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Al-Mussallam AS, Alshathri RS, Desmedt B, Aldawsari FS, Deconinck E, Alharthi OA, Bawazir AT. Quantitative risk assessments of skin sensitization for 26 allergens in different consumer products in the Saudi market. Regul Toxicol Pharmacol 2024; 153:105714. [PMID: 39368536 DOI: 10.1016/j.yrtph.2024.105714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/15/2024] [Accepted: 09/30/2024] [Indexed: 10/07/2024]
Abstract
Fragrance chemicals are ubiquitous in cosmetics; however, they have been linked to allergic contact dermatitis. Allergy prevention involves two main strategies. Firstly, consumers are protected by limiting the maximum concentration of fragrance in a given product to avoid inducing allergies. Secondly, consumers who are already sensitized are protected by having the presence of such fragrance communicated to them. In this study, a validated GC-MS method was employed to quantify 26 allergens in 108 products marketed in Saudi Arabia.Additionally, a quantitative risk assessment (QRA) was performed on the studied cosmetics to determine the risk of inducing allergies. The results indicated that most allergens were present at acceptable concentrations, while 19 products carried a risk of inducing allergies. Furthermore, Lilial and Lyral, two prohibited fragrances, were detected in 97 products. It should be emphasized that this is the first study conducted in Saudi Arabia to evaluate the safety of the well-known 26 fragrance allergens. Hence, this study can potentially serve as a regional standard for future research.
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Affiliation(s)
| | | | - Bart Desmedt
- Medicines and Health Products, Sciensano, Julliette Wytsmanstraat 14, 1050, Elsene, Belgium
| | | | - Eric Deconinck
- Medicines and Health Products, Sciensano, Julliette Wytsmanstraat 14, 1050, Elsene, Belgium
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2
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Lopez C, Trautner BW, Kulkarni PA. Managing External Urinary Catheters. Infect Dis Clin North Am 2024; 38:343-360. [PMID: 38599895 DOI: 10.1016/j.idc.2024.03.011] [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] [Indexed: 04/12/2024]
Abstract
This narrative review explores the use of external urinary catheters. These devices are available in various types and materials for male and female patients. The indications for the use of external urinary catheters include managing incontinence linked to overactive bladder and neurogenic lower urinary tract dysfunction. Contraindications to the use of external urinary catheters include urinary obstruction. Proper skin care and proactive infection control measures are necessary to prevent complications. The collection of a urine specimen for culture requires a standardized technique to prevent contamination. Clinician-led patient education on catheter management plays a important role in ensuring patient comfort and safety.
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Affiliation(s)
- Corina Lopez
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Prathit A Kulkarni
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Mailstop: MCL-111, Houston, TX 77030, USA; Department of Medicine, Infectious Diseases Section, Baylor College of Medicine, Houston, TX, USA.
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3
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Edwards SK, Bunker CB, van der Snoek EM, van der Meijden WI. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol 2023; 37:1104-1117. [PMID: 36942977 DOI: 10.1111/jdv.18954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy. OBJECTIVE The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions. METHODS The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence. RESULTS The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN). CONCLUSION Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.
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Burli A, Schlarbaum JP, Liszewski WJ, Mansh MD, Maibach HI. Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action. Dermatitis 2023; 34:29-32. [PMID: 36705650 DOI: 10.1089/derm.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. Methods: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. Results: Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. Conclusions: Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.
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Affiliation(s)
- Anuk Burli
- From the Department of Dermatology, University of California, San Francisco.,Santa Clara Valley Medical Center, San Jose, CA
| | - Jamie P Schlarbaum
- Department of Dermatology, Oregon Health Science and University, Portland
| | - Walter J Liszewski
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Matthew D Mansh
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis
| | - Howard I Maibach
- From the Department of Dermatology, University of California, San Francisco
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5
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Burli A, Schlarbaum JP, Liszewski WJ, Mansh MD, Maibach HI. Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action. Dermatitis 2022; Publish Ahead of Print:01206501-990000000-00077. [PMID: 36255395 DOI: 10.1097/der.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. METHODS Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. RESULTS Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. CONCLUSIONS Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.
