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Journal of the American Academy of Dermatology

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Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016 - 10/03/21

Doi : 10.1016/j.jaad.2020.07.059 
Amber Reck Atwater, MD a, ⁎ , Amy J. Petty, BS b, Beiyu Liu, PhD c, Cynthia L. Green, PhD c, Jonathan I. Silverberg, MD d, Joel G. DeKoven, MD, MHSc e, Donald V. Belsito, MD f, Margo J. Reeder, MD g, Denis Sasseville, MD h, James S. Taylor, MD i, Howard I. Maibach, MD j, Matthew J. Zirwas, MD k, James G. Marks, MD l, Kathryn A. Zug, MD m, Joseph F. Fowler, MD n, Melanie D. Pratt, MD o, Vincent A. DeLeo, MD p, Erin M. Warshaw, MD q, r
a Department of Dermatology, Duke University Medical Center, Durham, North Carolina 
b Duke University School of Medicine, Durham, North Carolina 
c Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina 
d Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC 
e Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada 
f Department of Dermatology, Columbia University Medical Center, New York, New York 
g Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 
h Division of Dermatology, McGill University Health Centre, Montréal General Hospital, Montréal, Canada 
i Department of Dermatology, Cleveland Clinic, Cleveland, Ohio 
j Department of Dermatology, University of California Medical School, San Francisco, California 
k Probity Medical Research, Dermatologists of the Central States, Columbus, Ohio 
l Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania 
m Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 
n Division of Dermatology, University of Louisville, Louisville, Kentucky 
o Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada 
p Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California 
q Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota 
r Department of Dermatology, University of Minnesota, Minneapolis, Minnesota 

∗Correspondence to: Amber R. Atwater, MD, 5324 McFarland Dr #210, Durham, NC 27707.5324 McFarland Dr #210DurhamNC27707

Abstract

Background

Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited.

Objective

To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group.

Methods

We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016.

Results

A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time.

Limitations

Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias.

Conclusions

This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016.

Il testo completo di questo articolo è disponibile in PDF.

Key words : allergic contact dermatitis, benzyl alcohol, contact dermatitis, formaldehyde, formaldehyde releaser, iodopropynyl butylcarbamate, methylchloroisothiazolinone/methylisothiazolinone, methyldibromo glutaronitrile/phenoxyethanol, methylisothiazolinone, NACDG, paraben, patch test, phenoxyethanol, preservative, preservative allergy

Abbreviations used : ACDS, aq, CIR, DMDM, FR, IPBC, MCI, MDBGN, MI, NACDG, OP, pet, PP, ppm, PPTR, SPIN


Mappa


 Funding sources: Supported in part by Duke Dermatology, which provided statistical funding. 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.
 Disclosure: Dr Atwater received a Pfizer Independent Grant for Learning & Change. Dr Taylor owns noncontrolling shares of common stock in Cigna, Merck, Johnson and Johnson, and Opko Health; has consulted for Bayer and Kao Brands; has a nondependent child who is an employee of Pfizer; is a steering committee member of Cosmetic Ingredient Review; and is a US Food and Drug Administration special government employee for the Center for Devices and Radiologic Health. Author Petty and Drs Liu, Green, Silverberg, DeKoven, Belsito, Reeder, Sasseville, Maibach, Zirwas, Marks, Zug, Fowler, Pratt, DeLeo, and Warshaw have no conflicts of interest to declare.
 IRB approval status: Reviewed and approved by the Duke University IRB (approval no. 00092478).
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc. Tutti i diritti riservati.
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Vol 84 - N° 4

P. 965-976 - aprile 2021 Ritorno al numero
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  • Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016
  • Erin M. Warshaw, Lindsey M. Voller, Howard I. Maibach, Kathryn A. Zug, Joel G. DeKoven, Amber R. Atwater, Margo J. Reeder, Denis Sasseville, James S. Taylor, Joseph F. Fowler, Melanie D. Pratt, Jonathan I. Silverberg, Anthony F. Fransway, Matthew J. Zirwas, Donald V. Belsito, James G. Marks, Vincent A. DeLeo
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  • Erin M. Warshaw, Sara A. Kullberg, Joel G. DeKoven, Howard I. Maibach, Donald V. Belsito, Jonathan I. Silverberg, Joseph F. Fowler, Amber R. Atwater, Denis Sasseville, Margo J. Reeder, James S. Taylor, Vincent A. DeLeo, Melanie D. Pratt, Kathryn A. Zug, Anthony F. Fransway

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