Showing papers in "Dermatitis in 2019"

Psoriasiform Dermatitis After Initiation of Treatment with Dupilumab for Atopic Dermatitis.

Abstract: testing was performed to rule out contact dermatitis as an exacerbating factor. Testing revealed 3+ reaction to 2-hydroxyethyl methacrylate, but no reaction to epoxy resin, ethyl acrylate, or methyl methacrylate. She was not tested for sensitivity to ethyl cyanoacrylate. With these results, she stopped using preformed nails and gel nail polishes. After 3 months, a tenuous nail plate began to form, and the nail bed was no longer inflamed. She was then started on bimatoprost 0.03% to the proximal nail folds to augment regrowth. After approximately 2 years with complete avoidance of her allergens on this treatment regimen, her thumbnails grew in and normalized (Fig. 2). 2-Hydroxyethyl methacrylate is commonly found in acrylic and gel nails. Multiple cases of sensitization and development of allergic contact dermatitis among members of beauty and dental industries have been reported. One retrospective study examined 122 individuals who were patch tested for 2-hydroxyethyl methacrylate and found that 37 had positive relevant reactions where 28 were related to artificial nails. In these cases, the most commonly affected regions were the hands and fingers. Common symptoms were pulpitis, fissuring, and pruritus. Nails were less commonly affected, but symptoms included onycholysis and nail dystrophy. Sensitization may have occurred through preformed nail tips, although their role in contact dermatitis is contested. Our patient also applied gel nail polish containing 2-hydroxyethyl methacrylate to her preformed nail tips. Although no testing was performed for sensitivity to ethyl cyanoacrylates, they are not known to cause cross-reactions with methacrylates. Acrylates have been implicated in oral lichen planus. In our case, a primary acrylate-induced dermatitis caused lichen planus– like changes of the nail plate. Clinicians should be aware of the potential for acrylate contact hypersensitivity to induce changes and consider patch testing if a patient presents with isolated nail lichen planus with an exposure to acrylates.

Poison Ivy, Oak, and Sumac Dermatitis: What Is Known and What Is New?

Abstract: Poison ivy, poison oak, and poison sumac are the most common causes of clinically diagnosed allergic contact dermatitis in North America. Approximately 50% to 75% of the US adult population is clinically sensitive to poison ivy, oak, and sumac. We reviewed the botany and history of these plants; urushiol chemistry and pathophysiology, clinical features, and the prevalence of allergic contact dermatitis caused by these plants; and current postexposure treatment and preventive methods, including ongoing investigations in the development of a vaccine (immunotherapy). Although extensive efforts have been made to develop therapies that prevent and treat contact dermatitis to these plants, there lacks an entirely effective method, besides complete avoidance. There is a need for a better therapy to definitively prevent allergic contact dermatitis to these plants.

Psoriasis-like Dermatitis Developing in a Patient with Atopic Dermatitis Treated with Dupilumab.

Abstract: J.I.S. served as a consultant and/or advisory board member for Abbvie, AnaptysBio, Asana, Arena, Boehringer-Ingelheim, Dermavant, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Kiniksa, Leo, Menlo, Novartis, Pfizer, and Regeneron-Sanofi; is receiving honoraria from RealM; is speaker for Regeneron-Sanofi; and received research grants from GlaxoSmithKline. The other authors have no funding or conflicts of interest to declare. 376 DERMATITIS, Vol 43 • No 6 • November/December, 2019

Atopic Dermatitis and Hospitalization for Mental Health Disorders in the United States.

Abstract: Little is known about mental health (MH) emergencies in atopic dermatitis (AD) and their financial burden. We sought to determine hospitalization rates and costs of MH disorders in AD patients. We analyzed data from the Nationwide Inpatient Sample from 2002 to 2012, containing a representative 20% sample of US hospitalizations. Overall, 835 AD (1.36%) and 2,434,703 non-AD (0.75%) patients had a primary admission for an MH disorder. Atopic dermatitis patients admitted for MH disorders were more likely to be younger, Asian, of black race, and in a higher income quartile and have an increasing number of chronic conditions. In multivariable logistic regression models adjusting for demographics, AD was associated with a primary admission for MH disorders in adults, including mood disorders, schizophrenia, and developmental disorders. Atopic dermatitis was not associated with a primary admission for an MH disorder in children. There were an estimated US $183,821,629 excess costs of care annually for MH disorders in inpatients with versus without AD. In conclusion, AD was associated with higher odds of hospitalization for all MH disorders and substantial excess costs of inpatient care.