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Affiliation(s)
| | - Jamie P Schlarbaum
- Department of Dermatology, Oregon Health Science and University, Portland
| | - Walter J Liszewski
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Matthew D Mansh
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis
| | - Howard I Maibach
- From the Department of Dermatology, University of California, San Francisco
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6
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Marcelis Q, Gatzios A, Deconinck E, Rogiers V, Desmedt B, Vanhaecke T. Quantitative risk assessment of allergens leaching from menstrual hygiene products. Regul Toxicol Pharmacol 2022; 135:105260. [PMID: 36067853 DOI: 10.1016/j.yrtph.2022.105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Allergic contact dermatitis (ACD) often associated with the topical use of perfumed products, remains one of the most common chronic skin disorders in Western countries. Since labelling of scented menstrual hygiene products (MHPs) is not mandatory, women might be unknowingly exposed to allergens. Given that vaginal mucosae lack the vital barrier function of the skin, skin allergens can easily penetrate and become systemically available and hence women may experience adverse effects in the anogenital region. The aim of this study was therefore to investigate whether women using scented MHPs are at risk of sensitization and hence developing ACD. Hereto, a Quantitative Risk Assessment (QRA) is performed on four well-known skin sensitizing chemicals (α-isomethyl ionone, benzyl salicylate, hexyl cinnamaldehyde and heliotropine) that were previously found leaching from five different scented MHPs including tampons and sanitary pads. The amounts of heliotropine, leached by one of the investigated tampons, exceeded acceptable exposure levels determined with the QRA and could induce sensitization. In addition, although no sensitization is expected for the other three compounds, an allergenic reaction might be provoked in women who are already sensitized. Labelling of allergens on scented MHPs would therefore help consumers to prevent adverse effects linked to ACD.
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Affiliation(s)
- Quinten Marcelis
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Alexandra Gatzios
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Eric Deconinck
- Medicines and Medicinal Health Products, Sciensano, Julliette Weytsmanstraat 14, 1050, Elsene, Belgium.
| | - Vera Rogiers
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Bart Desmedt
- Medicines and Medicinal Health Products, Sciensano, Julliette Weytsmanstraat 14, 1050, Elsene, Belgium.
| | - Tamara Vanhaecke
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
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7
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Narla S, Silverberg JI, Simpson EL. Management of inadequate response and adverse effects to dupilumab in atopic dermatitis. J Am Acad Dermatol 2022; 86:628-636. [PMID: 34126094 DOI: 10.1016/j.jaad.2021.06.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus, skin pain, and sleep disturbances. Currently, dupilumab is the only systemic therapy and biologic medication approved by the United States Food and Drug Administration for moderate-to-severe AD in adults and children. There is a sparsity of literature available on determining treatment failure with dupilumab and the next steps health care providers can take to treat AD. Individual goals and quality of life and not just body surface area should be considered when defining treatment failure. Possible confounding dermatoses also should be ruled out. Early identification of dupilumab-induced adverse events is important. For most patients, dupilumab can be continued while treatment for the adverse event is initiated. Adjusting the frequency of dupilumab dosing also may be considered in some circumstances. Adjuvant therapies, such as methotrexate, azathioprine, mycophenolate mofetil, cyclosporine, or phototherapy can be added but the safety and efficacy of these combination treatments are not known at this time.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
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8
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Characterization of Residual Facial Dermatitis during Dupilumab Therapy: A Retrospective Chart Review to Delineate the Potential Role of Expanded Series Patch Testing. Dermatitis 2022; 33:51-61. [PMID: 35029349 DOI: 10.1097/der.0000000000000801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine the incidence of RFDD in patients receiving dupilumab and the rate of resolution of RFDD after expanded series patch testing (ESPT) and allergen avoidance. METHODS This is a retrospective chart review of 80 patients with atopic dermatitis who were evaluated for RFDD after treatment with dupilumab. Expanded series patch testing findings and response to allergen avoidance were assessed in the subset of patients with RFDD who subsequently underwent ESPT while continuing to receive dupilumab. RESULTS Forty-nine patients (61.3%) experienced facial dermatitis before initiating dupilumab. Thirty-five patients (43.8%) experienced RFDD after starting dupilumab. Of the 14 patients with RFDD who received ESPT, 92.9% had 1 or more relevant positive patch test results, with 50% of such patients being mostly to completely clear of facial dermatitis after allergen avoidance. Importantly, 50.6% of the positive reactions to allergens were not included on the North American Contact Dermatitis Group Core 80. CONCLUSIONS Many patients with RFDD benefit from patch testing and subsequent allergen avoidance. Expanded series patch testing should be offered to patients who experience RFDD after beginning dupilumab therapy to ensure that such patients have eliminated any exogenous component of their dermatitis, such as concomitant allergic contact dermatitis.
