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Süßmuth K, Magnolo N, Oji V, Koll PO, Striegel A, Tantcheva-Poór I. [Inflammatory dermatoses in children and adolescents : Diagnosis and treatment of atopic dermatitis and psoriasis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:325-339. [PMID: 38353728 DOI: 10.1007/s00105-023-05257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 03/27/2024]
Abstract
Atopic dermatitis (AD) and psoriasis belong to the most common inflammatory dermatoses that we treat in everyday clinical practice. AD manifests in more than 70% of cases before the age of 5 years. Approximately one-third of psoriasis patients report on onset of disease in the first two decades of life. Here, we are going to review both disorders in the light of pediatric dermatology. We are going to discuss selected subtypes and present clues for further examination with respect to the differential diagnoses and comorbidities. The article provides insight into current therapeutic developments that are relevant for the treatment of children and adolescents.
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Affiliation(s)
- Kira Süßmuth
- Klinik für Dermatologie und Allergologie, Helios Klinikum Berlin-Buch, Campus der Medical School Berlin, Schwanebecker Ch 50, 13125, Berlin, Deutschland.
| | - Nina Magnolo
- Klinik für Hautkrankheiten, Universitätsklinik Münster, Münster, Deutschland
| | - Vinzenz Oji
- Klinik für Hautkrankheiten, Universitätsklinik Münster, Münster, Deutschland
- Praxis am Buddenturm, Münster, Deutschland
| | - Phillipp Otto Koll
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln, Köln, Deutschland
| | - Anne Striegel
- Praxis für Kinder- und Jugendmedizin Delißen und Striegel mit dem Schwerpunkt pädiatrische Pneumologie und Allergologie, Köln, Deutschland
| | - Iliana Tantcheva-Poór
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln, Köln, Deutschland
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Choi YJ, Byun JY, Choi YW, Roh JY, Choi HY. Analysis of Positive Patch Test Allergens in Allergic Contact Dermatitis Patients with Atopic Dermatitis. Ann Dermatol 2023; 35:303-312. [PMID: 37550231 PMCID: PMC10407336 DOI: 10.5021/ad.23.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND There has been debate regarding whether patients with atopic dermatitis (AD) have an altered frequency of contact allergen sensitization. Increased exposure to topical medications and moisturizers as well as impaired skin barrier function increase the risk of contact sensitization, whereas the Th2-skewed inflammatory pathway of AD is associated with a reduced risk. OBJECTIVE This retrospective study was performed to determine the characteristics of contact sensitization in allergic contact dermatitis (ACD) patients with a current or past history of AD. METHODS A clinical record review was conducted for patients referred to Ewha Womans University Medical Center, for patch tests between March 2017 and March 2021. We compared the rates of contact sensitization between ACD patients with and without AD. RESULTS In total, 515 patch test results were reviewed and divided into the AD group (n=53) and non-AD group (n=462). The AD group showed decreased any-allergen positivity (1+, 2+, or 3+) (56.6%) compared to the non-AD group (72.9%) (p=0.013). The positivity rate for budesonide was significantly higher in the AD group (p=0.011), while the prevalence of a positive result for balsam of Peru was higher in the non-AD group (p=0.036). Nickel sulfate, cobalt chloride, and potassium dichromate were the most common sensitized allergens in both groups. CONCLUSION Our study shows a decreased prevalence of contact sensitization in AD patients compared to non-AD patients. Clinicians should be aware of the risk of corticosteroid allergies in ACD patients with history of AD.
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Affiliation(s)
- Yoon Jin Choi
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Yeon Byun
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - You Won Choi
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hae Young Choi
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea.
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Amat-Samaranch V, Silvestre Salvador JF. [Translated article] Haptens, Proteins, and Atopic Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T308-T317. [PMID: 36848955 DOI: 10.1016/j.ad.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 02/27/2023] Open
Abstract
Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.
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Affiliation(s)
- V Amat-Samaranch
- Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, Spain.
