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Contact Dermatitis Associated With Skin Cleansers: Retrospective Analysis of North American Contact Dermatitis Group Data 2000–2014

Warshaw, Erin, M., MD, MS*†‡; Goodier, Molly, C., BS†‡§; DeKoven, Joel, G., MD; Maibach, Howard, I., MD; Taylor, James, S., MD#; Sasseville, Denis, MD**; Belsito, Donald, V., MD††; Fowler, Joseph, F., Jr, MD‡‡; Fransway, Anthony, F., MD§§; DeLeo, Vincent, A., MD∥∥; Marks, James, G., Jr, MD¶¶; Pratt, Melanie, D., MD##; Mathias, Toby, MD***; Zirwas, Matthew, J., MD†††; Zug, Kathryn, A., MD‡‡‡

doi: 10.1097/DER.0000000000000330

Background There is limited information regarding contact dermatitis (CD) associated with skin cleansers (SCs).

Objective The aim of the study was to evaluate the prevalence of allergic patch test (APT) reactions and irritant CD (ICD) associated with SCs.

Methods A retrospective cross-sectional analysis was performed using North American Contact Dermatitis Group data, 2000–2014.

Results Of 32,945 tested patients, 1069 (3.24%) had either APT reaction or ICD associated with SCs. Of these, 692 (64.7%) had APT reaction only, 350 (32.7%) had ICD only, and 27 (2.5%) had both. Individuals with APT reaction and/or ICD were more likely to have occupationally related skin disease (relative risk [RR] = 3.8 [95% confidence interval {CI} = 3.3–4.5] for APT reaction and 10.0 [95% CI = 8.2–12.2] for ICD, respectively, P < 0.0001). As compared with those without APT reaction to SC, individuals with APT reaction had significantly higher frequencies of hand (RR = 2.4 [95% CI = 2.1–2.7]) and arm dermatitis (RR = 1.3 [95% CI = 1.1–1.6], P ≤ 0.001). Irritant CD was strongly associated with hand dermatitis (RR = 6.2 [95% CI = 5.2–7.3], P < 0.0001). More than 50 allergens were associated with SCs including quaternium-15 (11.2%), cocamidopropyl betaine (9.5%), methylchloroisothiazolinone/methylisothiazolinone (8.4%), coconut diethanolamide (7.9%), fragrance mix I (7.7%), Myroxylon pereirae (5.9%), 4-chloro-3,5-xylenol (5.8%), amidoamine (5.5%), and formaldehyde (4.4%).

Conclusions Many allergens, especially preservatives and surfactants, were associated with SCs. Most cases involved the hands and were occupationally related.

From the *Department of Dermatology, University of Minnesota Medical School; †Department of Dermatology, Minneapolis Veterans Affairs Medical Center; ‡HCMC Parkside Occupational and Contact Dermatitis Clinic; §University of Minnesota School of Medicine, Minneapolis; ∥Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; ¶Department of Dermatology, University of California San Francisco; #Department of Dermatology, Cleveland Clinic, OH; **Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; ††Columbia University Medical Center, New York; ‡‡University of Louisville, KY; §§Associates in Dermatology, Fort Myers, FL; ∥∥Department of Dermatology, Keck School of Medicine, Los Angeles, CA; ¶¶Department of Dermatology, Pennsylvania State University, State College; ##Division of Dermatology, University of Ottawa, Ontario, Canada; ***Department of Dermatology, University of Cincinnati, OH; †††Ohio State University, Columbus; and ‡‡‡Dartmouth-Hitchcock Medical Center, Lebanon, NH.

No reprints available.

The authors have no funding or conflicts of interest to declare.

This material is the result of work supported with resources and the use of facilities at the Minneapolis Veterans Affairs Medical Center.

The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.

© 2018 American Contact Dermatitis Society
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