Alopecia Areata After Treatment with Dupilumab.

Abstract: trial, as in our patient. Regarding mucosal FDE, different morphologies have been described, including bullous/erosive and aphthous forms, the most easily misdiagnosed as herpes simplex lesions. Since 1994, various cases of FDE to fluconazole have been described, some of them with herpes simplex labialis–like lesions, as our patient presented. Establishing if the lesions are herpes simplex lesions or FDEmucosal lesions is critical to avoid wrong diagnosis and treatment. Severity and course of FDE have been related to viral infections through a subtype of CD8 T cells called tissue-resident memory T cells. These cells may appear after viral skin infections, and they stay circumscribed to the original location for at least 6 months. Because of cross-reactive drug antigens, these cells may be responsible for FDE. Only 1 case of FDE to itraconazole has been described with cross-reaction to fluconazole, but recently, a lack of in vitro cross-reactivity between these 2 triazoles has been described in another patient. Thus, itraconazole may be a safe option for recurrent candidiasis in fluconazole-sensitive patients, and oral challenge should be performed to rule out cross-reactivity. In conclusion, we would like to draw attention to misdiagnosis of FDE to fluconazole as herpes simplex labialis to prevent unnecessary treatments. Itraconazole would be a therapeutic alternative in these patients.

Patch Testing Ingredients of Dermabond and Other Cyanoacrylate-Containing Adhesives.

Abstract: Background Cyanoacrylates are strong adhesives used for a variety of medical, industrial, and cosmetic applications and have been implicated as a cause of allergic contact dermatitis. Objective The aim of the study was to review our experience in patch testing with cyanoacrylates. Methods We reviewed patch test results of 38 patients with a clinical history of contact dermatitis due to a cyanoacrylate-containing adhesive (mostly Dermabond). Testing used cyanoacrylates of >99% purity diluted to 10% to 30% in petrolatum (pet.), undiluted octyl cyanoacrylate, and/or Dermabond Mini or Advanced "as is." Patch tests were also performed with methacrylates, formaldehyde (a cyanoacrylate impurity), benzalkonium chloride, and cyanoacrylate polymerization inhibitors. Three patients were also tested with Dermabond Mini on abraded skin. Results Commercial cyanoacrylate patch testing material (ethyl cyanoacrylate 10% pet.) detected 29% of Dermabond-allergic patients, whereas patch testing with octyl cyanoacrylate 10% pet. increased detection to 50%. Testing with higher concentrations and/or on abraded skin further increased yield. Thirteen (37%) of our 35 cyanoacrylate-allergic patients were also allergic to methacrylates or acrylates. Conclusions Octyl cyanoacrylate is the usual allergenic ingredient in Dermabond. Patch testing with high concentrations is often required. Testing Dermabond on abraded skin further improves diagnostic sensitivity by more closely simulating clinical use.

Allergens in Medical Hand Skin Cleansers.

Abstract: Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of "low-allergen" medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time.

Dupilumab for Systemic Allergy Syndrome With Dermatitis.

Abstract: Allergic contact dermatitis (ACD) has been traditionally identified as TH1-mediated delayed-type hypersensitivity reactions. There is currently no Food and Drug Administration-approved systemic therapy indicated for ACD. Among patients with ACD, there is a subgroup that experience not only concomitant atopic dermatitis and ACD but also systemic allergic dermatitis driven by allergens encountered through dietary consumption. Basic science and clinical studies have supported the notion that ACD involves a complex interaction between both TH1 and TH2 axes of the secondary immune system on an allergen-by-allergen basis. Herein, we report the patients with systemic allergy syndrome with dermatitis to either Balsam of Peru or nickel who achieved remarkable improvement and regained their quality of life without continuing adherence to strict diets. Our study suggests that dupilumab may be an efficacious solution for a particular subgroup of patients with recalcitrant ACD when first- and second-line therapies have failed.

