minnesota Medical School, Minneapolis Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, University of California San Francisco Department of Dermatology, Cleveland Clinic, OH Department of Dermatology, Duke University Medical Center, Durham, NC Department of Dermatology, Columbia University Irving Medical School, New York, NY Department of Dermatology, The George Washington University School of Medicine and Health Sciences, DC Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada Division of Dermatology, University of Louisville, KY Division of Dermatology, University of Ottawa, Ontario, Canada Associates in Dermatology, Fort Myers, FL Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Background/objectives: Carvone, a flavoring agent, may cause allergic contact dermatitis. This study summarizes patch test reactions to carvone in patients tested by the North American Contact Dermatitis Group, 2009 to 2018.

Methods: This was a retrospective analysis of patients positive to carvone (5% petrolatum). Demographics were compared with those of patients who were negative. Other analyses included reaction strength, clinical relevance, coreactivity with other fragrance/flavor allergens, and exposure sources.

Results: Of 24,124 patients tested to carvone, 188 (0.78%) were positive. As compared with carvone-negative patients, carvone-positive patients were significantly more likely older than 40 years (P = 0.0284). Women (76.1%) and/or facial involvement (33.0%) were common in the carvone-positive group but not statistically different from carvone-negative patients; 73.3% (n = 138) of the reactions were currently relevant. Relevant sources were personal care products (46.3%, n = 87) and food (14.3%, n = 27). Coreactivity with other fragrance/flavor markers was present in 60.6% of carvone-positive patients, most commonly fragrance mix I (34.6%), balsam of Peru (24.5%), and cinnamic aldehyde (15.4%).

Conclusions: Ten-year prevalence of carvone sensitivity was 0.78%. Most carvone-positive patients were female, were older than 40 years, and/or had facial dermatitis. Personal care products were the most common source. Two-fifths of carvone reactions would have been missed by relying on other fragrance/flavoring allergens.
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http://dx.doi.org/10.1097/DER.0000000000000741DOI Listing
April 2021

Patch testing with sodium disulfite: North American Contact Dermatitis Group experience, 2017 to 2018.

Contact Dermatitis 2021 Sep 25;85(3):285-296. Epub 2021 Apr 25.

Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA.

Background: Sodium disulfite (SD), also known as sodium metabisulfite, is an increasingly recognized cause of allergic contact dermatitis.

Objectives: The objective of this work was to characterize individuals with positive patch test reactions to SD as well as analyse reaction strength, clinical relevance, and sources.

Methods: This is a retrospective analysis of patients patch tested with SD (1% petrolatum) by the North American Contact Dermatitis Group (NACDG), 2017 to 2018.

Results: Of 4885 patients patch tested with SD, 132 (2.7%) had a positive reaction. Common primary anatomic sites of dermatitis were face (28.8%), hands (20.5%), and a scattered/generalized distribution (13.6%). Compared with SD-negative patients, SD-positive patients were more likely male (odds ratio 2.81, 95% confidence interval 1.98-4.00) and/or over 40 years (odds ratio 1.95, 95% confidence interval 1.30-2.94). Reactions were most commonly + (50.4%) or ++ (34.1%); 65.2% were considered currently relevant. About 15.2% were definitively confirmed in sources, commonly personal care products (18.9%, especially hair dye), and drugs/medications/alcoholic beverages (9.1%). Only 2.3% of positive reactions were linked to occupation.

Conclusions: Positive reactions to SD occurred in 2.7% of tested patients. Reactions were often clinically relevant and linked to personal care products and drugs/medications/alcoholic beverages.
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http://dx.doi.org/10.1111/cod.13860DOI Listing
September 2021

Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology.

Contact Dermatitis 2021 Sep 6;85(3):274-284. Epub 2021 May 6.

Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.

Background: Data regarding teledermatology for patch testing are limited.

Objectives: Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs).

Methods: Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading.

Results: Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement.

