Methyl Paraben May Increase the Risk of Pruritus in African Americans Whereas Triclosan Is Inversely Associated With Pruritus and Eczema Background Phenols and parabens (P&Ps) are commonly found in skin care products. However, P&Ps' role in pruritus and eczema has not been studied. Objective The aim of the study was to investigate the association between P&Ps, and pruritus and eczema. Methods This is a cross-sectional population-based study of 2202 participants. We examined the association between urinary phenols (triclosan, bisphenol A, benzophenone-3) and parabens (methyl and propyl parabens) and itchy rash/eczema using the 2005–2006 National Health and Nutrition Examination Survey database. Phenols and parabens were divided into quartiles (Qs) with the first Q as the reference. We calculated odds ratios and 95% confidence intervals, adjusting for multiple variables. Results Urinary triclosan was inversely associated with itchy rash (P trend = 0.048). In a subpopulation analysis by race/ethnicity, urinary methyl paraben was positively associated with itchy rash in African Americans (fourth Q vs first Q: odds ratio, 12.60; 95% confidence interval, 1.03–154.06; P trend = 0.02). Triclosan was inversely associated with eczema in whites (P trend = 0.04). Conclusions Methyl paraben exposure may increase the risk of itchy rash in African Americans, whereas triclosan may decrease the risk of itchy rash and eczema. The potential effect of triclosan and methyl paraben in pruritus and eczema warrants further study. Address reprint requests to Sooyoung Kim, MD, 601 N Caroline St, Ste 8033, Baltimore, MD 21287. E-mail: skim424@jhmi.edu. K.A.C.'s work on the project was funded by the Johns Hopkins Institute for Clinical and Translational Research, under grant number UL1 TR001079 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research. The authors have no conflicts of interest to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dermatitisjournal.com). © 2019 American Contact Dermatitis Society

Do it Yourself Without Allergic Contact Dermatitis: Safe Household Cleaning Product Alternatives No abstract available

Etiological Contact Allergen Chemical Identification and Confirmation Identification of the etiological chemical agent(s) associated with a case(s) of allergic contact dermatitis (ACD) is important for both patient management and public health surveillance. Traditional patch testing can identify chemical allergens to which the patient is allergic. Confirmation of allergen presence in the causative ACD-associated material is presently dependent on labeling information, which may not list the allergenic chemical on the product label or safety data sheet. Dermatologists have expressed concern over the lack of laboratory support for chemical allergen identification and possibly quantification from patients' ACD-associated products. The aim of the study was to provide the clinician a primer to better understand the analytical chemistry of contact allergen confirmation and unknown identification, including types of analyses, required instrumentation, identification levels of confidence decision tree, limitations, and costs. Address reprint requests to Paul D. Siegel, PhD, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Rd, Morgantown, WV 26505. E-mail: pds3@cdc.gov. The authors have no funding or conflicts of interest to declare. This study involved the use of resources and facilities at the Minneapolis Veterans Affairs Medical Center as well as the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention. The contents do not represent the views of the US Department of Veterans Affairs or the US Government. The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. © 2019 American Contact Dermatitis Society

Unilateral Allergic Contact Dermatitis Due to Timolol in Eye Drops Used for Treating Glaucoma in a Patient With Sturge-Weber Syndrome and a Choroidal Hemangioma No abstract available

Genipin in Temporary Jagua Tattoos—Another Black Dye Causing Severe Allergic Contact Dermatitis No abstract available

Contact Allergy to and Other Adverse Effects of Fragrances: A Brief Overview This article gives an overview of fragrance allergy. The following subjects are discussed: composition of perfumes, contact with fragrances, diagnosing fragrance allergy, frequency of allergy, clinical picture of allergic contact dermatitis, culprit products, occupational contact dermatitis, and other adverse effects of fragrances. For diagnosing fragrance sensitization, personal products and a fragrance series may need to be tested in addition to the baseline series. In the general adult population, up to 4.5% may be allergic to fragrance materials, and in consecutive patients patch tested for suspected contact dermatitis, the frequency may reach 20% to 25%. More than 150 fragrances have caused contact allergy. The most frequent sensitizers are linalool and limonene hydroperoxides, hydroxyisohexyl 3-cyclohexene carboxaldehyde, treemoss and oakmoss absolute, isoeugenol, cinnamyl alcohol, and cinnamal. Culprit products for induction of sensitization are often deodorants, fine fragrances, and aftershaves. Occupational contact dermatitis from fragrances is seen occasionally. Other adverse effects are all discussed but occur infrequently. Address reprint requests to Anton C. de Groot, MD, PhD, acdegroot publishing, Schipslootweg 5, 8351 HV Wapserveen, the Netherlands. E-mail: antondegroot@planet.nl. The author has no funding or conflicts of interest to declare. Anton de Groot is the author of the book Monographs in Contact Allergy, Volume II—Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019, to which is referred repeatedly in this article. © 2019 American Contact Dermatitis Society

