Publications by authors named "Rosemary Nixon"

137 Publications

Solution using Stomahesive® wafers for allergic contact dermatitis caused by isobornyl acrylate in glucose monitoring sensors.

Australas J Dermatol 2021 Jul 27. Epub 2021 Jul 27.

Skin Health Institute, Carlton, Victoria, Australia.

Isobornyl acrylate (IBOA) has recently caused a number of cases of allergic contact dermatitis (ACD) from its use in medical devices. We would like to enhance the awareness of this issue with the reporting of three Australian cases, involving two adults and a child. We also report a successful solution by using hydrocolloid wafer (Stomahesive®) as a barrier. As IBOA is not usually found on baseline patch test series and does not cross-react with other acrylic monomers, ACD to IBOA may be missed by clinicians.
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http://dx.doi.org/10.1111/ajd.13675DOI Listing
July 2021

Patch test reactivity to iodopropynyl butylcarbamate between 2011-2018 in Melbourne, Australia.

Contact Dermatitis 2021 Jul 6. Epub 2021 Jul 6.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/cod.13930DOI Listing
July 2021

Contact dermatitis.

Nat Rev Dis Primers 2021 05 27;7(1):38. Epub 2021 May 27.

Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.
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http://dx.doi.org/10.1038/s41572-021-00271-4DOI Listing
May 2021

Clinical features of viral exanthems.

Aust J Gen Pract 2021 04;50(4):231-236

AM, BSc (Hons), MBBS, MPH, FACD, FAFOEM, Consultant Dermatologist and Occupational Physician; Adjunct Clinical Associate Professor, Monash University, Vic; Honorary Associate Professor, The University of Melbourne, Vic; Director, Occupational Dermatology Research and Education Centre, Vic.

Background: Patients with viral exanthems commonly present to the general practitioner. Although it can be challenging to make a specific diagnosis on the basis of the clinical presentation, most viral exanthems can be distinguished initially on the basis of age, distribution and morphology of the rash without requiring investigations.

Objective: The aim of this article is to provide an initial guide to the clinical diagnosis of viral exanthems based on age, distribution and morphology of the rash.

Discussion: Although most viral exanthems can present at any age, it may be helpful to initially consider certain exanthems depending on the age of the patient. Following consideration of differential diagnoses according to age groups, it is proposed that most exanthems can be distinguished by the distribution and morphology of the rash. Other diagnostic considerations include associated symptoms and diagnostic tests if applicable.
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http://dx.doi.org/10.31128/AJGP-02-20-5246DOI Listing
April 2021

Contact allergy and allergic contact dermatitis from benzalkonium chloride in a tertiary dermatology center in Melbourne, Australia.

Contact Dermatitis 2021 Mar 3. Epub 2021 Mar 3.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia.

Background: Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer.

Objective: To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients.

Methods: We conducted a single-center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019.

Results: Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear.

Conclusion: Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID-19) pandemic is likely to further expose people to BAK.
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http://dx.doi.org/10.1111/cod.13826DOI Listing
March 2021

Disinfectant cleaning wipes can burn! The hazards of cleaning without adequate skin protection.

Contact Dermatitis 2021 Jul 22;85(1):109-110. Epub 2021 Mar 22.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/cod.13800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014262PMC
July 2021

Post-operative rashes in the orthopaedic ward caused by allergic contact dermatitis to Dermabond Prineo.

ANZ J Surg 2020 07;90(7-8):1529

Department of Dermatology, Fiona Stanley Hospital, Perth, Western Australia, Australia.

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http://dx.doi.org/10.1111/ans.16009DOI Listing
July 2020

Allergic contact dermatitis to phenol-formaldehyde resin at a single tertiary dermatology centre.

Contact Dermatitis 2021 Jul 8;85(1):26-31. Epub 2021 Mar 8.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia.

Background: Phenol-formaldehyde resin 2 (PFR2) has been shown to be a useful marker of contact allergy (CA) to various phenol-formaldehyde resins. These compounds are used in several industries as solids, powders, or semisolid resins, and are known to be sensitizing agents.

