Characterization of Pediatric Patch Testing: A Retrospective Review, 2020-2023.

Background: Recent evidence shows similar rates of allergic contact dermatitis (ACD) among children and adults despite children accounting for less than 10% of patch testing subjects. With a need for in-depth analyses of pediatric ACD, we herein characterize a pediatric cohort at a large North American patch testing center. Methods: A retrospective chart review was conducted for 135 patients ages 1-17 years who underwent patch testing from July 2020 from August 2023. Data were stratified by age 1-5, 6-11, and 12-17 years. Significance-Prevalence Index Numbers (SPIN) were calculated. Results: A total of 86% were sensitized, 40% had a relevant reaction, and positivity rates were equal between males and females. Top allergens by SPIN differed with age, but overall were linalool hydroperoxides (SPIN = 11.01), propylene glycol (10.30), limonene hydroperoxides (10.27), fragrance mix I (5.62), and lanolin (4.90). In total, 14% of the top allergens were not represented on the North American Contact Dermatitis Group standard series. Of those tested to personal products, 45% had positive reactions and 72% of which were relevant. Conclusions: Emulsifiers and fragrances were the most relevant allergen categories, with the impact of emulsifiers not previously reported. ACD may affect males and females equally in this population. Supplemental allergens and personal products tested "as-is" contribute to conclusive pediatric patch testing.

Allergic contact dermatitis to salicylic acid: A case series of relevant sensitization.

INTRODUCTION: Allergic contact dermatitis (ACD) to salicylic acid (SA) is widely unreported. Furthermore, cross-reactivity between SA and other salicylates has not been reported despite well-documented in-group salicylate cross-reactivity. OBJECTIVE: To describe our clinic's experience patch testing to SA, highlighting seven cases of relevant reactions and concomitant reactivity with other salicylates. METHODS: Results of patch testing to 5% SA in petrolatum between 1 January 2020, and 9 February 2024, are reported. Seven cases of relevant reactions to SA are detailed. RESULTS: A total of 489 patients (27.5%) were tested to SA, 21 of which were positive: 7 doubtful (+/-), 14 weak positive (+), and no strong/extreme positive reactions. Four irritant reactions were documented. Of the 14 weak positive (+) reactions, 7 had definite or probable clinical relevance, 5 of which also reacted to other salicylates. CONCLUSIONS: ACD to SA is likely underreported due to a lack of testing. In our experience, testing SA 5% petrolatum is tolerable without significant irritation. Cross-reactivity between SA and other salicylates is probable. Though SA appears to be the primary sensitizer in some cases, more studies are needed to understand its possible role as a marker for salicylate allergy.

Clinical relevance of doubtful reactions in patch testing: A single-centre retrospective study.

BACKGROUND: Doubtful reactions in patch testing are infrequently reported in the literature; however, recent reports have suggested they be assessed with the same scrutiny as stronger reactions. OBJECTIVE: Assess the clinical relevance of doubtful reactions in patch testing. METHODS: Retrospective study of 1514 patients comprehensively patch tested via the NACDG standard series and additional allergens based on history. The clinical relevance of each reaction was graded based on the NACDG scale: definite, probable, possible, past, unknown and irritant. Reactions were considered 'unique' if an additional mild-to-strong reaction to the same chemical at a different concentration was not observed. RESULTS: 68.9% (1043) of patients demonstrated at least 1 doubtful reaction. Of 4453 total doubtful reactions, 92.2% (4106) were unique. Only 3.3% (137) and 12.2% (500) of these were determined to be of definite or probable clinical relevance respectively. 'Fragrance' was the most common allergen family present among the unique definite doubtful reactions (37). However, 24 (64.9%) of these also had a stronger reaction to another fragrance. Cocamidopropyl betaine was the second most frequent allergen demonstrating definite doubtful reactions (27) and unique in 85.2% (23) of cases. Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) was most prevalent (36) but less frequently unique (58.3%, 21). CONCLUSIONS: Doubtful reactions may not be as impactful to clinical decision making as theorised in the literature. Few demonstrate definite clinical significance, and many have related stronger reactions that capture them for clinical purposes. Identification of doubtful reactions to cocamidopropyl betaine and MCI/MI may be of greatest significance as they most frequently were not supported by stronger reactions.

