Erin M Warshaw's research while affiliated with HealthPartners Institute for Education and Research and other places
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Publications (362)
Background: Allergic contact dermatitis (ACD) in older adults (OA) represents a significant health burden, but few studies examine the prevalence and characteristics of contact allergy and ACD in this population. Objective: To compare positive and clinically relevant patch test results in OA versus younger adults (YA) and children. Methods: Retrosp...
Sodium disulfite, also known as sodium metabisulfite or sodium pyrosulfite, is an inorganic compound, which may cause allergic contact dermatitis. Sulfites act as antioxidants and preservatives; common sources include food/beverages, pharmaceuticals, and personal care products. Importantly, sulfites are not included in most screening patch test ser...
Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018)....
Background: Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. Objectives: To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. Methods: This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Gro...
Background: Benzophenone (BZP)-3 and BZP-4 are ultraviolet (UV) absorbers used in sunscreens and personal care products (PCPs) and may cause allergic contact dermatitis. Objective: To characterize positive patch test reactions to BZP-3 (10% in petrolatum [pet]) and BZP-4 (2% pet) in a screening allergen series. Methods: Retrospective analysis of pa...
Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2019, to December 31, 2020. Methods: At 13 centers in North America, patients were tested in a standardized manner wi...
Importance
The common use of isothiazolinones as preservatives is a global cause of allergic contact dermatitis. Differences in allowable concentrations of methylisothiazolinone (MI) exist in Europe, Canada, and the US.
Objective
To compare the prevalence of positive patch test reactions to the methylchloroisothiazolinone/methylisothiazolinone (MC...
Background: Cobalt is a recognized cause of allergic contact dermatitis (ACD); however, detailed information on patient characteristics, sites, and sources is lacking. Objective: The aim of the study is to assess trends in patch test reactions to cobalt and associated patient characteristics, common sources, and body sites affected. Methods: The st...
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...
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...
Background:
An updated understanding of allergic contact cheilitis is needed.
Objectives:
To characterize clinical characteristics and allergen relevance in patients with cheilitis referred for patch testing.
Methods:
Retrospective analysis of 43,772 patients patch tested with the North American Contact Dermatitis Group (NACDG) screening serie...
Background
There is increasing awareness of the negative effects of ultraviolet (UV) light in individuals with skin of color (SOC), especially in regards to pigmentation disorders induced and/or exacerbated by UV exposure.¹ As a result, there has been a surge in sunscreens marketed to this population. We aimed to characterize cost, marketing claims...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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 (...
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...
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...
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...
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...
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....
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).
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...
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...
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...
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...
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...
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...
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...
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...
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...
: 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...
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...
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...
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...
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...
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...
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...
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/...
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...
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...
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....
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:...
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...
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...
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....
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...
Citations
... Based on these promising reports and early studies, interventional and investigative trials using dupilumab in the treatment of ACD are underway (NCT03935971, NCT05535738). However, there are also case reports of eczematous dermatitis triggered by contact allergens that flare after initiation of dupilumab or fail to respond to dupilumab [55][56][57]. Perhaps additional evidence to support blockade of Th2 inflammation as a therapeutic avenue is the emerging data on JAK inhibitors. ...
... 22,23 In the NACDG's 2019-2020 patch test results, paraben mix 12.0% was found to elicit 0.4% positive reactions. 24 Marketing of paraben-free formulations is popular due to public perception of the potential disruption of endocrine function, though this is not corroborated. 25 Formaldehyde Formaldehyde is a well-established irritant, allergen, and carcinogen. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/11431281123474819-1677715693405_Q64/Cory-Dunnick.jpg)
... Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 states that "a cosmetic product made available on the market shall be safe for human health when used under normal or reasonably foreseeable conditions of use" [4]. Epidemiological data confirm that regulatory restrictions on the use of ingredients with known sensitizing properties can result in a reduction of sensitization rates [5]. This positive effect may be partly hampered by the fact that cosmetic products sometimes contain undeclared ("hidden") ingredients or contaminants with possible adverse effects going beyond of what would be expected based on their declared content [6,7]. ...
... This frequency is slightly higher than the rates reported in previous studies, which ranged from 1.3% to 5.8%. [1][2][3][4][5][6] The increased prevalence may be attributed to the growing use of various types of cosmetics. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/11431281188818446-1694788878172_Q64/Jonathan-Silverberg.jpg)
... In a group of 1919 children, 6% had an allergic reaction to cobalt (Co). ACD triggered by Co should be suspected with dermatitis in a diffused generalized distribution, trunk, or face [9]. ...