Torkil Menné

Textbook of contact dermatitis

The Textbook of Contact Dermatitis covers every conceivable aspect of modern day management of contact dermatitis. Both irritatnt and allergic types of contact dermatitis are dealt with clearly and comprehensively, special emphasis being given to occupational aspects as well as to prevention, diagnosis and treatment. Also covered are epidemiological aspects, computerization of patch test data and patient imformation systems, noninvasive bioengineering measurement techniques, methods of skin testing other than patch testing, histopathology of both irritant and allergic contact dermatitis, and subjective reactions. The editors and contributing authors are all leading practitioners in the field. Their expertise has been brought to bear to

The epidemiology of hand eczema in the general population: prevalence and main findings

Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. These studies are of high value as they tend to be less biased than studies using clinical populations and as they are important for healthcare decision makers when they allocate resources. This study aimed to review the epidemiology of hand eczema in the general population.

Metal Allergy—A Review on Exposures, Penetration, Genetics, Prevalence, and Clinical Implications

The prevalence of metal allergy is high in the general population, and it is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1-3% are allergic to cobalt and chromium. Among dermatitis patients, the prevalence of metal allergy is even higher. Metal allergy is mainly an environmental disorder although null mutations in the filaggrin gene complex were recently found to be associated with nickel allergy and dermatitis. Environmental metal exposures include jewelry, buttons, clothing fasteners, dental restorations, mobile phones, and leather. Although consumer exposure is responsible for most cases of metal allergy, the importance of occupational metal exposure remains present and should always be taken into consideration when one interprets allergic patch test reactions to metals. Traditionally, nickel, cobalt, and chromium have been the most important contact allergens. However, recently, gold and palladium have drawn much attention as the prevalence of contact allergy to these metals is high. Palladium allergy is mainly a result of cross-sensitization to nickel, whereas gold allergy is rarely clinically relevant when one takes its high prevalence into account. The epidemiology of metal allergy has recently changed in Europe as nickel allergy among ear-pierced Danish women has decreased following regulatory intervention on nickel release from consumer products. In the United States, the prevalence of nickel allergy is still increasing, which may be explained by the absence of regulation. The prevalence of chromium allergy is increasing in the United States, Singapore, and Denmark among dermatitis patients. This increase is significantly associated with leather exposure in Denmark. Metal allergy may result in allergic contact dermatitis and systemic allergic (contact) dermatitis. Furthermore, metal allergy has been associated with device failure following insertion of intracoronary stents, hip and knee prostheses, as well as other implants. This area is in need of more research.

The baboon syndrome: systemically-induced allergic contact dermatitis*

The catchword “baboon syndrome” is used to denote a characteristic distribution pattern of systemic allergic contact dermatitis. Diffuse erythema of the buttocks, upper inner surface of the thighs, and axillae are characteristic features. We describe 3 cases provoked by ampicillin, nickel and mercury. The condition may be overlooked and suspected of being a textile dermatitis or seborrhoeie dermatitis of the elderly.

Monitoring levels of preservative sensitivity in Europe - A 10-year overview (1991-2000)

A 10‐year multicentre analysis of the frequency of sensitivity to common preservatives collected in 16 centres in 11 countries has shown stable but persisting high levels of sensitivity to formaldehyde and 5‐chloro‐2‐methyl‐4‐isothiazolin‐3‐one + 2‐methyl‐4‐isothiazolin‐3‐one (MCI/MI). It has also revealed a significant increase in the level of reactivity to methyldibromoglutaronitrile (MDBGN) from 0.7% in 1991 to 3.5% in 2000. The current high level of sensitivity to MDBGN requires an urgent safety re‐evaluation and risk assessment update along with consideration of immediate lowering of use concentrations, especially in leave‐on products.

Changes in the pattern of sensitization to common contact allergens in Denmark between 1985–86 and 1997–98, with a special view to the effect of preventive strategies

The objective of the present study is to describe any changes in the prevalence of sensitization to common contact allergens in patch‐tested patients over a 12‐year period. Attention is given to possible effects of preventive strategies introduced in Denmark regarding nickel and chromate sensitization during that period, and particular areas of concern are identified. Members of the Danish Contact Dermatitis Group collected patch‐test results from consecutive eczema patients as well as information about exposures and demographic variables over a 6‐month period in 1985–86. The investigation was repeated in 1997–98 in the same clinics, at the same time of year, using identical methods and patch‐test substances, including nickel sulphate 5%, potassium dichromate 0·5% and fragrance mix 8%. Nickel was the most common contact allergen in both study periods, followed by the fragrance mix. In children 0–18 years of age, the frequency of nickel allergy decreased from 24·8% in the first study period to 9·2% in the second study period (P < 0·0008). Fragrance mix allergy doubled in frequency from 4·1% in 1985–86 to 9·9% in 1997–98, an increase that affected all age groups. Contact allergy to potassium dichromate decreased significantly from 3·0% in the first period to 1·2% in the second period (P = 0·001). The decrease was seen in both sexes and was most pronounced among those of working age. No other significant changes were found in the frequency of sensitization to common allergens over the 12‐year observation period.