Important New Fragrance Allergens. II. Limonene Hydroperoxides Limonene is a fragrance widely used in cosmetics and household products. Until recently, contact allergy to limonene was considered rare because positive patch tests to it were infrequently observed. In recent years, however, it has been demonstrated that exposure of limonene to oxygen (air) results in the formation of a number of oxidation products, of which the hydroperoxides have a far stronger sensitizing potency than the pure compound. By routine testing of patients suspected of contact dermatitis with hydroperoxides of limonene, high frequencies of positive reactions were found, indicating that these chemicals are important fragrance allergens. It should be realized, however, that a number of “positive” reactions may well be false-positive, irritant responses. Address reprint requests to Anton de Groot, MD, PhD, Schipslootweg 5, 8351 HV Wapserveen, the Netherlands. E-mail: antondegroot@planet.nl. The author has no funding or conflicts of interest to declare. Anton de Groot is the author of the book Monographs in Contact Allergy, Volume II—Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019, to which is referred repeatedly in this article. © 2019 American Contact Dermatitis Society

Adverse Events Attributed to the Sterilization Method Essure: Failure to Demonstrate a Causal Association With Nickel Sensitization Background Essure is an effective method for hysteroscopic sterilization. Reports of adverse effects, the underlying mechanisms of which are unknown, have increased in recent years. Objective The aim of the study was to determine whether there is a relationship between adverse events attributed to Essure and nickel sensitization. Methods Patients presenting alleged adverse reactions to Essure were referred for nickel patch testing before removal. Data regarding medical history of nickel sensitization and symptoms attributed to Essure were collected. Dimethylglyoxime spot tests were performed on the explanted Essure. There was a follow-up at 3 months to evaluate whether there is improvement of the symptoms after Essure removal. Conclusions Nickel sensitization via the classic delayed hypersensitivity pathway did not seem to be responsible for adverse events attributed to Essure. Among systemic symptoms reported, extracutaneous symptoms had the highest prevalence. Systemic contact dermatitis to nickel could not be ruled out in one case. Address reprint requests to Nadia Raison-Peyron, MD, Department of Dermatology, Allergology Unit, Saint Eloi Hospital, 80 Ave Fliche, Univ Montpellier, CHU Montpellier, 34295 Montpellier cedex 5, France. E-mail: n-raison@chu-montpellier.fr. This study was funded by the Montpellier University Hospital, Montpellier, France. The authors have no conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Painting a Picture of Paint-Related Methylisothiazolinone Allergy in the United States No abstract available

Allergic Contact Dermatitis–Induced Stereospecificity Overview Frequent allergens are known, but not whether allergens are enantiomer specific. Chemicals were tested on guinea pigs and humans to answer this question. Frullanoides showed evident allergic enantiospecificity, whereas the conclusion was shaded for α-methylene-γ-butyrolactone. A link between this chemical and chronic actinic dermatitis was proposed. No clear tendency to enantio-stereospecificity in inducing allergic contact dermatitis was ascertained. Future studies using contemporary analytical chemistry and new immunologic knowledge have to be undertaken to provide clearer mechanistic insights. This information may aid in attempts to decrease product allergenicity. Address reprint requests to Alix Danoy, MS, 6 rue des Pyrénées, 31130 Flourens, France. E-mail: alix.danoy@gmail.com; or Howard I. Maibach, MD, Department of Dermatology, University of California, San Francisco, 90 Medical Center Way, Box 0989, Surge Bldg, Room 110, San Francisco, CA 94143. E-mail: Howard.maibach@ucsf.edu. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society