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Amat-Samaranch V, Silvestre Salvador JF. Haptens, Proteins, and Atopic Dermatitis. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:308-317. [PMID: 36529271 DOI: 10.1016/j.ad.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/16/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory disease that is multifactorial in nature. Allergic contact dermatitis and protein contact dermatitis are allergic conditions that may occur in the context of atopic dermatitis and be the cause of exacerbations. Although the prevalence of allergic contact dermatitis is similar in atopic patients and the general population, these 2 conditions are frequently associated because atopic inflammation disrupts the skin barrier. Skin tests are therefore recommended in atopic individuals. Dupilumab could be useful for treating allergic contact dermatitis if it is mediated by type 2 helper T cells but could exacerbate inflammation if mediated by TH1 cells: further study is needed before conclusions can be drawn. Although the mechanism by which exposure to environmental proteins exacerbates atopic dermatitis remains under discussion, such exacerbations are routinely seen in clinical practice. Prick testing is recommended in symptomatic atopic dermatitis. When prick-test findings are positive, patients should be advised to avoid the culprit substances.
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Affiliation(s)
- V Amat-Samaranch
- Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España.
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Vieira J, Marcelino JLA. Patch Testing in Special Populations: a Review. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Efficacy and Safety of an Antioxidant-Enriched Medical Device for Topical Use in Adults with Eczematous Dermatitis. Dermatol Ther (Heidelb) 2022; 12:1015-1025. [PMID: 35389183 PMCID: PMC8988533 DOI: 10.1007/s13555-022-00705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emollients reduce the severity of dermatitis-associated symptoms. Antioxidant supplementation may be helpful to control inflammatory processes and consequential skin damage. The clinical performance and safety of an emollient medical device for topical treatment enriched with antioxidant ingredients in adults with mild-to-moderate dermatitis is presented in this manuscript. METHODS We performed a monocenter, open-label, uncontrolled clinical trial. Participants applied the product twice a day for 28 days. No other medication or moisturizer was allowed. Changes in dermatitis severity were assessed at days 14 and 28 by study investigators. Subjects self-assessed pruritus, Dermatology Life Quality Index, and product satisfaction. At the end of the study, a global evaluation of the product was done both by patient-reported outcomes and investigators' evaluations. RESULTS Forty subjects were enrolled in the study (mean age 35 years). Treatment success was achieved in 87.5% of subjects (p < 0.0001) after 28 days. Mean Investigator's Global Assessment (IGA) and Eczema Area and Severity Index (EASI) scores decreased at days 14 and 28 (p < 0.0001). Subjects reported a reduction in pruritus severity and improvement of quality of life (p < 0.0001), along with satisfaction with the product. At the end of the study, skin condition improved in more than 90% of subjects. No safety issues were identified. CONCLUSION The medical device studied for topical use in this clinical trial is considered safe and reduces pruritus in adults with atopic and contact dermatitis.
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Dupuy E, Miller M, Harter N. What We Have Learned–Milestones in Pediatric Contact Dermatitis. CURRENT DERMATOLOGY REPORTS 2022; 11:1-12. [PMID: 35369649 PMCID: PMC8959272 DOI: 10.1007/s13671-022-00353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review This review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children. Recent Findings ACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use. Summary ACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.
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Affiliation(s)
- Elizabeth Dupuy
- Division of Pediatric Dermatology, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - Melanie Miller
- Department of Dermatology, LAC+USC Keck School of Medicine, Los Angeles, CA USA
| | - Nicole Harter
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE USA
- Division Chief, Pediatric Dermatology, Children’s Hospital & Medical Center Omaha, 8534 Cass St., Omaha, NE 68114 USA
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Deletion of hypoxia-inducible factor prolyl 4-hydroxylase 2 in FoxD1-lineage mesenchymal cells leads to congenital truncal alopecia. J Biol Chem 2022; 298:101787. [PMID: 35247391 PMCID: PMC8988008 DOI: 10.1016/j.jbc.2022.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
Hypoxia-inducible factors (HIFs) induce numerous genes regulating oxygen homeostasis. As oxygen sensors of the cells, the HIF prolyl 4-hydroxylases (HIF-P4Hs) regulate the stability of HIFs in an oxygen-dependent manner. During hair follicle (HF) morphogenesis and cycling, the location of dermal papilla (DP) alternates between the dermis and hypodermis and results in varying oxygen levels for the DP cells. These cells are known to express hypoxia-inducible genes, but the role of the hypoxia response pathway in HF development and homeostasis has not been studied. Using conditional gene targeting and analysis of hair morphogenesis, we show here that lack of Hif-p4h-2 in Forkhead box D1 (FoxD1)-lineage mesodermal cells interferes with the normal HF development in mice. FoxD1-lineage cells were found to be mainly mesenchymal cells located in the dermis of truncal skin, including those cells composing the DP of HFs. We found that upon Hif-p4h-2 inactivation, HF development was disturbed during the first catagen leading to formation of epithelial-lined HF cysts filled by unorganized keratins, which eventually manifested as truncal alopecia. Furthermore, the depletion of Hif-p4h-2 led to HIF stabilization and dysregulation of multiple genes involved in keratin formation, HF differentiation, and HIF, transforming growth factor β (TGF-β), and Notch signaling. We hypothesize that the failure of HF cycling is likely to be mechanistically caused by disruption of the interplay of the HIF, TGF-β, and Notch pathways. In summary, we show here for the first time that HIF-P4H-2 function in FoxD1-lineage cells is essential for the normal development and homeostasis of HFs.
