RESUMO
The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.
Assuntos
Dermatite de Contato/prevenção & controle , Dermatite Ocupacional/prevenção & controle , Dermatoses da Mão/prevenção & controle , Higiene das Mãos/normas , Guias de Prática Clínica como Assunto , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Betacoronavirus/patogenicidade , COVID-19 , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dermatite de Contato/etiologia , Dermatite Ocupacional/etiologia , Dermatoses da Mão/induzido quimicamente , Pessoal de Saúde , Humanos , Irritantes/administração & dosagem , Irritantes/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , SARS-CoV-2 , Sabões/efeitos adversos , Sociedades Médicas/normas , Estados UnidosAssuntos
Continuidade da Assistência ao Paciente/organização & administração , Dermatologia/organização & administração , Pessoas Mal Alojadas/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Dermatopatias/terapia , Adulto , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Dermatologia/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnósticoRESUMO
BACKGROUND: Chronic urticaria (CU) is a cutaneous disease that can be debilitating, difficult to treat, and sometimes life-threatening. Treatment with antihistamines is often ineffective. Immunosuppressants are second line therapy but can have significant side effects. Data is needed on effective therapies with safer profiles. OBJECTIVES: To determine the efficacy and side-effects of colchicine in patients with CU. METHODS: Patients were identified through retrospective chart reviews at the University of Utah from 2002-2007. We identified 36 patients with a diagnosis of chronic urticaria based on history, physical examination, and a skin biopsy. Length of treatment ranged from one month to 17 months. RESULTS: Subjective clinical responses to colchicine therapy reported as complete (n=15) or partial (n=5) were found in 56 percent of patients. The mean±SD duration of treatment was 7±6 months. Three patients (15%) who had resolution of urticaria stopped colchicine secondary to diarrhea and hematuria. Of the complete responders, nine individuals (60%) have remained symptom free and four individuals (27%) had recurrence after colchicine was stopped. LIMITATIONS: Short-term follow-up and retrospective study design. CONCLUSIONS: This retrospective study demonstrated that colchicine was an effective and well-tolerated treatment for patients unresponsive to antihistamines. The data supports the use of colchicine for CU patients and further controlled studies are warranted to better characterize the use of colchicine in patients with CU refractory to antihistamines.
Assuntos
Anti-Inflamatórios/uso terapêutico , Colchicina/uso terapêutico , Urticária/tratamento farmacológico , Adulto , Anti-Inflamatórios/efeitos adversos , Doença Crônica , Colchicina/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: Systemic allergic reactions to nickel alloys in percutaneous atrial septal defect occlusion devices have a poorly defined natural history. We describe our experience of surgical removal of the offending device in a series of patients with nickel allergy and refractory symptoms. METHODS: Patients with atrial septal defect device explants for nickel allergy were reviewed. Administered questionnaires focused on symptoms, quality of life, and satisfaction along with the 36-Item Short Form Health Survey to measure physical and mental health postsurgery. RESULTS: Atrial septal defect devices were removed for nickel allergy in 58 patients during the past 10 years. The median age was 42 years (range, 24-71 years) and 95% were women. Explantation occurred at a median of 8 years (range, 6 months-18 years) after insertion. Symptoms included fatigue (82%), chest pain (78%), headache (73%), and palpitation (58%). Surveys were available for 45 patients: 58% rated their quality of life as poor and 69% were not at all satisfied with their device. Postexplant, all patients reported improvement in their symptoms, with 18 patients (42%) noting complete resolution. In 12 patients prospectively studied, the preoperative scores in physical and mental health domains were lower than the validation group, indicating significant disability. Similarly, there was marked improvement in each domain postremoval. CONCLUSIONS: Patients with nickel allergy and severe refractory symptoms after atrial septal defect device implantation experience profound resolution of symptoms and improved quality of life after removal. Nickel allergy should be considered before device insertion, and a low threshold should exist for surgical removal for refractory symptoms.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Remoção de Dispositivo , Comunicação Interatrial/terapia , Hipersensibilidade/cirurgia , Níquel/efeitos adversos , Dispositivo para Oclusão Septal/efeitos adversos , Adulto , Idoso , Bases de Dados Factuais , Remoção de Dispositivo/efeitos adversos , Feminino , Nível de Saúde , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Satisfação do Paciente , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
