Patch Testing With Formaldehyde 2.0% (0.60 mg/cm2) Detects More Contact Allergy to Formaldehyde Than 1.0% Background The International Contact Dermatitis Research Group increased the patch test concentration of formaldehyde from 1.0% aqueous (aq) to 2.0% aq (in 2011). Objective This study was designed to investigate the outcome of the decision. Methods Consecutive dermatitis patients in 8 different clinics were patch tested with formaldehyde 1.0% aq and 2.0% aq. The test solutions were applied with a micropipette to the filter paper discs in the respective chamber. Results A total of 2778 patients were tested with 1.0% aq and 2766 to 2.0% aq. Sixty-five patients (2.3%, calculated from 2766 tested, to 2.0% aq) had positive patch test reactions interpreted as contact allergy to formaldehyde. This is a rather low frequency. Of these 65, 46 were women (46/1703 [2.7%]) and 19 were men (19/1063 [1.8%]). Thirty-six reacted only to 2.0% aq, 21 patients reacted to both concentrations, and 8 patients reacted only to 1.0% aq. Significantly, more patients reacted to 2.0% aq compared with 1.0% aq (P < 0.001). There was no significant sex difference. A total of 0.8% irritant reactions were recorded to formaldehyde 2.0% aq and 0.1% to 1.0% aq. Conclusions The increased formaldehyde patch test concentration to 2.0% aq revealed more formaldehyde contact allergy. Address reprint requests to Marléne Isaksson, MD, PhD, Department of Occupational and Environmental Dermatology, Jan Waldenströms gata 16, SE 205 02, Malmö, Sweden. E-mail: marlene.isaksson@skane.se. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Effectiveness of Dupilumab for the Treatment of Generalized Prurigo Nodularis Clinical Phenotype of Adult Atopic Dermatitis Background Generalized prurigo nodularis (GPN) is a debilitating, inflammatory skin disease characterized by chronic pruritus, signs of prolonged scratching, and multiple pruriginous papules and nodules. Recent studies identified several forms of GPN as a clinical phenotype of adult atopic dermatitis (AD). Objective The aim of the study was to evaluate the effectiveness of dupilumab (D) in adults affected by persistent AD showing a clinical feature of GPN. Methods A retrospective study was performed on adult patients affected with GPN clinical variant of AD, treated with D from July 2018 to March 2019. Atopic dermatitis severity was evaluated using the Eczema Area and Severity Index, visual analog scales ranging from 0 to 10 for pruritus, and Dermatology Life Quality Index. Results Ninety AD patients (52 males [57.7%]; mean age = 44.6 years; range = 18–66 years) were treated with D. In 9 (10.0%) of 90 cases, GPN pattern was observed. A significant improvement in Eczema Area and Severity Index, Dermatology Life Quality Index, and pruritus visual analog scale score was instead observed after treatment with D. Conclusions Generalized prurigo nodularis is currently also considered as a rather common clinical pattern of adult AD. Dupilumab can be an efficacious treatment of this condition, especially in cases where history of atopy is recorded and conventional treatments are ineffective. Address reprint requests to Maddalena Napolitano, MD, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, via Francesco De Santis snc, 86100, Campobasso, Italy. E-mail: maddy.napolitano@gmail.com. The authors have no funding or conflicts of interests to declare. © 2019 American Contact Dermatitis Society

Willingness to Participate in Atopic Dermatitis Research Studies and Clinical Trials No abstract available

Allergens in Medical Hand Skin Cleansers: Product Review and Alternatives Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens (Dermatitis 2017;28(2):141–143) found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of “low-allergen” medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time. Address reprint requests to Amber Reck Atwater, MD, Department of Dermatology, Duke University Medical Center, 5324 McFarland Dr, #210, Durham, NC 27707. E-mail: amber.atwater@duke.edu. A.R.A. received a Pfizer Independent Grant for Learning and Change. L.G.R.-H. has no funding or 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

Expanded Series and Personalized Patch Tests for Children: A Retrospective Cohort Study Background Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children. Objective The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures. Methods Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis. Conclusions Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD. Address reprint requests to Carrie C. Coughlin, MD, Division of Dermatology, Department of Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8123, St Louis, MO 63110. E-mail: coughlinc@wustl.edu. The authors have no funding or conflicts of interest. © 2019 American Contact Dermatitis Society

Prevalence of Common Surfactant Groups and Individual Surfactants in Contact Allergen Management Program Background Surfactants are common ingredients in topical products, which can cause both irritant and allergic contact dermatitis. Objective The aim of this study was to determine the prevalence of 12 common groups of surfactants and 12 common individual surfactants in each product category in the American Contact Dermatitis Society Contact Allergen Management Program (CAMP). Methods The American Contact Dermatitis Society CAMP was queried for the 12 surfactant groups and the 12 individual surfactants. Results The laureth/pareth sulfate group was the most prevalent surfactant group in CAMP (17.9%). Laureth/pareth sulfates were the most common surfactant group in all product categories, except household and eye care products. The betaine/sultaine group (13.5%) and glucosides (10.0%) were also found in a significant proportion of CAMP products. Oleamidopropyl dimethylamine has the highest positive reaction rate (3.5%) but was tied for the lowest prevalence (0.20%) of the 12 individual surfactants studied. In contrast, cocamidopropyl betaine has a lower positive reaction rate (1.6%) with a higher prevalence (10.4%). Conclusions Surfactants were commonly found across all product types in CAMP. This study provides important information on allergen and irritant exposures in care products. Address reprint requests to Annika P. Weinhammer, MD, 408 LaBelle Lane, Monona, WI 53716. E-mail: AWeinhammer@uwhealth.org. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Reactivation of Alopecia Areata After Dupilumab Therapy for Atopic Dermatitis No abstract available

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