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Axel Schnuch - One of the best experts on this subject based on the ideXlab platform.
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Current trends in patch testing - new data from the German Contact Dermatitis Research Group (DKG) and the Information Network of Departments of Dermatology (IVDK).
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2014Co-Authors: Vera Mahler, Johannes Geier, Axel SchnuchAbstract:Zusammenfassung Hintergrund und Ziele Die Bedeutung einzelner Kontaktallergene ist einem bestandigen Wandel unterworfen, der wesentlich durch veranderte Expositionen aufgrund von Verbrauchervorlieben und der Gesetzesvorgaben beeinflusst wird. Ziele der Arbeit sind, Trends aus dem Epikutantest-Kollektiv der DKG- und IVDK-Kliniken darzustellen, die zur aktuellen Anderung (gultig ab 1.1.2014) der DKG-Standardreihe gefuhrt haben und die aktuell geltenden gesetzlichen Rahmenbedingungen darzulegen, die Einfluss auf diese Trends und die Durchfuhrung der Epikutantestung zur Aufklarung von Kontaktallergien haben. Patienten und Methodik Das Epikutantestkollektiv aus 56 DKG-/IVDK-Kliniken der Jahre 2010 (n = 13 117), 2011 (n = 13 320), 2012 (n = 12 529) wurde bezuglich der Sensibilisierungshaufigkeiten (Hitliste) auf Kontaktallergene und Lokalisationen allergischer Kontaktekzeme ausgewertet. Ergebnisse Mit uber 15 % Sensibilisierungshaufigkeit stellt Nickel noch immer das am haufigsten erkannte Kontaktallergen dar. Eine Zunahme der Sensibilisierungshaufigkeit auf Duftstoff-Mix I auf 9,1 % und auf das Konservierungsmittelgemisch aus Chlormethylisothiazolinon/Methylisothiazolinon (MCI/MI) auf 4,5 %, sowie auf Methylisothiazolinon (MI) alleine auf 6,8 % ist zu verzeichnen. Ein Abwartstrend zeigt sich fur Kaliumdichromat von uber 6 % (2007) auf 3 % (2012) und fur Bufexamac (derzeit bei 0,6 %). Die Hintergrunde, gesetzliche Rahmenbedingungen und resultierende Aktualisierung der DKG-Standardreihe werden dargestellt. Schlussfolgerungen Die aufgezeigten Trends demonstrieren die Bedeutung der klinischen Epidemiologie und „Wachterfunktion“ von DKG und IVDK im Hinblick auf offentliche Gesundheitsfursorge und die Pravention von Kontaktallergien.
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current trends in patch testing new data from the german contact dermatitis research group dkg and the information network of departments of dermatology ivdk
Journal Der Deutschen Dermatologischen Gesellschaft, 2014Co-Authors: Vera Mahler, Johannes Geier, Axel SchnuchAbstract:Summary Background and objectives The relevance of contact allergens is subject to constant change due to changing exposures according to consumers’ preferences and legal requirements. The objective of this paper is to present trends in contact sensitization from the DKG and IVDK patch test clinics, which have led to changes in the DKG standard series (as of 1.1.2014), as well as the current legal framework which has influenced these trends and the way patch testing is performed. Patients and methods The patients from 56 DKG and IVDK patch test clinics from 2010 (n = 13,117), 2011 (n = 13,320) and 2012 (n = 12,529) were analyzed with regard to frequencies of sensitization (hit list) to contact allergens as well as the location of allergic contact dermatitis. Results With a sensitization rate of 15 % nickel is still the most frequently recognized contact allergen. An increase can be observed for fragrance mix I (9.1 %), the preservative composition of methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) (4.5 %) and methylisothiazolinone (MI) alone (6.8 %). A decline is present for potassium dichromate from above 6 % (2007) to 3 % (2012) and for Bufexamac (currently at 0.6 %). Backgrounds, legal requirements and resulting changes to the DKG standard series are illustrated. Conclusions The indicated trends demonstrate the relevance of clinical epidemiology and the “sentinel function” of DKG and IVDK with regard to public health and prevention of contact allergies.
