Contact Dermatitis

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.