Tag Archive for: allergic contact dermatitis

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Petrolatum Facts—150 years to today.

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Petrolatum was discovered in 1859 inadvertently by the oil rig drillers in Titusville, Pennsylvania. The thick “rod wax” caused the rigs to malfunction and had to scraped off, however the workers found it to help soothe and heal their skin cuts. Robert Chesebrough, a chemist, refined, distilled, patented, and named it Vaseline—from the German wasser (water) and the Greek elaion (olive oil).

Purified petrolatum is a highly useful moisturizer and skin protectant as it prevents up to 98% of transepidermal water loss, is triple-purified and devoid of any allergens. It is recommended by the National Eczema Association as safe treatment option. There have not been any evidence-based reports directly linking purified petrolatum to cancer.

However, unrefined, low grade petrolatum does contain carcinogens called polycyclic aromatic hydrocarbons. Although the US does not regulate petrolatum use in cosmetics, labels stating “white petrolatum” or “Petrolatum, USP” can be sure they are buying a purified high grade product.

Petrolatum itself has never been reported to cause allergic contact dermatitis. Some petrolatum-based products, however, may not use a purified form of petroleum and often have additional ingredients such as Lanolin or fragrances and should be carefully evaluated for their ingredients by patients with known sensitizations.  

low nickel diet

Low Nickel Diet article

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Low Nickel Diet: A Patient-Centered Review

‘ A meta review by Jensen specifically assessed elicitation of SCD due to nickel ingestion, and found that 1% of those sensitized to nickel react to the nickel content of a “normal” diet, defined as 0.22 mg, 0.35 mg, or 0.53 mg [12]. Furthermore, a dose-response relationship was revealed showing 10% of nickel sensitized patients responding to exposures between 0.55 mg and 0.89 mg. Such low exposures can be easily attained by consuming foods high in nickel content.  …many patients sensitized to nickel are unaware that dietary exposure may play a role in their morbidity.’  A low nickel diet may help them get their rashes better.

To read more about the Low Nickel Diet: A Patient-Centered Review click here:

http://www.omicsonline.org/open-access/low-nickel-diet-a-patientcentered-review-2155-9554-1000355.php?aid=73356

methylisothiazolinone scrutiny

methylisothiazolinone scrutiny

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Methylisothiazolinone scrutiny is very much needed.  This preservative is sensitizing a significant number of adults and children worldwide.  It is found in personal products, household cleaners, household paint, and air fresheners.  Reactions to it may look like atopic dermatitis!

“Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children.” Learn more by clicking here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197884/.

It is time for methylisothiazolinone scrutiny – there is an epidemic!  The Dermatitis Academy [www.dermatitisacademy.com] is tracking this epidemic and reporting new cases of methylisothiazolinone and new sources!!!  It is important that consumers continue to let the Food and Drug Administration [FDA] know that they are known to be allergic to methylisothiazolinone and which product they have reacted to.  Click here for information on FDA reporting: https://www.dermatitisacademy.com/methylisothiazolinone-page/

 

 

Nickel Summit Webinar

Nickel Contact Dermatitis Summit Webinar

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Nickel Contact Dermatitis Summit

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested patients of all ages worldwide, which we call attention to as the Nickel Contact Dermatitis Summit approaches.  And yet, nickel sensitivity is a much wider problem than the documentation suggests, as Peltonen alarmingly and poignantly pointed out over 30 years ago: “half of the subjects sensitized to nickel have never consulted a doctor because of their nickel dermatitis; still fewer have visited a dermatologist”.    In the US we are in the midst of a prospering hidden nickel epidemic akin to that seen in Europe prior to nickel regulation legislation.  There are millions of adults and children sensitized each year – the rates are UNACCEPTABLE, because this is a PREVENTABLE cause of allergic contact dermatitis.  The Nickel Summit webinar by Dr. Jennifer Chen discusses the impact of nickel allergy in the US and the lack of regulation.

 

Article Synopsis

Below is a summary of an article speaking more to this topic.

Synopsis by Janna Vassantachart, MD Loma Linda University School of Medicine

Article: Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel Allergy in US Adults-A 53-Year Review of Indexed Cases. Dermatitis. 2015 Jul 14.

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested US patients of all ages. In 1994, the European Union (EU) decreased rates of sensitization by enacting a Nickel Directive to regulate nickel release to no more than 0.5 µg/cm2/week. No such directive currently exists in the USA.

