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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.

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.

Allergic contact hypersensitivity reactions of the oral mucosa pose a significant medical concern for some patients. Oral hypersensitivity reactions can result from a vast number of allergenic chemicals, but occur commonly from dental materials, flavorings, and preservatives. Clinical presentation is varied and often overlaps with other oral conditions, complicating their diagnosis and management. The most common clinical entities associated with oral hypersensitivity reactions are oral lichenoid reactions and allergic contact cheilitis. In addition to reviewing these conditions and their most common corresponding allergens, this article summarizes the pathogenesis of oral hypersensitivity reactions and addresses patch testing pearls., Competing Interests: Disclosure The authors have nothing to disclose., (Published by Elsevier Inc.)

Background: There is currently no standardized protocol for photopatch testing and phototesting in the United States. Certain testing paramaters (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 the survey are presented, and they confirm that a variety of techniques and testing materials are used., Conclusions: It would be beneficial to enlist a panel of expert contact dermatologists to create by formal consensus, using these research findings, a standard photopatch test protocol for use in this country.

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.

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.

Nodular scleroderma, also known as keloidal scleroderma, is a rare form of scleroderma that may occur with either systemic sclerosis or localized scleroderma. Clinically, this disorder is characterized by keloidal nodules that form in sclerodermatous areas. These nodules may histologically show the presence of keloidal collagen. Because of the rarity of this condition, clinicians may not be familiar with the clinical and histologic features relevant to this scleroderma variant. In this report, we describe 2 cases of nodular scleroderma.

A 45-year-old woman presented in October 2005 with a history of an eruption involving her scalp and face, including her eyelids and behind her ears. The eruption began at the end of August. It flared after she used a calming moisturizer containing feverfew (Tanacetum parthenium). A second patient, a 25-year-old woman, presented complaining of a 1-month history of an eruption around the eyes that started after she began using a moisturizer containing feverfew. Both patients were patch-tested with the North American Contact Dermatitis Group series, cosmetic and plant series, and their own skin care products. Patient 1 had a + reaction to sesquiterpene lactone mix, a + reaction to Compositae mix, a + reaction to parthenolide, a + reaction to Tanacetum vulgare, and a + reaction to the calming moisturizer. Patient 2 had + reactions to sesquiterpene lactone, Compositae mix, and the same calming moisturizer. It is thought that both of these eruptions are a result of contact dermatitis from the Compositae plant family.

Considering the widespread use of colophony-containing epilating products and the frequency of sensitization to colophony, it is somewhat surprising that reports of allergic contact dermatitis from these products are so infrequent. Reactions to colophony can be severe, and they may present even after initial exposure (primary sensitization). Consequently, health care practitioners should be aware of potential colophony-induced allergic contact dermatitis in patients exposed to epilating products. Patch testing with commercially available colophony unmodified rosins often fails to detect reactions to the modified-rosin derivatives found in the actual epilating products. Therefore, the evaluation of colophony allergy may require testing with the patient's own products as well as additional modified colophony rosins. We describe a case of allergic contact dermatitis caused by colophony found in an epilating product.

Purpose of Review: The following paper reviews the recent literature pertaining to allergic contact dermatitis in the pediatric population., Recent Findings: Allergic contact dermatitis may affect as many as 20% of the pediatric population. Recent studies implicate the following chemicals as the most common causes: nickel, topical antibiotics, preservative chemicals, fragrances and rubber accelerators. Several less common, but emerging, allergens have also been reported recently, including para-phenylenediamine in henna tattoos, cocamidopropyl betaine in 'no tears' shampoos and cleansers, and disperse dyes in clothing materials. Allergic contact dermatitis occurs less frequently in the first few months of life and increases in prevalence with increasing age. In the adolescent age group, females have significantly higher rates of allergic contact dermatitis on the face. This is likely explained by increased exposures to nickel in piercings and to preservative and fragrance chemicals in cosmetic products., Summary: The documented rates of allergic contact dermatitis in children are on the rise. This increased prevalence may be due to increased chemical exposures in this age group, better recognition by pediatricians and perhaps more widespread use of epicutaneous patch testing. This review outlines the basic pathophysiology, epidemiology and clinical manifestations of allergic contact dermatitis in children.

The use of botanical extracts for their perceived therapeutic benefits has gained increased popularity in this country and abroad. In particular, tea tree oil (the extracted oil of Melaleuca alternifolia) has gained widespread use for its purported antimicrobial and therapeutic effects. In parallel with this increased use is an expanding series of reported adverse effects, including allergic contact dermatitis, systemic contact dermatitis, linear immunoglobulin A disease, erythema multiforme-like id reactions, and systemic hypersensitivity reactions. We present a review of tea tree oil with regard to its history, chemistry, purported medicinal uses, and possible adverse cutaneous effects.