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BACKGROUND: Data regarding teledermatology for patch testing are limited. OBJECTIVES: Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS: Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS: Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION: For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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Dermatite Alérgica de Contato/diagnóstico , Dermatite Irritante/diagnóstico , Variações Dependentes do Observador , Testes do Emplastro/métodos , Testes do Emplastro/normas , Consulta Remota , Alérgenos/administração & dosagem , Competência Clínica , Dermatologistas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Fotografação/normas , AutoimagemRESUMO
Importance: Consumers have reported skin rash/irritation and hair loss/breakage with Wen by Chaz Dean Sweet Almond Mint Cleansing Conditioner (WCDSAMCC), however epidemiologic, toxicologic and clinical hair loss studies have not provided an explanation. Contact dermatitis has been hypothesized.Objective: To assess the tolerability of six products: WCDSAMCC, three other hair cleansing conditioners, and two controls [salicylic acid shampoo (SAS) and baby shampoo (BS)].Design: Double-blind, randomized, controlled trial.Setting: Single-site study.Population: General population volunteers.Intervention: Standard semi-open patch tests (SOPTs) and duration-escalation repeat open application tests (ROATs) over 5 weeks.Main Outcome Measures: Primary outcome measure was "stopping point" [ROAT total component score ≥6 (maximum 10) or global ≥4 (maximum 5)]. Secondary outcomes included "any reaction" (ROAT component score ≥1) and SOPT ≥ doubtful.Results: Two hundred of 298 volunteers were enrolled. There were no significant differences in the tolerability of WCDSAMCC and any of the other three hair cleansing conditioners as assessed by SOPT or ROAT. WCDSAMCC was significantly better tolerated than SAS ("stopping point", or "any reaction", p values<0.0001) as well as BS (p = 0.01). The frequency of doubtful SOPT reactions was lowest for WCD (2.2%) and highest for SAS (7.1%, p = 0.04).Conclusions: As assessed by both ROAT and SOPTs, WCDSAMCC was similar in tolerability to three other hair cleansing conditioners and significantly better tolerated than both controls (SAS and BS).Summary: This double-blind, randomized, controlled study found that WCDSAMCC was similar in tolerability to three other HCCs and was significantly better tolerated than both SAS and BS. This study provides critical clinical evidence on the comparative lack of cutaneous effects with use of WCDSAMCC.Trial Registration: NCT03483025 ClinicalTrials.gov.
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Preparações para Cabelo/administração & dosagem , Adulto , Idoso , Qualidade de Produtos para o Consumidor , Dermatite Alérgica de Contato , Método Duplo-Cego , Feminino , Preparações para Cabelo/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Estados Unidos , United States Food and Drug AdministrationRESUMO
Background There has been no systematic study assessing nickel release from surgical instruments and equipment used within the operating suite. This equipment represents important potential sources of exposure for nickel-sensitive patients and hospital staff. OBJECTIVE: To investigate nickel release from commonly used surgical instruments and operating room equipment. METHODS AND MATERIALS: Using the dimethylglyoxime nickel spot test, a variety of surgical instruments and operating room equipment were tested for nickel release at our institution. RESULTS: Of the 128 surgical instruments tested, only 1 was positive for nickel release. Of the 43 operating room items tested, 19 were positive for nickel release, 7 of which have the potential for direct contact with patients and/or hospital staff. CONCLUSION: Hospital systems should be aware of surgical instruments and operating room equipment as potential sources of nickel exposure.
