Erin M. Warshaw's research while affiliated with Park Nicollet Health Services and other places

Publications (344)

Article
Background: Shoe contact allergy can be difficult to diagnose and manage. Objective: The aim of the study was to characterize demographics, clinical characteristics, patch test results, and occupational data for the North American Contact Dermatitis Group patients with shoe contact allergy. Methods: This is a retrospective study of 33,661 pati...
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Background: Dental personnel are at risk of developing occupational contact dermatitis. Objectives: The aims of the study were to determine prevalence of occupational contact dermatitis in dental personnel referred for patch testing and to characterize relevant allergens and sources. Methods: The study used a retrospective, cross-sectional ana...
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Background Dermatitis localized to hands (HD), feet (FD), or both hands and feet (HFD) has multiple etiologies including atopic dermatitis (AD), irritant contact dermatitis (ICD), and allergic contact dermatitis (ACD). Little is known about clinical differences between patients with HD, FD and HFD. Objectives To characterize differences of demogra...
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Background: Allergic contact dermatitis (ACD) to cobalt is more common in children and adolescents than adults. However, detailed information on sites and sources of cobalt ACD are limited. Objectives: To assess trends in positive and clinically relevant patch test reactions to cobalt in children and associated patient characteristics, common so...
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Background Alkyl glucosides are nonionic surfactants increasingly used in personal care products (PCPs). Objective To characterize positive patch test reactions to decyl glucoside (5% pet, tested 2009-2018) and lauryl glucoside (3% pet, tested 2017-2018). Methods Retrospective analysis of patients tested by the North American Contact Dermatitis G...
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Background: Lanolin is an important cause of allergic contact dermatitis. Objectives: The aims of this study were to describe the epidemiology of lanolin allergy and to assess trends in patch test reactions to lanolin over time. Methods: This study used a retrospective analysis of patients patch tested with lanolin alcohol 30% or Amerchol L-10...
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Background Identification of allergens causing medical adhesive contact allergy is difficult. Objective Characterize the demographics, clinical characteristics, patch test results and occupational data for North American Contact Dermatitis Group (NACDG) patients with medical adhesive contact allergy. Methods Retrospective study of 43,722 NACDG pa...
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Full-text available
Purpose of Review Use of essential oils (EOs) has become popular due to consumer demand for natural products. Despite the widespread perception that natural ingredients are safe, allergic contact dermatitis (ACD) is a well-described complication of EO use. This article provides a comprehensive overview regarding allergenicity, prevalence of positiv...
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Full-text available
Background Few studies explored the relationship between stasis dermatitis (SD) and allergic contact dermatitis (ACD).Objective To examine trends, associations, and clinical relevance of ACD in patients referred for patch testing who had a final SD diagnosis.Methods Retrospective analysis from 2001 to 2016 of 38,723 patients from the North American...
Article
Importance: Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens. Objective: To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances. Design, setting, and participants: A 17-year, retr...
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Photoallergic contact dermatitis (PACD) is an unusual but not rare form of photosensitivity with an etiology similar to that of allergic contact dermatitis (ACD), with the added requirement of concomitant exposure to ultraviolet (UV) light.1 Photopatch testing (PPT) is a critical tool for diagnosing PACD. There are only a few large studies of photo...
Article
Background: Ethylhexylglycerin (EHG) is a recently recognized contact allergen. Objective: The aims of the study were to characterize individuals with positive patch test reactions to EHG and to analyze reaction strength, clinical relevance, and allergen sources. Methods: This study was a retrospective analysis of the patients patch tested to...
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Background/objectives: Topical medications may lead to allergic contact dermatitis. This study characterized positive patch test reactions associated with medications in patients evaluated by the North American Contact Dermatitis Group (NACDG). Methods: This study is a retrospective analysis of the NACDG data (2001-2018). Patients with at least...
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Background: Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions including allergic contact dermatitis. Objective: To characterize positive patch test reactions to APS (2.5% pet). Methods: Retrospective analysis of patients tested to the North American Contact Dermatit...
