European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice

Jeanne D. Johansen1, Kristiina Aalto-Korte2, Tove Agner3, Klaus E. Andersen4, Andreas Bircher5, Magnus Bruze6, Alicia Cannavó7, Ana Giménez-Arnau8, Margarida Gonçalo9, An Goossens10, Swen M. John11, Carola Lidén12, Magnus Lindberg13, Vera Mahler14, Mihály Matura15, Thomas Rustemeyer16, Jørgen Serup3, Radoslaw Spiewak17, Jacob P. Thyssen1, Martine Vigan18, Ian R. White19, Mark Wilkinson20 and Wolfgang Uter21

1 Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark,

2 Occupational Medicine, Finnish Institute of Occupational Health, 00250 Helsinki, Finland, 3Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2400 Copenhagen, Denmark, 4Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark, 5Allergy Unit, Department of Dermatology, University Hospital and University of Basel, 4031 Basel, Switzerland, 6Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, SE-20502 Malmö, Sweden, 7Hospital Municipal de Vicente López ‘Profesor Bernard Houssay’, Buenos Aires, Argentina, 8Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, 08003 Barcelona, Spain, 9Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal, 10Contact Allergy Unit, Department of Dermatology, University Hospital K. U. Leuven, B-3000 Leuven, Belgium, 11Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, D-49069 Osnabrueck, Germany, 12Institute of Environmental Medicine, Karolinska Institutet, SE-17177 Stockholm, Sweden, 13Department of Dermatology, University Hospital Örebro, SE-70185 Örebro, Sweden, 14Allergy Unit, Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany, 15Unit of Occupational and Environmental Dermatology, Centre for Occupational and Environmental Medicine, SLSO, SE-11365 Stockholm, Sweden, 16Department of Dermatology, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands, 17Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, 30-688 Krakow, Poland, 18Department of Dermatology, CHRU Besançon, 25030 Besançon Cedex, France, 19Department of Cutaneous Allergy, St John’s Institute of Dermatology, St Thomas’ Hospital, London, SE1 7EH UK, 20Spire Hospital, Leeds, LS8 1NT UK, and 21Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany doi:10.1111/cod.12432 Correspondence: Jeanne D. Johansen, Department of Dermato-allergology, Gentofte Hospital, 2900 Hellerup, Denmark. Tel: +4538677301. E-mail: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 Conflicts of interests: KAK, JDJ, AC, CL, ML, MM, JS, IRW: No conflicts. TA: Giving talks at meetings arranged by Leo Pharma and GlaxoSmithKline; KEA: Advisor to SmartPractice, Hillerød. Medical Director for Dermatological Investigation (DIS). Research support from IFRA and RIFM; AB: Educational grants from Novartis, GSK, Vifor; MB: member of the REXPAN, collaboration with SmartPractice on metal allergens; AGA: Medical Advisor for Uriach Pharma, Genentech, Novartis research grants by Intendis – Bayer, Uriach Pharma, Novartis, educational activities sponsored by Uriach Pharma, Novartis, Genentech, Menarini, GSK, MSD, Almirall; MG: Participated in the EDEN study on fragrance allergy. Since January 2014 participatation in the National Advisory Board for NOVARTIS (omalizumab for urticaria). Lectures on immunology of psoriasis for Portuguese dermatologists paid by Janssen (2012/13); AG: Departmental service (contact allergy website) financially supported by cosmetic and a few pharmaceutical companies; lecture on allergic contact dermatitis from cosmetics for GSK; lectures to pharmacists and dermatologists on dermatological preparations (contact allergy, irritancy) for Fagron; SMJ: Lecture fees from Almirall, Biogen-Idec, Galderma; VM: Has received lecturing fees from SmartPractice, Almirall Hermal, GlaxoSmithKline, Basilea; TR: Grants for the department from Almirall, Novartis, Zilverlon, Stallergenes; RS: Shareholder and scientific adviser of the Polish representative of Chemotechnique Diagnostics; JPT: Sold a cobalt spot test to Smart Health, Az, USA; MV: Grants from GlaxoSmithKline, Unilever, l’ARCAA; MW: Attended a drug advisory board meeting for GlaxoSmithKline; WU: Accepted travel reimbursement and partly honorarium for presentations given to cosmetic industry (associations) by them. Lecture fee from Almirall Hermal for educational lectures on contact allergy. Accepted for publication 6 May 2015

Summary

The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, indi vidual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

Key words: contact allergy; guideline; patch testing; review.