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Níquel/análise , Exposição Ocupacional/análise , Segurança do Paciente , Aço Inoxidável/química , Instrumentos Cirúrgicos , Dermatite Alérgica de Contato/etiologia , Humanos , Níquel/efeitos adversos , Salas Cirúrgicas , Oximas , Aço Inoxidável/classificaçãoRESUMO
A 3-year-old child with recessive dystrophic epidermolysis bullosa treated with bone marrow transplantation subsequently developed body-wide epidermal detachment distinct from his epidermolysis bullosa. Toxic epidermal necrolysis was diagnosed by examination and skin biopsy. Although graft-vs-host disease was considered, he had no features of this diagnosis by laboratory studies or skin biopsy, and he improved without addition of further immune suppressants. Throughout the episode, the patient was maintained on cyclosporine A, a component of his transplant regimen, and also a reported therapy for toxic epidermal necrolysis. He had full recovery. Re-epithelialization occurred in a unique folliculocentric pattern, which we postulate was related to the patient's mesenchymal stem cell infusion, received as an adjunct to his marrow transplantation.
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Transplante de Medula Óssea/efeitos adversos , Epidermólise Bolhosa Distrófica/terapia , Síndrome de Stevens-Johnson/etiologia , Pré-Escolar , Ciclosporina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Transplante de Células-Tronco Mesenquimais , Síndrome de Stevens-Johnson/terapiaAssuntos
Dermatite Alérgica de Contato/etiologia , Produtos de Higiene Feminina/efeitos adversos , Doenças dos Genitais Femininos/induzido quimicamente , Triazóis/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Feminino , Doenças dos Genitais Femininos/diagnóstico , Humanos , Pessoa de Meia-Idade , Testes do Emplastro , Incontinência Urinária por Estresse/terapiaRESUMO
Background: Recent evidence shows similar rates of allergic contact dermatitis (ACD) among children and adults despite children accounting for less than 10% of patch testing subjects. With a need for in-depth analyses of pediatric ACD, we herein characterize a pediatric cohort at a large North American patch testing center. Methods: A retrospective chart review was conducted for 135 patients ages 1-17 years who underwent patch testing from July 2020 from August 2023. Data were stratified by age 1-5, 6-11, and 12-17 years. Significance-Prevalence Index Numbers (SPIN) were calculated. Results: A total of 86% were sensitized, 40% had a relevant reaction, and positivity rates were equal between males and females. Top allergens by SPIN differed with age, but overall were linalool hydroperoxides (SPIN = 11.01), propylene glycol (10.30), limonene hydroperoxides (10.27), fragrance mix I (5.62), and lanolin (4.90). In total, 14% of the top allergens were not represented on the North American Contact Dermatitis Group standard series. Of those tested to personal products, 45% had positive reactions and 72% of which were relevant. Conclusions: Emulsifiers and fragrances were the most relevant allergen categories, with the impact of emulsifiers not previously reported. ACD may affect males and females equally in this population. Supplemental allergens and personal products tested "as-is" contribute to conclusive pediatric patch testing.
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PURPOSE: Quantitative bibliometrics are increasingly used to evaluate faculty research productivity. This study benchmarks publication rates for radiation oncologists from highly ranked National Cancer Institute-designated cancer centers and reveals how productivity changes over the arc of a career and of the field over time. METHODS AND MATERIALS: Peer-reviewed articles from 1970 to 2022 were obtained using Scopus for the 348 radiation oncologists listed as faculty for the top 10 cancer hospitals ranked by US News and World Report in 2022. Bibliometrics were analyzed for authorships (AË), authorships where the individual was first or last author (FËL), the monograph equivalent of authorships (MËE), h-index, and ha-index (an analog to h-index using MËE in place of publications). Career start was defined as the year of first publication. Bibliometric inflation was explored by analyzing authorship and bibliometric changes between 1990 and 2022. RESULTS: Publication rates peak, with as much as a 500% increase, 20 to 25 years from the start of a career before declining until retirement. At career ages of 1, 10, 20, and 30 years, the median bibliometrics were AË = (1.5, 4.1, 6.5, 7.0) year-1, FËL = (0.5, 0.9, 1.2, 0.6) year-1, MËE= (0.2, 0.5, 0.7, 0.8) year-1, h-index = (1, 12, 22, 47), and ha-index = (0.4, 4.4, 6.9, 18.4). With regards to authorship patterns across eras, the median number of authors listed per paper increased by 240% between 1990 and 2022. Meanwhile, research productivity per individual as measured by FËL and MËE was unchanged. CONCLUSIONS: The research publication rates of the median radiation oncologist change substantially over the course of their career. Productivity improves steadily for more than 2 decades before peaking and declining. The culture of authorship has also changed between 1990 and 2022. The number of authors listed per paper has trended upwards, which has an inflationary effect on the number of authorships and h-index. Meanwhile, the rate of manuscripts published per faculty has not changed.