Conclusion: For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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http://dx.doi.org/10.1111/cod.13856DOI Listing
September 2021

Prevalence and Trend of Allergen Sensitization in Adults and Children with Atopic Dermatitis Referred for Patch Testing, North American Contact Dermatitis Group Data, 2001-2016.

J Allergy Clin Immunol Pract 2021 07 27;9(7):2853-2866.e14. Epub 2021 Mar 27.

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

Background: The association between atopic dermatitis (AD) and allergic contact dermatitis (ACD) is controversial.

Objective: To analyze the prevalence, reaction strength, and trends of the most commonly positive and relevant allergens in patients with AD referred for patch testing.

Methods: This was a retrospective analysis of 38,482 patients from the North American Contact Dermatitis Group, 2001 to 2016.

Results: Most adults (56.0%) and children (52.8%) with a history of AD had a final diagnosis of ACD. Adults (66.5% vs 65.6%; χ, P = .1459) and children (61.4% vs 62.3%, P = .7074) with or without a history of AD had similar proportions of one or more allergic patch test reactions. Adults with a history of AD had a greater number of allergic patch test positive reactions than those without it (2.0 ± 2.4 vs 1.9 ± 2.3; t test, P < .0001), whereas children did not (1.5 ± 1.8 vs 1.4 ± 1.6; P = .3839). Nickel sulfate, methylisothiazolinone, formaldehyde, fragrance mix I, sodium gold thiosulfate, and thimerosal were the most common allergens in adults and children with a history of AD. In multivariable logistic regression models, adults with versus without a history of AD had increased odds of reacting to 10 of the top 25 North American Contact Dermatitis Group screening allergens. Most allergens had similar strengths of reaction in adults or children with and without a history of AD or a current AD diagnosis; cobalt, fragrance mix I, and propylene glycol had weaker reactions. In multivariable logistic regression, adults with versus without an AD history had increased odds of relevance for 10 of the 25 most currently relevant allergens, whereas children with an AD history did not have increased relevance for any specific allergens.

Conclusions: Most patients referred for patch testing with AD history had a final diagnosis of ACD. Patients with AD history had a similar likelihood of having a positive patch test reaction as those without an AD history. Adults with an AD history had a higher number of positive patch test reactions.
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http://dx.doi.org/10.1016/j.jaip.2021.03.028DOI Listing
July 2021

Occupational contact dermatitis: Retrospective analysis of North American Contact Dermatitis Group Data, 2001 to 2016.

J Am Acad Dermatol 2021 Mar 19. Epub 2021 Mar 19.

Division of Occupational Medicine, Department of Medicine, St Michael's Hospital, Unity Health, University of Toronto, Toronto, Ontario, Canada.

Background: Patch testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings.

Objective: Provide an overview of occupational skin disease (OSD) and an analysis of occupational ACD in North American patients undergoing patch testing between 2001and 2016.

Methods: Patients with OSD were analyzed for frequency of allergic reactions to a screening series of allergens, occupational relevance, location of skin disease, and exposure sources. Demographic, occupation, and industry information were recorded.

Results: Of 38,614 patients evaluated, 4471 (11.6%) had OSD, of whom 3150 (70.5%) had ACD. The most common occupationally related allergens included rubber accelerators, preservatives, and bisphenol A epoxy resin. Hands (75.8%), arms (30.0%), and face (15.9%) were common sites of dermatitis. The occupations most affected were service workers and machine operators.

Limitations: Our cohort may not reflect the general working population.

Conclusion: This study identified common occupational allergens, exposure sources, and occupations/industries at risk. This information may help the clinician evaluate and manage patients with occupational contact dermatitis.
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http://dx.doi.org/10.1016/j.jaad.2021.03.042DOI Listing
March 2021

Patch Testing to Methyldibromoglutaronitrile/Phenoxyethanol: North American Contact Dermatitis Group Experience, 1994-2018.

Dermatitis 2021 Jul-Aug 01;32(4):256-266

Associates in Dermatology, Fort Myers, FL.

