Characterization of Tattoo Aftercare Products: Allergenic Ingredients and Marketing Claims.

BACKGROUND: Common recommendations for tattoo aftercare to ensure proper healing include application of topical products. Little is known about tattoo aftercare products. METHODS: Tattoo aftercare products were identified from a previous study and a search on Amazon.com using the phrase "tattoo aftercare." Duplicates and products without complete ingredient lists were excluded. Marketing claims were tabulated. All ingredients were entered in Excel and grouped according to Contact Allergen Management Program categories. Comparison of ingredients to North American Contact Dermatitis Group (NACDG) screening and American Contact Dermatitis Society (ACDS) Core allergens was conducted. RESULTS: A total of 84 tattoo aftercare products from 52 distinct brands were found. Forty-eight distinctive market claims were identified; the use of "natural ingredient(s)" (42.9%) was most common. There were 4 to 28 ingredients per product (mean = 11.8 ± 5.5) with a total of 369 distinct ingredients listed. Products contained an average of 7.9 ± 3.9 ACDS Core allergens per product and 7.0 ± 3.7 NACDG allergens per product. Most common allergens included fragrance/botanicals (n = 529), vitamin E derivatives (n = 43), and vitamin B5 derivatives (n = 11). CONCLUSIONS: This review of 84 products found that tattoo aftercare products contain an average of 8 ACDS Core and 7 NACDG allergens. Clinicians should be aware of potential allergens in tattoo aftercare products.

Establishing osteopathic assessments to fulfill osteopathic recognition standards: a model for dermatology and other subspecialties.

The 5 year transition period for American Osteopathic Association (AOA) training programs to apply for and receive Accreditation Council for Graduate Medical Education (ACGME) accreditation (i.e., the single graduate medical education system) was completed June 30, 2020. Of the previously AOA accredited programs that applied for or received osteopathic recognition (OR), only 24.5% are nonprimary care specialty programs according to the ACGME. The reluctance of specialty programs to apply for OR may be because osteopathic principles and practices (OPP) are not assessed. In order for programs to receive OR, they must have a standard method of assessment to assess osteopathic knowledge, including OPP and osteopathic manipulative treatment. In this Commentary, based on our assessment of the results of a literature review, we propose a model to provide a focused osteopathic assessment for the purposes of maintaining OR within residency training based on the ACGME six core competencies. Examples of multiple choice and essay questions are provided, as is a rubric for grading. The model is applied to the field of dermatology in this article and could serve as a blueprint to other subspecialties. With this framework, collaboration among programs will streamline the process to obtain OR in the ACGME single accreditation system.

Allergic Contact Dermatitis to Pramoxine (Pramocaine).

Prescription and over-the-counter topical anesthetics are commonly used. Although allergy to amide and ester anesthetics is known, little has been reported on the nonamide, nonester pramoxine (pramocaine). This article briefly reviews allergy to topical anesthetics, provides detailed information on pramoxine, and describes characteristics of multiple patients with positive, relevant reactions to pramoxine.

Formaldehyde Release From Predispersed Tattoo Inks: Analysis Using the Chromotropic Acid Method.

BACKGROUND: Allergic contact dermatitis to tattoo ink may last from weeks to years. Formaldehyde is a strong sensitizer that may be present in predispersed tattoo inks. OBJECTIVES: The aim of this study was to evaluate the presence of formaldehyde in predispersed tattoo inks using the chromotropic acid method. METHODS: Tattoo inks from 39 companies were evaluated. Inclusion criteria included availability to purchase inks online through US tattoo product wholesalers or individual Web sites. Brands were grouped based on prevalence of use: common, uncommon, or rare. For common brands, 8 colors (primary colors, secondary colors, black, and white) were purchased. For uncommon and rare brands, 5 colors (primary colors, black, and white) were purchased. Each ink was tested with standard chromotropic acid method procedures; concentration of formaldehyde released was quantified using spectrophotometry. RESULTS: In total, 127 tattoo inks were purchased and tested. Ninety-three (73%) tested positive for formaldehyde release; 34 (27%) tested negative. Formaldehyde release did not correlate with color or brand. At least 1 ink from all brands (except 1) was positive for formaldehyde release. CONCLUSION: Approximately three-quarters of selected US tattoo inks tested positive for formaldehyde release. Clinicians should be aware of tattoo ink as a potential source of formaldehyde.

Cutaneous Reactions to Aluminum.

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

Formaldehyde Release From Baby Wipes: Analysis Using the Chromotropic Acid Method.

BACKGROUND: Formaldehyde is a common preservative and strong sensitizer. OBJECTIVE: The aim of the study was to evaluate the release of formaldehyde from baby/toddler wet wipes using the chromotropic acid method (CAM). METHODS: An online search of best-selling baby wipes was conducted. None declared formaldehyde or formaldehyde-releasing preservatives. Standard CAM procedures were used: a 1 × 1-in square of fresh wipe was placed in a bottle with an open vial of 4 mg/1 mL of chromotropic acid and sulfuric acid solution, sealed, and stored for 48 hours. Formalin and water served as controls. A blinded investigator graded color change (negative, indeterminate, mild, moderate, or strong). For quality control, 20% of all samples as well as all positives were retested. RESULTS: Fifty-one popular and highly reviewed baby and toddler wet wipe products were tested using CAM. Twelve wipes (24%) released formaldehyde (8 mild, 4 moderate/strong). Chromotropic acid method testing of 9 wipes (18%) was indeterminate and 30 (59%) were negative. CONCLUSIONS: Almost one quarter of baby/toddler wet wipes released formaldehyde when evaluated with CAM. Patients and clinicians should be aware of this potentially undeclared source of this common allergen.

Formaldehyde Release From Clothing and Upholstery Fabrics Using the Chromotropic Acid Method.

BACKGROUND: Formaldehyde resins may be used in textiles. OBJECTIVE: The aim of the study was to investigate the presence of formaldehyde in textiles using the chromotropic acid method. METHOD: Clothing scraps (from local department store tailors, n = 77) and upholstery fabric cuttings (from a furniture reupholstery store, n = 22) were collected. Each fabric was cut into a 1-cm square and tested using the chromotropic acid method. Samples were retested in a systematic fashion (every 10th sample) to assess reproducibility. RESULTS: All 99 clothing and upholstery fabrics tested negative for formaldehyde release. CONCLUSIONS: Our study suggests that textile manufactures may be using nonformaldehyde resins for durable press finishing in clothing likely to be tailored as well as fabrics used for furniture reupholstery. Additional studies involving other metropolitan areas and a variety of fabrics are needed to confirm these findings.