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Neoplasias , Radio-Oncologistas , Humanos , Publicações , Bibliometria , Docentes , AutoriaRESUMO
Patch testing is essential for identification of culprit allergens responsible for allergic contact dermatitis. This manuscript reviews how to perform patch testing and how to read and interpret the results.
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Alérgenos , Dermatite Alérgica de Contato/diagnóstico , Testes do Emplastro/métodos , HumanosRESUMO
We characterized skinfluencers from various training backgrounds and compared their posts on Instagram featuring skin care products.
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BACKGROUND: Delusional infestation is the conviction that one's skin is infested with foreign organisms or materials despite contradictory objective evidence. OBJECTIVE: To delineate clinical characteristics of patients presenting with delusional infestation. METHODS: We performed a retrospective study of patients meeting delusional infestation criteria who were seen for diagnosis and treatment in our tertiary care academic medical center (2001-2007). Medical records were reviewed to abstract demographic, historical, and physical findings and treatment. RESULTS: Over 7 years, 147 patients presented with delusional infestation; 87% (123/142) for another opinion. Mean age was 57 years; female-to-male ratio was 2.89 to 1; 82 (56%) were married. Mean duration of symptoms was 31 months. Employment data were available for 145 patients: 48 (33%) were self-described as disabled, 16 of whom cited delusions as their disability; 41 (28%) were retired; and 38 (26%) were employed. Reported infestations included multiple materials (45% [64/143]), not limited to insects (79% [113/143]), worms (27% [39/143]), and fibers (20% [29/143]). Most patients presented initially to dermatology or other specialties; only 3 presented to psychiatry. A high proportion (81%) had prior psychiatric conditions. Thirty-eight (26%) of the 147 patients had a shared psychotic disorder. LIMITATIONS: The retrospective nature of the study and the incompleteness of some data because not all the characteristics that were analyzed were documented for every patient. CONCLUSION: Patients were predominantly female, had a long history of symptoms, and had been seen previously at many medical centers. A large proportion were disabled or retired. Patients reported skin infestation with both animate and inanimate objects.
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Ectoparasitoses/psicologia , Doença de Morgellons/psicologia , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Coortes , Comorbidade , Ectoparasitoses/epidemiologia , Emprego , Feminino , Helmintos , Humanos , Insetos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Doença de Morgellons/epidemiologia , Estudos Retrospectivos , Esquizofrenia Paranoide/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. METHOD: We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. RESULTS: During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. CONCLUSIONS: Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation.
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Assistência Ambulatorial/estatística & dados numéricos , Delusões/epidemiologia , Ectoparasitoses/psicologia , Transtornos Mentais/epidemiologia , Doença de Morgellons/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Delusões/diagnóstico , Ectoparasitoses/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Minnesota , Doença de Morgellons/epidemiologia , Encaminhamento e Consulta , Estudos Retrospectivos , Transtorno Paranoide Compartilhado/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Hairdressers and barbers are among the top occupations to develop occupationally related nickel allergy. While nickel release has previously been detected in metal items in the hairdressing trade, metal items in the barber trade have not been specifically tested. This study screened for nickel release from metal tools in United States barber trade. METHODS: One hundred ninety-two metal tools from 12 barbershops in St. Paul, Minnesota, were tested with dimethylglyoxime test. An employee survey was conducted about each metal tool. RESULTS: Nickel release was detected in 10 of 192 metal tools (5.2%). Items with nickel release included one of 57 scissors (1.7%), one of 32 trimmers (3.1%), four of 13 barbershop chairs (30.8%), three of six cape clips, and one of one nail clippers. CONCLUSIONS: Nickel release was detected in items unique to the barber trade. These items should be considered when preventing and assessing occupational nickel allergy in barbers.
