Issues in transgender dermatology: A systematic review of the literature.

BACKGROUND: Transgender patients have many unique dermatologic needs, yet the literature concerning dermatologic care of transgender individuals is lacking. OBJECTIVE: We aimed to provide a systematic review of the literature on dermatology care in transgender individuals to provide a foundation for future research and education. METHODS: We systematically reviewed peer-reviewed published studies that examined dermatologic treatment of transgender patients. RESULTS: A total of 110 articles met the inclusion criteria for systematic review. LIMITATIONS: Because of a lack of quantitative research in transgender dermatology, much of the available literature included in this review relies on case reports and expert opinions. CONCLUSION: Dermatologists have the ability to greatly affect the care of transgender patients, and there are ample opportunities for dermatologists to expand the literature pertaining to this population.

Different concentrations and volumes of p-phenylenediamine in pet. (equivalent doses) are associated with similar patch test outcomes: a pilot study.

BACKGROUND: Concern about causing active sensitization when patch testing is performed with p-phenylenediamine (PPD) 1% pet. has led to a recommendation to use PPD 0.3% pet. as a potentially safer preparation. However, the dose per area of allergen delivered, and hence the risk of active sensitization, depend on the amount dispensed into the patch test chamber, which can vary widely. OBJECTIVE: To evaluate whether patch testing with equivalent doses of different concentrations of PPD in pet. is associated with similar outcomes. METHODS: Seventeen known PPD-sensitive subjects were patch tested with different volumes and concentrations of PPD in pet. that deliver the same allergen dose per unit area (6 mg of PPD 1% pet. and 20 mg of PPD 0.3% pet. in Finn Chambers®, both equivalent to ∼ 0.09 mg/cm2 ). RESULTS: Eleven patients (65%) had positive reactions to both doses; 4 patients (24%) had negative results [percentage agreement of 88% (15/17)]. One patient each had a positive reaction to only one dose. CONCLUSIONS: The 88% concordance suggests that dose per unit area is more important in determining reactions to allergens than the excipient volume dispensed. Patch testing with a smaller volume of 1% PPD may be a reasonable alternative to testing with 20 mg of 0.3% PPD.

Pediatric "pet consort dermatitis"-Allergic contact dermatitis from transfer of bronopol from a pet cat.

Consort dermatitis refers to an allergic contact dermatitis caused by transfer from an intimate contact to a sensitized patient. Although close contact with other humans most commonly provokes consort dermatitis, pets have been the source in a minority of cases. We present a unique case of transfer dermatitis from a patient's cat litter to her forearms. Pediatric dermatologists should be aware of the possibility of consort or "transfer" allergic contact dermatitis from pets.

Temozolomide-induced inflammation of disseminated superficial actinic porokeratosis.

We report a case of temozolomide (TMZ)-induced inflammation of disseminated superficial actinic porokeratosis (DSAP), an uncommon and pre-malignant cutaneous disorder. Dermatologists and oncologists should be aware of this cutaneous eruption of DSAP associated with TMZ to prevent the discontinuation of effective medical therapy in cancer patients.

Association between atopic dermatitis and contact sensitization: A systematic review and meta-analysis.

BACKGROUND: It is unclear whether patients with atopic dermatitis (AD) have an altered prevalence or risk for contact sensitization. Increased exposure to chemicals in topical products together with impaired skin barrier function suggest a higher risk, whereas the immune profile suggests a lower risk. OBJECTIVE: To perform a systematic review and meta-analysis of the association between AD and contact sensitization. METHODS: The PubMed/Medline, Embase, and Cochrane databases were searched for articles that reported on contact sensitization in individuals with and without AD. RESULTS: The literature search yielded 10,083 citations; 417 were selected based on title and abstract screening and 74 met inclusion criteria. In a pooled analysis, no significant difference in contact sensitization between AD and controls was evident (random effects model odds ratio [OR] = 0.891; 95% confidence interval [CI] = 0.771-1.03). There was a positive correlation in studies that compared AD patients with individuals from the general population (OR 1.50, 95% CI 1.23-1.93) but an inverse association when comparing with referred populations (OR 0.753, 95% CI 0.63-0.90). LIMITATIONS: Included studies used different tools to diagnose AD and did not always provide information on current or past disease. Patch test allergens varied between studies. CONCLUSION: No overall relationship between AD and contact sensitization was found. We recommend that clinicians consider patch testing AD patients when allergic contact dermatitis is suspected.

V-Y Advancement Flaps Based on Yotsuyanagi Aesthetic Subunit Principles for Small Nasal Defects in Asian Patients.

Cosmesis is paramount in the reconstruction of small nasal defects. Yotsuyanagi et al have previously described nasal aesthetic subunits in patients of Asian descent and their implications for reconstruction of large nasal defects, including forehead flap and Z-plasty. The impact of Asian skin types and aesthetic subunits on reconstruction planning of small nasal defects has not been rigorously explored. The aim of this article is to present a novel method for repairing small nose defects in patients of Asian descent using V-Y advancement flap designed using Yotsuyanagi nasal subunit aesthetic principles. A total of 21 defects ranging from 7 to 22 mm in size in 21 patients of Asian descent were repaired with either 1 or 2 V-Y advancement flaps designed along Yotsuyanagi nasal subunit borders. All reconstructions were completed successfully in one stage. Scars were inconspicuous and nasal subunits were neither displaced nor twisted. All patients were pleased with the cosmetic outcomes. The use of V-Y advancement flaps based on Asian aesthetic nasal subunit principles for the reconstruction of small nasal defects is a novel, cosmetically sensitive alternative.

