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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.