Objectives: The aims were to investigate contact allergy to PFR2 in a single tertiary dermatology centre, to examine associated simultaneous allergic reactions, and to identify cases of allergic contact dermatitis (ACD) to PFR2.

Methods: A retrospective study was performed of patients patch tested to PFR2 between 1 January 2003 and 17 June 2020.

Results: In all, 337 of 7922 patients were tested to PFR2 and 16 (4.7%) reacted. Of those 16 individuals, six (37.5%) had a relevant reaction (1.8% of total). Simultaneous allergic reactions were noted to colophonium in eight (50.0%) patients, Myroxylon pereirae in five (31.3%), and fragrance mix I (FMI) of three cases (18.8%).

Conclusion: Contact allergy to PFR2, even in a selected population of patients, is uncommon. However, patients exposed to plastics and glues, or who work with wood products should be routinely patch tested to a plastics and glues series containing PFR2. We recommend that all centres include PFR2 in their plastics and glues series.
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http://dx.doi.org/10.1111/cod.13771DOI Listing
July 2021

Occupational skin disease in mining: an Australian case series.

Arch Environ Occup Health 2020 Dec 29:1-7. Epub 2020 Dec 29.

Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia.

The mining industry has one of the highest rates of occupational disease across all industries. However, occupational skin disease (OSD) is not commonly reported in this industry, although has been estimated to affect up to 51 people per 100,000 workers, with contact dermatitis accounting for the majority of cases. It often has a poor prognosis and leads to days lost from work. There have been relatively few reports regarding the specific forms of OSD encountered by miners worldwide. We report our experience of miners attending our Occupational Dermatology Clinic and our investigations at two Australian mines. We compare our findings with other reports of OSD in the mining population. The most commonly observed skin condition was irritant contact dermatitis, but miliaria and allergic contact dermatitis were also observed. It is not surprising that most cases of OSD appear to be related to harsh working conditions and exposures to multiple skin irritants, however, specific exposures causing ACD should not be forgotten. Our findings are consistent with previous studies of OSD in miners.
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http://dx.doi.org/10.1080/19338244.2020.1857674DOI Listing
December 2020

Comment on "How to improve the clinical experience for dermatology patients requiring a genital examination: A randomized trial of deodorizing wipes versus standard of care".

J Am Acad Dermatol 2021 Apr 25;84(4):e215-e216. Epub 2020 Dec 25.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1016/j.jaad.2020.11.069DOI Listing
April 2021

Vulval allergic contact dermatitis: Medicaments are a common cause.

Australas J Dermatol 2020 Nov 2;61(4):388-390. Epub 2020 Jul 2.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Vic, Australia.

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http://dx.doi.org/10.1111/ajd.13375DOI Listing
November 2020

How good is the Australian baseline series at detecting allergic contact dermatitis?

Australas J Dermatol 2021 Feb 11;62(1):51-56. Epub 2020 Sep 11.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia.

Background: Patch testing is the gold standard for the diagnosis of allergic contact dermatitis (ACD). The Australian Baseline Series (ABS) was formulated by our group to include the 60 most common and relevant allergens in our patient population. The aim of this study was to assess the efficacy of testing with the Australian Baseline Series in order to diagnose allergic contact dermatitis.

Methods: We conducted a retrospective study of 964 patients with ACD diagnosed at our centre from 1 January 2012 to 31 December 2018. Patients with at least one relevant positive reaction were stratified into three groups: i) reactions only to allergens in the Australian Baseline Series; ii) reactions to allergens in the Australian Baseline Series and to additional allergens; and iii) reactions only to allergens not present in the Australian Baseline Series.