This study conducted a literature review of peer-reviewed adult nickel dermatitis cases published within the United States to identify trends over the past decades, sources of nickel sensitization, and regional variations.  It highlights the problem we are encountering at the top of the nickel contact dermatitis summit.   The results of the study demonstrated:

  • Between 1962 and 2015, there were 74 articles published reporting 18,251 cases of nickel sensitivity in US adults.
  • Over the past decades, the frequency of published articles on nickel sensitivity has continuously increased with a significant correlation (r = 0.798, P = 0.057). Compared to only one article published between 1960 and 1970, in the last 5 years, 30 articles have been published.
  • Five articles reported occupational exposures such as a stethoscope, chalk, and a military-issued lanyard chain from an identification neck tag (aka ‘‘dog tag’’). The most commonly reported nonoccupational sources were Essure contraceptive microinserts and Amplatzer septal occluders for atrial septal defects.
  • Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis.

Most nickel dermatitis cases seen clinically are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic towards the nickel summit. However, this study reveals that even the literature has seen a significant increase in published cases over the past decades. Rising rates of US nickel ACD highlight the need for medical professionals, legislators, and manufacturers to advocate for an EU-like Nickel Directive to regulate the release of free nickel.

 

 

The Dermatitis Academy Story

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It was 2004, Europe had instituted the European Union Nickel Directive limiting the allowable release of nickel from items that were in direct and prolonged contact with the skin and the sensitization (allergy) rates to nickel were plummeting.  I became aware of this great need in the United States and decided to pursue training at NYU with Dr. David Cohen in contact dermatitis.  That same year, at the University of Miami, we conceived the business model for an institute for contact dermatitis that would serve the growing needs of patients with contact dermatitis by offering the highest tier of comprehensive patch testing, serve the needs of trainees who could come to the center to learn in partnership with excellent patient care, and provide the most up-to-date evidence-based resources for education.  This marked the inception of the Dermatitis Academy.

Over the next three years, we grew the contact dermatitis practice at the University of Miami serving contact dermatitis needs throughout South Florida with referrals from Mexico, central and south America.  We trained dermatology residents and began a training program for Fellows and Affiliate Providers and laid the foundation for informational and interactive educational resources.

During this time I became actively (passionately) involved in a campaign for safer regulation of nickel in the US.    In 2008, as a member of the Public Relations Committee of the American Contact Dermatitis Society, we presented a resolution to the American Academy of Dermatology (AAD) to issue a health advisory and document a need for an EU-like nickel directive in the United States. In response, the AAD developed a Nickel Workgroup, which formalized the resolution and ultimately the Council on Government Affairs and Health Policy and Practice approved and presented to the American Medical Association House of Delegates (AMAHOD). In June 2011, the AMA-HOD adopted the nickel resolution and sent a letter to the Consumer Patient Safety Commission (CPSC) regarding nickel:

“The AMA urges the CPSC to protect the public health by issuing safety standards that would limit the amount of nickel in consumer products with prolonged skin contact.”  The Deputy Executive Director for Safety Operations at the CPSC responded, “The issue of nickel sensitization and consumer products is one that the CPSC and its staff have been aware of since the agency’s inception” (CPSC inception was in 1972)!

In February 2015, we formally launched the Dermatitis Academy in partnership with the Nickel Allergy Alliance to track the pediatric and adult cases of nickel in the US and bring awareness to this silent epidemic.  We redrafted a nickel resolution and submitted it to the American Contact Dermatitis Society’s (ACDS) Health Policy Committee.  In partnership with this committee, the American Academy of Pediatrics, the American Academy of Allergy Asthma and Immunology and the American College of Asthma Allergy and Immunology and the National Eczema Association the resolution was finalized and submitted to the AAD, which approved the resolution and formed a nickel workgroup to study the issue and develop a position statement.  In August 2015, the AAD publicly issued a nickel position statement.

Twelve years later, I am still actively engaged in this public health campaign.  In March 2016, the Dermatitis Academy launched the free website to expanded the outreach, to provide educational resources on the most prevalent allergens identified through evidence-based meta-analysis of the literature, webinars, and the Simple and Free™ guideline.

This month (May 2016), just two months since the launch of the public website, we have had over 31,000 visits to our site… We hope you find the Dermatitis Academy a useful education tool… please share.

