Occupational contact dermatitis: Return to work using a multidisciplinary clinic model.

BACKGROUND: Occupational contact dermatitis often results in work disruption. Return-to-work (RTW) is an important outcome. OBJECTIVE: The objective of this study was to determine RTW outcomes and factors associated with such outcomes using a multidisciplinary clinic model. METHODS: Chart abstraction was performed for 194 workers who received RTW assistance over a 6-year period. Elements abstracted included demographic and diagnostic information and information about the RTW program including principles, program components, barriers, and facilitators. RESULTS: Of the 902 workers seen for dermatologic assessment, 194 received RTW assistance. At initial assessment, 37% were not working because of their skin disease, and at follow-up, 7% were not working because of their skin disease. The RTW plan components included a graduated or trial of RTW, specific recommendations for avoiding exposure, personal protective equipment, skin management, and ongoing skin monitoring. Principles associated with successful RTW included good communication and the availability of modified work and a worker adherence to the plan. Barriers included lack of modified work, unresponsive employers, and ongoing skin problems. CONCLUSIONS: Specific approaches are important to identify if RTW is to be successful for workers with occupational contact dermatitis.

Contact Dermatitis to Personal Sporting Equipment in Youth.

BACKGROUND: Contact dermatitis to personal sporting equipment in youth is poorly studied. OBJECTIVE: To review the results of patch testing 6 youth to their sporting equipment in a dermatology general private practice from 2006 to 2011. METHODS: A retrospective analysis of 6 youth aged 11 to 14 who were evaluated for chronic and persistent dermatitis occurring in relation to sports equipment was conducted. All patients were subjected to epicutaneous (patch) testing, which included some or all of the following: North American Contact Dermatitis Group (NACGD) series, textile series, rubber series, corticosteroid series, and raw material from the patients' own personal equipment. RESULTS: All cases had 1 or more positive patch test reactions to an allergen within the aforementioned series, and 3 subjects tested positive to their personal equipment in raw form. CONCLUSIONS: Allergic contact dermatitis, not irritant, was deemed the relevant cause of chronic dermatitis in 4 of the 6 patients due to positive reactions to epicutaneous tests and/or personal equipment. The utility of testing to patients' own sporting equipment was shown to be of additional value and should be considered when patch testing for contact allergy to sporting equipment.

The Skin Microbiome in Atopic Dermatitis and Its Relationship to Emollients.

BACKGROUND: Human-associated bacterial communities on the skin, skin microbiome, likely play a central role in development of immunity and protection from pathogens. In atopic patients, the skin bacterial diversity is smaller than in healthy subjects. OBJECTIVE: To review treatment strategies for atopic dermatitis in Canada, taking the skin microbiome concept into account. METHODS: An expert panel of 8 Canadian dermatologists explored the role of skin microbiome in clinical dermatology, specifically looking at atopic dermatitis. RESULTS: The panel reached consensus on the following: (1) In atopic patients, the skin microbiome of lesional atopic skin is different from nonlesional skin in adjacent areas. (2) Worsening atopic dermatitis and smaller bacterial diversity are strongly associated. (3) Application of emollients containing antioxidant and antibacterial components may increase microbiome diversity in atopic skin. CONCLUSION: The skin microbiome may be the next frontier in preventive health and may impact the approach to atopic dermatitis treatment.

Patch testing custom isocyanate materials from the workplace.

BACKGROUND: Patch testing with standard trays of commercially available allergens is the current practice for investigating suspected cases of isocyanate-induced allergic contact dermatitis (ACD). In some facilities, these standard trays are further supplemented with custom preparations of isocyanate-containing materials. OBJECTIVE: The aim was to determine whether added value exists in patch testing patients to custom isocyanate preparations in suspected cases of ACD. METHODS: We performed a retrospective analysis of 11 patients referred to our specialty clinic between January 2003 and March 2011 for suspected patients of ACD who had custom testing with isocyanate materials from their workplace. In addition to standard trays of allergens, all patients were patch tested with custom isocyanate materials from their workplaces. RESULTS: Three (27%) of 11 patients showed an added value in testing to custom isocyanate allergens. Of these 3 patients, one had a reaction that reinforced positive reactions to the standard isocyanate tray, but the other 2 (18%) had no reactions to any of the commercially available allergens. CONCLUSIONS: Because of the high proportion of reactions (27%), we recommend the use of custom testing to workplace isocyanate products as a supplement to current standard patch testing procedures.

Recall Dermatitis to Metronidazole.

BACKGROUND AND OBJECTIVE: Recall dermatitis is an uncommon entity that has been noted with patch testing, repeat exposures to a medication or allergen, and the concurrent use of ultraviolet radiation and certain medications. Recall dermatitis from primary cutaneous exposure and subsequent oral exposure are rare, and the etiology remains unknown. CONCLUSION: We report a case of recall dermatitis with a drug eruption secondary to metronidazole. Therapy with this medication was initially topical for rosacea and subsequently oral for a gastrointestinal infection. This case draws attention to the use of metronidazole and the risk of recall dermatitis.

Contact dermatitis mimickers: a tertiary care center's experience.

BACKGROUND: Contact dermatitis (CD) is very common but can be mimicked by numerous dermatologic conditions. Thus, a wide differential must be considered before a definitive diagnosis of CD is made to ensure the patient receives appropriate treatment and follow-up. OBJECTIVE: To describe conditions that can present similarly to contact dermatitis. METHODS: We retrospectively analyzed patients referred to the Occupational Disease Specialized Program at St. Michael's Hospital in Toronto between 2009 and 2011 for CD investigations but with a final diagnosis other than CD. RESULTS: We report cases of 2 feet-1 hand syndrome, Dermatitis Herpetiformis, Sézary syndrome and two cases of Pityriasis Rubra Pilaris misdiagnosed as CD and referred for patch testing at our busy tertiary care centre. Failing to recognize these mimickers of CD resulted in a significant delay in diagnosis for the patients and resulting initiation of necessary intervention. CONCLUSIONS: It is important to consider numerous mimickers before making a diagnosis of CD to ensure optimal outcome for patients.

Additive value of patch testing custom epoxy materials from the workplace at the occupational disease specialty clinic in Toronto.

BACKGROUND: Allergic contact dermatitis (ACD) to epoxy resins is one of the major causes of occupationally induced ACD. Testing of custom epoxy materials from the workplace is often performed to diagnose ACD. OBJECTIVE: The objective of this study was to investigate the additive value of patch testing custom-made epoxy materials. METHOD: We retrospectively analyzed outcomes of 24 patients who were tested to custom epoxy resin materials between January 2002 and July 2011. RESULTS: For 11 patients (46%), the testing of their materials from work had no additional value (negative results). For 13 patients (54%), there was an additional value of testing custom allergens. Of those, 7 patients (54%) had positive reactions to custom epoxy materials that reinforced the test results found with the commercially available allergens, and 6 (46%) patients had positive reactions only to custom epoxy materials. Therefore, for 6 patients (25%), there was a definite additive value of testing custom epoxy materials because the allergy was discovered with custom testing and not with the commercially available allergens. CONCLUSIONS: Because of the high percentage (54%) of patients with additive value of patch testing custom epoxy materials, we think that the inclusion of actual workplace epoxy materials should be strongly considered when patch testing patients with occupational epoxy exposure.