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News and events• News |
| Example of allergic contact dermatitis caused by Basic Red 46 |
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News
Doctors’ news
Dr Rosemary Nixon was recently appointed as an Adjunct Clinical Associate Professor at Monash University, for her ongoing contribution to occupational and contact dermatology in both research and teaching. Rosemary has also been busy contributing to the new edition of a major multi-authored text book in dermatology “The Handbook of Occupational Dermatology” with Dr Jenny Cahill. Jenny has also been working on a number of papers and has been updating our patient information sheets.
In September, Dr Rosemary Nixon, Dr Jenny Cahill and Adriene Lee attended the 10th Congress of European Society of Contact Dermatitis in Strasbourg, France and met up with former ODREC researchers Drs Jason Williams (UK), Danny Slodownik (Israel) and Yi Shi Wang (Singapore). All have fond memories of their time at the Foundation.
Rosemary has commenced a corporate skin check service, which will also help to assist funding ODREC with its research projects. For more information on the skin check service, please call 03 9623 9402 or email admin@occderm.asn.au
Congratulations to Dr Helen Saunders and husband fellow dermatologist Alex Chamberlain on the safe arrival of their first baby, Henry in September. Helen has been assisting Rosemary in the Occupational Dermatology clinic for the last two years.
PatchCams
The upgrade of our database program, CAMS© is now complete, and will be used in clinics from the start of 2011. The upgraded program is now known as PatchCams©, and is instrumental in our excellent ability to capture clinic data. We have recently participated in the first Australian contact dermatitis study to combine patch test data from two states, which was in the area of preservative allergy. This involved Dr Elizabeth Chow and used data from the Skin and Cancer Foundation in NSW, who also use the CAMS database. Benefits of PatchCams© include being able to be access the program remotely, no disruption when versions of Microsoft Access© are upgraded, and being able to enter patient data directly into the system rather than on paper. In particular, interrogating the database for research purposes will become much easier. Over twenty publications to date have relied on data from the database.
Contact Allergen Bank Australia
The Contact Allergen Bank Australia (CABA) was fully operational this year, and has had much success. It is based on an idea which originated in Denmark, which involves the preparation of individualised patch tests which are posted to dermatologists, in order to facilitate patch testing. It is especially useful for supplying dermatologists with unusual or rare allergens. We are experiencing a steady increase in demand for this service. PatchCams© will also facilitate the operation of the Contact Allergen Bank. CABA is now available online, via our PatchCams© website. For more information about this project email admin@occderm.asn.au
Website upgrade
We have made further modifications to our website www.occderm.asn.au. We now have patient information about the patch testing process, contact dermatitis, latex allergy, hand eczema and skin care. These are all available in PDF format. We have also added new sections for health professionals and Careers advice. We have been approached to develop websites for both the International Contact Dermatitis Research Group and the Asia-Pacific Environmental and Occupational Dermatology Group.
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Clinical and Research news
We have recently used our evidence-based data from the clinic to propose, for the first time, an Australian baseline patch test series. This series includes allergens important in the Australian population, including tea tree oil, chloroacetamide and basic red 46. This has been the result of much detailed analysis using our data base by Dr Yi Shi Wang, who worked with us during 2009, which will be published soon.
Once again the ODREC team have collaborated on a number of projects. We worked with Janine Tickle, a Bachelor of Science (Occupational Health and Safety) student from RMIT. Her research was based on data collected as part of our Skin Watch follow up project. Her project was titled ‘Occupational Contact Dermatitis: Does the worker’s understanding of their condition alter their clinical outcome?’
We have continued to work with epidemiologists Dr Melanie Matheson and Associate Professor Shyamali Dharmage from Melbourne University, who play a pivotal role in providing statistical analysis and epidemiological advice for many of our research projects and publications. International medical student Melissa Lau assisted in investigating quality of life in our Skin Watch cohort. She has also helped with analysis of Skin Watch patients with persistent dermatitis. Recently we have identified that the two most significant risk factors for the development of persistent post-occupational dermatitis are the initial severity of dermatitis and smoking. This is very exciting, and has not been reported elsewhere. This observation was enabled through our development of a validated severity scale for occupational dermatitis in 2008, the ODDI (Occupational Contact Dermatitis Disease Severity Index).
We are also currently working on an international study of two new oxidised fragrance allergens, co-ordinated by Dr Johanna Brared-Christenssen from Sweden. Other international collaborators include Professors Tove Agner (Copenhagen), Pavikki Sustival (Helsinki) and Linn Holness (Toronto) as well as Dr Danny Slodownik (Israel).
ODREC continues to offer training in contact dermatitis to registrars, dermatologists and research fellows, both locally and internationally. .
We are grateful to Epiderm for funding many of our projects, including Jenny Cahill’s initial traineeship, and the CAMS database upgrade.
2011
We have recently received funding to undertake a project titled ‘Improving Public Health-Raising Awareness of Contact Dermatitis.’ This project aims to create greater public health awareness about contact dermatitis, leading to improved prevention of this condition. Areas to be included are:
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Promoting the concept that workers with more severe dermatitis need early assessment, diagnosis and treatment.
