Potassium dichromate sensitivity presenting as tefillin dermatitis: A retrospective cohort study

Background

Tefillin are a religious article worn by Jewish men during daily prayer. Tefillin dermatitis secondary to potassium dichromate sensitivity is recognised, but data remain sparse.

Objective

To investigate the prevalence and clinical characteristics of tefillin dermatitis.

Methods

Patients who underwent patch testing with the European baseline series in a tertiary dermatology clinic in 2009–2023 and were diagnosed with tefillin dermatitis were identified by file review and their clinical data recorded.

Results

Of 1679 consecutive male patients tested, 25 (1.49%) were diagnosed with tefillin dermatitis, accounting for 15.34% of all potassium-dichromate-positive patients (163/1679). Mean pre-symptomatic duration of tefillin use was 38 ± 16.9 years, and mean follow-up time, 3.1 ± 2.9 years. Patients presented with an eczematous rash on body areas in direct contact with the leather box or straps of the tefillin. An id reaction was noted in 32%, and sensitivity to other leather accessories, in 44%. Fourteen patients (56%) switched to chromate-free tefillin: symptoms resolved completely in 11 (79%) and partially in 2.

Limitations

Retrospective cohort design.

Conclusion

This is the largest study to date of tefillin dermatitis caused by sensitivity to potassium dichromate used in leather production. Prognosis after switching to chromate-free tefillin was good-to-excellent. Tefillin dermatitis may be more prevalent than previously thought.