Acrylics Update

/in , , , /by

Voller LM, Warshaw EM. Acrylates: new sources and new allergens. Clin Exp Dermatol. 2020;45(3):277-283. doi:10.1111/ced.14093

Reviewed by Jalal Maghfour and Alina Goldenberg MD

Acrylates, a group of synthetic thermoplastic resins, are becoming essential in industrial societies; they are commonly found in various nail products, adhesives, insulators, paints and windshields. Acrylates are known to cause allergic contact dermatitis (ACD) with the first documented case dating from 1941. ACD resulting from acrylates has been well-documented in the literature. In fact, acrylates were listed as the 2012 allergen of the year by the American Contact Dermatitis Society (ACDS).

Given the emergence of new sources of acrylates the aim of this synopsis is to highlight ACD associated with non-occupational and occupational acrylates exposure.

Non-occupational ACD secondary to acrylate exposure has been commonly reported. In 1995, Isobornyl acrylate (IBOA) was first documented to induce ACD during insulin infusion pump. Most recently, IBOA was isolated from the adhesives used primarily in many medical devices such as insulin pump and glucose monitors. This has resulted in IBOA becoming recognized as the 2020 allergen of the year by ACDS. Thus, diabetic patients and healthcare providers are particularly vulnerable to ACD due to IBOA.  

Acrylates contained in various artificial nail preparations are also a major source of sensitization. Cyanoacrylates are used in cosmetic and medical glues. There have been reports of ACD due to Dermabond which is a common surgical glue, due to its 2-octyl and cyanoacrylate ingredients.  

Occupational exposure to acrylates is also frequent.  Nail technicians are at high risk for developing acrylate allergy. Other fields such as orthodontists and dental technicians may be at increased risk for developing ACD given that the wide use of methacylates in dental prostheses.

As with any ACD, patch testing remains the gold standard diagnostic modality. Once an acrylate sensitization is diagnosed, patients should be adequately counseled on avoiding any cosmetic or industry products that contain acrylates. Workers at high-risk of exposure are recommended to wear trilaminated polyethylene gloves which  confer protection up to 4 hours. 

Cinnamon Synopsis

/in , , /by

Ackermann L, Aalto-Korte K, Jolanki R, Alanko K. Occupational allergic contact dermatitis from cinnamon including one case from airborne exposure. Contact Dermatitis. 2009;60(2):96-99. doi:10.1111/j.1600-0536.2008.01486.x

Reviewed by Jalal Maghfour, Alina Goldenberg MD

Cinnamon is derived from the bark of cinnamon trees Cinnamomum Zeylanicum or Cinnamomum Cassia. Cinnamon has a versatile function and is widely used in food, pharmaceutical and cosmetic industries.

Allergic contact dermatitis (ACD) to cinnamon is very rare but has been reported by several authors across the literature. Cinnamal aldehyde is what makes cinnamon an allergenic compound. It also is what gives the rich odor and flavor to cinnamon. Upon contact with the skin, cinnamal aldehyde can act as an allergen. This binding results in an immune complex reaction that triggers the inflammatory cascade resulting in ACD.

Herein this synopsis we provide an overview of a study describing six patients who developed ACD due to a sensitization to cinnamon.

Of the six patients, three developed ACD primarily on the hands, where they had direct contact with cinnamon powder, contained in flour/rye. One patient developed ACD on the neck and face area presumably caused by airborne exposure to cinnamon in a working environment.

For diagnosis of any ACD, a detailed history and patch testing are required in order to identify the offending agent. However, spices are well known to be irritating in patch testing, which may result in high rate of false-positives.  Therefore, diluting series for patch testing is recommended for accurate diagnosis. Additionally, cinnamon is not commonly tested via patch testing, rather cinnamic aldehyde and cinnamal, strong sensitizers found in fragrances, are tested which can cross-react.   Therefore, patients with confirmed patch testing due to fragrance mix containing eugenol, cinnamal and cinnamyl alcohol should be counseled on the possible cross-reactivity with cinnamon. 

In summary, cinnamon is a very rare allergen, but has been reported to induce ACD. Patch testing is the gold standard diagnostic tool to elucidate an underlying cinnamon sensitivity.

What is essential in essential oil?

/in , , , /by

Reeder MJ. Allergic Contact Dermatitis to Fragrances. Dermatol Clin. 2020;38(3):371‐377. doi:10.1016/j.det.2020.02.009

Reviewed by Jalal Maghfour and Dr. Alina Goldenberg, MD

https://www.webmd.com/beauty/news/20180813/essential-oils-promise-help-but-beware-the-risks
https://www.poison.org/articles/2014-jun/essential-oils

Essential oils (EOs) are the quintessential oils in flowers, stems, seeds, leaves, roots and berries.  Although the name “essential” may imply purity, in reality, EOs are processed hydrophobic volatile compounds from raw plant material with various stabilizing additives.  Nevertheless, since ancient times, EOs have been used for skin beauty, cosmetics and treatments of various conditions such as pain and anxiety and continue to be highly marketed today despite their intrinsic risks.

The extraction of EOs is by no means simple. Common techniques for extraction include distillation and cold compression. Because of their hydrophobicity, the addition of a solvent is often required for both extraction and dilution of EOs. Solvents may include petroleum ether, methanol,  and ethanol  These solvents may be toxic pesticides such as methanol which has been associated with nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death. . Hence, there is no such a thing as “pure” essential oil.

Historically, EOs have been perceived as safe. This misconception is rooted from the fact that all herbs are considered safe because they are ‘natural’. This has led to an increase in use and misuse of EOs  With increased popularity of EOs for aromatherapy, there has been an expansion of EOs use in other products, even in EO products  advertised for their efficacy in treating various disorders including dermatologic conditions.  While the FDA can enforce guidelines to restrict how products are marketed, it is important to recognize that EOs are not FDA regulated.

It is therefore not surprising that increased accessibility of these products by the public has led to an increase in their use. In dermatology, EO induced Allergic contact dermatitis (ACD) is not new to clinicians but it is becoming increasingly more prevalent. In fact, fragrances, which also contain EOs as ingredients, have been designated as the 2007 allergen of the year, by the American Contact Dermatitis Society (ACDS).

EO-induced ACD is of clinical importance as standard patch testing may miss EO sensitizations. If there is high suspicion for an EO allergy, it is important to perform expanded patch testing to avoid false negative results. In the US, melaluca (tea tree) and ylang ylang are common allergenic oils that could be potentially missed if testing was limited to standard fragrance. 

Another common myth is that toxicity of EOs correlates with dose concentration. In reality, all EOs can be toxic at high concentrations but there are some types of EOs that are inherently toxic even at low doses, especially when taken orally . Camphor is a very toxic compound which can prove fatal for infants and children on ingestion even in very small doses. The strong aroma associated with camphor has attracted its use in many EOs, especially as a remedy for the common cold. Patients who ingested camphor can develop severe nausea, vomiting, lethargy, ataxia, and even seizures. Inhaling eucalyptus offers a soothing effect when suffering from a cold, however ingestion of eucalyptus oils can lead to seizures. Nutmeg is an EO which enhances food flavor; misusing it can lead to hallucinations and coma. Thus, even ‘safe’ EOs can be detrimental to patients if misused.  Even EOs advertised as non-toxic have the potential to be toxic to certain vulnerable individuals and age groups (babies, elderly) and/or if taken for a long period of time.  

In summary, although some EOs have been recognized to have beneficial properties, they have the potential to be extremely hazardous and dangerous to humans. It is vital for patients to appreciate the complexity of EOs and be aware of the fact that they are not as “pure” nor as free of risks as advertised.

Unmask the facts- the truth behind “fragrance free”

/in , , , , /by

Original Article:

Scheinman PL. Exposing covert fragrance chemicals. Am J Contact Dermat. 2001;12(4):225‐228. doi:10.1053/ajcd.2001.28697

Reviewed by Jalal Maghfour and Dr. Alina Goldenberg

Fragrances are widely used in personal care products, cosmetics, medicaments, and foods within the US. Fragrances are responsible for many cases of allergic contact dermatitis, leading it to be perceived as a significant public health problem. 

