Atopy patch tests may identify patients at risk for systemic contact dermatitis.

BACKGROUND: A subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients. METHODS: We present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen-specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non-AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel. RESULTS: APT demonstrated fewer positive results than serum-specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD. CONCLUSION: Our aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low-potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.

Patterns and risk factors of causative contact allergens in Thai adult patients with contact dermatitis

BACKGROUND: Surveillance on common allergens identified by patch testing plays an important role in emerging allergen detection, which leads to both individual and societal level prevention. OBJECTIVE: To study the changes in the pattern of contact sensitization and to identify risk factors associated with allergens. METHOD: The data of 206 patients who underwent patch testing at King Chulalongkorn Memorial Hospital during 2012 to 2015 were assessed. The associations between patient risk factors and positive reactions to each allergen were evaluated. The results were compared with data from 2003-2004. RESULTS: The top five most common allergens during 2012-2015 were nickel sulfate (19.4%), methylchloroisothiazolinone/ methylisothiazolinone (MCI/MI) (13.6%), fragrance mix I (FM I) (10.7%), carba mix (9.2%) and cobalt chloride (6.3%) whereas, during 2003-2004, these were nickel sulfate, cobalt chloride, FM I, potassium dichromate and Myroxylon pereirae. A positive patch test to nickel was strongly associated with a history of metal and seafood allergy (p<0.001; OR, 4.94; 95% CI = 2.33-10.47 and p=0.028; OR, 2.55; 95% CI, 1.11-5.85, respectively). MCI/MI was correlated with a history of personal care products allergy, and fragrance was correlated with a history of urticaria (p=0.005; OR, 4.05; 95% CI = 1.54-10.66 and p=0.031; OR, 2.71; 95% CI, 1.10-6.68, respectively). CONCLUSIONS: There was an alteration in the pattern of contact sensitization detected by our standard series. MCI/MI has become the most common preservative causing contact allergy.

Allergic contact dermatitis: Patient diagnosis and evaluation.

Allergic contact dermatitis resulting from exposure to a chemical or chemicals is a common diagnosis in the dermatologist's office. We are exposed to hundreds of potential allergens daily. Patch testing is the criterion standard for diagnosing the causative allergens responsible for allergic contact dermatitis. Patch testing beyond standard trays is often needed to fully diagnose patients, but not all dermatology practices have access to this testing procedure or these allergens. In order to adequately evaluate patients, physicians must understand the pathophysiology of the disease process and be well versed in the proper evaluation of patients, indications for patch testing, proper testing procedure, and other diagnostic tools available and be aware of new and emerging allergens.

Allergic contact dermatitis: Patient management and education.

Allergic contact dermatitis is a common diagnosis resulting from exposure to a chemical or chemicals in a patient's personal care products, home, or work environment. Once patch testing has been performed, the education and management process begins. After the causative allergens have been identified, patient education is critical to the proper treatment and management of the patient. This must occur if the dermatitis is to resolve. Detailed education is imperative, and several resources are highlighted. Photoallergic contact dermatitis and occupational contact dermatitis are other considerations a clinician must keep in mind.

The Financial and Emotional Impact of Atopic Dermatitis on Children and Their Families.

OBJECTIVE: To examine the personal financial impact of atopic dermatitis (AD) and attempt to correlate cost of AD with emotional impact. STUDY DESIGN: Between March 2011 and December 2013, 82 caretakers of children 6 months to 12 years of age with moderate-to-severe AD were recruited at the time of dermatology clinic visits in Cleveland, Ohio, to complete surveys. The response rate was >95%. Participants were asked questions about direct expenses (medical visits, medications, and other products) and indirect expenses (time missed from work, childcare costs) related to AD in the past 4 weeks. Emotional impact was measured by the Childhood Atopic Dermatitis Impact Scale. RESULTS: The mean monthly personal cost of AD in the month before the office visit was $274 (median $114; IQR $29, $276), with $75 from direct costs (median $45; IQR $20, $110) and $199 from indirect costs (median $0; IQR $0, $208). An average of 34.8% of available monthly money was spent on AD care in the month before the office visit. For patients with Medicaid, there was a significant correlation between monthly adjusted personal cost and Childhood Atopic Dermatitis Impact Scale score (r = 0.548; P < .001); however, this correlation did not exist for patients who had commercial insurance (r = 0.269; P = .166). CONCLUSIONS: Our results illustrate the high emotional and financial burden of childhood AD and provide insight into spending patterns. In addition, our study correlate costs with emotional burden of AD for lower-income patients.