Jewellery: alloy composition and release of nickel, cobalt and lead assessed with the EU synthetic sweat method.

BACKGROUND: Several studies have shown nickel and cobalt release from jewellery by using spot tests, but the metal composition of jewellery is largely unknown. OBJECTIVES: To evaluate the metal composition of a large worldwide sample of mainly inexpensive jewellery items, and investigate the release of nickel, cobalt and lead from a subsample by using EN 1811:1998-required methods. METHODS: A total of 956 metallic jewellery components were examined with X-ray fluorescence spectroscopy. A subsample of 96 jewellery items purchased in the United States were investigated for nickel, cobalt and lead release by the use of artificial sweat immersion and plasma optical emission spectroscopy. RESULTS: Eighteen elements were detected. The 10 most frequently occurring were, in order of frequency, copper, iron, zinc, nickel, silver, chromium, tin, manganese, lead, and cobalt. Release of nickel was noted from 79 of the 96 US samples (0.01-98 µg/cm(2) /week), release of cobalt from 35 samples (0.02-0.5 µg/cm(2) /week), and release of lead from 37 samples (0.03-2718 µg/cm(2) /week). CONCLUSIONS: We present here a comprehensive list of the most frequently encountered metals in jewellery and fashion accessories. Different allergenic and non-allergenic metals are utilized. We also report the frequent release of nickel, cobalt and lead from these objects, despite legislative restrictions.

Easter egg hunt dermatitis: systemic allergic contact dermatitis associated with chocolate ingestion.

Pediatric systemic allergic contact dermatitis to nickel has previously been reported in association with cocoa. We present four clinical cases of hypersensitivity temporally associated with chocolate consumption at Easter. Clinicians should be aware of the potential for foods high in nickel to provoke patients with known nickel sensitivity and systemic dermatitis.

Spectrometric analysis of mercury content in 549 skin-lightening products: is mercury toxicity a hidden global health hazard?

BACKGROUND: Cosmetic skin lightening is practiced worldwide. Mercury is a well-documented melanotoxin added to some lightening products. However, mercury can cause many dermatologic, renal, and neurologic problems. The Food and Drug Administration limits the amount of mercury in cosmetic products to trace amounts, 1 ppm. OBJECTIVE: The objective of this study was to quantitatively evaluate a large international sample of lightening products for mercury content, focusing on products available to US consumers either online or in stores. METHODS: A total of 549 skin-lightening products, manufactured in 32 countries, were purchased online in the United States, Taiwan, and Japan and in stores in the United States, China, Taiwan, Thailand, Japan, and Sri Lanka. Cosmetics were screened for mercury content above 200 ppm using a low-cost portable x-ray fluorescence spectrometer. RESULTS: Of the 549 tested products, 6.0% (n = 33) contained mercury above 1000 ppm. In all, 45% of mercury-containing samples contained mercury in excess of 10,000 ppm. Of lightening products purchased in the United States, 3.3% were found to contain mercury in excess of 1000 ppm. LIMITATIONS: Our study did not evaluate creams for other melanosuppressive ingredients. Only 1 sample of each product was tested. CONCLUSION: Our study confirms the national and global presence of mercury in skin-lightening products.

p-Phenylenediamine and other allergens in hair dye products in the United States: a consumer exposure study.

BACKGROUND: Hair dye products constitute an important source of allergen exposure, and contribute importantly to allergic contact dermatitis in consumers and hairdressers. OBJECTIVES: To evaluate the presence of potent contact sensitizers in oxidative hair dye products intended for home use on the US market. METHODS: Ingredient labels of 107 hair dyes from 10 major brands were examined and used to assess the prevalence of hair dye substances known to be potent contact sensitizers. RESULTS: One hundred and six of 107 (99%) products contained at least one potent sensitizer, and the average product contained six (range 0-11). p-Phenylenediamine (PPD) was found in 83 products (78%), but resorcinol (89%), m-aminophenol (75%), p-aminophenol (60%) and toluene-2,5-diamine (21%) were also frequently identified. CONCLUSIONS: Potent contact sensitizers were almost universally included in the hair dyes investigated in the United States. Although PPD is a common allergen, resorcinol and m-aminophenol were found more frequently. In total, 30 potent sensitizers were found. Clinicians should consider other allergens in addition to PPD when evaluating patients with suspected hair dye allergy.

An unusual presentation of nickel-associated "school chair sign".

Symmetric sources of exposure generally result in symmetric contact dermatitis, but patient habits may distort or modify exposures in ways that may obscure clinical relevance. We present a variant of "school chair sign" consistent with the child's usual habit of sitting obliquely with her right leg crossed over her left leg.