Rosemary Nixon

• Managing Director at Skin Cancer Foundation Victoria

Oral presentation at the Contact Dermatitis session

Oral presentation at patch test training day

Background: Propylene glycol (PG) is used in a variety of cosmetics, food and pharmaceuticals. PG is a known sensitizer but also irritating when patch tested (PT). Objectives: The aims were to investigate the frequency of contact sensitization to PG and to identify cases of allergic contact dermatitis (ACD). Methods: A retrospective study was...

Background: Allergic contact dermatitis (ACD) caused by hexavalent chromium (Cr(VI)) is often severe and difficult to treat. The content of Cr(VI) in cement can be reduced by, for example, addition of iron(II) sulfate. Since 2005 the content of Cr(VI) in cement is regulated in the EU Directive 2003/53/EC and must not exceed 2 ppm. Since this regula...

Background: This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management. Methods: A multi-site retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10)...

Background Hyperkeratotic flexural erythema (HKFE), also known as granular parakeratosis, is a scaly, erythematous or brown eruption, which usually occurs in the intertriginous and flexural areas. It has been linked to the use of benzalkonium chloride (BAK). Aim To review the clinical presentation of patients diagnosed with HKFE who had been expos...

Purpose of Review Irritant contact dermatitis is the most common form of contact dermatitis and the most common occupational skin disease. This review provides a comprehensive summary of the endogenous and exogenous factors that play a role in the pathogenesis of irritant contact dermatitis. Recent Findings In conjunction with avoidance of irritan...

Background: Allergic contact dermatitis (ACD) to Compositae is caused by sensitisation to sesquiterpene lactones (SQLs) and subsequent exposure can occur from direct handling or from airborne transmission. Plants from the Compositae family are ubiquitous globally and their plant extracts are also used in various products. Objectives: Investigati...

Background: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. Objectives: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. Met...

Pruritus is a common and often debilitating symptom that is associated with dermatological conditions including eczema, allergic contact dermatitis, urticaria, some drug eruptions and less commonly systemic diseases and neuropathic causes¹. We report here an unusual familial centrofacial pruritus without any history or clinical findings of a rash,...

Isobornyl acrylate (IBOA) has recently caused a number of cases of allergic contact dermatitis (ACD) from its use in medical devices. We would like to enhance the awareness of this issue with the reporting of three Australian cases, involving two adults and a child. We also report a successful solution by using hydrocolloid wafer (Stomahesive®) as...

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological...

Background: Benzalkonium chloride (BAK) is a quaternary ammonium compound widely used as an antiseptic and preservative. It is a strong irritant and considered a weak sensitiser. Objective: To analyse the temporal trend of BAK sensitisation and the demographics of sensitised patients. Methods: We conducted a single centre retrospective study o...

Background Phenol‐formaldehyde resin 2 (PFR2) has been shown to be a useful marker of contact allergy (CA) to various phenol‐formaldehyde resins. These compounds are used in various industries as solids, powders or semisolid resins and are known to be sensitising agents. Objectives The aims were to investigate the contact allergy to PFR2 in a sing...

The mining industry has one of the highest rates of occupational disease across all industries. However, occupational skin disease (OSD) is not commonly reported in this industry, although has been estimated to affect up to 51 people per 100,000 workers, with contact dermatitis accounting for the majority of cases. It often has a poor prognosis and...

Occupational skin disease is one of the most common work‐related illnesses. It includes a number of disorders, which may be caused by chemical, biological, or physical agents. The skin is the largest organ of the body and performs a number of functions vital for survival. The effect of dermal exposure to chemicals is a growing concern with increasi...

Objectives: Hand sanitisers are urgently needed in the time of COVID-19, and as a result of shortages, some people have resorted to making their own formulations, including the repurposing of distilleries. We wish to highlight the importance of those producing hand sanitisers to avoid methylated spirits containing methanol and to follow WHO recomm...

Patch testing is the most important diagnostic tool for allergic contact dermatitis (ACD). However, just as there are different exposures, there will be variation in the causes of ACD around the world, necessitating the testing of regional contact allergens as well as the more ubiquitous allergens. Our group proposed the first Australian Baseline S...

Hand eczema (or hand dermatitis) is a term used to describe all eczematous skin conditions that affect the hands. Hand eczema is considered an umbrella term that covers both different clinical disease manifestations along with different causations, the most prevalent ones being contact dermatitis and atopic dermatitis, which often makes diagnosis,...

Background: Patch testing is the gold standard for the diagnosis of allergic contact dermatitis (ACD). The Australian Baseline Series (ABS) was formulated by our group to include the 60 most common and relevant allergens in our patient population. The aim of this study was to assess the efficacy of testing with the Australian Baseline Series in or...

The Dermabond Prineo skin closure system (Ethicon, Somerville, New Jersey) is a wound closure device that combines a 2-octyl cyanoacrylate liquid adhesive and a self-adhesive polyester mesh. Although cyanoacrylates traditionally have been associated with low rates of sensitization, allergic contact dermatitis (ACD) to Dermabond products is being in...

Background: Fragrance mix II (FM II) is included in the baseline patch test series recommended by the International Contact Dermatitis Research Group (ICDRG). Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is the most important sensitizer of the 6 fragrance materials included in FM II. Besides being a part of FM II, HICC is also tested separa...

Malignant neoplasms of the skin comprise a group of cancers which are often less commonly considered occupational in origin than many other types of cancers related to workplace exposures, such as mesothelioma, lung or bladder cancer. One reason for this is that skin neoplasms are very common in the community and the main causal exposure, sunlight,...

Background: Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing....