Oat and wheat as contact allergens in personal care products.

Oat and wheat are used as ingredients in various cosmetics and personal care products because of their moisturizing properties. Impaired barrier functions in atopic dermatitis (AD) may increase the risks of sensitization to oat and wheat proteins via skin. Immediate- and delayed-type hypersensitivity reactions to oat and wheat in personal care products have been reported in previous studies, and most of those cases were patients with AD. Patch testing with oat and wheat proteins should be performed more frequently, especially in atopic children. It may help identify contact dermatitis, which may be a cause of flares in patients with AD. Complete avoidance of oat- or wheat-derived products is suggested as we cannot conclude that some oat- or wheat-derived components such as oils are free of protein.

Long-pulsed 1064-nm Nd:YAG laser significantly improves keratosis pilaris: a randomized, evaluator-blind study.

BACKGROUND: Keratosis pilaris (KP) is a very common disorder; yet, very few treatment options are available. OBJECTIVES: To evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser for the treatment of KP. MATERIALS AND METHODS: Eighteen patients with untreated KP on the upper outer arms were enrolled in a randomized clinical trial. One arm was treated with long-pulsed 1064-nm Nd:YAG laser at 30 msec pulse width and fluence of 34 J/cm(2), while the contralateral arm served as control. Patients received three consecutive treatments at 4-week intervals. Three blinded dermatologists assessed digital photographs using a quartile grading system to separately rate global improvement, erythema and the number of keratotic papules. RESULTS: Seventeen patients completed the study. There were statistically significant improvements in global assessment, erythema and the number of keratotic papules at 4 weeks after the last treatment (p < 0.05). All patients also stated that their lesions improved and were satisfied with the laser treatment. CONCLUSION: Long-pulsed 1064-nm Nd:YAG laser has been shown to improve KP in Thai patients compared with control after three treatment sessions.

Periorbital rejuvenation with fractional 1,550-nm ytterbium/erbium fiber laser and variable square pulse 2,940-nm erbium:YAG laser in Asians: a comparison study.

BACKGROUND: Ablative and fractional lasers are used for periorbital rejuvenation, with different downtime, side effects, and efficacy. OBJECTIVES: To compare effects of fractional 1,550-nm ytterbium- and erbium-doped (Yb/Er) fiber laser and variable square pulse (VSP) 2,940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser treatment for periorbital wrinkles. MATERIALS AND METHODS: This side-by-side comparison study randomized 22 women with mild to moderate periorbital rhytides to receive three treatments with fractional 1,550-nm Yb/Er fiber laser or 2,940-nm Er:YAG laser treatment on either side at 4-week intervals. A video camera was used for objective assessment of wrinkles. Standardized photographs, patient satisfaction, side effects, and pain score were recorded. RESULTS: Twenty subjects completed the study. The median change in wrinkle measurement 3 months after laser treatments from baseline of the fractional Yb/Er fiber laser side was -3.03 versus -3.09 on the VSP Er:YAG side (p = .63, Wilcoxon signed-rank test). There was no significant difference in degree of wrinkle improvement analyzed according to global assessment between the sides (p = .25, Wilcoxon signed-rank test). Less downtime correlated with greater patient satisfaction of the fractional laser treatment . Two subjects experienced hyperpigmentation. CONCLUSION: Fractional Yb/Er fiber and VSP Er:YAG lasers are effective in improving periorbital wrinkles in Asians, with minimal side effects.

Split-face comparison of long-pulse-duration neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm laser alone and combination long-pulse and Q-switched Nd:YAG 1,064-nm laser with carbon photoenhancer lotion for the treatment of enlarged pores in Asian women.

