Robert M. Adams

Prospective study of cosmetic reactions: 1977-1980

This prospective study (1977-1980) of cosmetic adverse reactions by eleven dermatologists identified 487 cases of cosmetic-induced dermatitis. Approximately half of the cases were covert in nature. Eighty percent were due to allergic contact dermatitis; the face, eye, and upper arm were the most involved sites. Skin care products, hair preparations (including colors), and facial makeup products were the most commonly involved product categories. Fragrances, preservatives, lanolin and lanolin derivatives, p -phenylenediamine, and propylene glycol were the most commonly identified causative agents. The data may not be representative of the country at large because of the special interests of the dermatologists involved.

Patch testing—a recapitulation

Although patch testing continues to be one of the most useful office tools of the inquiring dermatologist, the procedure is not used as often as patients deserve. This article reviews the use of the patch test and emphasizes its utility in the practice of dermatology. Although simple to perform, the test requires experience and keen objectivity for accurate interpretation. The rewards are great, however, as between 5% and 10% of dermatology practice consists of contact dermatitis. Failure to diagnose this percentage of patients accurately constitutes an important omission on our parts.

The case for patch test readings beyond day 2: Notes from the lost and found department

Additional patch test readings taken after 2 days (48 hours) are valuable in distinguishing false-positive reactions, which may occur up to 22% of the time. Second readings taken on days 3 through 7 may detect an additional 34% positive reactivity. Those reactions, both lost (initially positive, later negative) and found (initially negative, later positive) by delayed readings, require clinical correlation for relevance as do the readings that persist at and beyond day 2 (positive at both readings).

Contact allergic dermatitis due to diethylthiourea in a wetsuit.

Maibach H I, Meneghini C L, Wilkinson D S. Patch testing with some components of balsam of Peru. Contact Dermatitis 1976: 2: 57-58. 8. Magnusson B, Wilkinson D S. Cinnamic aldehyde in toothpaste. Contact Dermatitis 1975: 1: 70-76. 9. Schorr W. Cinnamic aldehyde allergy. Contact Dermatitis 1975: 1: 108-111. 10. Calnan CD. Cinnamon dermatitis from an ointment. Contact Dermatitis 1976: 2: 167170. 11. Rudzki E, Grzywa Z. Balsam of Peru as screening agent for essential oils sensitivity. Dermatologica 1977: 155: 115-121. 12. Wilkinson D S, Fregert S, Magnusson B, Bandmann H-J, Malten K E, Meneghini C L, PiriHi V. Terminology of contact dermatitis. Acta Dermato-venereologica 1970: 50: 287-292.

Concomitant positive patch test results with standard screening tray in North America 1985–1989

Responses to patch test substances may occur contemporaneously. Such simultaneous reactions may reflect concomitant sensitization to 2 dissimilar allergens to which concurrent exposure has taken place (e.g., ethylenediamine dihydrochloride and neomycin). It may occur when the individual has been exposed to only 1 of the substances and exhibits a response to other substances of similar chemical structure (i.e., cross‐sensitization such as between para‐phenylenediamine and benzocaine). Such simultaneous responses may also be chance occurrences, reflecting multiple sensitization or the result of altered response due to the “angry back syndrome”. This investigation established that such concurrence of response is not uncommon and adds further documentation to the literature of these associations in patch test responses.

Patch testing with mercaptobenzothiazole and mercapto-mixes

In 1976 we reported a comparative study of the results of patch testing with mercaptobenzothiazole (MBT) in 1 % pet. and mercapto-mix which consisted of MBT, N-cyc1ohexylbenzothiazylsulphenamide, dibenzothiazyldisulphide and morpholinylmercaptobenzothiazole each 0.25% in pet. obtained from Trolle-Lassen, Denmark (Table 1). 104/166 (39%) patients were positive to MBT and mix, but 51/166 (31%) patients were

Allergic contact dermatitis to “silver oak” wooden arm bracelets

Three women developed contact dermatitis from wearing wooden arm bracelets made from a tropical tree, Grevillea robusta. All three patients had positive patch tests to extracts made from wood shavings.

Contact dermatitis to benzoin in greasepaint makeup.

Case 1 A 61-year-old Caucasian male presented with an edematous, erythematous, vesicular eruption of the entire face. Two days prior, he had attended a Halloween party dressed as a caterpillar and had applied a green greasepaint (Zauders Green Makeup) to his face only. A diagnosis of acute contact dermatitis was made and he was treated with Celestone Soluspan 9 mg IM and a tapering course of Prednisone in addition to wet compresses. The eruption cleared rapidly. The ingredients of the makeup as reported by Zauder Bros. Company include: chromium oxide, fragrance, tallow, titanium dioxide, benzoin, triethylalamine, propylene glycol and stearic acid. He was patch tested to potassium dichromate 0.5 %, jasmine synthetic 10 %, balsam of Peru 25 %, hydroxycitronellal 4 %, cinnamic alcohol 5 %, stearyl alcohol3 %, tincture of benzoin 10 %, and green makeup as is. A 3 + vessicular reaction to the benzoin and green makeup patches was noted at 48 h.

Contact allergic dermatitis to dicyclohexylcarbodiimide used in protein synthesis

Dicyclohexylcarbodiimide is a commonly used coupling agent found in protein synthesis. It is a potent allergic sensitizer found especially in the emerging industries involved in recombinant DNA synthesis. Chemists who work in research and development of this industry are especially at risk of development of contact dermatitis, unless they are careful and avoid skin contact. This report describes two chemists with allergic contact dermatitis from repeated contact with this compound in their work as research and development chemists. An appropriate concentration for patch testing is suggested.

Severe bullous dermatitis from Anthemis cotula (stinking mayweed) in a crew of agricultural field workers

3075 patients (1949 female and 1126 male) were patch tested with the European Standard series inducting synthetic primin 0.01% pet. (Hermal-Trolab) during the last 5 years. The prevalence of positive test was 1.8% out of the total number tested patients, and 2.7% out of the total female patients tested. 95% of the positive reactions occurred in female patients. Median age 62 years. 84% of the positive tests became positive after 72 h, and 90% were positive after 7 days. Only 50% of the positive tests appeared after 48 h. 41% of the positive test patients had actual relevant primula dermatitis and another 41% gave past known relevance information. The main actual clinical primula dermatitis pattern was facial dermatitis alone or combined with limb dermatitis. Synthetic primin patch test sensitization was rare. We concluded that the incidence of primula dermatitis is still high, and that the synthetic primin patch test is a reliable tool for detecting primulasensitive patients.