Kojic acid (5-hydroxy-2-(hydroxymethyl)-4-pyrone), a fungal metabolic product, has increasingly been used as a skin-depigmenting agent in skin care products marketed in Japan since 1988. In order to determine its frequency of sensitization, during 1 year from October 1992 to September 1993, we performed patch testing with it in 220 female patients with suspected cosmetic-related contact dermatitis. Of the 220 patients, 8 used at least 1 skin care product containing kojic acid, 5 of whom reacted to kojic acid as well as to 1 or more their own products containing 1% kojic acid, but not to their other products not containing it, and 3 of whom were negative to kojic acid and all their own products. Patch testing with kojic acid in the remaining group of 212 patients, who had not previously used skin care products containing it, was negative without exception. The 5 kojic-acid-sensitive patients, aged 34 to 58 years, developed facial dermatitis 1-12 months after starting application of kojic-acid-containing products. Kojic acid is considered to have high sensitizing potential, as a comparatively high frequency of contact sensitivity was observed in patients using products containing it (5 out of 8).

A female patient, with a previous episode of contact dermatitis caused by a blue dress, developed similar dermatitis due to a navy-blue dress. Patch tests revealed multiple allergic positive reactions to paraphenylenediamine (PPD), the navy-blue dress, its extracts, 6 azo disperse dyes in a textile series, as well as 3 dye components, including Disperse (DP) Red 153, which were present in the dress; these were composed of 9 azo disperse dyes, all dyes being of a different chemical structure. On the basis of chemical similarities between these 16 azo dyes including PPD, these are classified into the following 4 groups: thiazol-azoyl-PPD group (including DP Blue 106, DP Blue 124 and 5 used dyes), aminoazobenzene group (DP Red 1, DP Red 17, DP Brown 1 and 2 used dyes), PPD group (PPD and DP Orange 3) and benzothiazol-azoyl-PPD group (2 dyes in DP Red 153). With few exceptions, cross-sensitizations between dyes in the same group have been reported by other authors, or are suggested by us, in the former 3 groups. Multiple azo disperse dye sensitization is therefore considered to be attributable mainly to group sensitizations to azo dyes.

Many contact allergens can cause an erythema‐multifor‐me (EM)‐like or urticarial papular and plaque eruption (UPPE) (1–6). Although numerous topical medicaments have been reported as causing UPPE, oxybenzone (2‐hydroxy‐4‐methoxy benzophenone, benzophenone 3, Eusolex 4360) has not.

In order to investigate the effect of occlusion on the skin, the flexor sides of both upper arms were covered with column-shaped with column-shaped closed chambers, 30 mm in outer diameter, 20 mm in inner diameter, and 5 mm in height, which were made of polyethylene foam. The tops of the chambers were sealed by plastic films with various levels of water vapor permeability to control moisture in each chamber. The raised chamber walls prevented direct contact between the skin and the plastic film. After 24 h of application, morphological changes of the skin surface were observed microscopically by the nitrocellulose-replica method. Although no visual alterations were found on all areas of occluded skin, microscopic evaluation showed that simple occlusion by films induced an increase in the number of deepened skin furrows on the skin surface. this increase was associated with lower water vapor permeability of the films, as well as with higher values of both temperature and humidity of the test day. Thus, since conditions which facilitate perspiration from the skin tend to cause skin irritation, prolonged exposure of the skin to sweat by simple occlusion may act as a primary skin irritant.

For 20 years, using the replica method, we have evaluated the skin irritancy of about 10,000 commercial products which come into contact with the skin. In this method, test substances are usually applied on the flexor side of the upper arm for 24 h by semi-open patch test. Subsequently, skin replicas are taken and skin irritancy is evaluated microscopically. In the semi-open patch test, test substances are not completely occluded as in the closed patch test. Thus, this method is less invasive than the closed patch test method to the tested subjects. In this study, we investigated the sensitivity of microscopic scoring (MS) of the replica and visual scoring (VS) of the skin. Sodium lauryl sulphate (SLS) at 0.02%, 0.05%, and 0.2% was applied on 20 subjects' upper arms, using closed and semi-open methods. In both the closed patch test and the semi-open patch test, the value of MS correlated with the concentration of SLS, while VS did not show such a clear correlation. In addition, we compared 2 clinical tests for skin irritancy which are commonly performed in Japan: VS of 48 h closed patch test reaction on the subjects' upper backs and MS of 24 h semi-open patch test reaction on the subjects' upper arms (replica method). MS on the upper arms resulted in a constant score, regardless of the location of application, while VS on the upper back produced results which differed widely depending on the location. Thus, the replica method is a useful clinical test for skin irritancy, because it is sensitive, reproducible and non-invasive.