Sensitivity to coconut diethanolamide

A 55-year-old woman attended with hand dermatitis which had been present for 3 months. During that time the dermatitis had become severe and had spread to the forearms, as well as involving the face and eyelids on occasions. She worked with her husband in a small printing works handling ink, paper, solvents and some hand creams and cleansers: rubber gloves had been worn only after the onset of the dermatitis. Patch testing was carried out to the European standard series, rubber chemicals, likely sensitizers, and agents used in her work. The only positive test was to a hand gel (diluted 1:10 in soft paraffin). This gel was applied before work and washed off after work: her husband could use it withoat irritation. The ingredients of the hand gel were obtained and diluted in soft paraffin to the concentration of each in the gel, and patch testing results were as follows: