R. Davenport, A. Palmer, R. Nixon
Allergic contact dermatitis to sunscreening chemicals is rare, although irritant reactions are more common, which we first reported over 20 years ago (1) and have recently confirmed these findings (to be published). We had found that reactions to excipients in sunscreens occurred twice as frequently as reactions to sunscreen actives (1). We have recently reviewed our database at the Skin and Cancer Foundation Inc in Melbourne from 1993, including over 9000 patients, and found that only 1.1% of those patch tested had positive relevant reactions to sunscreening chemicals. The average age of those with reactions to sunscreens was 44 years and 86.4% (76/88) We also performed a retrospective review of the likely sources of sensitisation in the 84 patients sensitised in 2014. These included most importantly shampoos and conditioners, then wet wipes, liquid hand and body washes, moisturising lotions, face/hand creams, occupational products such as paints and biocides and facial cleansers and scrubs.
Ironically, this epidemic has also raised awareness of the importance of considering allergic contact dermatitis as a diagnosis, especially in patients who do not have a history of atopic eczema or other skin rashes.
Case report: The psychological benefits of therapeutic patch testing for overcoming phobia to skin sensations J. Witherspoon, L. Spelman
Veracity Clinical Research, Tarragindi, Queensland, Australia
Patch testing is a useful technique which involves the application of common irritants to a patient’s skin, for the purpose of identifying contact allergies1. This diagnosis technique is generally beneficial for the patient’s physical health. However, a 25 year old woman found a profound psychological benefit to her patch testing procedure. She presented initially to a psychiatrist with a 3 week history of increased panic attacks, avoidance behaviour, somatic concerns and mild mood lowering as a result of longstanding concerns regarding her abnormal skin sensations. The patient had a significant aversion to occlusive materials applied to her skin resulting, a number of times, in her fainting and anxiety. All medical investigations were negative, although some investigations were not conducted as she could not tolerate skin contact with occlusive materials. Thus, she was diagnosed with panic disorder with agoraphobia and generalised anxiety disorder as well as a specific phobia to skin sensations. She planned on having children which she knew would involve skin contact with occlusive materials and was referred to Dr Lynda Spelman for assistance. Ultimately with careful planning, patient preparation and an incremented approach, she was able to tolerate patch testing and found that she was allergic to parabens. Although this allergy couldn’t account for her fainting symptoms, the process of patch testing certainly helped her tolerate occlusive items on her skin.
1. Johansen JD, Aalto-Korte K, et al., (2015) European Society of Contact Dermatitis guideline for diagnostic patch testing recommendations on best practice. Contact Dermatitis. Accessed 2015 Jul 14.