Contact Dermatitis Research Articles

Differences in Clinical Characteristics Between Hand Eczema and Hand Psoriasis.

Background: Hand eczema and hand psoriasis are common skin conditions that may present with similar clinical features, making differentiation challenging. Objective: This study aims to identify clinical characteristics that distinguish hand eczema from hand psoriasis. Methods: A retrospective chart review was conducted on patients diagnosed with either condition at the Contact Dermatitis and the Psoriasis Clinic of the Department of Dermatology, Siriraj Hospital, Mahidol University-a national tertiary referral center in Thailand-from January 2015 to November 2022. Results: A total of 398 patients with hand eczema and 140 with hand psoriasis were included. Exogenous (76.1%) and endogenous (23.9%) hand eczema showed similar lesion location and morphology. However, compared with hand psoriasis, endogenous hand eczema more commonly involved the palmar area, palmar side of digits, and finger pulps (P < 0.001). Conversely, hand psoriasis predominantly affected both sides of the wrist, the dorsal side of the hand, nail fold, and the nails (P < 0.001). Clinical manifestations such as papules, vesicles, scales, and fissures were more frequently observed in endogenous hand eczema, whereas hyperkeratotic plaques were more characteristic of hand psoriasis (P < 0.001). Itching was significantly more frequent in hand eczema (P < 0.001). Conclusions: Symptoms, lesion locations, and morphology may provide valuable insights that enhance diagnostic accuracy in distinguishing between hand eczema and psoriasis.

Polyelectrolyte Complex Coacervate Adhesive for Wearable Medical Devices.

Wearable electronics are becoming increasingly popular for personalized healthcare. These devices often use hydrophobic, pressure-sensitive adhesives to adhere to various parts of the body. With prolonged skin contact, commercial adhesives have been shown to cause allergic contact dermatitis as well as significant loss of adhesive strength when exposed to moisture and ionic compounds, such as sweat. To address these common issues, the development of a polyelectrolyte-based skin adhesive for wearable devices is underway. Here, it is demonstrated how coacervation is induced with a system composed of polyethylenimine (PEI) and sodium hexametaphosphate (PSP) as the counter polyelectrolyte. The coacervate is deposited onto a polyurethane film to form an effective adhesive that is mechanically comparable to a commercially available one, offering a promising alternative for wearable devices.

Genomic structural equation modeling elucidates the shared genetic architecture of allergic disorders

BackgroundThe intricate shared genetic architecture underlying allergic disorders—including allergic asthma, atopic dermatitis, contact dermatitis, allergic rhinitis, allergic conjunctivitis, allergic urticaria, anaphylaxis, and eosinophilic esophagitis—remains incompletely characterized.MethodsOur study employed genomic structural equation modeling (Genomic SEM) to define the common factor representing the shared genetic architecture of allergic disorders. Coupled with diverse post-GWAS analytical methods, we aimed to discover susceptible loci and investigate genetic associations with external traits. Furthermore, we explored enriched genetic pathways, cellular layers, and genomic elements, and investigated putative plasma protein biomarkers. Polygenic risk score (PRS) analyses, leveraging our integrated GWAS data, were conducted to assess chromosomal-level risk associations for allergic disorders.ResultsA well-fitted genomic SEM integrated GWAS data, revealing the shared genetic architecture of allergic disorders. We identified a total of 2038 genome-wide significant SNP loci (p < 5e-8), including 31 previously unreported loci. Fine-mapping of variants and gene sets pinpointed 2 causal variants and 31 candidate susceptible genes. Genetic correlation analyses further illuminated the shared genetic architecture underlying multiple traits, notably psychiatric disorders. Preliminary findings identified four putative causal plasma protein biomarkers.ConclusionNotably, this study presents the first comprehensive genetic characterization of allergic disorders through a GWAS analysis of an unmeasured composite phenotype, providing novel insights into shared etiological pathways across these conditions.