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Die häufigsten Kontaktallergene der Jahre 2007–2009
Allergo Journal, 2011Co-Authors: Johannes Geier, Wolfgang Uter, Andrea Krautheim, Holger Lessmann, Axel SchnuchAbstract:Hintergrund Die Ergebnisse epidemiologischer Untersuchungen zur Kontaktallergie mit Darstellung der häufigsten Kontaktallergene bei unselektierten Patienten sind für den Verbraucherschutz und die Routinediagnostik in der dermatologischen Praxis von Bedeutung. Methoden Analyse von Daten des Informations-verbundes Dermatologischer Kliniken (IVDK) der Jahre 2007–2009. Ergebnisse In den am IVDK beteiligten dermatologischen Abteilungen wurden im Untersuchungszeitraum 34.091 Patienten epikutan getestet. Im Jahr 2009 ergaben sich im Vergleich zu den beiden Vorjahren signifikant niedrigere Reaktionsquoten auf Nickelsulfat, Kobaltchlorid und Kaliumdichromat. Das Konservierungsmittel Methyldibromoglutaronitril (MDBGN, Dibromdicyanobutan) führte bereits seit 2008 zu signifikant weniger positiven Reaktionen. Auf den Duftstoff Hydroxyisohexyl-3-cyclohexencarboxaldehyd (HICC, Lyral®) wurden 2009 deutlich, jedoch nicht signifikant, weniger positive Reaktionen beobachtet als 2007 und 2008. Die Quote an Sensibilisierungen gegen Bufexamac ist seit Jahren mehr oder weniger konstant. Schlussfolgerungen Trotz der EU-Nickeldirektive stagnierte in den letzten Jahren die Quote der Sensibilisierungen gegen Nickel bei jungen Frauen auf hohem Niveau. MDBGN wurde 2008 EU-weit in Kosmetika und Körperpflegeprodukten verboten, was sich in sinkenden Sensibilisierungsquoten niederschlägt. Der Einsatz des Duftstoffs HICC in Kosmetika wurde reduziert; hier zeichnet sich bisher jedoch noch kein signifikanter Effekt auf die Sensibilisierungsquote ab. Wegen der Vielzahl von Sensibilisierungen gegen Bufexamac hat die EU-Kommision diesem Wirkstoff im Juli 2010 die Zulassung entzogen. Background Epidemiological surveillance of contact sensitization with presentation of the most frequent contact allergens is important for consumer protection and the quality of routine diagnostics in dermatology. Methods Analysis of data of the Information Network of Departments of Dermatology (IVDK) of the years 2007 to 2009. Results During the study period, 34,091 patients have been patch tested in the departments of dermatology forming the IVDK. Compared to the years before, reactions to nickel sulphate, cobalt chloride and potassium dichromate were significantly less frequent in 2009 than before. The preservative methyldibromo glutaronitrile (MDBGN) elicited significantly less positive reactions already from 2008 on. The proportion of positive reactions to the fragrance hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC, Lyral®) was considerably, albeit not significantly, lower in 2009, when compared to 2007 and 2008. Sensitization frequency to Bufexamac has been at a constant level for years. Conclusions In spite of the EU nickel directive, contact sensitization to nickel in young women hitherto remains on a high level. MDBGN has been banned from cosmetics and body care products by the EU commission in 2008. This measure resulted in decreasing sensitization rates. The use of HICC in cosmetics has been reduced; however, a substantial and significant reduction of the sensitization frequency could not yet be observed. Due to frequent sensitization, approval of Bufexamac has been withdrawn by the EU Commission in July 2010.
