Is Contact Allergy to Disperse Dyes and Related Substances Associated With Textile Dermatitis?

K. Ryberg; A. Goossens; M. Isaksson; B. Gruvberger; E. Zimerson; F. Nilsson; J. Björk; M. Hindsén; M. Bruze

Disclosures

The British Journal of Dermatology. 2009;160(1):107-115. 

In This Article

Abstract and Introduction

Abstract

Background: Disperse dyes (DDs) are the most common sensitizers among textile dyes, but there is little knowledge of the clinical relevance of positive patch test reactions.
Objective: To investigate if patient-reported textile-related skin problems can be explained by contact allergy to eight different DDs and/or to chemically related substances, by occupation or by atopic constitution, and if the skin problems are influenced by age or sex.
Methods: A questionnaire on textile-related skin problems was answered by 858 of 982 consecutively patch tested patients in Malmö, Sweden and in Leuven, Belgium. The baseline series used for patch testing was supplemented with a textile dye mix (TDM) consisting of the eight DDs and with the separate dyes. The association between textile-related skin problems and contact allergy to the DDs and other risk factors was investigated using multiple logistic regression analysis.
Results: Eighteen per cent of the patients suspected textiles as a cause of their skin problems. Atopic constitution and female sex were risk factors for skin reactions. Synthetic materials were the most common textiles to give skin problems. A significant association was found between self-reported textile-related skin problems and contact allergy to para-phenylenediamine (PPD) [adjusted odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0-4.3]. A similar, but more imprecise, adjusted OR was found for TDM (OR 1.9; 95% CI 0.57-5.6). Contact allergy to black rubber mix was too rare to be evaluated.
Conclusions: Contact allergy to PPD was a more prevalent indicator for skin reactions to textiles than the TDM used in this study.

Introduction

Textile dermatitis, i.e. skin manifestations due to clothing and other textiles, can be caused by irritant reactions to textile fibres or by contact allergy to textile dyes and finishing chemicals.[1,2,3] The prevalence of textile dermatitis in various countries is not known. Disperse dyes (DDs) are the most common sensitizers among textile dyes, but contact allergy to DDs may go undiagnosed because the clinical picture does not give rise to suspicion of textile dermatitis.[4] Some DDs known to cause contact allergy are included in textile patch test screening series but not in commercially available baseline patch test series,[5,6] whereas para-phenylenediamine (PPD), which historically has been considered to be a screening allergen for textile dye dermatitis,[7] is included in most baseline patch test series.

In a previous study we found that contact allergy to DDs is quite common in Sweden, with 1.5% of 3325 consecutively patch tested patients reacting positively to a textile dye mix (TDM) consisting of eight DDs: Disperse Blue (DB) 35, 106 and 124; Disperse Yellow (DY) 3; Disperse Orange (DO) 1 and 3; and Disperse Red (DR) 1 and 17.[8] As this study was retrospective, information about the clinical relevance of a positive TDM patch test reaction was not always available.

The aim of the present study was to investigate if clinical signs or symptoms suspected of being caused by textiles could be explained by contact allergy to the TDM and/or to chemically related substances, such as PPD and black rubber mix (BRM), or by other factors, such as occupation or atopic constitution. Furthermore, we wanted to clarify which types of textiles and on which areas of the body the patients experienced their problems and if skin problems from textiles could be influenced by age or sex. Factors possibly related to skin problems from textiles, investigated in the present study are shown in Figure 1.

Figure 1.

Possible associations between factors related to skin problems from textiles as investigated in the present study. BRM = black rubber mix; DDs = disperse dyes; PPD = para-phenylenediamine; TDM = textile dye mix.

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