Approaches to vulvar dermatology

Vulvar dermatoses constitute a significant yet frequently overlooked aspect of patient care, often requiring detailed attention from health care practitioners as patients may not readily disclose their vulvar concerns. This article outlines the importance of targeted questioning regarding symptoms such as itching, burning, pain, dyspareunia, and incontinence. We provide an overview of 6 common vulvar conditions: vulvar lichen sclerosus, erosive vulvovaginal lichen planus, allergic and irritant contact dermatitis, vulvovaginal candidiasis, vulvodynia, and genitourinary syndrome of menopause. For each condition, we discuss the clinical presentation, pertinent physical examination findings, and treatment options. By equipping dermatology physician assistants with the knowledge and skills to correctly diagnose and treat common vulvar dermatoses, this review aims to facilitate the delivery of comprehensive and patient-centered care to individuals affected by these conditions

Randomized controlled trial on the efficacy and safety of the combination therapy of topical 0.1% finasteride - 5% Minoxidil in male androgenetic alopecia.

Current FDA-approved treatments for androgenetic alopecia (AGA) are oral finasteride and topical minoxidil. Topical finasteride offers a potential alternative with similar efficacy and fewer systemic side effects. This study evaluated the effectiveness and safety of combining topical finasteride and minoxidil for male AGA. This 12-week randomized controlled trial divided subjects into two groups which are topical finasteride 0.1%-minoxidil 5% (treatment) and topical minoxidil 5% (control) (NCT05990400, registered 2023-08-04). Hair density, hair diameter, terminal hair rate, and vellus hair rate (assessed using phototrichogram), and the occurrence of side effects (SE) was monitored at four-week intervals. Out of 40 subjects, 2 dropped out in the treatment group. Significant increases in hair density, diameter, and terminal hair rate; and decrease of vellus hair rate were observed at each visit compared to baseline, yet no differences between groups. Systemic SEs included libido reduction (control), mild erectile dysfunction, and chest pain (treatment). Common local SEs (itching, shedding, and dandruff) were similar between groups. One patient (treatment) experienced contact dermatitis. Combining topical finasteride 0.1% with topical minoxidil 5% has similar safety and effectiveness for increasing hair density and diameter in male AGA patients compared to topical minoxidil 5% after 12 weeks of observation.

The Prevalence of Contact Allergies for Wound Dressings in Patients With Diabetic Foot Ulcers (PAID Study), an Observational Prospective Trial.

This investigator initiated prospective observational study investigates the prevalence of contact allergies in patients with a Diabetic Foot Ulcer (DFU). Patients with a DFU received a combined PATCH-test (a test used to investigate the origin of an allergic reaction on the skin) at the upper back, with the European baseline series, the European leg ulcer series, and local used material for leg ulcers. A total of 108 patients with DFU were included of which 86 (79.6%) were male, and 9 (8.3%) and 99 (91.7%) patients had Type 1 and Type 2 diabetes, respectively. Twenty-one patients had a sensitization in the standard series, 30 patients in the leg ulcer series, and 11 patients in both series. Two patients had a positive reaction for one of the local used materials. Most frequent sensitizations were found for Perubalsem (N = 6) and Fragrance-Mix II (N = 4) in the standard series. A sensitization for Povidone-Iodine (N = 20) was most frequently seen in the leg ulcer series. In the local used materials a sensitization for silver sulfadiazine (N = 1) and cutimed-gel (n = 1) were seen. In conclusion, this study provides novel information about sensitizations in patients with DFU, but more research is needed to demonstrate the relationship between allergic reactions and delayed wound healing. The study protocol was registered in www.clinicaltrials.gov (NCT04085705, PAID study).

Cutaneous manifestations of WHIM syndrome.

Warts, Hypogammaglobulinemia, Infections, and Myelokathexis (WHIM) syndrome is a rare immunodeficiency caused by gain-of-function mutations in the chemokine receptor CXCR4. While human papillomavirus (HPV) skin infection (warts) is the dermatological hallmark of the disease, individuals with WHIM have high rates of other skin manifestations that may aid early diagnosis and management. This study was a retrospective review of medical records from a United States National Institutes of Health natural history cohort of patients with WHIM syndrome seen between 2005 and 2024, including a cross-sectional analysis of cutaneous manifestations and CXCR4 variants. The cohort compromised 45 patients with genetically confirmed WHIM syndrome, 16 men and 29 women, with a mean age of 33.3 years (range, 0-69 years) and mean age at diagnosis of 20.4 years (range, 0-59 years). The cohort exhibited a range of skin manifestations which included cutaneous infections with HPV in 34 (76%) patients, bacteria in 32 (71%) patients, other viruses in 27 (60%) patients, and fungi in 25 (56%) patients. Inflammatory conditions included six (13%) patients with seborrheic dermatitis, five (11%) with contact dermatitis, four (9%) with psoriasis, three (7%) with nummular eczema, and 13 (29%) with other eczematous dermatitis. Despite the young median age, seven (16%) patients had skin cancer. All seven patients had CXCR4 truncation mutations, while those with a missense mutation (E343K) generally had fewer skin manifestations. Our study found that WHIM syndrome is associated with diverse infectious, inflammatory, and neoplastic skin conditions beyond HPV skin infection.

