SARS-CoV-2 (COVID-19) vaccination in dermatology patients on immunomodulatory and biologic agents: Recommendations from the Australasian Medical Dermatology Group.

As the phase III COVID-19 vaccine trials excluded patients on immunosuppressive treatments, or patients with significant autoimmunity, the Australasian Medical Dermatology Group make the following preliminary recommendations around COVID-19 vaccination in dermatology patients on immunomodulatory and/or biologic agents. Vaccination against COVID-19 is strongly encouraged for all patients on immunomodulatory drugs and/or biologic agents. There are currently insufficient data to recommend one COVID-19 vaccine or vaccine type (mRNA, recombinant, inactivated virus) over another. No specific additional risk in patients on immunomodulatory or biologic therapies has so far been identified. Data on vaccine efficacy in patients on immunomodulatory or biologic therapies are missing, so standard vaccination protocols are recommended until otherwise advised.

The first Australian Baseline Series: Recommendations for patch testing in suspected contact dermatitis.

BACKGROUND AND OBJECTIVES: Patch testing is a standard diagnostic tool used in the identification of causative allergens in allergic contact dermatitis. Ongoing surveillance of rates of allergen positivity is vitally important to detect trends and allow comparisons between countries. The objective of this study was to propose the first evidence-based Australian baseline series, based on retrospective review of our patch test data. We aimed to identify the most important and most relevant allergens in our population. METHODS: We conducted a 10-year (2001-2010) retrospective review of data from the contact dermatitis clinic and the occupational dermatitis clinic from our institution. RESULTS: We patch tested 5281 patients in all. The top 20 allergens with the highest number of relevant positive patch test reactions were: fragrance mix 1: nickel, potassium dichromate, Myroxylon pereirae, formaldehyde, p-phenylenediamine (PPD), thiuram mix, colophony (rosin), dermatophagoides mix, ammonium persulfate, quaternium-15, cobalt chloride, methylchloroisothiazolinone or methylisothiazolinone, diazolidinylurea, epoxy resin, 1,3-dimethylol-5,5-dimethyl hydantoin, Compositae mix, toluenesulfonamide formaldehyde resin, basic red 46 and imidazolidinyl urea. CONCLUSION: We have elucidated the most frequent and relevant contact allergens in our patient population and used this information to construct the first Australian baseline series.

Allergic contact dermatitis to methylisothiazolinone: exposure from baby wipes causing hand dermatitis.

BACKGROUND/OBJECTIVES: Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a preservative used in both cosmetic and industrial settings. In Europe it is allowed to be used in rinse-off cosmetics only because of its propensity to cause allergic contact dermatitis (ACD). No such legislation exists in Australia. In recent years MI without MCI has been used. In August 2010 the first cases of MI causing non-occupational ACD were reported in Europe. The objective here was to present a case series of ACD to MI occurring in the Australian setting. METHODS: : We retrospectively reviewed positive reactions to MI and MCI/MI from the Skin and Cancer Foundation patch test clinical database. MI was added to our baseline test series in January 2011. RESULTS: : In total 653 patients were tested for MI and there were 43 reactions, of which 23 were relevant, based on a history of exposure to MI. Seven were parents of young children with hand dermatitis caused by ACD to MI contained in baby wipes. The remaining patients reacted to MI in shampoos, conditioners, deodorants, moisturisers, a skin cleanser and a facial wipe. Three patients had ACD to MI associated with occupational exposure to hand cleansers. CONCLUSIONS: These data demonstrate for the first time that MI is an emerging, important allergen in both cosmetic and occupational settings in Australia. An important source of exposure was baby wipes, which was predominantly associated with hand dermatitis in parents. We believe that it is important to test for MI, not just MCI/MI, in the baseline series.

Retrospective study of oral lichen planus and allergy to spearmint oil.

Oral lichen planus (OLP) is a chronic inflammatory disorder with significant morbidity, associated with symptoms of pain and local discomfort. The concept of contact allergy aggravating or inducing OLP is recognised, and reported allergens include amalgam, metals used in dental restoration and flavourings. To date there has been only one case report of a contact allergy to spearmint oil in a patient with a 3-year history of OLP. We retrospectively reviewed our positive spearmint oil patch test data at the Skin and Cancer Foundation Victoria over a period of 11 years. In total 73 patients of the 1467 tested for allergy to spearmint oil had positive patch tests. The total number of patches tested during this time was 6134. Of the 73 positive reactions, 19 (26%) were classified as relevant, in that the patients had a history of using spearmint oil-containing products. Coexisting OLP and a spearmint allergy were found in 14 of these 19 patients. All patients had erosive OLP and were female. Patients, especially women, with OLP recalcitrant to treatment should be patch tested to flavourings, especially spearmint oil. We believe that spearmint allergy should be considered a cause of OLP, or at least, of oral lichenoid reactions.

Textile allergy--the Melbourne experience.

