Contact Dermatitis (eBook)

Preface to the Fifth Edition 6
Contents 7
1: Historical Aspects 12
1.1 Introduction 12
1.2 Historical Aspects of Patch Testing 13
1.2.1 The Pre-Jadassohn Period 13
1.2.2 Josef Jadassohn, the Father of Patch Testing in Dermatology 13
1.2.3 Jean-Henri Fabre’s Experiments 14
1.2.4 A General Overview of Patch Testing During the Period 1895–1965 15
1.2.5 Bruno Bloch’s Pioneering Work in Basel and in Zurich 15
1.2.6 The Influence of Poul Bonnevie in Scandinavian Countries 16
1.2.7 A Controversial Period: The Pros and Cons of a Standard Series 17
1.2.8 Marion Sulzberger, the Initiator of Patch Testing in North America and Alexander Fisher, a World Leader in the Field of C 17
1.2.9 The Founding of Groups 17
1.2.10 The Founding of the European Environmental and Contact Dermatitis Research Group (EECDRG) and the European Society of Co 18
1.2.11 Dermatochemistry and Contact Dermatitis 18
1.2.12 Recent Advances in the Management of Patch Testing 18
1.3 Historical Aspects of Prick Testing 19
References 19
Part 1: Basic Features 21
2: Genetics and Individual Predispositions in Contact Dermatitis 22
2.1 General Introduction 23
2.2 Genetic Factors in Allergic Contact Dermatitis1 23
2.2.1 Early Studies in the Genetics of Contact Allergy 24
2.2.1.1 Experimental Sensitization 24
2.2.1.2 Family Studies 25
2.2.1.3 Twin Studies 25
2.2.1.4 Studies of Immunogenetic Markers 26
2.2.2 In Search of the Phenotype of Contact Allergy: Polysensitization 26
2.2.3 Polymorphisms in Allergic Contact Dermatitis 27
2.2.3.1 Tumor Necrosis Factor (TNF) 28
Studies of TNF Polymorphisms in ACD (See Table 2.4) 28
2.2.3.2 Interleukin-16 31
Studies of IL-16 Polymorphisms in ACD 31
2.2.3.3 N-Acetyltransferase 1 and 2 (NAT1/NAT2) 31
Studies of NAT: Polymorphisms in ACD 32
2.2.3.4 Glutathione Transferases M1 and T1 (GSTM1 and GSTT1) 33
Studies of GSTM1 and GSTT1 Polymorphisms in ACD 34
2.2.3.5 Manganese Superoxide Dismutase 34
Studies of the MnSOD Polymorphisms in ACD 34
2.2.3.6 Angiotensin-Converting Enzyme 35
Studies of the ACE Polymorphisms in ACD 35
2.2.3.7 Filaggrin 35
Studies of FLG Mutations in ACD 35
2.2.3.8 General Remarks on the Study of “Candidate Gene” Polymorphisms in ACD 36
2.3 Irritant Contact Dermatitis 37
2.3.1 Individual Variability in Irritant Responses in Healthy Individuals 38
2.3.2 Predisposition Related to Specific Phenotypes 39
2.3.2.1 Atopic Dermatitis 39
2.3.2.2 Sex 40
2.3.2.3 Age 40
2.3.2.4 Ethnicity 40
2.3.2.5 Other Skin Diseases 41
2.3.2.6 Regional Differences 41
2.3.2.7 Skin Type 41
2.3.2.8 Body Mass Index 41
2.3.3 Genetic Predisposing Factors 42
References 43
3: Mechanisms of Irritant and Allergic Contact Dermatitis 52
3.1 Introduction 52
3.2 Irritant Contact Dermatitis 52
3.2.1 Skin Barrier Perturbation Can Lead to Irritant Contact Dermatitis 52
3.2.2 Pathogenesis of Acute Irritant Contact Dermatitis 53
3.2.3 Development of Chronic Irritant Contact Dermatitis 55
3.2.4 Genetic Risk Factors in Irritant Contact Dermatitis and Atopic Dermatitis 56
3.2.5 Cellular Immunological Changes in Irritant Contact Dermatitis 56
3.3 Introduction Allergic Contact Dermatitis 57
3.3.1 Binding of Contact Allergens to Skin Components 59
3.3.1.1 Chemical Nature of Contact Allergens 59
3.3.1.2 Hapten Presentation by Langerhans Cells (LC) 60
3.3.1.3 Pre and Prohaptens 60
3.3.2 Hapten-Induced Activation of Allergen-Presenting Cells 61
3.3.2.1 Physiology of Langerhans Cells 61
3.3.2.2 Hapten-Induced LC Activation 61
3.3.3 Recognition of Allergen-Modified Langerhans’ Cells by Specific T Cells 63
3.3.3.1 Homing of Naive T Cells Into Lymph Nodes 63
3.3.3.2 Activation of Hapten-Specific T Cells 64
3.3.4 Proliferation and Differentiation of Specific T Cells 66
3.3.4.1 T-Cell Proliferation 66
3.3.4.2 T-Cell Differentiation 66
3.3.4.3 Cytokine Environment 67
3.3.4.4 Nature of the Allergen 68
3.3.4.5 Neuroendocrine Factors 68
3.3.5 Systemic Propagation of the Specific T-Cell Progeny 69
3.3.5.1 T-Cell Recirculation 69
3.3.5.2 Allergen-Specific T-Cell Recirculation: Options for In Vitro Testing 72
3.3.6 The Effector Phase of Allergic Contact Dermatitis 73
3.3.6.1 Elicitation of ACD 73
3.3.6.2 Irritant Properties of Allergens 73
3.3.6.3 Early Phase Reactivity 74
3.3.6.4 T-Cell Patrol and Specificity of T-Cell Infiltrates 75
3.3.6.5 Effector T-Cell Phenotypes 75
3.3.6.6 Downregulatory Processes 76
3.3.7 Flare-Up and Retest Reactivity 77
3.3.7.1 Local Allergen Retention 77
3.3.7.2 Local T-Cell Retention 77
3.3.8 Hyporeactivity: Tolerance and Desensitization 80
3.3.8.1 Regulation of Immune Responses 80
3.3.8.2 Cellular Basis of Active Tolerance 81
3.3.8.3 Regulatory Mechanisms of the Effector Phase 82
3.3.8.4 Redundancy of Tolerance Mechanisms 83
3.3.8.5 Induction of Lasting Tolerance Only in Naive Individuals 83
3.3.8.6 Transient Desensitization in Primed Individuals 83
3.4 Summary and Conclusions 84
References 84
4: Molecular Aspects in Allergic and Irritant Contact Dermatitis 100
4.1 Introduction 100
4.2 Chemical Interactions 100
4.2.1 Weak Interactions 101
4.2.2 Strong Interactions 101
4.2.3 Heterolytic or Nucleophilic–Electrophilic Reactions 102
4.2.4 Homolytic or Radical Reactions 103
4.2.5 Coordination Bonds 103
4.3 Chemical Aspects of Allergic Contact Dermatitis 103
4.3.1 Reactive Amino Acids 104
4.3.2 Reactivity of Haptens 105
4.3.3 Mechanisms of Reactions 105
4.4 Modifications of Molecules 107
4.4.1 Enzymatic Processes: Prohaptens 107
4.4.2 Nonenzymatic Processes: Prehaptens 108
4.5 Haptens and Cross-Allergies 108
4.6 Some Applications of the Chemical Knowledge 109
4.6.1 Understanding Cross-Reactions Among Corticosteroids 109
4.6.2 Development of Quantitative Structure-Activity Relationships (QSARs) 112
4.6.2.1 Introduction 112
4.6.2.2 Example of Fragrance Aldehydes 113
4.6.2.3 Predictive Tests Based on Hapten Reactivity 113
Introduction 113
The Direct Peptide Reactivity Assay (DPRA) 114
4.7 Molecular Aspects in Irritant Contact Dermatitis 115
4.7.1 Introduction 115
4.7.2 Acido-Basic Properties 115
4.7.3 Surfactants 115
4.7.4 Alkylating Agents 115
4.8 Conclusion 117
References 117
5: Bio-Guided Fractionation and Identification of Allergens in Complex Mixtures and Products 120
5.1 Introduction 120
5.2 The Principle of Bioassay-Guided Fractionation 121
5.3 The Principle Behind Structure-Activity Relationships in Allergic Contact Dermatitis 122
5.4 Combined Use of Bioassay-Guided Fractionation and SARs to Identify Allergens in Fragrance Complex Mixtures 123
5.4.1 General Methodology 124
5.4.2 The Case of an Eau de Toilette 124
5.4.3 The Case of Oak Moss 125
5.5 Conclusion 127
References 127
6: Role of the Permeability Barrier in Contact Dermatitis 129
6.1 Introduction 129
6.2 Barrier Physiology 129
6.3 Skin Lipids 131
6.4 Epidermal Proliferation and Differentiation 132
6.5 Tight Junctions and Desmosomal Proteins: A Second-Line Epidermal Barrier 134
6.6 Cytokine Signaling: Regulation of Epidermal Homeostasis and Repair 134
6.7 Experimental Barrier Disruption, Lipids and Protein Modification in Epidermal Differentiation 134
6.8 Barrier Disturbance in Contact Dermatitis 135
6.9 Pathological Skin Barriers: Skin Barrier Function in Dermatoses 135
6.10 Atopic Dermatitis as a Model for the Consequence of a Chronically Disturbed Barrier 135
6.11 Influence of the Permeability Barrier on the Immune System and Contact Dermatitis 136
6.12 Barrier and Patch Testing 138
6.13 Treatment Implications and Approaches: Restoring the Skin’s Protective Function 138
References 140
7: Immediate Contact Reactions 144
7.1 Introduction 144
7.2 Definitions, Concepts, and Symptoms 145
7.3 Mechanisms and Clinical Aspects of Nonimmunologic Immediate Contact Reactions 145
7.3.1 Histamine 145
7.3.2 Skin Nerves 146
7.3.3 Ultraviolet Light 146
7.3.4 Prostanoids 146
7.3.5 Molecular Structure 146
7.3.6 Agents Producing Nonimmunologic Immediate Contact Reactions 147
7.3.7 Tests in Animal Skin 147
7.3.8 Tests in Human Skin 148
7.3.8.1 Open Test 148
7.3.8.2 Chamber Test 148
7.3.8.3 Factors to be Considered in Skin Tests 148
7.4 Mechanisms and Clinical Aspects of Immunologic Immediate Contact Reactions 149
7.4.1 Induction 149
7.4.2 Elicitation 150
7.4.3 Agents Producing Immunologic Immediate Contact Reactions 150
7.4.4 Tests in Animals 156
7.4.5 Tests in Humans 156
References 157
8: Mechanisms of Phototoxic and Photoallergic Reactions 161
8.1 Introduction 161
