RESUMEN
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.
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Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Administración Tópica , Adolescente , Adulto , Anciano , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Profesional/epidemiología , Dermatitis Profesional/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Pruebas del Parche , Estudios RetrospectivosRESUMEN
BACKGROUND: Patch testing is the gold standard diagnostic test for allergic contact dermatitis and needs to be relevant to the region and the population being tested. The aim of this study was to develop a specific New Zealand baseline series (NZBS). METHOD: We performed a retrospective case note review of patients attending four regional patch test centres between 2008 and 2020. Demographic and diagnostic information was collected for each patient along with results of patch testing. Using the results of this review, a group of 11 dermatologists with an interest in contact dermatitis agreed on a core group of allergens for inclusion in an NZBS, based on the frequency of positive reactions and allergens of interest. The remaining potential allergens were ranked by each dermatologist using an online questionnaire, with inclusion in the final NZBS by consensus. RESULTS: Results from 2402 patients (67% female, mean age 44 years) from Auckland, Wellington, Palmerston North and Christchurch were collated. The 10 most frequent positive (relevant and non-relevant) allergens were nickel sulfate (22.0%), fragrance mix I (8.6%), cobalt chloride (7.3%), Myroxylon pereirae (5.6%), colophonium (5.1%), p-phenylenediamine (4.9%), methylisothiazolinone/methylchloroisothiazolinone (4.1%), fragrance mix II (3.9%), potassium dichromate (3.5%) and methylisothiazolinone (3.4%). Based on these results, a core series of 30 allergens was developed, with an additional 30 allergens added to form the extended series (total 60 allergens). CONCLUSION: The baseline series of patch test allergens for routine use in New Zealand (NZBS) is based on national patch test data and expert consensus.
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Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Pruebas del Parche , Adulto , Alérgenos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVES: Allergic contact dermatitis is an uncommon but important cause of skin disease in the anogenital region. Relevant allergens are described in women and less commonly in men. The aim of this study was to describe outcomes of patch testing in men and women presenting with anogenital dermatoses. MATERIALS AND METHODS: Cases patch tested for anogenital conditions at 2 patch test clinics in Sydney, Australia, from 2002 to 2017 were reviewed. Positive and relevant patch test reactions were recorded. RESULTS: Thirty-seven women and 27 men were included. Dermatitis was the most common diagnosis, followed by psoriasis and lichen sclerosus. Thirty percent had a final diagnosis of allergic contact dermatitis. The most frequent relevant allergens were fragrance mix I (9%), patients own products (9%), Myroxylon pereirae (8%), cocamidopropyl betaine (3%), and benzocaine (3%). CONCLUSIONS: The top positive and relevant allergens seen were in concordance with other reports from Australia and the rest of the world. Fragrances and medicaments are common allergens, and it is recommended that products used on anogenital skin be fragrance free. Testing patients own products is imperative.