We aim to provide an overview of fragrance chemicals and how knowledge of fragrance elements can shape patient outcomes.

Patch testing continues to be the gold standard for the diagnosis of fragrance sensitization. Patch test commonly include fragrance mix (FM) and balsam of Peru. FM, which includes cinnamic aldehyde, cinnamic alcohol, eugenol, isoeugenol, hydroxycitronellal geraniol, oak moss absolute, and alpha-amyl cinnamic aldehyde,  is highly ubiquitous worldwide with an estimated sensitization prevalence of 11%.  

While patch testing can detect 70 to 80% of fragrance elements, false negative reactions to FM may occur. Hence, it is important to conduct an expanded series of fragrance chemicals if the suspicion for an allergy is high. This is of clinical importance since identification of the exact etiology may guide disease management and empowers patients to take control over their own health.

Although being aware of fragrance allergy is important, many products that are labeled as “fragrance-free” are not truly free of chemical fragrance. For instance, benzyl alcohol is often used as a preservative but it is also considered a fragrance agent. However, because benzyl alcohol has a dual function, companies can legally label a product as “fragrance-free”. This makes it challenging for sensitized patients to avoid certain “fragrance-free” products.  Hence, knowledge of various products by clinicians can be vital for patient care. Historically, plant and animal ingredients were the main extracts used in making fragrance. It is therefore important to note that a patient who is allergic to a fragrance agent in a product may also react to the same ingredient found in plants and flowers.  

Sensitization to an allergen is necessary for elicitation to occur in which the rash of ACD is present. Initial sensitization usually requires a higher dose of the chemical allergen. However, if a fragrance is applied to skin areas with high absorption capacity such as face, genitals, and traumatized areas (shaving, post-surgical sites, excoriated lesions of atopic dermatitis/eczema), a lower dose is may be necessary to sensitize an individual. It is noteworthy that for sensitized individuals subsequent exposure of a lower dose of the allergen may be enough to elicit a cutaneous eruption. Hence, in addition to removing fragrances from commonly used products, public policy should also focus on reducing the levels of fragrance use to prevent reactions in sensitized individuals.

Nickel allergy – immunologic inflammatory pathways

/in , , /by

Review of: Nickel sulfate promotes IL-17A producing CD4+ T-cells by an IL-23 dependent mechanism regulated by TLR4 and Jak-STAT pathways

Original article: Bechara, R, Antonios, D, Azouri, H, Pallardy, M, Nickel sulfate promotes IL-17A producing CD4+ T-cells by an IL-23 dependent mechanism regulated by TLR4 and Jak-STAT pathways. The Journal of Investigative Dermatology. 2017 Jun 17.