8.2 Clinical Aspects of Photoallergic and Phototoxic Reactions 162
8.3 Phototoxicity: General Mechanisms 163
8.4 Some Examples of Specific Agents Capable of Causing Phototoxic Reactions 165
8.4.1 Psoralens 165
8.4.2 Porphyrins 166
8.4.3 Fluoroquinolones 166
8.4.4 Nonsteroidal Anti-Inflammatory Drugs 167
8.4.5 Amiodarone 167
8.5 Photoallergic Reactions: General Mechanisms 167
References 168
Part 2: Pathology 170
9: Histopathological and Immunohistopathological Features of Irritant and Allergic Contact Dermatitis 171
9.1 Introduction: General Considerations 171
9.2 Histopathological Features of Positive Allergic Patch Test Reactions 172
9.2.1 Epidermal Changes 172
9.2.2 Dermal Changes 173
9.3 Histopathological Features of Positive Irritant Patch Test Reactions 174
9.3.1 Epidermal Changes 175
9.3.2 Dermal Changes 176
9.4 Histopathological Criteria for Distinguishing Between Allergic and Irritant Patch Test Reactions in Humans 177
9.5 Comparative Immunohistochemical and Immunocytochemical Characteristics of Allergic and Irritant Patch Test Reactions in 179
9.5.1 Epidermal Langerhans Cells in Irritant and Allergic Positive Patch Test Reactions 179
9.5.2 Cells of the Infiltrate in Irritant and Allergic Positive Patch Test Reactions: Immunophenotypic Studies 179
9.6 Conclusions 180
References 180
10: Ultrastructure of Irritant and Allergic Contact Dermatitis 182
10.1 Introduction 182
10.2 Ultrastructural Changes in the Epidermis 183
10.2.1 Stratum Corneum 183
10.2.2 Viable Keratinocytes 183
10.2.2.1 Irritant Contact Dermatitis 183
10.2.2.2 Allergic Contact Dermatitis 186
10.2.3 Langerhans Cells 186
10.2.3.1 Allergic Contact Dermatitis 186
10.2.3.2 Irritant Contact Dermatitis 187
10.3 Ultrastructural Changes in the Dermis 191
10.4 Ultrastructural Changes in Chronic Contact Dermatitis 193
10.5 Summary 194
References 194
11: Epidemiology 196
11.1 Introduction 196
11.2 Measures of Disease Frequency 196
11.2.1 Source Population 197
11.3 Clinical Epidemiology 197
11.3.1 Description of (Patch Test) Patients 198
11.3.2 Special Aspects of the Analysis of Patch Test Data 199
11.4 Observational Studies 201
11.5 Case Ascertainment 202
11.6 Incidence and Prevalence of Contact Dermatitis and Contact Sensitisation 204
11.6.1 General Population 204
11.6.2 Incidence and Prevalence of Notified Occupational Contact Dermatitis 207
11.7 Incidence and Prevalence in Different Work Forces 209
11.8 Special Considerations: Confounding, Atopy, Interactions and Effect Modification 210
11.8.1 Classic Articles and Monographs 211
References 212
Part 3: Dermatotoxicology 215
12: Skin Penetration 216
12.1 Introduction 216
12.2 Diffusion 217
12.2.1 Fick’s Laws 217
12.3 Three-Compartment Model 217
12.4 The Skin Surface 218
12.4.1 Surface Contact 218
12.5 The Skin Barrier 218
12.5.1 Corneocytes 218
12.5.2 Intercellular Lipid 219
12.5.3 Appendages 219
12.5.4 Pathways Across the Stratum Corneum 220
12.5.5 Inter- and Intraindividual Variation in Skin-Barrier Function 221
12.6 Viable Tissue 221
12.6.1 Skin Metabolism 223
12.6.2 Resorption 223
12.6.3 The Influence of Pathologic Processes on Skin Barrier 224
12.6.4 Allergens 225
12.7 Vehicles 225
12.8 Conclusions 225
References 226
13: Predictive Tests for Irritants and Allergens and Their Use in Quantitative Risk Assessment 229
13.1 Introduction 229
13.2 Definitions 229
13.3 Predictive Tests for Irritants 230
13.4 Predictive Tests for Allergens 231
13.5 Quantitative Risk Assessment 233
13.5.1 Summary and Future Perspectives 234
References 237
14: Allergic Contact Dermatitis in Humans: Experimental and Quantitative Aspects 240
14.1 Introduction 240
14.2 Individual Variation 240
14.3 Exposure-Related Factors 241
14.4 Experimental Human Models 242
14.4.1 Serial Dilution Patch Test 242
14.4.2 The Repeated Open Application Test 243
14.4.3 The Axillary Exposure Test 244
14.4.4 The Shampoo Test 245
14.4.5 The Liquid Soap Test 245
14.4.6 The Finger Immersion Test/Experimental Hand Eczema 246
14.5 The Comparative Approach 247
14.6 Elicitation Data Used in Prevention and Regulations 247
References 248
Part 4: Clinical Features 251
15: Clinical Features 252
15.1 Introduction 252
15.2 The Medical History of the Patient 253
15.2.1 History of Hereditary Diseases 253
15.2.2 General Medical History 253
15.2.3 History of Previous Dermatitis 254
15.2.4 Time of Onset 254
15.2.5 History of Aggravating Factors 254
15.2.6 Course of the Dermatitis 256
15.2.7 Types of Symptoms 256
15.3 Clinical Features of Eczematous Reactions 256
15.3.1 Acute and Recurrent Dermatitis 256
15.3.2 Chronic Dermatitis 259
15.3.3 Nummular (Discoid) Eczema 259
15.3.4 Secondarily Infected Dermatitis 260
15.3.5 Clinical Features of Contact Dermatitis in Specific Groups of Persons 261
15.3.5.1 Gender 261
15.3.5.2 Children 261
15.3.5.3 Elderly Persons 261
15.3.5.4 Ethnicity 261
15.3.5.5 Atopy 261
15.4 Identifying the Cause of Contact Dermatitis from the Clinical Pattern 262
15.4.1 Clinical Patterns Indicating General Causes of Contact Dermatitis 262
15.4.1.1 Contact Pattern 262
15.4.1.2 Streaked Dermatitis in Exposed Areas 264
15.4.1.3 Airborne Contact Dermatitis 265
15.4.1.4 Mechanical Dermatitis 266
15.4.1.5 Hyperkeratotic Eczema 267
15.4.1.6 Ring Dermatitis 267
15.4.1.7 Follicular Reactions 267
15.4.1.8 Connubial and Consort Dermatitis 268
15.4.1.9 Recurrent Vesicular Hand and/or Foot Dermatitis 268
15.4.1.10 Fingertip Eczema (Pulpitis) 269
15.4.1.11 Eczema Nails 269
15.4.1.12 Papular and Nodular Excoriated Lesions 269
15.4.1.13 Contact Urticaria of the Hands and Lips 270
15.4.1.14 Clinical Patterns of Systemically Induced Contact Dermatitis 271
15.4.2 Characteristic Clinical Patterns of Dermatitis Associated with Specific Substances or Types of Application 271
15.4.2.1 Cement Ulcerations 271
15.4.2.2 Pigmented Contact Dermatitis 272
15.4.2.3 Caterpillar Dermatitis and Irritant Dermatitis from Plants and Animals 272
15.4.2.4 Head and Neck Dermatitis 272
15.4.2.5 Dermatitis from Transcutaneous Delivery Systems 272
15.4.2.6 Berloque Dermatitis 272
15.4.2.7 Stomatitis Due to Mercury or Gold Allergy 273
15.5 Regional Contact Dermatitis 273
15.5.1 Dermatitis of the Scalp 273
15.5.2 Dermatitis of the Face and Neck 274
15.5.2.1 The Lips 277
15.5.2.2 The Eyes and Eyelids 277
15.5.2.3 The Ear 278
15.5.3 Dermatitis of the Trunk 278
15.5.3.1 The Axillary Region 279
15.5.3.2 The Anogenital Region 280
15.5.3.3 Stoma Dermatitis 281
15.5.4 Dermatitis of the Legs 282
15.5.5 Dermatitis of the Feet 283
15.5.5.1 Recurrent, Pruritic, Vesicular, Plantar Dermatitis 283
15.5.5.2 Hyperkeratotic Plantar Eczema 284
15.5.6 Dermatitis of the Arms 284
15.5.7 Contact Stomatitis 284
15.5.8 Dermatitis Caused by Items Within the Body 285
15.6 Differential Diagnosis 285
15.7 Case Reports 289
15.7.1 Case Report 1 289
15.7.2 Case Report 2 290
References 291
16: Clinical Aspects of Irritant Contact Dermatitis 301
16.1 Definition 301
16.2 Clinical Picture 301
16.2.1 Chemical Burns 302
16.2.2 Irritant Reactions 303
16.2.3 Acute Irritant Contact Dermatitis 305
16.2.4 Chronic Irritant Contact Dermatitis 312
16.3 Case Report 317
16.3.1 Special Forms of Irritation 317
16.3.1.1 Climatic Factors 317
16.3.1.2 Aggravation of Endogenous Dermatoses by Friction and Occlusion 318
16.4 Epidemiology 319
16.5 Pathogenesis 321
16.5.1 Exogenous Factors 321
16.5.2 Endogenous Factors 322
16.5.3 Sensitive (Hyperirritable) Skin 323
16.6 Diagnostic Tests and Experimental Irritant Contact Dermatitis 325
16.7 Action of Irritants and Inflammatory Mediators 326
16.8 Quantification of the Irritant Response (Bioengineering Techniques) 326
16.9 Therapy and Prevention 327
16.10 Neurosensory Irritation (“Stinging”) 329
16.10.1 Immediate-Type Stinging 329
16.10.2 Delayed-Type Stinging 329
16.10.3 Pathogenesis of Stinging and Influencing Factors 330
16.11 Suggested Reading 333
References 333
17: Systemic Contact Dermatitis 342
17.1 Introduction 342
17.2 Clinical Features 343
17.3 Mechanism 344
17.4 Medicaments 345
17.5 Metals 346
17.5.1 Nickel 346
17.5.2 Chromium and Cobalt 348
17.5.3 Gold 348
17.5.4 Mercury 348
17.6 Other Contact Allergens 348
17.7 Risk Assessment-Oriented Studies 349
17.8 Diagnosis 350
17.9 Case Reports 352
17.9.1 Case Report 1 352
17.9.2 Case Report 2 352
References 352
18: Phototoxic and Photoallergic Reactions 356
18.1 Introduction 356
18.2 General Mechanisms of Photosensitivity 357
