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      Clinicoepidemiological and Patch Test Profile of Patients Attending the Contact Dermatitis Clinic of a Tertiary Care Hospital in North India: A 7-Year Retrospective Study

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          Abstract

          Introduction:

          Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases.

          Aims and Objectives:

          To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department.

          Materials and Methods:

          It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability.

          Results:

          A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix.

          Conclusion:

          Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.

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          Most cited references29

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          The epidemiology of contact allergy in the general population--prevalence and main findings.

          A substantial number of studies have investigated the prevalence of contact allergy in the general population and in unselected subgroups of the general population. The aim of this review was to determine a median prevalence and summarize the main findings from studies on contact allergy in the general population. Published research mainly originates from North America and Western Europe. The median prevalence of contact allergy to at least 1 allergen was 21.2% (range 12.5-40.6%), and the weighted average prevalence was 19.5%, based on data collected on all age groups and all countries between 1966 and 2007. The most prevalent contact allergens were nickel, thimerosal, and fragrance mix. The median nickel allergy prevalence was 8.6% (range 0.7-27.8%) and demonstrates that nickel was an important cause of contact allergy in the general population and that it was widespread in both men and women. Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. Nickel was a risk factor for hand eczema in women. Finally, heavy smoking was associated with contact allergy, mostly in women. Population-based epidemiological studies are considered a prerequisite in the surveillance of national and international contact allergy epidemics.
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            Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis.

            Atopic diseases are common in children and adolescents. However, epidemiological knowledge is sparse for hand eczema and allergic contact dermatitis in this age group. Furthermore, no population-based studies have evaluated the prevalence of atopic diseases and hand and contact dermatitis in the same group of adolescents. To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark. The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing. The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%, P < 0.001) using predefined questionnaire criteria. The 1-year period prevalence of AD was 6.7% and the point prevalence 3.6% (Hanifin and Rajka criteria). In the interview the lifetime prevalence of inhalant allergy was estimated as 17.7% (6.9% allergic asthma, 15.7% allergic rhinitis). The lifetime prevalence of hand eczema based on the questionnaire was 9.2%, the 1-year period prevalence was 7.3% and the point prevalence 3.2%, with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%, P < 0.001), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%). High prevalence figures were found for atopic diseases, hand eczema and allergic contact dermatitis, and the diseases were closely associated. A considerable number of adolescents still suffers from AD, and a considerable sex difference was noted for hand eczema and allergic contact dermatitis. Nickel allergy and perfume allergy were the major contact allergies. In the future this cohort of eighth grade school children will be followed up with regard to the course and development of atopic diseases, hand eczema and contact dermatitis.
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              Skin type, but neither race nor gender, influence epidermal permeability barrier function.

              Previous studies that compared transepidermal water loss in subjects of different race and sex showed minimal differences in basal permeability barrier function. These studies often did not assess the ability of the stratum corneum to withstand or recover from insults to the epidermal permeability barrier. We compared epidermal permeability barrier function in the following human subjects (age range, 22 to 38 years): white (n = 8) vs Asian (n = 6); male (n = 7) vs female (n = 7); and skin type II/III (n = 14) vs skin type V/VI (n = 7) (scale, I to VI). Basal transepidermal water loss was measured by evaporimetry (three sites) on the volar aspect of the forearm. Barrier integrity then was assessed by determining the number of tape strippings required to reach a transepidermal water loss greater than or equal to 20 g/m2 per hour. The rates of barrier recovery then were compared at 6, 24, and 48 hours and 1 week after abrogation. Neither the number of tape strippings required to perturb the barrier nor the rates of barrier recovery were significantly different in white vs Asian subjects or in female vs male subjects. However, patients with skin types II/III required only 29.6 +/- 2.4 tape strippings to perturb the barrier, while the skin type V/VI group required 66.7 +/- 6.9 tape strippings. Furthermore, while barrier function in skin type II/III recovered by approximately 20% by 6 hours and 55% by 48 hours, barrier function in skin type V/VI, independent of race, recovered more quickly, 43% and 72% at 6 and 48 hours, respectively. Finally, neither the differences in barrier integrity nor in rates of recovery could be attributed to variations in cohesiveness, since stripping appears to remove the same weight of stratum corneum in both groups. Darkly pigmented skin displays both a more resistant barrier and one that recovers more quickly after perturbation by tape stripping than does the skin of individuals with lighter pigmentation. These findings have potential implications for transdermal delivery of topical or systemic therapeutic agents, the ability of individuals with different skin types to withstand environmental or occupational insults, and the influence of acquired hyperpigmentation or pigment loss to influence permeability.
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                Author and article information

                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatology Online Journal
                Wolters Kluwer - Medknow (India )
                2229-5178
                2249-5673
                Nov-Dec 2019
                01 November 2019
                : 10
                : 6
                : 669-675
                Affiliations
                [1] Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India
                Author notes
                Address for correspondence: Dr. Iffat Hassan, Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, J and K, India. E-mail: hassaniffat@ 123456gmail.com
                Article
                IDOJ-10-669
                10.4103/idoj.IDOJ_26_19
                6859765
                2e28a8a2-36ea-4bb8-b0ad-220724b1d585
                Copyright: © 2019 Indian Dermatology Online Journal

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : January 2019
                : April 2019
                Categories
                Original Article

                Dermatology
                allergic contact dermatitis,patch testing,retrospective study
                Dermatology
                allergic contact dermatitis, patch testing, retrospective study

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