Primary penile melanoma and genital lichen sclerosus.

Background: There is a well-established association between squamous cell cancer and genital lichen sclerosus (GLSc). Although there have been several reported cases of vulval melanoma (MM) associated with LSc, particularly in the paediatric population, fewer cases of male genital (M) GLSc and penile (Pe)MM have been published. Objectives: The aim of this study was to explore further the relationship between PeMM and MGLSc by reviewing all the cases managed by our multidisciplinary service over a finite period. Methods: All patients known to our tertiary urology and male genital dermatology service with a diagnosis of PeMM and where histology was available for review were identified over an 11-year period (2011-2022). The histology was reviewed by two independent, mutually 'blinded' histopathologists. Photographs and clinical notes, where available, were retrospectively reviewed by two independent dermatologists for signs or symptoms of LSc. Results: Eleven patients with PeMM were identified for review. Histopathological examination found evidence of LSc in nine patients, and review of clinical photos corroborated the presence of LSc in three. Overall, features of LSc were present in nine out of eleven cases (82%). Conclusion: The presence of LSc in 9 out of 11 cases of PeMM is suggestive of a causative relationship between LSc and PeMM. This may be due to chronic melanocytic distress created by chronic inflammation secondary to LSc.

Presentations to emergency departments in Melbourne, Australia diagnosed as allergic contact dermatitis.

BACKGROUND: This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management. METHODS: A multisite retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed. RESULTS: Two hundred twenty-eighty patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs. 14.5%, P = 0.004) topical corticosteroids (92.9% vs. 38.7%, P < 0.01), emollients (38.1% vs. 20.4%, P = 0.01) and less often advising antihistamines (16.7% vs. 44.6%, P < 0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs. 11.1%, P < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs. 4%, P = 0.01). CONCLUSION: Improved understanding, diagnosis and management of CD are needed in EDs.

Hyperkeratotic flexural erythema (more commonly known as granular parakeratosis) with use of laundry sanitizers containing benzalkonium chloride.

BACKGROUND: Hyperkeratotic flexural erythema (HKFE), also known as granular parakeratosis, is a scaly, erythematous or brown eruption, which usually occurs in the intertriginous and flexural areas. It has been linked to the use of benzalkonium chloride (BAK). AIM: To review the clinical presentation of patients diagnosed with HKFE who had been exposed to laundry sanitizer containing BAK, and the therapies trialled to treat these patients. METHODS: This was a retrospective cases series of 45 patients seen by dermatologists in Victoria, Australia. Information was collected on clinical presentation, investigation and management. RESULTS: The patients varied in age from 18 months to 89 years. The rash typically presented as a symmetrical erythema with characteristic multilayered brownish epidermal scaling. The most common location of the rash was the inguinal/anogenital area (32 of 45 patients; 71.1%) and there was a female predominance. Regarding treatment, topical corticosteroids were frequently prescribed and antibiotics were trialled in 11 patients; however, the condition resolved spontaneously over time in all patients with use of emollients, along with cleaning of the washing machine by running an empty wash, and repeated washing or sometimes disposal of BAK-contaminated clothing. CONCLUSION: This large case series highlighted the characteristic clinical presentation of HKFE in the setting of BAK used in laundry sanitizer, demonstrating a potential causal link. Further studies are required to evaluate the role of the skin microbiome.

Contact dermatitis.

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

Contact allergy and allergic contact dermatitis from benzalkonium chloride in a tertiary dermatology center in Melbourne, Australia.

BACKGROUND: Benzalkonium chloride (BAK) is a quaternary ammonium compound that is used widely as an antiseptic and preservative. It is a strong irritant and considered a weak sensitizer. OBJECTIVE: To analyze the temporal trend of BAK sensitization and the demographics of sensitized patients. METHODS: We conducted a single-center retrospective study of 7390 patients who were patch tested with BAK between January 1, 2003 and December 31, 2019. RESULTS: Of the 7390 patients who were patch tested to BAK, 108 (1.5%) had a positive reaction, with 21 reactions deemed clinically relevant (0.3% of total patch tested) and a further 5 doubtful reactions deemed clinically relevant, resulting in a total of 26 relevant reactions (0.4% of total patch tested). Common sources of exposure were ophthalmic drops (30.8%), topical antiseptic preparations (26.9%), cosmetics (15.4%), disinfectant solutions (11.5%), hand sanitizers (11.5%), and hand washes (7.7%). One fifth of patients with relevant reactions were health care workers. There has been a dramatic increase in the number of positive reactions since 2017, for reasons not totally clear. CONCLUSION: Contact allergy (CA) and allergic contact dermatitis (ACD) in response to BAK are now increasing at our center. Awareness of this trend is important, given that the coronavirus disease 2019 (COVID-19) pandemic is likely to further expose people to BAK.