 

Photo of positive DMG test

Electronics cause nickel rash (iPad)

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Nickel sensitization (and the clinical manifestation of nickel allergic contact dermatitis) is an issue that affects individuals of all ages. Nickel allergic contact dermatitis may present as a diffuse, or localized reaction, often leading the allergy to be confused with other conditions such as atopic dermatitis. While cases of nickel allergy are increasing, the cause of sensitization may not always be clear. Allergens must be identified, and actions must be taken to prevent contact.

This review by Chandler Rundle, BS. MSI, Loma Linda University of  iPad – Increasing Nickel Exposure in Children.  Sharon E. Jacob, MD and Shehla Admani, MD  In PEDIATRICS, Vol 134 – Issue 2 – 2014 highlights that:

*Flares of atopic dermatitis may be associated with increased contact with items containing nickel.

*Electronic devices, including the iPad, are a potential source of nickel sensitization in children.

*To prevent sensitization from electronics (and flares of allergic contact dermatitis), measures should be taken to minimize contact, such as including a case or duct tape as a barrier.

*With the increasing prevalence of nickel allergy among the pediatric population, identifying relevant allergens must become a priority in order to prevent AD flares.

Goblin's Copper Nickel Policy

Time for Nickel Policy

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Goblin’s Copper –The Time For a Nickel-Directed US Health Policy is Here. In THE DERMATOLOGIST, Vol 23 – Issue 3 – March 2015, pg 18-21

By Sharon E. Jacob, MD, Alina Goldenberg, MAS, Nanette Silverberg, MD, Luz Fonacier, MD, Bruce Brod, MD, Richard Usatine, MD, Robert Sidbury, MD, MPH, James Young, DO, Anthony Fransway, MD, Jonathan Silverberg, MD, PhD, MPH, Albert Yan, MD, and Janice L. Pelletier, MD, FAAP

Review by Chandler Rundle, BS. MSI, Loma Linda University

For years, nickel sensitization has plagued individuals of all ages. Nickel allergy can present as a localized or diffuse reaction, leading the reaction to often be confused with other conditions such as atopic dermatitis. Cases of nickel allergy are increasing, but there is minimal legislation on nickel restriction. The Jacob et al. article reviews/highlights that:

*International initiatives that regulated the allowable amount of nickel release from items inserted in piercings limited to <0.2 μg/cm2/week has led to decreased sensitization rates and a cost savings of $2 billion US dollars over a twenty year period.*A significant percentage of the clinical cases are unpublished – hence underrepresented.
* Half of the subjects sensitized to nickel have never consulted a doctor because of their nickel dermatitis
*Rates of nickel dermatitis have risen significantly. While awareness of nickel dermatitis has heightened as a public health issue.
* United States legislation has yet to formulate regulation of nickel in products – as Europe did in the 1990’s.

Nickel Contact Dermatitis

Nickel Contact Dermatitis in US Adults-A 53-Year Review- Synopsis

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Authors: Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel Allergy in US Adults-A 53-Year Review of Indexed Cases. Dermatitis. 2015 Jul 14.

Synopsis by Janna Vassantachart, MSIV — Loma Linda University School of Medicine

For 53 years, nickel has been unparalleled as the most common allergen documented in patch-tested US patients of all ages. In 1994, the European Union (EU) decreased rates of sensitization by enacting a Nickel Directive to regulate nickel release to no more than 0.5 µg/cm2/week. No such directive currently exists in the USA.
This study conducted a literature review of peer-reviewed adult nickel dermatitis cases published within the United States to identify trends over the past decades, sources of nickel sensitization, and regional variations. The results of the study demonstrated:
• Between 1962 and 2015, there were 74 articles published reporting 18,251 cases of nickel sensitivity in US adults.
• Over the past decades, the frequency of published articles on nickel sensitivity has continuously increased with a significant correlation (r = 0.798, P = 0.057). Compared to only one article published between 1960 and 1970, in the last 5 years, 30 articles have been published.
• Five articles reported occupational exposures such as a stethoscope, chalk, and a military-issued lanyard chain from an identification neck tag (aka ‘‘dog tag’’). The most commonly reported nonoccupational sources were Essure contraceptive microinserts and Amplatzer septal occluders for atrial septal defects.
• Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis.

Most nickel dermatitis cases seen clinically are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic. However, this study reveals that even the literature has seen a significant increase in published cases over the past decades. Rising rates of US nickel ACD highlight the need for medical professionals, legislators, and manufacturers to advocate for an EU-like Nickel Directive to regulate the release of free nickel.