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Background: Vitamin E (tocopherol) a naturally occurring mixture of antioxidants commonly used in topical skin care products, may cause allergic contact dermatitis. Objective: The aim of this study was to characterize positive patch test reactions to tocopherol and tocopherol acetate. Methods: This is a retrospective analysis of North American...
Article
Differences in consumer product availability, distribution, and use may lead to national differences in contact sensitization frequencies. Objective: The aim of the study was to describe the differences in contact allergy between the United States (US) and Canada. Methods: This is a retrospective cross-sectional analysis of the North American C...
Article
Background An updated understanding of allergic contact dermatitis (ACD) is needed, particularly in children. Objectives To compare positive and clinically-relevant reactions in children vs. adults referred for patch testing. Methods Retrospective analysis of 1,871 children and 41,699 adults from the North American Contact Dermatitis Group from 2...
Article
Background: Hair care products (HCPs) may cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). Objectives: The aims of the study were to determine the prevalence of HCP-associated ICD/ACD and to characterize relevant allergens. Methods: This study is a retrospective analysis of North American Contact Dermatitis G...
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Background/objective: Both active and inactive ingredients in topical ophthalmic agents may cause allergic contact dermatitis. Here, we examined ingredients in prescription topical ophthalmic medications available in the United States. Methods: A comprehensive list of topical ophthalmic medications was generated using AccessPharmacy. Categories...
Article
Background: Patch testing is a vital component of the workup for allergic contact dermatitis. There are limited data on changes of patch testing use among Medicare providers, as well as patch testing reimbursement rates. Objective: The aim of the study was to evaluate trends in the use of patch testing among various Medicare providers and Medica...
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Background: Little is known about the relationship between psoriasis and allergic contact dermatitis (ACD). Objective: To examine the associations with ACD, related clinical characteristics, and common positive and clinically relevant allergens of patients with a final diagnosis of psoriasis who were referred for patch testing. Methods: Retros...
Article
Background/objectives: Carvone, a flavoring agent, may cause allergic contact dermatitis. This study summarizes patch test reactions to carvone in patients tested by the North American Contact Dermatitis Group, 2009 to 2018. Methods: This was a retrospective analysis of patients positive to carvone (5% petrolatum). Demographics were compared wit...
Article
Background Data regarding teledermatology for patch testing are limited. Objectives Compare patch test readings and final interpretation by 2 in‐person dermatologists (IPDs) with 8 teledermatologists (TDs). Methods Patch tested patients had photographs taken of 70 screening series allergens at 48‐hour (48H) and second (2nd) readings. 8 TDs review...
Article
Background Sodium disulfite (SD), also known as sodium metabisulfite, is an increasingly recognized cause of allergic contact dermatitis. Objectives Characterize individuals with positive patch test reactions to SD as well as analyze reaction strength, clinical relevance and sources. Methods Retrospective analysis of patients patch tested to SD (...
Article
Background: Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) is a broad-spectrum preservative mixture used in consumer and industrial products. Objectives: The aims of the study were (1) to characterize the prevalence and clinical relevance of patch test reactions to MDBGN/PE and the epidemiology of positive patients and (2) to determine th...
Article
Background Patch-testing is an important diagnostic tool for suspected allergic contact dermatitis (ACD) in occupational settings. Objective Provide an overview of occupational skin disease (OSD) and analysis of occupational ACD in North American patients undergoing patch-testing 2001-2016. Methods Patients with OSD were analyzed for frequency of...
Article
Background The association between atopic dermatitis (AD) and allergic contact dermatitis (ACD) is controversial. Objectives To analyze the prevalence, reaction strength, and trends of the most commonly positive and relevant allergens in patients with AD referred for patch testing. Methods Retrospective analysis of 36,834 patients from the North...
Article
Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective: This study documented the North American Contact Dermatitis Group (NACDG) patch testing results from March 1, 2017, to December 31, 2018. Methods: At 14 centers in North America, patients with dermatitis were tested in a st...
