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Background: There is currently no standardized protocol for photopatch testing and phototesting in the United States. Certain testing parameters (such as chemicals tested, time between test application and irradiation, and time of final interpretation) vary from provider to provider. These variations may impact comparability and consistency of test results. Objective: The goal of our survey-based study was to outline the photopatch test and phototest protocols used by US contact dermatologists. The information obtained will aid in the development of a national consensus on testing methodologies. Methods: Based on a literature search conducted on differences in testing methodologies, we constructed a questionnaire. The survey was distributed at the American Contact Dermatitis Society annual meeting and via the American Contact Dermatitis Society Web site. Standard descriptive analysis was performed on data obtained. Results: Of the 800 dermatologists contacted, 117 agreed to participate in the survey. Among these respondents, 64 (54.8%) conduct photopatch testing. Results of survey are presented in the main article, and they confirm that a variety of techniques and testing materials are used. Conclusions: Similar to the procedure in other countries, it is recommended that a panel of expert contact dermatologists be created and, using these research findings, establish a formal consensus. [ABSTRACT FROM AUTHOR]

The American Contact Dermatitis Society recognizes the interest in the evaluation and management of metal hypersensitivity reactions. Given the paucity of robust evidence with which to guide our practices, we provide reasonable evidence and expert opinion based guidelines for clinicians with regard to metal hypersensitivity reaction testing and patient management. Routine preoperative evaluation in individuals with no history of adverse cutaneous reactions to metals or history of previous implant-related adverse events is not necessary. Patients with a clear self-reported history of metal reactions should be evaluated by patch testing before device implant. Patch testing is only 1 element in the assessment of causation in those with postimplantation morbidity. Metal exposure from the implanted device can cause sensitization, but a positive metal test does not prove symptom causality. The decision to replace an implanted device must include an assessment of all clinical factors and a thorough risk-benefit analysis by the treating physician(s) and patient. [ABSTRACT FROM AUTHOR]

In recent years, there has been a growing interest in the use of skin patch testing to evaluate patients for orthopedic, implant-related adverse effects. This may be done preoperatively to avoid implanting a material to which an individual may be allergic or postoperatively to implicate sensitivity as a cause for implant failure. There is emerging evidence that patch testing might have utility in the workup of implant-related adverse events; however, the level of evidence at the present time is weak and based only on a collection of case reports, series, and retrospective cohort studies (level IV evidence as per United States Department of Health and Human Services guidelines); there are no randomized controlled trials (level I evidence) with which to guide medical decision making. Recent reports have advocated that patch testing be broadly used in the preoperative evaluation of all patients self-reporting a history of metal sensitivity. In addition, several authors have advocated that patch test results should guide preoperative implant selection and postoperative implant removal. It is the opinion of this author that these recommendations are premature, lacking robust clinical evidence, and unfeasible given the broad-reaching logistical impact and societal costs involved. More robust clinical data are needed, and thorough cost-benefit analyses must be performed before such far-reaching and costly systematic practices should be broadly implemented. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 57-year-old man with a history of diabetes mellitus and psoriasis who complaint of malaise, perianal papule and occasional bright red blood per rectum.