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Wee C, Tan CH, Zhao X, Yew YW, Goon A. Pattern of contact sensitisation in patients with and without atopic dermatitis in an Asian dermatology centre. Contact Dermatitis 2022; 86:398-403. [PMID: 35133669 DOI: 10.1111/cod.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the traditional understanding is that contact sensitisation is less frequent in atopic dermatitis (AD) patients, recent studies have shown similar or higher rates of positive patch test results in AD patients. METHODS This was a single-centre, ten-year retrospective review on contact sensitisation in patients who underwent patch testing between 2007 and 2017. The aims were to characterise the pattern of contact sensitisation and to ascertain a link between contact sensitisation and AD. RESULTS There were 4903 patients (males:females = 1:1.4; mean age 40.1 years old) included. About half (2499, 51.0%) of all patients developed at least one positive reaction. The top five frequent reactions were to nickel sulfate (45.4%), potassium dichromate (16.0%), p-phenylenediamine (13.4%), Myroxylon pereirae (11.8%) and fragrance mix I (11.2%). The overall prevalence of contact sensitisation was not significantly different between patients with or without AD. Patients with AD were less likely to develop contact allergies to budesonide and thiuram mix, and more likely to develop contact allergies to potassium dichromate. CONCLUSIONS Contact sensitisation was detected in 50% of patients patch-tested. Nickel sulfate was the most frequently sensitising allergen. The prevalence of contact allergies in atopic patients is comparable to that in non-atopic patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | - Yik Weng Yew
- National Skin Centre, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Anthony Goon
- National Skin Centre, Singapore.,Lee Kong Chian School of Medicine, Singapore
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Abdali S, Yu J. Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic. Dermatol Clin 2021; 39:555-568. [PMID: 34556245 PMCID: PMC8165076 DOI: 10.1016/j.det.2021.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The recent coronavirus disease 2019 (COVID-19) pandemic has led to the dramatic increase in use of personal protective equipment (PPE) among health care providers and the general public. Herein the authors discuss the various occupational dermatoses including allergic and irritant contact dermatitis, acne, seborrheic dermatitis, and rosacea related to frequent handwashing, disinfecting of surfaces, and prolonged wear of various PPE including face masks, gloves, and gowns. The authors provide an overview of published PPE-associated occupational dermatoses during the COVID-19 pandemic and also discuss prevention strategies and treatment options to help patients with these complaints.
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Affiliation(s)
- Selli Abdali
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 50 Staniford St, Boston, MA 02114, USA.
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Contact Dermatitis: Overcoming Challenges of Specific Patients, Deciphering the Results and Reaching a Correct Diagnosis. Handb Exp Pharmacol 2021; 268:227-246. [PMID: 34236521 DOI: 10.1007/164_2021_481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Skin lesions caused by allergic contact dermatitis are an important occupational and environmental disease. Patch testing is the gold-standard procedure used to diagnose allergic contact dermatitis.The present chapter summarizes aspects of patch testing for the diagnosis of contact allergy: important working definitions, relevance of treating contact dermatitis, materials, technique, test result and interpretation, and special consideration regarding individual factors which influence the patch test outcome or necessitate special attention.Performing and interpreting patch tests requires know-how. Knowing how to perform them and the particularities of specific cases is essential to correctly interpret the results. A correct evaluation and diagnosis will significantly impact the natural history of the disease and significantly improve the quality of life of the patient.
