Practices of French and Francophones allergists in the management of allergic risks and complications of anti-SARS- COV- 2 vaccination

Background: The SARS-COV- 2 vaccination campaign has massively mobilized the allergists' community to screen patients deemed at risk for the SARS-COV- 2 vaccines. To describe data regarding the management of medical calls regarding the allergic risk for the SARS-COV- 2 vaccination, amongst French allergists. Method(s): A questionnaire-based survey was launched on the AdviceMedica platform (a platform of medical advice exchange between peers) between July and October 2021 (including two reminders). Result(s): Fifty-four allergists answered the survey. Three quarters of the responders were full-time allergists. Overall, 42% and 35% had an exclusive hospital or private practice, respectively. Allergists were mostly contacted by telephone (96.3%) and e-mail (79.6%), by general practitioners (92.6%) or physicians practicing in vaccination centers (88.8%) (median of vaccine related medical calls: 10 per week (Q25-Q75: 7-20, range (2-300). Allergists favored in-person visits rather than teleconsultations (85.2% vs. 61.1%). Allergy testing was prescribed for suspicions of allergy to polyethylene glycol (84.4%) or other vaccines and non-identified drugs (64.4%). Half of the responders (29, 53.7%) could perform vaccination and four (13.7%) declared reactions during vaccination. The responders used several tools in taking their clinical decision: exchanges with peers from the AdviceMedica platform (40.4%), advice from tertiary university hospital allergy units (25%), recommendations of the French Society of Allergy (17.3%). The three most frequent drawbacks that the allergists encountered were: having a hard time adding supplementary patient visits within optimal delays (three quarters of the responders), the reluctance expressed by the physicians requiring the advice and by the patients (two thirds) and the fact that the learnt society recommendations were deemed not to cover many on-field situations (one third). The major benefits from screening were estimated to be the lack of allergy contraindication to vaccination (88.7%) and the increased visibility of the allergist's role (69.8%). Conclusion(s): This survey put numbers on the management of screening patients deemed at risk for the SARS-COV- 2 vaccination amongst French allergists. Peer exchange was the most frequent tool in taking a clinical decision.

Anaphylactic shock induced by a depot corticosteroid: Reflections on a clinical case

Introduction (contexte de la recherche): IgE-mediated reactions to systemic corticosteroids (CSs) are rare. Hydrocortisone and methylprednisolone succinate ester are the most frequent elicitors. Excipients of depot corticosteroids (like carmellose or macrogol) may also be involved. The involvement of the dipropionate form of betamethasone (present in the depot Diprostene) has not been studied. Objectif: To describe the case of a 40-year-old woman, who presented an anaphylactic shock reaction upon intra-articular administration of Diprostene (Betamethasone sodium phosphate and betamethasone dipropionate), associated with an iodinated radiocontrast media (ICM, Xenetix). Methodes: An allergy work-up was performed, according to recommendations for severe immediate reactions. Nine months after the reaction [hypotension (7/5 mmHg), erythema and desaturation at 94%, treated with adrenalin, methylprednisolone hemisuccinate, dexchlorpheniramine] the patient underwent skin prick tests (SPT) and intradermal tests (IDT) with ICM, bethamethasone and Diprostene (commercial molecules). Latex and chlorexidine were also studied. Resultats: The tests resulted negative for ICM, latex and chlorexidine (including serum specific IgE ImmunoCAP ThermoFisher Scientific), bethametasone phosphate (IDT 0.4 mg/mL) and carmellose (IDT 0.5 mg/mL). SPT elicited a positive reaction towards Diprostene in immediate reading, (for 5, 0.5, 0.05 mg/mL) with an erythema (10, 8, 5 mm respectively) and a wheal (of at least 3 mm for each SPT). We performed an oral drug challenge to bethametasone phosphate for a total of 8 mg and it was well tolerated. The basal tryptase was 5.5 microg/mL. Tryptasemia 30 minutes after the reaction was 26.8 microg/mL. Conclusion(s): We describe an anaphylactic reaction to Diprostene, proven by positive ST. The hypothesis of allergy to betamethasone dipropionate is under investigation. The hypothesis of allergy to macrogol, the other excipient of (which was not tested separately) is less likely, since the patient received Commirnaty SARS-CoV-2 vaccine 3 months after the reaction. The allergy work-up is ongoing (tests are programmed for betamethasone dipropionate alone).Copyright © 2023