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Allergisches Gesichtsekzem
Der Hautarzt, 2008Co-Authors: Axel Schnuch, C. Szliska, W UterAbstract:The face is exposed to many foreign substances and may thus be a site of allergic contact dermatitis. Our aim is to elucidate the spectrum of factors associated with facial dermatitis by analyzing data of patients patch tested in the Information Network of Departments of Dermatology (IVDK) between 1995 and 2007. In 18,572 patients the main anatomical site of dermatitis was the face. Among these, the proportion of females and of patients with past or present atopic eczema was increased, while probable occupational causation was less common than in the overall group. Cosmetic allergens, as well as nickel, were significantly more common in women than men, including fragrance mix (10.8% vs. 8.3%), p-phenylenediamine (4.0% vs. 2.8%), lanolin alcohols (3.0% vs. 2.2%), Lyral^TM (3.1% vs. 2.0%) and Bufexamac (1.8% vs. 1.1%). In comparison, only epoxy resin contact allergy was diagnosed significantly more often in men than women: In patients with airborne contact dermatitis, over-represented allergens included sesquiterpene lactone mix, compositae mix, epoxy resin, (chloro-) methylisothiazolinone and oil of turpentine. In the clinical approach to patients with facial dermatitis, occupational airborne causation should be considered in addition to non-occupational (e.g., cosmetic) allergen exposure. Das Gesicht ist zahlreichen Stoffen ausgesetzt, und kann somit auch Schauplatz kontaktallergischer Reaktionen sein. Ziel dieser Arbeit ist die Ermittlung der mit einem Gesichtsekzem assoziierten Faktoren. Dazu wurden die Daten des IVDK der Jahre 1995–2007 ausgewertet. Bei n=18.572 traf die Ekzemlokalisation „Gesicht“ zu. Der Anteil der Frauen und der Patienten mit atopischer Dermatitis war erhöht, derjenige mit Verdacht auf Berufsdermatose erniedrigt. Bei den Frauen sind (neben Nickel) v. a. Allergene signifikant häufiger als bei den Männern vertreten, die in Kosmetika eingesetzt werden: Duftstoff-Mix (10,8/8,3), para-Phenylendiamin (4,0/2,8), Wollwachsalkohole (3,0/2,2), Lyral (3,1/2,0) und Bufexamac (1,8/1,1). Demgegenüber ist bei den Männern lediglich Epoxidharz signifikant häufiger vertreten als bei den Frauen. Beim aerogenen Kontaktekzem wurden folgende Sensibilisierungen signifikant häufiger diagnostiziert: Sesquiterpenlacton-Mix, Kompositen-Mix, Epoxidharz, Methyl(chlor)isothiazolinon und Terpentinöl. Bei Gesichtsekzem sollte neben der privaten Allergenexposition (Kosmetika) eine berufliche Exposition bedacht werden.
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Facial allergic contact dermatitis. Data from the IVDK and review of literature
Der Hautarzt; Zeitschrift fur Dermatologie Venerologie und verwandte Gebiete, 2008Co-Authors: Axel Schnuch, C. Szliska, Wolfgang UterAbstract:The face is exposed to many foreign substances and may thus be a site of allergic contact dermatitis. Our aim is to elucidate the spectrum of factors associated with facial dermatitis by analyzing data of patients patch tested in the Information Network of Departments of Dermatology (IVDK) between 1995 and 2007. In 18,572 patients the main anatomical site of dermatitis was the face. Among these, the proportion of females and of patients with past or present atopic eczema was increased, while probable occupational causation was less common than in the overall group. Cosmetic allergens, as well as nickel, were significantly more common in women than men, including fragrance mix (10.8% vs. 8.3%), p-phenylenediamine (4.0% vs. 2.8%), lanolin alcohols (3.0% vs. 2.2%), Lyral TM (3.1% vs. 2.0%) and Bufexamac (1.8% vs. 1.1%). In comparison, only epoxy resin contact allergy was diagnosed significantly more often in men than women: In patients with airborne contact dermatitis, over-represented allergens included sesquiterpene lactone mix, compositae mix, epoxy resin, (chloro-) methylisothiazolinone and oil of turpentine. In the clinical approach to patients with facial dermatitis, occupational airborne causation should be considered in addition to non-occupational (e.g., cosmetic) allergen exposure.
Bernhard Przybilla - One of the best experts on this subject based on the ideXlab platform.
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Delayed contact hypersensitivity to non-steroidal anti-inflammatory drugs.
Contact dermatitis, 1999Co-Authors: Beata Gniazdowska, Franziska Ruëff, Bernhard PrzybillaAbstract:Several non-steroidal anti-inflammatory drugs (NSAIDs) are available for topical treatment of acute soft tissue trauma or degenerative musculoskeletal disorders; the NSAID Bufexamac is mainly used for therapy of chronic inflammatory skin diseases. In order to assess the occurrence of contact allergy to NSAIDs in 371 consecutive patients presenting for diagnosis of presumed contact allergy, patch tests were performed with a standard series and additionally with a series of NSAIDs, comprising acetylsalicylic acid, Bufexamac, diclofenac, etofenamate, felbinac, flufenamic acid, ibuprofen, indomethacin, and piroxicam. 17 individuals (4.6%) exhibited delayed hypersensitivity to one of the NSAID preparations: 12 patients (3.2%) had patch test reactions to Bufexamac, 2 (0.5%) to etofenamate, 2 (0.5%) to indomethacin, and 1 patient (0.3%) to flufenamic acid. These patch test results corresponded well to the individual history in 11 individuals (including 10 patients with reactions to Bufexamac), and in 2 patients the clinical relevance of the reactions was probable. In view of the high frequency of allergic contact reactions to Bufexamac, we propose to test this drug particularly in patients with atopic eczema or other chronic eczematous diseases.