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García-Souto F, Lorente-Lavirgen AI, Bernabéu-Wittel J, Rojas C, Lorente R. Long-lasting contact dermatitis in patients with atopic dermatitis or psoriasis. Australas J Dermatol 2020; 61:342-345. [PMID: 32662093 DOI: 10.1111/ajd.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aetiology of contact dermatitis, a common inflammatory skin disorder, is often complex and multifactorial. OBJECTIVES To describe the characteristics of patients with contact dermatitis who also have concomitant atopic dermatitis or psoriasis. METHODS Between 2000 and 2011, adult patients with chronic contact dermatitis (six months or more), which also had concomitant atopic dermatitis or psoriasis, were recruited for a descriptive retrospective study in a tertiary care Spanish hospital. Univariate and multivariate analyses were used for the analysis of the collected data. RESULTS 76 patients with atopic dermatitis and 130 with psoriasis were recruited. The most frequent site of contact dermatitis in both groups was the hands. The most frequent clinically relevant allergen in both groups was nickel sulphate. According to multivariate logistic regression, a statistically significant association was found between facial contact dermatitis and atopic dermatitis (adjusted OR 0.2 95% CI: 0.05-0.8; P = 0.022). No differences were found between the groups for patch test results (adjusted OR 0.6 CI 95%: 0.3-1.3; P = 0.194). CONCLUSIONS Although the number of patients was limited, our results provide valuable insight on the behaviour of contact dermatitis in patients with atopic dermatitis and with psoriasis. Facial contact dermatitis was positively associated with atopic dermatitis. No differences were found with respect to rates of contact hypersensitivity or positivity to different allergens.
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Affiliation(s)
| | | | | | - Carmen Rojas
- Industrial Engineering School, Extremadura University, Badajoz, Spain
| | - Rafael Lorente
- Industrial Engineering School, Extremadura University, Badajoz, Spain
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Skin Barrier Dysfunction in Contact Dermatitis and Atopic Dermatitis-Treatment Implications. CURRENT TREATMENT OPTIONS IN ALLERGY 2020. [DOI: 10.1007/s40521-020-00264-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rundle CW, Presley CL, Militello M, Barber C, Powell DL, Jacob SE, Atwater AR, Watsky KL, Yu J, Dunnick CA. Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society. J Am Acad Dermatol 2020; 83:1730-1737. [PMID: 32707253 PMCID: PMC7373692 DOI: 10.1016/j.jaad.2020.07.057] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Chandler W Rundle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Colby L Presley
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Michelle Militello
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Cara Barber
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Douglas L Powell
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Sharon E Jacob
- Loma Linda Veterans Affairs Medical Center, Loma Linda, California; Department Medicine and Pediatrics, University of California, Riverside, California; Department of Dermatology, Loma Linda University Center, Loma Linda, California
| | - Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Kalman L Watsky
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
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Silverberg NB, Pelletier JL, Jacob SE, Schneider LC. Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention. Pediatrics 2020; 145:e20200628. [PMID: 32341178 DOI: 10.1542/peds.2020-0628] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics).To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population.This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high-nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel-avoidance strategies on both individual and global levels.
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Affiliation(s)
- Nanette B Silverberg
- Departments of Dermatology and Pediatrics, Mt Sinai Hospital and Icahn School of Medicine at Mt Sinai, New York, New York;
| | - Janice L Pelletier
- Northern Light Health, Bangor, Maine
- College of Medicine, University of New England, Biddeford, Maine
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
- Departments of Medicine and Pediatrics, University of California, Riverside, California; and
| | - Lynda C Schneider
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Novosel T, Rundle CW, Yu JD, Jacob SE. Art of prevention: The importance of bath time and avoiding extended exposure to irritating and allergenic chemicals. Int J Womens Dermatol 2019; 5:152-154. [PMID: 31360747 PMCID: PMC6637102 DOI: 10.1016/j.ijwd.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tracy Novosel
- Department of Dermatology, Atlantic Dermatology Associates, Virginia Beach, Virginia
| | | | - Jiade D. Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sharon E. Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California
- Corresponding Author.