Allergist coorporation, the COVID-19 vaccination's keystone

Background: The French vaccination campaign against COVID-19 was accompanied by an overwhelming increase in allergists work load highlighting our key role in the stratification of the allergy risk prior to vaccination. Method(s): In order to describe our triage and testing experience for the COVID-19 vaccination all requests were analysed in a standardized way prospectively. Our final goal was to filter the requests and avoid any delay in the vaccination process. We first set up and validated locally a questionnaire (completed by the requesting practitioner) allowing to evaluate the risk of allergy to the vaccine, based on the clinical history of the patient. Questionnaire-based allergy advices were delivered (regular vaccination or allergy testing prior to vaccination). Result(s): From January 2021 to January 2022, we addressed 1047 requests. Forty-one patients (4%) were tested. 96% had allergies to other compounds, not increasing the risk of reacting to the covid vaccines and were vaccinated safely. Half of the tested patients experienced an immediate reaction to the vaccine and the other half had a history of allergy to the vaccine's components. We identified 3 groups of patients: -Suspicions of polyethylene glycol (PEG) containing laxative allergy comprised 8 patients (26%), including 2 cases with proven IgE-mediated allergy to PEG. They were 63% (5) women, 63% (5) atopic (average age of 49 +/-10 yrs). Two thirds (63%, 5 patients) had an immediate reaction to PEG, including 3 and 2 patients with anaphylaxis with and without shock, respectively. The two allergic patients refused vaccination and received a certificate of contraindication to PEG-containing vaccines (as per French law). -Reactions to the covid vaccine comprised 21 patients: most were women (86%, 18 patients) and 29% (6) were atopic (average age was 51 +/-19 yrs). Three quarters (76%, 16 patients) presented a reaction within 1 hour after the vaccination, considered as potential anaphylaxis in 12 patients (8 patients with and 5 without shock). 100% (21 patients) were tested negative. Twenty patients (95%) were further vaccinated without reaction. One required H1 antihistamine. -Suspicions of allergy to PEG or polysorbate as excipients included 12 patients (29%). Most clinical histories were anaphylactic (42% without and 33% with shock). Following negative excipient skin testing, regular vaccination was authorized. Conclusion(s): Overall, only 4% of the initial requests were deemed eligible for allergy testing. We did not diagnose any allergy in patients who reacted to the vaccines and we delivered two certificates of contraindication to mRNA COVID-19 PEG-containing vaccines in two cases of confirmed IgE-mediated allergy to PEG.

SYMPTOMATOLOGY AND TREATMENT OF COVID-19 AFFECTING SKIN APPENDAGES: A NARRATIVE REVIEW BEYOND COVID-TOES.

SARS-CoV-2 is the cause of COVID-19 disease and responsible for a pandemic since the 2020. Multiple organ involvement has been described including cutaneous symptoms. Affection of skin appendages, however, seems to be under-reported except for COVID-toes. We performed a PUBMED research for "COVID-19" OR "SARS-CoV-2" AND "skin appendages", "hair", "nails", and "skin glands" from January 2020 to April 2022. COVID toes were excluded since this symptom had extensively been discussed. The focus of this narrative review was laid on clinical presentation, association to the course of COVID-19 disease and treatment options. Skin appendages can be affected by COVID-19 disease beyond COVID-toes, both by symptomatic and asymptomatic course. Telogen effluvium, androgenetic alopecia, and alopecia areata are the most common hair disorders in COVID-19 patients. Nails are less commonly affected by COVID-19 than hair. Splinter hemorrhages and leukonychia are the most frequent findings. While sebaceous glands seem to be uninvolved, SARS-CoV-2 spike proteins have been identified in eccrine sweat glands. Alopecia areata is often seen among asymptomatic COVID-19 patients while telogen effluvium is observed in symptomatic and asymptomatic patients. The half-moon sign on the nails could be a red flag for a more severe course of COVID-19. Treatment options are summarized. Skin appendages are not spared by COVID-19. Their knowledge will help to identify asymptomatic patients and patients at risk for a more severe course of the viral disease.