Reinhard H.h. Neubert - One of the best experts on this subject based on the ideXlab platform.
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Screening for new antioxidative compounds for topical administration using skin lipid model systems.
Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences Societe canadienne des sciences phar, 2005Co-Authors: Hagen Trommer, Reinhard H.h. NeubertAbstract:The effects of forty seven different substances (drugs, plant extracts, plant ingredients and polysaccharides) on UV irradiation induced lipid peroxidation were investigated. Two lipid systems of different complexity were used as in vitro screening models. Iron ions were added as transition metal catalysts. A UV irradiation device was used to create high level radiation. The amount of lipid peroxidation secondary products was quantified by the thiobarbituric acid assay detecting malondialdehyde. The screening for antioxidative compounds for topical administration resulted in new, interesting findings. In the drug testings amantadine, Bufexamac, tryptophan, melatonin, propranolol and hyaluronic acid were found to act antioxidatively whereas for ascorbic acid pro-oxidative effects were determined. Buckwheat extract significantly reduced the level of irradiation induced lipid peroxidation as well as the extracts of St. John's Wort, melissa and sage. The resistant starch novelose 330 and the samples of locust bean gum from a swing mill grinding series showed lipid protection after UV irradiation in the polysaccharide test rows. Human skin is constantly exposed to UV light and oxygen. Therefore, the administration of protectors in cosmetic formulations or sunscreens, as found in this study, may be helpful for the protection of the human skin against UV induced damage. In vivo experiments with substances found as protectors should follow to allow in vitro-in vivo correlation and clinical interpretation of the data.
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SCREENING FOR NEW ANTIOXIDATIVE COMPOUNDS FOR TOPICAL ADMINISTRATION USING SKIN LIPID MODEL SYSTEMS
2005Co-Authors: Hagen Trommer, Reinhard H.h. NeubertAbstract:Purpose: The effects of forty seven different substances (drugs, plant extracts, plant ingredients and polysaccharides) on UV irradiation induced lipid peroxidation were investigated. Methods: Two lipid systems of different complexity were used as in vitro screening models. Iron ions were added as transition metal catalysts. A UV irradiation device was used to create high level radiation. The amount of lipid peroxidation secondary products was quantified by the thiobarbituric acid assay detecting malondialdehyde. Results: The screening for antioxidative compounds for topical administration resulted in new, interesting findings. In the drug testings amantadine, Bufexamac, tryptophan, melatonin, propranolol and hyaluronic acid were found to act antioxidatively whereas for ascorbic acid pro-oxidative effects were determined. Buckwheat extract significantly reduced the level of irradiation induced lipid peroxidation as well as the extracts of St. John`s Wort, melissa and sage. The resistant starch novelose 330 and the samples of locust bean gum from a swing mill grinding series showed lipid protection after UV irradiation in the polysaccharide test rows. Conclusions: Human skin is constantly exposed to UV light and oxygen. Therefore, the administration of protectors in cosmetic formulations or sunscreens, as found in this study, may be helpful for the protection of the human skin against UV induced damage. In vivo experiments with substances found as protectors should follow to allow in vitro-in vivo correlation and clinical interpretation of the data
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Examinations of the antioxidative properties of the topically administered drug Bufexamac reveal new insights into its mechanism of action.