Article
Background Few studies examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD). Objective To examine the trends, associations, and clinical relevance of ACD in NE patients referred for patch testing. Methods Retrospective analysis of 38,723 patients from the North American Contact Dermatitis Group....
Article
A 71‐year‐old man presented with a 5‐year history of intermittent dermatitis predominantly located on the face and neck which worsened with sun exposure. He described pruritic, burning red papules with subsequent flaking, most prominent along the cheekbones with involvement of the lower eyelids (Figs. 1A, B).
Article
Background Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited. Objective To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group. Methods We conduc...
Article
Background Little is known about the etiologies and relevant allergens in pediatric patients with hand eczema (HE). Objective To characterize the etiologies and determine proportion of positive and currently relevant allergens in children/adolescents (age <18 years) with HE referred for patch testing. Methods Retrospective analysis (2000–2016) of...
Article
Background: Carmine is a natural red dye that may cause allergic contact dermatitis. Objective: The aim of this study was to analyze patch test reactions to carmine (2.5% in petrolatum) and characterize carmine-positive patients. Methods: This study conducted a retrospective analysis of North American Contact Dermatitis Group data compiled bet...
Article
Objectives: Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population. Methods: The 1994-2016 North American Contact Dermatitis Group screening series data were analyze...
Article
Background: Allergic contact dermatitis to tattoo ink may last from weeks to years. Formaldehyde is a strong sensitizer that may be present in predispersed tattoo inks. Objectives: The aim of this study was to evaluate the presence of formaldehyde in predispersed tattoo inks using the chromotropic acid method. Methods: Tattoo inks from 39 comp...
Article
Importance: When fragrance- and botanical-related (F/BR) allergy is identified, concomitant reaction (CR) frequencies can help direct avoidance recommendations. Objective: This study aimed to determine the CR rates for F/BR allergens. Design: A retrospective cross-sectional analysis of the North American Contact Dermatitis Group data 2007-2016...
Article
Background/objective: This study characterizes concomitant reactions to carba mix (CM) and thiuram mix (TM) in a large North American population. Because thiurams and dithiocarbamates have structural similarity, concomitant reactions are expected. Methods: The 1994-2016 North American Contact Dermatitis Group data were analyzed. Patients with a...
Article
Background: Data regarding patient-reported symptoms during patch testing are limited. Objective: To provide frequency of symptoms (pain, sleep difficulty, medication need, site itching, itch elsewhere, and worsening rash) experienced by patients undergoing extensive patch testing and to determine association of these symptoms with patient chara...
Article
Background: Isothiazolinones are commonly used preservatives, which may cause allergic contact dermatitis. The Lovibond Isothiazolinone Test Kit (LITK) has been reported to successfully identify clinically relevant, occult isothiazolinones in patient personal care products. Objective: The aim of the study was to analyze dish soaps and personal c...
Article
: Cutaneous exposure to aluminum may occur via contact with metal items, medications, and personal care products. Despite the widespread use of aluminum, allergic contact dermatitis is relatively rare. Sensitization is often incidentally identified during patch testing with aluminum-based chambers. This article presents several cases along with a l...
Article
Background Hand eczema (HE) is a heterogeneous and burdensome disorder. Objective To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing. Methods Retrospective analysis (2000–2016) of North American Contact Dermatitis Group data (n=37,113). Results Overall, 10,034 were diagnos...
Article
Background/objectives: Carba mix (CM, 3% petrolatum) contains 1,3-diphenylguanidine (DPG, 1%), zinc diethyldithiocarbamate (1%), and zinc dibutyldithiocarbamate (1%). Because DPG is a component of CM, DPG is often not tested separately. The purpose of this study was to determine the frequency of concomitant reactions to CM and DPG. Methods: A re...
Article
Background Personal care products(PCPs) are commonly responsible for allergic(ACD) and irritant contact dermatitis(ICD). PCP use was historically associated with women but increasingly, male-targeted PCPs are being marketed. Objective To characterize and compare males and females with PCP-related contact dermatitis(MPCP, FPCP). Methods Retrospect...