Réintroduction du vaccin COMIRNATY® chez une patiente présentant une allergie confirmée au PEG

Introduction (contexte de la recherche) Une allergie à l'un des composants du vaccin contre la Covid-19, comme le polyéthylène glycol (PEG), fait partie des contre-indications à la vaccination par COMIRNATY®. Un avis allergologique est nécessaire pour confirmer une éventuelle suspicion d'allergie au PEG. Objectif Présentation d'une proposition de prise en charge des patients ayant des antécédents de réaction allergique immédiate à l'un des composants du vaccin contre la Covid-19. Méthodes Nous présentons le cas d'une patiente travaillant dans le secteur médical, ayant présenté une réaction anaphylactique immédiate (nausée, vomissements, urticaire généralisée et céphalée) après avoir pris un laxatif contenant du PEG en tant que principe actif (MACROGOL®), 15 années auparavant, dans un contexte de constipation. Nous avons confirmé l'allergie au PEG par un test cutané (en prick) positif. Le prick test au vaccin COMIRNATY® était également positif. Après avoir évalué de façon stricte la balance bénéfice-risque individuelle de la vaccination, nous avons vacciné la patiente en hôpital de jour d'allergologie selon un protocole de réintroduction progressive et sous surveillance clinique rapprochée. Résultats La patiente a bénéficié de la réintroduction de ce vaccin (sans prémédication) selon un protocole en 4 étapes (dose totale 0,3 mL). Le protocole a été réalisé en milieu sécurisé dans le service d'allergologie et après avoir obtenu le consentement de la patiente. Une surveillance clinique classique d'un test de réintroduction à risque a été réalisée. Les résultats du test de réadministration du vaccin n'ont montré aucune réaction allergique après une surveillance prolongée (2 heures après la dernière dose). Conclusions En présence d'une balance bénéfice-risque favorable à la vaccination et avec une surveillance stricte, la réintroduction du vaccin COMIRNATY® chez les patients avec une allergie confirmée au PEG est possible, avec une bonne tolérance.

Facteurs prédictifs d'une poussée de psoriasis après une infection par le SARS-CoV-2 chez l'enfant

Introduction: La pandémie à SARS-CoV-2 a été source de nombreuses questions quant à l'impact de l'infection sur les dermatoses inflammatoires chroniques, et de l'impact des traitements de ces dermatoses sur la sévérité de l'infection. Le registre international Chi-PsoCov (enfants psoriasique souffrant de psoriasis et ayant développé une infection à SARS-CoV-2) a permis de montrer que les biothérapies n'augmentaient pas le risque de formes sévères de COVID-19 chez les enfants atteints de psoriasis. Par ailleurs, il était montré que le COVID-19 était responsable du développement de psoriasis de novo ou de l'aggravation d'un psoriasis connu chez certains enfants.Dans cette partie du travail nous nous sommes concentrés sur les enfants ayant développé une poussée de psoriasis après l'infection : aspects phénotypiques des poussées, et recherche de facteurs de risque liés à la maladie, au psoriasis, ou aux traitements, associés à l'aggravation du psoriasis après l'infection. Matériel et méthodes: Les données ont été collectées de février 2021 à mai 2022 en provenance de 14 pays. Les enfants étaient inclus s'ils avaient moins de 18 ans, un antécédent de psoriasis ou psoriasis apparu dans le moins suivant l'infection COVID-19, et avaient été infectés par le SARS-CoV-2 avec ou sans symptômes. Les enfants ayant développé un psoriasis de novo étaient exclus de cette étude. Résultats: Sur les 152 inclusions du registre Chi-PsoCov, dix enfants ont développé un psoriasis dans le mois suivant l'infection et n'ont pas été retenus dans ce travail. L'analyse a porté sur 135 enfants ayant développé 142 COVID-19. Le psoriasis était stable dans 120 cas (84,5 %) et s'aggravait dans le mois suivant l'infection dans 22 cas (15,5 %).Dans 20 cas, lors de la poussée, le phénotype était inchangé, et dans 2 cas, il y avait un changement de phénotype : psoriasis en plaques en psoriasis en gouttes (n = 1) ou inversé (n = 1).Ni les caractéristiques démographiques, ni les aspects du psoriasis (notamment psoriasis actif vs en rémission), ni la sévérité de l'infection à SARS-CoV-2 n'étaient associés à des poussées de psoriasis. Seule l'utilisation de traitements systémiques du psoriasis, conventionnels ou biothérapies, lors de l'infection semblait protectrice de la survenue de poussées (50,0 % dans le groupe stable vs 27,3 % dans le groupe poussées, p = 0,049). Discussion: L'infection à SARS-CoV-2 est responsable dans environ 15 % des cas de poussées de psoriasis. Dans la grande majorité des cas, le phénotype précédent l'infection est conservé. Ces poussées ne sont pas associées à la sévérité du psoriasis, de l'infection ou autres paramètre cliniques. Seuls les traitements systémiques semblent réduire ce risque, probablement en « contrôlant » la poussée. Il est possible qu'une susceptibilité d'ordre génétique, non explorée ici, explique aussi cette susceptibilité à l'infection.