We assessed outcomes in nickel allergic patients treated with percutaneous interatrial shunt device closure with the Helex device. Nickel toxicity has been well described in patients undergoing interatrial shunt closure with the Amplatzer device, which has a nitinol design. There have been no reports using Helex in nickel allergic patients. Ninety-five consecutive patients underwent percutaneous interatrial shunt closure at a single US center by one operator. In those with possible nickel allergy, patch testing with the North American Contact Dermatitis Group standard series and a metal series was performed. The mean age was 48 +/- 16 years (range 18-81), 48% were male, 21 (22%) had atrial septal defect, and 74 (78%) had patent foramen ovale. Six patients had a positive skin test to nickel and underwent successful closure with Helex. Of the remaining 89 patients, 88 were closed with Amplatzer and one with Helex. All procedures were successful with no deaths, myocardial infarctions, strokes, or systemic emboli at six-month followup. None of the Helex patients developed an allergic reaction, significant chest pain, or arrhythmia. Of those without pre-procedural known nickel allergy, 12% had palpitations, 5% had atrial fibrillation, and 13% had chest pain. When compared with a published report that 89% of nickel-allergic patients developing an allergic reaction to the Amplatzer or Premere device, Helex appeared far safer in nickel allergic patients (P < 0.001). In patients with nickel allergy, percutaneous interatrial shunt device closure with Helex device is safe, and is not associated with allergy to nickel.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Forame Oval Patente/terapia , Comunicação Interatrial/terapia , Hipersensibilidade/prevenção & controle , Níquel/efeitos adversos , Politetrafluoretileno , Dispositivo para Oclusão Septal/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/instrumentação , Materiais Revestidos Biocompatíveis , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Testes Cutâneos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To assess the effectiveness of lectures for continuing medical education (CME) in dermatology in a global health setting and to determine provider and patient demographics of physician assistants (PAs) practicing in rural Ghana. METHODS: Physician assistants from Ghana who attended dermatology lectures at the International Seminar for Physician Assistants in 2011 or 2014 were included in this study. Surveys were administered to participants to determine dermatology resource availability, commonly encountered skin diseases, and management practices. Quizzes were administered before and after CME dermatology lectures to assess short-term retention of lecture material. RESULTS: In all, 353 PAs participated in this study. Physician assistants reported seeing an average of 55 patients per day. The most commonly seen skin diseases were infections, with antifungals and antibiotics being the most commonly prescribed medications. Dermatology-related complaints represented 9.5% of total clinic visits. Among practicing PAs, 23.2% reported having internet access. A total of 332 PAs completed the quizzes, and a statistically significant increase in test scores was noted in postlecture quizzes. CONCLUSIONS: This study reinforces the importance of dermatology education for PAs practicing in rural areas of Ghana and lends insight to critical topics for dermatology curriculum development. In addition, the increase in test scores after CME sessions suggests that lectures are an effective tool for short-term retention of dermatology-related topics. Our study indicates that as the need for health workers increases globally and a paradigm shift away from the traditional physician model of care occurs, dermatology training of PAs is not only important but also achievable.
