Identification of the pigments used in permanent makeup and their ability to elicit allergic contact dermatitis.

BACKGROUND: Decorative tattoos are known to contain ingredients that may elicit allergic contact dermatitis; it is less well-known if permanent makeup pigments carry the same risk. OBJECTIVE: Identify pigments used in permanent makeup inks sold in the United States and review cases of allergic contact dermatitis to these pigments. METHODS: Using internet searches, permanent makeup inks sold in the United States were identified. Safety data sheets were used to catalog pigments used in permanent makeup. A subsequent literature search was performed to identify cases of allergic contact dermatitis to these pigments. RESULTS: A total of 974 permanent makeup inks were reviewed, and 79 unique pigments were identified. The average product contained 4 pigments. Twenty of the pigments were inorganic metals, including carbon, iron, chromium, manganese, and molybdenum. Fifty-nine pigments were organic, of which most were azo, quinacridone, or anthraquinone dyes. A literature search revealed that 10 of the 79 pigments were associated with allergic contact dermatitis. CONCLUSION: Permanent makeup primarily uses organic pigments, although some metallic pigments are still used. Physicians should also be aware that some of these pigments-both organic and inorganic-are known causes of allergic contact dermatitis. Of note, patch testing to these ingredients can be negative.

Permanent makeup: A review of its technique, regulation, and complications.

Permanent makeup (PMU) is a popular form of tattooing used to replace or enhance the use of daily makeup. The purpose of this literature review is to provide an overview of PMU, with a particular focus on its use, regulation, and potential complications reported in the literature. In the United States, there is significant variation in the regulation and training required to perform PMU. Adverse outcomes of PMU include infectious, allergic, and inflammatory complications. These complications may be more common if proper hygiene and aftercare practices are not followed. Cosmetically, PMU may shift or have an altered appearance if the underlying skin is treated with cosmetic fillers or local anesthetics. Given the popularity of PMU and its cosmetic uses, dermatologists should be aware of the PMU industry, potential complications, and how best to manage complications.

An Analysis of the Content and Recommendations of 700 American Tattoo Aftercare Instructions.

BACKGROUND: Tattoo aftercare instructions describe how to care for a new tattoo. Unfortunately, tattoo artists often base their advice on personal experience rather than best practices in medical wound management. The diversity of recommendations in these instructions is currently unknown. OBJECTIVES: Our review was performed to determine current recommendations in tattoo aftercare instructions in the United States. METHODS: Using a Google search, a total of 700 aftercare instructions from all 50 states and Washington D.C. were collected and their contents analyzed. RESULTS: Most instructions encouraged washing new tattoos with antibiotic soaps, including chlorhexidine, and 14.9% encouraged using topical antibiotics. Few instructed individuals to wash their hands before touching a healing tattoo. A total of 70 moisturizers were recommended. Of these, 22 were niche products made specifically for tattoo aftercare. Only a subset of instructions provided parameters about when to contact the tattooist (49.9%) and/or a physician (19.4%) should there be a complication in the healing process. CONCLUSION: The content and recommendations of the 700 instructions vary tremendously. Many lacked instructions on appropriate hygiene and when to seek medical care. As skin and wound care experts, there may be an opportunity for the dermatology community to partner with tattooists to create more useful evidence-based tattoo aftercare practices.

Review of aluminum, paraben, and sulfate product disclaimers on personal care products.

BACKGROUND: Product disclaimers listed on personal care products face limited regulation. These disclaimers may be helpful or may mislead the public. OBJECTIVE: Review the evidence supporting the potential harms of 3 compounds commonly addressed by product disclaimers: parabens, aluminum, and sulfates. METHODS: Reported cases of adverse events to these compounds were identified. Trends in allergic contact dermatitis reactions to chemicals used in place of these compounds were also identified. RESULTS: There is limited evidence that parabens and aluminum pose a threat to human health; there is even less evidence that topical sulfate-containing products pose a danger to consumers. In the setting of paraben avoidance, there has been a steady increase in cases of allergic contact dermatitis to preservatives that are more allergenic, specifically the isothiazolinones. LIMITATIONS: Assessment of the toxicology of these compounds is ongoing and may change with new data. CONCLUSION: There is limited evidence that parabens, aluminum, and sulfates used in personal care products pose a health risk. There is evidence that avoidance of parabens has resulted in an epidemic of allergic contact dermatitis to isothiazolonine preservatives.

Incisional Biopsy Technique Is Associated With Decreased Overall Survival for Cutaneous Melanoma.

