title: Correlation between lesion site and concentration of dimethyl fumarate in different parts of shoes in patients with contact dermatitis caused by dimethyl fumarate in footwear.
abstract: BACKGROUND
  Dimethyl fumarate (DMF) has been identified as being responsible for an outbreak of shoe contact dermatitis in Europe. All reported cases to date have involved the dorsa of the toes and the dorsa of the feet, sometimes in association with other areas.
  
  
  OBJECTIVE
  To establish a correlation between the site of the lesions and the concentration of DMF in different parts of the footwear from patients suffering from shoe contact dermatitis.
  
  
  METHODS
  We performed a retrospective study of 8 patients with shoe contact dermatitis caused by DMF. Clinical data and patch test results obtained with DMF were recorded. The contents of DMF in different parts of eight samples of shoes involved were analysed with gas chromatography-mass spectrometry.
  
  
  RESULTS
  The chemical analysis of all samples studied showed the presence of DMF, both in the uppers and the soles of the shoes. A clinical-analytical correlation was found in all cases. The presence of DMF in a child's boot was detected 1 year after withdrawal of the sachet with DMF from the shoe box.
  
  
  CONCLUSIONS
  A correlation exists between the concentrations of DMF in the different parts of the shoe and the localization of the lesions. Although DMF is a volatile substance, it can remain impregnated in shoes for a long period of time.
authors.affiliation: Dermatology Department, Hospital General Universitario de Alicante, 03010 Alicante, Spain. fernandotoledoalberola@hotmail.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Toledo
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Silvestre
authors.forename: Laura
authors.initials: L
authors.lastname: Cuesta
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Borrego
authors.forename: María
authors.initials: M
authors.lastname: Pérez
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects* / Q000032:analysis* / Q000737:chemistry; D002675:Child, Preschool; D003877:Dermatitis, Contact / Q000175:diagnosis / Q000209:etiology*; D000069462:Dimethyl Fumarate; D005260:Female; D005533:Foot Dermatoses / Q000139:chemically induced* / Q000175:diagnosis; D005650:Fumarates / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests / Q000379:methods; D012775:Shoes; D014581:Urticaria / Q000139:chemically induced; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005650:Fumarates; D000069462:Dimethyl Fumarate