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Biomedical subjects

Donald V Belsito

Publications and source records attributed to Donald V Belsito.

31 records · Page 2Linked to original sources
PubMed2003

Glutaraldehyde-induced and formaldehyde-induced allergic contact dermatitis among dental hygienists and assistants.

BACKGROUND: Research has found that among health care workers, dental personnel are especially likely to have reactions to glutaraldehyde and formaldehyde. METHODS: The authors conducted patch test evaluations with a voluntary cohort of randomly recruited, healthy dental hygienists, or DHs, and dental assistants, or DAs, and nondental professionals to determine the incidence of glutaraldehyde-induced and formaldehyde-induced allergic contact dermatitis, or ACD; the potential for coreactivity between glutaraldehyde and formaldehyde; and the correlation between training methods in safe handling of sterilizing solutions and the sensitivity to glutaraldehyde and formaldehyde among DHs and DAs. RESULTS: The researchers enrolled 101 DHs and DAs and 51 nondental professionals in the study. All except one DH/DA subject were female. The dental subjects' mean age was 34.3 +/- standard deviation of 10.7 years; the nondental subjects', 33.8 +/- 11.0 years. DHs and DAs had worked in their profession for a mean of 11.0 +/- 9.3 years. Among the dental professionals, 80 (79.2 percent) had had a known exposure to cold sterilizing solutions, while the remainder were unable to provide a known history of exposure. Eleven (10.9 percent) dental professionals had clear reactions to glutaraldehyde, four (4.0 percent) were questionably allergic to glutaraldehyde, and two (2 percent) were definitively allergic to formaldehyde. One (2 percent) control subject had a reaction to glutaraldehyde, and one other (2 percent) had a reaction to formaldehyde. CONCLUSIONS AND CLINICAL: IMPLICATIONS: The authors found a statistically significant disparity in the rates of glutaraldehyde sensitivity among healthy DHs and DAs versus healthy control subjects (10.9 percent versus 2 percent reactively; P = .02). They found no evidence of cross-reactivity between glutaraldehyde and formaldehyde. The preponderance of reactions among the DHs and DAs suggests that their present safety practices are largely ineffective in protecting against sensitization to glutaraldehyde in sterilizing solutions.

Adult↗
PubMed2003

North American Contact Dermatitis Group patch-test results, 1998 to 2000.

BACKGROUND: Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. OBJECTIVE: This study reports patch-testing results from July 1, 1998, to December 31, 2000, by the North American Contact Dermatitis Group. METHODS: Patients were tested with the same screening series of allergens, using a standardized patch-testing technique. The data from these patients were recorded on a standard computer entry form and analyzed. RESULTS: Fifty allergens were tested on over 5,800 patients. Amidoamine, benzophenone-3, and iodopropynyl butylcarbamate were the new allergens. The top 10 allergens in frequency of positive reactions were identical to those of our 1996-to 1998-study period. The incidence of allergic nickel reactions continues to go up, leading all the test substances by 16.2%. CONCLUSION: Our findings reinforce the need for a more comprehensive group of diagnostic allergens than is found in the T.R.U.E. TEST, which is sold in the United States.

Allergens↗
PubMed2003

Common shoe allergens undetected by commercial patch-testing kits: dithiodimorpholine and isocyanates.

The diagnosis of allergic contact dermatitis of the feet is challenging because the constituents of shoes are not labeled. In addition, the materials and technologies used in the manufacturing of shoes are continuously evolving. Since the 1950s, rubber allergens have been the most common cause of shoe dermatitis. However, the causal allergens in rubber have changed. Instead of 2-mercaptobenzothiazole, dithiodimorpholine, an allergen that is not contained on standard patch-testing trays, now may be one of the more common rubber sensitizers in shoes. Other allergens not found on standard series that can account for shoe dermatitis include isophorone diisocyanate, dimethylaminoethyl ether, and mixed dialkyl thioureas. Therefore, physicians evaluating patients with allergic-appearing foot dermatitis need to test with allergens beyond those present on standard screening series.

Allergens↗
PubMed2002

Relationship of occupation to contact dermatitis: evaluation in patients tested from 1998 to 2000.