18.2.1 Phototoxicity vs. Photoallergy 357
18.3 Clinical Patterns of Photosensitivity 358
18.3.1 Acute Manifestations of Photosensitivity 360
18.3.1.1 Immediate Reactions 360
18.3.1.2 Acute Phototoxicity, Mimicking Sunburn 360
18.3.1.3 Acute Photoallergic Eczema 360
18.3.2 Subacute Manifestations of Photosensitivity 360
18.3.2.1 Pseudoporphyria 361
18.3.2.2 Photoonycholysis 361
18.3.2.3 Dyschromia 361
18.3.2.4 Other Clinical Patterns 361
18.3.3 Delayed and Late Effects of Photosensitivity 363
18.3.3.1 Lupus Erythematosus 363
18.3.3.2 Chronic Actinic Dermatitis 363
18.3.3.3 Enhancement of Photocarcinogenesis 363
18.4 Main Topical and Systemic Photosensitizers 363
18.4.1 UV Filters 364
18.4.2 Plants Causing Phytophotodermatitis 365
18.4.3 Photosensitive Drugs 366
18.4.3.1 Antimicrobials 366
18.4.3.2 Nonsteroidal Anti-Inflammatory Drugs 367
Ketoprofen 367
Piroxicam 368
18.4.3.3 Other Drugs as Photosensitizers 368
18.5 Conclusions 369
References 369
19: Pigmented Contact Dermatitis and Chemical Depigmentation 372
19.1 Hyperpigmentation Associated with Contact Dermatitis 372
19.1.1 Classification 372
19.1.2 Pigmented Contact Dermatitis 373
19.1.2.1 History and Causative Agents 373
19.1.2.2 Differential Diagnosis 376
19.1.2.3 Prevention and Treatment 377
19.1.3 Pigmented Cosmetic Dermatitis 378
19.1.3.1 Signs 378
19.1.3.2 Causative Allergens 379
19.1.3.3 Treatment 380
19.1.4 Purpuric Dermatitis 382
19.1.5 “Dirty Neck” of Atopic Eczema 383
19.2 Depigmentation from Contact with Chemicals 384
19.2.1 Mechanism of Leukoderma Due to Chemicals 384
19.2.2 Contact Leukoderma Caused Mainly by Contact Sensitization 387
References 387
20: Hand Eczema 389
20.1 Epidemiology 389
20.1.1 Frequency 389
20.1.2 Risk Factors 389
20.1.3 Validity of Self-Reported Hand Eczema 390
20.2 Aetiology and Morphology 391
20.2.1 Allergic Contact Dermatitis 391
20.2.2 Irritant Contact Dermatitis 391
20.2.3 Atopic Dermatitis 392
20.2.4 Contact Urticaria 392
20.2.5 Endogenous Forms 392
20.2.5.1 Vesicular Hand Eczema (Pompholyx) 392
20.2.5.2 Hyperkeratotic Eczema 393
20.3 Severity Assessment 393
20.4 Occupational Hand Eczema 393
20.5 Prognosis 394
20.6 Treatment (Table 20.3) 395
20.7 Prevention 396
20.7.1 Regulation of Threshold Values for Allergens 396
20.7.2 Identification of Risk Groups 396
20.7.3 Skin Protection 397
20.8 Quality of Life 397
20.9 Differential Diagnosis 397
References 397
21: Protein Contact Dermatitis 401
21.1 Introduction 401
21.2 Clinical Features 401
21.3 Causes [2, 4, 5] (Tables 21.1–21.3) 402
21.4 Pathogenesis 405
21.5 Diagnostic Tests 405
21.6 Differential Diagnosis 406
21.7 Conclusion 406
References 407
22: Noneczematous Contact Reactions 408
22.1 Introduction 408
22.2 Erythema Multiforme-Like Reaction (Urticarial Papular and Plaque Eruptions) 408
22.2.1 Differentiation from Classical Erythema Multiforme 409
22.2.2 Causes 410
Woods and Plants 410
Topical Medicaments 410
Metals and Chemicals 411
22.3 Pigmented Purpuric Eruption 412
22.4 Lichen Planus-Like or Lichenoid Eruption 413
22.4.1 Histology 414
22.4.2 Mechanism 414
22.5 Bullous Eruption 415
22.6 Nodular and Papular Eruption 415
22.7 Granulomatous Eruption 415
22.8 Pustular Eruption 416
22.9 Erythematous and Exfoliative Eruption 416
22.9.1 Trichloroethylene 417
22.9.2 Methyl Bromide 417
22.10 Scleroderma-Like Eruption 417
22.11 Pigmented Contact Dermatitis 418
22.12 Lymphomatoid Contact Dermatitis 418
22.13 Vascular-Occlusive Contact Dermatitis 419
References 419
23: Respiratory Symptoms from Fragrances and the Link with Dermatitis 421
23.1 Introduction 421
23.2 Localisation, Prevalence and Severity 422
23.3 Epidemiological Associations 422
23.4 Pathophysiology 423
23.4.1 Immunological Mechanisms 423
23.4.2 Sensory Mechanisms 424
23.4.3 Psychological Mechanisms 424
23.5 Genetic and Environmental Factors 425
23.6 Conclusion 425
23.7 Case Report with a Typical Treatment Strategy 425
23.8 Diagram Summarising the Current View on the Pathogenesis of Respiratory Symptoms from Fragrance Exposure 426
References 426
Part 5: Diagnostic Tests 429
24: Patch Testing 430
24.1 Introduction 430
24.1.1 The Purpose of Patch Testing 430
24.1.2 Standardization 431
24.1.3 Bioavailability 431
24.2 Test Systems 431
24.2.1 Original System (Allergen–Patch–Tape) 432
24.2.1.1 Patches 432
24.2.1.2 Allergens 432
24.2.1.3 Vehicles 432
24.2.1.4 Concentrations 433
24.2.1.5 Tapes 433
24.2.1.6 Application of Test Preparations to the Patches 433
24.2.1.7 Suppliers 433
24.2.2 Ready-to-Use Systems 433
24.2.3 Some Practical Suggestions 434
24.2.3.1 Storage 434
24.2.3.2 Sequence of Allergens 434
24.2.3.3 Testing in Pregnancy 435
24.2.3.4 Test Sites 435
24.2.3.5 Removal of Hair 435
24.2.3.6 Degreasing of Test Site 435
24.2.3.7 Application of Test Strips 435
24.2.3.8 Skin Markers 435
24.2.3.9 Positive Control 435
24.2.3.10 Instructions 435
24.2.3.11 Reading 435
24.3 Allergens 435
24.3.1 Numbers 435
24.3.2 Screening Series 435
24.3.3 Variations Concerning Concentration and Vehicle 436
24.4 Baseline Series 436
24.4.1 Deciding What to Include in the Baseline Series 437
24.5 Reading and Evaluation of Patch Tests 437
24.5.1 Reading: When and How 438
24.5.1.1 Exposure Time 438
24.5.1.2 Reading When? 438
24.5.1.3 Compromise 438
24.5.2 Recording of Test Reactions 439
24.5.3 Interpretation of Reactions at Test Sites 439
24.5.3.1 Discrimination Between Allergic and Irritant Reactions 441
24.5.3.2 Ring-Shaped Test Reactions 441
24.5.3.3 Ultrastructure 441
24.5.3.4 Doubtful and One Plus Reactions 441
24.5.3.5 Cross-Sensitivity 441
24.5.4 Relevance 443
24.5.5 False-Positive Test Reactions 443
24.5.5.1 The Compromise (Item 1) 444
24.5.5.2 Excited-Skin Syndrome: “Angry Back” (Items 7 and 8) 444
24.5.5.3 The Patch (Item 11) 444
24.5.6 False-Negative Test Reactions 444
24.5.6.1 Common Causes 444
24.5.6.2 Compound Allergy (Item 6) 445
24.6 Ethnic and Climatic Considerations 445
24.7 Effect of Medicaments and Irradiation on Patch Tests 445
24.7.1 Corticosteroids 445
24.7.2 Antihistamines 446
24.7.3 Immunomodulators 446
24.7.4 Irradiation 446
24.7.5 Seasonal Variations 446
24.8 Complications 446
24.8.1 Patch Test Sensitization (Item 1) 447
24.8.2 Subjective Complaints (Item 4) 447
24.8.3 Penicillin (Item 9) 447
24.9 Open Tests 447
24.9.1 Open Test 447
24.9.2 Semi-Open Test 447
24.10 Use Tests 448
24.10.1 Purpose 448
24.10.2 Repeated Open Application Test 448
24.11 Noninvasive Techniques 449
24.12 Quality Control of Test Materials 449
24.12.1 Identification and Purity 449
24.12.2 Test Preparations Under the Microscope 449
24.12.3 Fresh Samples 449
24.12.4 Adhesive Tapes 449
24.13 Tests with Unknown Substances 449
24.13.1 Warning! 449
24.13.2 Strategy 449
24.13.3 Test or Not? 450
24.13.4 Cosmetics and Similar Products 450
24.14 The Future 450
References 451
25: Atopy Patch Testing with Aeroallergens and Food Proteins 456
25.1 Introduction 456
25.2 APT Methods and Influence on Reactions 458
25.3 Evaluation of APT Reactions 460
25.4 Predictors, Sensitivity and Specificity of APT 460
25.5 APT with Food Proteins 461
25.6 APT and Atopic Eczema “Intrinsic Type” 462
25.7 Outlook 462
25.8 Classic Article 463
References 463
26: Patch Testing in Adverse Drug Reactions 466
26.1 Introduction 466
26.1.1 Definition and Types of Cutaneous Adverse Drug Reactions 466
26.1.2 Main Clinical Patterns of Immune-Mediated CADRs 467
26.1.3 Pathomechanisms Involved in Immune-Mediated Drug Eruptions 469
26.1.4 T-Cell Involvement in Drug Eruptions 469
26.2 The Workup in the Diagnosis of an Immune-Mediated CADR 470
26.2.1 Clinical Diagnosis and Drug Imputation 470
26.2.2 Complementary Tests to Confirm Drug Imputation 471
26.3 Patch Testing in CADRs 472
26.3.1 The General Value of Patch Testing 472
26.3.2 Patch Test Technique 474
26.3.3 Material for Patch Testing with Drugs 475
26.3.3.1 Patch Testing with Pure Drugs 475
26.3.3.2 Patch Testing with Drugs Used by the Patient 475
26.3.4 Safety of Patch Testing 477
26.3.5 Specificity of Patch Test Reactions 477
26.3.6 Evaluating Cross-Reactivity on Patch Testing 477
26.4 Conclusions: Interpretation of Patch Test Results 478
26.5 Classic Articles and Monographs 478
References 479
27: Allergens Exposure Assessment 483
27.1 Spot Tests and Chemical Analyses 483
27.1.1 Introduction 483
27.1.2 pH Measurement 484
27.1.3 Spot Tests 484
27.1.4 Thin-Layer Chromatography 484
27.1.5 Gas Chromatography 484