BACKGROUND: Previous studies examining melanoma biopsy technique have not demonstrated an effect on overall survival. OBJECTIVE: To examine overall survival of patients with cutaneous melanoma diagnosed by shave, punch, incisional, or excisional techniques from the National Cancer Database (NCDB). MATERIALS AND METHODS: Melanoma data from the 2004 to 2016 NCDB data set were analyzed. A Cox proportional hazards model was constructed to assess the risk of 5-year all-cause mortality. RESULTS: In total, 42,272 cases of melanoma were reviewed, with 27,899 (66%) diagnosed by shave biopsy, 8,823 (20.9%) by punch biopsy, and 5,550 (13.1%) by incisional biopsy. Both the univariate and multivariate analyses demonstrated that tumors diagnosed by incisional biopsy had significantly (p = .001) lower overall 5-year survival compared with shave techniques (hazard ratio [HR] = 1.140, 95% confidence interval [CI] 1.055 to 1.231). We found no difference (p = .109) between shave and punch biopsy techniques (HR 1.062, 95% CI 0.987-1.142) or between punch and incisional techniques (HR 1.074, 95% CI 0.979-1.177, p = .131). CONCLUSION: Incisional biopsies were associated with decreased overall 5-year survival in the NCDB. No difference was observed between shave and punch biopsy techniques. These findings support current melanoma management guidelines.

The use of social media platforms to discuss and educate the public on allergic contact dermatitis.

BACKGROUND: Social media platforms are increasingly used by patients to research and discuss medical problems. OBJECTIVE: The aim of this study was to identify by whom, how frequently, and in what manner allergic contact dermatitis (ACD) is discussed on social media sites. METHODS: Search terms "allergic contact dermatitis" and "contact dermatitis" were queried across Twitter, Instagram, Reddit, Facebook, YouTube, and Google search metrics. The frequency, content, and creators of the content were assessed. RESULTS: ACD content was identified on all platforms, generated by by patients, physicians, professional organizations, and companies. When comparing the volume of posts, more content was on Instagram than Twitter, particularly among patients. Patient support groups were identified on Facebook but not on Reddit. A formal analysis of YouTube videos found that the medical information presented in these videos was often of poor quality. CONCLUSIONS: Patch testing physicians should be aware that information on ACD exists across social media sites. While some content is generated by physicians, patients and industry groups also post and share material. Patch testing physicians should know that there is an opportunity to share ACD information, but they should also be aware that patients are posting and creating online support communities independent of physicians. HIGHLIGHTS: Online support communities exist for patients with ACD on Facebook. Online information is of lower quality, with a mean QUEST quality score of 7.4/28 on reviewed YouTube videos. Of the five social media sites reviewed, patients are most active on Instagram, Reddit, and Facebook. Approximately 9000 Google searches per month are conducted using contact dermatitis-related search terms. Differences in terminology exist between physicians and non-physicians. While the most popular hashtag term was "contact dermatitis", physicians disproportionately authored posts tagged with "allergic contact dermatitis."

THE demographics and trends in pediatric melanoma in the United States: An analysis of the National Cancer Database.

BACKGROUND/OBJECTIVE: Relative to adults, rates of melanoma are lower in children. Due to its rarity, it is difficult to assess the incidence, trends, and outcomes of this malignancy. Much of our understanding comes from single institution or regional cancer registries which may not be large enough to detect subtleties in the burden of pediatric melanoma. METHODS: Data from the 2004 to 2016 National Cancer Database were analyzed; this database captures approximately 70% of all cancer diagnoses in the United States. RESULTS: Our analysis consisted of 1903 cases. A majority were White (89.8%), the mean age was 12.4 years, and the ratio of females: males was 1.2:1.0. The most common anatomic location was the trunk (31.1%). Between 2004 and 2016, a decreasing trend in the number of new melanoma cases was observed. Comparing histologic subtype by age, there was an increased percentage of nodular and epithelioid and spindle cell tumors in the pre-teen children and a greater percentage of superficial spreading tumors in teenagers. Overall, a majority of cases were stage 0 or I (56.9%), with relatively few stage IV cases (2.0%). A 5-year all-cause survival of greater than 90% was observed for stage I-III tumors, with stage IV tumors having a 5-year all-cause survival of 34.4%. CONCLUSION: Comparable to previous studies, pediatric melanoma occurred most often in Whites, females, and adolescents. However, we detected a decreasing trend in new cases, noted differences between histologic subtype and age, and observed a 5-year all-cause survival rate of greater than 90% for stage I-III tumors.

Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision.

BACKGROUND: Optimal surgical management for melanoma of the head and neck remains controversial. OBJECTIVE: Assess outcomes for melanomas of the head and neck treated with Mohs micrographic surgery (MMS) versus wide local excision (WLE) from the National Cancer Database. METHODS: Head and neck melanoma data from the National Cancer Database from years 2004-2015 were analyzed. RESULTS: In total, 50,397 cases of head and neck melanoma were reviewed; 3510 (7%) were treated with MMS and 46,887 (93%) with WLE. After controlling for potential confounding variables, patients treated with MMS were more likely than patients treated with WLE to survive after 5 years (hazard ratio [HR] 1.181, 95% confidence interval [CI] 1.083-1.288; P < .001). Factors associated with a statistically significant survival disadvantage included male sex (HR 1.287, 95% CI 1.242-1.357; P = 0), tumor ulceration (HR 1.687, 95% CI 1.616-1.760; P = 0), and positive surgical margins (HR 1.395, 95% CI 1.306-1.490; P = 0). Patient survival was inversely proportional to tumor Breslow depth. LIMITATIONS: Database study, limited number of MMS treated melanomas. CONCLUSION: MMS is a valid treatment option for melanoma of the head and neck; National Cancer Database data suggests that MMS might confer a survival benefit over WLE.

