Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016.

BACKGROUND: Little is known about the aetiologies and relevant allergens in paediatric patients with hand eczema (HE). OBJECTIVES: To characterize the aetiologies and determine the proportion of positive and currently relevant allergens in children/adolescents (age < 18 years) with HE referred for patch testing. METHODS: A retrospective analysis (2000-2016) of North American Contact Dermatitis Group data was performed. RESULTS: Of 1634 paediatric patients, 237 (14·5%) had involvement of the hands. Final physician diagnoses included allergic contact dermatitis (49·4%), atopic dermatitis (37·1%) and irritant contact dermatitis (16·9%). In multivariable logistic regression models, employment was the only association with increased odds of any HE or primary HE. Children with HE vs. those without HE had similar proportions of positive patch tests (56·1% vs. 61·7%; χ2 -test, P = 0·11). The five most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside and lanolin. In multivariable logistic regression models of the top 20 relevant allergens, HE was associated with significantly higher odds of currently relevant reactions to lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole and colophony. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel and methylchloroisothiazolinone/methylisothiazolinone. CONCLUSIONS: Children with HE who were referred for patch testing had a high proportion of positive patch tests, which was similar to the proportion found in children without HE. Children with HE had a distinct and fairly narrow profile of currently relevant allergens.

Acrylates: new sources and new allergens.

Acrylates are synthetic thermoplastic resins used in a multitude of products, ranging from bone cement to artificial nails. They represent an important and increasing cause of both occupational and nonoccupational allergic contact dermatitis. Isobornyl acrylate, an acrylic monomer found within ultraviolet-cured inks, adhesives and various medical devices for diabetes, has emerged as an important sensitizer. In addition, long-lasting nail products have played a significant role in the increased prevalence of acrylate allergy. Sensitized individuals classically present with facial or eyelid dermatitis, and some patients experience associated fingertip and nail changes. This manuscript reviews these two important sources of acrylate allergy and summarizes other potential new exposures, including surgical glues and wound-care products.

Verrucous carcinoma occurring in a lesion of oral lichen planus.

Verrucous carcinoma of the oral cavity is relatively rare. Well-documented associations include human papillomavirus and carcinogens such as tobacco. Less well understood is the association with chronic inflammation, such as seen in lichen planus. Verrucous carcinoma has previously been described occurring in lesions of lichen planus of the foot and penis. We report the first case, to our knowledge, of verrucous carcinoma occurring in a lesion of oral lichen planus.

Reliability of self-reported willingness-to-pay and annual income in patients treated for toenail onychomycosis.

BACKGROUND: Willingness-to-pay (WTP) is a health economics measure that has recently been used for skin diseases to evaluate patients' quality of life. However, the reliability of this measure has not been investigated in the dermatology literature and is essential in validating its use in health services research. OBJECTIVES: This study evaluated the test-retest reliability of self-reported annual income and WTP, a health economics measure of disease impact, in patients with toenail onychomycosis. METHODS: Forty-six patients enrolled in a randomized clinical trial comparing two different dosing regimens of terbinafine completed a self-administered questionnaire at baseline and 1 month later. The questionnaire asked: (i) how much patients would be willing to pay for a theoretical treatment with a cure rate of 85% for their current onychomycosis (10 categories: $0-50, $51-100, to > $800); and (ii) annual income (10 categories: $0-10,000 to > $200,000). RESULTS: Forty-four patients reported WTP at both visits, and 55% reported the same WTP. The quadratic-weighted (Fleiss-Cohen) kappa statistic indicated moderate agreement (kappa = 0.50, 95% confidence interval, CI 0.24-0.75, P < 0.01) as did the Spearman rank-order correlation coefficient (r(s) = 0.57, P < 0.01; median difference = 0, P = 0.50). Strong agreement was shown among the 42 patients who reported income at both visits; 71% reported the same annual income category (kappa = 0.72, 95% CI 0.47-0.96, P < 0.01; r(s) = 0.68, P < 0.01; median difference = 0, P = 0.77). Age, disease severity and duration, previous therapy, self-reported annual income, and medication side-effects were not statistically associated with the reliability of WTP. CONCLUSIONS: WTP and annual income demonstrated moderate and strong test-retest reliability, respectively. Self-reported WTP can serve as a reliable measure for future health economics research on onychomycosis.

Latex allergy.

UNLABELLED: Coined the next major health concern of the decade, allergy to natural rubber latex affects people routinely exposed to rubber products. Groups at highest risk include health care workers, rubber industry workers, and persons who have undergone multiple surgical procedures, especially those with spina bifida. Allergy to latex is a type I, immediate, IgE-mediated reaction, which can lead to anaphylaxis and death. Much of latex research is published in allergy journals. Dermatologists may not be aware of the prevalence, symptoms, risks, diagnosis, and treatment of latex allergy. These topics are the subject of this review. Research concerning antigenic proteins, as well as sources of latex alternatives, is also summarized. (J Am Acad Dermatol 1998;39:1-24.) LEARNING OBJECTIVE: At the completion of this learning activity, participants should have a clear understanding of the history, biology, epidemiology, mechanism, clinical characteristics, diagnostic work-up, and treatment of latex allergy. Readers should also have a greater understanding of multiple potential allergenic latex proteins and their importance in preventing future latex-sensitization.

Prevalence of evaluation for latex allergy and association with practice characteristics in United States dermatologists: results of a cross-sectional survey.

BACKGROUND: Natural rubber latex allergy is a potentially life-threatening, immunoglobin E (IgE) mediated reaction. Despite great strides in identification of high-risk groups, methods for diagnosis remain limited in the United States and most evaluations are performed by allergists. OBJECTIVE: The objective of this study was to estimate the prevalence of evaluation for latex allergy and association with practice characteristics in United States dermatologists. METHODS: A cross-sectional survey of one third of United States Fellows of the American Academy of Dermatology. RESULTS: The survey response rate was 43%. Of responding dermatologists, 17% stated that they evaluate patients for latex allergy, most commonly with a radioallergosorbent (RAST) or use test. Only 3.6% stated that they perform prick or scratch tests for latex allergy in their office, and most of these dermatologists (86%) prepare their own latex prick test solutions. Evaluation for latex allergy was significantly associated with patch testing, photopatch testing, an interest in contact dermatitis, and number of contact dermatitis books owned, but not with number of years in practice. CONCLUSIONS: Most United States dermatologists do not evaluate patients for latex allergy, most likely because of lack of available antigens and because methods for diagnosing latex allergy are not familiar to most dermatologists.

Sesquiterpene lactone allergy.

Sesquiterpene lactones are a large, diverse group of chemicals found in several plant families that cause allergic contact dermatitis. The biological, botanical, allergenic, and structural significance of sesquiterpene lactones is explored as well as the clinical characteristics of cutaneous reactions. The association with UV-light sensitivity and proposed mechanisms for this relationship as well as new developments in patch test methods and treatment are reviewed.