Formaldehyde Release From Personal Care Products: Chromotropic Acid Method Analysis.

Abstract: Background Preservatives such as formaldehyde and formaldehyde releasers (F/FRs) are found in personal care products. Studies from Europe and Israel have indicated that products with undeclared F/FRs on product labels may have detectable levels of formaldehyde. Objective The aim of the study was to determine the presence of formaldehyde in samples of US personal care products. Methods Fifty-four baby and adult products were tested with the chromotropic acid method. A blinded investigator graded the color change as mild, moderate, or strong. Results All 8 products declaring F/FRs resulted in a deep purple color change, indicating a strong reaction. Of the 46 products with undeclared F/FRs, 4 (8.6%) were found to release formaldehyde. All 4 resulted in a light purple color change, indicating a mild reaction. Conclusions Overall, 4 of 54 products (7.4%) had label information, which did not match chromotropic acid method testing results. Clinicians and formaldehyde-allergic individuals should be aware of the limitations of product ingredient labeling in managing allergic contact dermatitis to formaldehyde.

Systemic Treatments for Allergic Contact Dermatitis

Abstract: Allergic contact dermatitis is a common disease within the family of delayed-type hypersensitivity reactions. In more severe cases of allergic contact dermatitis, topical steroids may prove insufficient, and systemic therapeutic agents are often used. Even when systemic therapies such as cyclosporine lead to improvement, withdrawal of these agents is challenging and can lead to undesirable morbidities. Currently, there are no systemic treatments indicated for the treatment of widespread recalcitrant contact dermatitis. This review discusses the targets of in-use off-label systemic medications and potential therapeutics in the pipeline.

Airborne Allergic Contact Dermatitis: Management and Responsible Allergens on the American Contact Dermatitis Society Core Series.

Abstract: Airborne allergic contact dermatitis occurs when allergen particles suspended in the air deposit on the skin. Many allergens can result in an airborne distribution if presented in an aerosolized form. This review summarizes the allergens in the American Contact Dermatitis Society Core Allergen Series that have been documented to cause airborne allergic contact dermatitis. In addition to responsible allergens, this article also reviews management and treatment options.

Allergic Contact Dermatitis to Operating Room Scrubs and Disinfectants.

Abstract: Background Both surgical personnel and patients undergoing procedures are exposed regularly to different antiseptic chemicals in various forms. Little is known about the ingredients in these antiseptics and the risk these products may provoke allergic contact dermatitis. Objective The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period. Methods DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; those found on the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series were noted from each product. Conclusions A total of 1940 products were identified, of which 267 were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Within the group analyzed, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained a single ACDS allergen. There were significant differences in allergens based on product type and active ingredient, with iodine-containing products having the fewest number of allergens. The most common ACDS allergens found were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%).

Conceptual Model to Illustrate the Symptom Experience and Humanistic Burden Associated With Atopic Dermatitis in Adults and Adolescents.

Abstract: Atopic dermatitis (AD) is a pruritic or painful dermatologic disease characterized by xerosis and eczema lesions. The symptoms/signs of AD can significantly impact patients' health-related quality of life (HRQoL). This study aimed to qualitatively explore the adult and adolescent experience of AD. A targeted literature review and qualitative concept elicitation interviews with clinicians (n = 5), adult AD patients (n = 28), and adolescent AD patients (n = 20) were conducted to elicit AD signs/symptoms and HRQoL impacts experienced. Verbatim transcripts were analyzed using thematic analysis. Twenty-nine symptoms/signs of AD were reported, including pruritus, pain, erythema, and xerosis. Atopic dermatitis symptoms/signs were reported to substantially impact HRQoL. Scratching was reported to influence the experience of symptoms and HRQoL impacts. Four proximal impacts (including discomfort and sleep disturbance) were reported. Ten domains of distal impact were reported, including impacts on psychological and social functioning and activities of daily living. A conceptual model was developed to summarize these findings. This study highlights the range of symptoms and HRQoL impacts experienced by adults and adolescents with AD. To our knowledge, this study was first to explore the lived experience of AD in both adult and adolescent patients, providing valuable insight into the relatively unexplored adolescent experience of AD.