Background: Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) is a broad-spectrum preservative mixture used in consumer and industrial products.

Objectives: The aims of the study were (1) to characterize the prevalence and clinical relevance of patch test reactions to MDBGN/PE and the epidemiology of positive patients and (2) to determine the frequency of concomitant reactions of MDBGN/PE and its components.

Methods: This study used a retrospective analysis of cross-sectional data compiled by the North American Contact Dermatitis Group from 1994 to 2018.

Results: Of 55,477 tested patients, 2674 (4.8%) had positive patch test reactions to MDBGN/PE (1.0%-2.5% petrolatum [pet]); most were + (63.3%) or ++ (22.3%). Clinical relevance was considered definite in 3.0% and probable in 19.3% of reactions. Common dermatitis sites included the hands (26.4%), scattered/generalized distribution (24.7%), and the face (18.3%). Patients with a positive reaction to MDBGN/PE and/or MDBGN and/or PE were significantly more likely to be male and older than 40 years and/or had hand dermatitis (P ≤ 0.0033). Positivity to MDBGN/PE 2.0% pet decreased significantly over time (from 6.0% in 1998-2000 to 2.5% in 2017-2018, P < 0.0001). Personal care products were the most common exposure source (53.2%).

Conclusions: Over time, positivity to MDBGN/PE 2.0% pet decreased significantly from 6.0% (in 1998-2000) to 2.5% (in 2017-2018). The high proportion of weak (63.3%) reactions underscore the need for careful interpretation of patch test sites. Important demographic associations included male sex and age older than 40 years.
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http://dx.doi.org/10.1097/DER.0000000000000732DOI Listing
March 2021

Prevalence and trend of allergen sensitization in patients with nummular (discoid) eczema referred for patch testing: North American Contact Dermatitis Group data, 2001-2016.

Contact Dermatitis 2021 Jul 16;85(1):46-57. Epub 2021 Mar 16.

Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA.

Background: Few studies have examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD).

Objective: To examine trends, associations, and clinical relevance of ACD in patients with NE who were referred for patch testing.

Methods: Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group.

Results: Overall, 748 patients (1.9%) were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001 and 2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE increased steadily with age and was associated with male sex and Asian and other race/ethnicity, and inversely associated with a history of atopic dermatitis (AD) and hay fever. Patients with NE had lower proportions of one or more positive allergic reactions and lower odds of a positive reaction in multiple individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium 15, fragrance mix I, and propylene glycol.

Conclusion: NE is a heterogeneous disorder with distinct subsets of lesional distributions and a profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly one in four patients with NE had ACD, supporting the role of patch testing in patients with NE.
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http://dx.doi.org/10.1111/cod.13824DOI Listing
July 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 With Carmine 2.5% in Petrolatum by the North American Contact Dermatitis Group, 2011-2012.

Dermatitis 2021 Mar-Apr 01;32(2):94-100

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

Background: Carmine is a natural red dye that may cause allergic contact dermatitis.

Objective: The aim of this study was to analyze patch test reactions to carmine (2.5% in petrolatum) and characterize carmine-positive patients.

Methods: This study conducted a retrospective analysis of North American Contact Dermatitis Group data compiled between 2011 and 2012.

Results: Of 4240 patients patch tested to carmine, 132 (3.1%) had reactions with a final interpretation of "allergic" (positive). Carmine-positive patients were significantly more likely to be female (77.7% vs 68.3%; P = 0.0237) and have a final primary diagnosis of allergic contact dermatitis (74.8% vs 47.2%; P < 0.0001). As compared with carmine-negative patients, carmine-positive patients were significantly more likely to have involvement of all facial sites combined (48.1% vs 29.9%; P < 0.0001) and the lips (7.6% vs 3.6%; P = 0.0166). At final reading, most carmine reactions were weak (+; 64.9%). Approximately half (53.4%) were currently clinically relevant; identified sources were primarily personal care products (77.1%), especially makeup (31.4%) and lip products (8.6%).

