Erin M Warshaw1, Jenna L Ruggiero2, Joel G DeKoven3, Melanie D Pratt4, Jonathan I Silverberg5, Howard I Maibach6, Kathryn A Zug7, Amber R Atwater8, James S Taylor9, Margo J Reeder10, Denis Sasseville11, Joseph F Fowler12, Anthony F Fransway13, Donald V Belsito14, Vincent A DeLeo15, Marie-Claude Houle16, Cory A Dunnick17. 1. Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. 2. Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: Ruggi020@umn.edu. 3. Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 4. Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada. 5. Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC. 6. Department of Dermatology, University of California San Francisco, San Francisco, California. 7. Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 8. Department of Dermatology, Duke University Medical Center, Durham, North Carolina. 9. Department of Dermatology, Cleveland Clinic, Cleveland, Ohio. 10. Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 11. Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. 12. Division of Dermatology, University of Louisville, Louisville, Kentucky. 13. Associates in Dermatology, Fort Myers, Florida. 14. Department of Dermatology, Columbia University Irving Medical School, New York, New York. 15. Department of Dermatology, Keck School of Medicine, Los Angeles, California. 16. Division of Dermatology, Centre Hospitalier Universitairede Quebec, Laval University, Quebec City, Quebec, Canada. 17. Department of Dermatology, University of Colorado, Boulder, Colorado.
Abstract
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% petrolatum). METHODS: Retrospective analysis of patients tested to the North American Contact Dermatitis Group screening series from 2015 to 2018. RESULTS: Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared with APS-negative patients, APS-positive patients were significantly more likely to be male (43.2% vs 28.0%; P < .0001); have primary hand dermatitis (30.2% vs 22.0%; P = .0064), scattered generalized dermatitis (25.5% vs 17.9%; P = .0064), or trunk dermatitis (8.9% vs 4.9%; P = .0123); and have dermatitis that is occupationally related (22.2% vs 10.9%; P < .0001). More than half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially hairdressers (68.4%). Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common sources of APS. LIMITATIONS: Immediate reactions and follow-up testing were not captured. CONCLUSION: The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals were important sources of APS exposure.
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% petrolatum). METHODS: Retrospective analysis of patients tested to the North American Contact Dermatitis Group screening series from 2015 to 2018. RESULTS: Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared with APS-negative patients, APS-positive patients were significantly more likely to be male (43.2% vs 28.0%; P < .0001); have primary hand dermatitis (30.2% vs 22.0%; P = .0064), scattered generalized dermatitis (25.5% vs 17.9%; P = .0064), or trunk dermatitis (8.9% vs 4.9%; P = .0123); and have dermatitis that is occupationally related (22.2% vs 10.9%; P < .0001). More than half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially hairdressers (68.4%). Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common sources of APS. LIMITATIONS: Immediate reactions and follow-up testing were not captured. CONCLUSION: The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals were important sources of APS exposure.