Orofacial granulomatosis secondary to sodium metabisulfite contact allergy.

Dietary triggers are well-recognised contributors to orofacial granulomatosis. As such, a cinnamon- and benzoate-free diet is often suggested as first-line management. We report a novel case of orofacial granulomatosis secondary to sodium metabisulfite, which was identified through patch testing.

Pseudolinfoma cutáneo secundario a tatuaje: un caso clínico

Tattoos can cause various dermatological complications, such as infections, contact dermatitis, lichenoid reactions, and granulomatous reactions. It is crucial for general practitioners and dermatologists to be informed about these complications to properly prevent, recognize, and treat patients. This is a case of tattoo pseudolymphoma appearing months after the tattoo was done, in the areas corresponding to the red ink. Cutaneous pseudolymphoma is a reactive lymphocytic proliferation that mimics a cutaneous lymphoma. Although the pathophysiology is uncertain, red pigment has been associated with higher complication rates. The lack of specific regulation in Chile and contamination in tattoo inks highlight the need for better standards. The complication presents as papules and plaques that may resolve spontaneously or with treatment. Prevention is recommended through the choice of reputable tattoo artists and safe inks.

Immunoreactivity to Cocoa and Nickel in Atopic and Allergic Contact Dermatitis

Immunoreactivity to Cocoa and Nickel in Atopic and Allergic Contact Dermatitis

The crosstalk of monocyte-neutrophil in hair follicles regulates neutrophil transepidermal migration in contact dermatitis

The excessive accumulation of neutrophils within the epidermis is a significant hallmark of cutaneous diseases; however, the mechanisms governing neutrophil transepidermal migration (NTEM) remain inadequately understood. In this study, we develop trichromatic-fluorescence-labeled chimeric mice by utilizing Cx3cr1GFP/+Lyz2RFP/+ mice as bone marrow donors and Krt14YFP/+ mice as recipients. This approach enables us to visualize the process of NTEM and the crosstalk between neutrophils and monocytes in a murine model of irritant contact dermatitis (ICD). Intravital imaging reveals a preferential transmigration of neutrophils through hair follicle (HF), where dermal neutrophils exhibit limited mobility and interact with dermal monocytes. Notably, 18 h following hapten exposure, dermal neutrophils continuously migrate toward HF regions and form clusters within 3 h. Importantly, MMP-9 is identified as essential for the NTEM process; the depletion of dermal monocytes results in a significant reduction of MMP-9 expression in the skin and inhibits the NTEM process in ICD. Mechanistically, dermal monocytes are found to be a crucial source of the cytokines TNF-α and CXCL2, which promote the upregulation of MMP-9 in neutrophils. Therefore, our results highlight HF regions as crucial gateways for dermal monocyte-modulated NTEM and provide visual insights into the crosstalk between neutrophils and monocytes in inflammatory skin disorders.

Contact Urticaria and Related Conditions: Clinical Review.

Contact urticaria (CoU) is an immediate contact reaction occurring within minutes to an hour after exposure to specific proteins or chemicals. CoU is categorised into non-immunologic (NI-CoU) and immunologic (I-CoU) types, with I-CoU potentially leading to anaphylaxis. Both forms of CoU can be associated with protein contact dermatitis and the CoU syndrome. Patients with I-CoU may also have other type I (immediate) allergic diseases, such as allergic conjunctivitis, rhinitis, asthma or food allergy. This review provides a detailed overview of CoU and related conditions, focusing on triggers, diagnostic methods and management strategies. NI-CoU is typically triggered by low molecular weight chemicals, while I-CoU involves IgE-mediated hypersensitivity to both high molecular weight proteins and low molecular weight chemicals. Early diagnosis is crucial, though CoU is often underrecognized. The diagnostic approach includes a thorough medical history, physical examination, evaluation of photographs, (non)invasive skin tests and invitro assessments. Management strategies prioritise trigger avoidance and pharmacological treatments when avoidance is not fully possible. For I-CoU, second-generation H1-antihistamines are the first-line treatment. Severe cases of I-CoU may benefit from anti-IgE therapy (omalizumab). Patients at risk of anaphylaxis should carry an adrenaline auto-injector and wear a medical alert bracelet.

