Use of consumer product ingredients for patch testing.

BACKGROUND: Patch testing for suspected sensitivity to cosmetics and other personal care products is usually done by testing with nonirritating products "as is" and by panels of antigens likely to contain causative ingredients. Most allergic reactions are reportedly due to sensitivity to either fragrances or preservatives. Although most preservatives found in patients' products are available for patch testing, only a small number of fragrance ingredients are available, and fragrance components are seldom labeled. Most personal care products contain many other ingredients, and unless the patient reacts to the whole product and the ingredients are obtained from the manufacturer, most of these are seldom tested. OBJECTIVE: To investigate the importance of testing with these other ingredients. METHODS: Investigators reviewed patch-test records of patients who presented with eruptions compatible with the use of their personal care products and who were tested with available ingredients that were listed on the labels of products they were using. This allowed testing with many ingredients in products that are too irritant for "as is" testing. Some of the results included those of persons who were tested in other series, so these were separated. RESULTS: Of patch tests with 52 cosmetic ingredients also tested in other series, 3.4% produced at least one+or greater reaction. Of those antigens tested only when present in products used by the patient, 55 of the 121 ingredients produced at least one+reaction, and about 3.6% of the test results were positive. CONCLUSIONS: Adding ingredients found in the patient's personal care products to patch tests done on those compatible with exposure increases the positive yield in patch testing, and the number of positive results is likely to increase as more ingredients are available for testing.

Serum carotenoids and alpha-tocopherol and risk of nonmelanoma skin cancer.

BACKGROUND: Carotenoids and tocopherols have been hypothesized to protect against cancer. METHODS: We prospectively evaluated associations of several carotenoids and alpha-tocopherol with risk of nonmelanoma skin cancer using serum collected at baseline from 302 subjects in the Isotretinoin-Basal Cell Carcinoma Prevention Trial. All subjects had at least two BCCs in the 5 years prior to randomization. During 5 years of follow-up, 70 subjects did not develop a nonmelanoma skin cancer, 221 developed a BCC, and 85 developed a squamous cell carcinoma (SCC). Cox proportional hazards models were used to estimate risk ratios. Models were stratified by clinical center and gender and adjusted for age, solar damage, skin type, number of prior BCCs and/or SCCs, treatment group, body mass index, and serum low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol. RESULTS: Risk of developing a subsequent BCC was not related to serum levels of any of the carotenoids measured or to alpha-tocopherol. Serum levels of alpha-carotene, beta-carotene, lycopene, and alpha-tocopherol also were not independently related to risk of a subsequent SCC. However, serum lutein, zeaxanthin, and beta-cryptoxanthin were positively related to SCC risk; risk ratios for subjects in the highest versus lowest tertiles of these micronutrients were 1.63 [95% confidence interval (95% CI) 0.88-3.01; P for trend = 0.01], 2.40 (95% CI 1.30-4.42; P for trend = 0.01), and 2.15 (95% CI 1.21-3.83; P for trend = 0.09), respectively. CONCLUSION: Additional research is needed on the relationship of carotenoids to SCC risk in the general population and in subsets of the population who are at increased risk.

Eyelid dermatitis: a report of 215 patients.

Between April 2001 and October 2003, 215 persons presented with eyelid dermatitis for the first time. They ranged in age from 4 months to 95 years, with an average age of 49.6 years and a median age of 51 years. There were 173 females and 42 males. 165 of 215 had allergic contact dermatitis (ACD) and another 9 had protein contact dermatitis without relevant positive patch tests. Atopic eczema comprised 37 of 215 (17%), but 33 of 37 also had contact allergies. Seborrheic dermatitis, psoriasis or both were found in 35 (16%). Sources of ACD included personal care products in 54 (25%), including 12 with at least 1 positive patch test to cosmetic applicators and 12 sensitive to at least 1 botanical ingredient. Allergy to artificial nails and/or nail lacquer occurred in 18 of 215 (8%). 5 persons had rosacea or periorbital dermatitis, and 2 had dermatomyositis. Other causes included bacterial, fungal and viral infections, some of which were quite unusual. The evaluation of persons presenting with eyelid dermatitis remains a relatively complex but rewarding discipline.

Clinical presentations of patients sensitive to natural rubber latex.

BACKGROUND: Eczematous reactions to natural rubber latex (NRL) have been associated with both immediate and delayed hypersensitivity. OBJECTIVE: To determine clinical cases that might require testing for immediate sensitivity or patch testing for delayed hypersensitivity to latex fabric. METHODS: Patients with suspected sensitivity to NRL were given in vitro testing by radioallergosorbent test (RAST) or ImmunoCAP test and if negative, were prick-tested. If prick-test results were negative and the patients were still available, patch testing was done with latex glove fabric. Case histories of persons with positive results on RASTs, ImmunoCAP tests, prick tests, and patch tests were reviewed for clinical presentation and relevance. RESULTS: Of 92 persons with positive responses, 26 had positive RAST results, 26 had positive ImmunoCAP test results, 33 had positive prick-test results, and 7 had a positive patch-test result. Presentations included hand urticaria or eczema (46 patients), eyelid dermatitis (14), shoe dermatitis (10), atopic eczema (6), waistband dermatitis (5), clothing dermatitis (3), contact eczema to elastic in a mask (2), urticaria to a phlebotomy tourniquet, and eczema over the elbows and from an elastic bandage used for occlusive dressing therapy. Several other presentations were less likely to be relevant. CONCLUSION: Persons with putative contact dermatitis in areas that may come into contact with NRL deserve not only to be patch-tested with rubber chemicals but also to be tested for immediate sensitivity and, if results are negative, to be patch-tested with NRL.

Eyelid dermatitis: experience in 203 cases.

Allergic contact dermatitis has been considered the most common of the many dermatologic conditions found with eyelid dermatitis. This is a retrospective study of 203 patients who presented with persistent or recurrent eyelid dermatitis with or without dermatitis elsewhere. Almost all underwent patch testing and, when indicated, radioallergosorbent test, skin prick and intradermal tests, and in many cases, usage tests as part of the workup. Relevant allergic contact dermatitis was found in 151 of 203 patients (74.%): 46 (23.%) had protein contact dermatitis, but only 7% had protein contact dermatitis without concurrent allergic contact dermatitis. Less than 1% had irritant dermatitis alone. Twenty-three patients had atopic eczema, of whom 16 also had allergic contact dermatitis, protein contact dermatitis, or both. Other conditions included seborrheic dermatitis (n = 11), psoriasis (n = 7), dry eyes (n = 9), and dermatomyositis or overlapping connective tissue disease (n = 7). Important sources of contact sensitivity include cosmetics, metals, topical medications including corticosteroids, eye medications, dust mites, animal dander, and artificial nails; only 5 cases were caused by nail lacquer. Eyelid dermatitis is a multifaceted clinical problem, but in this group of patients, allergic contact dermatitis was a common cause, even among those with atopic eczema.