The pathogenesis of frontal fibrosing alopecia (FFA) is complicated and incompletely understood, and the cause for its increasing incidence over the last 10‐15 years is unknown. It has been reported to affect both Caucasians and darker skinned individuals, including in Asia and Africa. This article is protected by copyright. All rights reserved.

Background Opioid‐manufacturing facility workers are at risk of developing occupational contact dermatitis. Objectives To describe the causes of occupational allergic contact dermatitis to opioids in an opioid‐manufacturing facility. Materials and Methods A retrospective review was performed of patients assessed at the Occupational Dermatology Cl...

Background Occupational contact dermatitis is one of the most common occupational diseases, but there is a lack of reliable information on incidence. Despite acknowledged limitations, workers’ compensation statistics may provide insights into contact dermatitis patterns. Objective The objective of the study was to characterise historical patterns...

As important allergens methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI) are removed from products, their replacements, including other isothiazolinones, may emerge as significant allergens. We report a case of allergic contact dermatitis of the hands to benzisothiazolinone (BIT) after exposure to a liquid soap and a dishwashing conc...

Background Lavender is commonly used in aromatherapy and in a broad range of personal and household products. It has been identified as a contact sensitizer and has been reported to cause allergic contact dermatitis (ACD). Objectives To report our experience with contact allergy and ACD to lavender and to raise awareness of lavender as a potential...

Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia with a complicated pathogenesis yet to be fully understood. FFA appears to be increasing in incidence worldwide, especially in the last decade. In order to consider current treatment options, we reviewed current evidence for its pathogenesis comprising immune‐mediated, gen...

Background The European Chemical Agency (ECHA) definition of prolonged contact was introduced in 2014 and has not been evaluated clinically. Objectives To assess whether nickel‐sensitized individuals react on patch testing with high nickel‐releasing metal discs for short and repetitive periods. Materials and methods We patch tested 45 nickel‐sens...

Despite being a well‐recognised cause of allergic contact dermatitis with an embargo in many countries around the world, bufexamac is available over the counter in topical preparations in Australia. We present a series of patients who developed severe cutaneous eruptions after the topical application of bufexamac containing preparations to highligh...

Linked Article: Hamnerius et al. Br J Dermatol 2018; 178:452–461.

Chlorhexidine is a widely used and effective antiseptic agent. Although skin contact is usually well tolerated, it may cause both immediate and delayed hypersensitivity reactions. We report a case of immediate hypersensitivity to chlorhexidine causing both skin and respiratory symptoms following occupational exposure to chlorhexidine in a health-ca...

Linked Article: Crane et al. Br J Dermatol 2017; 176:955–964.

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allerg...

Background: Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD). Objectives: To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic. Methods: A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014. Results: Of 685...

Background: Limonene and linalool are common fragrance terpenes. Both oxidized R-limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively. Objective: To investigate concomitant reactions between oxidized R-limonene and oxidized linalo...

We report a case of a 50-year-old lady with allergic contact dermatitis to para-phenylenediamine, who in her quest to find a substitute hair dye, subsequently reacted to a number of plant-based hair dyes, including pure henna, black tea and indigo powder respectively. While these substances all contain tannins, testing to possible constituents tann...

Occupational skin diseases (OSDs) are the second most common occupational diseases worldwide. Occupational contact dermatitis (OCD) is the most frequent OSD, and comprises irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), contact urticaria and protein contact dermatitis. There are many endogenous and exogenous factors which affe...

The interventional workplace-based study of Geens et al 1 showed that appropriate glove use by hairdressers significantly reduced systemic exposure to the permanent hair dye intermediate paratoluenediamine (toluene-2,5-diamine; PTD). These results are of interest because this is one of only three such real-work studies among hairdressers, and the f...

Background Australia has the highest incidence of skin cancer in the world, a preventable disease caused primarily by exposure to ultraviolet radiation (UVR) in sunlight. Health promotion strategies play a significant role in sun protection.Objectives To assess the understanding of a population sample as to the time of year that the sun was ‘at its...

No abstract is available for this article.

Background: Contact allergy to phenol-formaldehyde resins (PFRs) based on phenol and formaldehyde is not detected by a p-tertiary-butylphenol-formaldehyde resin included in most baseline patch test series. Objective: The aims of this study were to investigate the contact allergy rate to PFR-2 in an international population and to investigate ass...

To describe the characteristics of patients with occupational skin disease (OSD) in a tertiary referral clinic in Victoria, Australia. A retrospective review was conducted of records from patients seen at the Occupational Dermatology Clinic in Melbourne, Australia between 1 January 1993 and 31 December 2010. Of the 2894 people assessed in the clini...

Numerous risk factors have been suggested for hand eczema. This systematic review evaluates the association between tobacco smoking and hand eczema. To review the literature systematically on the association between smoking and HE. The PubMed and EMBASE databases were searched up to 27 January 2015 for articles on the association between tobacco sm...

We report a case of pseudoepitheliomatous hyperplasia (PEH) in a 55-year-old woman following allergic contact dermatitis (ACD) to Grevillea Robyn Gordon. We believe this to be the first reported case of PEH secondary to ACD, and postulate that this was an exaggerated response to severe ACD as a result of a lack of topical treatment. © 2015 The Aust...

Patch testing (PT) is essential for making the diagnosis of allergic contact dermatitis (ACD). However, the extent of PT undertaken by Australian dermatologists is unknown. The objectives of this study were to determine the rate and type of PT in Australia, the perceived obstacles to PT, and to explore the exposure to PT in dermatology training. Da...

The use of antiseptic hand rubs (AHRs), rather than washing with soap and water, is considered to be the gold standard for reducing the frequency of nosocomial infections, as well as being less damaging to the hands than washing with soap and water, but little is known at a population level about usage patterns for AHRs. To describe AHR use pattern...