Results: The Australian Baseline Series alone was successful in identifying the cause of allergic contact dermatitis in 63.4% (611/964) of patients. In 23.0% (222/964), the Australian Baseline Series detected at least one relevant allergen, but there were relevant allergens outside of the Australian Baseline Series as well. In 13.6% (141/964), no relevant allergens were detected in the Australian Baseline Series, but allergens were detected in additional series or by testing patients' own products. The most frequently occurring allergens not included in the Australian Baseline Series were citral, ammonium persulfate, geraniol, oakmoss absolute and chlorhexidine diacetate.

Conclusions: The Australian Baseline Series is an adequate screening tool for identifying patients with ACD. Nevertheless, females should be additionally routinely tested with the fragrance series. Patients with suspected occupationally related dermatitis should always be tested with additional allergens and own products.
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http://dx.doi.org/10.1111/ajd.13456DOI Listing
February 2021

Allergic Contact Dermatitis to Dermabond Prineo After Elective Orthopedic Surgery.

Orthopedics 2020 Nov 3;43(6):e515-e522. Epub 2020 Sep 3.

The Dermabond Prineo skin closure system (Ethicon, Somerville, New Jersey) is a wound closure device that combines a 2-octyl cyanoacrylate liquid adhesive and a self-adhesive polyester mesh. Although cyanoacrylates traditionally have been associated with low rates of sensitization, allergic contact dermatitis (ACD) to Dermabond products is being increasingly reported after orthopedic surgery. The authors describe the first case series of ACD to Dermabond Prineo where patch testing confirmed the diagnosis in all patients. Six patients who had suspected Dermabond Prineo ACD after lower limb orthopedic surgery were assessed. Of these patients, 5 had itching within 4 days of surgery and rash within 5 days. All 5 of these patients reported previous exposure to Dermabond products. All patients had removal of the adhesive and mesh earlier than planned and were treated with corticosteroids. In addition, 4 patients received systemic antibiotics; however, only 1 had a microbiologically confirmed superficial skin infection. In all patients, the dermatitis resolved within 2 weeks of dressing removal, with no adverse effect on the orthopedic outcome. Patch testing showed positive reactions to Dermabond Prineo glue for all patients. Orthopedic surgeons should be aware of the potential for ACD to Dermabond Prineo, especially among patients with previous exposure to Dermabond products. The authors discuss the risk factors for ACD to Dermabond Prineo in the orthopedic cohort and provide recommendations for prevention and management. [Orthopedics. 2020;43(6):e515-e522.].
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http://dx.doi.org/10.3928/01477447-20200827-01DOI Listing
November 2020

A cross-sectional study of dermatological conditions in rural and urban Timor-Leste.

Australas J Dermatol 2020 Nov 16;61(4):e395-e398. Epub 2020 Jun 16.

Northern Clinical School, University of Sydney, Sydney, NSW, Australia.

Background: There is limited information about the type of skin disease in Timor-Leste. In order to determine the type and magnitude of skin disease in Timor-Leste, we conducted a cross-sectional point prevalence study of 271 patients from rural and urban Timor-Leste. The aim of the study was to estimate the magnitude and burden of dermatological disease.

Methods: Two Australian-trained dermatologists conducted clinics in the city of Dili (urban) and village of Manusae (rural) in Timor-Leste between the period of June and July 2016. They independently recorded all patient presentations and diagnoses.

Results: A total of 271 patients were reviewed over two months, of whom 37% were seen in an urban setting and 63% in a rural setting. Scabies accounted for 96% of all presentations in the rural setting, which was significantly higher than its presentation in the urban setting (8%), P < 0.001. Scabies also accounted for the majority of presentations in the paediatric population aged 10 years or younger. Fungal and bacterial skin and soft tissue infections were both more common in urban areas (P < 0.001).

Conclusions: Scabies infection remains the most prevalent dermatological condition encountered in the Timor-Leste rural population and has hopefully been addressed by a recent mass drug administration. It is important to raise awareness of the systemic problems that can arise from untreated skin infections.
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http://dx.doi.org/10.1111/ajd.13347DOI Listing
November 2020

Contact urticaria caused by occupational exposure to green beans.