The Journal of pharmacy and pharmacology, 2003Co-Authors: Hagen Trommer, Manuela Plätzer, Klaus Raith, Wolfgang Wohlrab, Hans-peter Podhaisky, Reinhard H.h. NeubertAbstract:The effect of Bufexamac on UV-irradiation-induced lipid peroxidation was investigated. Linolenic acid was used as a model lipid. Bufexamac was shown to be capable of reducing the amount of lipid peroxidation. The quantification was carried out by the thiobarbituric acid assay. Irradiation experiments were also performed using HaCaT keratinocytes as a model system. The oxidative changes were quantified by DNA synthesis measurements and cell viability determinations. Bufexamac was found to act antioxidatively again. To investigate free radical involvement, electron paramagnetic resonance studies were carried out. The influence of Bufexamac on the concentration of hydroxyl radicals generated by the Fenton system was examined using the spin trapping technique. Moreover, the hydroxamic acid's ability to react with stable radicals was checked. The quantification assay of 2,2-diphenyl-1-picrylhydrazyl hydrate showed no concentration changes of the stable radical caused by Bufexamac. In the Fenton assay antioxidative effects were measured after the addition of the drug. The qualitative changes after irradiating Bufexamac were studied at a molecular level by electrospray mass spectrometry. Multiple-stage mass spectrometry experiments enabled the establishment of fragmentation schemes. Phenolic degradation products were detected. The results suggest a new interpretation of the controversially debated mechanism of action of Bufexamac and indicate possible reasons for its eczema provoking potential.
Wolfgang Uter - One of the best experts on this subject based on the ideXlab platform.
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Die häufigsten Kontaktallergene der Jahre 2007–2009
Allergo Journal, 2011Co-Authors: Johannes Geier, Wolfgang Uter, Andrea Krautheim, Holger Lessmann, Axel SchnuchAbstract:Hintergrund Die Ergebnisse epidemiologischer Untersuchungen zur Kontaktallergie mit Darstellung der häufigsten Kontaktallergene bei unselektierten Patienten sind für den Verbraucherschutz und die Routinediagnostik in der dermatologischen Praxis von Bedeutung. Methoden Analyse von Daten des Informations-verbundes Dermatologischer Kliniken (IVDK) der Jahre 2007–2009. Ergebnisse In den am IVDK beteiligten dermatologischen Abteilungen wurden im Untersuchungszeitraum 34.091 Patienten epikutan getestet. Im Jahr 2009 ergaben sich im Vergleich zu den beiden Vorjahren signifikant niedrigere Reaktionsquoten auf Nickelsulfat, Kobaltchlorid und Kaliumdichromat. Das Konservierungsmittel Methyldibromoglutaronitril (MDBGN, Dibromdicyanobutan) führte bereits seit 2008 zu signifikant weniger positiven Reaktionen. Auf den Duftstoff Hydroxyisohexyl-3-cyclohexencarboxaldehyd (HICC, Lyral®) wurden 2009 deutlich, jedoch nicht signifikant, weniger positive Reaktionen beobachtet als 2007 und 2008. Die Quote an Sensibilisierungen gegen Bufexamac ist seit Jahren mehr oder weniger konstant. Schlussfolgerungen Trotz der EU-Nickeldirektive stagnierte in den letzten Jahren die Quote der Sensibilisierungen gegen Nickel bei jungen Frauen auf hohem Niveau. MDBGN wurde 2008 EU-weit in Kosmetika und Körperpflegeprodukten verboten, was sich in sinkenden Sensibilisierungsquoten niederschlägt. Der Einsatz des Duftstoffs HICC in Kosmetika wurde reduziert; hier zeichnet sich bisher jedoch noch kein signifikanter Effekt auf die Sensibilisierungsquote ab. Wegen der Vielzahl von Sensibilisierungen gegen Bufexamac hat die EU-Kommision diesem Wirkstoff im Juli 2010 die Zulassung entzogen. Background Epidemiological surveillance of contact sensitization with presentation of the most frequent contact allergens is important for consumer protection and the quality of routine diagnostics in dermatology. Methods Analysis of data of the Information Network of Departments of Dermatology (IVDK) of the years 2007 to 2009. Results During the study period, 34,091 patients have been patch tested in the departments of dermatology forming the IVDK. Compared to the years before, reactions to nickel sulphate, cobalt chloride and potassium dichromate were significantly less frequent in 2009 than before. The preservative methyldibromo glutaronitrile (MDBGN) elicited significantly less positive reactions already from 2008 on. The proportion of positive reactions to the fragrance hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC, Lyral®) was considerably, albeit not significantly, lower in 2009, when compared to 2007 and 2008. Sensitization frequency to Bufexamac has been at a constant level for years. Conclusions In spite of the EU nickel directive, contact sensitization to nickel in young women hitherto remains on a high level. MDBGN has been banned from cosmetics and body care products by the EU commission in 2008. This measure resulted in decreasing sensitization rates. The use of HICC in cosmetics has been reduced; however, a substantial and significant reduction of the sensitization frequency could not yet be observed. Due to frequent sensitization, approval of Bufexamac has been withdrawn by the EU Commission in July 2010.