Patch testing with fragrances: results of a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes

The objective of this study was to determine the frequency of reactivity to a series of commonly fragrances in dermatological patients. A total of 48 fragrances (FF) were chosen, based on the publication of Fenn in 1989 in which the lop 25 constituents of 3 types (1. perfumes, 2. household products, 3. soaps) of 400 commercial products on the US market had been determined. In a pilot study on a total of 1069 patients in 11 centres, the appropriate test concentration and vehicle were examined. For most fragrances, 1% and 5% were chosen, and petrolatum proved to be the best vehicle in comparison to isopropyl myristate and diethyl phthalate. In the main study, a set of 5 to 10 fragrances at 2 concentrations was patch tested in each centre on a minimum of 100 consecutive patients seen in the patch test clinic. These patients were also patch tested to a standard series with the 8% fragrance mix (FM) and its 8 constituents. In patients with a positive reaction to any of the 48 FF, a careful history with regard to past or present reactions to perfumed products was taken. A total of 1323 patients were tested in 11 centres. The 8% FM was positive in 89 patients (8.3% of 1072 patients). Allergic reactions to the constituents were most frequent to oak moss (24), isoeugenol (20), eugenol (13), cinnamic aldehyde (10) and geraniol (8). Reactions read as allergic on day 3/4 were observed only 10 × to 7 materials of the new series (Iso L: Super® (2), Lyral® (3), Cyclacet® (1), DMBCA (1), Vertofix® (1), citronellol (1) and amyl salicylate (1)). The remaining 41 fragrances were negative. 28 irritant or doubtful reactions on day 3/4 were observed to a total of 19 FF materials (more than 1 reaction: 5% citronellol (2), 1%amyl salicylate (2), 1%isononyl acetate (3), 0.1% musk xylol (2). 1%citral (2), and 1% ionone beta (2)). Clinical relevance of positive reactions to any of the FF series was not proved in a single case. This included the 4 reactions in patients who were negative to the 8% FM. In conclusion, the top 25 fragrances commonly found in various products caused few reactions in dermatological patients and these few appeared to be clinically irrelevant, with the possible exeption of Lyral®. However, this data should be interpreted in the light of the relatively small number of patients tested (only 100 in most centres).

Allergic contact sensitization in an adult Danish population: two cross-sectional surveys eight years apart (the Copenhagen Allergy Study).

In 1990 and 1998 15-41-year-old people were patch-tested in 2 cross-sectional studies of random samples of the population in the western part of Copenhagen County, Denmark. In 1990, 290 subjects and in 1998, 469 subjects were patch-tested. The participation rates were 69% and 51%, respectively. Contact sensitivity to one or more haptens was found in 15.9% and 18.6% in 1990 and 1998, respectively. Nickel sensitivity is still the most common contact sensitivity. The risk of contact sensitivity to the cosmetic-related haptens included in the series (formaldehyde was not included) increased significantly from 2.4% in 1990 to 5.8% in 1998 (odds ratio 2.44, 95% confidence interval 1.04-5.73). The prevalence of contact sensitivity to cosmetic-related allergens has been doubled between 1990 and 1998.

Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel‐exposure regulation

Summary Background To reduce the skin nickel exposure of the population the Danish Ministry of Environment issued a regulation that was implemented in 1992, and the European Union countries have recently adopted an expanded regulation.

Reduced frequency of nickel allergy upon oral nickel contact at an early age.

From animal studies we know that oral administration of T‐dcpcndcnt antigens before sensitization effectively induces systemic immune unresponsiveness. Such ‘oral tolerance’ is persistent, dose‐dependent, antigen‐specific and presumably T suppressor cell‐mediated. Oral tolerance induction could be an effective way to prevent undesired T cell‐mediated immune functions, such as playing a role in allograft reaction, autoimmune and allergic diseases. In the present study allergic contact hypersensitivity (ACH) to nickel, currently presenting the most frequent contact allergy in man, was chosen to establish the feasibility of oral prevention of undesired T cell‐mediated immunity in man. Potentially tolerizing (oral nickel contacts via orthodontic braces) as well as sensitizing (ear piercing) events were studied retrospectively in 2176 patients attending nine European patch test clinics. Patients were interviewed by means of a confidential questionnaire. The results show that ear piercing strongly favoured development of nickel ACH. More importantly, patients having had oral contacts with nickel‐releasing appliances (dental braces) at an early age, but only if prior to ear piercing, showed a reduced frequency of nickel hypersensitivity. Frequencies of other hypersensitivities, in particular to fragrance, were not affected. These results support our view that induction of specific systemic immunologic tolerance by timely oral administration of antigens is feasible in man.