27.1.6 High-Performance Liquid Chromatography 485
27.1.7 Atomic Absorption Spectrophotometry 485
27.1.8 UV-VIS Spectrophotometry 485
27.1.9 Infrared Spectrophotometry 485
27.1.10 Mass Spectrometry 485
27.1.11 Inductively Coupled Plasma-Mass Spectrometry 486
27.1.12 Nuclear Magnetic Resonance Spectroscopy 486
27.1.13 Common Chemical Methods Used by Dermatologists 486
27.1.13.1 Detection of Nickel Ions Released from Metal Objects 486
27.1.13.2 Detection of Hexavalent Chromium (Chromate) 486
Chromate on the Surface of a Solid Object 489
Chromate in Solutions 489
Chromate in Powders Insoluble in Water (E.g. Cement) 489
27.1.13.3 Detection of Epoxy Resin Based on Bisphenol A 490
27.1.13.4 Detection of Formaldehyde 490
Chromotropic Acid Method 490
Acetylacetone Method 492
27.1.14 Summary 493
27.2 Skin Exposure Assessment 493
27.2.1 Introduction 493
27.2.2 Techniques for the Assessment of Skin Exposure 493
27.2.2.1 Fluorescent Tracer Technique 494
27.2.2.2 Removal Techniques 494
Washing, Rinsing and Wiping 494
Tape Stripping 495
Vacuuming 496
27.2.2.3 Surrogate Skin Sampling 496
27.2.2.4 Assessment by Observation 496
27.2.2.5 Biomonitoring 496
27.2.3 Analytical Methods 496
27.2.4 Application of Results 497
References 497
28: Skin Tests for Immediate Hypersensitivity 501
28.1 Introduction 501
28.2 Skin Prick Testing 502
28.2.1 Material for Testing 502
28.2.2 Procedure 504
28.2.3 Reading of SPT 504
28.3 Intracutaneous (or Intradermal) Test 505
28.3.1 Material for Testing 505
28.3.2 Procedure 505
28.4 Scratch-Patch Test (S-P) 505
28.5 Skin Application Food Test 505
28.6 Open Application Test 506
28.7 Atopy Patch Testing 506
28.8 Conclusions 506
References 507
29: Photopatch Testing 508
29.1 Introduction 508
29.2 Indications for Performing Photopatch Tests 509
29.2.1 Main Indication 509
29.2.2 Other Indications for Photopatch Testing 510
29.3 Photopatch Testing Technique 511
29.3.1 How to Perform Photopatch Tests 511
29.3.2 When to Perform Photopatch Tests 512
29.3.3 Irradiation Source and UV Dose 512
29.3.4 Photopatch Testing in Particular Cases (Immunosuppression and Photosensitivity) 513
29.4 Reading and Interpretation of Test Results 513
29.4.1 Timing of the Readings 513
29.4.2 Scoring of the Reactions 513
29.4.3 Interpretation of Test Results: Allergy or Photoallergy 514
29.4.4 Relevance of Positive Reactions 515
29.5 Allergens for Photopatch Testing (Basic and Additional Series) 515
29.5.1 UV Filters in the Basic and Additional Tray for Photopatch Testing 517
29.5.2 Drugs in the Basic and Additional Tray for Photopatch Testing 517
29.5.3 Other Allergens for Photopatch Testing 518
29.6 Conclusions 518
References 519
30: Noninvasive Techniques for Quantification of Contact Dermatitis 521
30.1 Introduction 521
30.2 Prerequisites and Planning of Study by Noninvasive Techniques 521
30.3 Review of Noninvasive Techniques Relevant to the Study of Contact Dermatitis 522
30.3.1 Changes in the Skin Surface 522
30.3.2 Epidermal Hydration and Water Barrier Function 523
30.3.3 Parameters of Inflammation 524
30.4 Allergic Contact Dermatitis 525
30.5 Irritant Contact Dermatitis 526
30.5.1 Edema 527
30.5.2 Sensitive Skin and Hyperirritable Skin 527
30.6 Urticarial Wheals 528
References 529
Part 6: Allergic Contact Dermatitis Related to Specific Exposures 531
31: Allergens from the European Baseline Series 532
31.1 Introduction 532
31.2 Nickel 533
31.3 Chromium 537
31.4 Cobalt 539
31.5 Fragrance Mix I & II
31.6 Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde (Lyral®) 542
31.7 Balsam of Peru 543
31.8 Colophonium 543
31.9 Neomycin 545
31.10 Benzocaine (Ethylaminobenzoate) 545
31.11 Clioquinol 546
31.12 Wool Wax Alcohols (Lanolin) 546
31.13 Paraben Mix 547
31.14 Formaldehyde 548
31.15 Quaternium-15 550
31.16 Methylchloro- and Methylisothiazolinone (MCI/MI) 551
31.17 Para-phenylenediamine 552
31.18 Thiuram Mix 554
31.19 Mercapto Mix and Mercaptobenzothiazole 555
31.20 N-Isopropyl-N-Phenyl-p-Phenylenediamine (IPPD) 555
31.21 Epoxy Resin 556
31.22 Para-Tertiary-Butylphenol-Formaldehyde Resin 558
31.23 Primin 559
31.24 Sesquiterpene Lactone Mix (SL Mix) 559
31.25 Budesonide 561
31.26 Tixocortol Pivalate 561
31.27 Methyldibromo Glutaronitrile 562
31.28 Ethylenediamine (No Longer Included in the Baseline Series) 562
References 563
32: Cosmetics and Skin Care Products 578
32.1 What are Cosmetics? 578
32.2 Epidemiology of Side Effects from Cosmetics 578
32.2.1 The General Population 578
32.2.2 Patients Seen by Dermatologists 579
32.3 Clinical Picture 580
32.4 The Products Causing Cosmetic Allergy 580
32.5 The Allergens 580
32.5.1 Fragrances 581
32.5.2 Preservatives 582
32.5.2.1 Methylchloroisothiazolinone (and) Methylisothiazolinone 582
32.5.2.2 Methyldibromo Glutaronitrile 583
32.5.2.3 Formaldehyde 583
32.5.2.4 Formaldehyde Donors 583
32.5.3 Quaternium-15 584
32.5.4 Imidazolidinyl Urea 584
32.5.5 Diazolidinyl Urea 584
32.5.6 2-Bromo-2-Nitropropane-1,3-Diol (Bronopol) 584
32.5.7 DMDM Hydantoin 584
32.5.7.1 Parabens 584
32.5.7.2 Iodopropynyl Butylcarbamate 584
32.5.7.3 Miscellaneous Preservatives 585
32.5.8 Tosylamide/Formaldehyde Resin 585
32.5.9 p-Phenylenediamine and Related Hair Dyes 585
32.5.10 Cocamidopropyl Betaine 585
32.5.11 UV Filters 586
32.5.12 Lanolin and Derivatives 586
32.5.13 Glyceryl Thioglycolate 586
32.5.14 Propylene Glycol 586
32.5.15 Antioxidants 587
32.5.16 Miscellaneous Allergens 587
32.6 Diagnostic Procedures 587
32.7 Ingredient Labeling in the European Union 588
References 588
33: Fragrances 593
33.1 Introduction 593
33.2 Fragrance Ingredients 593
33.3 The Fragrance Formula 594
33.4 Chemistry 594
33.5 Fragrance Contact Allergens 594
33.5.1 Fragrance Chemicals 595
33.5.2 Oxidation Products 596
33.5.3 Fragrance Naturals 597
33.6 Epidemiology of Fragrance Contact Allergy 598
33.7 Clinical Aspects 599
33.8 Exposure to Fragrance Allergens 600
33.8.1 Consumer Products 600
33.8.2 Occupational Exposure 602
33.9 Diagnosis of Fragrance Contact Allergy 603
33.10 Clinical Relevance and Patient Advice 606
33.11 Other Skin Effects 607
33.11.1 Immediate Reactions 607
33.11.2 Photoallergy/Phototoxic Reactions 608
33.11.3 Irritant Contact Dermatitis 608
33.12 Case Reports 608
References 608
34: Hair Dyes 614
34.1 Introduction 614
34.2 Clinical Picture 615
34.2.1 Allergic Contact Dermatitis 615
34.3 Temporary Black Tattoos 615
34.4 Diagnosis 616
34.5 Immediate Reactions 618
34.6 PPD: The Archetype 618
34.6.1 Chemistry 618
34.6.2 Immunology 619
34.6.3 Epidemiology 619
34.6.4 Cross Reactions 619
34.6.5 Occupational Allergy to PPD 620
34.7 Substances Other than PPD 620
34.7.1 Toluene-2,5-Diamine 621
34.7.2 Resorcinol 621
34.7.3 Aminophenol 621
34.7.4 Henna 621
34.7.5 Bleaching Agents 621
34.7.5.1 Monoethanolamine (MEA) 621
34.7.6 New Generation of Hair Dyes 622
34.8 Pretesting and Advising Patients 622
34.8.1 Pretesting 622
34.8.2 Advising Patients 622
34.9 Case Reports 622
References 623
35: Metals 627
35.1 Introduction 628
35.2 Nickel 629
35.2.1 Nickel Use and Exposure 629
35.2.2 Quantification of Nickel Exposure 631
35.2.3 Patch Testing with Nickel 632
35.2.4 Clinical Picture 633
35.2.5 Systemic Allergic Contact Dermatitis 634
35.2.6 Tolerance to Nickel 634
35.2.7 Epidemiology 635
35.2.8 Hand Eczema and Nickel Allergy 636
35.2.9 Specific Treatment 637
35.2.10 Prevention and Legislation 637
35.2.11 Suggested Reading 638
35.3 Chromium 638
35.3.1 Physicochemical Aspects and Sensitizing Potential 639
35.3.2 Chromium Use and Exposure 640
35.3.3 Patch Testing with Chromate 642
35.3.4 Clinical Picture 643
35.3.5 Systemic Contact Dermatitis 643
35.3.6 Epidemiology 643
35.3.7 Prevention and Legislation 644
35.4 Cobalt 646
35.4.1 Cobalt Use and Exposure 646
35.4.2 Allergic Contact Dermatitis 647
35.4.3 Patch Testing with Cobalt 648
35.4.4 Prevention and Legislation 648
35.5 Aluminum 648
35.5.1 Allergic Contact Dermatitis 648
35.6 Beryllium 649
35.6.1 Allergic Contact Dermatitis 649
35.7 Cadmium 649
35.7.1 Allergic Contact Dermatitis 650
35.8 Copper 650
35.8.1 Allergic Contact Dermatitis 650
35.8.2 Irritant Contact Dermatitis 650
35.9 Gold 650
35.9.1 Gold Use and Exposure 651
35.9.2 Patch Testing with Gold and Gold Compounds 651
35.9.3 Clinical Picture 652
35.9.4 Systemic Contact Dermatitis 652
35.9.5 Epidemiology 652
35.10 Mercury 653
35.10.1 Allergic Contact Dermatitis 653
35.11 Palladium 653
35.11.1 Allergic Contact Dermatitis 653
35.12 Platinum 654