Myxofibrosarcoma, also known as myxoid malignant fibrous histiocytoma, is increasingly recognized as a distinct malignant neoplasm of fibroblastic origin with variable clinical and histopathologic features. Myxofibrosarcomas are among the most common malignant mesenchymal neoplasms of older adults, and approximately two thirds develop within the dermis or subcutis. Herein, we describe the clinicopathologic features of four cases of myxofibrosarcoma involving the skin. Three of these cases were initially misdiagnosed as benign cutaneous neoplasms, two as myxoid neurofibroma. These cases illustrate the clinicopathologic spectrum encompassed by myxofibrosarcoma in the skin and highlight the diagnostic difficulties it may present. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis in the pediatric population is more common than previously recognized, with recent prevalence estimates of positive patch test reactions in the range of 14–70% of children patch tested. The aim of this study was to confirm the prevalence of clinically relevant allergic contact dermatitis in children at two referral centers and determine the most common contact allergens. We performed a retrospective case series analysis of 65 symptomatic children (35 girls and 30 boys) aged 1–18 years old who were patch tested over a 5-year period for recalcitrant dermatitis. Positive patch test reactions were noted in 54 of the 65 children (prevalence rate of 83%) to 80 different allergens. Fifty children (77%) had positive reactions which were determined to be of “definite” or “probable” current clinical relevance. We conclude that the diagnosis of allergic contact dermatitis to specific relevant allergens is common in children referred for patch testing and that contact allergy should be considered in all children with recalcitrant dermatitis. With this article, we review the literature and present a US based study regarding the clinical relevance of positive patch test reactions in children. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis is now known to be a common problem in pediatric populations, accounting for up to 20% of all dermatitis seen in children. Seminal studies conducted over the past decade have demonstrated a prevalence rate in the range of 25% to 60% of children referred for epicutaneous patch testing. This patch test procedure is generally accepted as the gold standard in vivo technique to diagnose allergic contact dermatitis. However, the overwhelming majority of research studies to date have been conducted on adult populations. Increasingly, pediatric patients are undergoing patch test procedures with techniques that have been standardized and optimized almost exclusively in adults. With this article, we hope to emphasize common misconceptions and pitfalls encountered with this approach. In addition, we hope to stimulate research interest in this field so as to determine the optimum patch test conditions and techniques for children. [ABSTRACT FROM AUTHOR]

We report two cases of focal preauricular dermal dysplasia and review the available literature. Focal preauricular dermal dysplasia is a form of aplasia cutis congenita in which atrophic skin lesions occur in a stereotypical bilateral distribution in the preauricular region. Although focal preauricular dermal dysplasia and membranous cutis aplasia of the scalp share clinical similarities, focal preauricular dermal dysplasia represents a form of aplasia cutis congenita that is not typically associated with extracutaneous anomalies. [ABSTRACT FROM AUTHOR]

The article presents a case report of a 42-year-old man suffering from Group B Streptococcal Toxic Shock-Like Syndrome. It is a rare, life-threatening systemic illness characterized by the sudden onset of fever, a scarlatiniform eruption, hypotension, vomiting, diarrhea, renal and hepatic abnormalities, disseminated intravascular coagulation and shock. The patient was treated with intravenous cefazolin and clindamycin over several weeks. His blood pressure normalized in the first week, followed by improvement in his pulmonary function. Finally, the patient's hepatic and renal function normalized, urine output slowly returned and was discharged home after 2 months of hospitalization.

Presents a case report regarding the development of erythematous facial plaques in a patient with leukemia. Characteristics of the lesions; Physical examination results.

Leishmania are obligate intracellular protozoa that parasitize mononuclear phagocytes. Because mononuclear phagocytes are also the primary source of leukocytic pyrogen and of lymphocyte-activating factor, both considered properties of interleukin-1 (IL-1), we investigated in vitro production of leukocytic pyrogen and of lymphocyte-activating factor from human monocytes infected with Leishmania tropica. Despite parasitization of 95% of cells, 24- and 48-hr culture supernatants and cell lysates derived from L. tropica-infected monocytes did not contain IL-1. Leishmania that were killed by freezing or by glutaraldehyde treatment similarly did not induce monocyte production of IL-1. Of importance is the observation that human monocytes infected with L. tropica for 6 hr and then challenged with a potent IL-1 inducer (Staphylococcus epidermidisi) produced significantly less IL-1 than did uninfected monocytes that were similarly challenged (P <.001). This difference was not affected by the addition of indomethacin to the cultures. In contrast, soluble immune complexes prepared with an excess of L. tropica antigen and rabbit antibody to L. tropica induced high levels of IL-1 production from normal monocytes. Neither antigen nor antibody alone incubated with monocytes led to significant production of IL-1, however. Thus, these studies suggest that despite leishmanial adherence to, entrance into, and replication within human monocytes there is little or no stimulation of IL-1 production. This may represent a parasite evasion mechanism that retards the development of protective immune responses in leishmaniasis. [ABSTRACT FROM PUBLISHER]

The article presents a clinical pediatric dermatology case that describes an infant born with flesh-colored soft-tissue appendages that extended from the occiput, leg, and hand. The infant's features are consistent with disorganization syndrome. Epithelial and mesenchymal hamartomas are revealed by histopathologic examination at low power and high power.