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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_16] [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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Abstract
OBJECTIVES Allergic contact dermatitis is an uncommon but important cause of skin disease in the anogenital region. Relevant allergens are described in women and less commonly in men. The aim of this study was to describe outcomes of patch testing in men and women presenting with anogenital dermatoses. MATERIALS AND METHODS Cases patch tested for anogenital conditions at 2 patch test clinics in Sydney, Australia, from 2002 to 2017 were reviewed. Positive and relevant patch test reactions were recorded. RESULTS Thirty-seven women and 27 men were included. Dermatitis was the most common diagnosis, followed by psoriasis and lichen sclerosus. Thirty percent had a final diagnosis of allergic contact dermatitis. The most frequent relevant allergens were fragrance mix I (9%), patients own products (9%), Myroxylon pereirae (8%), cocamidopropyl betaine (3%), and benzocaine (3%). CONCLUSIONS The top positive and relevant allergens seen were in concordance with other reports from Australia and the rest of the world. Fragrances and medicaments are common allergens, and it is recommended that products used on anogenital skin be fragrance free. Testing patients own products is imperative.
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Weyandt G, Breitkopf C, Werner RN, Zidane M, Furtwängler A, Jongen J, Rothhaar A, Schaefer D, Lenhard B. S1‐Leitlinie Diagnostik und Therapie des Analekzems. J Dtsch Dermatol Ges 2020; 18:648-657. [PMID: 32519493 DOI: 10.1111/ddg.14125_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Gerhard Weyandt
- Klinik für Dermatologie und Allergologie, Klinikum Bayreuth, Bayreuth
| | | | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Alex Furtwängler
- Praxisklinik 2000, Proktologische Praxis Freiburg, Freiburg im Breisgau
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Weyandt G, Breitkopf C, Werner RN, Zidane M, Furtwängler A, Jongen J, Rothhaar A, Schaefer D, Lenhard B. German S1 guidelines for the diagnosis and treatment of perianal dermatitis (anal eczema). J Dtsch Dermatol Ges 2020; 18:648-657. [PMID: 32469472 DOI: 10.1111/ddg.14125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/14/2019] [Indexed: 11/30/2022]
Abstract
Perianal dermatitis (anal eczema, perianal eczema) is one of the most common proctological conditions. It may occur as a sequela or a presenting symptom of various proctological, dermatological, allergic or pathogen-induced disorders. The three main types of anal eczema are irritant-toxic, atopic and allergic contact dermatitis. Adequate and successful treatment requires a comprehensive diagnostic workup to determine disease etiology and includes treatment/elimination of causative factors as well as nonpharmacological interventions (avoidance of aggravating factors). In addition, adjuvant topical anti-inflammatory and/or specific symptomatic treatment may be required. The present guidelines contain recommendations for the diagnostic and therapeutic management of perianal dermatitis. Target users of these guidelines are clinicians in the fields of dermatology and proctology, as well as all other specialties involved in the management of patients with perianal dermatitis, both in hospital and office-based settings.
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Affiliation(s)
- Gerhard Weyandt
- Department of Dermatology and Allergology, Klinikum Bayreuth, Bayreuth, Germany
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alex Furtwängler
- Praxisklinik 2000, Proktologische Praxis Freiburg, Freiburg im Breisgau, Germany
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_16-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fortier E, Cerruti A, Clec’h CLE, Bigot P. Review of cutaneous penile lesions. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817735232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Penile lesions often go undiagnosed and are difficult to identify for general practitioners and specialists, yet the stakes could be high. Indeed, the condition is highly varied and includes physiological variants, specific skin entities, genital dermatoses, genital ulcers, balanitis, premalignant lesions, and, finally, cancerous lesions. Knowledge of these entities can help to prevent overlooking potentially progressive lesions and diagnose cancerous lesions early so that patients can be offered conservative treatment, improving chances of survival. We review here these different lesions. Materials and methods and authors personal experience: A literature review was carried out in December 2016 using the Medline/Pubmed database, without any restrictions regarding the time period but limiting the review to studies in English or French. The main keywords used were “penile lesion”, “penile cancer”, “balanitis” and “premalignant lesion”. A specific review was performed for each type. All the pictures and cases came from our personal practice in our specific uro-dermatological consultation. All the patients gave us their informed consent for the utilization of their pictures. Results: We studied 66 references covering the field of benign and malignant lesions and their respective treatment. It is essential to take a medical history and perform a clinical examination, despite the fact that some lesions are not specific. A biopsy must be performed systematically in the case of all suspicious lesions. Conclusion: Lesions on genital organs in men are very diverse. Some are difficult to diagnose and treat, with the main challenge being early diagnosis of lesions with a high progressive potential in order to prevent dissemination and the need for mutilating surgery.
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Affiliation(s)
| | - Arnaud Cerruti
- Department of Urology, Angers University Hospital, France
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, France
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Abstract
BACKGROUND Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. OBJECTIVE The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. METHODS Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. RESULTS One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. CONCLUSIONS Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.