BACKGROUND: Both irritant and allergic contact dermatitis can be influenced by occupational and nonoccupational environmental exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing was conducted with the 50 screening allergens of the North American Contact Dermatitis Group and occupational coding by the Surveillance Branch of the National Institute of Occupational Safety and Health. RESULTS: Of the 5,839 patients patch tested for contact dermatitis, 1,097 (19%) were deemed to be occupationally related. Of the occupational cases, 60% were of allergic and 32% were of irritant origin. The hands were the primary body part affected in 64% of allergic occupational cases and 80% of irritant occupational cases. Epoxy resin was the only allergen tested that was associated more with an occupational exposure than nonoccupational exposure. The allergens encountered most frequently in the occupational cases were carba mix, thiuram mix, epoxy resin, formaldehyde, and nickel. The medical field is overrepresented in the data compared with other occupations. CONCLUSIONS: Occupational contact dermatitis frequently was found to be multifactorial and associated with several specific allergens and occupations.

Adult↗
PubMed2002

Regional variation in prevalence and etiology of allergic contact dermatitis.

BACKGROUND: The 1994-1996 North American Contact Dermatitis Group (NACDG) patch test results were the first, since the inception of the NACDG in 1970, to include results from a medium-sized metropolitan city in the Midwest. OBJECTIVE: The aim of this study was to determine whether the causative allergens of allergic contact dermatitis (ACD) in the Midwest differ from those in other regions of the United States and, if so, whether occupational or other factors account for the observed differences. METHODS: Retrospective analyses of patch test data collected at the University of Kansas Medical Center (Kansas City, KS) were compared with the data collected by the other NACDG centers. RESULTS: Patients in Kansas City were statistically more likely to react to potassium dichromate, formaldehyde and its releasers, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), and glutaraldehyde. Occupational exposures to chromium and formaldehyde were increased significantly among patients from Kansas City, although the percentages of the local population engaged in these occupations did not differ from those in other NACDG cities. Equal percentages of workers in Kansas City and nationally had occupationally related allergy to glutaraldehyde, although the overall rate of glutaraldehyde was higher among patients from Kansas City. Most cases of relevant allergy to MCI/MI were cosmetically induced both in Kansas City and nationally. CONCLUSIONS: The current findings show significant regional differences in causal allergens. The increased percentages of patients seen with ACD to formaldehyde, formaldehyde-releasing agents, and potassium dichromate in Kansas City were likely caused by the referral of greater numbers of work-related cases. However, occupationally acquired ACD to MCI/MI and glutaraldehyde were not more frequent in Kansas City than nationally, suggesting that other factors might be operative. Although awareness of national trends is important, dermatologists must be cognizant of regional variations in allergen sources within their communities and referral networks.

Adolescent↗
PubMed2002

Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis: a 5-year study.

BACKGROUND: Irritant contact dermatitis is thought to be the leading cause of occupational skin disease in the United States. Recent reports suggest otherwise. OBJECTIVES: The purposes of this study were to determine the prevalence of allergic and irritant forms of occupational contact dermatitis in the population seen at a Midwestern dermatologic referral clinic, report professions commonly affected by occupational skin disease, and indicate which substances are frequent allergens. METHODS: A retrospective analysis of patch test data collected at the University of Kansas between 1994 and 1999 was performed. RESULTS: Of 537 patients who underwent patch testing, 135 (25%) had occupational skin disease. Allergic contact dermatitis affected 81 (60%) patients, and irritant contact dermatitis was found in 46 (34%). Health care professionals, machinists, and construction workers accounted for nearly half of all patients with occupational skin disease. Nickel sulfate, glutaraldehyde, and thiuram mix were the most common allergens. CONCLUSION: Patch tests with a wider array of allergens than those currently available in the United States are needed to prevent misdiagnosis of occupational contact dermatitis.

Adult↗
PubMed2002

Allergic contact dermatitis to detergents: a multicenter study to assess prevalence.

