Because both atopic dermatitis (AD) and contact dermatitis (CD) are characterized by a similar morphologic appearance and similar distribution of skin involvement, the diagnosis of CD in AD has been ...difficult. Historically, it was thought that patients with AD were unable or less likely to develop CD due to various studies in which patients with AD stimulated with strong allergens failed to develop sensitization at rates similar to patients without AD. However, more recent evidence from the United States and Europe has shown that patients with AD have similar if not higher rates of positive patch test results to common contact allergens, including metals and fragrance, than those patients without AD. In this review, we highlight evidence for and against the role of contact allergy in patients with AD and seek to give clinically relevant management recommendations for the evaluation of CD in the patient with AD.
Background
Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD).
...Objectives
To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability of current German patch test recommendations for this occupational group.
Patients and methods
As part of the OCCUDERM project, occupational exposure of 230 metalworkers with suspected OD patch tested in the departments of dermatology in Göttingen and Osnabrück (both Lower Saxony, Germany) in 2012–2017 was recorded by questionnaire. These data, as well as results, of patch testing with standardized allergens and with workplace material were analysed.
Results
Metalworking fluids and skin care products were the most important exposures. Among MWF allergens, most frequently sensitizations to formaldehyde and formaldehyde releasers, colophony/abietic acid and monoethanolamine were observed. Sensitization to methylisothiazolinone (MI) was frequent, probably as part of the general European epidemic of contact allergy to MI in leave‐on cosmetics. Sensitization to glove ingredients only played a minor role.
Conclusions
The known occupational allergen spectrum could largely be confirmed. In order not to miss relevant sensitizations, patch testing with material from the patients’ workplaces in parallel to baseline and MWF series is recommended. Sensitizations diagnosed could not always be linked to particular occupational exposures.
Keratinocytes in allergic skin diseases Albanesi, Cristina
Current opinion in allergy and clinical immunology,
2010-October, 2010-Oct, 2010-10-00, 20101001, Letnik:
10, Številka:
5
Journal Article
PURPOSE OF REVIEWThe aim of the review is to provide up-to-date information on the multiple roles of epidermal keratinocytes in the immune reactions associated with allergic contact dermatitis and ...atopic dermatitis skin diseases.
RECENT FINDINGSIn the last two decades, it has become clear that keratinocytes are highly active immunological cells, with major control over the acute and the chronic phases of skin inflammation by means of cytokine/chemokine production and surface molecule expression. Keratinocyte responses in skin allergic reactions are rather disease-specific and keratinocytes from genetically determined skin disorders, including atopic dermatitis, show intrinsic abnormalities in their capacity to respond to trigger factors.
SUMMARYLymphokines and cytokines released by T lymphocytes and other immune cells represent the most important stimuli that elicit the inflammatory activation of keratinocytes. Depending on the type and extent of T-cell infiltrate present in allergic contact dermatitis and atopic dermatitis skin lesions, keratinocytes are exposed to different cytokine micromilieu and, in turn, produce flogosis mediators qualitatively and quantitatively specific for each disease. Keratinocyte-derived inflammatory molecules amplificate skin immune responses associated with allergic contact dermatitis and atopic dermatitis, and contribute to the disease process and clinical phenotype development.
It is unclear whether the type 2 T helper cell–specific immunosuppressive action of dupilumab interferes with patch testing.
We sought to evaluate the reliability of patch testing on dupilumab and ...the contribution of allergic contact dermatitis (ACD) to complex dermatitis in patients with residual dermatitis on dupilumab.
This is a retrospective chart review of 48 patients with atopic dermatitis (AD) who were treated with dupilumab. We compare the results of patch tests performed before and after the initiation of dupilumab and the prevalence of comorbid ACD in patch-tested individuals.
A minority of patch test reactions were “lost” on dupilumab (13/125; 10.4%). Five of 13 lost reactions occurred in individuals with documented immunodeficiency. Thirty-two of 35 patch-tested patients (91.4%) had comorbid ACD; 92.3% of individuals patch tested on dupilumab experienced further clinical improvement with allergen avoidance.
This is a nonrandomized study in a small cohort of patients. The clearance of dupilumab was assessed by subjective patient reports.
Dupilumab does not appear to exert a dampening effect on patch test results. AD with comorbid ACD was highly prevalent and allergen avoidance resulted in significant improvement in residual dermatitis that had not resolved without dupilumab therapy.
Background
Common pesticides used in the region by agricultural workers may cause contact allergy.