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Holmes GA, Vassantachart JM, Sung CT, Goldenberg A, Jacob SE. Contact dermatitis and atopic dermatitis: two tales, an interwoven story. GIORN ITAL DERMAT V 2019; 154:425-434. [DOI: 10.23736/s0392-0488.18.06236-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Milam EC, Jacob SE, Cohen DE. Contact Dermatitis in the Patient with Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:18-26. [DOI: 10.1016/j.jaip.2018.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
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Novak-Bilić G, Vučić M, Japundžić I, Meštrović-Štefekov J, Stanić-Duktaj S, Lugović-Mihić L. IRRITANT AND ALLERGIC CONTACT DERMATITIS - SKIN LESION CHARACTERISTICS. Acta Clin Croat 2018; 57:713-720. [PMID: 31168208 PMCID: PMC6544100 DOI: 10.20471/acc.2018.57.04.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Contact skin lesions may be the consequences of contact with various irritants or allergens, or due to other factors (e.g., UV radiation, microbials), intrinsic factors (e.g., in autoimmune responses), or even their combination. There are many substances related to irritant contact dermatitis (CD), causing irritant or toxic effects, e.g., chemical and physical agents, plants, phototoxic agents, airborne irritants, etc. Impaired barrier function (e.g., aberrancies in epidermal pH buffering capabilities) also participates by promoting bacterial biofilms and creating an environment favoring sensitization. Development of allergic CD skin lesions includes complex immune pathways and inflammatory mediators, influenced by both genetic (predominantly filaggrin mutations) and environmental triggers. In the pathogenesis of allergic CD, antimicrobial peptides play a prominent role; they are produced by various skin cells (e.g., keratinocytes, sebocytes) and move to inflamed lesions during an inflammation process. Also, in allergic CD skin lesions, the skin shows different types of immune responses to individual allergens, although clinical manifestations do not depend on the causative allergen type, e.g., nickel stimulates immune activation primarily of the Th1/Th17 and Th22 components. Also important are alarmins, proteases, immunoproteomes, lipids, natural moisturizing factors, tight junctions, smoking, etc. We expect that future perspectives may reveal new pathogenetic factors and scientific data important for the workup and treatment of patients with CD.
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Affiliation(s)
| | - Majda Vučić
- 1Dermatology and Venereology Unit, Zabok General Hospital, Zabok, Croatia; 2Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Iva Japundžić
- 1Dermatology and Venereology Unit, Zabok General Hospital, Zabok, Croatia; 2Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jelena Meštrović-Štefekov
- 1Dermatology and Venereology Unit, Zabok General Hospital, Zabok, Croatia; 2Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sandra Stanić-Duktaj
- 1Dermatology and Venereology Unit, Zabok General Hospital, Zabok, Croatia; 2Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- 1Dermatology and Venereology Unit, Zabok General Hospital, Zabok, Croatia; 2Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Contact Dermatitis in Atopic Dermatitis Children—Past, Present, and Future. Clin Rev Allergy Immunol 2018; 56:86-98. [DOI: 10.1007/s12016-018-8711-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.
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Affiliation(s)
- Justine Fenner
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Nanette B Silverberg
- Department of Dermatology, Mt Sinai West, Icahn School of Medicine at Mt Sinai, New York, NY.
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Signs of atopic dermatitis and contact dermatitis affected by distinct H2-haplotype in the NC/Nga genetic background. Sci Rep 2018; 8:2586. [PMID: 29416104 PMCID: PMC5803211 DOI: 10.1038/s41598-018-21049-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/23/2018] [Indexed: 12/11/2022] Open
Abstract
We recently advocated in favour of naming a novel H2-haplotype consisting of Kd, D/Ldm7, I-Ak and I-Ek in the atopic dermatitis (AD) mouse model NC/Nga as “H-2nc.” The role of the H2-haplotype in AD development was investigated in H2b-congenic NC/Nga mice (NC.h2b/b and NC.h2b/nc) established by backcrossing. A severe 2,4-dinitrofluorobenzene (DNFB)-induced dermatitis in NC/Nga was alleviated partially in NC.h2b/nc and significantly in NC.h2b/b. The AD phenotype was correlated with thymic stromal lymphopoietin (TSLP)-epidermal expression levels and serum levels of total IgE and IL-18/IL-33. Histologically, allergic contact dermatitis (ACD) was accompanied by lymphocytes and plasma cells-infiltrating perivasculitis in NC.h2b/nc and NC.h2b/b and clearly differed from AD accompanied by neutrophils, eosinophils and macrophages-infiltrating diffuse suppurative dermatitis in NC/Nga. Interestingly, IFN-γ/IL-17 production from autoreactive CD4+ T-cells remarkably increased in DNFB-sensitised NC.h2b/b but not in NC/Nga. Our findings suggest that AD or ACD may depend on haplotype H-2nc or H-2b, respectively, in addition to the NC/Nga genetic background.
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Poveda-Montoyo I, Álvarez-Chinchilla PJ, Silvestre JF. Allergic Contact Dermatitis: Therapeutic Management. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Limone BA, Jacob SE. Staphylococcal infections in atopic dermatitis and nickel allergy: Immunologic implications and elemental opportunities. J Trace Elem Med Biol 2018; 45:21-22. [PMID: 29173478 DOI: 10.1016/j.jtemb.2017.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/17/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Brittanya A Limone
- MSIV, School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, CA, United States.
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