Abstract: Contact allergy (sensitisation) and allergic contact dermatitis (ACD) resulting from it have

Overview

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Key numbers

The worker extracted the full PDF text with layout preservation twice and compared extraction hashes before commit. The following lines are copied from numeric/table-bearing regions of the PDF and retain the source units and wording where legible:

(susceptibility) factors. According to current epidemiological data from Europe, some 20% of the
of magnitude of eliciting dose/area (3). It has been estimated that in Germany, 12.7% (95% confidence
interval (CI): 11.5–14.0%) of the population has, at some point in their lifetime, suffered from ACD (4).
AND (“2018/01/01”(Date-Publication): “3000”(Date-Publication)), “3000” meaning until the current day,
the topic of the present review, or further processed by reviewing the full text. Altogether, n = 118
(n = 74), basic science results not pertinent to the article’s topic (n = 36), diseases other than contact
allergy/dermatitis in focus (n = 48), therapeutic drug studies (n = 9), obvious poor quality (n = 6) or lack
of new evidence (n = 19, meaning no new, just confirmative, evidence in relation to publications before
Figure 1. Suitable cosmetovigilance complements contact allergy surveillance. X represents any
a random sample of n = 3119 in five European countries found the lowest prevalence of nickel contact
allergy (8.3%) in Sweden, whereas overall, it was 14.5%, and highest in Portugal (18.5%), supporting the
nickel allergy, ranging from “piercing ever, but not currently” (OR 3.86, 95% CI: 2.85–5.24) to “currently
found that nickel release exceeded 0.35 µg/cm2 per week in 26 of 160 piercing posts (16.2%) and 0.88
0.35 µg/cm2 per week in 2–5.9% of other parts; these limit values correspond to the current ”pass”
sample, found in 49.3% of all samples, are indicated by short vertical bars (taken from (11)).
diagnosis of nickel allergy by patch testing, the standard nickel sulfate hexahydrate 5% in petrolatum
(pet.) is usually sufficient, which is now also recommended in the USA, where traditionally 2.5% pet.
is used, owing to a significantly higher sensitivity (19). If doubtful or negative reactions result with 5%
pet., despite a strong suspicion of nickel allergy, testing with nickel sulfate hexahydrate 30% and 15%
of ACD affecting the eyebrows due to an eyebrow pencil containing 8–9 mg/kg nickel (21). A study
Cobalt, patch tested as cobalt chloride hexahydrate 1% pet., is a “difficult” allergen, as (i) the
shoes and gloves in Denmark, in which 7/43 shoes and 3/16 gloves contained >1% cobalt, unrelated to
tackled by another regulation, limiting the content of dichromate to <3 mg/kg leather (Commission
and ICPMS. Cr(VI) was identified in 90% of samples, with levels of 0.22–4.09 mg/kg, i.e., well above
the ankle that in the leather sole (225 mg/kg vs. 268 mg/kg) (41). Unfortunately, the analysis of total Cr
Interestingly, the positive patch test reaction to palladium chloride 1% pet. also evolved into a persistent
was identified in the lesion (45). In consecutively (routinely) patch-tested Spanish patients (n = 3678),
palladium dichloride 2% pet. caused 8.6% positive reactions; only 26/316 positive patients were not
vanadium (tested as trichloride 1% pet.) are difficult to interpret; additional evidence for the role
developed spreading lichenoid ACD and was found patch-test positive to tin 50% pet.; reduction of
chambers, and an aluminium salt for further confirmation, is indicated (52). Use of 2% aluminium
In a French patch test study involving 97 children, using 2% aluminium chloride hexahydrate pet.,
21.6% were found sensitised; 8/21 also reacting to metallic aluminium. All 5 children tested for persistent
the patch test was positive to gold sodium thiosulfate 0.5% and 2% (56). In a similar case from
62% were deemed relevant by the authors, who suggest prospective studies to arrive at a definite
to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant-related
only to Lim-OOHs 0.3% pet. and her own cosmetic product. Avoidance of all limonene-containing
after switching to an unscented product. Patch testing was positive to Lin-OOHs 1% pet., which could
be identified by HPLC in the culprit deodorant (8.4 ppm linalool-6-hydroperoxide and 5.6 ppm
containing Lim-OOHs at 1260, 420 and 140 ppm, equal to a dose/area per application of Lim-OOHs of
3.0, 0.99 and 0.33 µg/cm2 . Among the 11 subjects allergic to Lim-OOHs, 11 (100%), 7 (64%), and 3 (27%),
geraniol 6% pet. and 8% to geraniol 11% pet., the higher test concentration also yielding 5% doubtful

Methods (brief)

a random sample of n = 3119 in five European countries found the lowest prevalence of nickel contact
sample, found in 49.3% of all samples, are indicated by short vertical bars (taken from (11)).
mass spectrometry (ToF–SIMS)), nickel deposition in the stratum corneum and upper epidermis
a recent large sample of USA paints did not find any cobalt by spot testing and X-ray fluorescence
work. Analysis with inductively coupled plasma mass spectrometry (ICPMS) demonstrated median
source of cobalt exposure, as demonstrated by the analytical results of a convenience sample of leather
and ICPMS. Cr(VI) was identified in 90% of samples, with levels of 0.22–4.09 mg/kg, i.e., well above
fashion were able to elicit ACD in 4 of these (while only 1 reacted to the leather sample in patch
inflammatory reaction. By the use of ICPMS, a 3-fold higher palladium signal than in control biopsies
be identified by HPLC in the culprit deodorant (8.4 ppm linalool-6-hydroperoxide and 5.6 ppm
SCCS-Opinion, and their use is widespread, e.g., in 47% of respondents to a US convenience sample
between 30 and 100 ppm (107). Similar results were seen in a sample of 47 US paints, of which 96%
method (138). Among a sample of 28 US nail polishes advertised to be “formaldehyde-free”, four were
parabens and a positive patch test to these (and a sample of the plaster), the patient tolerated paraben
baseline series and samples of their own shoes, partly extracts and thin layer chromatograms thereof,
and finally to a compound identified by HPLC analysis, namely dimethylthiocarbamylbenzothiazole
often treated with pesticides, which pose some risk of sensitisation, as demonstrated in a small sample
necessarily correspond to HPLC analysis (336). Cross-reactivity—that is, the sensitisation by one

Implications

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Update history

The five most recent substantive edits to this page, classified major (evidence or structure moved), correction (a published value or statement was wrong and has been fixed), or minor (narrative rewritten without changing the underlying evidence). Each description is derived from what the edit did to this page; the linked commit is the authoritative record, routine regeneration passes are excluded, and the full version history lives in git. When DOI minting comes online (see schema docs), each entry below will also link to a version-pinned DataCite DOI.

Commit	Date	Change	Description
b01ec52c	2026-08-04	major	2 sections added
d49e450f	2026-08-03	major	5 sections added; narrative text revised