Methods
Thirty agricultural workers with a history of pesticide exposure and dermatitis involving ...the face, neck, trunk or extremities, and 20 controls comprising 2 groups of 10 subjects each, group 1 with dermatitis and no exposure to pesticides, and group 2 with neither exposure to pesticides nor dermatitis, were patch tested with 10 pesticides commonly used in the region by use of the Finn Chamber method.
Results
The 30 patients, 20 of whom were male, aged 30‐77 years, had dermatitis for 1 month to 18 years, with relapses and remissions. Seasonal exacerbation was present in 18 patients. Six patients attributed aggravation of their dermatitis to pesticide exposure, and 2 of these reacted positively to propiconazole. Positive patch test reactions to pesticides occurred in 10 patients, but not in controls. Thiuram was the commonest sensitizer (4 patients). Three patients were sensitized to propiconazole, and 2 patients reacted positively to metaldehyde. Formaldehyde, mercaptobenzothiazole, cypermethrin and isoproturon gave positive reactions in 1 patient each.
Conclusion
The sensitizing potential of pesticides remains a concern. Apparently, pesticide contact dermatitis is more common than expected, but remains under‐reported, as the implicated pesticides vary across regions and according to the crop patterns.
Summary
Background
The Global Burden of Disease (GBD) Study provides an annually updated resource to study disease‐related morbidity and mortality worldwide.
Objectives
Here we present the burden ...estimates for atopic dermatitis (AD), including data from inception of the GBD project in 1990 until 2017.
Methods
Data on the burden of AD were obtained from the GBD Study.
Results
Atopic dermatitis (AD) ranks 15th among all nonfatal diseases and has the highest disease burden among skin diseases as measured by disability‐adjusted life‐years (DALYs). Overall, the global DALY rate for AD in 1990 was 121 95% uncertainty interval (UI) 65·4–201 and remained similar in 2017 at 123 (95% UI 66·8–205). The three countries with the highest DALY rates of AD were Sweden (327, 95% UI 178–547), the UK (284, 95% UI 155–478) and Iceland (277, 95% UI 149–465), whereas Uzbekistan (85·1, 95% UI 45·2–144), Armenia (85·1, 95% UI 45·8–143) and Tajikistan (85·1, 95% UI 46·1–143) ranked lowest.
Conclusions
The global prevalence rate of AD has remained stable from 1990 to 2017. However, the distribution of AD by age groups shows a bimodal curve with the highest peak in early childhood, decreasing in prevalence among young adults, and a second peak in middle‐aged and older populations. We also found a moderate positive correlation between a country’s gross domestic product and disease burden. GBD data confirm the substantial worldwide burden of AD, which has remained stable since 1990 but shows significant geographical variation. Lifestyle factors, partially linked to affluence, are likely important disease drivers. However, the GBD methodology needs to be developed further to incorporate environmental risk factors, such as ultraviolet exposure, to understand better the geographical and age‐related variations in disease burden.
What is already known about this topic?
Atopic dermatitis (AD) is a common skin condition affecting around 20% of children and up to 10% of adults in high‐income countries.
There is a sparsity of studies that have taken a truly global approach, in particular among adult populations.
What does this study add?
We provide the first global map of the burden of AD across age groups, including disability‐adjusted life‐years.
This ranks AD 15th among nonfatal diseases overall and top among skin diseases.
The burden of AD has remained stable between 1990 and 2017, with the highest prevalence rate seen during early childhood and a second rise from middle age.
Plain language summary available online
Allergic contact dermatitis (ACD) is a serious health and socio-economic problem. Accurate and reliable assessment of exposure to ACD factors in the work environment would increase quality of life ...and work of employees. The aim of this study was to assess the level of exposure of workers of a multidisciplinary hospital to the factors causing ACD.
: The proprietary OSDES-16 questionnaire was used. The effectiveness of the OSDES-16 was confirmed statistically. The study included 230 employees of the medical center in Polanica Zdrój, divided into groups.
: The differences in the overall assessment of exposure between the individual groups in the OSDES-16 scale were statistically insignificant (
> 0.05). There was no significant correlation between the current workplace and the level of exposure to ACD (
> 0.05). The level of exposure to ACD in the group of employees with work experience in the current position for more than 10 years was significantly higher than those working less than 6 years (
< 0.05).
: Nurses, midwives and paramedics are the occupational group most exposed to the development of contact allergy related to exposure to factors present in the work environment. The seniority of more than 10 years in the current position was linked with a higher level of occupational exposure.
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