Psoriasis-Like Dermatitis Developing in an Atopic Dermatitis Patient Treated With Dupilumab No abstract available

Patch Test Practice Patterns of Members of the American Contact Dermatitis Society Background Patch testing is the criterion standard for diagnosis and management of allergic contact dermatitis. Limitations on the number of allergens tested can negatively impact patient care. Objective This study reports clinical practice patterns of American Contact Dermatitis Society (ACDS) members. Methods In October and November 2018, the US-based members of the ACDS received an electronic survey regarding their procedures and experiences with patch testing. We evaluated the type of practice, number of patients tested, type of screening and supplemental series, number of allergens tested, and billing and reimbursement concerns. Results There were 149 respondents; 62% use ACDS Core 80, 70% “sometimes” or “always” test with supplemental series, and 70% “sometimes” or “always” test patient products. Participants estimated that supplemental series identify relevant allergens 35% of the time. Approximately 66% most commonly test more than 81 allergens per patient, and 78% expressed concerns regarding fair reimbursement. Conclusions Most ACDS members routinely test more than 81 allergens per patient. Barriers to fair payment for beyond a fixed number of patches at any one visit may impede the diagnosis of allergic contact dermatitis, prolong suffering, and worsen outcomes. Address reprint requests to Amber Reck Atwater, MD, Department of Dermatology, Duke University Medical Center, 5324 McFarland Dr, #210, Durham, NC 27707. E-mail: amber.atwater@duke.edu. This study was supported in part by Duke Dermatology (statistics support). A.R.A. received a Pfizer Independent Grant for Learning and Change. J.T. has consulted for Bayer, Johnson and Johnson, Equinox Group, and Kao Brands. He owns common stock in Johnson and Johnson, Merck, Express Scripts, Astra Zeneca, and Opko Health and is an author for Decision Support in Medicine. A nondependent child is an employee of Pfizer. This study was exempt by Duke Health IRB. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dermatitisjournal.com). © 2019 American Contact Dermatitis Society

Patch Testing for Cheilitis: A 10-Year Series Background The etiology of cheilitis includes endogenous, irritant, and allergic dermatitis; lichenoid and granulomatous disorders; infection trauma; and actinic damage. Patch testing is indicated for refractory cases (other than actinic cheilitis). Objective The aim of the study was to review demographics and allergens in patients patch tested for cheilitis at 2 sites in Sydney, Australia. Methods Records for patients patch tested for a 10-year period from 2007 to 2017 were reviewed. Baseline characteristics and patch test results were compared for patients with and without cheilitis. Conclusions There were 1584 patients including 91 with cheilitis. Patients with cheilitis were more likely to be female, younger, and atopic and have concurrent eyelid involvement than those presenting with other dermatoses. Seventeen percent of patients with cheilitis had a post–patch test diagnosis of allergic contact cheilitis, and the most frequent relevant reactions were to patients' own products, fragrances, and sunscreens. Those with cheilitis had more positive reactions to sunscreens, especially benzophenones, compared with those without cheilitis (P < 0.001). This is an important finding in Australia where high rates of melanoma and nonmelanoma skin cancer necessitate promotion of strict sun protection measures. Address reprint requests to Harriet S. Cheng, FRACP, Department of Dermatology, Auckland District Health Board, Private Bag 92024, Auckland Mail Centre, Auckland 1142, New Zealand. E-mail: harrietc@adhb.govt.nz. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Allergic Contact Dermatitis to Dyclonine (Dyclocaine) No abstract available

Allergic Contact Dermatitis in the Operating Room: A Comprehensive Analysis of Surgical Scrubs and Disinfectants Background Sterility and sanitation are fundamentals in the operating room. However, little is known about the ingredients of these disinfectant products and their risk of allergic contact dermatitis. Objective The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period. Methods DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series allergens present in each product were noted. Conclusions A total of 1940 products were identified, of which 267 products were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Among these products, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained 1.0 ACDS allergen. There were significant differences in allergens based on product type and active ingredient with iodine-containing products having the fewest number of allergens. The most common ACDS allergens were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%). Again, there was variation in allergen type based on product type and active ingredient. Address reprint requests to Sara A. Hylwa, MD, 7550 34th Ave S, Suite 101 Minneapolis, MN 55450. E-mail: schla255@umn.edu. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Patch Test Results of Contact Sensitization in Children Without Atopic Dermatitis: A Single Tertiary Center Experience Background Allergic contact dermatitis (ACD) has become more frequent in children. The prevalence of contact sensitization varies with respect to age, sex, and geographic localization. Objective The aim of the study was to investigate the experience of a tertiary health center about the patch test results of contact sensitization in children without atopic dermatitis. Methods This is a retrospective review of 89 children (30 boys and 59 girls) who were aged between 3 and 18 years and who were diagnosed with ACD between July 2013 and July 2017. Children with a known history of atopic dermatitis were excluded. All patients were tested with TRUE (Thin-layer Rapid Use Epicutaneous) test series. Results The most frequently determined allergens by TRUE test were methylchloroisothiazolinone (n = 7 [16.3%]), disperse blue 106 (n = 5 [11.6%]), and bacitracin (n = 5 [11.6%]). Conclusions Preservatives, such as methylchloroisothiazolinone, formaldehyde, and formaldehyde releasers, emerge as the most frequent allergens in children who undergo patch testing because of ACD. This finding might be attributed to the increase in the utilization of these chemical compounds in personal hygiene products for children. Address reprint requests to Selcen Kundak, MD, Department of Dermatology, Izmir Dr. Behcet Uz Children's Research and Training Hospital Alsancak, Konak, 35210 Izmir, Turkey. E-mail: drselcen@yahoo.com.tr. The author has no funding or conflicts of interest to declare. The study protocol was approved by the Izmir Dr. Behcet Uz Children Research and Training Hospital Local Ethics Committee (2019/277). Because of the retrospective design, written informed consent has not been obtained from the parents or relative of the patients, but in polyclinic, written informed consent is obtained from the parents of every patient for applying TRUE test. © 2019 American Contact Dermatitis Society