35.13 Rhodium 654
35.13.1 Allergic Contact Dermatitis 654
35.14 Silver 654
35.15 Tin 655
References 655
36: Metalworking Fluids 664
36.1 Metalworking Fluids: Usage and Ingredients 664
36.2 Occupational Skin Disease Due to Metalworking Fluids 665
36.3 Irritant Contact Dermatitis Due to Metalworking Fluids 666
36.4 Contact Allergy Due to Metalworking Fluids 666
36.5 Important Allergens in Metalworking Fluids 667
36.5.1 Monoethanolamine (MEA), Diethanolamine (DEA), Triethanolamine (TEA) and Diglycolamine 667
36.5.2 Colophonium/Abietic Acid 667
36.5.3 Fragrances 668
36.5.4 Cobalt, Nickel and Dichromate 668
36.5.5 Formaldehyde and Formaldehyde Releasers 669
36.5.6 Methyldibromo Glutaronitrile (MDBGN) and 2-Phenoxyethanol (PE) 669
36.5.7 Methylchloroisothiazolinone/Methylisothiazolinone (MCI/MI) 669
36.5.8 Other Biocides 670
36.5.9 p-Aminoazobenzene (PAAB) 670
36.6 MWF Patch Test Series 670
36.7 Patch Testing with MWF from the Patient’s Workplace 672
36.8 Preventive Measures 674
References 674
37: Plastic Materials 678
37.1 Acrylic Plastics 679
37.1.1 Applications 679
37.1.2 Chemistry 679
37.1.3 Skin Exposure 682
37.1.4 Skin Hazards 682
37.1.4.1 Contact Allergy 682
37.1.4.2 Animal Studies 683
37.1.4.3 Irritancy 684
37.1.5 Prevention 684
37.1.6 Patch Testing 684
37.2 Epoxy Plastics 684
37.2.1 Applications 685
37.2.2 Chemistry 685
37.2.2.1 Epoxy Resins 685
37.2.2.2 Curing Agents 686
37.2.2.3 Reactive Diluents 686
37.2.3 Skin Exposure 687
37.2.4 Skin Hazards 687
37.2.4.1 Contact Allergy 687
Epoxy Resins 687
37.2.4.2 Irritancy 688
37.2.5 Patch Testing 688
37.2.6 Prevention 688
37.3 Phenol-Formaldehyde Plastics 689
37.3.1 Applications 690
37.3.2 Chemistry 690
37.3.3 Skin Hazards 690
37.3.4 Patch Testing 692
37.4 Isocyanates and Polyurethane Plastics 693
37.4.1 Applications 693
37.4.2 Chemistry 693
37.4.3 Skin Exposure 695
37.4.4 Skin Hazards 695
37.4.4.1 Contact Allergy 695
37.4.4.2 Irritancy 696
37.4.5 Patch Testing 696
37.4.6 Prevention 697
Sec39_37 697
37.5 Other Plastics 697
37.5.1 Amino Plastics 697
37.5.1.1 Skin Hazards from Amino Plastics 697
37.5.2 Polyester Plastics 697
37.5.2.1 Skin Hazards from Polyester Plastics 698
37.5.3 Polyvinyl Chloride Plastics 699
37.5.3.1 Skin Hazards from Polyvinyl Chloride Plastics 699
37.5.4 Polystyrene Plastics 699
37.5.4.1 Skin Hazards from Polystyrene Plastics 699
37.5.5 Polyolefin Plastics 700
37.5.5.1 Skin Hazards from Polyolefin Plastics 700
37.5.6 Polyamide Plastics 700
37.5.6.1 Skin Hazards from Polyamide Plastics 700
37.5.7 Polycarbonate Plastics 700
37.5.7.1 Skin Hazards from Polycarbonate Plastics 700
37.5.8 Rare Plastics 701
37.6 Plasticizers and Other Additives 701
37.6.1 Plasticizers 701
37.6.2 Flame Retardants 701
37.6.3 Heat Stabilizers 701
37.6.4 Antioxidants 701
37.6.5 Ultraviolet-Light Absorbers 702
37.6.6 Initiators 702
37.6.7 Biocides 702
37.6.8 Colorants (Dyes and Pigments) 702
37.6.9 Metals and Metal Salts 702
37.6.10 Skin Hazards from Additives 702
References 703
38: Topical Drugs 712
38.1 Incidence and Prevalence 712
38.1.1 Incidence 712
38.2 Factors Predisposing to Medicament Contact Dermatitis 713
38.3 Clinical Patterns of Contact Reactions 714
38.3.1 Irritant Contact Dermatitis 714
38.3.2 Contact Urticaria 714
38.3.3 Other Important Clinical Patterns 715
38.3.4 Allergic Contact Dermatitis 716
38.4 Allergens 717
38.4.1 Local Anaesthetics 717
38.4.2 Antibiotics and Antimicrobials 718
38.4.3 Antivirals 719
38.4.4 Antimycotics 720
38.4.5 Corticosteroids 721
38.4.6 Antihistamines 724
38.4.7 Non-steroidal Anti-Inflammatory Drugs 725
38.4.8 Ingredients of the Vehicles 726
38.4.9 Other Allergens 727
38.4.10 Transdermal Therapeutic Systems 729
38.5 Sites at Risk 729
38.5.1 Ophthalmic and ENT Preparations 729
38.5.2 Anogenital Dermatoses 731
38.5.3 Stasis Dermatitis and Leg Ulcer Patients 731
38.6 Systemic Contact Dermatitis 732
38.7 Diagnosis and Prognosis 734
38.8 Appendix: Allergens in Medicaments 734
References 738
39: Dental Materials 746
39.1 Introduction 746
39.2 Dental Personnel 746
39.2.1 Irritant Contact Dermatitis 748
39.2.2 Clinical Picture of Irritant Contact Dermatitis in Dental Personnel 748
39.3 Dental Patients 748
39.3.1 Irritant Contact Stomatitis 748
39.3.2 Clinical Picture of Irritant Contact Stomatitis in Dental Patients 748
39.4 Allergic Contact Dermatitis 749
39.4.1 Clinical Picture of Allergic Contact Dermatitis in Dental Personnel 749
39.5 Allergic Contact Stomatitis and Cheilitis 749
39.5.1 Clinical Picture of Allergic Contact Stomatitis and Cheilitis in Dental Patients 749
39.6 Lichen and Lichenoid Lesions 750
39.7 Causative Agents in Allergic Contact Dermatitis and Stomatitis/Cheilitis 751
39.7.1 Acrylics and Other Plastic Chemicals 751
39.7.1.1 Dental Composite Resins 751
39.7.1.2 Dentin Bonding Agents are Plastics Without Fillers and are Called Resins 752
39.7.1.3 Prosthetic Materials: Prostheses 753
39.7.1.4 Additives in Dental Acrylics-Initiators, Activators, Stabilizers 754
39.7.1.5 UV-Absorbers 754
39.7.1.6 Bisphenol A and DGEBA Resin 755
39.7.1.7 Ethyl Cyanoacrylate Glue 755
39.7.1.8 Plastic and Fillers Composite 755
39.7.1.9 Two Materials for Short-term Use 756
39.7.1.10 Impression Materials and Resin Carriers 756
39.7.1.11 Resin Carrier 756
39.7.1.12 Product Analysis of Acrylic Resins 756
39.7.2 Rubber and Plastics in Gloves 756
39.7.2.1 Protective Effect of Medical Gloves 757
39.7.3 Metals 757
39.7.3.1 Aluminum 758
39.7.3.2 Beryllium 758
39.7.3.3 Chromium 758
39.7.3.4 Cobalt 759
39.7.3.5 Copper 759
39.7.3.6 Gold 759
39.7.3.7 Indium 760
39.7.3.8 Iridium 760
39.7.3.9 Manganese 760
39.7.3.10 Mercury 760
39.7.3.11 Nickel 761
39.7.3.12 Palladium 761
39.7.3.13 Platinum 761
39.7.3.14 Silver 762
39.7.3.15 Tin 762
39.7.3.16 Titanium 762
39.7.3.17 Zinc 762
39.7.4 Disinfectants 762
39.7.4.1 Povidone-Iodine 762
39.7.5 Eugenol, Colophony, Carvone 763
39.7.5.1 Colophony 763
39.7.5.2 Carvone 763
39.7.6 Local Anesthetics 763
39.8 Patch Testing 764
39.8.1 Indications for Patch Testing 765
39.8.2 Patch Test Sensitization 765
39.8.3 Screening for Contact Allergy to Acrylics 766
39.9 Immediate Reactions 767
39.9.1 Clinical Picture 767
39.9.2 Causative Agents 767
39.9.2.1 Proteins in Natural Rubber Latex and Corn Starch 767
Corn Starch Powder 767
39.9.2.2 Gutta-Percha 768
39.9.2.3 Low-Molecular-Weight Chemicals 768
39.9.2.4 Local Anesthetics 769
39.9.2.5 Fibrin Tissue 769
39.9.2.6 Metals 769
39.9.2.7 Methacrylates 769
References 769
40: Clothing 775
40.1 Introduction 775
40.2 Clinical Examination 776
40.3 The Inducers of Dermatitis 777
40.3.1 Textile Fibers 777
40.3.2 Textile Resins and Formaldehyde 778
40.3.3 Textile Dyes 781
40.3.3.1 Disperse Dyes 781
Anthraquinone Dyes 781
Azo Dyes 784
Root 786
Methine, Nitro, and Quinoline Dyes 786
40.3.3.2 Acid Dyes 786
40.3.3.3 Basic Dyes 786
40.3.3.4 Direct Dyes 787
40.3.3.5 Vat Dyes 788
40.3.3.6 Fiber Reactive Dyes 788
40.3.3.7 Sulfur, Solvent, and Nondisperse Azoic Dyes 789
40.3.3.8 Dye-Fixing and Dye-Coupling Agents 789
40.3.4 Rubber 789
40.3.4.1 Other Components of Garments 789
40.3.4.2 Cleaners, Softeners, and Other Auxiliaries 790
40.4 Patch Testing 790
40.5 Chemical Analyses 793
40.5.1 Identification of Formaldehyde 793
40.5.1.1 Chromotropic Acid Method 793
40.5.1.2 Schiff’s Reagent Method 793
40.5.1.3 Acetylacetone Method 793
40.5.2 Identification of Dyes 794
40.6 Patient Advice 795
References 796
41: Shoes 800
41.1 Introduction 800
41.2 Epidemiology 800
41.3 Risk Factors 800
41.4 Clinical Presentation and Clues Pointing to Allergens 801
41.5 Allergens in Shoes 803
41.6 Hidden Sources of Shoe Allergens 804
41.7 Occupational Dermatitis 804
41.8 Patch Testing for Shoe Allergy 804
41.9 Differential Diagnosis 806
41.10 Prognosis and Outcome 806
41.11 Allergen Substitution 806
41.12 Conclusion 807
41.13 Case Report 807
41.14 Classic Articles 808
References 809
42: Occupational Contact Dermatitis 812
42.1 Introduction 812
42.2 Definition 812
42.3 Clinical Aspects 814
42.4 Causative Factors 815
42.5 Diagnostic Workup 816
42.5.1 History 816
42.5.2 Information on Workplace Materials 817
42.5.3 Diagnostic Testing 818
42.6 Therapy and Prevention 818
References 819
43: Occupational Contact Dermatitis: Health Personnel 821
43.1 Introduction 821
43.2 Range of Occupations 821
43.3 Type of Cutaneous Disease 822
43.4 Irritant Contact Dermatitis 822
43.5 Atopy as a Risk Factor 822
43.6 Wet Work 822
