Trends in patch-test results and allergen changes in the standard series: a Mayo Clinic 5-year retrospective review (January 1, 2006, to December 31, 2010).

BACKGROUND: Patch testing is essential for identification of culprits causing allergic contact dermatitis. OBJECTIVE: We sought to identify trends and allergen changes in our standard series during 2006 to 2010, compared with our previous report (2001-2005). METHODS: We conducted a retrospective review of patch-test results. RESULTS: A total of 3115 patients were tested with a mean of 73.0 allergens. Since our prior report, 8 allergens were added to the standard series; 14 were deleted. Significantly higher rates of allergic positive reaction were documented for carba mix, 3%, and Disperse Orange 3, 1%. Rates were lower for 10 allergens: neomycin sulfate, 20%; gold sodium thiosulfate, 0.5%; hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, 1%; disperse blue 124, 1%; disperse blue 106, 1%; diazolidinyl urea, 1%; hexylresorcinol, 0.25%; diazolidinyl urea, 1% aqueous; 2-bromo-2-nitropropane-1,3-diol, 0.25%; and lidocaine, 5%. Many final patch-test readings for many allergens were categorized as mild reactions (erythema only). Overall allergenicity and irritancy rates declined significantly since our prior report. Results were generally comparable with those in a North American Contact Dermatitis Group report from 2005 to 2006. LIMITATIONS: This was a retrospective study; there is a lack of long-term follow-up. CONCLUSIONS: Since our previous report, our standard series composition has changed, and overall rates of allergenicity and irritancy have decreased. Notably, many final patch-test readings showed mild reactions.

Patients' perceptions of the usefulness and outcome of patch testing.

BACKGROUND: Studies have shown the effect of allergic contact dermatitis on quality of life, but few address the impact of patch testing. OBJECTIVE: We sought to determine patient satisfaction with patch testing, patients' perceptions of its usefulness, dermatitis outcomes, and recall of allergens. METHODS: After patch testing, surveys were mailed to 1453 patients. RESULTS: Response rate was 52.1%, 757 surveys returned: 518 women (68.4%) and 239 men (31.6%). More than 75% (578) of respondents were at least "somewhat satisfied" with the process; 51% (388) were "very satisfied." More than half (430, 58.3%) reported improved dermatitis. The 580 patients who had positive reactions remembered a mean of 51.0% of allergens; 198 of these (34.1%) remembered 100%. Of 2547 positive reactions to allergens, 1229 (48.3%) were remembered correctly. LIMITATIONS: Limitations were reporting bias and individual interpretations of questions. CONCLUSION: Although patients reported both satisfaction with patch testing and improvement in skin conditions, they forgot more than 40% of identified allergens. Techniques are needed to improve patient recall.

Sternal erythema: a distinctive postsurgical eruption.

BACKGROUND/OBJECTIVE: Wound complications constitute a diverse array of surgical and dermatologic entities. We sought to describe the clinical and pathologic attributes of a series of patients in whom a distinctive thoracic surgical wound eruption developed after coronary bypass grafting. METHODS: We performed a detailed chart review, including history, surgical procedure notes, and biopsy findings, obtained from 3 patients; we examined the data and reconciled them with conventional etiologies in an attempt to discern a shared diagnosis and pathogenesis. RESULTS: The patients were white men (59, 68, and 73 years of age) in whom roughly symmetrical asymptomatic erythema developed within the borders of their sternal thoracotomy wounds between 1 and 2 years after open heart surgery. The cutaneous findings consisted of macular erythema and poikiloderma that blanched with external pressure. Biopsy findings yielded epithelial atrophy with capillary telangiectases. CONCLUSION: Although cellulitis, dermal hypersensitivity to surgically implanted hardware including sternal wire, and an anatomic variant of costal fringe remain as possible diagnoses, an additional consideration includes a form of postsurgical reflex sympathetic dystrophy.

Follicular mycosis fungoides: successful treatment with oral bexarotene.

Follicular mycosis fungoides, a subtype of cutaneous T-cell lymphoma, is often difficult to treat. We present a case of a female with follicular mycosis fungoides who showed an excellent response to low-dose (150 mg/m2) oral bexarotene (Targretin). To our knowledge, this is the first reported case of follicular mycosis fungoides demonstrating a response to bexarotene.

Patch test results may vary depending on where testing is performed: a comparison of patch test results from three geographically distinct sites in the USA.

