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1.
Dermatol Clin ; 38(3): 329-338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32475511

RESUMO

This article provides an overview of the evaluation and management of occupational contact dermatitis, including how to evaluate a patient with suspected occupational contact dermatitis. Patch testing, how to perform a site visit, and how to properly manage using preventative measures, prescribed therapies, and patient education are discussed.

2.
Dermatol Clin ; 38(3): 339-349, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32475512

RESUMO

The prevalence of occupational contact dermatitis is estimated to be between 6.7% and 10.6% and can lead to missed work and job loss. Although treatment may provide temporary relief, identifying the culprit allergen may help the clinician counsel on how to avoid or reduce exposure. Some of the most common high-risk occupations for allergic contact dermatitis include agricultural workers, construction workers, health care workers, hairdressers, mechanics, and machinists. In this article, we discuss the common occupational exposures of these high-risk professions, and summarize the common culprit allergens.

4.
Dermatitis ; 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32049715

RESUMO

BACKGROUND: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) allergy has increased for the last decade, mostly not only because of high concentrations in cosmetics but also because of its use as a biocide in industrial settings. OBJECTIVE: We report an outbreak of allergic contact dermatitis in 8 workers at a water bottling plant secondary to excess levels of MCI/MI in the cooling system, found to be at levels 5 times the manufacturer's recommendations. METHODS: Of 15 workers in the plastic bottle manufacturing area, 8 developed dermatitis, and 4 were referred for patch testing using a 100-allergen panel applied and interpreted in the standardized method according to the North American Contact Dermatitis Group. RESULTS: Four workers had a positive reaction to MCI/MI. An investigation at the plant revealed that the concentration of MCI/MI was 365 ppm. The manufacturer's recommended level was 48 ppm. The cooling system was subsequently flushed, and biocide levels decreased to recommended levels. Afterward, all the affected workers experienced clearance of their allergic contact dermatitis. CONCLUSIONS: Occupational sensitization to MCI/MI is on the rise, in this instance, because of excess levels in the cooling system. Our findings demonstrate the continued need for awareness of the allergenicity of this preservative in the occupational setting.

5.
J Cutan Pathol ; 47(6): 530-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32068905

RESUMO

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that primarily affects women of African descent. Although histopathological features of CCCA have been described, the pathophysiology of this disease remains unclear. To better understand the components of CCCA pathophysiology, we evaluated the composition of the inflammatory infiltrate, the distribution of Langerhans cells (LCs), and the relationship between fibrosis and perifollicular vessel distribution. Our data indicate that CCCA is associated with a CD4-predominant T-cell infiltrate with increased LCs extending into the lower hair follicle. Fibroplasia associated with follicular scarring displaces blood vessels away from the outer root sheath epithelium. These data indicate that CCCA is an inflammatory scarring alopecia with unique pathophysiologic features that differentiate it from other lymphocytic scarring processes.

6.
J Am Acad Dermatol ; 82(1): 156-160, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31306731

RESUMO

BACKGROUND: Syphilis is often misdiagnosed clinically, and biopsies might be required. OBJECTIVE: To determine histopathologic features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF). METHODS: Histopathologic features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared. RESULTS: Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72, respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR can be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be used as distinguishing features. CONCLUSIONS: Histopathologic features characteristic of syphilis can be seen in PL, PR, and early MF. Distinguishing syphilis from PL can be difficult histologically, and a high index of suspicion is required. Although elongation of rete and interstitial inflammation favor syphilis, plasma cells (historically considered a significant feature of syphilis) are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature appears to be more common in syphilis.


Assuntos
Micose Fungoide/diagnóstico , Pitiríase Liquenoide/diagnóstico , Pitiríase Rósea/diagnóstico , Neoplasias Cutâneas/diagnóstico , Sífilis/diagnóstico , Sífilis/patologia , Diagnóstico Diferencial , Humanos , Micose Fungoide/patologia , Pitiríase Liquenoide/patologia , Pitiríase Rósea/patologia , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia
7.
J Clin Aesthet Dermatol ; 12(4): 28-30, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31119007

RESUMO

Nonmelanoma skin cancers, typically induced by ultraviolet light, are rarely found on the palmar aspects of the hands. Here, we describe a case of a basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) collision tumor on the palm of a 71-year-old woman. A brief review of literature regarding basal cell carcinoma of the palm and hand are provided, including etiology, diagnosis, and treatment recommendations.

8.
Dermatitis ; 30(3): 183-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045932

RESUMO

Poison ivy, poison oak, and poison sumac are the most common causes of clinically diagnosed allergic contact dermatitis in North America. Approximately 50% to 75% of the US adult population is clinically sensitive to poison ivy, oak, and sumac. We reviewed the botany and history of these plants; urushiol chemistry and pathophysiology, clinical features, and the prevalence of allergic contact dermatitis caused by these plants; and current postexposure treatment and preventive methods, including ongoing investigations in the development of a vaccine (immunotherapy). Although extensive efforts have been made to develop therapies that prevent and treat contact dermatitis to these plants, there lacks an entirely effective method, besides complete avoidance. There is a need for a better therapy to definitively prevent allergic contact dermatitis to these plants.