Occupationally Related Nickel Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 1998-2016.

Abstract: BACKGROUND The epidemiology of nickel allergy in occupational settings is not well understood. OBJECTIVE The aim of the study was to characterize occupationally related nickel allergy (ORNA). METHODS This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2016. Characteristics of individuals with ORNA were compared with those with non-ORNA (NORNA). RESULTS A total of 7928 (18.2%) individuals were positive to nickel sulfate 2.5%. Two hundred sixty-eight (3.4%) had ORNA. As compared with NORNA, ORNA was statistically associated with the male sex (41.0% vs 12.9%, P < 0.001), a diagnosis of irritant contact dermatitis (22.4% vs 12.0%, P < 0.001), and no history of eczema (81.7% vs 75.7%, P = 0.0217). The most common sites of ORNA dermatitis were hand (39.9%) and arm (18.1%), which were significantly more common than in NORNA (P < 0.0001). Sixteen industry categories and 22 occupation categories were identified for ORNA; the most common industries were durable goods manufacturing (24.6%) and personal services (15.7%), and the most frequent occupations were hairdressers/cosmetologists/barbers (14.3%), machine operators (9.3%), and health care workers (7.1%). Overall 30% of ORNA occupations were in metalworking. Of 215 ORNA sources identified, instruments/phones/other equipment (16.3%), vehicles/machinery (15.8%), and tools (15.3%) were the most common. CONCLUSIONS Occupational nickel allergy is distinct from nonoccupational nickel allergy.

Allergic Contact Dermatitis to Shin Pads in a Hockey Player: Acetophenone Is an Emerging Allergen.

Abstract: Acetophenone azine (AA) has recently been identified as a new allergen in shin pads and sports shoes. We report the case of a boy with allergic contact dermatitis of the shins caused by AA present in his shin pads. High-performance liquid chromatography of samples of shin pads was performed to help identify potential contact allergens. Patch tests revealed strongly positive reactions to pieces of his shin pads and to AA down to a concentration of 0.001% in acetone. To our knowledge, this is the first reported case of allergic contact dermatitis to AA in the United Kingdom. Here we recommend the optimal concentration of AA for patch testing at 0.1% in acetone and summarize previous relevant published cases.

Bathing Additives for Atopic Dermatitis - A Systematic Review.

Abstract: Bathing additives are regularly used for a range of inflammatory dermatoses that affect a large body surface area. Emerging evidence demonstrates that certain bathing additives have anti-inflammatory, skin barrier repair, antimicrobial, and antioxidative properties, all pertinent to atopic dermatitis. This review summarizes the mechanism and effects of Dead Sea salt, hard water, commercial baby cleansers, oatmeal, rice, and natural oils as bathing additives for the treatment of atopic dermatitis. The use of these compounds seems to augment the benefit of traditional treatments while also reducing the need for and side effects of prescription modalities. Bathing additives are useful adjuvant treatments for atopic dermatitis. Benefits of these compounds are derived from anti-inflammatory, antimicrobial, antioxidative, and skin barrier repair properties.

Real-World Outpatient Prescription Patterns for Atopic Dermatitis in the United States.