Australas J Dermatol 2020 Nov 20;61(4):372-373. Epub 2020 May 20.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/ajd.13334DOI Listing
November 2020

Allergic chromate dermatitis to cement in Australia: an ongoing problem.

Occup Environ Med 2020 09 13;77(9):658. Epub 2020 May 13.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1136/oemed-2020-106639DOI Listing
September 2020

Contact Allergy to Fragrance Mix II and Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde: A Retrospective Study by International Contact Dermatitis Research Group.

Dermatitis 2020 Jul/Aug;31(4):268-271

Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada.

Background: Fragrance mix II (FM II) is included in the baseline patch test series recommended by the International Contact Dermatitis Research Group (ICDRG). Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is the most important sensitizer of the 6 fragrance materials included in FM II. Besides being a part of FM II, HICC is also tested separately in the ICDRG baseline series.

Objectives: The aim of the study was to investigate the prevalence of contact allergy to FM II and HICC in 2012-2016 with a focus on simultaneous reactions and the percentage of missed contact allergy to HICC provided that only FM II had been tested.

Patients And Methods: A total of 25,019 consecutive dermatitis patients in 13 dermatology clinics representing 12 countries in 5 continents were patch tested with FM II and HICC in the baseline series.

Results: Contact allergy to FM II and HICC was found in 3.9% and 1.6%, respectively. For FM II, the frequency varied from 1.5% to 7.6% in different centers. The corresponding range for HICC was 0.2% to 3.6%. Simultaneous contact allergy to FM II and HICC was noted in 1.4% with the range 0.2% to 2.6%. Seventy-seven patients (0.31%) with contact allergy to HICC did not test positively to FM II. The range for missed HICC allergy by testing only FM II in the different centers would be 0.04% to 0.74%. The ratio between the contact allergy rates for FM II and HICC was similar for all centers, except for Montreal having significantly more contact allergy to FM II than to HICC.

Conclusions: The frequency of missed contact allergy to HICC when testing only with FM II was less than 0.5%, therefore questioning the need to test HICC separately in the ICDRG baseline series.
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http://dx.doi.org/10.1097/DER.0000000000000545DOI Listing
May 2021

Allergic contact dermatitis to triclosan-coated suture material.

Contact Dermatitis 2020 May 5;82(5):330-331. Epub 2020 Feb 5.

Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/cod.13476DOI Listing
May 2020

Revised Baseline Series of the International Contact Research Group.

Dermatitis 2020 Jan/Feb;31(1):e5-e7

Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden Allergy Center and Department of Dermatology, and Allergy Centre, University Hospital, School of Medicine, Republic University, Montevideo, Uruguay Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark Dermatology Department, Buenos Aires University, Clinicas Hospital, Argentina Occupational Dermatology, Ruprecht-Karls-University, Heidelberg, Germany Department of Dermatology, University Clinic Jena, Germany National Skin Centre, Singapore Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Portugal University Hospital KU Leuven, Dermatology, Leuven, Belgium Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Croatia Department of Dermatology, MGM Medical College, Navi Mumbai, Maharashtra, India Faculty of Medicine and Dentistry, Catholic University of Louvain, Belgium Department of Dermatology, The Catholic University of Korea, Seoul, South Korea Department of Dermatology, UCSF School of Medicine, San Francisco, California. Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Nagoya, Japan Department of Cutaneous Allergy, St John's Institute of Dermatology, London, United Kingdom Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia University of Ottawa, The Ottawa Hospital, Ontario, Canada Institute of Dermatology, Bangkok, Thailand Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden.

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http://dx.doi.org/10.1097/DER.0000000000000532DOI Listing
January 2020

Allergic contact dermatitis in children and proposal for an Australian Paediatric Baseline Series.

Australas J Dermatol 2020 Feb 20;61(1):33-38. Epub 2019 Oct 20.

Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia.

Background: Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing.

Methods: We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch-testing centres in Melbourne, Victoria.

Results: A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium.