Patch Testing With Formaldehyde 2.0% (0.60 mg/cm2) Detects More Contact Allergy to Formaldehyde Than 1.0% Background The International Contact Dermatitis Research Group increased the patch test concentration of formaldehyde from 1.0% aqueous (aq) to 2.0% aq (in 2011). Objective This study was designed to investigate the outcome of the decision. Methods Consecutive dermatitis patients in 8 different clinics were patch tested with formaldehyde 1.0% aq and 2.0% aq. The test solutions were applied with a micropipette to the filter paper discs in the respective chamber. Results A total of 2778 patients were tested with 1.0% aq and 2766 to 2.0% aq. Sixty-five patients (2.3%, calculated from 2766 tested, to 2.0% aq) had positive patch test reactions interpreted as contact allergy to formaldehyde. This is a rather low frequency. Of these 65, 46 were women (46/1703 [2.7%]) and 19 were men (19/1063 [1.8%]). Thirty-six reacted only to 2.0% aq, 21 patients reacted to both concentrations, and 8 patients reacted only to 1.0% aq. Significantly, more patients reacted to 2.0% aq compared with 1.0% aq (P < 0.001). There was no significant sex difference. A total of 0.8% irritant reactions were recorded to formaldehyde 2.0% aq and 0.1% to 1.0% aq. Conclusions The increased formaldehyde patch test concentration to 2.0% aq revealed more formaldehyde contact allergy. Address reprint requests to Marléne Isaksson, MD, PhD, Department of Occupational and Environmental Dermatology, Jan Waldenströms gata 16, SE 205 02, Malmö, Sweden. E-mail: marlene.isaksson@skane.se. The authors have no funding or conflicts of interest to declare. © 2019 American Contact Dermatitis Society

Effectiveness of Dupilumab for the Treatment of Generalized Prurigo Nodularis Clinical Phenotype of Adult Atopic Dermatitis Background Generalized prurigo nodularis (GPN) is a debilitating, inflammatory skin disease characterized by chronic pruritus, signs of prolonged scratching, and multiple pruriginous papules and nodules. Recent studies identified several forms of GPN as a clinical phenotype of adult atopic dermatitis (AD). Objective The aim of the study was to evaluate the effectiveness of dupilumab (D) in adults affected by persistent AD showing a clinical feature of GPN. Methods A retrospective study was performed on adult patients affected with GPN clinical variant of AD, treated with D from July 2018 to March 2019. Atopic dermatitis severity was evaluated using the Eczema Area and Severity Index, visual analog scales ranging from 0 to 10 for pruritus, and Dermatology Life Quality Index. Results Ninety AD patients (52 males [57.7%]; mean age = 44.6 years; range = 18–66 years) were treated with D. In 9 (10.0%) of 90 cases, GPN pattern was observed. A significant improvement in Eczema Area and Severity Index, Dermatology Life Quality Index, and pruritus visual analog scale score was instead observed after treatment with D. Conclusions Generalized prurigo nodularis is currently also considered as a rather common clinical pattern of adult AD. Dupilumab can be an efficacious treatment of this condition, especially in cases where history of atopy is recorded and conventional treatments are ineffective. Address reprint requests to Maddalena Napolitano, MD, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, via Francesco De Santis snc, 86100, Campobasso, Italy. E-mail: maddy.napolitano@gmail.com. The authors have no funding or conflicts of interests to declare. © 2019 American Contact Dermatitis Society

Willingness to Participate in Atopic Dermatitis Research Studies and Clinical Trials No abstract available

Allergens in Medical Hand Skin Cleansers: Product Review and Alternatives Health care workers may be at risk of occupational allergic contact dermatitis because of their frequent exposure to medical hand skin cleansers. We identified American Contact Dermatitis Society Core 80 Allergens (Dermatitis 2017;28(2):141–143) found in medical hand skin cleansers (waterless skin soaps, water-needed skin soaps, and skin disinfectants) in the United States and developed a list of “low-allergen” medical hand skin cleansers. Waterless skin soaps most commonly contained fragrance, tocopherol, and sodium benzoate. Top allergens in water-needed skin soaps included fragrance, chloroxylenol, propylene glycol, and cocamidopropyl betaine. The most common allergens identified in skin disinfectants were chlorhexidine, cocamide diethanolamine, and fragrance. We identified 11 waterless skin soaps that were free of American Contact Dermatitis Society Core 80 Allergens. Low-allergen products were also identified for water-needed skin soaps (2 products) and skin disinfectants (4 products). This information is accurate as of the date of publication; product availability and ingredients may change over time. Address reprint requests to Amber Reck Atwater, MD, Department of Dermatology, Duke University Medical Center, 5324 McFarland Dr, #210, Durham, NC 27707. E-mail: amber.atwater@duke.edu. A.R.A. received a Pfizer Independent Grant for Learning and Change. L.G.R.-H. has no funding or conflicts of interest to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dermatitisjournal.com). © 2019 American Contact Dermatitis Society