BACKGROUND: Long-pulse and Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm laser used for facial rejuvenation can improve pore size. Topical carbon has been used to enhance efficacy. OBJECTIVE: To compare the efficacy and safety of a 1,064-nm long-pulse Nd:YAG laser alone with that of a combination Q-switched Nd:YAG laser with topical carbon lotion followed by long-pulse Nd:YAG to improve enlarged pores. METHODS: Twenty Thai women randomly received five treatments with a long-pulse Nd:YAG laser on one facial half (LP side) and long-pulse Nd:YAG after carbon-assisted Q-switched Nd:YAG laser on the contralateral side (carbon QS+LP side) at 2-week intervals. Participants were evaluated using digital photography, complexion analysis, and a chromometer. RESULTS: There was significant decrease in pore counts of 35.5% and 33% from baseline on the carbon QS+LP and LP sides, respectively. Physician-evaluated pore size improvement was 67% on the carbon QS+LP sides and 60% on the LP sides. Chromometer measurement showed an increase in skin lightness index. There was no significant difference between the two treatments, although there were more adverse effects on the carbon QS+LP side. CONCLUSION: Long-pulse Nd:YAG 1,064-nm laser improves the appearance of facial pores and skin color. Adding carbon-assisted Q-switched Nd:YAG did not enhance the results but produced more side effects.

Pattern of corticosteroid allergy in Thailand.

BACKGROUND: Corticosteroid allergy is a complication of topical therapy detected by patch-testing with corticosteroid allergens. OBJECTIVE AND METHODS: Ten-year retrospective review to study the prevalence and patterns of corticosteroid allergy in Thai patients. RESULTS: Of 882 patients who were patch-tested, 29 (3.29%) had allergic reactions to corticosteroids. Of these 29 patients, 17 (58.62%) had positive reactions to one corticosteroid, and 12 (41.38%) reacted to multiple corticosteroids. Rates of reaction to corticosteroid groups ranged from 31.03 to 80.95%. Concomitant reactions between groups were noted. The prevalence of topical corticosteroid allergy (using two screening allergens, tixocortol pivalate and budesonide) was 2.27% (20 of 882). Testing with additional steroid allergens in suspected cases increased the prevalence to 3.29%. Tixocortol pivalate detected 51.72% of corticosteroid-allergic cases, and budesonide detected 24.14%. Combining both tixocortol and budesonide detected 68.97% of cases. CONCLUSION: Corticosteroid allergy is found to multiple corticosteroids, and concomitant reactions occur across groups. Group D1 corticosteroid esters produced a higher positive reaction rate (61.9%) than groups D2 (52.38%) and A (51.72%). This may be due to different prescribing habits or the easy access to D1 corticosteroids sold over the counter by pharmacies in Thailand.

Purpura-free treatment of lentigines using a long-pulsed 595 nm pulsed dye laser with compression handpiece: a randomized, controlled study.

BACKGROUND: Pulsed dye lasers (PDL) are one of the first, and popular, nonablative lasers for the treatment of rhytids and superficial pigmented lesions. Recent addition of a compression handpiece (CHP) allows treatments with minimal adverse effects. OBJECTIVES: The purpose of this study was to investigate the efficacy and safety of new parameters of 595 nm PDL in the treatment of lentigines and wrinkles in the darker skin phototypes. MATERIALS AND METHODS: Ten female subjects with photodamaged skin were enrolled in this study. One side of the face received three monthly treatments with one pass of PDL with the fluence of 6 J/cm2, 6 msec pulse duration followed by a second pass when lentigines were individually treated with CHP 6 J/cm2, 6 msec with CHP. The untreated side served as control. Digital photography was used for global evaluation while the numbers of lentigines and wrinkles were analyzed by VISIA. RESULTS: All 10 subjects, aged 39-55 years, completed the study. The mean changes in numbers of lentigines at the twelfth week on the treated side was -6.1 (decrease), while that of the controlled side was +2.8 (increase) (P=0.075, paired t test). There was also a statistically significant difference in the degree of improvement of lentigines by global assessment (P=0.008, Wilcoxon signed rank test). No statistically significant difference in the degree of improvement of wrinkles analyzed by VISIA (P=0.490) and global assessment (P=0.157, Wilcoxon signed rank test) was observed. Hyperpigmentation was seen in two subjects. CONCLUSION: The parameters of 595 nm PDL used in this study are effective and safe in the treatment of facial lentigines. There was no significant improvement in wrinkles in this study. A study limitation may be the relatively small sample size.