Amanda’s Allergic Contact Dermatitis Story – My ACD story

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Amandasstory

“My MI/MCI story by Amanda B.

In April of 2013, I began struggling with sleep. Friends suggested I go on Hormone Replacement Therapy, and my doctor, who knew nothing about hormones, suggested I visit a gynecologist for HRT. She also offered me sleeping pills. Not wanting either alternative, I chose to hope for the best and tough it out. But months and months later, I still wasn’t sleeping, and my thoughts and feelings began to become affected. The day before Thanksgiving, my only surviving family member and sibling was admitted into the hospital 2,000 miles away. She passed away on December 11 and I was unable to attend her funeral.  My college-aged children were home and I pressured myself into preparing elaborate holiday feasts. My business, which is in full swing during the holidays, was demanding my attention. I say all of this so you can understand that I was on overload, to say the least. I fully believe that my sensitization to MI/MCI was due in large part to stress, the fact that I wasn’t handling my stress well, and my use of denial (“it will all get better”).

That Christmastime, I began experiencing itchy rashes on the back of my hands. I was at a loss as to what was causing it. I booked a January appointment with a dermatologist and they kind of shrugged, gave me a preliminary diagnosis of dyshidrotic eczema (although the presentation of my rashes was irregular for that diagnosis), gave me some very strong ointment, and sent me on my way. I read the package insert of the medication and was alarmed at how they stated it could interfere with the adrenals. I used it sparingly, and it worked.

I kept having these sorts of breakouts on my hands, but then later in 2014, I began breaking out on my face, chest and arms. These blisters were horrible. As the rash on my face was in a butterfly shape, the dermatologist tested me for Lupus, which was negative. No indication on their part as to what could be causing the rashes. More corticosteroids.

Finally in early 2015, after a facial caused my lips to flare, I insisted we get to the bottom of the problem. The dermatologist suggested a patch test to determine if I had contact allergies. She administered the TRUE test and I reacted quite strongly, and only to isothiazolinone. Not one person in the office could pronounce it, and not one person talked with me about Allergic Contact Dermatitis (ACD). They handed me a printout from the TRUE test and said, “this is what the problem is.” I immediately talked with the aesthetician who had given me the facial. She began looking on her phone right away. The first site she went to was Wikipedia, and then she went to Facebook. She found the MI group and I immediately began following. To date, these MI support groups have provided me with nearly 100% of my education on ACD.

Like everyone else with ACD, the allergy ruled my life at first (and it still does, for the most part, but I have a safe home now, and I know how to live with the diagnosis). I spent a great deal of time focusing on how to keep out of a flare. I am a jewelry artist and am exposed to chemicals on a regular basis, but it was cleaning out my basement this past winter that caused a huge flare that I couldn’t seem to heal. Although I have prescriptions for various corticosteroids, I try to use them sparingly, even to wean myself off of them, because they are known for thinning the skin, and the ingredients are absorbed into the bloodstream. So during this particular flare, I began using natural salves that were absolutely lovely (in my opinion). But something wasn’t right. I would use corticosteroids one night, the natural salves another night, and I kept flaring. There was no MI/MCI in any of the products I was using. So back to the dermatologist. She had mentioned that there was a specialist about an hour and a half away who could patch test me on a larger scale if I needed it, so I said, “it’s time”. Fortunately, I have medical insurance that would pay for it.

In April of 2016, I had my appointment and was given 129 patches on my back. The results were that I had developed sensitivities to some of the ingredients in the natural salves I had been using. My new allergens include Fragrance II, Propolis, the botanicals neroli and lemongrass, as well as ethylhexylglycerin and dodecyl gallate. I was told to avoid all fragrances, all botanical oils and beeswax, in addition to MI/MCI.

Now I use very little on my skin, as I fear that I will become sensitized to more allergens. Something that I feel has been missing in all of this is patient education about how to heal a flare once you get one. And that education for the medical community in this arena is sorely lacking. I know that doctors become highly specialized and it may be impossible for them all to know about ACD, but it seems to me that dermatologists ought to be able to patch test a patient sooner than later.   I think that most of us ACD sufferers are out there floundering with no idea of diagnosis and treatment. I am grateful that Dermatitis Academy exists now to help us all through this maze!”

My Allergic Contact Dermatitis (ACD) Story is a portion of the Dermatitis Academy Blog that highlights real life, user submitted, allergic contact dermatitis journeys in an attempt to provide awareness and encouragement regarding this crippling disease.

Infographic by Peter Gust