Research Publication Rates Are Age- and Era-Dependent for Radiation Oncologists From Highly Ranked NCI-Designated Cancer Centers.

PURPOSE: Quantitative bibliometrics are increasingly used to evaluate faculty research productivity. This study benchmarks publication rates for radiation oncologists from highly ranked National Cancer Institute-designated cancer centers and reveals how productivity changes over the arc of a career and of the field over time. METHODS AND MATERIALS: Peer-reviewed articles from 1970 to 2022 were obtained using Scopus for the 348 radiation oncologists listed as faculty for the top 10 cancer hospitals ranked by US News and World Report in 2022. Bibliometrics were analyzed for authorships (A˙), authorships where the individual was first or last author (F˙L), the monograph equivalent of authorships (M˙E), h-index, and ha-index (an analog to h-index using M˙E in place of publications). Career start was defined as the year of first publication. Bibliometric inflation was explored by analyzing authorship and bibliometric changes between 1990 and 2022. RESULTS: Publication rates peak, with as much as a 500% increase, 20 to 25 years from the start of a career before declining until retirement. At career ages of 1, 10, 20, and 30 years, the median bibliometrics were A˙ = (1.5, 4.1, 6.5, 7.0) year-1, F˙L = (0.5, 0.9, 1.2, 0.6) year-1, M˙E= (0.2, 0.5, 0.7, 0.8) year-1, h-index = (1, 12, 22, 47), and ha-index = (0.4, 4.4, 6.9, 18.4). With regards to authorship patterns across eras, the median number of authors listed per paper increased by 240% between 1990 and 2022. Meanwhile, research productivity per individual as measured by F˙L and M˙E was unchanged. CONCLUSIONS: The research publication rates of the median radiation oncologist change substantially over the course of their career. Productivity improves steadily for more than 2 decades before peaking and declining. The culture of authorship has also changed between 1990 and 2022. The number of authors listed per paper has trended upwards, which has an inflationary effect on the number of authorships and h-index. Meanwhile, the rate of manuscripts published per faculty has not changed.

Successful Treatment of Recalcitrant Mpox Lesions With Intralesional Cidofovir in a Patient With HIV/AIDS.

This case report describes a man in his 50s with HIV/AIDS who presented with widely scattered recalcitrant mpox lesions.

A Deep Dive Into Instagram's Top Skinfluencers.

We characterized skinfluencers from various training backgrounds and compared their posts on Instagram featuring skin care products.

Negative formaldehyde release from textiles washed with a formaldehyde-containing laundry soap according to manufacturer instructions: An application of chromotropic acid testing.

BACKGROUND: Formaldehyde is a common preservative used to prevent microbial growth in water. It can be found in personal care products and household cleaning products, including laundry detergents. Formaldehyde has frequently been recognised as a cause of allergic contact dermatitis, but whether it remains present in textiles washed with formaldehyde-containing laundry detergents is unknown. OBJECTIVES: This study aimed to utilise the chromotropic acid method (CAM) to assess formaldehyde release from textiles washed with a laundry detergent known to contain formaldehyde. MATERIALS AND METHODS: Textiles were laundered with a detergent containing calcium formate at four concentrations (0×, 0.5×, 1× and 5× the recommended amount per manufacturer label) and kept wet or allowed to dry. Select textiles were subjected to an additional rinse cycle. Textiles were then tested utilising the CAM. A sample of the pure laundry detergent was also tested using the CAM. RESULTS: The CAM was positive only for wet textiles washed at 5× the recommended concentration of detergent and pure detergent. All dry textiles were negative. CONCLUSIONS: Formaldehyde release was not detected from any textiles washed following the manufacturer's recommendations. Once dry, it is likely safe for formaldehyde-allergic patients to wear textiles washed with formaldehyde-containing detergents.

Sunscreens: A Review of UV Filters and Their Allergic Potential.

Abstract Active ingredients of sunscreens, or UV filters, have increased in use because public awareness of sun safety has risen. In addition to this intentional use, unintentional exposures to UV filters also occur through application of personal care products, where the filters are incorporated into the product. There are 2 main types of UV filters: organic (chemical) filters and the 2 inorganic (mineral) filters, titanium dioxide and zinc oxide. Both allergic contact dermatitis (ACD) and photoallergic contact dermatitis (PACD) have been caused by organic filters; oxybenzone (benzophenone-3) is the most frequently reported contact and photocontact allergen compared with all other UV filters. There are no reports of ACD or PACD to the inorganic (physical) UV filters. Here, we review the categories of sunscreens available, currently marketed UV filters, and their corresponding ACD and PACD.