Conclusions: Weak patch test reactions to carmine should be interpreted with caution. Allergic contact dermatitis to carmine should be suspected in women with facial and/or lip dermatitis, especially those using carmine-containing cosmetics.
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http://dx.doi.org/10.1097/DER.0000000000000643DOI Listing
January 2021

Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016.

Dermatitis 2021 Jul-Aug 01;32(4):232-244

Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Objectives: Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population.

Methods: The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure.

Results: A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively).

Conclusions: Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.
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http://dx.doi.org/10.1097/DER.0000000000000675DOI 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

Positive Patch Test Reactions to Carba Mix and Thiuram Mix: The North American Contact Dermatitis Group Experience (1994-2016).

Dermatitis 2021 May-Jun 01;32(3):173-184

Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Background/objective: This study characterizes concomitant reactions to carba mix (CM) and thiuram mix (TM) in a large North American population. Because thiurams and dithiocarbamates have structural similarity, concomitant reactions are expected.

Methods: The 1994-2016 North American Contact Dermatitis Group data were analyzed. Patients with a final reaction interpreted as "allergic" to either CM or TM were included.

Results: A total of 49,758 patients were tested to both CM and TM. A total of 3437 (6.9%) had positive reactions to CM and/or TM including the following groups: CM+ only (n = 1403, 40.8%), TM+ only (n = 1068, 31.0%), or both (n = 966, 28.1%). A total of 47.5% of TM+ patients were positive to CM and 40.8% of CM+ patients were positive to TM. Male sex, occupationally related dermatitis, and hand involvement were significantly more common in individuals positive to CM and/or TM as compared with those who were negative (P < 0.0001). More than 80% of CM+/TM+ reactions were currently relevant. Gloves were the most common source of CM and TM; clothing and footwear were also frequent.

Conclusions: Carba mix and TM remain important, clinically relevant allergens. Although significant concomitant reaction frequency was demonstrated, more than half of the patients reacting to either CM or TM would have been missed if both had not been tested, underscoring the importance of testing to both.
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http://dx.doi.org/10.1097/DER.0000000000000648DOI Listing
December 2020

Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016.

J Am Acad Dermatol 2021 Apr 28;84(4):989-999. Epub 2020 Nov 28.

Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.

Background: Hand eczema (HE) is a heterogeneous and burdensome disorder.

Objective: To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing.

Methods: Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113).

Results: Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ, P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators.

Limitations: No data on HE phenotype.

Conclusion: HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.
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http://dx.doi.org/10.1016/j.jaad.2020.11.054DOI Listing
April 2021

Patch Testing to Diphenylguanidine by the North American Contact Dermatitis Group (2013-2016).

Dermatitis 2020 Nov/Dec;31(6):350-358

From the *Department of Dermatology, Park Nicollet Health Services †Department of Dermatology, University of Minnesota ‡Department of Dermatology, Minneapolis Veterans Affairs Medical Center §University of Minnesota Medical School, Minneapolis ∥Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada ¶Division of Dermatology, University of Louisville, KY **Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC ††Department of Dermatology, Duke University, Durham, NC ‡‡Department of Dermatology, Cleveland Clinic, OH §§Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison ∥∥Department of Dermatology, University of California San Francisco ¶¶Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada ***Department of Dermatology, Columbia University, New York, NY †††Department of Dermatology, Keck School of Medicine, Los Angeles, CA ‡‡‡Division of Dermatology, University of Ottawa, Ontario, Canada §§§Department of Dermatology, Pennsylvania State University, State College ∥∥∥Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH ¶¶¶Department of Specialty Medicine, Ohio University, Columbus.

Background/objectives: Carba mix (CM, 3% petrolatum) contains 1,3-diphenylguanidine (DPG, 1%), zinc diethyldithiocarbamate (1%), and zinc dibutyldithiocarbamate (1%). Because DPG is a component of CM, DPG is often not tested separately. The purpose of this study was to determine the frequency of concomitant reactions to CM and DPG.