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Canal Anal/inmunología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/epidemiología , Genitales/inmunología , Adulto , Anciano , Canal Anal/patología , Femenino , Genitales/patología , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Pruebas del Parche , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: Neutrophilic dermatosis of the hands is an inflammatory skin condition related to Sweet syndrome that responds to corticosteroids. It commonly affects the dorsum of the hand and often mimics infection, with violaceous inflammatory papules and plaques that may ulcerate. The aim of this study was to review the clinical presentation of neutrophilic dermatosis of the hands. METHODS: A retrospective review was undertaken of all cases of neutrophilic dermatosis of the hands seen at a tertiary hospital in New South Wales, Australia, over a 5-year period. RESULTS: Seventeen cases were identified. The mean time to diagnosis was 9 days after lesion onset. Most cases were older adults (mean age, 71 years). The most common referral diagnoses were infection or a nonhealing wound and 65% of cases reported a history of trauma. The dorsal index finger was the site of involvement in 41% of cases. One case involved the palm. Histopathology reports were available for skin punch biopsy for 14 of 17 cases, which showed dermal neutrophilic infiltrate (93%) and epidermal involvement with necrosis, ulceration, or pustulation (64%). Six cases were treated surgically prior to the correct diagnosis and management being introduced. CONCLUSIONS: Neutrophilic dermatosis of the hands was often misdiagnosed as infection. A history of trauma is common and may be misleading. Dermatological consultation and skin punch biopsy are useful in confirming the diagnosis, ideally prior to surgical management. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
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Dermatosis de la Mano/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Errores Diagnósticos , Femenino , Glucocorticoides/uso terapéutico , Dermatosis de la Mano/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Neutrófilos/patología , Estudios Retrospectivos , Piel/patología , Enfermedades Cutáneas Infecciosas/diagnóstico , Síndrome de Sweet/complicacionesAsunto(s)
Corticoesteroides/administración & dosificación , Apósitos Oclusivos , Enfermedades de la Piel/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Hospitalización , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: Granular parakeratosis (GP) is a benign dermatosis characterised by a rash at intertriginous sites. The pathogenesis is uncertain although it is proposed to be an irritant contact reaction with cases related to benzalkonium chloride (BAC) reported. Our experience is that patients often have delayed diagnosis. This study aims to review the clinical presentation and histopathological features of GP. METHODS: This study is a retrospective case series of adult and paediatric patients seen at dermatology clinics in Auckland, New Zealand. Information was collected on patient demographics, presentation, investigations and management. RESULTS: Thirteen cases (seven adults; six children) are included. The typical presentation of GP was erythematous or brown, scaly papules and plaques with desquamation in a predominantly flexural distribution. All patients reported recent exposure to BAC in laundry rinse solution. Nine biopsies were taken from four patients. Psoriasiform and eczematous findings were common on histopathology. The mainstay of treatment was cessation of BAC exposure. CONCLUSION: GP has a distinct clinical pattern although histopathological findings are varied. Clinicians should have a high index of suspicion for GP in patients presenting with erythematous flexural eruptions and seek a history of BAC exposure, especially in the context of the COVID-19 pandemic and increased antiseptic use.
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Compuestos de Benzalconio/envenenamiento , Detergentes/envenenamiento , Paraqueratosis/inducido químicamente , Paraqueratosis/diagnóstico , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Paraqueratosis/patología , Estudios RetrospectivosRESUMEN
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.
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Cosméticos/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Aceites Volátiles/efectos adversos , Pruebas del Parche/métodos , Adulto , Alérgenos/efectos adversos , Cosméticos/química , Femenino , Humanos , Masculino , Nueva Zelanda , Extractos Vegetales/efectos adversos , Estudios RetrospectivosRESUMEN
AIM: Vulval lichen sclerosus is an inflammatory genital skin condition associated with poor quality of life, sexual dysfunction and risk of squamous cell carcinoma. The aim of this study was to document the demographics of women with lichen sclerosus seen at specialist vulval clinics. METHOD: We performed a retrospective review of women with lichen sclerosus seen at a tertiary combined gynaecology/dermatology vulval clinic over 12 months and Auckland Regional sexual health vulval clinics over five years. Data were collected for age, ethnicity, skin biopsy, treatment, referral source and time from symptom onset to diagnosis. Ethnicity was compared with Census data for the Auckland region. DISCUSSION: Three hundred and thirty-five women were included; 273 from the gynaecology/dermatology clinic and 62 from sexual health. Women seen at sexual health were younger than those seen by gynaecology/dermatology (mean age 45 and 64, respectively; p<0.0001). Most referrals were from general practitioners (54%), although self-referrals made up 42% of sexual health consultations. The most common ethnicity was European (82%) followed by Asian (10%), Maori (4%) and Pacific Peoples (3%). Compared with Census data, European women were over-represented and Maori, Pacific and Asian women were under-represented. CONCLUSION: We found inequitable ethnic representation of women with vulval lichen sclerosus seen at our institution. Causes may include sociocultural beliefs, variations in access to care or ethnic differences in the prevalence of lichen sclerosus. A deeper understanding of underlying issues would enable planning of initiatives to ensure equitable access to specialist care for all New Zealand women with vulval conditions.
