Allergic contact dermatitis in children: trends in allergens, 10 years on. A retrospective study of 500 children tested between 2005 and 2014 in one UK centre.

BACKGROUND: Contact allergy in children is becoming increasingly recognized as a cause of eczema. The causal agents may change with time, but there are few comparative data for this age group. OBJECTIVES: To compare data from the past 10 years with a similar study from the previous decade. METHODS: Between 2005 and 2014, 500 consecutive children who had been patch tested at Leeds Teaching Hospitals were identified, and the results were reviewed. RESULTS: Twenty-seven per cent (134 cases) of children had one or more positive patch test findings. The mean ± standard deviation age of patients with a positive test reaction was 11.9 ± 4.1 years, which was significantly higher than that of patients with a negative result (10.9 ± 4.0 years) (p = 0.01; Mann-Whitney U-test). No significant relationship between sex and a positive patch test result was found (p = 0.48, chi-squared). Allergy to nickel was the most frequent finding, although this accounted for 18%, rather than 33% (1995-2004), of all positive reactions. The next most common allergens included fragrance mix 1 (17%), p-phenylenediamine (16%), and methylchloroisothiazolinone/methylisothiazolinone (6%). CONCLUSIONS: Although the overall incidence of contact allergy in our paediatric population is static, there has been a significant change in the allergens detected, probably as a result of changes in European legislation and cosmetic product use in children.

Palmoplantar hyperkeratosis: a rare cutaneous manifestation of juvenile dermatomyositis.

We report the case of a 12-year-old girl with juvenile dermatomyositis (JDM). She had a 12-month history of palmoplantar hyperkeratosis that was initially treated as eczema. We wish to alert clinicians to this rare cutaneous manifestation of JDM.

A novel use for botulinum toxin A in the management of ileostomy and urostomy leaks.

PURPOSE: To assess the efficacy of Botulinum toxin A (BoNT-A) in the treatment of patients with hypercontractile stomas resulting in repeated pouching system failures and leaks. DESIGN: Prospective case series. SUBJECTS AND SETTING: Ten consecutive patients who presented to the outpatient stoma clinic with actively contractile stomas that shortened spasmodically resulting in leaks were offered treatment with BoNT-A if treatment with other measures had been unsuccessful. METHODS: Following an observed reduction in the peristalsic shortening of a stoma after intradermal injection of BoNT-A for hyperhidrosis, we conducted a prospective case series of 10 patients with pouch adhesive failures attributed to spasmodic shortening of the stoma. Ten patients, 3 with urostomies and 7 with ileostomies, were offered BoNT-A injection. The first was treated cautiously with 15 units of BoNT-A injected into the muscularis layer, followed by an additional 25 units injected 1 month later. Subsequent patients received doses varying from 50 to 100 units. Ongoing treatments ranged 50 to 100 units every 3 to 6 months. RESULTS: Seventy percent (n = 7) of patients reported a useful reduction in leakage and pouching system seal failures. In these 7 patients, the frequency of pouch changes changed from an average of 2.18 to 0.44 per day (over all 10 patients this was a change from an average of 2.35 per day to 1.16 per day). No adverse side effects were reported. CONCLUSION: Findings from this clinical case series suggest that BoNT-A may be a promising treatment in the management of patients with leaks caused by actively contracting stomas.