BACKGROUND: Allergic contact dermatitis (ACD) to optical brighteners and enzymes in laundry detergents was the focus of numerous reports in the early 1970s. Subsequently, there has been little published on the incidence of allergic reactions to chemicals in laundry detergents. Nonetheless, consumers and physicians continue to ascribe allergic contact reactions to laundry detergents. OBJECTIVE: This article reports the findings of a multicenter study on the prevalence of patch test reactions to a liquid and a granular laundry detergent provided by Procter & Gamble Company (Cincinnati, Ohio). METHODS: Patients referred to members of the North American Contact Dermatitis Group for evaluation of potential ACD were invited to participate in the study, which involved the placement of 2 patch tests (a 0.1% aqueous dilution of a granular laundry detergent and a 0.1% aqueous dilution of a liquid laundry detergent). Whether the patients had atopic dermatitis and whether they or their physicians felt that their dermatitis might be related to laundry detergents were noted. Reactions to the laundry detergents were correlated with allergic reactions to the following screening chemicals: fragrances, nickel, and potassium dichromate. Patients who experienced a reaction to at least one of the laundry detergents could enter phase II of the study, which involved testing to varying dilutions of the laundry detergents, to 0.1% sodium lauryl sulfate (as an irritant control), and to laundered patches of cotton. Patients positive in phase II could enter phase III, which involved wearing a garment laundered with the detergent. Phases II and III were double blinded. RESULTS: Of the 3120 patients seen by members of the North American Contact Dermatitis Group during the 2 years of this study, 738 patients volunteered to enroll. Enrollment was not statistically randomized. Of these 738, 5 (0.7%) had positive patch test reactions to granular laundry detergent (0.1%, aqueous); 3 of these 5 also had positive reactions to the liquid laundry detergent (0.1%, aqueous). In 4 of the 5 patients, the reaction to detergent was thought to have present relevance to their dermatitis; in 1 of the 5, the reaction was deemed to have past relevance. One of these 5 patients had allergy to fragrances. None of the patients was positive to nickel or chromate. Two of the 5 entered phases II and III. Of these 2 patients, 1 had essentially negative repeat dilutional patch testing and "use testing" suggesting that the earlier reaction patterns may have been irritant. The remaining patient had positive dilutional reactions to both the liquid and granular laundry detergent; however, she also had a positive reaction to sodium lauryl sulfate and to a swatch from a T-shirt laundered without detergent. Upon "use testing" in phase III, this latter patient experienced diffuse dermatitis under both the half of the T-shirt laundered with detergent and that laundered without detergent. CONCLUSION: Laundry detergents appear to be a rare cause of ACD. Among 738 patients with dermatitis, 5 (0.7%) reacted to a 0.1% aqueous dilution of a laundry detergent. Only 2 of these 5 patients could be evaluated in greater detail to differentiate allergic from irritant patch test reactions to detergents. Upon further testing in 2 patients, the reaction in 1 of 2 could not be reduplicated and the reaction in the other was invoked both by the detergents and the controls. Thus, whether our study patients were truly allergic and, if so, what the allergenic material(s) in detergents might be, remains unknown. Therefore the reported incidence rate for detergent-induced allergy of 0.7% in dermatitic patients may be too high, possibly because of false-positive irritant reactions.

Adult↗
PubMed2002

The effect of race and ethnicity on patch test results.

BACKGROUND: Allergic contact dermatitis is a condition that may be affected by differences in genetic and environmental factors. Race and ethnicity are possible examples of the former. OBJECTIVE: The objective of this study was to examine the differences in patch test results between white and black individuals tested by the members of the North American Contact Dermatitis Group from July 1, 1992, to June 30, 1998. METHODS: Patients evaluated in our patch test clinics were exposed to a standardized patch testing technique involving a standard series of 41 allergens in total. The standard series we used varied over the 6 years of the study in 2-year cycles. The series was the same at all centers during each of these 2-year cycles: 1992-94, 1994-96, and 1996-98. Over a 6-year period, our group tested 9624 patients. Of those individuals, 8610 (89.5%) were white and 1014 (10.5%) were black. RESULTS: Allergic contact dermatitis and irritant contact dermatitis were the final diagnoses assigned by the investigators to individuals of the 2 races: 49% and 16%, respectively, for the white patients and 46% and 15%, respectively, for the black patients. In at least one of the three 2-year periods, testing in white patients revealed higher rates of sensitization to formaldehyde, glutaraldehyde, and a number of the formaldehyde-releasing preservatives, as well as lanolin, epoxy resin, thioureas, and balsam of Peru. Black patients exhibited higher rates of sensitization to para-phenylenediamine, cobalt chloride, thioureas, and p-tert-butylphenol formaldehyde resin in at least one of the 2-year periods. CONCLUSION: In this test population, we found no differences in the overall response rate to allergens. There were some differences between white and black patients in their response to specific allergens. These differences, although possibly related to genetic factors based on race, are more likely related to differences in allergen exposure determined by ethnicity.