Chronic actinic dermatitis - a familial link?

Chronic actinic dermatitis (CAD) is an inflammatory, immune-mediated photodermatoses that is characterised by erythematous, pruritic, lichenified plaques affecting photo-exposed areas of the body. The pathogenesis of CAD remains unknown with many postulated theories in the literature. The predominant hypothesis suggests a delayed type IV hypersensitivity reaction caused by photosensitive skin antigens - similar in disease process to allergic contact dermatitis (ACD).1 Despite current evidence suggesting no familial inheritance we present the first reported cases of CAD affecting three members of the same family, with increasing severity in each subsequent generation (i.e., two generations), strengthening the case for potential genetic predisposition.

Long-Term Observations on the European Photopatch Test Baseline Series (EPTBS) in Real Clinical Practice: 11 Years of Results in a Spanish Cohort and Suggestions for an EPTBS Update.

The European Photopatch Testing Baseline Series (EPTBS) was published in 2013. However, limited data exist regarding the real-world clinical application of the EPTBS. This study aims to describe the photopatch test experience with the EPTBS over 11 years at a tertiary hospital in Spain. A retrospective chart review spanning from February 2012 to October 2023 was conducted on patients who underwent photopatch testing (PPT) with the EPTBS. Additionally, patch testing was performed on all patients according to the European recommendations. Data from 148 patients were collected, and showed a PPT positivity rate of 7.4% (n = 11). Specifically, we found a photoallergic contact dermatitis (PACD) in 11/148 patients (15 positive reactions to 8 different allergens, including one patient own's product). Of them, 87% had current relevance and non-steroidal anti-inflammatory drugs (NSAIDS) were the main culprits of PACD (60%). Alternatively, we found a contact allergy to the EPTBS allergens in 14/148 (9.3%) patients, (21 positive reactions both in the irradiated and non-irradiated set to 17 different allergens, including many patients' products). Of them, UV solar filters represented the main cause of ACD. Regarding the patch testing results, we observed a positivity rate of 39.9% (116 positives in 59 different patients). The most frequent were methylchloroisothiazolinone/methylisothiazolinone, fragrance mix I and II and Myroxylon pereirae resin (balsam of Peru). EPTBS implementation has permitted a more accurate study of PACD. Our positivity rate for PPT is slightly lower than previous reports, however the main culprits for PACD remain to be NSAIDS. The inclusion of contact allergens applied in photoexposed areas in the EPTBS could contribute to discriminating between PACD, photoaggravated ACD and ACD.

Head and neck dermatitis: a variant of atopic dermatitis.

Atopic dermatitis involves the head and neck area across all age groups. This manifestation is frequently referred to as "the head and neck dermatitis." Aside from a considerable deterioration of the quality of life, it poses a significant diagnostic and therapeutic challenge. The head and neck dermatitis may be mimicked by other inflammatory conditions such as seborrheic dermatitis or contact dermatitis. Furthermore, it can be associated with a wide range of infectious, ocular, psychiatric and hair disorders, which should raise clinical alertness and encourage a multidisciplinary management of the affected individuals. Skin lesions in the head and neck area are often difficult to treat, particularly because of a considerable exposure of this region to exacerbating factors and limitations regarding the use of some pharmaceuticals. Although several hypotheses explaining the recalcitrant course of head and neck dermatitis have been proposed, none of them provide successful solutions applicable in the daily clinical practice. This comprehensive review comprises the current insights on the pathogenesis, clinical presentation, and comorbidities of the head and neck dermatitis. Recommendations regarding possible treatments of this condition such as antifungals, as well as special considerations for the choice of biologics or JAK inhibitors in the candidates for systemic treatment are outlined.

Incidence and Characteristics of Medical Adhesive-Related Skin Injuries in Patients Following Spinal Surgery: A Prospective Observational Study.