Influence of Cosmetic Skincare Products with pHal Evaluation

Ciska Janssens‑Böcker  · Claudia Doberenz · Marta Monteiro · Marta de Oliveira Ferreira

C. Janssens‑Böcker (*) · C. Doberenz  MedSkin Solutions Dr. Suwelack AG, Billerbeck, Germany e-mail: ciska.janssens-boecker@medskin-suwelack. com M. Monteiro · M. de Oliveira Ferreira  Inovapotek, Pharmaceutical Research & Development, Porto, Portugal

Received: September 10, 2024 / Accepted: November 27, 2024 / Published online: December 21, 2024 © The Author(s) 2024

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s13555-​024-​01321-x.

ABSTRACT

Introduction:

The human skin acts as a pro‑ tective barrier against external pathogens and hosts a diverse microbiome consisting of bacte‑ ria, fungi, viruses, and archaea. Disruptions to the skin microbiome can impact immune func‑ tion, leading to inflammatory and autoimmune conditions. The importance of pH for the micro‑ biome is paramount. Cosmetic skincare prod‑ ucts interact with the skin microbiome and skin pH, playing a key role in maintaining microbial  balance. Research suggests that products with non-physiological pH levels may disrupt the skin microbiota. Our clinical study aimed to evaluate the effects of low-pH cosmetic products (pH<5) on the skin microbiome, contributing to improved skin health.

Methods: The clinical study focused on evalu‑

ating the skin microbiome diversity following

the application for 28 days of four different low

pH cosmetic products (vitamin C, resveratrol, a

collagen mask, and a native algae mask) on the

forearms of post-menopausal women with skin

pH>5.5.

Results:

The diversity of the natural skin microbiome increased consistently through‑ out the study, evident in both the untreated area and after the application of the Vitamin C Concentrate, Resveratrol Concentrate, Colla‑ gen Mask, and Native Algae Mask, as indicated by Shannon’s diversity index. The native algae mask notably reduced the Corynebacterium genus and significantly lowered the pH. The skin pH changes corresponded with microbiota stability.

Conclusions:

In conclusion, enhanced diver‑ sity of the natural skin microbiome was observed over the study duration. None of the investi‑ gational products caused significant disruption to the skin microbiome diversity, as evidenced by the stable Shannon’s diversity index and relative abundance of specific genera. Notably, the native algae mask significantly decreased the presence of the opportunistic pathogenic Corynebacterium genus, which is likely attribut‑ able to a minor reduction in skin pH following extended product use. The findings suggest that the use of low-pH skincare products, like the native algae mask, do not disrupt skin micro‑ biome diversity and may have the potential to positively impact skin microbiome diversity and health by reducing certain pathogenic microbial

Keywords: Human skin; Microbiome; Skincare; Cosmetics; pH

Key Summary Points

Why carry out this study?

This study investigated the intricate relation‑ ship between cosmetic skincare products, the skin microbiome, and skin health. It evaluated the impact of low-pH skincare products on skin microbiome diversity and skin barrier function.

What was learned from this study?

The diversity of the skin microbiome increased following the application of vita‑ min C concentrate, resveratrol concentrate, a collagen mask, and a native algae mask, as demonstrated by Shannon’s diversity index. The native algae mask notably decreased the genus Corynebacterium and lowered the pH, with the pH changes aligning with micro‑ biota stability. Low-pH skincare products maintain skin microbiome diversity and health by reducing pathogenic microbial populations, promot‑ ing a positive impact on skin microbiome health.

Construction and validation of a predictive model for the risk of intraoperative acquired pressure injuries in the maxillofacial region in patients undergoing surgery in the prone position

Wei Li1 , Jing Huang1 , Hua Li1 , Tingchun Gou1 , Ling Tang1 , Xuesu Dong1 and Chunmei Luo2*

*Correspondence: Chunmei Luo 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1  Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, P.R. China

2 Department of Orthopedics, Xinqiao Hospital, Army Medical University,83 Xinqiao Main Street, Shapingba District, Chongqing 400037, P.R. China

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/.