Allergens↗
PubMed2002

The etiology of allergic-appearing foot dermatitis: a 5-year retrospective study.

OBJECTIVES: The objectives of this 5-year retrospective investigation were threefold. (1) Among patients with dermatitis of the feet consistent with allergic contact dermatitis (ACD), what were the final diagnoses of those with dermatitis only on the feet and those whose foot dermatitis was accompanied by other cutaneous involvement? (2) Among those patients determined to have ACD, what were the relevant allergens? (3) Have the allergens in shoes in the United States changed as a consequence of modifications in footwear manufacture and style design? METHODS: Of 704 patients patch-tested at the University of Kansas Medical Center with the North American Contact Dermatitis Group's standard allergen tray and/or the University of Kansas "shoe and rubber" tray, 70 patients presented with a clinical pattern suggestive of ACD of the foot. RESULTS: Compared with those without foot dermatitis, these patients were more likely to be atopic and male with bimodal age distribution: <19 and 41 to 60 years. Despite clinical evidence suggesting allergy, only 23 (32.9%) patients had ACD to components of shoes, whereas 30 (42.9%) had psoriasis. Among the remaining patients, 4 (5.7%) had a non-shoe allergy, 3 (4.3%) had dyshidrosis, 2 (2.9%) had nummular dermatitis, 2 (2.9%) had tinea pedis, and 1 (1.4%) each had pityriasis rubra pilaris, juvenile plantar dermatosis, atopy, id reaction, and traumatic/frictional dermatitis as their primary diagnosis. One patient had not received a diagnosis when last seen. CONCLUSIONS: When evaluated by sites of involvement, psoriasis was diagnosed as often as ACD to shoes when the dermatitis was confined to the foot but was more frequent than ACD when both the hands and feet were involved. With respect to shoe dermatitis, rubber components were the principal allergens, followed by chromated leather and adhesives. Iatrogenic ACD was also common, and among all allergens, bacitracin caused the most frequently observed relevant reaction.

Adult↗
PubMed2002

Chronic acquired dyskeratotic papulosis of the face.

A Vietnam veteran who had been exposed to Agent Orange presented with a 28-year history of a papulonodular disease mainly affecting the face. Over those years, pin-sized papules had developed into dark nodules. Multiple biopsies of both fresh and mature papulonodules had been performed for routine histopathology and electron microscopy. Results had been positive for spongiosis with exocytosis, acanthosis, dyskeratotic keratinocytes, and marked incontinence of pigment, which together are suggestive of a previously unreported clinical entity that we term chronic acquired dyskeratotic papulosis.

Acanthosis Nigricans↗
PubMed2002

Frequency and etiology of hand and forearm dermatoses among veterinarians.

BACKGROUND: Veterinarians are exposed to a range of skin irritants and allergens, yet few studies have addressed the occurrence of dermatoses among veterinarians. OBJECTIVES: The goals of this study were to determine the frequency of noninfectious hand and forearm dermatoses among Kansas veterinarians, to estimate the role of occupational exposures in the aggravation of such dermatoses, to determine the frequency and nature of infectious dermatoses among veterinarians, and to investigate patterns of glove use. The secondary goals of this study were to collect information about the impact of skin disease on the lives and careers of veterinarians and to provide physicians with a practical approach to the treatment of veterinarians with dermatoses. METHODS: A questionnaire was mailed to all members of the Kansas Veterinary Medical Association. RESULTS: The response rate was 60%. Twenty-four of respondents reported noninfectious, recurrent/persistent hand or forearm dermatoses; 66% were work related. Large animal veterinarians (P =.026) and atopics (P =.009) were more likely than their counterparts to attribute their dermatoses to work-related factors. Thirty-eight percent of respondents had contracted at least one infectious skin disease from an animal. Veterinarians who never or rarely use gloves during obstetric procedures were more likely to report work-related dermatoses (odds ratio, 4.25; 1.78 < OR < 10.07; P <.001) than those who use gloves. CONCLUSION: Veterinarians are affected frequently by infectious and noninfectious dermatoses. Improvement of barrier protection habits during obstetric procedures would likely reduce the frequency of occupational dermatoses among veterinarians.

Adult↗