COVID-19 et psoriasis de l'enfant : facteurs associés à une évolution défavorable de la COVID-19 et impact de l'infection sur le psoriasis. Registre Chi-PsoCov

Introduction: La pandémie à SARS-CoV-2 a soulevé de nombreuses questions sur la prise en charge des maladies chroniques et leurs traitements. Les données concernant l'utilisation des biothérapies chez les adultes atteints de psoriasis sont rassurantes, mais manquent chez l'enfant. Par ailleurs, l'infection à SARS-CoV-2 pourrait influencer l'évolution du psoriasis chez l'enfant. L'objectif de cette étude était d'évaluer l'impact de l'infection à SARS-CoV-2 sur le psoriasis, et la sévérité de l'infection selon le traitement systémique reçu. Matériel et méthodes: Les données ont été collectées de février 2021 à février 2022 en provenance de 14 pays. Les enfants étaient inclus s'ils avaient moins de 18 ans, un antécédent de psoriasis ou apparu dans le moins suivant l'infection COVID-19, et avaient été infectés par le SARS-CoV-2 avec ou sans symptômes. Résultats: Au total, 117 enfants ont été inclus (filles : 49,6 %, âge moyen : 12,4 ans) avec 120 infections) SARS-CoV-2. La principale forme de psoriasis était le psoriasis en plaques (69,4 %) ;le psoriasis était actif avant l'infection dans 70,1 % des cas. La majorité des enfants ne prenaient pas de traitement systémique au moment de l'infection (54,2 %), 33 enfants (28,3 %) étaient sous biothérapie (principalement anti-TNF alpha et ustékinumab), et 24 (20,0 %) sous traitement systémique conventionnel (principalement méthotrexate). L'infection était confirmée chez 106 enfants (88,3 %) et 3 ont eu la maladie 2 fois (1 enfant asymptomatique sous ustékinumab et 2 enfants symptomatiques sans traitement systémique). L'infection était symptomatique chez 75 enfants (62,5 %) avec une durée moyenne des symptômes de 6,5 jours, significativement plus longue chez les enfants sous traitement systémique conventionnel (p = 0,002) ou sans traitement systémique (p = 0,006) par rapport aux enfants traités par biothérapies. Six enfants ont nécessité une hospitalisation, dont un enfant en réanimation ;ils étaient plus fréquemment sous traitements systémiques conventionnels par rapport aux autres enfants (p = 0,01), et principalement sous méthotrexate (p = 0,03). Aucun enfant sous biothérapie n'a été hospitalisé, et aucun décès n'a été rapporté.Après l'infection, le psoriasis s'est aggravé dans 17 cas (15,2 %), sans modification du phénotype sauf pour un enfant avec un psoriasis initialement en plaques qui a eu suite à l'infection une poussée de psoriasis en gouttes. Neuf enfants (8,0 %) ont développé un psoriasis de novo dans le mois qui a suivi l'infection, plus souvent un psoriasis en gouttes (p = 0,01) par rapport aux enfants ayant un antécédent connu de psoriasis. Ces enfants avaient un antécédent familial de psoriasis dans 75,0 % des cas. Discussion: L'utilisation des biothérapies semble rassurante sans augmentation du risque de forme sévère de COVID-19 chez les enfants atteints de psoriasis. L'infection à SARS-CoV-2 était responsable du développement de psoriasis de novo ou de l'aggravation d'un psoriasis connu chez certains enfants.