Abstract

Objective To construct a model for predicting the risk of IAPI (Intraoperative acquired pressure injury) in the facial area of patients undergoing prone position surgery and to validate the predictive effectiveness of this model.

Methods We analyzed data from 970 patients who underwent prone position surgery at a tertiary general hospital in Chongqing, China, from January 2022 to October 2022. Using univariate analysis and logistic regression analysis, we identified risk factors for IAPI in the maxillofacial region of patients undergoing prone position surgery and constructed a nomogram prediction model using R software. On the basis of the selected predictive factors, a risk prediction model was constructed and evaluated using the concordance index (C-index) and the area under the curve (AUC). External validation was conducted to verify the model’s performance.

Results The incidence of IAPI in prone surgery patients was 17.8%. Multivariate logistic regression analysis revealed  that BMI, history of diabetes, surgical duration, muscle relaxant dosage, history of allergies, and preoperative Braden score were the most important factors for the occurrence of intraoperative pressure injuries in the facial region of patients who underwent prone position surgery (P<0.05). The area under the ROC curve of the prediction model is 0.863, the maximum Youden index is 0.681, the optimal cutoff value is 0.214, the sensitivity is 0.815, the specificity is 0.866, and the accuracy in actual application is 91.1%.

Conclusions The IAPI risk prediction model for maxillofacial surgery patients in the prone position constructed in this study demonstrated good predictive performance, providing a basis for clinical medical staff to quickly identify high risk patients and implement precise intervention plans before surgery.

Keywords Pressure ulcer, Prone position, Maxillofacial, Nomogram, Prediction model

Correlation between myocardial work and disease activity in rheumatoid arthritis patients with preserved left ventricular ejection fraction: a retrospective study based on non‑invasive pressure‑strain loop

Xiaolong Yu1  · Jing Xi1  · Jiabiao Wu2  · Ruixiao Song1

Received: 24 November 2024 / Revised: 18 January 2025 / Accepted: 16 February 2025 / Published online: 5 March 2025

© The Author(s) 2025

* Ruixiao Song 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China

2 Rheumatology and Immunology Department, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China

Abstract

Background Early cardiac damage is very common in RA patients, but it is usually subclinical. Therefore, finding a non invasive method for the early detection and treatment of cardiac damage in autoimmune diseases is particularly important.

Objective To evaluate left ventricular function changes in rheumatoid arthritis (RA) patients with preserved left ventricular ejection fraction (LVEF) using left ventricular pressure-strain loop (LV-PSL) technology and to explore the correlation between myocardial work (MW) and disease activity.

Methods A total of 62 RA patients with preserved LVEF, treated at Wujin Hospital Affiliated with Jiangsu University from January 2021 to September 2023, were included. Patients were categorized into low (25), medium (18), and high (19) disease activity groups based on the 28 joint disease activity score (DAS28). A control group of 29 healthy individuals was also established. LV-PSL technology assessed left ventricular global longitudinal strain (GLS) and MW parameters: global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Cor relations between MW parameters, GLS, LVEF, and DAS28 scores were analyzed.

Results There were no significant differences in general data between study and control groups (p>0.05). However, labora tory indicators (RF, CRP, ESR) showed significant differences (p<0.05). GWI, GCW, GWE, and GLS were significantly lower in the high disease activity group compared to controls (p<0.05). GWI, GCW, and GWE were positively correlated with LVEF and absolute GLS, while GWW correlated negatively with LVEF (p<0.05).

Conclusion RA disease activity is closely associated with impaired myocardial work. LV-PSL technology effectively moni tors myocardial function abnormalities in RA patients, providing valuable insights for clinical management.

Key PointsMyocardial work is significantly impaired in RA patients with high disease activity. Left ventricular pressure-strain loop (LV-PSL) technology effectively assesses cardiac function in this patient population. Increased disease activity correlates with reduced myocardial work parameters.

