Bullous pemphigoid: Its incidence, mortality and clinical outcome in New Zealand.

BACKGROUND/OBJECTIVES: Bullous pemphigoid (BP) is an uncommon autoimmune bullous disorder, with significant morbidity and mortality. Mortality may be as high as 23.5% in the first year after diagnosis. Clear epidemiologic data across Australasia are lacking. METHODS: A retrospective, multi-centred cohort study was designed to determine the incidence and mortality of bullous pemphigoid in New Zealand. Data from all histopathologically diagnosed patients with bullous pemphigoid between 2009 and 2015 from the Auckland region were obtained. Demographics, clinical characteristics and outcome 3 years from diagnosis (until 31 December 2018) were collected. Demographic data were compared against a denominator year-matched New Zealand Census population. RESULTS: One hundred sixty-one patients had confirmed bullous pemphigoid, with an incidence rate of 3.03/100 000 person-years [95% CI 2.58-3.54]; 70% were of European ethnicity; 12.4% were Pacific peoples; 11.2% were Asian; and 6.8% were Maori. 45.3% had associated cognitive impairment and/or stroke. In the 3-year follow-up, 25% had treatment complications mostly from prednisone therapy. The mortality rate was 40%, highest in the first year of diagnosis, with age at diagnosis a predictor. CONCLUSION: The incidence and mortality rates are comparable to the UK/Northern Europe. Knowledge of the epidemiology of bullous pemphigoid in New Zealand and within an international settling informs the provision of future care and treatments.

Topical corticosteroid allergy: Results of sequential testing to a corticosteroid series in New Zealand.

BACKGROUND: Our institution tests the European Baseline Series (EBS) and a steroid series sequentially in all patients presenting for patch testing. The rate of steroid sensitization in New Zealand has not previously been documented. OBJECTIVES: To investigate the rate of corticosteroid sensitization and assess additional benefit of testing the full steroid series over the steroid allergy markers in the EBS. METHODS/PATIENTS: Retrospective analysis of all patient demographics and patch test results over a 5-year period (2014 to 2019) was performed at a tertiary patch test clinic in Auckland, New Zealand. RESULTS: A total of 319 patients completed patch testing, and 4.4% were sensitized to one or more corticosteroids. As much as 79% of positive reactions were of current relevance; 11/14 reactions were to tixocortol pivalate or budesonide. The "number needed to test" to detect one additional case of corticosteroid sensitization by using the full corticosteroid series over the EBS alone was 107. CONCLUSIONS: Although corticosteroid sensitization was not uncommon in our population, the results suggest that sequential testing with the corticosteroid markers (budesonide and tixocortol) in the standard series alone is adequate. The additional corticosteroid series should be added if the markers are positive or where there is a clinical suspicion of corticosteroid allergy.

Photopatch Testing in New Zealand: A 12-Year Retrospective Review.

BACKGROUND: Little is known about the common photoallergens in New Zealand, where ultraviolet exposure is particularly high. Availability of photopatch testing is limited because of it being performed in very few tertiary referral and contact dermatitis clinics. OBJECTIVE: To review the photopatch testing experience in New Zealand. METHOD: A retrospective review of all patients who underwent photopatch testing at a tertiary referral center in Auckland from 2008 to 2019 was performed. RESULTS: Seventy patients had photopatch testing over the 12-year period. Of the 58 patients tested using the photoallergen series, 6 (10%) patients had a positive photopatch test reaction, of which 4 were to promethazine and 2 were to benzophenone-3. The most common postpatch diagnosis was endogenous dermatitis (54%), followed by allergic contact dermatitis (21%), photoallergic contact dermatitis (9%), and chronic actinic dermatitis (4%). CONCLUSIONS: Both patch and photopatch testing are important investigations in patients with suspected photoallergic contact dermatitis. Promethazine and benzophenone-3 were the most frequent and only photoallergens in our population. Promethazine sensitization was via oral exposure, supporting a mechanism of systematized photoallergy to promethazine.

Patch testing to plants: sensitisation associated with exposure to plants, essential oils and botanicals in cosmetics.

BACKGROUND: Contact allergy to plants, particularly Compositae, presents with dermatitis and is diagnosed with skin patch testing. Sesquiterpene lactone mix is a common screening allergen for plant allergy. The rate of plant allergen sensitisation in New Zealand, which is affected by local horticultural factors, has not previously been documented. AIMS: To investigate the rate of plant allergen sensitisation in New Zealand's regional population, characterise common allergens and reassess appropriate allergens for patch testing. METHODS: Retrospective analysis of patient demographics and patch-test results over an eight-year period (2012 to 2020) was performed at a tertiary patch-test clinic in Auckland, New Zealand. RESULTS: 820 patients completed patch testing. There was a 12.9% sensitivity rate (a positive reaction on patch testing) to at least one plant allergen and a 6.2% plant allergy rate (positive reaction of current relevance). The most frequent positive reactions were Myroxylon pereirae (n=38), colophonium (n=35) and sesquiterpene lactone mix (n=14). Of patients with a plant allergy (n=51), the allergy source was a botanical in a cosmetic product in 27 cases (52.9%), a plant in ten (19.6%) and an essential oil in two (3.9%). CONCLUSIONS: Reactions to plant allergens were related to botanicals in cosmetics and creams, plants and essential oils. Rates of plant sensitisation in our cohort are comparable with international data.

Perioperative management and the associated rate of adverse events in dermatological procedures performed by dermatologists in New Zealand.

Dermatological surgery performed in an outpatient setting is common and generally perceived as safe, but the potential for serious adverse events does exist. Furthermore, there is a current lack of guidelines regarding preoperative and intraoperative monitoring of such patients. This is a retrospective study that involved a written questionnaire sent to current practising New Zealand dermatologists. Aspects investigated include their practice relating to preoperative assessments and intraoperative monitoring during standard dermatological procedures, and the resulting rate of adverse events. We found that most respondents performed dermatological procedures in dedicated theatres in outpatient clinics. The majority of survey respondents would screen for and optimize risk factors prior to surgery. Most respondents would not record vital sign measurements either preoperatively or intraoperatively. Antibiotic prophylaxis was generally only prescribed if clinically indicated, and anticoagulation and antiplatelet therapies were in the majority of cases never withheld prior to surgery. Infection (<3.5%) and bleeding (<2%) were the most common postoperative complications, with other serious adverse events being extremely rare. Although dermatological surgery continues to be safely performed in the outpatient setting, attempts should still be made to identify patients who are at higher risk for surgery and extra precautions should be applied to these selected patients.

Epidemiology of dermatophyte infection in Auckland, New Zealand.

This report describes the epidemiology of culture-proven dermatophyte infection in Auckland, New Zealand. The authors undertook a retrospective review of laboratory data for the period from June 1999 to July 2002. There were 10 004 dermatophyte isolates. The most common isolates were Trichophyton rubrum (69%) and Trichophyton mentagrophytes (19%). Microsporum canis was mainly isolated from children. The prevalence of T. mentagrophytes increased with patient age (P < 0.001). Trichophyton rubrum was most common in those aged between 20 and 59 years. The incidence of culture-proven dermatophyte infection was 2.9/1000 population for the year 2000, and the incidence increased with patient age (P < 0.001). It is concluded that dermatophytes causing superficial mycoses in the Auckland region are essentially similar to Australia and other Western countries, although some new organisms are seen as a result of the migration of people from other countries. The incidence of local dermatophyte infection increases with age.