BACKGROUND: Do patch test results vary from one part of the USA to another? Few reports directly compare the results of patch testing across centers within the USA. OBJECTIVES: Our objective was to compare results of patch testing from three geographically disparate Mayo Clinic sites in the USA to ascertain whether there are any differences in allergic patch test rates. METHODS: We retrospectively reviewed patch test results for patients tested with a standard allergen series using our enterprise-wide protocol for patch testing. We compared data collected from January 1, 2001, through to December 31, 2007, from our practice sites in the Midwest, Southwest, and Southeast regions of the USA. RESULTS: In total, 5063 patients underwent patch testing. The mean (standard deviation) number of allergens tested per patient was 70.3 (3.8) (range: 10-87; interquartile range: 68-73). Analyses were conducted separately for 72 allergens with positive reactions from at least 20 patients. Risk-adjusted positive reaction rates (RAPRRs) for 44 allergens differed significantly (P<0.05) among the geographic sites; RAPRRs differed significantly across all three sites for 11 allergens and between two of the three sites for 33 allergens. CONCLUSIONS: Allergic patch test rates differed among our three practice sites for many allergens. It is likely that many factors contributed to these observed differences, including variations in the population undergoing patch testing, variations in allergen exposure, and variations in climate.

Photopatch testing of 182 patients: a 6-year experience at the Mayo Clinic.

BACKGROUND: Photopatch testing is important for diagnosing photoallergic contact dermatitis. Although results of photopatch testing have been presented from many European centers, there have been few reports of the results of photopatch testing in the United States. OBJECTIVE: To review the Mayo Clinic's recent experience with photopatch testing, identify common photoallergens, and compare our current and previous findings. METHODS: We retrospectively reviewed records of patients who underwent photopatch testing at the Mayo Clinic between January 1, 2000, and December 31, 2005 (N = 182). RESULTS: Fifty-four patients (29.7%) had photoallergic contact reactions, and 29 (15.9%) had allergic contact reactions. The most common photoallergens were medications, sunscreen agents, fragrances, and antiseptics. CONCLUSION: Photopatch testing is the technique useful in identifying photoallergens. The series of allergens used must be constantly updated to reflect newly identified and outdated photoallergens. We present a 6-year experience with photopatch testing. Medications, sunscreen agents, fragrances, and antiseptics were the most frequently identified photoallergens.

Changing trends and allergens in the patch test standard series: a mayo clinic 5-year retrospective review, january 1, 2001, through december 31, 2005.

OBJECTIVE: To present and interpret results of patch testing with the Mayo Clinic standard series over 5 years. DESIGN: Retrospective study. A standardized patch testing technique was used. Data were recorded on a standardized computer program from January 1, 2001, to December 31, 2005, and analyzed. SETTING: Tertiary referral center. PATIENTS: Patients who were referred for patch testing. INTERVENTION: Patch testing with the "standard series," ie, a standard series of allergens used by most clinicians to identify the most common offending allergens in patients with allergic contact dermatitis. MAIN OUTCOME MEASURES: Number of patients patch tested, allergens used over this period, and rates of allergic patch test reactions to allergens. RESULTS: A total of 3854 patients (mean age, 55.1 years; age range, 6.2-99.4 years; 2576 female [66.8%]) were tested. All dermatologists in the department performed patch testing. The mean number of allergens included was 69.3 (range, 6-87). There were 2664 patients with at least 1 positive reaction (69.1%) and 1933 with 2 or more positive reactions (50.2%). Metals, fragrances, topical antibiotics, preservatives, and individual allergens used in hair-care products, topical corticosteroids, glues, plastics, and rubber were still the most common allergen groups associated with allergic patch test reactions. CONCLUSIONS: We describe the structure of the patch testing service at our referral center. Ongoing analysis of our patch test reaction rates allows us to recommend broad, clinically relevant, and up-to-date allergens for testing.

Contact dermatitis: diagnosing and treating skin conditions in the elderly.

Contact dermatitis is a significant cause of skin disease in geriatric patients. We discuss factors that predispose older adults to contact dermatitis, such as changes in barrier function and types of commonly contacted irritants and allergens.

A baffling basaloid blain.

Cutaneous metastases may present in a variety of histologic guises simulating more common primary tumors. We present the clinicopathologic features of a case masquerading as basal cell carcinoma. Epidermotropism, vascular invasion, and the absence of stromal retraction around tumor nests prompted further investigation. Clinical history and directed immunohistochemical staining ultimately revealed the diagnosis of cutaneous metastasis of transitional cell bladder carcinoma (TCC).