43.7 Hand Dermatitis 822
43.8 Nurses, Clinical Assistants and Cleaners 823
43.9 Surgeons 825
43.10 Laboratory Personnel 826
43.11 Other Therapists 827
43.12 Veterinarians 827
43.13 Laboratory Animal Handlers 829
43.14 Conclusion 829
Acknowledgements 829
References 829
44: Occupational Contact Dermatitis: Chefs and Food Handlers 832
44.1 Epidemiology and Risk Factors of Occupational Skin Diseases in Chefs and Food Handlers 832
44.2 Specific Exposures to Irritants, Contact and Protein Allergens in Chefs and Food Handlers 834
44.2.1 Irritants in Food Handling Occupations 834
44.2.2 Contact Allergens in Food Handling Occupations 834
44.2.3 Elicitors of Phototoxic and Photoallergic Reactions in Food Handling Occupations 840
44.2.4 Elicitors of Protein Contact Dermatitis, Immunological Contact Urticaria and Non-immunological Contact Urticaria in Fo 840
44.3 Conclusion for the Treatment of OSD in Chefs and Food Handlers 842
References 842
45: Occupational Contact Dermatitis: Hairdressers 844
45.1 Epidemiology of Hand Eczema 844
45.1.1 Smoking 845
45.1.2 Atopic Dermatitis 845
45.1.3 Exposure to Allergens 845
45.1.3.1 Hair Dye 845
45.1.3.2 Persulfates 845
45.1.3.3 Hydrogen Peroxide 845
45.1.3.4 Glyceryl Monothioglycolate 845
45.1.3.5 Cysteamine Hydrochloride 846
45.1.3.6 Nickel 846
45.1.3.7 Fragrance Ingredients 846
45.1.3.8 Pyrogallol 846
45.1.3.9 Methyldibromo Glutaronitrile 847
45.2 Gloves 847
45.3 Nail Disorders 847
45.4 Contact Urticaria 847
45.5 Suggestions for a Patch Test Series for Hairdressers 848
45.6 Cancer 849
References 849
46: Plants and Plant Products 851
46.1 Introduction 851
46.2 Clinical Pictures 852
46.2.1 Immediate-Type Reactions 852
46.2.1.1 Contact Urticaria 852
Nonimmunological Contact Urticaria 852
Immunological (IgE-mediated) Contact Urticaria 852
46.2.1.2 Protein Contact Dermatitis 853
46.2.2 Irritant Contact Dermatitis 854
46.2.2.1 Mechanical Irritation 854
46.2.2.2 Chemical Irritation 855
46.2.3 Allergic Contact Dermatitis 855
46.2.3.1 Acute ACD: Acute Eczema 855
46.2.3.2 Chronic ACD and the Example of “Tulip Fingers” 855
46.2.3.3 Erythema Multiforme-like and Atypical Dermatitis 857
46.2.3.4 Airborne Contact Dermatitis 858
46.2.4 Photodermatitis (Phytophotodermatitis) 859
46.2.4.1 Phytophototoxicity 859
46.2.4.2 Phytophotoallergic Contact Dermatitis 860
46.3 Inducers of Dermatitis 862
46.3.1 Alliaceae (Onion Family) 862
46.3.2 Alstroemeriaceae (Alstroemer Family) and Liliaceae (Lily Family) 862
46.3.3 Amaryllidaceae (Daffodil Family) 864
46.3.3.1 Anacardiaceae, Ginkgoaceae, and Proteaceae 865
Anacardiaceae (Cashew Family) 865
Ginkgoaceae (Maidenhair Family) 868
Proteaceae 869
Allergens 869
46.3.4 Compositae (Asteraceae) and Liverworts 870
46.3.4.1 Asteraceae/Compositae (Daisy Family) 870
46.3.4.2 Liverworts (Jubulaceae) 874
46.3.4.3 Sesquiterpene Lactone Allergens 874
46.3.5 Cruciferae (Cabbage or Mustard Family, Brassicaceae) 877
46.3.6 Euphorbiaceae (Spurge Family) 878
46.3.7 Lichens 879
46.3.8 Primulaceae (Primrose Family) 881
46.3.9 Ranunculaceae (Buttercup Family) 882
46.3.10 Umbelliferae/Apiaceae (Carrot Family), Rutaceae (Rue Family), and Moraceae (Mulberry Family) 883
46.3.11 Woods 884
46.3.11.1 American and Australian Woods 885
46.3.11.2 Asian Woods 886
46.3.11.3 African Woods 886
46.3.11.4 European Woods 887
46.3.12 Mushrooms 888
46.3.13 Ferns 888
46.3.14 Miscellaneous Plants 888
46.3.14.1 Araliaceae (Ginseng, Aralia, Ivy Family) 888
46.3.14.2 Papaveraceae (Poppy Family) 888
46.3.14.3 Guttiferae (St John’s Wort or Mangosteen Family) 888
46.3.14.4 Hydrangeaceae 889
46.3.14.5 Iridaceae (Iris Family) 889
46.3.14.6 Labiatae (Mint Family) 889
46.3.14.7 Paeoniaceae (Peony Family) 889
46.3.14.8 Solanaceae (Nightshade Family) 889
46.4 Diagnosis of Plant Dermatitis 889
46.4.1 Raw Plants 890
46.4.1.1 Plant Identification 890
46.4.1.2 Prick Tests 890
46.4.1.3 Patch Tests 890
46.4.2 Plant Extracts 891
46.4.3 Allergen Identification 891
46.4.4 Commercial Allergens 891
46.4.5 Photopatch Testing 891
46.4.6 Results and Relevance 892
46.4.7 Multiple Plant Reactions and Cross-Sensitivity 892
46.5 Prevention and Treatment 892
46.5.1 Removal of the Allergens and Irritants 892
46.5.2 Barrier Creams 893
46.5.3 Gloves 893
46.5.4 Acute Dermatitis 893
46.5.5 Chronic Dermatitis 893
46.5.6 Hyposensitization 893
46.6 Example of Botanical Nomenclature 893
References 894
47: Pesticides 904
47.1 Introduction 904
47.2 Use of Pesticides and its Limitations 905
47.3 Terminology, Classification, and Formulations 906
47.4 Skin Exposure and Absorption Through Skin 906
47.4.1 Prevention of Skin Exposure 907
47.5 Skin Effects of Some Pesticides 908
47.5.1 Herbicides and Desiccants 908
47.5.2 Insecticides 909
47.5.3 Fungicides 909
47.5.4 Repellents 910
47.5.5 Rodenticides 910
47.5.6 Preservatives for the Treatment of Articles and Materials 910
47.6 Patch Testing 910
References 912
48: Contact Allergy in Children 914
48.1 Introduction 914
48.2 Prevalence and Incidence 914
48.2.1 Prevalence of Contact Allergy in an Unselected Population 915
48.2.2 Prevalence of Contact Allergy in a Selected Population 915
48.2.3 Prevalence in Relation to Genetic Factors 915
48.2.4 Prevalence Related to Sex 919
48.2.5 Prevalence Related to Age 919
48.2.6 Prevalence Related to Origin 919
48.2.7 Prevalence in Relation to the Sensitization Source 920
48.3 The Clinical Picture 920
48.4 Allergic Contact Dermatitis and Atopy 921
48.5 Patch Testing in Children 922
48.6 The Most Frequent Allergens in Children 923
48.6.1 Metals 923
48.6.1.1 Nickel 923
48.6.1.2 Cobalt 924
48.6.1.3 Potassium Dichromate 924
48.6.1.4 Mercury 924
48.6.1.5 Aluminum 924
48.6.1.6 Palladium 924
48.6.1.7 Iron 924
48.6.1.8 Copper 924
48.6.1.9 Gold 924
48.6.2 Pharmaceutical Products 925
48.6.3 Cosmetics 926
48.7 Tattoos 927
48.8 Toys 927
48.9 Electronic Devices 927
48.10 Rubber Items 928
48.11 Shoes and Clothes 929
48.12 Plastic Materials and Resins 929
48.13 Plants 930
48.13.1 Poison Ivy, Poison Oak, Poison Sumac 930
48.13.3 Urtica urens 930
48.13.4 Asteraceae or Compositae 930
48.13.5 Lichens 930
48.13.6 Gingko Fruit 931
48.13.7 Dioscorea Batatas Decaisne 931
48.13.8 Protein Contact Dermatitis 931
48.13.9 Various Plant Materials 931
48.14 “Occupational” Allergens 931
48.15 Is it Advisable to Test with a Shortened Standard Series for Children? 931
48.16 Conclusions 932
References 933
49: Therapy and Rehabilitation of Allergic and Irritant Contact Dermatitis 939
49.1 Recognize (the Causative Allergic/Irritant Agent) 939
49.2 Remove (the Irritant/Allergen) 940
49.2.1 Preventive Measures 940
49.2.2 Elimination Diets 942
49.3 Reduce Inflammation: Pharmacologic Therapy 942
49.3.1 Basic Topical Therapy 942
49.3.2 Specific Therapies 944
49.3.2.1 Topical Corticosteroids 944
49.3.2.2 Topical Calcineurin Inhibitors 945
49.3.2.3 Retinoids 945
49.3.2.4 Phototherapy 946
49.3.2.5 Ionizing Radiation Therapy 947
49.3.2.6 Systemic Corticosteroids and Immunosuppressive Agents 947
49.3.2.7 Other Treatment Approaches 949
49.4 Restore the Skin Barrier 949
49.4.1 Recovery Time 949
49.4.2 The Effect of Moisturizers on Barrier Repair 950
49.4.2.1 Occlusive Properties 951
49.4.2.2 Lipids Content 951
49.4.2.3 Humectants and Other Ingredients 952
49.4.2.4 pH 953
49.4.2.5 Additional Data on Moisturizers 953
49.4.3 The Influence on the Barrier Repair of the Different Modalities Used in the Treatment of Dermatitis 953
49.4.3.1 Corticosteroids 954
49.4.3.2 Calcineurin Inhibitors 954
49.4.3.3 Phototherapy 954
49.4.3.4 Retinoids 955
49.4.4 Other Factors Influencing Barrier Repair 955
References 955
50: Prevention of Hand Eczema: Gloves, Barrier Creams and Workers’ Education 960
50.1 Introduction: Trends and Tasks in Dermatological Prevention 960
50.1.1 Primary Prevention 962
50.1.2 Secondary Prevention 963
50.1.3 Tertiary Prevention 965
50.2 Personal Skin Protection 967
50.2.1 Protective Gloves 967
50.2.1.1 Introduction 967
50.2.1.2 Rules and Regulations 968
Chemical Protective Gloves 968
Medical Gloves (MGs) 969
50.2.1.3 Standard Methods for Testing the Protective Glove Barrier 970
Penetration 970
Permeation 970
Degradation 971
50.2.1.4 Glove Materials and Manufacturing 971
50.2.1.5 Unwanted Side Effects of Gloves 972
Selection of the Wrong Glove 972
Internal Contamination of Gloves 972
Occlusion Effects 972
Allergic Contact Dermatitis from Protective Gloves 972
50.2.1.6 Perspectives 973
