Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016.

BACKGROUND: Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE). OBJECTIVES: To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing. METHODS: A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed. RESULTS: Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ2 -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone. CONCLUSIONS: Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens.

Dermatologic diagnosis and treatment of itchy red eyelids.

Distinguishing the cause of itching, red eyelids is often difficult. Pruritic, inflamed eyelids can reflect various etiologies and are a common clinical presentation to the office of a dermatologist or ophthalmologist. In this article, five of the more common causes of eyelid dermatitis (atopic dermatitis, contact dermatitis, contact urticaria, rosacea, seborrhea, and psoriasis) are reviewed in detail, with particular emphasis on the ocular and periocular features. Clinical clues, historical features, and patch testing in cases of eczematous eyelid dermatitis aid in differential diagnosis. In addition, pathogenesis and treatment are reviewed.

Assessing the preferences of patients with psoriasis. A quantitative, utility approach.

BACKGROUND AND DESIGN: Patient preferences for health outcomes can be explicitly assessed and expressed in quantitative terms known as utilities. Three standard methods for utility assessment have been used to quantify patient preferences, but these methods have not previously been applied to skin disease. Eighty-seven patients with psoriasis from a tertiary medical center were interviewed, using an interactive, computer-based utility assessment questionnaire, U-Titer. Utilities for three categories of psoriasis severity and potential adverse outcomes of methotrexate therapy were assessed by the vertical rating scale, time trade-off, and standard gamble. RESULTS: Patients assigned a broad range of utilities for each of the health states. Utilities obtained by the vertical rating scale did not correlate well with utilities obtained by standard gamble or time trade-off methods. However, utilities assessed by standard gamble and time trade-off were not significantly different. Patient characteristics such as age, gender, and education were not correlated with utility and did not explain the variation. Indicators of the patients' disease severity were not predictive of utilities for the assessed health states. The relatively high utility for liver biopsy suggests that there is less patient aversion to the procedure than suspected. CONCLUSIONS: Utilities, or quantitative measures of patient preferences for health states, are measurable and vary widely for mild, moderate, and severe psoriasis and possible adverse outcomes of methotrexate treatment. The process of elucidating individual patient utilities for various health outcomes can be used to incorporate patient preferences into the process of clinical decision making. Guidelines that are based solely on severity of symptoms, without input from patients on how they value such symptoms, must be questioned.

Sesquiterpene lactone allergy.

Sesquiterpene lactones are a large, diverse group of chemicals found in several plant families that cause allergic contact dermatitis. The biological, botanical, allergenic, and structural significance of sesquiterpene lactones is explored as well as the clinical characteristics of cutaneous reactions. The association with UV-light sensitivity and proposed mechanisms for this relationship as well as new developments in patch test methods and treatment are reviewed.

Eczematous dermatitis: a practical review.

Eczematous dermatitis is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritus may be stressful and frustrating for patients. The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence. Other common eczematous dermatoses, particularly allergic dermatitis and irritant contact dermatitis, must be accurately diagnosed, since improvement and resolution rely on appropriate diagnosis and avoidance of pertinent triggering factors. Principles of treatment include general skin care, patient education about avoidance of irritants, skin hydration and the use of topical corticosteroids when necessary. Use of systemic corticosteroids is not generally recommended for the treatment of chronic eczematous dermatitis.

Contact dermatitis to multiple exotic woods.

Occupational contact dermatitis to individual wood species from foreign countries, such as Asia, Africa, Central America, and South America, has been described. This report concerns the case of a domestic woodworker who developed allergic contact dermatitis shortly after beginning to work with multiple exotic woods. Patch testing with domestic and exotic wood fresh sawdust samples, 1% and 10% in petrolatum, yielded strong positive reactions to six exotic woods: zericote, pao ferro, cocobolo, becote, macassar ebony, and padauk. Later testing confirmed sensitivity to the allergenic quinonoid constituents in pao ferro (R-3,4-dimethoxydalbergione), cocobolo (obtusaquinone), and macassar ebony (macassar quinone).

Triethanolamine allergy inadvertently discovered from a fluorescent marking pen.

Triethanolamine is used as an emulsifier in many topical preparations and is an infrequent cause of contact allergy. We report a case of a woman with a contact allergy to triethanolamine inadvertently discovered when she had a reaction to a triethanolamine-containing fluorescent marking pen that was used in patch testing. On further investigation, triethanolamine was found to be in several of her topical products.

Systemic contact dermatitis to raw cashew nuts in a pesto sauce.

Systemic contact dermatitis from the cashew nut shell oil resorcinol allergens cardol and anacardic acid is recognized clinically as a dermatitis with flexural accentuation, typically distributed on the extremities, groin, and buttocks, and occurring generally 1 to 3 days after ingestion of raw cashew nuts contaminated with allergenic oil. We report a case of systemic contact dermatitis to raw cashew nuts, an atypical and unexpected ingredient flavoring an imported pesto sauce. Plants with allergens that potentially cross-react with poison ivy and other Toxicodendrons, and the concepts of systemic contact dermatitis and hyposensitization are reviewed.

Evaluation and management of the "red face". Interview by K. Watsky and M. Rothe.

Patients presenting with a "red face" challenge clinicians to consider a broad differential diagnosis that includes contact dermatitis. The diagnosis may be obscured or complicated by underlying actinic damage or rosacea. Unraveling this Gordian knot to arrive at a precise and accurate diagnosis takes patience and practice. The collective experience of our invited group of expert clinicians sheds light on this process.