title: Positive patch-test reactions to gold: patients' perception of relevance and the role of titanium dioxide in cosmetics.
abstract: BACKGROUND
  Positive patch-test reactions to gold that are without obvious clinical relevance are common. We speculate that titanium dioxide in cosmetics and sunscreens may adsorb gold particles in jewelry that occasionally contacts facial skin and cause contact dermatitis on this area despite the absence of dermatitis under gold jewelry worn on the hands.
  
  
  OBJECTIVE
  To identify subgroups of gold allergic patients who improve with avoidance of gold.
  
  
  METHODS
  A questionnaire was mailed to 102 gold-allergic patients.
  
  
  RESULTS
  There were 49 responses, of which all but one were from women. When asked to evaluate the statement that patch testing with gold was useful to them, one-third of respondents agreed completely, one-third agreed in part, and one-third disagreed. The majority of patients reported that their dermatitis improved after patch testing, but most were avoiding other allergens in addition to gold.
  
  
  CONCLUSIONS
  Avoidance of gold earrings did not appear to benefit patients with earlobe dermatitis, but total avoidance of gold jewelry on the hands and wrists did seem to benefit a subgroup of patients with facial and eyelid dermatitis who wore powder, eye shadow, or foundation on affected areas.
authors.affiliation: Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH, USA. STN@case.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Nedorost
authors.forename: Alexis
authors.initials: A
authors.lastname: Wagman
mesh_terms: D000485:Allergens / Q000009:adverse effects*; D003358:Cosmetics / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology; D005148:Facial Dermatoses / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006046:Gold / Q000009:adverse effects; D006229:Hand Dermatoses / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D008297:Male; D009820:Ohio; D010328:Patch Tests; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D014025:Titanium / Q000009:adverse effects*
chemical_list: D000485:Allergens; D003358:Cosmetics; C009495:titanium dioxide; D006046:Gold; D014025:Titanium