Medicine by Alexandros G. Sfakianakis: Dermatitis

Tuesday, July 16, 2019

Dermatitis

No abstract available

Poison Ivy, Oak, and Sumac Dermatitis: What Is Known and What Is New?

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.

Bathing Additives for Atopic Dermatitis — A Systematic Review

Bathing additives are regularly used for a range of inflammatory dermatoses that affect a large body surface area. Emerging evidence demonstrates that certain bathing additives have anti-inflammatory, skin barrier repair, antimicrobial, and antioxidative properties, all pertinent to atopic dermatitis. This review summarizes the mechanism and effects of Dead Sea salt, hard water, commercial baby cleansers, oatmeal, rice, and natural oils as bathing additives for the treatment of atopic dermatitis. The use of these compounds seems to augment the benefit of traditional treatments while also reducing the need for and side effects of prescription modalities. Bathing additives are useful adjuvant treatments for atopic dermatitis. Benefits of these compounds are derived from anti-inflammatory, antimicrobial, antioxidative, and skin barrier repair properties.

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

Background Wool clothing may be perceived as a poor choice for use by individuals with sensitive skin or atopic dermatitis. Objectives The aims of the study were to evaluate the effect on atopic dermatitis of wearing fine Merino wool clothing versus standard clothing and to assess the effect of Merino wool clothing on quality of life in children and adults with atopic dermatitis 5 years and older. Methods Subjects with mild to moderate atopic dermatitis were assessed in a crossover fashion after wearing Merino wool clothing for 6 weeks and standard clothing for 6 weeks, for Eczema Area and Severity Index, Dermatology Life Quality Index, static Investigator's Global Assessment, and skin hydration. Results While wearing Merino wool clothing, compared with standard clothing, statistically significant improvements were seen in mean Eczema Area and Severity Index scores, Dermatology Life Quality Index scores, and static Investigator's Global Assessment scores. No significant difference was seen with skin hydration. Wearing Merino wool clothing did not produce any negative cutaneous effects compared with wearing standard clothing. Conclusions Merino wool clothing compared with standard clothing provided improvements in severity of atopic dermatitis as well as quality of life in atopic patients.

Formaldehyde Release From Baby Wipes: Analysis Using the Chromotropic Acid Method

Background Formaldehyde is a common preservative and strong sensitizer. Objective The aim of the study was to evaluate the release of formaldehyde from baby/toddler wet wipes using the chromotropic acid method (CAM). Methods An online search of best-selling baby wipes was conducted. None declared formaldehyde or formaldehyde-releasing preservatives. Standard CAM procedures were used: a 1 × 1-in square of fresh wipe was placed in a bottle with an open vial of 4 mg/1 mL of chromotropic acid and sulfuric acid solution, sealed, and stored for 48 hours. Formalin and water served as controls. A blinded investigator graded color change (negative, indeterminate, mild, moderate, or strong). For quality control, 20% of all samples as well as all positives were retested. Results Fifty-one popular and highly reviewed baby and toddler wet wipe products were tested using CAM. Twelve wipes (24%) released formaldehyde (8 mild, 4 moderate/strong). Chromotropic acid method testing of 9 wipes (18%) was indeterminate and 30 (59%) were negative. Conclusions Almost one quarter of baby/toddler wet wipes released formaldehyde when evaluated with CAM. Patients and clinicians should be aware of this potentially undeclared source of this common allergen.

Cross-sectional Survey of Nickel Allergy Management in the Context of Intracardiac Device Implantation

Background The occlusion devices used for repair of atrial septal defect and patent foramen ovale commonly contain nitinol, an alloy containing nickel. There are reports of nickel allergy in the context of intracardiac device implantation. Type IV delayed-type reactions likely predominate in intracardiac metal hypersensitivity, but there are potentially other mechanisms such as cytotoxic or innate immunity. Based on available literature to date, the significance of nickel allergy in intracardiac occluders remains unclear. Objective The aim of the study was to investigate nickel allergy management strategies in intracardiac occluders. Methods The American Contact Dermatitis Society facilitated distribution of a survey via e-mail to the members of its association, which included dermatologists and allergists/immunologists. A total of 70 individuals answered the survey. Conclusions There was no consensus regarding the ability of patch testing to accurately determine allergic reactions within cardiac tissue. There was also no agreement on the criteria for patch testing in patients undergoing intracardiac implantation. However, most would inquire about a history of contact sensitivity to previously implanted devices. With a positive patch test, nickel-based intracardiac devices should be avoided, or the decision should be left to the discretion of the cardiologist.

Screening for Gold Sensitization in Consecutive Eczema Patients: Prevalence, Relevance, and Sources of Exposure

Background Since the 1990s, gold has been recognized as an important contact allergen. Objectives Based on our results with gold sodium thiosulfate (GST) in the TRUE Test patch test system in the baseline series, the aims of the study were to evaluate baseline testing with gold salts worldwide and to discuss relevance. Methods Patients with positive patch test reactions to GST were questioned on exposure at day 7 reading. Results In a 1-year period, 89 (18.5%) of 480 patients tested positive to GST, making this the most frequent contact allergy. The 89 patients comprised 18 males and 71 females. The reaction was considered relevant in 21%; this is a minimum figure because 2 patients were withdrawn because of unknown relevance and because clinical features suggestive of gold contact allergy at distant sites, such as the face, were not taken into account. Altogether, 88% had been exposed. Worldwide, the prevalence of gold sensitization ranges between 0.78% and 30.7%, and relevance, in larger studies, has been between 15% and 20% of patients. The use of earrings and the presence of dental gold were important sources of exposure. Conclusions Because it may be difficult to diagnose gold allergy, screening may be recommended when history taken suggests gold exposure.

Allergic Contact Dermatitis to Licorice Root Extract