Assuntos
Dermatite Alérgica de Contato/prevenção & controle , Exposição Ambiental/efeitos adversos , Toxicodendron/efeitos adversos , Dermatite por Toxicodendron/prevenção & controle , Educação em Saúde/métodos , Humanos , América do Norte , Intoxicação por Plantas/prevenção & controle
9.
J Cutan Pathol ; 46(8): 586-590, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30957251

RESUMO

BACKGROUND: SOX10 immunostaining has been considered a highly sensitive and specific marker for melanoma. But there is evidence suggesting that SOX10 positive cells can be present in dermal scars. Therefore, we investigated whether non-melanocytic cell types present in chronic inflammatory processes or benign lymph nodes express SOX10. METHODS: We retrospectively selected 20 benign lymph nodes and 20 cutaneous granulomatous dermatoses. SOX10, CD68, and Melan-A immunohistochemistry was performed in all cases. RESULTS: Scattered SOX10 positivity was found in 85% of lymph nodes, specifically in subcapsular and medullary sinuses and in 85% of granulomatous dermatoses. In granulomatous dermatoses, the Melan-A stain did not label the scattered SOX10 positive cells and it was difficult to determine if CD68 was co-expressed on the SOX10 positive cells. In the lymph nodes, the SOX10 positive cells did not co-express Melan-A or CD68. CONCLUSIONS: We report SOX10 positive cells detected in granulomatous dermatoses and benign lymph nodes. In lymph nodes, SOX10 positive cells were exclusively in subcapsular and medullary sinuses. Therefore, SOX10 is an excellent stain for evaluation of metastatic melanoma with the caveat that positivity in subcapsular and medullary sinuses can be of non-melanocytic origin; the use of additional melanocytic markers is recommended in this situations.


Assuntos
Biomarcadores Tumorais/metabolismo , Linfonodos/metabolismo , Melanoma/metabolismo , Proteínas de Neoplasias/metabolismo , Fatores de Transcrição SOXE/metabolismo , Dermatopatias/metabolismo , Neoplasias Cutâneas/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Linfonodos/patologia , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias/patologia , Neoplasias Cutâneas/patologia , Coloração e Rotulagem
12.
Allergy Asthma Proc ; 39(6): 468-471, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30401325

RESUMO

Although allergists often evaluate rashes associated with allergic, IgE mediated etiologies, it is important to consider a wide range of differential diagnoses that includes inflammatory, infectious, and autoimmune etiologies. The case of a 58-year-old woman with a 1-year history of progressive pruritic rash that did not improve with topical creams and steroids is presented. The patient did not state any other symptoms, and a physical examination was notable for a widespread rash. After a detailed evaluation of the rash, a differential diagnosis was made, and results of a skin biopsy confirmed a specific diagnosis. Even in the context of a medical history of atopy, one must consider nonallergic causes of rash, including abnormal presentations of systemic conditions. It is important to determine the specific etiology of the rash because this will dictate treatment and prognosis and/or complications of the disease associated with the skin manifestations.


Assuntos
Exantema/diagnóstico , Prurido/diagnóstico , Biomarcadores , Biópsia , Diagnóstico Diferencial , Feminino , Mãos , Humanos , Imunoensaio , Pessoa de Meia-Idade , Fenótipo , Avaliação de Sintomas
13.
Dermatol Online J ; 22(6)2016 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-27617597

RESUMO

Linear vesicles or papules in a newborn can be a presenting sign of incontinentia pigmenti (IP). In this report, we present two cases of neonates with cutaneous manifestations of incontinentia pigmenti. In one case, mild peripheral eosinophilia was noted. No extra-cutaneous manifestations were noted otherwise in both cases after complete ophthalmological and neurological evaluations. These cases serve as a reminder for clinicians to consider IP in newborns presenting with linear vesicles or papules.


Assuntos
Incontinência Pigmentar/patologia , Dermatoses da Perna/patologia , Feminino , Humanos , Incontinência Pigmentar/diagnóstico , Recém-Nascido , Dermatoses da Perna/diagnóstico
15.
J Am Acad Dermatol ; 73(6): 1025-30, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26464219

RESUMO

BACKGROUND: Secondary syphilis has a wide spectrum of clinical and histologic manifestations. OBJECTIVE: We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. METHODS: In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. RESULTS: The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). LIMITATIONS: This was a retrospective review. CONCLUSION: The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.


Assuntos
Sífilis Cutânea/epidemiologia , Sífilis Cutânea/patologia , Sífilis/epidemiologia , Sífilis/patologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Estudos de Coortes , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos/epidemiologia , Adulto Jovem
16.
J Cutan Pathol ; 42(8): 574-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25950447

RESUMO

Atypical acquired melanocytic nevi in patients with epidermolysis bullosa (EB) have been referred to as EB nevi and are considered to be a type of recurrent nevus with atypical but distinctive histopathologic findings. Herein, we describe an atypical nevus in a patient with Hailey-Hailey disease with different histopathologic findings from EB nevi because of presumably different pathogenesis. It is important to be aware that the recurrent nevi phenomenon can be seen in acantholytic conditions as well as blistering disorders, given these lesions may clinically resemble melanoma.


Assuntos
Melanoma/patologia , Recidiva Local de Neoplasia/patologia , Nevo Pigmentado/patologia , Pênfigo Familiar Benigno/patologia , Neoplasias Cutâneas/patologia , Adulto , Feminino , Humanos
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