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The first step in the treatment of any contact dermatitis is to identify the offending agent, whether an allergen or a caustic irritating chemical Once identification has been made, the subsequent step is avoidance of the culprit compound and, in the case of ACD, all crossreactive substances Alternative product substitution is imperative for the wellbeing of the patient Furthermore, measures should be taken to ensure barrier integrity (ie, decreased hand washing with soaps and increased emollient use) for both allergic- and irritant-based dermatoses The use of emollients to help heal the skin is important, especially with regard to reactions that are irritant in nature (see 31) In the interim, while the avoidance regimen is being instituted and the immune system is being given a chance to forget the sensitization, symptomatic treatment in ACD and CU may consist of topical corticosteroids or topical immunomodulators At times, with severe acute or chronic extensive
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ician should know about managing patients with fragrance allergy J Am Acad Dermatol 1999;41:1020 Adams RM, Maibach HI A five-year study of cosmetic reactions J Am Acad Dermatol 1985;13:1062 Hill AM, Belsito DV Systemic contact dermatitis of the eyelids caused by formaldehyde derived from aspartame Contact Dermatitis 2003;49:258 Jensen CD, Johansen JD, Menne T, et al MDGN in rinse-off products causes allergic contact dermatitis: an experimental study Br J Dermatol 2004;150:90 De Groot AC, van Ginkel CJ, Weijland JW Methyldibromoglutaronitrile (Euxyl K 400): an important new allergen in cosmetics J Am Acad Dermatol 1996; 35:743 S nchez-P rez J, Del Rio MJ, Jim nez YD, et al Allergic contact dermatitis due to methyldibromo glutaronitrile in makeup removal wipes Contact Dermatitis 2005;53:357 Schnuch A, Kelterer D, Bauer A, et al Quantitative patch and repeated open application testing in methyldibromo glutaronitrile-sensitive patients Contact Dermatitis 2005;52:197 Jong CT, Statham BN Methyldibromoglutaronitrile contact allergy the beginning of the end Contact Dermatitis 2006;54:229 US Environmental Protection Agency Web site http://wwwepagov/oppsrrd1/ REDs/factsheets/3092factpdf Accessed January 2, 2007 Mowad CM Methylchloro-isothiazolinone revisited Am J Contact Dermat 2000;11:115 Isaksson M, Gruvberger B, Bruze M Occupational contact allergy and dermatitis from methylisothiazolinone after contact with wallcovering glue and after a chemical burn from a biocide Dermatitis 2004;15:201 Collier PJ, Ramsey A, Waigh RD, et al Chemical reactivity of some isothiazolone biocides J Appl Bacteriol 1990; 69:578 Dermatitis linked to preservative in moisturizers (Kathon CG found to be cause of cosmetic allergy) Nutrition Health Review 9/22/1990 Wolf R, Orion E, Matz H Co-existing sensitivity to metronidazole and isothiazolinone Clin Exp Dermatol 2003; 28:506 Cashman AL, Warshaw EM Parabens: a review of epidemiology, structure, allergenicity, and hormonal properties Dermatitis 17(1) http://medscapecom/ parabens Accessed August 30, 2007 Lee CH, Kim HJ A study on the absorption mechanisms of drug through membranes Arch Pharm Res 1994;17:182 Oishi S Lack of spermatotoxic effects of methyl and ethyl esters of p-hydroxybenzoic acid in rats Food Chem Toxicol 2004;42:1845 Endocrine disruption http://envirocancer cornelledu/Bibliography/cENDOCRINE cfm Accessed September 3, 2006 Routledge EJ, Parker J, Odum J, et al Some alkyl hydroxyl benzoate preservatives (parabens) are estrogenic Toxicol Appl Pharmacol 1998;153:12 Blair RM, Fang H, Branham WS, et al The estrogen receptor relative binding affinities of 188 natural and xenochemi-
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cals: structural diversity of ligands Toxicol Sci 2000;54:138 Darbre PD, Byford JR, Shaw LE, et al Oestrogenic activity of benzylparaben J Appl Toxicol 2003;23:43 Darbre PD Underarm cosmetics and breast cancer J Appl Toxicol 2003;23:89 Darbre PD, Aljarrah A, Miller WR, et al Concentrations of parabens in human breast tumours J Appl Toxicol 2004;24:5 Darbre PD, Environmental oestrogens, cosmetics and breast cancer Best Pract Res Clin Endocrinol Metab 20;121:206 CTFA Response Statement, April 17, 2003; RSPT 03 12 http://wwwnuskincom/ corp/science/hottopics/parabens Accessed September 3, 2006 Parabens http://wwwcfsanfdagov/~dms/ cos-parahtml Accessed August 13, 2006 Menne T, Hjorth N Routine patch testing with paraben esters Contact Dermatitis 1988;19:189
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46 Verhaeghe I, Dooms-Goossens A Multiple sources of allergic contact dermatitis from parabens Contact Dermatitis 1997;36:269 47 Scanberg IL Allergic contact dermatitis to methyl and propyl paraben Arch Dermatol 1967;95:626 48 Wiepper KD Paraben contact dermatitis JAMA 1967;202:579 49 Simpson JR Dermatitis due to parabens in cosmetic creams Contact Dermatitis 1978;5:311 50 Eguino P, S nchez A, Agesta N, et al Allergic contact dermatitis due to propylene glycol and parabens in an ultrasonic gel Contact Dermatitis 2003; 48:290 51 Fisher AA Allergic paraben and benzyl alcohol hypersensitivity relationship of the delayed and immediate varieties Contact Dermatitis 1975;1:281 52 Fisher AA Dermatitis of the hands from food additives Cutis 1982;30:21
53 Krob HA, Fleischer AB Jr, D Agostino R Jr, et al Prevalence and relevance of contact dermatitis allergens: a metaanalysis of 15 years of published TRUE test data J Am Acad Dermatol 2004; 51:349 54 Pratt MD, Belsito DV, DeLeo VA, et al North American Contact Dermatitis Group patch-test results, 2001 2002 study period Dermatitis 2004;15:176 55 Frosch PJ, Johansen JD, Menne T, et al Further important sensitizers in patients sensitive to fragrances Contact Dermatitis 2002;47(5):279 56 Belsito DV, Fowler JF Jr, Sasseville D, et al Delayed-type hypersensitivity to fragrance materials in a select North American population Dermatitis 2006; 17:23 57 Frosch PJ, Johansen JD, Menne T, et al Further important sensitizers in patients sensitive to fragrances Contact Dermatitis 2002;47(2):78
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