Formaldehyde Release From Eyelash Glues: Analysis Using the Chromotropic Acid Method.

BACKGROUND: Popularity of eyelash enhancements has increased dramatically. Eyelash enhancements are available as an over-the-counter consumer product with glue included and as a professional product where proprietary glues are typically used. Both types of eyelash extension glues may release formaldehyde despite not being declared as an ingredient. Although formaldehyde is a carcinogen and may cause allergic contact dermatitis, few studies have assessed its presence in eyelash glues. OBJECTIVE: The aim of the study was to evaluate professional and consumer eyelash glues for the presence of formaldehyde using the chromotropic acid method (CAM). METHODS: A total of 37 eyelash glues were evaluated: 17 consumer eyelash glues (2 of which declared formaldehyde) and 20 professional eyelash glues (none of which declared formaldehyde) were purchased and analyzed with the CAM of testing. RESULTS: For consumer eyelash glues, the 2 glues that declared formaldehyde were positive on CAM testing as well as 2 glues (13.3% [2/15]) that did not declare formaldehyde. Of the 20 professional eyelash glues, 15 (75.0%) were positive for formaldehyde. CONCLUSIONS: Some consumer eyelash glues and most professional eyelash glues released formaldehyde when evaluated with CAM. Patients and clinicians should be aware that both consumer and professional eyelash glues can be sources of formaldehyde.

Stevens-Johnson syndrome precipitated by Moderna Inc. COVID-19 vaccine: a case-based review of literature comparing vaccine and drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis.

The Moderna COVID-19 vaccination was approved for use in the United States in December of 20201 and since that time massive public health efforts have been made to vaccinate patients against the COVID-19 infection. Adverse reactions from the vaccination are well-reported and include both local skin reactions, such as pain, swelling, and erythema at the injection site, as well as systemic reactions including fever, malaise, headache, muscle aches, drowsiness, nausea, and vomiting. While severe serious cutaneous adverse reactions, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), remain rare; two cases of SJS/TEN related to COVID-19 vaccination have been reported. We herein review the two previously reported cases of SJS/TEN and report the first case of SJS precipitated by the Moderna Inc., MRNA 1273 COVID-19 vaccination in the United States. Although we review potential adverse reactions to vaccination, the benefits of COVID-19 vaccination outweigh the risks based on current data. Cases should be reported to the Vaccine Adverse Event Reporting System (https://vaers.hhs.gov/) to help public health officials recognize and track these severe but rare adverse events.

Nickel release from metal tools in United States barbershops.

BACKGROUND: Hairdressers and barbers are among the top occupations to develop occupationally related nickel allergy. While nickel release has previously been detected in metal items in the hairdressing trade, metal items in the barber trade have not been specifically tested. This study screened for nickel release from metal tools in United States barber trade. METHODS: One hundred ninety-two metal tools from 12 barbershops in St. Paul, Minnesota, were tested with dimethylglyoxime test. An employee survey was conducted about each metal tool. RESULTS: Nickel release was detected in 10 of 192 metal tools (5.2%). Items with nickel release included one of 57 scissors (1.7%), one of 32 trimmers (3.1%), four of 13 barbershop chairs (30.8%), three of six cape clips, and one of one nail clippers. CONCLUSIONS: Nickel release was detected in items unique to the barber trade. These items should be considered when preventing and assessing occupational nickel allergy in barbers.

Contact Allergy Cross-reactions and Thresholds: A Review.

ABSTRACT: Consideration of contact allergen concomitant reactivity, which encompasses cross-reactors, co-reactors, and pseudo cross-reactors, is an important aspect of patient care, yet information on how these terms are differentiated and used in clinical practice is lacking. In this review, we provide definitions of cross-reactors, coreactors, and pseudo cross-reactors and discuss the utility of the American Contact Dermatitis Society Contact Allergen Management Program database cross-reactor groupings. We also discuss limitations to the current categorization of cross-reactivity and recommend incorporating new terms, including "apparent cross-reactor" and "derivative cross-reactor," when classifying cross-reactors.