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Reduction in the use of powdered disposable latex gloves
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Warning beauty therapists, hairdressers and their trainees and apprentices of the dangers of having temporary tattoos, which may contain permanent hair dye in a concentrated form, which may lead to the development of a severe allergic reaction
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Advising against the unnecessary use of essential oils on the skin.
A number of lectures at international scientific meetings are scheduled for 2011, in New Orleans, Toronto and Chandigarh, India.
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Interesting findings from our clinic
Clinical case
Mrs K was a 45-year-old studying acupuncture. She has a long history (approx 10 years) of hand eczema, which became exacerbated when she was performing corporate massage using Redwin sorbolene cream. She thought aggravating factors to her skin condition included exposure to yeast, tomato and mustard. She recently required prednisolone on two occasions in the last 2 months, for four to five days.
She had a past history of anaphylaxis to hair dye. She also reacted to nickel. She was recently diagnosed with iron deficiency and anaemia.
She used polyethylene gloves working in the kitchen and when performing activities such as gardening. She recently also described reactions to clothing.
Examination showed marked erythema involving palms. She also had a rash on the back of her neck.
Patch testing showed a number of reactions.
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Disperse blue dye mix
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Disperse orange 3
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Aminoazobenzene
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Fragrance mix 1
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Fragrance mix 2
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Epoxy resin
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Nickel sulphate
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Fragrances – geraniol, lavender, ylang-ylang, linalool
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Citral
Mrs K was not tested to paraphenylenediamine (hair dye) because of her history of previous severe reaction.
Blood tests performed show an elevated IgE of 257kU/mL (0-120), consistent with an atopic background and latex RAST was negative.
We made the diagnosis:
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Allergic contact dermatitis to fragrance, particularly lavender oil used in massage
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Allergic contact dermatitis to clothing dyes which cross react with hair dye. This related to reactions to dark coloured clothing.
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Allergic contact dermatitis to nickel. Interestingly this appears to have dietary relevance to ingestion of chocolate.
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Immediate hypersensitivity to tomato
- Known allergy to hair dye
Follow-up
With avoidance of these allergens, particularly fragrance, Mrs K hand dermatitis improved. Once allergies have been identified, avoidance of specific allergens is often associated with clinical improvement.
Teaching points
- Mrs K had put up with her hand dermatitis for 10 years while living in England. She had never been referred for patch testing.
- People can develop allergic contact dermatitis at any stage, soon after first contact with a chemical or product, or after many years of contact.
- Recent European legislation has improved the labelling of fragrances and this has helped patients to avoid specific fragrances.
- While systemic nickel allergy is uncommon, it is known that nickel can be present in chocolate, soy and oats and this may sometimes have relevance.
People made allergic to hair dye following use of a 'henna' or temporary tattoo-travellers beware!
We have seen a variety of patients who have developed severe allergies to hair dye, following a temporary tattoo, which they believed contained henna. In fact para-phenylenediamine was used, to which they became allergic. These people cannot subsequently tolerate exposure to permanent hair dyes (containing para-phenylenediamine) used on their scalp or in eyelid or eyebrow tinting. This is an absolute disaster for hairdressers, or those wishing to become hairdressers.
We would caution against the use of these tattoos, especially where the ingredients of the temporary tattoo cannot be ascertained. This phenomenon has been observed around the world, although many of our cases have had their tattoos performed in Bali.
Saunders H, O'Brien T, Nixon R. Textile dye allergic contact dermatitis following paraphenylenediamine sensitisation from a temporary tattoo. Australas J Dermatol 2004; 45:229-31
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Past Awards
Eminent Scientist of the Year 2009
Dr Rosemary Nixon was awarded the "Eminent Scientist of the Year 2009 in Dermatology and Occupational Health" from the International Research Promotion Council (IRPC). Rosemary was selected to receive this award for her contribution to the field of dermatology and occupational health, as a researcher and the only dual qualified dermatologist and occupational physician in Australia. Her article "Describing Outcomes in Occupational Dermatitis" can be read in Recent Advances and Recent Updates, Vol: 11, No: 1, Jan 2010.
Jan Wahlberg prize
In 2008, ODREC founder Dr Rosemary Nixon was awarded the prestigious Jan Wahlberg prize, for the best paper submitted to the biennial European Society of Contact Dermatitis meeting. Her paper was entitled: "Severity Scale and Algorithm for Outcomes in Occupational Contact Dermatitis".
Appointment to the International Contact Dermatitis Research Group (ICDRG)
In 2009, Dr Nixon was appointed to the ICDRG, succeeding Dr Susi Freeman. The members of this group comprise Professor Jean-Marie Lachapelle (Belgium), Professor Howard Maibach (USA), Professor Hee Chul Eun (Korea), Professor Magnus Bruze (Sweden), Professor Klaus Andersen (Denmark), Professor An Goosens (Belgium), Professor Thomas Diepgen (Germany), Professor Peter Elsner (Germany), Dr Iris Ale (Uruguay), Professor Chee Leok Goh (Singapore), Professor Kayoko Matsunaga (Japan), Dr Denis Sasseville (Canada), Dr John McFadden (UK) and Dr Hemanji Jerajani (India).
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