This single-center prospective observational study aimed to compare the incidence, types, and characteristics of medical adhesive-related skin injuries (MARSI) in spinal surgery patients based on the type of dressing used. All adult patients who were scheduled for spinal surgery within a one-year period in a single institution were included. A structured case report form was created to collect data; a single assessor evaluated MARSI for eligible patients. Group differences were analysed with an independent t-test or Mann-Whitney U test, and survival analysis was conducted using Kaplan-Meier analysis, the log-rank test, and Cox proportional hazard regression analysis. Within 10 days of surgery, 45% of 140 study participants developed MARSI, with contact dermatitis being the most common type (41.4%). The acrylate-dressing group had a higher cumulative incidence (56.8%) than the silicone group (31.8%) (p = 0.003) as well as a shorter time to the first MARSI (p < 0.001), longer MARSI duration (p < 0.001), and a 2.55-time higher risk of MARSI (p < 0.001). In summary, the use of post-operative dressings with silicone adhesives post-spinal surgery was associated with a lower incidence, longer time to the occurrence, shorter duration, and lower risk of MARSI compared to the use of acrylate dressings.

Spectrum of Dermatoses and Infections Affecting the Lower Leg and Foot in an Outpatient Clinic at a Tertiary Care Hospital.

Infections and dermatoses of the lower leg and foot can be attributed to factors such as blood stagnation, chemical contact, and abnormal mechanics. These factors make the lower leg and foot more susceptible to microbial infections, contact dermatitis, stasis eczema, ulcers, corns, and calluses. To identify the patterns of infections and dermatoses on the lower leg and foot. This study took place between September 2020 and August 2021 at an outpatient dermatology clinic. All patients with lower leg and foot skin conditions were included in the study, irrespective of age, sex, or occupation. Patients with generalized lesions all over the body were excluded. Of the 42,527 patients who presented to the outpatient dermatology clinic during the study period, 424 patients (1%) had lower leg and foot skin conditions. The ratio of male to female patients was 2.3:1. Patients ranged in age from 4 to 76 (mean, 44.8 ± 15) years. A total of 152 patients had infections, and 272 patients had dermatoses. Fungal infection (21.7%) was most common among patients with infections, followed by bacterial (8.25%) and viral infections (7.07%). Lichen simplex chronicus (29.3%) and dermatoses due to venous stasis (19%) were most common among patients with dermatoses. The most commonly involved site was the shin, followed by the dorsum and sole of the foot. The identification of high-risk patients is key in taking preventive measures to avoid complications.

Predicting the skin sensitizing potential of pesticides using Pred-skin 3.0-A web-based prediction tool.

Predicting the skin sensitizing potential of pesticides using Pred-skin 3.0-A web-based prediction tool.

Varying Patterns of Dermatoses Presenting in the Diaper Area in Children: A Prospective Observational Study at a Tertiary Care Children Hospital

Introduction: Diaper area dermatoses is an umbrella term used to describe various skin conditions that can occur in the diaper area which is a common dermatological problem in neonates and younger children. Diaper dermatoses (DD) can occur as a primary disorder or as a part of an underlying systemic disorder. Methods: One hundred and thirty-five children below the age of 5 years with eruptions in the diaper area were enrolled in the study. A detailed history and physical and dermatological examination were done and recorded on a predesigned proforma. Tests to aid in the diagnosis such as Gram stain, Tzanck smear, KOH examination, culture sensitivity, biochemical and hematological investigations, and skin biopsy were done whenever necessary. Results: The prevalence of DD was 3.4%. A total of 26 dermatoses were encountered. Infections were the most common dermatoses observed in 68.8% followed by diaper dermatitis (primary irritant contact dermatitis) in 14.1% of children. The rarer dermatoses seen in our study were napkin psoriasis, purpura fulminans secondary to rickettsial infection, perianal pseudoverrucous papules and nodules, and aplasia cutis. Conclusions: Our study highlighted the various morphological presentation and etiological factors of DD. Infective disorders were the most common dermatoses presenting in the diaper area in the present study.

Bilateral Hyperpigmented Linear Streaks on The Face: An Unusual Presentation of Allergic Contact Dermatitis

Bilateral Hyperpigmented Linear Streaks on The Face: An Unusual Presentation of Allergic Contact Dermatitis