Allergic contact dermatitis to footwear in Thailand: Prevalence, clinical characteristics and common allergens.

BACKGROUND: Footwear contact allergy is caused by exposure to allergens in shoes. The prevalence and common allergens vary by region and time due to differences in customs and lifestyle. OBJECTIVES: To determine the clinical characteristics and common allergens of patients with footwear-related allergic contact dermatitis (ACD) who attended Siriraj Hospital in Bangkok, Thailand, between 2001 and 2020. METHODS: The medical records of 247 patients with clinically suspected footwear dermatitis who underwent patch testing were reviewed. RESULTS: The prevalence of ACD to footwear was 1.8%. Females were predominant (71.6%). The three most common allergens were carba mix (7.7%), mercapto mix (6.9%) and potassium dichromate (6.9%). According to the allergens found, rubber (14.2%), adhesives (7.7%) and leathers (6.9%) were the three most common groups. Dorsal-limited skin lesions were significantly associated with footwear ACD. CONCLUSION: Rubber and leather allergens were still the most common culprit allergens. Dermatologists should keep up-to-date on common allergens in footwear and emerging allergens to include in patch test series.

Programme for prevention of foot dermatoses in patients with work-related skin diseases: Baseline data and first results of a prospective cohort study (OCCUPES).

BACKGROUND: Programmes for prevention of hand dermatoses in patients with work-related skin diseases (WRSD) are well established. Similar interventions for foot dermatoses (FD) are widely missing. OBJECTIVE: To evaluate the effectiveness of a programme for prevention of FD based on health education in patients with WRSD while investigating the impact and possible causative factors of FD. METHODS: In a prospective cohort study (OCCUPES), 231 patients with WRSD and FD participating in the programme were recruited. The skin was examined and questionnaires were completed, including assessment of footwear, FD severity, symptoms and health-related quality of life. RESULTS: The baseline and some early results are presented. A work-related causation of FD was likely in 60 patients (26.0%) with irritant contact dermatitis being the most frequent diagnosis. Work-related FD were associated with male sex (p = 0.012), sweating in footwear (p = 0.004) and wearing of safety footwear (p = 0.013). FD were often long-lasting with a high degree of work-absenteeism, quality of life impairment, itch and pain, particularly in work-related FD. CONCLUSIONS: Interventions are needed to reduce the burden of FD in patients with WRSD. The programme addresses current shortcomings in prevention of FD. A long-term evaluation of its effectiveness follows.

Shoe Allergens: A Retrospective Analysis of Cross-sectional Data From the North American Contact Dermatitis Group, 2005-2018.

BACKGROUND: Shoe contact allergy can be difficult to diagnose and manage. OBJECTIVE: The aim of the study was to characterize demographics, clinical characteristics, patch test results, and occupational data for the North American Contact Dermatitis Group patients with shoe contact allergy. METHODS: This is a retrospective study of 33,661 patients, patch tested from 2005 to 2018, with a shoe source, foot as 1 of 3 sites of dermatitis, and final primary diagnosis of allergic contact dermatitis. RESULTS: Three hundred fifty-two patients met the inclusion criteria. They were more likely to be male (odds ratio = 3.36, confidence interval = 2.71-4.17) and less likely to be older than 40 years (odds ratio = 0.49, confidence interval = 0.40-0.61) compared with others with positive patch test reactions. The most common relevant North American Contact Dermatitis Group screening allergens were potassium dichromate (29.8%), p-tert-butylphenol formaldehyde resin (20.1%), thiuram mix (13.3%), mixed dialkyl thioureas (12.6%), and carba mix (12%). A total of 29.8% (105/352) had positive patch test reactions to supplemental allergens, and 12.2% (43/352) only had reactions to supplemental allergens. CONCLUSIONS: Shoe contact allergy was more common in younger and male patients. Potassium dichromate and p-tert-butylphenol formaldehyde resin were the top shoe allergens. Testing supplemental allergens, personal care products, and shoe components should be part of a comprehensive evaluation of suspected shoe contact allergy.

Shoe Dermatitis.

Shoe dermatitis is a type of contact dermatitis precipitated by allergens or irritants found in shoes. Potassium dichromate, commonly used in leather processing, is one of the most prevalent agents responsible for shoe dermatitis; however, it is not the only one. Shoe dermatitis caused by an allergen or an irritant may affect a person of any age, sex, or ethnicity. Numerous treatments exist for shoe dermatitis, the most simple yet important being avoidance of causative agents. Pharmaceutical agents commonly used are emollients, humectants, and topical corticosteroids. In more severe cases, topical calcineurin inhibitors and phototherapy may be used.