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Wedi B. Ekzem-Update — klinische Manifestationen, Pathogenese und aktuelle Therapieansätze. ALLERGO JOURNAL 2016. [DOI: 10.1007/s15007-016-1183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
The oral allergy syndrome is one of the most common form of food allergy and manifests as contact urticaria of the oral mucosa after consumption of cross reacting foods. Whereas allergic contact stomatitis often occurs due to dental materials, allergic contact cheilitis is usually a reaction due to topical therapeutics like herpes ointments or lip care products. As late type reactions are more frequent than immediate type reactions in the anogenital mucosa, contact dermatitis in this area should be identified via epicutaneous testing. In case of contact urticaria at the genital mucosa, a semen allergy or a latex allergy should be given due consideration as a possible cause. Angioedemas, which are mostly common histamine mediated, usually prefer skin areas with loose connective tissue such as the oral or genital mucosa. Fixed drug eruption also occurs preferentially in these areas. Bullous drug-induced skin reactions (e.g., SJS and TEN) are characterized by severe hemorrhagic, erosive affections of mucous membranes.
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Abstract
Balanitis is a descriptive diagnosis for a heterogeneous group of infectious or inflammatory dermatoses which have to be differentiated from malignant conditions. Balanitis is caused not only by Candida spp. and bacterial infections, including anaerobic bacteria: viral infections, parasites and other sexually transmitted infections (STI) also have to be considered. Lichen planus, psoriasis and contact dermatitis can characteristically lead to inflammatory conditions of the glans penis. In addition to a complete skin examination, a thorough patient history with respect to topically applied products and sexual behavior is essential. Infections must be treated and the glans penis should be kept dry. It is important to ensure a balanced genital hygiene in patients. As a last resort therapeutic circumcision can be considered for most forms of chronic balanitis.
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Affiliation(s)
- S Borelli
- Dermatologisches Ambulatorium, Stadtspital Triemli Zürich, Herman-Greulich-Str. 70, 8004, Zürich, Schweiz,
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Havlickova B, Weyandt GH. Therapeutic management of anal eczema: an evidence-based review. Int J Clin Pract 2014; 68:1388-99. [PMID: 24898365 PMCID: PMC4282279 DOI: 10.1111/ijcp.12457] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/14/2014] [Indexed: 11/30/2022] Open
Abstract
AIM To conduct a systematic review of treatments for anal eczema (AE). METHODS We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. RESULTS The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. DISCUSSION Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. CONCLUSION This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared.
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Affiliation(s)
- B Havlickova
- Global Clinical Development Dermatology, Bayer HealthCare, Berlin, Germany
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Schwitulla J, Gefeller O, Schnuch A, Uter W. Risk factors of polysensitization to contact allergens. Br J Dermatol 2014; 169:611-7. [PMID: 23647229 DOI: 10.1111/bjd.12423] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND 'Polysensitization' (PS) is usually defined as contact sensitization to three or more unrelated haptens of the baseline patch test series. Despite PS being an important clinical phenotype indicating increased susceptibility to contact allergy, statistical approaches to analyse PS have hitherto been preliminary. OBJECTIVES To apply an appropriate regression model for count data, namely, negative binomial hurdle regression, to a large set of clinical patch test data with the aim of estimating PS risk in more detail than previously achieved. METHODS The detailed information provided by the hurdle model includes a separate estimation of an 'increment factor' quantifying the likelihood of further positive reactions, i.e. PS. Clinical data of 126 878 patients patch tested by departments comprising the IVDK (Information Network of Departments of Dermatology) network (www.ivdk.org) between 1995 and 2010 were included. RESULTS Regarding anatomical sites as exposure (surrogate), the axillae and the feet were found to be strong PS risk factors. Moreover, age was a strong PS risk factor, and less so, female sex. In comparison, atopic eczema and occupational dermatitis were less important risk factors. Single allergens contributed to PS to a varying extent. CONCLUSIONS The data presented point to some, very likely exposure-related, risk factors which need to be considered in future PS research, e.g. addressing the genetic basis for PS.
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Affiliation(s)
- J Schwitulla
- Department of Medical Informatics Biometry and Epidemiology, University of Erlangen/Nürnberg, Waldstr. 4-6, D-91054, Erlangen, Germany
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Vermaat H, Smienk F, Rustemeyer T, Bruynzeel DP, Kirtschig G. Anogenital allergic contact dermatitis, the role of spices and flavour allergy. Contact Dermatitis 2008; 59:233-7. [DOI: 10.1111/j.1600-0536.2008.01417.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weyandt G. Proctology. J Dtsch Dermatol Ges 2007; 5:503-19. [PMID: 17537045 DOI: 10.1111/j.1610-0387.2007.06372.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gerhard Weyandt
- Department of Dermatology, Venereology and Allergy, University of Würzburg, Germany.
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Zuberbier T, Worm M. Allergies and the skin, an interdisciplinary approach in GA(2)LEN and EAACI activities. Allergy 2006; 61:1373-6. [PMID: 17073864 DOI: 10.1111/j.1398-9995.2006.01266.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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