Abstract: Atopic dermatitis (AD) often requires combination treatment regimens. However, little is known about treatment combinations and polypharmacy in AD. We sought to characterize patterns of outpatient prescriptions and polypharmacy among US children and adults with AD. Data from the 1993-2015 National Ambulatory Medical Care Survey were analyzed, including 128,300 pediatric and 623,935 adult outpatient visits. Among AD visits, dermatologists prescribed more topical corticosteroids (TCSs, P = 0.01) than any other clinicians, particularly multiple TCSs (P < 0.0001), topical calcineurin inhibitors (TCI, P = 0.009), combination TCIs with TCSs (P = 0.004), and systemic immunosuppressants (P = 0.003). Prescriptions for multiple TCSs increased from ages 0 to 19 years, 20 to 39 years, and peaked at 40 to 59 years (P = 0.0002). Prescriptions for prednisone peaked at ages of 40 to 59 years (P = 0.003). A subset of AD patients was prescribed oral antibiotics (7.1%), although fewer than half had a diagnosis of bacterial infection (42.1%). The proportion of patients receiving multiple prescriptions was higher in visits to primary care practitioners versus dermatologists, those with private versus public insurance, and 50 years or older versus 20 to 49 years versus 0 to 19 years. Visits with 4 or more prescriptions by dermatologists increased between 1993-2000 (10%) and 2011-2015 (29%, P = 0.0001). In conclusion, significant treatment variation exists among specialists managing AD, with increasing polypharmacy over time.

Alternatives for Allergens in the 2018 American Contact Dermatitis Society Core Series: Report by the American Contact Alternatives Group.

Abstract: The most successful treatment for contact allergy is allergen avoidance. Patient improvement ultimately relies on identification of safe alternative products, which can be used by the patient. "Safe" personal care product options can typically be found using ingredient database programs. Avoidance of allergens in other products (ie, shoes, clothing, dental care, etc) is often challenging. In this article, the American Contact Alternatives Group discusses how to find specific safe alternatives for the 80 allergens on the American Contact Dermatitis Society core allergen series (Dermatitis. 2017;28:141-143). The alternatives listed in this article are accurate as of the date of publication; however, the availability of these alternatives may change in the future (disclaimer).

Scalp Dermatitis in Patients Sensitized to Components of Hair Products.

Abstract: BACKGROUND Allergic contact dermatitis is an inflammatory condition that less commonly presents with scalp involvement. Recently, T regulatory cells have been documented to be residents of hair follicles, illuminating why contact allergens are less likely to elicit dermatitis in the scalp. OBJECTIVE The aims of the study were to determine the prevalence of scalp symptoms, with and without other affected areas, in patients presenting for evaluation of allergic contact dermatitis and to determine the allergens most likely to be associated with scalp dermatitis. METHODS We examined allergens commonly found in hair products and stratified positive patch test results by the following affected areas: face, eyelid, neck, or hands, where exposure by runoff is common, versus scalp. CONCLUSIONS Para-phenylenediamine (PPD) is the most common allergen in patients with scalp dermatitis. The rate of PPD sensitization is higher in nonwhite compared with white patients. In the small number of patients with isolated scalp involvement, positive patch tests to PPD were documented in a minority. Other allergens found in hair products may present without scalp symptoms. Patients with dermatitis affecting areas other than the scalp should provide their hair product ingredients to guide patch test selection.

Effect of Patch Testing on the Course of Allergic Contact Dermatitis and Prognostic Factors That Influence Outcomes.

Abstract: Background Allergic contact dermatitis (ACD) has been shown to adversely affect the quality of life of patients. Objective The aim of the study was to study the effect of patch test on the severity of dermatitis, the quality of life of patients, and the prognostic factors influencing the outcome. Methods The study included 111 patients patch tested with the preliminary diagnosis of ACD. Patients with clinically relevant positive patch test reactions were included in the ACD group. All patients were assessed with the Investigator Global Assessment and the Dermatology Quality of Life Index before and 6 months after patch testing. Results At the sixth-month control, more significant regressions in the mean Investigator Global Assessment and Dermatology Quality of Life Index scores were noted in the ACD group. The allergens were correctly remembered by 75% of the patients. The improvement was more significant in patients with ACD who correctly remembered the allergens and made appropriate lifestyle changes. Multiple allergen positivity was identified as a poor prognostic factor. Conclusions The effect of patch test on the prognosis of contact dermatitis depends not only on providing necessary information to patients but also on the number of positive reactions, patient's ability to recall the allergens, how much the avoidance was achieved, and patient-related factors such as sex.

Isothiazolinone Content of US Consumer Adhesives: Ultrahigh-Performance Liquid Chromatographic Mass Spectrometry Analysis.

