Browsing by Author "Becker, Detlef"

Abstract Background Earlier studies suggested a potential association between tobacco smoking and nickel sensitization, but little is known about other contact allergens. Objectives To investigate the association of smoking status and contact sensitizations as well as subtypes of dermatitis, and to analyse the sensitization profiles of tobacco smokers. Patients and Methods Within the Information Network of Departments of Dermatology (IVDK), we performed a cross‐sectional multicentre pilot study comprising 1091 patch‐tested patients from 9 departments, comparing 541 patients with a history of cigarette smoking (281 current and 260 former smokers) with 550 never‐smokers. Results We could not confirm the previously reported association between nickel sensitization and tobacco smoking. Moreover, sensitizations to other allergens, including colophony, fragrance mix I, Myroxylon pereirae and formaldehyde, were not increased in cigarette smokers compared with never smokers. Hand dermatitis (50.6% vs. 33.6%) and occupational cause (36.2% vs. 22.5%) were significantly more frequent among cigarette smokers compared with never‐smokers as shown by non‐overlapping 95% confidence intervals. Conclusions Although our study does not allow a firm conclusion on whether smoking status contributes to certain contact sensitizations, it confirms an association of smoking with hand dermatitis and occupational cause.

Background: Hidden allergen exposure may contribute to persistence and relapse of chromate dermatitis. According to case reports, chromated metal products, such as screws, fittings, etc., may be relevant allergen sources for patients sensitized to chromate. Objectives: To examine concomitant patch test reactivity to potassium dichromate 0.5% petrolatum ( pet.) and three different types of chromated metal rings. Patients/Methods: Patients with proven or suspected chromate allergy were patch tested with potassium dichromate 0.5% pet. and three different types of chromated metal rings ( yellow, olive, and black). Hexavalent chromium Cr(VI) release from the patch tested rings was chemically analysed. Results: Ninety-five patients were tested: 49/95 (52%) reacted to potassium dichromate and 25/95 (26%) reacted to black chromated rings. Reactions to chromated rings exclusively occurred in patients reacting to potassium dichromate. Of 20 patients with a strong reaction to potassium dichromate, 14 reacted to black chromated rings. These were shown to have a high Cr(VI) release. Only two patients reacted to the other chromated rings, which had a very low Cr(VI) release. Conclusions: Handling chromated metal products must be regarded a hazard to chromate-sensitive patients, in particular those with a strong sensitization.

p-Phenylenediamine (PPD) 1% in petrolatum has been shown in a prospective study to elicit late reactions in 1.5% of routine patch tests, which may be indicative of patch test sensitization. Objectives. To assess the frequency of late reactions to reduced PPD patch test concentrations. Methods. In 1838 patients, PPD was tested at three concentrations (0.5% pet., group I; 0.4% pet., group II; and 0.35% pet., group III). Patch tests were read on D1 (D2) to D3 (D4); additional late readings were performed on D7, D14, and D21. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14, and D21, and questioned about a reaction at the patch test sites. Results. Data of 1666 patients (1069 women and 597 men) were eligible. Late reactions were observed in 9 patients, 3 in group I (0.49%) and 5 in group II (0.63%). In 7 of 8 of the patients with late reactions, patch tests were applied for 48 hr. On retesting, 4 of 5 patients became positive at D2 or D3. Conclusions. The occurrence of late reactions to PPD may be influenced by patch test concentration and duration. PPD 0.4-0.5% pet. may cause late reactions indicative of active sensitization.

Background: Although many allergens in metalworking fluids (MWF) are identified, there are still some MWF components, which are not sufficiently investigated concerning their sensitizing properties. Objectives: To investigate sensitization to 10 frequently used MWF components, which are not part of the established MWF test series, in metalworkers with suspected occupational dermatitis due to MWF. Patients/Methods: Oleyl alcohol, myristyl alcohol, dimethylolurea, 4,4'-methylenebis morpholine, imazalil, 1-amino-2-propanol (monoisopropanolamine; MIPA), 2-amino-2-ethyl-1,3-propanediol (AEPD), 2,5-bis(n-octyldithio)-1,3,4-thiadiazole, zinc alkyl dithiophosphate and dibenzyl disulfide have been patch tested in 144 patients. Results: 7 patients reacted positively to the formaldehyde releaser 4,4'-methylenebis morpholine, and 6 of these patients also reacted to formaldehyde and/or other formaldehyde releasers. 4 patients reacted positively to myristyl alcohol tested at 10% petrolatum (pet.). Additionally, 20 doubtful or irritant reactions occurred. 1 patient each reacted positively to oleyl alcohol, MIRA, and AEPD. None of the other test substances mentioned above elicited any clear-cut positive reaction. Patch testing with well-known MWF allergens showed proportions of positive reactions, which were comparable to those from other studies, e.g. 11% to monoethanolamine, 8% to colophonium and 3%-5% to various preservatives. Conclusions: 4,4'-methylenebis morpholine may be an important MWF allergen, although clinical relevance could not be stated definitely in every case. Myristyl alcohol should not be patch tested at 10% pet., but at a lesser concentration, due to irritant properties.