Methods: A retrospective analysis of the 2013-2016 North American Contact Dermatitis Group data was conducted. The study group consisted of patients with final interpretation of "allergic" to either DPG or CM. Reactions coded as irritant or doubtful/macular erythema (+/- and not interpreted as allergic) were excluded.

Results: A total of 10,457 patients were patch tested to both CM and DPG, and 610 (5.8%) had allergic reactions to either CM or DPG (CM only [n = 292, 47.9%], DPG only [n = 190, 31.1%], both [n = 128, 21.0%]). A total of 39.4% of CM-allergic patients reacted to DPG, and 59.7% of DPG-allergic patients reacted to CM. Analyses found that 25% (++/+++ subgroup) to 40% (all patients) of allergic reactions to DPG would have been missed by testing to CM alone. More than 70% of reactions to CM and DPG were +/- or +.

Conclusions: Patch testing to CM will miss 25% to 40% of positive reactions to DPG. Both CM and DPG have a high frequency of +/- and + reactions.
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http://dx.doi.org/10.1097/DER.0000000000000629DOI Listing
November 2020

The Utility of an Occupational Contact Dermatitis Patch Test Database in the Analysis of Workplace Prevention Activities in Toronto, Canada.

Ann Work Expo Health 2021 03;65(2):196-200

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Occupational skin diseases are common suggesting that there are still gaps in workplace prevention. Patch test surveillance systems provide an opportunity to collect work related information in addition to clinical information and patch test results.

Objectives: To examine 5 years of data related to workplace prevention by industry sector in a patch test surveillance database for workers with a diagnosis of occupational contact dermatitis.

Methods: The study was approved by the Research Ethics Board of St Michael's Hospital. Information including demographics, clinical history, healthcare utilization, and workplace characteristics and prevention practices in addition to patch test results was collected from consenting patients.

Results: Workers in the healthcare and manufacturing sectors were more likely to report workplace training including skin protection training, whereas those in services and construction were less likely to report training.

Conclusions: Collecting basic workplace information with patch test surveillance databases can inform the occupational health and safety system about prevention practices in the workplace and identify areas for focussed intervention.
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http://dx.doi.org/10.1093/annweh/wxaa077DOI Listing
March 2021

Contact Dermatitis to Personal Care Products is Increasing (but Different!) in Males and Females: North American Contact Dermatitis Group (NACDG) Data, 1996-2016.

J Am Acad Dermatol 2020 Oct 8. Epub 2020 Oct 8.

Division of Dermatology, University of Ottawa, Ontario, Canada.

Background: Personal care products(PCPs) are commonly responsible for allergic(ACD) and irritant contact dermatitis(ICD). PCP use was historically associated with women but increasingly, male-targeted PCPs are being marketed.

Objective: To characterize and compare males and females with PCP-related contact dermatitis(MPCP, FPCP).

Methods: Retrospective cross-sectional analysis of North American Contact Dermatitis Group(NACDG) data (1996-2016).

Results: 4680/16,233 males (28.8%) and 12,730/32,222 (39.5%) females had a PCP identified as a source of ICD 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. As compared to FPCP, a larger proportion of MPCP were older and/or had trunk/extremity dermatitis(p<0.0001). MPCP were twice as likely to have soaps as a source while FPCP were twice as likely to have hair care products(p values<0.001). The most common PCP-related NACDG allergens for both sexes were methylisothiazolinone(MI) (MPCP:28.8%, FPCP:21.5%), fragrance mix I (22.3%, 20.1%), balsam of Peru (18.5%, 14.1%), quaternium-15 (16.1%, 12.3%), and paraphenylenediamine (11.5%, 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.
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http://dx.doi.org/10.1016/j.jaad.2020.10.003DOI Listing
October 2020
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