Patch Testing With Benzophenone-3 and -4: The North American Contact Dermatitis Group Experience, 2013-2020.

Background: Benzophenone (BZP)-3 and BZP-4 are ultraviolet (UV) absorbers used in sunscreens and personal care products (PCPs) and may cause allergic contact dermatitis. Objective: To characterize positive patch test reactions to BZP-3 (10% in petrolatum [pet]) and BZP-4 (2% pet) in a screening allergen series. Methods: Retrospective analysis of patients tested to BZP-3 and BZP-4 was conducted by the North American Contact Dermatitis Group from 2013 to 2020. Results: Of 19,618 patients patch tested to BZP-3 and BZP-4, 103 (0.5%) and 323 (1.6%) had positive reactions, respectively: 413 (2.1%) reacted to at least 1 BZP (BZP-positive patient). As compared with BZP-negative patients, BZP-positive patients were significantly more likely to have a history of hay fever (39.3% vs 33.4%, P = 0.0134), history of atopic dermatitis (39.8% vs 30.7%, P = 0.0001), and facial involvement (37.4% vs 32.2%, P = 0.0272). Most reactions were currently clinically relevant (BZP-3: 90.4%; BZP-4: 65.8%). Common identified sources included PCPs and sunscreens. Coreactivity between BZP-3 and BZP-4 was low: 13.5% (14/104) of BZP-3-positive patients were allergic to BZP-4 and 4.3% (14/322) of BZP-4-positive patients were allergic to BZP-3. Conclusions: Eight-year prevalence of BZP positivity was 2.1%. Reactions were frequently clinically relevant and linked to PCPs and sunscreens.

IgA Vasculitis With Concurrent ANCA-Positivity in the Setting of Bacterial Endocarditis.

Cutaneous small vessel vasculitis (CSVV) or leukocytoclastic vasculitis (LCV) is a group of immune complex mediated vasculitides that affect dermal capillaries or post-capillary venules and classically presents as lower extremity palpable purpura. CSVV can be subdivided by antibody type and clinical features. In patients presenting with signs of LCV and ANCA positivity, clinicopathologic correlation is important in characterizing the type of vasculitis. We report an uncommon case of IgA vasculitis with concurrent ANCA-positivity attributed to bacterial endocarditis.

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.

Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018.

BACKGROUND: Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products. OBJECTIVE: To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018). METHODS: Retrospective analysis of patients tested by the North American Contact Dermatitis Group. RESULTS: Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside. LIMITATIONS: The cohort predominantly reflects a referral population, and follow-up after testing was not captured. CONCLUSION: Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.

Consumer preferences of top-rated over-the-counter acne treatment products: a cohort study.

Over 70% of patients with acne vulgaris wait at least 1 year before seeing a dermatologist and instead use over-the-counter (OTC) acne treatments. This study determined the association between product characteristics (ingredients, vehicles, and marketing claims) and consumer-reported positive and negative features of top-rated acne OTCs. This cohort study evaluated the top 1% of acne OTCs across the five largest online retailers. Products were analyzed for product characteristics and consumer-reported features. Artificial intelligence data scraper software was utilized to collect reviews, and a natural language processing algorithm was used to tag key phrases within reviews and categorize them based on characteristics and sentiment (positive or negative). An inter-rater reliability test compared reliability of results between a human rater and the software. In this cohort of 149 products, the most frequent ingredients were salicylic acid (33.6%) and benzoyl peroxide (19.5%). Over one-third of top-selling products contained solely "natural" ingredients. Product ingredients, over product vehicle, price, marketing claims, or packaging, were most associated with consumer-reported product effects. Products with active ingredients were reported more frequently as effective in treating acne (p < 0.001) and with side effects, such as erythema (p = 0.054) and hypersensitivity reactions (p = 0.0016). Products with "natural" ingredients were associated with improving skin texture (p = 0.008) and application ease (p = 0.04). Product ingredients, over vehicle, price, marketing claims, and packaging were the greatest indicator of a consumer's experience with acne OTCs. Given the wide array of and heavy reliance on OTCs to treat acne, information on product experience inform dermatologists on consumer preferences.

Hitchhiking spider: a case of unilateral vasculitis.

A 63-year-old man presented with two days of palpable purpura over the right anterior shin and calf with notable point tenderness on the distal mid-calf without any palpable deep abnormality. Localized right calf pain worsened with walking and was associated with headache, chills, fatigue, and low-grade fevers. A punch biopsy of the anterior right lower leg showed necrotizing neutrophilic vasculitis of superficial and deep vessels. Direct immunofluorescence showed non-specific focal granular deposition of C3 within vessel walls. Three days after presentation, a live spider was found and microscopically identified as a male hobo spider. The patient suspected the spider arrived via packages shipped from Seattle, Washington. The patient was treated with a prednisone taper with full resolution of his cutaneous symptoms. Given the unilaterality of his symptoms and otherwise unexplained etiology, the patient was diagnosed with acute unilateral vasculitis secondary to hobo spider bite. Microscopic examination is required for identification of hobo spiders. Although not deadly, there have been several reports of cutaneous and systemic reactions resulting from hobo spider bites. Our case illustrates the importance of considering hobo spider bites in areas outside of their native regions, as they are known to travel in packaged items.

Endometrial Adenocarcinomas With Significant Mucinous Differentiation: A Characterization of Intratumoral Heterogeneity of KRAS Mutations in Mucinous and Endometrioid Histologic Components.

OBJECTIVE: KRAS mutations are frequently seen in malignancies with mucinous morphology. In our previous study, mucinous endometrial carcinomas were associated with a significantly higher frequency of KRAS mutations as compared with matched conventional endometrioid carcinomas. This study expands our previous report by exploring possible intratumoral heterogeneity for KRAS gene mutations in the mucinous components of mucinous carcinomas (MCs) and endometrioid carcinomas with significant mucinous differentiation (ECSMD) versus their associated "usual" endometrioid components. MATERIALS AND METHODS: KRAS-positive cases from our previous report were studied, including 10 MCs and 10 ECSMDs. The specimens were microscopically dissected to separately isolate morphologically mucinous and endometrioid components. Direct DNA sequencing for KRAS mutations at codons 12 and 13 using capillary electrophoresis were performed. RESULTS: KRAS mutations were detected in the endometrioid components of 8 (80%) of 10 MCs and 3 (30%) of 10 ECSMDs. The endometrioid component of the ECSMD group was less frequently associated with KRAS mutation than the endometrioid component of the MC group, even when the mucinous component of the same tumor contained a mutation; the difference is statistically significant (P < 0.05). CONCLUSIONS: Our current study shows that intratumoral heterogeneity for KRAS gene mutation was associated with ECSMD, but less frequently with MC. It is possible that when the mucinous component predominates, qualifying for an MC, KRAS mutations appear to be widespread, irrespective of the mucinous or nonmucinous differentiation of the tumor cells. The findings suggest that multiple samples for KRAS tests may be useful, especially in endometrioid carcinoma with significant mucinous differentiation.