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Dermatite Alérgica de Contato , Níquel , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Humanos , Minnesota , Níquel/efeitos adversos , Ocupações , Inquéritos e Questionários , Estados UnidosRESUMO
Novel diabetic devices are being developed to help manage diabetes and improve the quality of life of patients with diabetes. Both insulin pumps and glucose monitors are becoming increasingly convenient, long-lasting, and discrete for patients, but this often requires the use of strong external cutaneous adhesives and increased contact time with the skin. As a consequence, these devices have been associated with a variety of dermatologic reactions, namely, irritant and allergic contact dermatitis. Some of these reactions can be severe, precluding the use of these devices, which puts patients' long-term health at risk. Herein, we review the history of diabetic devices and reported cutaneous reactions to diabetic devices and commonly cited allergens.
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Adesivos/efeitos adversos , Alérgenos/efeitos adversos , Automonitorização da Glicemia/instrumentação , Dermatite Alérgica de Contato/etiologia , Diabetes Mellitus/terapia , Sistemas de Infusão de Insulina , Acrilatos/efeitos adversos , Equipamentos e Provisões , HumanosRESUMO
BACKGROUND: Health care workers with occupational contact dermatitis often attribute their symptoms to frequent use of alcohol-based hand sanitizers. However, ingredient lists are difficult to obtain, and safe alternatives typically must accommodate brands utilized by a particular hospital system. OBJECTIVE: The aims of this study were to investigate allergenic ingredients present within health care hand sanitizers and to provide a comprehensive product list to assist with allergen avoidance. METHODS: Five major hospitals in Minnesota and 20 hospitals across the United States were called to obtain a product list. The National Library of Medicine's DailyMed Web site was searched to retrieve ingredients. Ingredients were compared with the American Contact Dermatitis Society 2017 Core Allergen Series and cross-reactors. RESULTS: The most common brands included Purell, Ecolab, DebMed, and Avagard. Active ingredients consisted of ethyl alcohol (85.0%), benzalkonium chloride (8.8%), or isopropyl alcohol (2.5%). Top 5 allergens included tocopherol (51.3%), fragrance (40.0%), propylene glycol (27.5%), benzoates (25.0%), and cetyl stearyl alcohol (12.5%). Four sanitizers were free of all American Contact Dermatitis Society allergens; 15 products contained only tocopherol or propylene glycol as allergens. CONCLUSIONS: We identified 19 low-allergen hand sanitizers within the most common brands utilized by US hospital systems. This product list will be useful for patients and health care workers seeking allergen avoidance.
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Alérgenos/efeitos adversos , Anti-Infecciosos Locais/química , Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Higienizadores de Mão/química , Infecção Hospitalar/prevenção & controle , Dermatite Alérgica de Contato/diagnóstico , Higienizadores de Mão/análise , Pessoal de Saúde , Humanos , Testes do Emplastro , Estados UnidosRESUMO
Prescription and over-the-counter topical anesthetics are commonly used. Although allergy to amide and ester anesthetics is known, little has been reported on the nonamide, nonester pramoxine (pramocaine). This article briefly reviews allergy to topical anesthetics, provides detailed information on pramoxine, and describes characteristics of multiple patients with positive, relevant reactions to pramoxine.