How good is the Australian baseline series at detecting allergic contact dermatitis?

BACKGROUND: Patch testing is the gold standard for the diagnosis of allergic contact dermatitis (ACD). The Australian Baseline Series (ABS) was formulated by our group to include the 60 most common and relevant allergens in our patient population. The aim of this study was to assess the efficacy of testing with the Australian Baseline Series in order to diagnose allergic contact dermatitis. METHODS: We conducted a retrospective study of 964 patients with ACD diagnosed at our centre from 1 January 2012 to 31 December 2018. Patients with at least one relevant positive reaction were stratified into three groups: i) reactions only to allergens in the Australian Baseline Series; ii) reactions to allergens in the Australian Baseline Series and to additional allergens; and iii) reactions only to allergens not present in the Australian Baseline Series. RESULTS: The Australian Baseline Series alone was successful in identifying the cause of allergic contact dermatitis in 63.4% (611/964) of patients. In 23.0% (222/964), the Australian Baseline Series detected at least one relevant allergen, but there were relevant allergens outside of the Australian Baseline Series as well. In 13.6% (141/964), no relevant allergens were detected in the Australian Baseline Series, but allergens were detected in additional series or by testing patients' own products. The most frequently occurring allergens not included in the Australian Baseline Series were citral, ammonium persulfate, geraniol, oakmoss absolute and chlorhexidine diacetate. CONCLUSIONS: The Australian Baseline Series is an adequate screening tool for identifying patients with ACD. Nevertheless, females should be additionally routinely tested with the fragrance series. Patients with suspected occupationally related dermatitis should always be tested with additional allergens and own products.

Occupational skin disease in mining: an Australian case series.

The mining industry has one of the highest rates of occupational disease across all industries. However, occupational skin disease (OSD) is not commonly reported in this industry, although has been estimated to affect up to 51 people per 100,000 workers, with contact dermatitis accounting for the majority of cases. It often has a poor prognosis and leads to days lost from work. There have been relatively few reports regarding the specific forms of OSD encountered by miners worldwide. We report our experience of miners attending our Occupational Dermatology Clinic and our investigations at two Australian mines. We compare our findings with other reports of OSD in the mining population. The most commonly observed skin condition was irritant contact dermatitis, but miliaria and allergic contact dermatitis were also observed. It is not surprising that most cases of OSD appear to be related to harsh working conditions and exposures to multiple skin irritants, however, specific exposures causing ACD should not be forgotten. Our findings are consistent with previous studies of OSD in miners.

Allergic contact dermatitis to phenol-formaldehyde resin at a single tertiary dermatology centre.

BACKGROUND: Phenol-formaldehyde resin 2 (PFR2) has been shown to be a useful marker of contact allergy (CA) to various phenol-formaldehyde resins. These compounds are used in several industries as solids, powders, or semisolid resins, and are known to be sensitizing agents. OBJECTIVES: The aims were to investigate contact allergy to PFR2 in a single tertiary dermatology centre, to examine associated simultaneous allergic reactions, and to identify cases of allergic contact dermatitis (ACD) to PFR2. METHODS: A retrospective study was performed of patients patch tested to PFR2 between 1 January 2003 and 17 June 2020. RESULTS: In all, 337 of 7922 patients were tested to PFR2 and 16 (4.7%) reacted. Of those 16 individuals, six (37.5%) had a relevant reaction (1.8% of total). Simultaneous allergic reactions were noted to colophonium in eight (50.0%) patients, Myroxylon pereirae in five (31.3%), and fragrance mix I (FMI) of three cases (18.8%). CONCLUSION: Contact allergy to PFR2, even in a selected population of patients, is uncommon. However, patients exposed to plastics and glues, or who work with wood products should be routinely patch tested to a plastics and glues series containing PFR2. We recommend that all centres include PFR2 in their plastics and glues series.