Assuntos
Dermatologia/educação , Educação Continuada/organização & administração , Assistentes Médicos/educação , População Rural , Dermatopatias/epidemiologia , Educação Continuada/normas , Gana/epidemiologia , Humanos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Fatores SocioeconômicosAssuntos
Fator de Necrose Tumoral alfa/antagonistas & inibidores , Urticária/tratamento farmacológico , Adalimumab , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Doença Crônica , Etanercepte , Feminino , Humanos , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêuticoRESUMO
The Euphorbiaceae family (commonly known as "spurge") is a large, diverse, and widely distributed family of plants that encompass around 300 genera and more than 8000 species. Their attractiveness and hearty nature have made them popular for both indoor ornamentation and outdoor landscaping. Despite their ubiquity, the potential to cause irritant contact dermatitis (ICD) is often overlooked in favor of more notorious causes of phytodermatitis, namely, Toxicodendron species and nettles. We examined case reports spanning 40 years and discovered that spurge-induced ICD tends to befall children and middle-aged adults who unwittingly encounter the plant through play or horticulture, respectively. Clinical presentation is pleomorphic. Erythema, edema, burning, vesicles, and pruritus of acute onset and rapid resolution are frequently observed. We present a classic case of ICD in a 12-year-old girl after exposure to Euphorbia myrsinites and review the literature on phytodermatitis caused by members of the Euphorbiaceae family.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Dermatite por Toxicodendron/diagnóstico , Euphorbia/efeitos adversos , Criança , Dermatite Alérgica de Contato/etiologia , Diagnóstico Diferencial , Euphorbiaceae , Feminino , HumanosRESUMO
BACKGROUND: Nickel is the most common allergen found by patch testing; however, not all cases of nickel allergy are type 4 (delayed) allergies. Contact urticaria (CU) to nickel (immediate reaction) has been reported; however, few seem to evaluate it as per a recent published survey of American Contact Dermatitis Society members. OBJECTIVE: The aim of the study was to present a series of patients who had clinical histories suggestive of nickel allergy and yet were patch test negative but prick test positive to nickel, thus demonstrating CU. METHODS: We reviewed the charts of 11 patients who were patch test negative but prick test positive. RESULTS: All 11 patients demonstrated evidence of CU by prick testing (or closed chamber test in 1). None were patch test positive to nickel 2.5% or 5.0%. Four patients' histories mentioned reactions to various jewelry/earrings within minutes, whereas 2 histories mentioned reacting within a few hours. These histories are consistent with CU. Others (except 1 patient) recalled reacting to jewelry/earrings but did not recall a time frame. CONCLUSIONS: Our series suggests that CU to nickel may be far more common than anticipated and should be evaluated with prick testing when patients' history suggests nickel allergy and yet they are patch test negative.
Assuntos
Urticária/diagnóstico , Adulto , Idoso , Feminino , Humanos , Testes Intradérmicos/métodos , Irritantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Níquel/efeitos adversos , Testes do Emplastro/métodos , Urticária/induzido quimicamenteRESUMO
The American Contact Dermatitis Society recognizes the interest in the evaluation and management of metal hypersensitivity reactions. Given the paucity of robust evidence with which to guide our practices, we provide reasonable evidence and expert opinion-based guidelines for clinicians with regard to metal hypersensitivity reaction testing and patient management. Routine preoperative evaluation in individuals with no history of adverse cutaneous reactions to metals or history of previous implant-related adverse events is not necessary. Patients with a clear self-reported history of metal reactions should be evaluated by patch testing before device implant. Patch testing is only 1 element in the assessment of causation in those with postimplantation morbidity. Metal exposure from the implanted device can cause sensitization, but a positive metal test does not prove symptom causality. The decision to replace an implanted device must include an assessment of all clinical factors and a thorough risk-benefit analysis by the treating physician(s) and patient.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Metais , Testes do Emplastro , Próteses e Implantes , Humanos , Sociedades MédicasRESUMO
IMPORTANCE: Microneedle therapy includes skin puncture with multiple micro-sized needles to promote skin rejuvenation or increase transdermal delivery of topical medications. In cosmetic practices, various cosmeceuticals are applied before microneedling to enhance the therapeutic effects. This results in intradermal tattooing of the topical product. Despite rapid increase in the use of microneedles in dermatology, there are few data about their safety. OBSERVATIONS: We describe 3 women, aged 40s to 60s, who developed open [corrected] facial granulomas following microneedle therapy for skin rejuvenation. Two patients had undergone microinjection of the same branded topical moisturizer (Vita C Serum; Sanítas Skincare) during microneedle therapy. Biopsy in all cases showed foreign body-type granulomas. Results of tissue cultures were negative. Chest radiography and serum angiotensin-converting enzyme findings were normal. The first 2 patients had a positive patch test reaction to Vita C Serum. Initial treatment with topical and oral corticosteroids was ineffective. Therapy with doxycycline hydrochloride and minocycline hydrochloride led to partial improvement in one case and resolution in another. CONCLUSIONS AND RELEVANCE: Application of topical products prior to microneedling can introduce immunogenic particles into the dermis and potentiate local or systemic hypersensitivity reactions. Because the microneedle therapy system is accessible for home use, health care providers need to be aware of its potential consequences.