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Anestésicos Locais/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Hipersensibilidade a Drogas/etiologia , Morfolinas/efeitos adversos , Administração Tópica , Humanos , Hipersensibilidade Imediata/induzido quimicamenteRESUMO
BACKGROUND: Data regarding patient-reported symptoms during patch testing are limited. OBJECTIVE: To provide frequency of symptoms (pain, sleep difficulty, medication need, site itching, itch elsewhere, and worsening rash) experienced by patients undergoing extensive patch testing and to determine association of these symptoms with patient characteristics. METHODS: This was a retrospective chart review of patients who underwent patch testing at a tertiary referral, contact dermatitis clinic over 15 months. Demographics, number of patches placed, patch location(s), and number of reactions (total and ++/+++) were extracted by chart review. Frequency of symptoms reported on a questionnaire administered at the 48-hour (48H) and final (F) visits was tabulated, and associations were evaluated using χ2 and Fisher exact tests. RESULTS: Six hundred forty-one patient records were accessed. The most common symptom was patch site itching (48H, 77.4%; F, 76.5%). Frequency of pain and sleep difficulty were significantly higher at 48H compared with F (P < 0.0001). Worsening of rash was significantly higher at F compared with 48H (P < 0.0001). The number of patches was significantly associated with all symptoms except sleep difficulty (P ≤ 0.0141). Patch location was significantly associated with pain, medication need, itch elsewhere, and worsening rash but not sleep difficulty or site itch (P ≤ 0.0257). The number of reactions (total and ++/+++) was significantly associated with all symptoms except itch elsewhere (total P ≤ 0.0316; ++/+++: P ≤ 0.0445). CONCLUSIONS: Most patients reported symptoms during patch testing, most commonly itching (at patch site and elsewhere), sleep difficulty, and need for medication. The number of positive patch test reactions (total and ++/+++) was the most common characteristic associated with the symptoms.
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Dermatite Alérgica de Contato/diagnóstico , Exantema/epidemiologia , Dor/epidemiologia , Testes do Emplastro/efeitos adversos , Prurido/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatite Alérgica de Contato/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Avaliação de Sintomas , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Allergic contact dermatitis to rubber accelerators in gloves has been well described in the literature. In response to this, glove manufacturers have recently marketed "accelerator-free" gloves. Little research has been done, to confirm whether these gloves are truly free from the accelerators known to cause contact dermatitis. OBJECTIVE: The aim of the study was to verify use of accelerators in reportedly accelerator-free/low-dermatitis-potential gloves. METHODS: A total of 16 commercially available medical gloves touted as "accelerator-free," "sensitive," or "low dermatitis potential" were obtained and analyzed via mass spectrometry (liquid chromatography heated electrospray ionization tandem mass spectrometry and liquid chromatography heated electrospray high-resolution tandem mass spectrometry) to determine whether any of the 9 known rubber accelerators were present (thiurams, carbamates, mercaptobenzothiazole, and diphenylguanidine). RESULTS: Despite marketing claims to the contrary, all tested gloves had at least 1 accelerant detected. Dipentamethylenethiuram disulfide, a thiuram, was found in all 16 gloves. Half of the gloves (8/16) contained more than 1 accelerator, with 1 glove having 5 rubber accelerators present. CONCLUSION: Patients with allergic contact dermatitis to accelerators should be aware potentially sensitizing accelerators may be present in gloves that are reported to not contain them.
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BACKGROUND: Contact dermatitis can be difficult to manage and overwhelming for patients, often requiring significant lifestyle changes. OBJECTIVE: The aim of the study was to investigate whether a contact dermatitis support group could help patients find community and learn from others who share similar experiences. METHODS: Hour-long, monthly support group meetings facilitated by a social worker, research fellows, and a faculty dermatologist were held for approximately 1.5 years. A 32-question, cross-sectional survey was administered to assess perception of contact dermatitis and overall usefulness of the group. RESULTS: Between 2 and 5 patients attended each group session; 9 participants completed the survey. Most were female (77.8%) and white (77.8%), with an average age of 68.8 years. Eight participants (88.9%) reported that it was important or somewhat important to socialize with others affected by contact dermatitis. Three group members (33.3%) had met with attendees outside of the monthly sessions. The majority (77.8%) reported that the support group had a positive effect on their understanding of contact dermatitis and would recommend the group to others (88.9%). CONCLUSIONS: Support groups may be helpful for patients learning to cope with the challenges associated with contact dermatitis. Although preliminary feedback is promising, further investigation is warranted to determine whether these groups are effective on a larger scale.