Conclusion: Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.
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http://dx.doi.org/10.1111/ajd.13169DOI Listing
February 2020

Fibreglass dermatitis in a caravan manufacturer manifesting as prurigo nodularis.

Contact Dermatitis 2019 Nov 8;81(5):381-383. Epub 2019 Jul 8.

Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Australia.

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http://dx.doi.org/10.1111/cod.13333DOI Listing
November 2019

Occupational contact dermatitis caused by opioids: A case series.

Contact Dermatitis 2019 Nov 3;81(5):332-335. Epub 2019 Jun 3.

Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, Australia.

Background: Opioid-manufacturing facility workers are at risk of developing occupational contact dermatitis.

Objectives: To describe the causes of occupational allergic contact dermatitis caused by opioids in an opioid-manufacturing facility.

Materials And Methods: A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne, Australia from 2004 to 2017.

Results: Fifteen workers from an opioid-manufacturing facility were assessed in our clinic over a period of 14 years. Of these, 11 individuals were diagnosed with occupational allergic contact dermatitis caused by opioids, with seven reacting to thebaine, five to morphine, four to norhydroxymorphinone, two to codeine, and two to oripavine. Two people were suspected of having immediate hypersensitivity reactions to opioids, including one who also had allergic contact dermatitis. Two patients were diagnosed with urticaria, aggravated at work. One patient was diagnosed with a non-occupational rash.

Conclusions: We report a case series of workers with allergic contact dermatitis caused by opioids in a manufacturing facility. With greater awareness, including implementation of an educational programme and improved skin protection, the number of cases declined over time. Interestingly, norhydroxymorphinone had not been reported as an allergen before. Further testing is required to establish optimal patch test concentrations of all opiates.
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http://dx.doi.org/10.1111/cod.13305DOI Listing
November 2019

Allergic contact dermatitis caused by benzisothiazolinone in a continuous positive airway pressure mask liquid soap.

Contact Dermatitis 2019 Aug 10;81(2):152-153. Epub 2019 Apr 10.

Occupational Dermatology Research and Education Centre, The Skin and Cancer Foundation Inc., Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/cod.13273DOI Listing
August 2019

Response to: Letter to the editor.

Contact Dermatitis 2019 04;80(4):261-262

NiPERA Inc., Durham, North Carolina.

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http://dx.doi.org/10.1111/cod.13223DOI Listing
April 2019

Contact allergy and allergic contact dermatitis caused by lavender: A retrospective study from an Australian clinic.

Contact Dermatitis 2019 Jul 16;81(1):37-42. Epub 2019 Apr 16.

Skin and Cancer Foundation Inc., Carlton, Victoria, Australia.

Background: Lavender is commonly used in aromatherapy and in a broad range of personal and household products. It has been identified as a contact sensitizer, and has been reported to cause allergic contact dermatitis (ACD).

Objectives: To report our experience with contact allergy and ACD caused by lavender, and to raise awareness of lavender as a potential contact allergen.

Method: A retrospective database review was performed of patients attending patch testing clinics at the Skin and Cancer Foundation, Victoria, Australia, from January 1, 1993 to December 31, 2017.

Results: Among the 2178 patients patch tested with lavender over this period, a total of 58 positive reactions were recorded in 49 individuals, giving a positive patch test prevalence for patients tested with lavender of 2.2%. Twenty-seven patients were diagnosed with ACD. The most common sources of exposure to lavender were personal care products and essential oils. Of the patients with ACD, 74% were tested with lavender absolute, with positive results in 90% of cases.

Conclusion: Lavender is an uncommon cause of ACD but is important to consider, given the potential for exposure through the use of personal care items and essential oils.
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http://dx.doi.org/10.1111/cod.13247DOI Listing
July 2019

Severe allergic contact dermatitis caused by topical bufexamac requiring hospitalization.

Contact Dermatitis 2019 Jun 19;80(6):395-397. Epub 2019 Feb 19.

Skin and Cancer Foundation Inc., Carlton, Australia.