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Dermatólogos , Liquen Escleroso y Atrófico/epidemiología , Calidad de Vida , Derivación y Consulta , Enfermedades de la Vulva/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Liquen Escleroso y Atrófico/diagnóstico , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Enfermedades de la Vulva/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: The etiology of cheilitis includes endogenous, irritant, and allergic dermatitis; lichenoid and granulomatous disorders; infection; trauma; and actinic damage. Patch testing is indicated for refractory cases (other than actinic cheilitis). OBJECTIVE: The aim of the study was to review demographics and allergens in patients patch tested for cheilitis at 2 sites in Sydney, Australia. METHODS: Records for patients patch tested for a 10-year period from 2007 to 2017 were reviewed. Baseline characteristics and patch test results were compared for patients with and without cheilitis. CONCLUSIONS: There were 1584 patients including 91 with cheilitis. Patients with cheilitis were more likely to be female, younger, and atopic and have concurrent eyelid involvement than those presenting with other dermatoses. Seventeen percent of patients with cheilitis had a post-patch test diagnosis of allergic contact cheilitis, and the most frequent relevant reactions were to patients' own products, fragrances, and sunscreens. Those with cheilitis had more positive reactions to sunscreens, especially benzophenones, compared with those without cheilitis (P < 0.001). This is an important finding in Australia where high rates of melanoma and nonmelanoma skin cancer necessitate promotion of strict sun protection measures.
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Queilitis/diagnóstico , Dermatitis Alérgica por Contacto/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alérgenos/efectos adversos , Queilitis/inducido químicamente , Niño , Preescolar , Cosméticos/efectos adversos , Cosméticos/química , Dermatitis Alérgica por Contacto/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas del Parche , Estudios Retrospectivos , Protectores Solares/efectos adversos , Protectores Solares/química , Pastas de Dientes/efectos adversos , Pastas de Dientes/química , Adulto JovenRESUMEN
Increasingly, existing evidence indicates that methotrexate-associated liver injury is related to comorbid risk factors such as diabetes, alcoholism, and obesity, rather than to methotrexate itself. Despite this fact, significant effort continues to be expended in the monitoring of low-dose methotrexate in patients with psoriasis. The gold standard investigation has been liver biopsy, but this is associated with significant morbidity and mortality. As methotrexate-induced liver injury is uncommon, the risk/benefit ratio of liver biopsy has been questioned. Fortunately, a number of new technologies have been developed for the diagnosis of chronic liver disease, including transient elastography (TE). TE is a type of shear wave ultrasound elastography, which measures the speed of shear waves used to estimate hepatic tissue stiffness. Several meta-analyses show very high pooled sensitivity and specificity for the diagnosis of hepatic cirrhosis (87% and 91%, respectively) in a variety of chronic liver disorders. It has a negative predictive value for cirrhosis of >90% and a positive predictive value of 75%. Recent European guidelines now advocate the use of TE as the first-line test for the assessment of fibrosis in alcohol- or hepatitis-related liver disease, including nonalcoholic fatty liver disease (NAFLD). As the prevalence of obesity and metabolic syndrome, including NAFLD, is significantly elevated in patients with psoriasis, TE may be worth considering as a routine investigation for any patient with psoriasis. Although high-quality studies comparing TE with standard liver biopsy in the monitoring of psoriatics on low-dose methotrexate are lacking, the evidence from multiple small cohort studies and case series demonstrates its effectiveness. A recent Australasian position statement recommends that TE should be considered as a routine investigation for monitoring methotrexate therapy, repeated every 3 years if kPa <7.5 and yearly if kPa >7.5. Liver biopsy should be considered for patients with a kPa >9.5.