Article
Background: Common recommendations for tattoo aftercare to ensure proper healing include application of topical products. Little is known about tattoo aftercare products. Methods: Tattoo aftercare products were identified from a previous study and a search on Amazon.com using the phrase "tattoo aftercare." Duplicates and products without complet...
Article
The American Contact Dermatitis Society Core Allergen series was introduced in 2013 and updated in 2017. Changes in our recommended allergens are again necessary, taking into account data from the American Contact Dermatitis Society's Contact Allergen Management Program top 100 allergens from 2018. For the updated series, we removed methyldibromogl...
Article
Background Scalp conditions are often multifactorial. Objective To characterize patients with scalp involvement and patch testing outcomes. Methods Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (<3 anatomic sites coded) with or without addi...
Article
Background Eyelid dermatitis is a common dermatologic complaint. Objective To characterize patients with eyelid dermatitis. Methods Retrospective analysis (1994 – 2016) of North American Contact Dermatitis Group data. Results Of 50,795 patients, 2,332 (4.6%) had eyelid dermatitis only (E-only), while 1,623 (3.2%) also had dermatitis of the head/...
Article
Prescription and over-the-counter topical anesthetics are commonly used. Although allergy to amide and ester anesthetics is known, little has been reported on the nonamide, nonester pramoxine (pramocaine). This article briefly reviews allergy to topical anesthetics, provides detailed information on pramoxine, and describes characteristics of multip...
Article
Background: Ingredients in nail care products may lead to allergic and/or irritant contact dermatitis. Objective: The aims of this study were to determine frequency of contact dermatitis associated with nail care products, characterize associated body sites, and describe causative allergens. Methods: A retrospective analysis was conducted with...
Article
Isothiazolinones, preservatives including methylisothiazolinone (MI), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), benzisothiazolinone (BIT), and octylisothiazolinone (OIT), are notorious contact allergens. Pediatric dermatologists are familiar with these preservatives in personal care products, homemade slime recipes, and wet wipes....
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Importance: Consumers have reported skin rash/irritation and hair loss/breakage with Wen by Chaz Dean Sweet Almond Mint Cleansing Conditioner (WCDSAMCC), however epidemiologic, toxicologic and clinical hair loss studies have not provided an explanation. Contact dermatitis has been hypothesized. Objective: To assess the tolerability of six products:...
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Accuracy in patch testing is critical for correct allergen identification. This multistep process is prone to error and risk increases with more staff (physicians, residents, fellows, technicians), antigens, and patients. Standardized safety checkpoints increase efficiency, consistency, and safety. In this article, we outline workflows developed fo...
Article
Background: Manufacturers are increasingly branding personal care products (PCPs) specifically for men. Objective: The aim of the study was to characterize ingredients and claims of facial moisturizers marketed to men. Methods: Men's facial moisturizers from 7 different online retailers were identified in June-September 2018. Ingredients were...
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Importance Contact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008....
Article
Importance Facial dermatitis in women is well characterized. However, recent shifts in the men’s grooming industry may have important implications for male facial dermatitis. Objective To characterize male patients with facial dermatitis. Design, Setting, and Participants A 22-year retrospective cross-sectional analysis (1994-2016) of North Ameri...
Article
Acrylates are synthetic thermoplastic resins used in a multitude of products, ranging from bone cement to artificial nails. They represent an important and increasing cause of both occupational and nonoccupational allergic contact dermatitis. Isobornyl acrylate, an acrylic monomer found within ultraviolet‐cured inks, adhesives and various medical d...
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Background: The epidemiology of nickel allergy in occupational settings is not well understood. Objective: The aim of the study was to characterize occupationally related nickel allergy (ORNA). Methods: This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2...
Article
Identification of the etiological chemical agent(s) associated with a case(s) of allergic contact dermatitis (ACD) is important for both patient management and public health surveillance. Traditional patch testing can identify chemical allergens to which the patient is allergic. Confirmation of allergen presence in the causative ACD-associated mate...