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http://dx.doi.org/10.1111/cod.13207DOI Listing
June 2019

An update of the pathogenesis of frontal fibrosing alopecia: What does the current evidence tell us?

Australas J Dermatol 2019 May 25;60(2):99-104. Epub 2018 Oct 25.

Barton Specialist Centre, Barton, Australian Capital Territory, Australia.

Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia with a complicated pathogenesis yet to be fully understood. FFA appears to be increasing in incidence worldwide, especially in the last decade. In order to consider current treatment options, we reviewed current evidence for its pathogenesis comprising immune-mediated, genetic, hormonal and environmental factors. Th1-mediated inflammation with collapse of hair follicle immune privilege and bulge epithelial stem cell destruction, peroxisome proliferator-activated receptor gamma (PPAR-γ) depletion and epithelial-mesenchymal transition are key events leading to permanent hair follicle destruction in FFA. Although the vast majority of cases are sporadic, familial reports of FFA implicate genetic or epigenetic mechanisms in its pathogenesis. The frequent onset of FFA in post-menopausal women, similar patterning and co-existence with female pattern hair loss, together with a reportedly good response to 5α-reductase inhibitors suggest a role for sex steroid hormones. The reported increasing incidence invites speculation for, yet unproven, environmental triggers such as sun exposure and topical allergens. More robust research into this unique entity is required to help understand the complexity of the pathogenesis of FFA in order to find satisfactory therapeutic targets for this often distressing condition.
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http://dx.doi.org/10.1111/ajd.12945DOI Listing
May 2019

Does clinical testing support the current guidance definition of prolonged contact for nickel allergy?

Contact Dermatitis 2018 Dec 14;79(6):356-364. Epub 2018 Sep 14.

NiPERA Inc., Durham, North Carolina.

Background: The European Chemical Agency (ECHA) definition of prolonged contact was introduced in 2014 and has not been evaluated clinically.

Objectives: To assess whether nickel-sensitized individuals react on patch testing with high nickel-releasing metal discs for short and repetitive periods.

Materials And Methods: We patch tested 45 nickel-sensitized individuals double-blind with 2 different types of high nickel-releasing discs for 10, 30 and 60 minutes on 3 occasions over a period of 2 weeks, and for 1 longer period. Discs were tested for nickel release.

Results: Nickel release from both discs significantly exceeded the 0.5 μg Ni/cm /week limit of the EU REACH nickel restriction. However, only 1 individual tested had a largely dose-dependent allergic reaction.

Conclusions: The majority of nickel-allergic subjects did not react to nickel discs after 2 hours or after repetitive exposures of up to 30 minutes on 3 occasions over a period of 2 weeks. The length of time needed to cause nickel allergic contact dermatitis in most nickel-allergic individuals is longer than the ECHA guidance definition. Longer test times are needed to define the time required to cause dermatitis in most nickel-allergic individuals. As a limitation, the test conditions did not adequately assess real-life factors such as friction, which is relevant for some uses of nickel.
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http://dx.doi.org/10.1111/cod.13095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749565PMC
December 2018

Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia?

Australas J Dermatol 2019 Feb 28;60(1):53-56. Epub 2018 Aug 28.

Department of Dermatology, John Hunter Hospital, Newcastle, New South Wales, Australia.

Despite being a well-recognised cause of allergic contact dermatitis with an embargo in many countries around the world, bufexamac is available over the counter in topical preparations in Australia. We present a series of patients who developed severe cutaneous eruptions after the topical application of bufexamac containing preparations to highlight the potential risks of this medication, as well as advocate for the reconsideration of its registration by the Therapeutic Goods Administration in Australia.
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http://dx.doi.org/10.1111/ajd.12910DOI Listing
February 2019

The methylisothiazolinone contact allergy epidemic in Australia.

Contact Dermatitis 2018 Sep 15;79(3):189-191. Epub 2018 May 15.

Skin & Cancer Foundation Inc., Carlton, Victoria, Australia.

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http://dx.doi.org/10.1111/cod.13025DOI Listing
September 2018
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