Reviewed by: Jacqueline Chen, BA. MSI & Brittanya A. Limone, MS, BS. MSIV

  • Allergic contact dermatitis (ACD) is classically described as a Type IV hypersensitivity reaction, however, the distinctive characteristics of a nickel-induced allergic contact dermatitis (Ni-ACD) lead to immunologic mechanisms that not only encompass a Th1 response but involve additional inflammatory cells, cytokines, and pathways.
  • In Ni-ACD, dendritic cells (antigen presenting [accessory] cells) play a critical role. Dendritic cells bind the antigenic nickel absorbed in the skin and then present it to T-cells at local lymph nodes, coordinating T-cell differentiation through cytokine messengers.
    • The two most crucial cytokine signals include:
      • IL-12p70 which promotes a T-helper Cell 1 type (Th1) response
      • IL-23 which stimulates the development of T-helper Cell 17 type (Th17) cells
    • Notably, the presence of IL-17A produced by Th17 cells correlates with the clinical reaction in nickel allergic patients. An injection of anti-IL-17 neutralizing antibodies may limit the severity of the contact hypersensitivity.
    • The IL-23/IL-12p70 balance determines the primary immunologic mechanism of the hypersensitivity reaction.
      • Increases in the IL-23/IL12p70 balance lead to a greater Th1 cell polarization
      • Decreases in the IL-23/IL-12p70 ratio produce a stronger Th17 cell response.
    • Brechara et al identified 5 specific modulators of T-cell differentiation that are important in the development of Ni-ACD through alterations in the IL-23/IL-12p70 balance.
      • IFN-γ
        • Produced by Th1 cells.
        • Greatly increases the IL-23 levels produced by nickel sulfate (NiSO4)-treated dendritic cells.
        • The increase in the IL-23/IL-12p70 ratio favors Th17 cell development.
      • Jak-STAT pathway
        • Inhibition of the Jak-STAT pathway increases IL-23.
        • Alternatively, activation of the pathway will increase IL-12p40 and IL-12p70 levels and decrease the IL-23/IL-12p70 balance.
        • This decrease in the IL-23/IL-12p70 balance favors a Th1 cell response.
      • TLR4, p38MAPK and NFkB pathways
        • Activation of these pathways is essential for nickel-induced production of IL-23, IL-12p40 and IL-12p70.
        • Since both IL-23 and IL-12 cytokines are produced, the IL-23/IL-12p70 balance remains high.
      • In summary, Ni-ACD is a complex immunologic disease involving not only a cell-mediated Th1 response but also Th17 cell development with alterations in IFN- γ levels and TLR4, Jak-STAT, p38MAPK, and NF-kβ immunologic pathways.

Article: link to publishers site

Researchers are investigating the role of piercings and the development of nickel allergy – please consider to take the Loma Linda University Nickel Allergy Survey:

Nickel allergy survey

 

 

TSW

Facing topical steroid withdrawal TSW – health matters

/in /by

TSW – topical withdrawal syndrome

Facing up to withdrawal from topical steroids 

By Mary C. Smith, RN, MSN; Susan Nedorost, MD; and Brandie Tackett, MD

“Topical corticosteroids applied to the face to treat these symptoms can cause steroid rosacea and steroid addiction syndrome, resulting in new symptoms that perpetuate the topical steroid usage.”  “withdrawal … which is called steroid addiction syndrome.”

” The best time to prevent … is when topical corticosteroids are first prescribed.”

” Getting the red out”

” Uncovering steroid rosacea”

” Stopping the cycle”

” Patient teaching”

Call to Action: “Learn to recognize this condition”

Get article here

 

NEW- ALLERGEN MATTERS – ATOPICS as greater risk for… BOP… Lanolin

/in , /by

Cocamidopropyl betaine, Amerchol L-101 {lanolin} and many of the Fragrances are only available for testing with comprehensive patch testing.  Propylene glycol and MI also ones that can be frequently missed, because they are not specifically tested.  P.E.A.S – pre-emptive [allergen] avoidance strategy highlights this top allergens and Simple and Free highlights products devoid of them…

“Lubbes S1, Rustemeyer T2, Sillevis Smitt JH1, Schuttelaar MA3, Middelkamp-Hup MA1.    Contact sensitization in Dutch children and adolescents with and without atopic dermatitis - a retrospective analysis.     Contact Dermatitis. 2016 Nov 11. doi: 10.1111/cod.12711.
BACKGROUND:
Allergic contact dermatitis is known to occur in children with and without atopic dermatitis, but more data are needed on contact sensitization profiles in these two groups.
OBJECTIVES:
To identify frequent allergens in children with and without atopic dermatitis suspected of having allergic contact dermatitis.

METHODS:
A retrospective analysis of children aged 0-17 years patch tested between 1996 and 2013 was performed.

RESULTS:
Of all 1012 children tested because of suspected contact dermatitis, 46% developed one or more positive reactions, the proportions for children with (n = 526) and without (n = 395) atopic dermatitis being 48% and 47%, respectively. Children with atopic dermatitis reacted more often to lanolin alcohols (30% pet., p = 0.030), Amerchol L-101 (p = 0.030), and fragrances [fragrance mix I (p = 0.048) and Myroxylon pereirae {BOP} (p = 0.005)].   Allergens outside the European baseline series that frequently gave positive reactions in these groups included cocamidopropyl betaine and Amerchol L-101. Reactivity to these allergens was significantly more frequently found in atopic dermatitis children.