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9
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Narla S, Silverberg JI. Dermatology for the internist: optimal diagnosis and management of atopic dermatitis. Ann Med 2021; 53:2165-2177. [PMID: 34787024 PMCID: PMC8604464 DOI: 10.1080/07853890.2021.2004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans.Key messages:Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral.AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA, USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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10
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Abstract
The vulvar area is a common site of both irritative and allergic contact dermatitis due to the thin skin, easily traversable by irritant and allergic substances. The purpose of this review is to provide an overview of the most frequent allergens causing contact dermatitis in this particular site. A literature search was conducted via PubMed through May 2021. Relevant English language studies are included in this review. Fragrances, preservatives, botanical products, and topical medicaments were found to be the most commonly involved allergens. Contact dermatitis is a very common occurrence that should also be considered in patients with chronic vulvar or anogenital dermatitis who do not respond to appropriate treatments.
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11
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Nguyen J, Chen JK. Environmental Causes of Dermatitis. Immunol Allergy Clin North Am 2021; 41:375-392. [PMID: 34225895 DOI: 10.1016/j.iac.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Environmental, or exogenous, dermatitis is comprised of irritant and allergic contact dermatitis, which account for 80% and 20% of cases of contact dermatitis, respectively. Contact dermatitis is extremely common, and failure to diagnose this entity may result in overlooking a potentially curable driver of disease. In this review, we describe how clinical features, such as morphology or history, can assist in distinguishing exogenous from endogenous causes of dermatitis, and allergic from irritant contact dermatitis. Additionally, we provide an overview of common contact allergens and how dermatitis distribution can suggest possible culprit allergens. Patch testing is needed to confirm contact allergy.
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Affiliation(s)
- Jannett Nguyen
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 2nd Floor, Redwood City, CA 94063, USA
| | - Jennifer K Chen
- Department of Dermatology, Stanford University School of Medicine, 450 Broadway Street, Pavilion C, 2nd Floor, Redwood City, CA 94063, USA.
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Woo YR, Han Y, Lee JH, Lee YB, Kim JE, Kim M, Park CJ, Lee JH, Cho SH. Real‐world prevalence and burden of genital eczema in atopic dermatitis: A multicenter questionnaire‐based study. J Dermatol 2021; 48:625-632. [DOI: 10.1111/1346-8138.15817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Yu Ri Woo
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
- Eczema Research Association of Catholic Medical Center Seoul Korea
| | - Yujin Han
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
| | - Ji Hae Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology St. Vincent’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Young Bok Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Uijeongbu St. Mary’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Jung Eun Kim
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Eunpyung St Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Miri Kim
- Department of Dermatology Yeouido St. Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Chul Jong Park
- Department of Dermatology Bucheon St. Mary’s Hospital College of Medicine The Catholic University of Korea Gyeonggi‐do Korea
| | - Ji Hyun Lee
- Eczema Research Association of Catholic Medical Center Seoul Korea
- Department of Dermatology Seoul St. Mary’s Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Sang Hyun Cho
- Department of Dermatology Incheon St. Mary’s Hospital The Catholic University of Korea Incheon Korea
- Eczema Research Association of Catholic Medical Center Seoul Korea
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13
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Contact Allergy to Topical Drugs. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Felmingham C, Saunders H, Veysey E, Nixon RL. Comment on "How to improve the clinical experience for dermatology patients requiring a genital examination: A randomized trial of deodorizing wipes versus standard of care". J Am Acad Dermatol 2020; 84:e215-e216. [PMID: 33347875 DOI: 10.1016/j.jaad.2020.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | - Helen Saunders
- Dermatology Department, The Royal Women's Hospital, Melbourne, Victoria, Australia; Dermatology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Emma Veysey
- Dermatology Department, The Royal Women's Hospital, Melbourne, Victoria, Australia; Dermatology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
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15
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Nguyen N, Corley S. Geriatric Vulvar Dermatology. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00332-8] [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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16
