Fragrance series testing in eyelid dermatitis.

BACKGROUND: Allergic contact dermatitis is considered one of the most common causes of eyelid dermatitis. In addition to metals and topical antibiotics, fragrances have emerged as a leading source of contact allergy for individuals with this condition. OBJECTIVES: The objective of this study was to determine the added benefit of including a fragrance tray when patch testing patients presenting with eyelid dermatitis. METHODS: During a 4.5-year period, all patients with suspected allergic contact dermatitis involving the eyelids were patch tested with both standard and fragrance trays. RESULTS: One hundred consecutive patients with eyelid dermatitis were patch tested. Of these patients, 42 (42%) tested positive for 1 or more allergens within the fragrance series. Of these patients, 15 (36%) had no fragrance markers detected on the standard series, and these allergens would therefore have been missed had fragrance series testing not been performed. Overall, fragrance markers within the standard series detected 73.2% (41/56) of cases of fragrance allergy. CONCLUSIONS: Our results suggest that there may be a significant benefit to fragrance series testing in patients with eyelid dermatitis. Fragrance tray inclusion in this population may identify additional cases of fragrance allergy that are missed by the standard series.

Isocyanates.

Owing to the widespread use of isocyanate-derived products across multiple industries, it is important for physicians to be aware of their sensitizing potential. We first provide a general overview of isocyanates and the industries that may be associated with exposure to these compounds. This is followed by a description of the most commonly used isocyanate products in commercial patch test preparations. Finally, we discuss appropriate isocyanate patch testing methodology and optimal isocyanate patch test concentrations.

Flare of pustular psoriasis after initiating ustekinumab therapy.

Anti-tumor necrosis factor-α therapy has been paradoxically associated with the new development or worsening of existing psoriasis. We describe the case of a patient who experienced a flare of pustular psoriasis after initiating anti-interleukin-12/23 therapy, which subsequently improved following discontinuation of the drug.

Cystic fibrosis presenting with dermatitis.

BACKGROUND: Patients with cystic fibrosis classically present with evidence of pulmonary disease, exocrine pancreatic insufficiency, and high sweat chloride concentrations. Dermatitis as an initial manifestation of the disease is uncommon and has been attributed to multiple nutritional deficiencies. OBSERVATION: We describe the case of a 3-month-old female infant with cystic fibrosis presenting with dermatitis in the setting of protein-energy malnutrition. A review of the laboratory study results in this case and others showed that a deficiency in zinc, essential fatty acids, and protein likely contributes to the development of the rash seen in cystic fibrosis. CONCLUSIONS: Given the frequent delay in diagnosis, as well as the increased morbidity and mortality associated with protein-energy malnutrition in these patients, it is important to consider cystic fibrosis as a possible diagnosis in any infant presenting with a rash and other signs of malnutrition. The relative contribution of specific nutritional deficiencies and the degree to which they influence and interact with each other in producing the dermatitis remain unclear, although they may all affect a common underlying metabolic pathway.