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

Results

Patch Test Reactions

The patients who tested positively to the TDM and/or to the eight separate components as well as simultaneous test reactions to PPD and BRM are shown in Table 2 . Twenty out of 982 patients (2%) tested positively to the TDM. Thirteen of the 20 TDM-positive patients tested positively to at least one of the components in the mix. The contact allergy rate to the separate components was in the range of one to six patients, with DO 1 as the most frequent, followed by DO 3. Most of the TDM reactions were weak (+ or ++). Two patients allergic to DO 1 and DO 3, respectively, did not test positively to the mix. Five per cent of the patients tested positively to PPD and 1% to BRM. A statistically highly significant interaction was seen between positive test results to both PPD and TDM (P < 0.001), and between the patients testing positively to both TDM and BRM (P < 0.001).

Statistically Significant Associations

Eight per cent of the patients reporting skin problems from textiles were allergic to PPD compared with 4% of those without intolerance to textiles (P = 0.057; Table 3 ). However, in the multiple logistic regression analysis contact allergy to PPD was found to be an important risk factor for textile-related skin problems with OR 2.14 (CI 1.01-4.31; P = 0.039; Table 4 ).

Eighteen per cent of the patients suspected textiles as a possible cause of their skin problems, 23% of the women and 12% of the men (P < 0.001). Sex was a risk factor in the multiple logistic regression analysis, where females had an increased risk of reporting problems from textiles. Increasing age was also an important predictor of the tendency to report problems from textiles. The results of the multiple logistic regression analysis can be seen in Table 4 .

Twenty-two per cent of the patients had had eczema as a child, 27% of the females compared with 14% of the males (P < 0.001; Table 3 ); 34% of those suspecting textiles had had eczema as a child compared with 19% without textile-related skin problems (P < 0.001; Table 5 ). In the multiple logistic regression analysis childhood eczema was also found to be an important risk factor for textile-related skin problems ( Table 4 ).

Fifty-eight per cent of the patients reporting intolerance to textiles suspected synthetic materials as a cause, followed by wool in 35%, cotton in 22% and silk in 6%. Forty-one per cent of the women with skin problems from textiles reported intolerance to wool compared with 19% of the men (P = 0.009). Thirteen per cent of the women who suspected intolerance to synthetic materials were allergic to PPD compared with 2% of women without skin problems from such textiles (P = 0.037). No association was found between skin problems from various types of textiles and contact allergy to TDM or BRM. Forty-seven per cent of the patients who had had childhood eczema reported wool as a cause of their rash/itch compared with 29% of those without eczema in childhood (P = 0.032). Except for intolerance to wool, no association was found between childhood eczema and skin problems from various types of textiles.

Statistically Nonsignificant Associations

Although not statistically significant, 3.2% of those reporting skin problems were allergic to TDM compared with 1.7% without skin problems (P = 0.211; Table 3 ). The OR for reporting skin problems, adjusted for age, sex and childhood eczema, associated with TDM was 1.9 (95% CI 0.57-5.6). BRM allergy was rare and no evident association with skin problems was found. There was a tendency for BRM-positive patients not to have used hair dye (P = 0.092) and to have had temporary 'black henna' tattoos (P = 0.087).

Two per cent had worked with textiles in dye works, in textile factories or in the manufacture of textile dyes or as a supplier of textile dyes. Three per cent of those with textile-related skin problems had worked in textile factories compared with 1% without skin problems to textiles (P = 0.163). Ten per cent had worked with finished textiles, e.g. as a dressmaker, in a fabric or garment shop or in the laundry business, 14% of the women compared with 4% of the men (P < 0.001). Fourteen per cent of those reporting skin problems had been working with finished textiles compared with 9% without problems to textiles (P = 0.069). No association was found between contact allergy to TDM, PPD, BRM or formaldehyde and work in textile factories or with finished textiles. The results are shown in Table 5 .

The most frequently involved skin sites were the legs, followed by the trunk, arms and neck, and the areas around the armpit and the groin (results not shown). No association was found between textile-related skin problems on a particular body area and contact allergy to the TDM, PPD, BRM or formaldehyde.

Analysis of the Nonrespondents

Thirteen per cent of the patients were not asked to complete the questionnaire. No important differences could be seen in sex, age and studied contact allergies between these patients and the patients who answered the questionnaire. Data on the two groups of patch tested patients are shown in Table 1 .

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