Abstract: Background There are limited data regarding the prevalence and concentration of isothiazolinone preservatives in consumer adhesives. Objectives The aim of this study was to determine the prevalence and concentration of 5 specific isothiazolinones (methylisothiazolinone [MI], methylchloroisothiazolinone [MCI], benzisothiazolinone [BIT], butyl BIT, and octylisothiazolinone) in US adhesives. Methods Thirty-eight consumer adhesives were analyzed using ultrahigh-performance liquid chromatographic-mass spectrometry. Fisher exact tests were used to test for isothiazolinone content and: 1) glue format (2) application purpose and 3) extraction method. Results Nineteen adhesives (50%) had at least 1 isothiazolinone, and 15 contained 2 isothiazolinones. Frequencies and concentrations were as follows: MI (44.7%; 4-133 ppm), MCI (31.6%; 7-27 ppm), BIT (15.8%; 10-86 ppm), and octylisothiazolinone (2.6%; 1 ppm). Butyl BIT was not detected in any of the adhesives. Format (stick vs liquid) was not statistically associated with isothiazolinone presence. At least half of adhesives in the following application purposes had at least 1 isothiazolinone: shoe, craft, fabric, and school. All-purpose glues had a statistically significant lower concentration of MI and MCI, whereas craft glues were associated with higher concentrations of MI and MCI. Compared with other glues, fabric adhesives were associated with a higher risk of containing BIT. Conclusions Half of the tested adhesives contained at least 1 isothiazolinone. Methylisothiazolinone and MCI were the most common. Consumers and dermatologists should be aware of adhesives as a source of isothiazolinones.

Successful Use of Dupilumab for Recalcitrant Atopic Dermatitis in an HIV Patient.

Abstract: pproved for the treatment of moderate to severe atopic Adermatitis (AD), dupilumab represents a monoclonal antibody against interleukin 4 (IL-4) receptor α that blocks signaling from IL-4 and IL-13, essential mediators of the T helper 2 (TH2) pathway. To date, all clinical trials investigating the use of dupilumab excluded patients with human immunodeficiency virus (HIV). Herein, we describe the use of dupilumab in a patient with AD and concomitant HIV infection. A 50-year-old man with well-controlled HIV and self-cleared hepatitis C virus presented for management of severe AD since childhood. Previous trials of high-potency topical corticosteroids, topical antibiotics, oral antihistamines, and bleach baths did not provide significant relief. Physical examination revealed excoriated scaly papules coalescing into plaques on the lower back, buttocks, arms, and legs with an Investigator Global Assessment Scale of 3. Because his AD remained refractory to topical steroids, the decision to start dupilumab was considered. He had a 15-year history of HIV, now well controlled on emtricitabine-tenofovir alafenamide and dolutegravir with a most recent CD4 count of 665/μL and undetectable HIV-1 viral load. After consultations with infectious disease and allergy/ immunology and an in-depth conversation with the patient regarding the benefits, risks, and adverse events, it was decided to start dupilumab with a standard loading dose of 600 mg and maintenance dosing of 300 mg every 2 weeks for treatment of his recalcitrant AD. Two weeks after the loading dose, the patient noted a painful ulcer on the right perianal skin. A viral culture was sent, and the patient was empirically started on valacyclovir 500mg twice daily for 7 days because of suspected herpes simplex virus (HSV) infection, although the HSV culture was negative. The patient had a notable history of anal dysplasia but no history of HSV. Two months after initiation of dupilumab, the patient had almost complete resolution of his AD (Investigator Global Assessment Scale 1). His HIV has remained well controlled with a CD4 count of 860/μL and an undetectable HIV-1 viral load at his last follow-up visit (4 months after dupilumab initiation). This is the first published case on the use of dupilumab in an atopic patient with HIV. The initial Food and Drug

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures.