Keywords Left ventricular pressure-strain loop · Myocardial work · Rheumatoid arthritis · Speckle-tracking echocardiography

Hypercholesterolemia Duration and Brain Area Determine Inflammatory Response Intensity and Apoptotic Mediator Activation in Apo E−/−/LDLR−/− Double‑Knockout Mice

Ewelina Czuba‑Pakuła1  · Jolanta Ochocińska2  · Sebastian Głowiński3  · Alicja Braczko4  · Ryszard T. Smoleński4  · Grażyna Lietzau1  · Przemysław Kowiański1,3

Received: 14 August 2024 / Accepted: 7 May 2025 © The Author(s) 2025

* Ewelina Czuba-Pakuła 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

* Przemysław Kowiański 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Jolanta Ochocińska 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Sebastian Głowiński 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Alicja Braczko 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Ryszard T. Smoleński 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Grażyna Lietzau 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Division of Anatomy and Neurobiology, Faculty of Medicine, Medical University of Gdansk, Dębinki 1, 80-211 Gdańsk, Poland

2 Department of Conservative Dentistry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

3 Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland

4 Department of Biochemistry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

Abstract

      Hypercholesterolemia (Hch) is a risk factor for cerebrovascular and neurodegenerative diseases, manifesting with symptoms that vary depending on damage to specific brain regions. Hch triggers inflammatory responses and cell death. However, the progression of these processes in relation to the duration of Hch and the location of pathology in the central nervous system remains unclear. Therefore, we aimed to investigate (1) the impact of age and duration of Hch on neuroinflammatory responses and programmed cell death in the brain and (2) the intensity of these processes in various brain areas during Hch. In this study, we used 3-, 6-, and 12-month-old male Apo E−/−/LDLR−/− double-knockout mice and age-matched wild-type C57BL/6 mice (control group). Concentrations of cytokines IL-1β, IL-4, and IL-6, as well as apoptotic mediators AIF and Cas-3, were measured using enzyme-linked immunosorbent assay in the whole brain and separately in the prefrontal cortex (PFCx), hippocampus (HIP), and striatum (STR). The results showed that the Hch-induced release of cytokines IL-1β and IL-6, decreased expression of IL-4, and elevated level of apoptotic markers AIF and Cas-3 correlated with Hch duration. The inflammatory response and expression of apoptotic markers were more pronounced in the HIP and STR compared to the PFCx. Our results indicate a correlation between the neurodegenerative effects of Hch and its duration and highlight the varying susceptibility of different brain areas to Hch-induced damage.

Graphical Abstract

      Hypercholesterolemia (Hch)-induced inflammatory response and programmed cell death activation in the prefrontal cortex (PFCx), hippocampus (HIP), and striatum (STR) of 3-, 6-, and 12-month-old, Apo E−/−/LDLR−/− double-knockout mice. In three age-groups the Hch-induced response involved release of inflammatory cytokines (IL-1ß and IL-6), a decrease of anti-inflammatory (IL-4) cytokine level, and activation of programmed cell death markers (AIF and Cas-3). The inflam matory response and expression of apoptotic markers were more pronounced in the HIP and STR, compared to the PFCx.

Keywords Apoptosis · Atherosclerosis · Cytokines · Hypercholesterolemia · Neurodegeneration · Neuroinflammation

Salt‑sensitive hypertension in GR mutant rats is associated with altered plasma polyunsaturated fatty acid levels and aortic vascular reactivity

S.Verouti1,2,3 · G. Aeschlimann1  · Q. Wang4  · D. Ancin Del Olmo1  · A. C. Peyter5  · S. Menétrey5  ·D.V. Winter6 · A. Odermatt6  · D. Pearce7  · E. Hummler1,2  · P. E. Vanderriele1,2

Received: 30 April 2024 / Revised: 22 August 2024 / Accepted: 23 August 2024 / Published online: 10 September 2024 © The Author(s) 2024