Semi-Permeable Gloves 973
Rip Up Gloves for the Work on Shifting Machines 973
“Hypoallergenic” Gloves 973
50.2.2 Barrier Creams 973
50.2.2.1 Study Designs to Prove Effectiveness 974
50.2.2.2 Usage and Application 975
50.2.2.3 Strategies 976
50.3 Workers’ Education 977
50.3.1 Definitions 983
50.3.1.1 Health Education 983
50.3.1.2 Patient Education 983
50.3.1.3 Eczema School 983
50.3.1.4 Skin Protection Programme 983
50.3.2 Aims and Methods of Educational Programmes 984
50.3.3 Theoretical Approaches in Health Educational Skin Protection Programmes 984
50.3.4 Professionalization of Health Education 985
50.3.5 Systematic Reviews on the Effectiveness of Educational Programmes in Prevention of OCD and Exemplary Studies with Edu 985
50.3.6 Further Implications in Health Educational Research in the Specific Field of OCD 986
References 986
51: Prevention of Allergic Contact Dermatitis: Safe Exposure Levels of Sensitizers 992
51.1 General Aspects of Contact Allergy Epidemics 992
51.2 Industrial Measures to Prevent Contact Allergy Epidemics Prior to Product Marketing 993
51.3 Detection and Surveillance of Contact Allergy Epidemics 993
51.4 Measures to Prevent Contact Allergy Epidemics After Product Marketing 994
References 996
52: Legislation 998
52.1 Introduction 998
52.2 Cosmetics Directive 998
52.2.1 Skin Irritation 1001
52.2.2 Skin Corrosivity 1001
52.2.3 Eye Irritation 1001
52.2.4 Skin Sensitization 1001
52.2.5 Dermal Absorption, Percutaneous Penetration 1001
52.2.6 Photoirritation 1001
52.3 Detergent Regulations 1001
52.4 REACH and the Dangerous Substances Directive (DSD) 1001
52.5 Dangerous Preparations Directive (DPD) 1002
52.6 Nickel 1002
52.7 Chromate 1002
References 1003
53: International Comparison of Legal Aspects of Workers’ Compensation for Occupational Contact Dermatitis 1004
53.1 Introduction 1004
53.2 Occupational Dermatitis in Germany 1005
53.2.1 Example A 1007
53.2.2 Example B 1007
53.2.2.1 Comment 1008
53.2.3 Example C 1008
53.3 Occupational Contact Dermatitis in Other European Countries, Australia and the USA 1008
54: Databases and Networks. The Benefit for Research and Quality Assurance in Patch Testing 1027
54.1 Scope 1027
54.2 Patch Test Software 1028
54.3 The Centre of a Multi-Centre Network 1030
54.4 Quality Control in Patch Test Networks 1030
54.5 Surveillance of Contact Allergy 1031
54.6 Detection of New Contact Allergens 1032
54.7 Examples from Existing Databases/Networks 1033
54.7.1 Increasing Contact Allergy Frequency 1033
54.7.2 Decreasing Contact Allergy Frequency 1034
54.7.3 Persisting Contact Allergy Problems 1034
54.7.4 Subgroup or Multi-Factorial Analyses 1034
54.7.5 Link with Other Data 1035
54.8 Auxiliary Databases 1035
54.8.1 Information on Allergens 1035
54.8.2 Product Databases 1035
References 1036
55: Contact Dermatitis Research Groups 1038
55.1 Introduction 1038
55.2 Contact Dermatitis Groups 1039
56: Patch Test Concentrations and Vehicles for Testing Contact Allergens 1044
References 1078
57: Patch Testing with the Patients’ Own Products 1079
57.1 Information on the Test Material Before Patch Testing 1080
57.1.1 Test Method 1081
57.1.1.1 Skin Tests 1081
57.1.1.2 pH 1082
57.1.1.3 Dilution 1082
57.1.2 Control Tests 1084
57.2 Product Categories for Patch Testing 1084
57.2.1 Decorative Cosmetics, Sunscreens, Toiletries (Tables 57.4 and 57.5) 1084
57.2.2 Hairdressing, Depilatory, and Nail Cosmetics (Table 57.6) 1085
57.2.3 Topical Medicaments 1085
57.2.4 Medical Appliances 1085
57.2.5 Dental Prosthesis and Other Dental Restorative Materials 1086
57.2.6 Disinfecting Agents 1086
57.2.7 Clothing 1086
57.2.8 Pesticides 1086
57.2.9 Detergents for Household Cleaning 1086
57.2.10 Food Stuff 1086
57.2.10.1 Scratch Chamber Testing [26] 1086
57.2.11 Plants 1087
57.2.12 Woods 1087
57.2.13 Office Work 1087
57.2.14 Construction Materials 1088
57.2.15 Paints, Lacquers 1088
57.2.16 Greases and Oils 1088
57.2.17 Metalworking Fluids 1088
57.2.18 Rubber Chemicals 1089
57.2.19 Glues and Adhesives 1089
57.2.20 Plastic Materials 1090
57.2.21 Do Not Test 1090
References 1091
58: Dictionary of Contact Allergens: Chemical Structures, Sources, and References 1092
1. Abietic acid 1092
2. Acetaldehyde 1093
3. Acid Blue 158 1093
4. Acrylamide 1093
5. Acrylates, Cyanoacrylate, and Methacrylates 1093
6. Acrylonitrile 1101
7. Alachlor® 1101
8. Alantolactone 1101
9. Alkyl Glucosides 1101
10. Allicin 1102
11. Allyl Glycidyl Ether 1102
12. Allyl Isothiocyanate 1102
13. Allylpropyldisulfide 1102
14. Alprenolol 1103
15. Amethocaine 1103
16. p-Amino-N,N-Diethylaniline Sulfate 1103
17. 4-Amino-3-Nitrophenol 1103
18. p-Aminoazobenzene 1104
19. p-Aminodiphenylamine (Hydrochloride) 1104
20. Aminoethylethanolamine 1104
21. o-Aminophenol 1104
22. p-Aminophenol 1104
23. Aminophylline 1105
24. N,N-bis-(3-Aminopropyl) Dodecylamine 1105
25. Ammonium Persulfate 1105
26. Ammonium Thioglycolate 1106
27. Amoxicillin 1106
28. Ampicillin 1106
29. Amprolium (Hydrochloride) 1107
30. Amyl Cinnamyl Alcohol 1107
31. Amylcinnamaldehyde 1107
32. Anacardic Acids 1107
33. Anethole 1108
34. Anisyl Alcohol 1108
35. Antimony Trioxide 1108
36. Arsenic and Arsenic Salts (Sodium Arsenate) 1108
37. Articaine (Hydrochloride) 1108
38. Atranol 1109
39. Azaperone 1109
40. Azathioprine 1109
41. Basic Red 22 1110
42. Basic Red 46 1110
43. Befunolol 1110
44. Benomyl 1110
45. Benzalkonium Chloride 1111
46. Benzisothiazolone 1111
47. Benzophenones 1111
48. Benzoyl Peroxide 1112
49. Benzydamine Hydrochloride 1113
50. Benzyl Alcohol 1113
51. Benzyl Benzoate 1113
52. Benzyl Salicylate 1114
53. Benzylpenicillin 1114
54. BHA 1114
55. BHT 1114
56. Bioban CS-1135 1115
57. Bioban® CS-1246 1115
58. Bioban® P-1487 1115
59. Bisphenol A 1115
60. Bisphenol A Diglycidyl Ether (DGEBA) 1116
61. o,p-Bisphenol F and p,p-Bisphenol F 1116
62. Bisphenol F Diglycidyl Ether (DGEBF) 1116
63. Brominated Epoxy Resin 1117
64. 1-Bromo-3-Chloro-5,5-Dimethylhydantoin 1118
65. Bromohydroxyacetophenone 1118
66. Bronopol 1118
67. Budesonide 1118
68. Bufexamac 1119
69. Buprenorphine 1119
70. 1,4-Butanediol Diglycidyl Ether 1120
71. N-tert-Butyl-bis-(2-Benzothiazole) Sulfenamide 1120
72. Butyl Carbitol 1120
73. p-tert-Butyl Catechol 1120
74. n-Butyl Glycidyl Ether 1121
75. tert-Butyl-Hydroquinone 1121
76. p-tert-Butyl-alpha-Methylhydrocinnamic Aldehyde 1121
77. Butylene Glycol 1121
78. Para-tert-Butylphenol 1122
79. Caffeic Acid Dimethyl Allylic Ester 1122
80. Captafol 1122
81. Captan 1123
82. Carbaryl 1123
83. Carbodiimide 1123
84. Carbofuran 1123
85. Cardols 1123
86. D-3-Carene 1124
87. Carteolol 1124
88. CD1 1124
89. CD2 1125
90. CD3 1125
91. CD4 1125
92. CD6 1126
93. Cefaclor 1126
94. Cephalosporins 1126
95. Cetearyl Isononanoate 1127
96. Chloramphenicol 1127
97. Chlorhexidine (Digluconate) 1127
98. 5-Chloro-1-Methyl-4-Nitroimidazole 1127
99. Chloroacetamide 1128
100. Chloroacetophenone 1128
101. Chloroatranol 1128
102. Chlorocresol 1128
103. Chlorophorin 1129
104. Chlorothalonil 1129
105. Chlorpromazine 1129
106. Cinnamal 1129
107. Cinnamyl Alcohol 1130
108. Citral 1130
109. Citronellol 1130
110. Clindamycin 1131
111. Clopidol 1131
112. Cloxacillin 1131
113. Cobalt Naphthenate 1132
114. Cocamidopropyl Betaine 1132
115. Cocamidopropyl Dimethylamine 1132
116. Coconut Diethanolamide 1132
117. Codeine (Phosphate, Hydrochloride) 1133
118. Costunolide 1133
119. Coumarin 1133
120. Cresyl Glycidyl Ether 1134
121. Cyclohexanone 1134
122. 2-Cyclohexen-1-one 1134
123. N-Cyclohexyl-2-Benzothiazylsulfenamide 1134
124. N-Cyclohexyl-N-Phenyl-p-Phenylenediamine 1135
125. N-Cyclohexyl-Thiophthalimide 1135
126. Cymene 1135
127. Cymoxanil 1136
128. Dazomet 1136
129. DDT 1136
130. Decyl glucoside 1136
131. Dehydrocostuslactone 1137
132. Deoxylapachol 1137
133. Diallyl Disulfide 1137
134. Diaminodiphenylmethane 1137
135. Diammonium Hydrogen Phosphate 1138
136. Diazodiethylaniline Chloride 1138
137. Diazolidinyl Urea 1138
138. Dibenzothiazyl Disulfide 1138
139. Dibucaine (Hydrochloride) 1139
140. Dibutyl Phthalate 1139
141. Dibutylthiourea 1139
142. 4,5-Dichloro-2-n-Octyl-4-Isothiazolin-3-one 1139
143. 1,3-Dichloropropene 1140
144. Dichlorvos 1140
145. N,N-Dicyclohexyl-2-Benzothiazole Sulfenamide 1140
146. Dicyclohexyl Carbodiimide 1140
147. Didecyldimethylammonium Chloride 1141
148. Diethanolamine 1141
149. Diethyl Sebacate 1141
150. Diethyleneglycol Diglycidyl Ether 1141
151. Diethylenetriamine 1142