Abstract: Background Wool clothing may be perceived as a poor choice for use by individuals with sensitive skin or atopic dermatitis. Objectives The aims of the study were to evaluate the effect on atopic dermatitis of wearing fine Merino wool clothing versus standard clothing and to assess the effect of Merino wool clothing on quality of life in children and adults with atopic dermatitis 5 years and older. Methods Subjects with mild to moderate atopic dermatitis were assessed in a crossover fashion after wearing Merino wool clothing for 6 weeks and standard clothing for 6 weeks, for Eczema Area and Severity Index, Dermatology Life Quality Index, static Investigator's Global Assessment, and skin hydration. Results While wearing Merino wool clothing, compared with standard clothing, statistically significant improvements were seen in mean Eczema Area and Severity Index scores, Dermatology Life Quality Index scores, and static Investigator's Global Assessment scores. No significant difference was seen with skin hydration. Wearing Merino wool clothing did not produce any negative cutaneous effects compared with wearing standard clothing. Conclusions Merino wool clothing compared with standard clothing provided improvements in severity of atopic dermatitis as well as quality of life in atopic patients.

Cross-sectional Survey of Nickel Allergy Management in the Context of Intracardiac Device Implantation

Abstract: Background The occlusion devices used for repair of atrial septal defect and patent foramen ovale commonly contain nitinol, an alloy containing nickel. There are reports of nickel allergy in the context of intracardiac device implantation. Type IV delayed-type reactions likely predominate in intracardiac metal hypersensitivity, but there are potentially other mechanisms such as cytotoxic or innate immunity. Based on available literature to date, the significance of nickel allergy in intracardiac occluders remains unclear. Objective The aim of the study was to investigate nickel allergy management strategies in intracardiac occluders. Methods The American Contact Dermatitis Society facilitated distribution of a survey via e-mail to the members of its association, which included dermatologists and allergists/immunologists. A total of 70 individuals answered the survey. Conclusions There was no consensus regarding the ability of patch testing to accurately determine allergic reactions within cardiac tissue. There was also no agreement on the criteria for patch testing in patients undergoing intracardiac implantation. However, most would inquire about a history of contact sensitivity to previously implanted devices. With a positive patch test, nickel-based intracardiac devices should be avoided, or the decision should be left to the discretion of the cardiologist.

Prevalence of Surfactant in the Contact Allergen Management Program.

Abstract: Background Surfactants are common ingredients in topical products, which can cause both irritant and allergic contact dermatitis. Objective The aim of this study was to determine the prevalence of 12 common groups of surfactants and 12 common individual surfactants among products in each category in the American Contact Dermatitis Society Contact Allergen Management Program (CAMP). Methods The American Contact Dermatitis Society CAMP was queried for the 12 surfactant groups and the 12 individual surfactants. Results The laureth/pareth sulfate group was the most prevalent surfactant group in CAMP products (17.9%). Laureth/pareth sulfates were the most common surfactant group in all product categories, except household and eye care products. The betaine/sultaine group (13.5%) and glucosides (10.0%) were also found in a significant proportion of CAMP products. Oleamidopropyl dimethylamine has the highest positive reaction rate (3.5%) but was tied for the lowest prevalence (0.20%) of the 12 individual surfactants studied. In contrast, cocamidopropyl betaine has a lower positive reaction rate (1.6%) with a higher prevalence (10.4%). Conclusions Surfactants were commonly found across all product types in CAMP. This study provides important information on allergen and irritant exposures in care products.

Formaldehyde release from baby wipes: Analysis using the chromotropic acid method

Abstract: Background Formaldehyde is a common preservative and strong sensitizer. Objective The aim of the study was to evaluate the release of formaldehyde from baby/toddler wet wipes using the chromotropic acid method (CAM). Methods An online search of best-selling baby wipes was conducted. None declared formaldehyde or formaldehyde-releasing preservatives. Standard CAM procedures were used: a 1 × 1-in square of fresh wipe was placed in a bottle with an open vial of 4 mg/1 mL of chromotropic acid and sulfuric acid solution, sealed, and stored for 48 hours. Formalin and water served as controls. A blinded investigator graded color change (negative, indeterminate, mild, moderate, or strong). For quality control, 20% of all samples as well as all positives were retested. Results Fifty-one popular and highly reviewed baby and toddler wet wipe products were tested using CAM. Twelve wipes (24%) released formaldehyde (8 mild, 4 moderate/strong). Chromotropic acid method testing of 9 wipes (18%) was indeterminate and 30 (59%) were negative. Conclusions Almost one quarter of baby/toddler wet wipes released formaldehyde when evaluated with CAM. Patients and clinicians should be aware of this potentially undeclared source of this common allergen.