Enquête COMPac (Complications allergiques des vaccins de la Covid) : étude des pratiques des allergologues français et francophones

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

Modèle de stratification du risque allergique à la vaccination SARS-COV2 via un questionnaire (et bénéfice du bilan allergologique)

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

Children with psoriasis infected by SARS-CoV-2

Objectives: To evaluate the impact of SARS-CoV-2 on psoriasis in children during and after SARS CoV- 2 infection. Method: We performed a retrospective study on children hospitalised with COVID-19 infection and diagnosed previously with severe psoriasis. Results: Case 1: A 16-year old boy, diagnosed with plaque psoriasis at the age of 10, was hospitalised 10 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with phototherapy. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Case 2: A 17-year-old boy diagnosed with plaque psoriasis at the age of 13 was hospitalised 12 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with MTX. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Case 3: A 16-year-old girl, diagnosed with plaque psoriasis at the age of 12, was hospitalised 12 days for COVID-19 (confirmed by PCR) with fever, cough, headache. Before admission to the hospital for COVID-19 infection psoriasis was treated with MTX. During hospitalisation psoriasis remained the same and no Long-COVID was noted. Discussion: No impact of SARS Cov2 infection was noted on evolution of children diagnosed and treated previously for severe psoriasis.

Children with psoriasis and COVID-19: factors associated with an unfavourable COVID-19 course, and the impact of infection on disease progression (Chi-PsoCov registry).

BACKGROUND: The COVID-19 pandemic has raised questions regarding the management of chronic skin diseases, especially in patients on systemic treatments. Data concerning the use of biologics in adults with psoriasis are reassuring, but data specific to children are missing. Moreover, COVID-19 could impact the course of psoriasis in children. OBJECTIVES: The aim of this study was therefore to assess the impact of COVID-19 on the psoriasis of children, and the severity of the infection in relation to systemic treatments. METHODS: We set up an international registry of paediatric psoriasis patients. Children were included if they were under 18 years of age, had a history of psoriasis, or developed it within 1 month of COVID-19 and had COVID-19 with or without symptoms. RESULTS: One hundred and twenty episodes of COVID-19 in 117 children (mean age: 12.4 years) were reported. The main clinical form of psoriasis was plaque type (69.4%). Most children were without systemic treatment (54.2%); 33 (28.3%) were on biologic therapies, and 24 (20%) on non-biologic systemic drugs. COVID-19 was confirmed in 106 children (88.3%) and 3 children had two COVID-19 infections each. COVID-19 was symptomatic for 75 children (62.5%) with a mean duration of 6.5 days, significantly longer for children on non-biologic systemic treatments (P = 0.02) and without systemic treatment (P = 0.006) when compared with children on biologics. The six children who required hospitalization were more frequently under non-biologic systemic treatment when compared with the other children (P = 0.01), and particularly under methotrexate (P = 0.03). After COVID-19, the psoriasis worsened in 17 cases (15.2%). Nine children (8%) developed a psoriasis in the month following COVID-19, mainly a guttate form (P = 0.01). DISCUSSION: Biologics appear to be safe with no increased risk of severe form of COVID-19 in children with psoriasis. COVID-19 was responsible for the development of psoriasis or the worsening of a known psoriasis for some children.