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Warshaw EM, Kimyon RS, Silverberg JI, Belsito DV, DeKoven JG, Maibach HI, Zug KA, Atwater AR, Mathias T, Sasseville D, Fowler JF, Marks JG, Reeder MJ, DeLeo VA, Pratt MD, Zirwas MJ, Taylor JS, Fransway AF. Evaluation of Patch Test Findings in Patients With Anogenital Dermatitis. JAMA Dermatol 2020; 156:85-91. [PMID: 31774454 DOI: 10.1001/jamadermatol.2019.3844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Contact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008. Objectives To characterize patients with anogenital dermatitis referred for patch testing by the North American Contact Dermatitis Group, to identify common allergens, and to explore sex-associated differences between anogenital dermatitis and allergens. Design, Setting, and Participants A retrospective, cross-sectional analysis was conducted of the North American Contact Dermatitis Group database among 28 481 patients who underwent patch testing from January 1, 2005, to December 31, 2016, at outpatient referral clinics in the United States and Canada. Exposure Patch testing for allergens. Main Outcomes and Measures Currently relevant allergic patch test reactions in patients with anogenital dermatitis. Results Of 28 481 patients tested during the study period, 832 patients (336 men and 496 women; mean [SD] age, 50.1 [26.5] years) had anogenital involvement and 449 patients (177 men and 272 women; mean [SD] age, 49.6 [17.4] years) had anogenital dermatitis only. Compared with those without anogenital involvement, there were significantly more male patients in the group with anogenital dermatitis (177 [39.4%] vs 8857 of 27 649 [32.0%]; relative risk, 1.37; 95% CI, 1.14-1.66; P < .001). In the group with anogenital involvement, female patients were significantly less likely than male patients to have allergic contact dermatitis as a final diagnosis (130 [47.8%] vs 107 [60.5%]; relative risk, 0.78; 95% CI, 0.64-0.94; P = .01), whereas a final diagnosis of other dermatoses (eg, lichen planus, lichen sclerosus, or lichen simplex chronicus) was more frequent for female patients than for male patients (67 [24.6%] vs 28 [15.8%]; relative risk, 1.54; 95% CI, 1.02-2.31; P = .03). Of the 449 patients in the group with anogenital involvement only, 227 (50.6%) had 1 or more relevant reaction with patch testing. Allergens that were statistically significantly more common in patients with anogenital involvement compared with those without anogenital involvement included medicaments such as dibucaine (10 of 250 patients tested [4.0%] vs 32 of 17 494 patients tested [0.2%]; relative risk, 22.74; 95% CI, 11.05-46.78; P < .001) and preservatives such as methylchloroisothiazolinone and methylisothiazolinone (30 of 449 patients tested [6.7%] vs 1143 of 27 599 patients tested [4.1%]; relative risk, 1.61; 95% CI, 1.14-2.41; P = .008). A total of 152 patients met the definition for anogenital allergic contact dermatitis, which is defined as anogenital involvement only, allergic contact dermatitis as the only diagnosis, and 1 or more positive reaction of current clinical relevance. Conclusions and Relevance For patients with anogenital involvement only who were referred for patch testing, male patients were more likely to have allergic contact dermatitis, whereas female patients were more likely to have other dermatoses. Common allergens or sources consisted of those likely to contact the anogenital area. For individuals with anogenital involvement suspected of having allergic contact dermatitis, reactions to preservatives, fragrances, medications (particularly topical anesthetics), and topical corticosteroids should be tested.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,Department of Dermatology, University of Minnesota, Minneapolis
| | - Rebecca S Kimyon
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota.,University of Minnesota Medical School, Minneapolis
| | - Jonathan I Silverberg
- Feinberg School of Medicine, Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California, San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Amber R Atwater
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Toby Mathias
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Denis Sasseville
- Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin Medical School, Madison
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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17
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Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Goossens A, Gonçalo M. Contact Allergy to Topical Drugs. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_38-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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McCleskey PE. Anogenital Dermatitis in Men Who Have Sex with Men. Dermatol Clin 2019; 38:227-232. [PMID: 32115132 DOI: 10.1016/j.det.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evaluation of anogenital dermatitis requires a detailed history, including a sexual history. Men who have sex with men have different risk of certain infectious causes compared with men who have sex with women. Infectious causes of balanitis and anal dermatitis are easily treatable once identified. Irritant contact dermatitis is a common cause of balanitis, and avoidance of irritants, including decreased soap washing, helps many patients improve. Detailed histories of the personal products used by the patient and partner(s), including soaps, lotions, perfumes, lubricants, condoms, topical medications, hygiene sprays, personal wipes, and laundry detergent, may reveal possible irritants or contact allergens.
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Affiliation(s)
- Patrick E McCleskey
- Department of Dermatology, Kaiser Permanente, 3701 Broadway, Oakland, CA 94611, USA.
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