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Facial allergic contact dermatitis. Data from the IVDK and review of literature
Der Hautarzt; Zeitschrift fur Dermatologie Venerologie und verwandte Gebiete, 2008Co-Authors: Axel Schnuch, C. Szliska, Wolfgang UterAbstract:The face is exposed to many foreign substances and may thus be a site of allergic contact dermatitis. Our aim is to elucidate the spectrum of factors associated with facial dermatitis by analyzing data of patients patch tested in the Information Network of Departments of Dermatology (IVDK) between 1995 and 2007. In 18,572 patients the main anatomical site of dermatitis was the face. Among these, the proportion of females and of patients with past or present atopic eczema was increased, while probable occupational causation was less common than in the overall group. Cosmetic allergens, as well as nickel, were significantly more common in women than men, including fragrance mix (10.8% vs. 8.3%), p-phenylenediamine (4.0% vs. 2.8%), lanolin alcohols (3.0% vs. 2.2%), Lyral TM (3.1% vs. 2.0%) and Bufexamac (1.8% vs. 1.1%). In comparison, only epoxy resin contact allergy was diagnosed significantly more often in men than women: In patients with airborne contact dermatitis, over-represented allergens included sesquiterpene lactone mix, compositae mix, epoxy resin, (chloro-) methylisothiazolinone and oil of turpentine. In the clinical approach to patients with facial dermatitis, occupational airborne causation should be considered in addition to non-occupational (e.g., cosmetic) allergen exposure.
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Allergic contact dermatitis to topical drugs—epidemiological risk assessment
Pharmacoepidemiology and drug safety, 2008Co-Authors: C. A. Menezes De Pádua, Axel Schnuch, Katrin Nink, Annette Pfahlberg, Wolfgang UterAbstract:Estimation of the population-based relative incidence (RI) of contact sensitization to a set of topical drug allergens (cases/100,000 defined daily doses (DDDs) per year) (1995-2004) and comparison of the RI for drugs with a similar therapeutic scope. Clinical data regarding the frequency of contact sensitization to important topical drug allergens in Germany were obtained from the Information Network of Departments of Dermatology (IVDK). This was extrapolated to the general population level using the 'clinical epidemiology and drug utilization research' (CE-DUR) approach. As denominator of exposure, national prescription data (DDDs of topical drug specialties) provided by the WIdO Research Institute (Bonn) were aggregated per substance. The probable RIs of contact sensitization to topical 'skin' corticosteroids ranged from 0.3 (dexamethasone phosphate disodium salt) to 23.3 (amcinonide) cases/100,000 DDDs per year. Concerning topical aminoglycoside antibiotics, the RI of framycetin sulphate was about threefold higher than that of gentamicin sulphate. Regarding topical ophthalmic use, the RI of kanamycin sulphate was higher compared to gentamicin sulphate. Active principles marketed over-the-counter (OTC) had, in general, lower RIs, with the exception of Bufexamac, benzocaine, clioquinol and phenylephrine. The population-based risk assessment--quantitatively considering exposure in the RI estimation--revealed a ranking of contact sensitization risk to topical drugs which partly differed from the respective frequencies in the clinical patch test population. Some drugs available OTC carry non-negligible risk, too. The current findings should contribute to differential therapeutic considerations regarding topical drug use.