Perniosis in the COVID-19 era.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) and the most common symptoms include fever, dry cough, dyspnea, fatigue, anorexia, ageusia, and anosmia. Cutaneous manifestations are less common and we share our experience with an otherwise healthy and asymptomatic young man. The patient presented with painless acrocynosis of the left toes which progressed to desquamation by day 16 of disease onset. Disease progression is documented via multiple photographs that portray progression of disease and subsequent resolution over approximately six weeks. Symptomatic treatment included non-steroidal anti-inflammatory medications, leg elevation, and warm compresses.

A clinical and histological comparison between acute cutaneous graft-versus-host disease and other maculopapular eruptions following hematopoietic stem cell transplantation: a retrospective cohort.

BACKGROUND: Prompt management of acute graft-versus-host disease (GVHD) may prevent its morbidity and mortality. Maculopapular (MP) eruption is a presenting sign of acute GVHD, but differentiation from other causes of MP rash is challenging. METHODS: A retrospective study was conducted among patients developing MP eruptions after allogeneic hematopoietic stem cell transplantation. We compared the clinical and histopathological differences between an acute cutaneous GVHD (group 1) and other MP eruptions (group 2). We also determined the clinical prognostic indicators linked to acute GVHD severity, morbidity, and mortality. RESULTS: Of 95 patients identified, 75 met the classification criteria for acute GVHD, and 25 had other MP eruptions. Palm and/or sole involvement was more frequently found (51.4% vs. 12%, odds ratio [OR] [95% confidence interval] = 7 [2.1, 23.7], P < 0.01 and 41.4% vs. 0%, OR 37.2 [2.2, 635], P < 0.01, respectively) in group 1 than in group 2. Comparing the histological features between the two groups, necrotic keratinocytes in basal and spinous layers (92.9% vs. 22.2%, OR 27 [3.5, 594.7], P < 0.01) and (85.7% vs. 33.3%, OR 9.3 [1.4, 60.8], P = 0.02, respectively), diffuse basal vacuolization (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04), lymphocyte satellitosis (71.4% vs. 0%, OR 44.3 [2.1, 936.8], P < 0.01), and subepidermal clefts (42.9% vs. 0%, OR 14.5 [0.7, 298.2], P = 0.04) were significantly more apparent in group 1. Among extracutaneous presentations, diarrhea alone and/or accompanied by hyperbilirubinemia (47.1% vs. 16%, OR 4.3 [1.4, 13.1], P = 0.03 and 27.1% vs. 0%, OR 19.3 [1.1, 332.8], P < 0.01, respectively) and newly developed transaminitis (37.1% vs. 12%, OR 3.3 [1.1, 12.6], P = 0.02) suggested the diagnosis of acute GVHD. Mucosal involvement and/or blister formation correlated with severe acute GVHD (OR 26.6 [5.4, 130.4], P < 0.01). Skin and systemic GVHD severity correlated with time to rash resolution (P = 0.03 and P = 0.04, respectively), length of hospital stays (P < 0.01 and P < 0.01, respectively), and mortality (OR 4.87 [1.4, 17.4], P = 0.02 and OR 4.6 [1.3, 16.5], P = 0.02, respectively). CONCLUSIONS: Our findings may be beneficial tools for establishing the diagnosis of acute GVHD.

Erythema Pernio-Like in Four Adolescents in the Era of the Coronavirus-2 Infection.

BACKGROUND: Although epidemic, novel coronavirus (SARS-CoV-2) infection rarely affects the pediatric population. However, in the last months, an increasing number of Italian pediatricians have reported the occurrence of erythema pernio-like in children following a flu-like syndrome, after the outbreak of SARS-CoV-2 infection. OBJECTIVE: The study aims to report cutaneous manifestation of SARS-CoV-2 infection in 4 adolescents. METHODS: Observational study reporting 4 adolescents with skin lesions, 2 weeks after the occurrence of a flu-like syndrome. RESULTS: Fourteen days after a flu-like syndrome, adolescents exhibited skin lesions to toes and feet. These lesions were rounded, with blurred limits, with a 5-15 mm diameter, red-violaceous- bluish colored, sometimes resulting in bullous lesions in correspondence of the central or apical portion, which tended to be covered with blackish crusts after evolution. Lesions were also accompanied by pain of variable intensity and evolved within two or three weeks to self-resolution without particular sequelae. In two patients, pharyngeal and nasal swabs were negative for SARSCoV- 2 infection, at the presentation of skin lesions. After 2 months from clinical manifestations, patients were tested positive for SARS-CoV-2 antibodies. CONCLUSIONS: In the pediatric and adolescent population, the occurrence of an erythema pernio-like after a flu-like syndrome could be associated with SARS-CoV-2 infection.

Cutaneous Manifestations in the Context of SARS-CoV-2 Infection (COVID-19). / Manifestaciones cutáneas en el contexto de la infección por SARS-CoV-2 (COVID-19).

The coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus2 (SARS-CoV-2), has had enormous health, economic, and social consequences. The clinical spectrum of cutaneous manifestations observed in patients with COVID-19 is both heterogeneous and complex. To date, reports have identified 5main categories: acral lesions, vesicular rashes, urticarial rashes, maculopapular rashes, and livedoid and necrotic lesions. However, these will probably be modified as new information comes to light. Cutaneous manifestations associated with COVID-19 probably reflect the activation of pathogenic pathways by the virus or a response to inflammatory processes, vascular or systemic complications, or even treatments. Familiarity with the cutaneous manifestations of COVID-19 may enable early diagnosis or help guide prognosis.

Social media and dissemination: impressions of fish pedicures following a case of onychomadesis.

Although the popularity of fish pedicures as cosmetic or routine services and/or tourist attractions has peaked in the past decade, the practice is still trending today and accompanying risks are less well-known by the public. More recently, a case of onychomadesis following fish pedicure has gained interest in both public and dermatologic populations, highlighting the importance of patient education. In this study, we aimed to demonstrate the wide reach of the manuscript through social media and news outlets. The majority of social media correspondences have come from Thai accounts whereas news outlets were mostly from the United States and various European or Asian countries. Analyzed by Altmetric score, the report was within the top 5% of all research outputs ever scored by Altmetric. Finally, Google Trend data indicates that fish pedicure interest decreased thereafter to the lowest levels in the past decade after the case report was published, signifying its likely effect on diminishing public interest. This case report and analysis of its news/social media reach emphasize the importance of literature/media outlets in informing patients and the public of adverse effects. As fish pedicures continue to be popular both in the US and overseas, appropriate education of the public remains important in preventing complications.

Trasplantado renal con sarcoma de Kaposi en el pie izquierdo / Kidney transplant patient with Kaposi sarcoma in the left foot

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Effects of Perching Surfaces and Foot Bandaging on Central Metatarsal Foot Pad Weight Loading of the Peregrine Falcon (Falco peregrinus).

Pododermatitis is prevalent in falcons and is characterized by inflammation and infection of the plantar aspect of the feet, particularly at the central metatarsal pad. Suboptimal perch design and increased weight loading on the plantar skin have been proposed as major risk factors for the development of pododermatitis. Prevention and treatment are challenging, but weight load reduction on the affected area of the foot is an accepted goal of initial treatment. To date, to our knowledge no studies have compared the performance of different bandage-perch surface combinations on weight redistribution away from the central metatarsal pad. An ex vivo factorial experiment was designed using the feet from a peregrine falcon cadaver to quantify weight load reduction on the central metatarsal pad with different combinations of perch surfaces (wood, neoprene, artificial turf) and bandages (none, interdigital, silicone shoe). Feet were attached to a digital force gauge mounted on a manual test stand for compression testing. Weight loading at the central metatarsal pad was measured using a small force sensor. Perch-surface combinations in randomized order were tested at 250 g, 500 g, and 1 kg with 9 replicates per foot. At 250 g, all combinations reduced measured metatarsal pad forces, but otherwise performed similarly. As compression forces increased, differences emerged with the shoe combinations performing better overall, followed by a group including the neoprene and artificial turf-interdigital bandage combinations, and a third group including the interdigital/wood and no bandage-artificial turf. All combinations performed better than control (no bandage on wood). This study may assist veterinarians in selecting appropriate perching surface/bandage combinations when treating falcons with pododermatitis.

Efficacy and Safety of Efinaconazole 10% Solution in the Treatment of Onychomycosis in Diabetic Patients.

Onychomycosis is especially common among diabetic patients. The purpose of this study was to investigate the efficacy of 10% efinaconazole solution among diabetic subjects, without restriction by nail plate involvement or glycemic control. Forty subjects were enrolled, with 36 reaching their final 50-week follow-up visit. Mycological cure was attained by 21 subjects (58.33%); 8 subjects (20%) attained either clinical cure (0% clinical involvement) or treatment success (≤10% clinical involvement). Glycemic control did not affect clinical outcome. The medication was well tolerated, with 4 local adverse events and no significant adverse events. The medication may represent a useful option for diabetic patients.

Erysipelas-like presentation of Wells' syndrome (eosinophilic cellulitis).

Wells' syndrome, also called eosinophilic cellulitis, is a rare eosinophilic dermatosis characterized by an unspecific inflammatory erythematous eruption often associated with systemic symptoms. Here we report the case of a 57-year-old female with bilateral painful pitting and pruritic feet progressive for two weeks despite one week of oral antibiotics. Skin biopsy was performed showing dermal eosinophilic infiltration. The patient showed a spontaneous progressive improvement of the condition. The presented case demonstrates both clinical and histologic presence of lesions of Wells' syndrome in the course of the disease. A careful diagnostic approach is needed because of the lack of specific signs. The global outcome is favorable and spontaneous resolution is possible.