The Ugly Face of Face Masks

Introduction: Prolonged and tightly use of face masks has been identified as cause for skin damage during the COVID-19 pandemic. Case series presentation: We evaluated patients seen in the outpatient clinic between March and May 2020, during the lockdown period, focusing on skin damage related to the use of face masks. We aimed to highlight the major impact of routine usage of face masks on the skin of individuals of different ages and professions. Contact dermatitis was prevalent, but we also recorded many cases of outbreak of seborrheic dermatitis, acne, rosacea, perioral dermatitis, atopic dermatitis, folliculitis, as well as neurotic excoriations caused by anxiety, tinea, and impetigo. We also observed a delay in the diagnosis of benign and malignant tumors. Conclusions: The most important step should be the assessment of dermatologic pathology related to the use of face masks. They say a picture is worth a thousand words. So take off the face mask, and look at the skin!

Smoking Habit and Correlation with Hand Eczema in Healthcare Workers in the Time of COVID-19

Background: Hand eczema, in time of COVID-19, is one of the most frequently diagnosed skin disorders in nurses. In this study, we sought to investigate whether smoking could be an additional risk factor for hand eczema in nurses during the COVID-19 pandemic. Method: Using a questionnaire about smoking details and hand eczema, we conducted a study among nurses involved in the frontline management of COVID-19 patients. A total of 1,000 questionnaires were sent out. The questionnaires were anonymous and based on self-reported answers, with no clinical examination or medical data evaluation. All nurses enrolled in the study were women, working in shifts for the last three months since the start of the COVID-19 pandemic. Results: Two-hundred forty-seven questionnaires were accepted for the study, after eliminating non-responders and nurses without hand eczema. The majority of nurses denied smoking (87.85%) in the past and at the moment of the study. Statistics related to years of smoking and occurrence of hand eczema showed no increase in the number of cases in correlation with the number of years of smoking. Similarly, a random distribution of cases of hand eczema was observed when compared to the number of cigarettes per day. Conclusion: Our data does not support the hypothesis that smoking is an independent risk factor for the development of occupational hand eczema during the COVID-19 pandemic.

The dermatological spectrum of coronavirus disease-19 disease: Cutaneous signs for diagnostics and prognosis and an expanded classification

During severe acute respiratory syndrome coronavirus (CoV)-2-induced CoV disease (COVID)-19 pandemic cutaneous signs of the disease gained increasing interest for early diagnosis, to establish a prognosis and for differential diagnoses. The present review aims to summarize current knowledge on cutaneous findings in COVID19. The findings are classified and described clinically. The spectrum of cutaneous signs include acro-ischemic lesions, rash, chilblain-like eruptions, and androgenetic alopecia. Their significance is given, and treatment options are presented. This may allow the clinicians to support triage and optimal treatment for COVID-19 patients.

Skin manifestations of COVID-19 in children: Part 1.

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID-19, chilblain-like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children, for both COVID-19 and any other pre-existing conditions.

A follow-up study of the occupational hand eczema and skin damage risk in healthcare providers from Romania in time of covid-19

The aim of this work was to estimate the prevalence and risk factors of self-reported, work-related occupational hand eczema, targeting personnel working in hospitals and ambulatory units throughout Romania. A standardized questionnaire was specifically addressed to healthcare professionals from different medical fields. Out of 245 healthcar e providers who took part in the survey, 161 (65.71%) were nurses, and 235 (95.92) women, which confirms that women are prevalent in this working sector. The latex powder-gloves were the most frequently implied trigger factor, 223 (91.02%) responders reported the daily use of protective gloves and 37 (15.12%) of them have reported the protective gloves as a possible cause for skin lesions. Also, an important part of responders testified a prolonged contact with water, which confirms the importance of wet environment in inducing occupational hand eczema. In addition, X-ray photoelectron spectroscopy (XPS) analysis of powder free latex gloves was performed in order to establish a correlation between the elemental composition and risk factors for hand eczema. The results support the implication of Cd and Ca, which were detected on the inner faces of the gloves, to the toxicity to the skin.