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Type‐IV sensitization profile of individuals with atopic eczema: results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG)
Allergy, 2006Co-Authors: Guido Heine, Axel Schnuch, Wolfgang Uter, Margitta WormAbstract:The role of atopic eczema (AE) as risk factor for the development of allergic contact dermatitis is discussed controversially, as well as its influence on patch test results due to increased irritability. In this study, we analysed the pattern of positive patch test results to most frequent contact allergens in patients with AE (n = 9020) and age matched nonatopic (n = 15 263) individuals. The pattern and the frequencies of the observed sensitizations did not differ greatly from nonatopic individuals. Bufexamac is an exception: in AE patients sensitization is observed three times more often. For the other substances tested only minor differences were detected. Moreover, the frequencies of single, double or polyvalent sensitizations were nearly identical between the two groups. The analysis of the anatomical sites of dermatitis shows differences between the groups: in AE patients, the face (7.2%) and hand dermatitis (6.6%) was more common, and leg dermatitis (4.0%) less common. Analysis of occupation, suspected allergen source, and accompanying factors revealed no major differences between the both groups. Conclusion: The chronic and long-term exposure to external drugs and emollients presumably carries a risk for sensitization against specific contact allergens in AE patients. However, the sensitization of contact allergens differs surprisingly little between patients with or without AE.
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Anogenitaldermatosen – allergische und irritative Auslösefaktoren Analyse von Daten des IVDK1 und Literaturübersicht
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2005Co-Authors: Katrin Kügler, Thomas Brinkmeier, Peter J. Frosch, Wolfgang UterAbstract:Anogenital dermatoses (AGD) are common and often very distressing. Clinically it is often unclear if allergic contact dermatitis or irritant dermatitis is involved. In order to optimize therapy and prophylaxis, it is essential to identify relevant allergens or irritants. Data of the Information Network of Departments of Dermatology (IVDK, data center in Göttingen) collected between 1999 and 2003 were analyzed. The anogenital area was involved in 1 168 patients with suspected allergic contact dermatitis. Clinical variables and patch test results were statistically compared with the remaining IVDK patch test population, the latter standardized for age and sex. Allergic contact dermatitis had been suspected prior to patch testing in 39.5 %, while in 24.6 % this diagnosis was eventually confirmed. Irritant contact dermatitis was diagnosed in 11.8 %. Other diagnoses, included balanitis, lichen sclerosus et atrophicus and herpes genitalis. Positive reactions to cinchocaine (6.6 %), Bufexamac (3.5 %) and benzocaine (2.4 %) were observed significantly more often among patients with anogenital dermatitis. Among those in whom co-factors were considered important (n = 422), wetness (38.4 %), occlusion (30.3 %), mechanical strain (4.7 %) and heat (3.6 %) were mentioned as irritation factors. Because of the significantly higher frequency of sensitization to cinchocaine, benzocaine and Bufexamac in patients with anogenital dermatitis, these ingredients should be used only with caution. According to the literature, ingredients of toiletries, cosmetics and contraceptives of any kind seem to cause allergic contact dermatitis rarely although there are several case reports. Comprehensive patch test including the standard series plus major sensitizers such as cinchocaine, benzocaine and Bufexamac, and in particular patients' own skin care products, is recommended.
Beata Gniazdowska - One of the best experts on this subject based on the ideXlab platform.
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Delayed contact hypersensitivity to non-steroidal anti-inflammatory drugs.
Contact dermatitis, 1999Co-Authors: Beata Gniazdowska, Franziska Ruëff, Bernhard PrzybillaAbstract:Several non-steroidal anti-inflammatory drugs (NSAIDs) are available for topical treatment of acute soft tissue trauma or degenerative musculoskeletal disorders; the NSAID Bufexamac is mainly used for therapy of chronic inflammatory skin diseases. In order to assess the occurrence of contact allergy to NSAIDs in 371 consecutive patients presenting for diagnosis of presumed contact allergy, patch tests were performed with a standard series and additionally with a series of NSAIDs, comprising acetylsalicylic acid, Bufexamac, diclofenac, etofenamate, felbinac, flufenamic acid, ibuprofen, indomethacin, and piroxicam. 17 individuals (4.6%) exhibited delayed hypersensitivity to one of the NSAID preparations: 12 patients (3.2%) had patch test reactions to Bufexamac, 2 (0.5%) to etofenamate, 2 (0.5%) to indomethacin, and 1 patient (0.3%) to flufenamic acid. These patch test results corresponded well to the individual history in 11 individuals (including 10 patients with reactions to Bufexamac), and in 2 patients the clinical relevance of the reactions was probable. In view of the high frequency of allergic contact reactions to Bufexamac, we propose to test this drug particularly in patients with atopic eczema or other chronic eczematous diseases.
