Contact allergy investigations in healthcare workers with face mask-related skin disease.

BACKGROUND: During the COVID-19 pandemic, the use of face masks has increased among healthcare workers (HCWs). Questionnaire studies have shown a high frequency of self-reported facial adverse skin reactions. Case reports have been published on face mask-induced allergic contact dermatitis and urticaria. OBJECTIVES: To describe the results of the contact allergy investigations in consecutive HCWs investigated for skin reactions to face masks during the COVID-19 pandemic and the results of the chemical investigations of face masks supplied by the hospital. METHODS: Participants were patch tested with baseline series and chemicals previously reported in face masks not included in the baseline series. Face mask(s) brought by the HCW were tested as is and/or in acetone extract. Chemical analyses were performed on nine different face masks for potential allergens. RESULTS: Fifty-eight HCWs were investigated. No contact allergies were found to the face mask(s) tested. Eczema was the most common type of skin reaction, followed by an acneiform reaction. Colophonium-related substances were found in one respirator and 2,6-di-t-butyl-4-methylphenol (BHT) were found in two respirators. CONCLUSION: Based on this report, contact allergies to face masks is uncommon. Patch test with colophonium-related substances and BHT should be considered when investigating adverse skin reactions to face masks.

Getting to the root of it: contact anaphylaxis from polyethylene glycol in a dental lubricant

A 46-year-old man with no known allergies or history of atopy was referred for the investigation of a severe anaphylactic reaction following root canal dental treatment. The procedure had been done under local anaesthetic and involved drilling the tooth, removal of dental pulp, cleaning and insertion of a temporary filling. Preliminary skin prick tests (SPTs) and intradermal tests were negative to natural rubber latex, articaine (the local anaesthetic used for his procedure), lidocaine and chlorhexidine. He had negative specific IgE to chlorhexidine and latex, and a negative lidocaine challenge, confirming that he was not allergic to lidocaine. He returned for further dental treatment, which was done without local anaesthetic. As the procedure was completed, he developed severe anaphylaxis again. He made a full recovery and his dentist was asked for detailed information and samples of all the materials used during the procedure. Subsequent SPT showed a positive weal of 12 x 6 mm to the dental lubricant, Glyde, which was used on both occasions. Its ingredients included polyethylene glycol (PEG) 4253. SPT to other high-weight macrogol-containing products showed positive reactions to a 5% lidocaine ointment, Movicol, EMLA cream and Depomedrone. On further questioning he recalled minor immediate irritation after using a brand of children's shampoo, but a SPT to the shampoo was negative. An open test, closed test and SPT to a lower-molecular-weight patch-test allergen (PEG400 in petrolatum) were negative. PEGs or 'Macrogols' are hydrophilic polymers used in food, cosmetics and pharmaceutical reagents. They have recently attracted attention as they are excipients in several COVID-19 vaccines and have been suggested as a possible cause of anaphylaxis. Anaphylaxis to higher-molecular-weight PEGs has been reported from the use of bowel preparations and parenteral steroids. There are a handful of reports of contact urticaria to PEG-containing medicaments. We report this case to raise awareness of severe immediate hypersensitivity to these apparently innocuous ingredients and a novel source of exposure. A low index of suspicion, lack of standardized nomenclature and commercial reagents for testing are current barriers to diagnosis.

Treatments for melasma: A cross-sectional study of YouTube videos including DISCERN scores

Background: Online searches have become a popular source of medical information, especially in the COVID-19 era. Methods: On February 13, 2021, we performed a YouTube search of “melasma treatment” with the “view count” filter on a private browser. The first 102 videos yielded were screened, and the top 30 videos meeting our inclusion criteria were independently evaluated by 2 reviewers using the DISCERN instrument. Results: The mean DISCERN score for the 30 videos was 41.4 points, categorizing them as “fair” in quality. The mean score for videos uploaded by dermatologists was similar at 46.3 points (“fair”) compared with 31.3 points (“poor”) by profit companies. It is concerning that only 53% of videos supported shared decision-making with a physician/dermatologist. Almost one-third of videos focused on natural home remedies, which generated the most views. A video using raw potato with 3.8 million views claimed to permanently “cure” melasma in weeks. Such false claims pose unrealistic expectations for viewers. Furthermore, only 17% of videos discussed melasma recurrence, and 60% mentioned treatment risks. Popular home ingredients (i.e., raw potato, lemon, etc.) that videos classified as “harmless” can certainly cause contact urticaria, anaphylaxis, or exacerbate melasma. Conclusions: The top 30 most-viewed videos with 15.5 million views contained mostly fair-quality medical information with a focus on home remedies without reliable sources of evidence. Dermatologists should be aware of common misconceptions propagated by these videos and thus underscore treatment risks, recurrence, and insufficient evidence in the literature on the efficacy of home remedies for melasma.

Skin diseases of frontline health workers in China: from perspectives of occupational protection against COVID-19

Introduction: Occupational protection for skin diseases among frontline health workers (HWs) has not received adequate attention during COVID-19 pandemic. Aim: To discuss the systematic measures to skin disease of HWs during emergency response to COVID-19, to promote long-term occupational health protection for them. Materials and Methods: Based on the reports about the skin diseases of frontline HWs during COVID-19 in China, we analyzed the situation within the framework of occupational diseases prevention and control, provided suggestions by professional principles. Results: 1. Little academic literature about derm issue of HWs during COVID-19 in China, while several news were reported by media. 2. Physical and mechanical injuries in the face of HWs due to long-time pressure of face mask nd respirator. Allergic contact dermatoses/contact urticaria caused by disinfectant, latex-containing products (e.g glove). Dermatophytes caused by long-time humid working environment when wearing gown, glove, google, face shield, rubber boots. 3. Skin diseases need to be addressed during emergency response to COVID-19. 4. Skin disease relevant to HWs should be integrated into the system of occupational disease prevention and control, and to be included in the national occupational diseases list, health surveillance and monitoring among HWs ought to be conducted. Conclusions: Occupational health of HWs and patient safety are 2 sides of the same coin of medical quality and safety. Skin diseases of HWs who fight against COVID-19 need to be tackled, experiences and lessons from China could be shared with the counterparts worldwide.