title: Footwear contact dermatitis from dimethyl fumarate.
abstract: BACKGROUND
  Dimethyl fumarate (DMF) is an effective inhibitor of mold growth. In very low concentrations, DMF is a potent sensitizer that can cause severe allergic contact dermatitis (ACD). It has been identified as the agent responsible for furniture contact dermatitis in Europe. The aim of this study was to evaluate patients in Slovakia with footwear ACD associated with DMF, with regard to clinical manifestations, patch test results, and results of chemical analysis of their footwear.
  
  
  METHODS
  Nine patients with suspected footwear contact dermatitis underwent patch testing with the following allergens: samples of their own footwear, commercial DMF, the European baseline, shoe screening, textile and leather dye screening, and industrial biocides series. The results were recorded according to international guidelines. The content of DMF in footwear and anti-mold sachets was analyzed using gas chromatography and mass spectrometry.
  
  
  RESULTS
  Acute ACD was observed in nine Caucasian female patients. All patients developed delayed sensitization, as demonstrated by positive patch testing using textile footwear lining. Seven patients were patch tested with 0.1% DMF, and all seven were positive. Chemical analysis of available footwear showed that DMF was present in very high concentrations (25-80 mg/Kg).
  
  
  CONCLUSIONS
  Dimethyl fumarate is a new footwear allergen and was responsible for severe ACD in our patients. To avoid an increase in the number of cases, the already approved European preventive measures should be accepted and commonly employed.
authors: Department of Dermatoneverology, Faculty of Medicine, Comenius University, Bratislava, Slovakia. danka.svecova@fmed.uniba.sk
authors: Danka
authors: D
authors: Švecová
authors: Maria
authors: M
authors: Šimaljakova
authors: Anna
authors: A
authors: Doležalová
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000032:analysis / Q000633:toxicity*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000209:etiology*; D000069462:Dimethyl Fumarate; D005260:Female; D005533:Foot Dermatoses / Q000139:chemically induced* / Q000175:diagnosis; D005650:Fumarates / Q000032:analysis / Q000633:toxicity*; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D006945:Hyperhidrosis / Q000209:etiology; D010328:Patch Tests; D012775:Shoes / Q000009:adverse effects*; D018154:Slovakia; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005650:Fumarates; D000069462:Dimethyl Fumarate