Preservative Contact Hypersensitivity among Adult Atopic Dermatitis Patients

Abstract

Atopic dermatitis (AD) is a chronic inflammatory disease characterised by an impaired skin barrier. The prolonged use of topical preparations containing medications, emollients, fragrances and preservatives may increase the risk of contact hypersensitivity (CHS). In the Allergy Outpatient Unit of the Department of Dermatology, Venereology and Dermatooncology of Semmelweis University, 5790 adult patients were patch tested between 2007–2021 with the European Environmental Baseline Series according to international standards. Among all the tested adult patients, 723 had preservative CHS (PCHS) and 639 had AD. Among the 723 PCHS patients, 68 (9.4%) had AD; the female to male ratio was 3:1 in this group. Out of 639 AD patients, 68 had PCHS (10.6%). In the AD-PCHS group, 83.8% had CHS to methylisothiazolinone (MI) (tested from 2014), 36.8% to Kathon CG®, 16.2% to methyldibromo-glutaronitrile, 11.8% to paraben, 7.4% to formaldehyde, 4.4% to para-tert-butylphenol-formaldehyde resin and 1.5% to Quaternium-15. The most common concomitant PCHS combination was Kathon CG® + MI. Most patients (32.4%) belonged to the age group of 21–30, and skin symptoms affected mostly the limbs and face. The most common other concomitant allergens were nickel, lanolin alcohol and balsam of Peru. Preservatives (especially MI and Kathon CG®) are important contact allergens in adult AD, mostly among young women. The rate of AD in the PCHS group and the rate of PCHS in the AD group is remarkable; thus, the role of PCHS should be highlighted in the topical therapy and in the prevention of possible AD exacerbations.

Contact Allergy in Atopic Patients

“…In our study, a total of 24 positive reactions to methylisothiazolinone (MI), Kathon CG®, methyldibromo glutaronitrile (MDBNH), formaldehyde, and quaternium-15 or 12.7% of contact hypersensitivity in atopics were found. According to Németh et al (2022), in 639 patients with AD and ACD, contact sensitization to preservatives was 10.6%, with the most common concomitant combination being Kathon CG® + MI [21]. As early as 1990, A. C. de Groot reported a high incidence of positive reactions to nickel (18.8%), cobalt (6%), Kathon CG (4.8%), and Balsam of Peru (3.6%) in 214 atopic patients [22].…”

Clinical Characteristics and Treatment of Acne with Sensitive Skin

“…In individuals with sensitive skin, exposure to rapid changes in physical and chemical conditions or variations in environmental temperature can lead to the rapid expansion of skin microvessels and increased blood fow, resulting in fushing of the skin [17]. In addition, the accelerated blood fow enhances the absorption of external irritants, increasing the likelihood of uncomfortable sensations such as itching, burning, or tingling [18]. Studies have demonstrated that the prevalence of sensitive skin is approximately 36.1% in China and around 50% in Japan, Europe, and the United States [19].…”

Az atópiás dermatitis (ekcéma) biopszichoszociális megközelítése

“…Rendszerint már csecsemőkorban megjelennek a bőrtünetek, ami az "atópiás menetelés" első lépése lehet, később allergiás rhinitis (szénanátha), majd asthma bronchiale követheti (Kárpáti, Gyulai, Kemény, Remenyik, & Sárdy, 2019). Az AD gyakran társul -elsősorban a kozmetikai szerekben található tartósítószerek iránti -kontakt hiperszenziti vitással is (Németh, Temesvári, Holló, & Pónyai, 2022). A gyakran nedvedző és pörkösödő tünetek kezdetben az orcákon, a homlokon és a hajas fejbőrön láthatóak, ezt követően a törzsre és a végtagok feszítő felszíneire terjednek ki, típusosan a pelenka alatti terület megkímélt.…”