BACKGROUND: Textile allergy is a well-established entity, but there are relatively few Australian reports in this area. OBJECTIVES: To report the combined experience of textile contact dermatitis from the general and occupational contact dermatitis clinics at the Skin and Cancer Foundation, Melbourne, Victoria, Australia. PATIENTS/METHODS: On the basis of the clinical suspicion of textile allergy, 2069 patients were tested with a textile series. RESULTS: One hundred and fifty-seven (7.6%) patients reacted to any of the textile-related allergens. The most common allergen was Basic Red 46 (20.2% of the positive reactions), followed by Disperse Blue 106 and Disperse Blue 124 (11.8% and 11.2%, respectively). Reactions to formaldehyde and formaldehyde-releasing chemicals accounted for 30.6% of the concomitant reactions, and reactions to p-phenylenediamine accounted for 12.6% of the concomitant reactions. The use of Disperse Blue mix yielded only 12.2% of patients sensitive to either of these two allergens, and it is not endorsed as a screening agent for textile dye allergy. CONCLUSION: Textile allergy is not uncommon. In Melbourne, Basic Red 46 in inexpensive, dark-coloured, acrylic-blend, men's work socks is the most important cause. It is important to test with samples of patients' clothing.

Nickel allergy presenting as mobile phone contact dermatitis.

A 39-year-old man presented with a 6-month history of a treatment-resistant facial dermatitis. The patient regularly used his mobile phone, predominantly on the left cheek. Patch testing confirmed the clinical suspicion of mobile phone contact dermatitis from nickel contained in the phone casing. Although infrequently reported, with the trend towards metallic mobile phone casings and the high incidence of nickel sensitization in the community, the incidence of mobile phone contact dermatitis is likely to increase.

Allergy to tea tree oil: retrospective review of 41 cases with positive patch tests over 4.5 years.

Tea tree oil use is increasing, with considerable interest in it being a 'natural' antimicrobial. It is found in many commercially available skin and hair care products in Australia. We retrospectively reviewed our patch test data at the Skin and Cancer Foundation Victoria over a 4.5-year period and identified 41 cases of positive reactions to oxidized tea tree oil of 2320 people patch-tested, giving a prevalence of 1.8%. The tea tree oil reaction was deemed relevant to the presenting dermatitis in 17 of 41 (41%) patients. Of those with positive reactions, 27 of 41 (66%) recalled prior use of tea tree oil and eight of 41 (20%) specified prior application of neat (100%) tea tree oil. Tea tree oil allergic contact dermatitis is under-reported in the literature but is sufficiently common in Australia to warrant inclusion of tea tree oil, at a concentration of 10% in petrolatum, in standard patch-test series. Given tea tree oil from freshly opened tea tree oil products elicits no or weak reactions, oxidized tea tree oil should be used for patch testing.

Prolonged paresthesia due to sculptured acrylic nails.

Allergic reactions to acrylates in sculptured nails are common. However, there are few reports of paresthesia as a consequence of acrylic exposure, and such paresthesia does not necessarily accompany the evolution of the dermatitis.

Allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion.

Dexpanthenol is the alcohol corresponding to pantothenic acid (the water-soluble vitamin B(5)). Although it is a common ingredient in many pharmaceuticals and cosmetics, contact allergy is relatively uncommon. Cocamidopropyl PG dimonium chloride phosphate is a phospholipid complex derived from pure coconut oil, and contact allergy is rare. We report a case of allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion.

Homozygous familial hypercholesterolaemia presenting with cutaneous xanthomas: response to liver transplantation.

A 19-month-old girl with cutaneous xanthomas was diagnosed with homozygous familial hypercholesterolaemia, treated with atorvastatin, plasma exchange and finally at the age of 3.5 years, with liver transplantation. Her serum cholesterol levels fell to normal and the xanthomas regressed following liver transplantation. She remains well 17 months post transplant.

Allergic contact dermatitis following exposure to essential oils.

Allergic contact dermatitis from the topical use of essential oils is not widely recognized as an occupational hazard. Four cases of allergic contact dermatitis to essential oils occurring in three aromatherapists and one chemist with a particular interest in aromatherapy are described. All presented with predominantly hand dermatitis and demonstrated sensitization to multiple essential oils. One patient developed a recurrence of cutaneous symptoms following ingestion of lemongrass tea. Workers within this industry should be aware of the sensitization potential of these products and the risk of limiting their ability to continue employment.

Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia.

We report a 24-year-old woman with androgenetic alopecia who became sensitized to topical minoxidil following use of an extemporaneous preparation of minoxidil 4% with retinoic acid in a propylene glycol base. She subsequently also became sensitized to saw palmetto (Serenoa repens), a topical herbal extract commonly promoted for the treatment of hair loss.

Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy.

There have been recent concerns about the possible association between isotretinoin therapy and depressive symptoms. We conducted a prospective study to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments. There were 215 patients (mean age 20 years) included in the study. Depression, quality of life and acne severity ratings were administered at baseline, 1 month, 3 months and end of treatment or 6 months, and compared between both treatment groups. The changes in the mean depression scores did not differ significantly between both groups (P = 0.62). The incidence of isotretinoin patients with moderate depressive symptoms remained relatively unchanged from baseline. The changes in the quality-of-life measures scores between treatment groups showed no significant difference. No correlation between isotretinoin dose and depression score was found. Although five isotretinoin patients were withdrawn during the study because of worsening of mood, no definite causal relationship was established. This pilot study does not appear to support any direct link between depression and isotretinoin, apart from being a rare unpredictable idiosyncratic side-effect. However, because of the study limitations, a larger study is needed to confirm the findings.