CONCLUSION:
Sensitization prevalences in children with and without atopic dermatitis were similar, but children with atopic dermatitis reacted significantly more often to lanolin alcohols and fragrances. Testing with additional series besides the European baseline series may be necessary, as reactions to, for example, cocamidopropyl betaine and Amerchol L-101 may otherwise be missed.”

https://www.ncbi.nlm.nih.gov/pubmed/27861990

silent pandemic

Silent pandemic

/in /by

Learn about one of the most important environmental campaigns in history…. the environmental working group studied cord blood samples and provide evidence that we are in the midst of a silent pandemic.

“Aught to do all we can to minimize exposures”… “industrial pollution begins in the womb”…”women use an average of about 12 personal care products a day and that exposes them to  more than 160 chemical ingredients, some of them rather toxic, day after day after day”.

“62,000 chemical were ‘grandfathered in'”

“…found 287 chemicals in just those 10 Americans  — 28 different waste byproducts — 47 different consumer product ingredients — most disturbing of all – 212 industrial chemicals and pesticide break down products that had been banned 30 years before… ” in UMBILICAL CHORD BLOOD!  Speaking to the silent pandemic.

“babies are born pre-polluted with as many as 300 industrial chemicals in their bodies.”  The math shows … “We have more health effects than we have chemicals, why is that? … many of these chemicals have multiple toxic effects.”  And, “Only 5 chemicals have been banned or restricted by EPA under the law“!  Moreover, “80% of all new chemicals approved within 3 weeks”

There is an “84% increase in acute lymphocytic leukemia“…

The Kid-Safe Chemicals Act (KSCA) of 2008 – “Requires that chemical be safe for CHILDREN and others who are sensitive”.  “Assumes chemicals are harming people until PROVEN OTHERWISE“.  “Prioritizes SAFETY REVIEWS, BANS, and PHASE-OUTS based on what’s in people and hazardous”.  Addressing the silent pandemic.

…historic moment … AN UNPRECEDENTED COALITION!!!

Learn more:

http://www.ewg.org/news/videos/10-americans

Preservative allergy alert!

Update on isothiazolinone (preservative) contact dermatitis

/in , , , /by

New! Off the Press today! An update on the impact of isothiazolinone (preservative) contact dermatitis allergy .

“Allergic contact dermatitis (ACD) is a socially and economically significant condition. ‘We are in the midst of an outbreak of allergy to a preservative [methylisothiazolinone] which we have not seen before in terms of scale in our lifetime…. I would ask the cosmetic industry not to wait for legislation but to…address the problem before the situation gets worse,” stated John McFadden, FRCP, consultant dermatologist at St. John’s Institution of Dermatology in London, in a 2013 article in The Telegraph. Because MCI was believed to be a more potent allergen than MI, MI was approved for use as an individual pre- servative in industrial products in 2000 and in cosmetics in 2005. Comparing pooled prevalence rates… In the 1980s, in response to the newly recognized isothiazolinone allergens, expert panels from the United States and European Union recommended more strict concentrations in cosmetic products. The Scientific Committee on Consumer Safety (SCCS) recommended to the Cosmetic Directive of the European Union to limit. ‘”

Read more: UPDATE ON ISOTHIAZOLINONES.   Isothiazolinones, including (methylisothiazolinone, methylchloroisothiazolinone, and benzisothiazolinone, are common synthetic biocides/preservatives found in many skin and hair products as well as industrial products.

By MICHAEL LIPP, DO, MISHA BERTOLINO, MA, ALINA GOLDENBERG, MD, MAS, AND SHARON E. JACOB, MD in The Dermatologist™.  Please click the ‘prevent’ button on Break the Isothiazolinone Cycle on the Dermatitis Academy Isothiazolinone allergen (hapten) page.