* P. E. Vanderriele 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland

2 National Center of Competence in Research, Kidney.CH, Lausanne, Switzerland

3 Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland

4 Division of Nephrology and Hypertension, Lausanne University Hospital (CHUV), Lausanne, Switzerland

5 Neonatal Research Laboratory, Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland

6 Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

7 Department of Medicine and Cellular & Molecular Pharmacology, University of California, San Francisco, USA

Abstract

In humans, glucocorticoid resistance is attributed to mutations in the glucocorticoid receptor (GR). Most of these mutations result in decreased ligand binding, transactivation, and/or translocation, albeit with normal protein abundances. However, there is no clear genotype‒phenotype relationship between the severity or age at disease presentation and the degree of functional loss of the receptor. Previously, we documented that a GR+/− rat line developed clinical features of glucocorticoid resistance, namely, hypercortisolemia, adrenal hyperplasia, and salt-sensitive hypertension. In this study, we analyzed the GR+/em4 rat model heterozygously mutant for the deletion of exon 3, which encompasses the second zinc finger, including the domains of DNA binding, dimerization, and nuclear localization signals. On a standard diet, mutant rats exhibited a trend toward increased corticosterone levels and a normal systolic blood pressure and heart rate but presented with adrenal hyperplasia. They exhibited increased adrenal soluble epoxide hydroxylase (sEH), favoring an increase in less active poly unsaturated fatty acids. Indeed, a significant increase in nonactive omega-3 and omega-6 polyunsaturated fatty acids, such as 5(6)-DiHETrE or 9(10)-DiHOME, was observed with advanced age (10 versus 5 weeks old) and following a switch to a high-salt diet accompanied by salt-sensitive hypertension. In thoracic aortas, a reduced soluble epoxide hydrolase (sEH) protein abundance resulted in altered vascular reactivity upon a standard diet, which was blunted upon a high-salt diet. In conclusion, mutations in the GR affecting the ligand-binding domain as well as the dimerization domain resulted in deregu lated GR signaling, favoring salt-sensitive hypertension in the absence of obvious mineralocorticoid excess.

Keywords Adrenal gland hyperplasia · Hypertension · Glucocorticoid receptor · Soluble epoxide hydrolase · Chrousos syndrome

Abbreviations

ACTH Adrenocorticotropic hormone DiHETrE Dihydroxyeicosatrienoic acid DiHOME Dihydroxy-9Z-octadecenoic acid EET Epoxyeicosatrienoic acid EpETrE Epoxyeicosatrienoic acid GR Glucocorticoid receptor HETE Hydroxyeicosatetraenoic acid KODE Ketooctadecenoic acid sEH Soluble epoxide hydrolase

◂Fig.1 GR+/em4 rats presented adrenal hyperplasia of the cortex and the medulla accompanied by a trend toward an increase in the plasma glucocorticoid concentration under standard diet. A Scheme of the wild-type (GR+, upper panel) and the mutated GRem2 (middle) and GRem4 (lower panel) structure of the GR. B Representation of the zinc finger domain of the GR with the deleted amino acids in red. C Rep resentative macroscopic images (scale bar, 1 mm) and D hematoxy lin/eosin-stained sections of whole adrenal glands (left panels; scale bar, 1  mm) and cortex (right panels; scale bar, 300  µm) from 3- to 4-week-old male GR+/+ and GR+/em4 rats (n=3) fed a standard salt diet; zf, zona fasciculata; zg, zona glomerulosa. E Measurement of the adrenal weight/body weight ratio (GR+/+, n=12; GR+/em4, n=14) and F cortex (left) and medulla (right panel) size (GR+/+ (n=3) and GR+/em4 (n=4)). G Determination of plasma concentrations of the glucocorticoids corticosterone, 11-dehydrocorticosterone and the corticosterone/11-dehydrocorticosterone ratio and H the mineralo corticoid aldosterone and its precursor 11-deoxycorticosterone in the morning (7–8 am) and afternoon (6–7  pm) of GR+/+ and GR.+/em4 (n=4 – 16) rats. The size measurements were evaluated using QuPath (vO.4.4), and the plasma concentrations were evaluated by two-way ANOVA and subsequently compared with an unpaired two tailed t test with Welch’s correction. The values are presented as the mean±SEMs. Differences were assessed at *P<0.05 and **P<0.01