Pediatric Cases Involving Chemical Burns to Garlic Used to Treat Warts.

Abstract: essential oil. Essential oils have become increasingly popular because of their use in fragrances, cosmetics, and homeopathic remedies. Linalool, a fragrance found in 88% of essential oils, is only weakly allergenic. Upon exposure to air, it is oxidized to hydroperoxide, and a potent allergen is created. Moreover, substances are more likely to cause ABCDwhen they are volatile or when they are heated, because a sufficient amount of gas can then accumulate to cause dermatitis. Thus, many fragrance diffusers create a perfect storm for ABCD: heating linalool-containing essential oils and allowing the allergen to widely disperse. Whereas most cases of allergic contact dermatitis to essential oils are a result of the application of pure oil, this case highlights the importance of inquiring about the use of diffusers in the environment to elucidate a unique potential exposure mechanism when such allergens are identified through patch testing.

Patch Testing in the African American Population: A 10-Year Experience.

Abstract: 1. ApplicationNumber 761055Orig1s000Medical Review. Center forDrug Evaluation and Research; 2017. Available at: https://www.accessdata.fda.gov/ drugsatfda_docs/nda/2017/761055Orig1s000MedR.pdf. Accessed March 1, 2019. 2. DUPIXENT (dupilumab) injection package insert. 2017. Available at: https:// www.accessdata.fda.gov/drugsatfda_docs/label/2018/761055s007lbl.pdf. Accessed March 1, 2019. 3. Fleming P, Drucker AM. Risk of infection in patients with atopic dermatitis treated with dupilumab: a meta-analysis of randomized controlled trials. J Am Acad Dermatol 2018;78(1):62–69.e1. 4. Marone G, Florio G, Triggiani M, et al. Mechanisms of IgE elevation in HIV-1 infection. Crit Rev Immunol 2000;20(6):477–496. 5. Linhar LS, Traebert J, Galato D, et al. Allergic diseases in subjects under 18 years living with HIV. Allergy Asthma Clin Immunol 2014;10(1):35.

"Fresh Breath" on Toothpaste: Peppermint as Cause of Cheilitis.

Abstract: A 25-year-old healthy woman was referred for recurrent cheilitis during the course of several years. Despite attempts to alleviate the cheilitis with various lip balm products and a trial of 0.1% tacrolimus ointment, she continued to have inflammation, fissuring, and severe dryness of her lips. The patient denied any associated oral or ocular complaints. Examination of the skin showed scaling and edema of the lips (Fig. 1). Patch testing with the North American Standard Series of 50 allergens, the cosmetic series, and the fragrance series revealed 2+ reactions to Mentha piperita oil (peppermint oil) and cinnamic alcohol at day 5 (Fig. 2). The patient admitted to using

Occupation-Related Symptoms in Hairdressers.

Abstract: BACKGROUND During work, hairdressers are exposed to several hazardous agents that can cause skin and respiratory symptoms. Because few data are available for long-term follow-up, and none are from Italy, the aim of our study was to investigate occupational symptoms in hairdressers after a 10-year follow-up. METHODS Work-related skin and respiratory symptoms were investigated in 2006 and 2016 by means of a standardized questionnaire and medical examination. RESULTS Eighty-two workers completed the 10-year follow-up with a response rate of 86.3%. At follow-up, skin- and respiratory work-related symptoms had increased significantly, involving 40.7% of workers. Skin symptoms increased to 12.5%, throat irritation to 15.6%, and cough to 12.5%. The occurrence of the symptom of skin irritation was significantly related to dryness of the skin at the baseline. CONCLUSIONS Our long-term follow-up on hairdressers demonstrated an increase in work-related irritant skin and upper respiratory symptoms that involved more than one-third of the population studied. More efforts are needed in prevention activities to promote better ventilation of workplaces, use of less irritating and less sensitizing hair products, and use of moisturizers to prevent dry skin.