Background: Psoriasis is an immune-mediated disease with a genetic background. Local psoriatic changes can be triggered by exogenous mechanical or irritant factors. Causative occupational factors have to be distinguished from the spontaneous course of psoriasis in occupational medical evaluations. The objective of this work is to demonstrate the medico-legal grounds for a homogenous assessment. Patients and methods: The presented recommendations were developed in a working group for Occupational and Environmental Dermatology (ABD) and the German contact dermatitis group (DKG) of the German Dermatologic Society (DDG) based on the German medico-legal framework. Results: Causality between the insured activity and the appearance of psoriasis is a prerequisite for the recognition of the occupational nature of the disease. This is the case if the occupational activity is the exclusive or a legally essential contributing factor either for first manifestation or aggravation of the disease. A connection must be denied if everyday events are sufficient to trigger the psoriasis. From 1995 to 2010, 130 cases of psoriasis have been recognized as occupationally related by the German statutory accident insurance. Conclusions: The appraisal of psoriatic disease in the occupational medical evaluation is subject to the case assessment of the expert witness. In this position paper we present recommendations for a homologous basis for diagnosis, causality assessment, estimation of reduction in earning capacity and rehabilitation of occupational psoriasis.

Summary Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board‐certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed‐type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note : This publication is part 1 of the short version of the S3 guidelines for “Epicutaneous patch testing using contact allergens and drugs” (registry no. 013 – 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org . The method report is available as online publication ( https://www.awmf.org/leitlinien/detail/ll/013‐018.html ) and contains the evidence tables in its appendix.

Zusammenfassung Der diagnostische Standard zum Nachweis einer bestehenden allergischen Kontaktdermatitis ist der Epikutantest. Die vorliegende Leitlinie richtet sich an Assistenz‐ und Fachärzte der Dermatologie, Allergologie und Ärzte weiterer Fachgruppen in Klinik und Praxis, die an der Indikationsstellung oder Durchführung von Epikutantests bei Patienten mit Kontaktekzemen und weiteren Spättypallergien beteiligt sind, sowie Kooperationspartner der Ärzteschaft (Fachberufe im Gesundheitswesen, Kostenträger). Die Leitlinie zur Durchführung des Epikutantests mit Kontaktallergenen wurde auf der Basis einer systematischen Literatursuche zu definierten Schlüsselfragen evidenzbasiert und im formellen Konsensusverfahren (S3) von Dermatologen unter Einbindung von Pädiatern, Arbeitsmedizinern, Assistenzpersonal und Patientenvertretern erstellt. Bezüglich der methodischen und inhaltlichen Arbeit, auf denen die Empfehlungen basieren, wird auf Methodenbericht und Evidenztabellen verwiesen. Die Leitlinie stellt allgemeine Aspekte der Epikutantestung sowie medizinrechtliche Aspekte dar. Es werden Empfehlungen gegeben zur Indikationsstellung, Patientenaufklärung, Auswahl von Testsubstanzen und Kammersystemen, Expositionsort, ‐dauer und Ablesezeitpunkten, Interpretation von Testreaktionen, endogenen und exogenen Einflussfaktoren, Testung besonderer Personengruppen (Kinder, Schwangere, Immunsupprimierte) sowie Risiken und unerwünschten Nebenwirkungen bei der Durchführung des Epikutantests mit Kontaktallergenen.

Abstract Background Sensitization to methylisothiazolinone (MI) has seen an exceptional epidemic, mainly attributed to its use in cosmetics. Objectives To trace the epidemic of MI allergy (2009–2018), and to analyze a possible change of patients' characteristics. Methods Informationsverbund Dermatologischer Kliniken‐data of patients patch tested between 2009 and 2018 with MI (0.05% aq.) were analyzed concerning anamnestic items and sensitization frequencies. Results Overall, 4.9% reacted positive to MI. Comparing sensitization to MI in three periods (2009, 2013/14, and 2017/18), there was an increase to 7% in 2013 and a decrease to 3.4% in 2018. The MOAHLFA Index (M=Men, O=Occupational Dermatitis, A=Atopic Dermatitis, L=Leg Dermatitis, F=Face Dermatitis, A= Age > 40) for the period 2013/14 is characterized by a lower proportion of occupational dermatitis and a higher proportion of face dermatitis. The period 2017/18 is characterized by increases of occupational dermatitis and hand dermatitis, and a decrease of face dermatitis. Painters, personal care workers, and hairdressers were particularly affected. Sensitization in hairdressers and personal care workers (mostly cosmeticians) decreased after the peak in 2013/14, whereas sensitization to MI in painters continued to increase. Conclusions After an unprecedented epidemic of MI allergy, mainly caused by its use in cosmetics, the continuous use of MI in industrial applications, for example, paints, and subsequent sensitization remain a matter of concern.

Background: The proper reading of patch test (PT) reactions, based on morphological criteria, is of utmost importance. Digital images are increasingly used for medical training. Objectives: To assess the diagnostic validity of readings of 20 digital images of various PT reaction grades by congress attendants. Methods: 122 volunteers took a PT quiz offered during the 8th ESCD meeting, September 2006, Berlin. No information on the respective allergen was given, nor the gold standard grading determined by an European Environmental and Contact Dermatitis Research Group (EECDRG) expert panel was disclosed while the quiz was open. Results: Overall, 63.5% of all ratings agreed 'exactly' with the gold standard, and 87.8% 'grossly', that is, with regard to the distinction between non-positive [doubtful or irritant (IR)] and positive (+, ++, and +++) reactions. Most images prompted a fair proportion of correct classifications. The distinction between doubtful and + and between +++, and strong bullous IR reactions proved partly difficult, probably because of blinding of the test substance. The least experienced in particular tended to misclassify IR reactions. Conclusions: The rating of digital images of PT reactions represents just 1 particular, isolated aspect of PT evaluation. Results were largely valid. Thus, the method could be used for continuing medical education, and for standardization in multicentre networks.