152. Diethylphthalate 1142
153. Diethylthiourea 1142
154. Diisopropyl Carbodiimide 1142
155. Diisopropylbenzothiazyl-2-Sulfenamide 1142
156. 2,5-Dimercapto-1,3,4-Thiadiazole 1143
157. Dimethoate 1143
158. Dimethoxon 1143
159. 2,6-Dimethoxy-1,4-Benzoquinone 1143
160. (R)-3,4-Dimethoxy-Dalbergione 1144
161. (S)-4,4’-Dimethoxy Dalbergione 1144
162. 5,8-Dimethoxypsoralen 1144
163. Dimethyl Phthalate 1144
164. 4-N,N-(Dimethylamino) Benzenediazonium Chloride 1145
165. 3-Dimethylaminopropylamine 1145
166. Dimethyldiphenylthiuram disulfide 1145
167. Dimethylformamide 1145
168 bis. Dimethyl fumarate 1146
169. 2,4-Dimethylol Phenol 1146
170. 2,6-Dimethylol Phenol 1146
171. Dimethylthiourea 1146
172. Dinitrochlorobenzene 1147
173. Dinitrofluorobenzene 1147
174. 2,4-Dinitrotoluene 1147
175. Dipentamethylenethiuram Disulfide 1147
176. Dipentamethylenethiuram Hexasulfide 1148
177. Dipentamethylenethiuram Tetrasulfide 1148
178. Dipentene 1148
179. Diphencyprone 1148
180. Diphenhydramine (hydrochloride) 1149
181. N,N’-Diphenyl-4-Phenylenediamine 1149
182. 1,3-Diphenylguanidine 1149
183. 4,4’-Diphenylmethane-Diisocyanate 1150
184. Diphenylthiourea 1150
185. Disperse Blue 106 1150
186. Disperse Blue 124 1150
187. Disperse Dyes 1151
188. Disperse Orange 3 1151
189. Disperse Orange 31 1151
190. Disperse Red 11 1152
191. Disperse Yellow 3 1152
192. Dithianone 1152
193. Dodecyl Gallate 1152
194. Doxepin 1153
195. Epichlorhydrin 1153
196. Epoxy Resins of the Bisphenol A Type 1153
197. 2,3-Epoxypropyl Trimethyl Ammonium Chloride 1154
198. Estradiol 1154
199. Ethoxyquin 1154
200. Ethyl Alcohol 1154
201. 4-Ethyl-Pyridine 1155
202. Ethylbutylthiourea 1155
203. Ethylene Oxide 1155
204. Ethylenediamine 1155
205. Ethylenethiourea 1156
206. Ethylhexylglycerin 1156
207. Eugenol 1156
208. Euxyl®K 400 (see 284. subentry 1,2-Dibromo-2,4-Dicyanobutane and 322. Phenoxyethanol) 1156
209. Famotidine 1157
210. Farnesol 1157
211. Fenvalerate 1157
212. Fluazinam 1157
213. Flutamide 1158
214. Folpet 1158
215. Formaldehyde 1158
216. Frullanolide 1159
217. Furaltadone 1159
218. Furazolidone 1159
219. Geraniol 1160
220. Glutaraldehyde 1160
221. Glyceryl Thioglycolate 1160
222. Glycidyl 1-Naphthyl Ether 1161
223. 3-Glycidyloxypropyltrimethoxysilane 1161
224. Grotan BK 1161
225 bis. HC Blue No. 7 1161
226. HC Yellow No. 7 1162
227. Hexamethylene Diisocyanate 1162
228. Hexamethylenediamine 1162
229. Hexamidine 1162
230. Hexanediol Diglycidyl Ether 1163
231. Hexyl Cinnamic Aldehyde 1163
232. Hydralazine 1163
233. Hydrangenol 1163
234. Hydrazine 1163
235. Hydrocortisone 1164
236. Hydrocortisone 17-Butyrate 1164
237. Hydrogen Peroxide 1164
238. Hydroquinone 1165
239. (S)-4-Hydroxy 4-Methoxydalbergione 1165
240. Hydroxycitronellal 1165
241. Hydroxylamine and Hydroxylammonium Salts 1165
242. Hydroxymethylpentacy­clohexenecarboxaldehyde 1166
243. Hypochlorous Acid and Hypochlorites 1166
244. Imidazolidinyl Urea 1166
245. Iodopropynyl Butylcarbamate 1167
246. Isoeugenol 1167
247. Alpha-Isomethylionone 1168
248. Isophorone Diamine 1168
249. Isopropyl Myristate 1168
250. N-Isopropyl-N-Phenyl-4-Phenylenediamine 1168
251. Ketoprofen 1169
252. Labetalol 1169
253. Lactucin 1169
254. Lactucopicrin 1169
255. Lapachenol 1170
256. Lapachol 1170
257. Lawsone 1170
258. Lidocaine 1171
259. Lilial® 1171
260. Limonene 1171
261. Linalool 1171
262. Linalyl acetate 1172
263. Lincomycin (Hydrochloride Monohydrate) 1172
264. Lindane 1172
265. Lyral® 1172
266. Malathion 1172
267. Mancozeb 1173
268. Maneb 1173
269. Melamine and Melamine-Formaldehyde Resins 1173
270. Mercaptobenzothiazole 1174
271. Mercaptobenzothiazole Salts 1174
272. MESNA 1174
273. Metacresol 1175
274. Metanil Yellow 1175
275. Methenamine 1175
276. Methidathion 1175
277. Methiocarb 1176
278. Methomyl 1176
279. (R)-4-Methoxy Dalbergione 1176
280. Methoxy PEG-17/Dodecyl Glycol Copolymer 1176
281. Methoxypsoralens 1177
282. Methyl aminolevulinate 1177
283. Methyl-2,3-Epoxy-3-(4-Methoxyphenyl)Propionate 1177
284. Methyl Gallate 1177
285. Methyl Heptine Carbonate 1178
286. Methyl Octine Carbonate 1178
287. Methyl Salicylate 1178
288. Methyl-Terpyridine 1178
289. 2-Methyl-4,5-Trimethylene-4-Isothiazolin-3-one 1179
290. Methylchloroisothiazolinone 1179
291. Methylchloroisothiazolinone.+.Methylsiothiazolinone (MCI/MI) 1179
292. Methyldibromoglutaronitrile 1179
293. Methylhexahydrophthalic Anhydride 1180
294. Methylisothiazolinone 1180
295. Methylol Phenols 1180
296. 1-Methylpyrrolidone 1181
297. Metol (Sulfate) 1181
298. Metronidazole (hydrochloride) 1181
299. Mevinphos 1181
300. Mezlocilin 1182
301. Monoethanolamine 1182
302. Morphine (Morphine Hydrochloride, Morphine Tartrate) 1182
303. 4-Morpholinyl-2-Benzothiazyle Disulfide 1182
304. Morpholinyl Mercaptobenzothiazole 1183
305. Naled 1183
306. 1-Naphthol 1183
307. Naphthol AS 1183
308. Neomycin (Neomycin B Hydrochloride, Neomycin B Sulfate) 1184
309. Nicotine 1184
310. 3-Nitro-4-Hydroxyethylaminophenol 1185
311. 2-Nitro-4-Phenylenediamine 1185
312. Nitrofurazone 1185
313. Nitroglycerin 1185
314. Nonoxynols 1186
315. Octocrylene 1186
316. Octyl Gallate 1186
317. 2-n-Octyl-4-Isothiazolin-3-one 1187
318. Olaquindox 1187
319. Oxacillin 1187
320. 7-Oxodehydroabietic Acid 1187
321. Oxprenolol 1188
322. Pantothenol 1188
323. Parabens (Parahydroxybenzoic Acid Esters) 1188
324. Paraphenylenediamine 1189
325. Paraquat (Dichloride, Methosulfate) 1190
326. Parathion 1190
327. Parthenolide 1190
328. Penicillins 1191
329. Pentachloronitrobenzene 1191
330. Pentadecylcatechol 1191
331. Phenoxyethanol 1191
332. Phenyl Glycidyl Ether 1192
333. Phenyl-Alpha-Naphthylamine 1192
334. Phenyl-Beta-Naphthylamine 1192
335. Phenylephrine (Hydrochloride) 1193
336. Phenylethyl Caffeate 1193
337. Phthalic Anhydride 1193
338. Picric Acid 1193
339. Alpha-Pinene 1194
340. Beta-Pinene 1194
341. Piperazine 1194
342. Piroxicam 1194
343. Pivampicillin 1195
344. Polymyxin B (sulfate) 1195
345. Potassium Metabisulfite 1196
346. Povidone-Iodine 1196
347. Prilocaine (Hydrochloride) 1196
348. Primin 1196
349. Pristinamycin 1197
350. Procaine (Hydrochloride) 1197
351. Propacetamol 1197
352. Propargite 1198
353. Propranolol 1198
354. Propyl Gallate 1198
355. Propylene Glycol 1199
356. Propylene Oxide 1199
357. Pseudoephedrine 1199
358. Pyrethroids 1199
359. Pyrethrosin 1200
360. Pyridine 1200
361. Pyrithione 1200
362. Pyrogallol 1201
363. PVP 1201
364. PVP/Eicosene Copolymer 1201
365. PVP/Hexadecene Copolymer 1202
366. Quaternium-15 1202
367. Quaternium-22 1202
368. Ranitidine 1203
369. Resorcinol 1203
370. Silane 1203
371. Sodium Bisulfite 1203
372. Sodium lauryl sulfate 1204
373. Sodium Metabisulfite 1204
374. Sodium Methyldithiocarbamate 1204
CAS Registry Number [137–42–8] 1204
375. Sodium Sulfite 1204
376. Solvent Red 23 1205
377. Sorbitan Sesquioleate 1205
378. Spectinomycin 1205
379. Tetrabenzylthiuram Disulfide 1206
380. Tetrabutylthiuram Disulfide 1206
381. Tetrabutylthiuram Monosulfide 1206
382. Tetrachloroacetophenone 1206
383. Tetraethylthiuram Disulfide 1206
384. Tetraethylthiuram Monosulfide 1207
385. Tetraisobutylthiuram Disulfide 1207
386. Tetramethylthiuram Disulfide 1207
387. Tetramethylthiuram Monosulfide 1208
388. Tetrazepam 1208
389. Thebaine 1208
390. Thiabendazole 1209
391. Thimerosal 1209
392. Thiourea 1209
393. Thymoquinone 1209
394. Timolol 1210
395. Tixocortol Pivalate 1210
396. Tocopherol, Tocopheryl Acetate (DI-, D-) 1210
397. Toluene-2,5-Diamine 1211
398. Toluene Diisocyanate 1211
399. Tosyl Chloride 1211
400. Triacetin 1211
401. Tribenoside 1212
402. Tributyltin Oxide 1212
403. Trichloroethane 1212
404. Trichloroethylene 1212
405. Triethanolamine 1213
406. Triethylenetetramine 1213
407. Triforine 1213
408. Triglycidyl Isocyanurate 1213
409. N-[3-(Trimethoxysilyl)Propyl]-N-(Vinylbenzyl)Ethylenediamine Monohydrochloride 1214
410. N-(3-Trimethoxysilylpropyl)-Ethylenediamine 1214
411. 2,4,6-Trimethylol Phenol 1214
412. Trimethylthiourea 1215
413. Tulipalin A and Tulipalin B 1215
414. Tuliposide A 1215
415. Tylosin 1215
416. Urushiol 1216
417. Usnic Acid (D-Usnic Acid, l-Usnic Acid) 1216
418. Vinylpyridine 1217
419. Virginiamycin 1217
420. Zinc bis-Dibutyldithiocarbamate 1218
421. Zinc bis-Diethyldithiocarbamate 1218
422. Zinc bis-Dimethyldithiocarbamate 1218
423. Zinc Ethylene-bis-Dithiocarbamate 1219
424. Zinc Propylene-bis-Dithiocarbamate 1219
58.1 Introduction 1092
Index 1220