A perplexing case of superficial granulomatous pyoderma with sporotrichoid-like distribution.

Superficial granulomatous pyoderma (SGP) is a rare pyoderma gangrenosum (PG) variant that differs from classic PG in that the ulcers tend to be more superficial, lack a rapidly advancing border, and are not typically associated with an underlying systemic disease. The ulcers are most commonly painless and located on the trunk, with a clean granulating base. They generally do not show undermining but may have a vegetative border. Lesions usually respond well to either topical or intralesional corticosteroids with complete healing. The classic histopathologic finding is a "three-layer granuloma" in the superficial dermis consisting of central neutrophilic inflammation and necrosis, a surrounding layer of histiocytes and multinucleated giant cells, and an outer most layer of plasma cells and eosinophils. Herein, we present a unique case of SGP with sporotrichoid-like distribution on the lower extremity.

Pigments in American tattoo inks and their propensity to elicit allergic contact dermatitis.

BACKGROUND: Tattoos have become increasingly common in the United States. Historically, tattoo inks were comprised of metallic pigments, which have the potential to cause allergic contact dermatitis. Data have been lacking on the current use of these pigments in tattoo ink. OBJECTIVE: Identify pigments currently used in tattoo inks manufactured in or sold by wholesalers in the United States and investigate cases of allergic contact dermatitis caused by these pigments. METHODS: Using specific key words, we performed an internet search. Pigment information listed in tattoo product inserts was collated and evaluated. RESULTS: In total, 1416 unique inks were surveyed. The average bottle of ink contained 3.0 pigments. We identified 44 distinct pigments, of which 10 contained metallic pigments, including iron, barium, zinc, copper, molybdenum, and titanium. The remaining 34 pigments contained carbon, azo, diketopyrrolopyrrole, quinacridone, anthraquinone, dioxazine, or quinophthalone dyes. A literature search revealed that 11 of the 44 (25%) pigments had been suspected to cause contact dermatitis. Five were confirmed by patch testing. CONCLUSION: These findings highlight the diversity of pigments currently used in tattoos. Relatively few inks contained metallic pigments to which allergic contact dermatitis has historically been attributed. Patch-test clinicians should be aware of these new pigments.

Acquired partial lipodystrophy treated with poly-L-lactic acid and hyaluronic acid fillers: a case report.

Acquired partial lipodystrophy (APL), also known as Barraquer-Simons syndrome, is a rare disorder characterized by progressive fat loss in the upper body. Use of poly-L-lactic acid and hyaluronic acid (HA) fillers for the treatment of APL is neither approved by the Food and Drug Administration nor described in the literature. Herein, we describe a case of APL that achieved significant improvement in facial volume following treatment with combination poly-L-lactic acid and HA fillers.

The incidence of pediatric malignant soft tissue tumors of the skin and subcutaneous tissue.

Soft tissue tumors are a known, albeit uncommon, cause of cutaneous malignancy in children. Little is known about which types and how frequently these tumors initially present in the skin or subcutis of children. Using data from the 2000-2014 SEER-18 database, we have identified 12 malignant soft tissue tumor types, which initially presented in the skin or subcutis of children in over 50% of cases.

The beliefs and willingness of men who have sex with men to comply with a one-year blood donation deferral policy: a cross-sectional study.

BACKGROUND: In 2016, the US Food and Drug Administration ended the lifetime blood donation deferral for men who have sex with men (MSM) and replaced it with a 1-year deferral period. It is currently unknown how many MSM may meet the new deferral policy and how many are willing to comply with it. STUDY DESIGN AND METHODS: An anonymous survey was shared on MSM-focused social media sites between May and July 2016 and enrolled self-identified American MSM who were at least 18 years old. The survey assessed the willingness of MSM to donate blood, donation history, and knowledge regarding current blood donation needs and testing limitations. RESULTS: A total of 764 men met criteria to be included in the final data set. Only 8.9% (95% confidence interval [CI], 6.9%-10.9%) met the current 12-month deferral criteria, yet 90.6% (95% CI, 88.5%-92.7%) were interested in donating. Among men interested in donating blood, 57.9% (95% CI, 54.3%-61.4%) would consider donating blood without meeting the 12-month deferral criteria. Overall, 26.7% (95% CI, 23.6%-29.8%) admitted to donating blood at least once in the past despite not meeting deferral criteria. CONCLUSIONS: Few MSM met the current deferral criteria, yet many were interested in donating, even without meeting deferral criteria. Possible motivations to donate without meeting deferral criteria may include a perceived shortage of donated blood and infallibility of current blood testing technology to detect human immunodeficiency virus. If the current 1-year deferral is maintained, it is essential that there is outreach to the MSM community to explain and educate why this policy exists.