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Allergic contact dermatitis to nickel is a continued health concern internationally. Nickel has been found to be the most prevalent and relevant allergen in tested populations for the last 3 decades. Furthermore, recent data from the North American Contact Dermatitis Group demonstrate positive patch-test reactions to nickel at approximately 19.5% of their tested population and a significant increase in the positivity rates for the last decade (Dermatitis. 2013;24:10-21. J Am Acad Dermatol. 1998;38:911-918). Because of the rise in allergic contact dermatitis rates to nickel, the American Contact Dermatitis Society recognized nickel to be the 2008 Allergen of the Year (J Am Acad Dermatol. 2009;60:1067-1069; Dermatitis. 2008;19:3-8). This article recognizes the importance of nickel avoidance and highlights potential alternatives.

Background Although there is no universally accepted topical emollient recommended for wound care, there has been a trend toward minimizing exposure to common culprits of allergic contact dermatitis. Objective To assess the current practices of postoperative emollient use of dermatologic surgeons. Methods and Materials An anonymous 10-question survey on postoperative emollient use for clean surgical wounds was e-mailed to 857 members of the American College of Mohs Surgery. Results Two hundred ninety-four members (34.3%) responded. After routine closure, the most commonly used topical emollient placed immediately postoperatively was petroleum jelly (53.1%), followed by Aquaphor (Beiersdorf Inc., Wilton, CT) (19.4%) and bacitracin (8.2%) (p

Lichen planus pigmentosus-inversus is rare with only twenty patients (including our patient) formally described in the literature. The reported twenty patients with lichen planus pigmentosus-inversus include eight men and twelve women with ages ranging from 25-84 years (average age of 55.3). Twelve were Caucasian, five were Asian, one was Hispanic and two were of unknown ethnicity. Seventeen out of twenty patients had lesions in the axillae and mild pruritus was present in eight patients. Our patient is the first patient reported to have post-auricular sulcus involvement.

Increased cases of acquired epidermodysplasia verruciformis (EDV) have been reported in patients with human immunodeficiency virus (HIV). With regard to management, there are no randomized controlled trials in either immunocompetent or immunocompromised patients, and only a limited number of anecdotal treatment options. Systemic retinoids, either independently or in combination with other treatment modalities, have been used with limited success, demonstrating transient clinical response and recurrence of lesions after cessation of therapy. We report a case of an HIV-positive patient with acquired EDV who achieved sustained clinical resolution even after discontinuation of oral acitretin by applying topical imiquimod to prevent recurrence of his lesions.

Lichen planus pigmentosus-inversus is rare with only twenty patients (including our patient) formally described in the literature. The reported twenty patients with lichen planus pigmentosus-inversus include eight men and twelve women with ages ranging from 25–84 years (average age of 55.3). Twelve were Caucasian, five were Asian, one was Hispanic and two were of unknown ethnicity. Seventeen out of twenty patients had lesions in the axillae and mild pruritus was present in eight patients. Our patient is the first patient reported to have post-auricular sulcus involvement.

Histopathologic examination is the gold standard for the diagnosis of melanocytic lesions, including melanoma, and guides management options and disease prognosis based on the depth of invasion. Although most melanomas can be readily distinguished from benign nevi, some pigmented lesions are more ambiguous and can be challenging to interpret as truly benign or truly malignant. Unfortunately, misclassification can render severe consequences for the patient, making it imperative to explore further analysis to determine the true nature of an ambiguous lesion. A relatively new technique known as fluorescence in situ hybridization (FISH) has become prevalent in dermatopathology for distinguishing between benign and malignant pigmented lesions; however, there are few reports on the application of FISH results in the clinical setting. We present 3 cases in which a FISH assay was utilized to assist in the diagnosis and management of ambiguous pigmented lesions. We also provide a review of the most recent literature regarding this diagnostic modality.

Background Although allergic contact dermatitis of the eyelids is a common condition, limited information is available regarding the selection of patch-testing chemicals for proper evaluation. Objective The purpose of this analysis was to evaluate the relevance of allergens responsible for allergic eyelid dermatitis among a series of patch-tested patients attending our clinic at the University of Miami and compare these results to published studies in the literature. Methods Data were retrospectively reviewed for eyelid-only dermatitis from clinically relevant patch-test evaluations performed between December 2004 and January 2007. Results Formaldehyde was the most frequently encountered antigen, accounting for 45.83% (11/24) of the cases, followed by nickel 33.33% (8/24) and balsam of Peru (Myroxylon pereirae) 29.17% (7/24). In addition, not only did we find a higher prevalence of certain allergens when compared with other studies, but we identified several relevant allergens not previously reported at other referral centers. Conclusions The allergens found to be relevant in eyelid dermatitis vary among different regions. These data may help contribute to generating a standard screening tool to improve the detection and management of these cases.

Port-wine stains (PWS) and morphea are distinct conditions that are easily recognized and diagnosed in pediatric patients. Rarely, early localized morphea may mimic an acquired PWS. We present 4 such cases, in two of which the initial clinical impression of acquired PWS was thought to be confirmed by histopathology. A diagnosis of morphea was made approximately 6 months to 3 years after the onset of the acquired PWS. Clinicians should be aware that an apparent acquired PWS may be an early manifestation of localized morphea and continue to monitor these lesions.

Parents frequently bring their infants, toddlers, children and adolescents to see their pediatricians for various dermatologic concerns. Primary care providers are the pivotal physicians who determine which patients can be managed in their offices and which patients need a referral to the dermatologist. Unfortunately, the burden of dermatitis can be overwhelming for all involved including the patient, family, pediatrician, and dermatologist. Although some dermatologic conditions (eg, atopic eczema) are more easily diagnosed, allergic contact dermatitis (ACD) is commonly under-recognized and overlooked, especially if it is a contributing factor to worsening atopic dermatitis (AD). Segurado Rodriguez et al linked ACD to a family history of AD (85%), female sex (74%), and 11 to 16 years (63%). ABOUT THE AUTHORS Rajiv I. Nijhawan, BS, is 4th year medical student, Department of Dermatology and Cutaneous Surgery University of Miami-Miller School of Medicine. Catalina Matiz, MD, is Pediatric and Adolescent Research Fellow, Department of Pediatrics and Adolescent Dermatology, University of California-San Diego, Rady Children’s Hospital, San Diego. Sharon E. Jacob, MD, is Assistant Professor of Medicine and Pediatrics (Dermatology), Departments of Medicine and Pediatrics (Dermatology) University of California-San Diego, Rady Children’s Hospital. Address correspondence to Sharon E. Jacob, MD, Assistant Professor, Departments of Medicine and Pediatrics (Dermatology), University of California-San Diego, Rady Children’s Hospital, 8010 Frost Street, Suite 602, San Diego, CA 92123; fax: 858-966-7476; e-mail: sjacob@contactderm.net. Mr. Nijhawan, Dr. Matiz, and Dr. Jacob have disclosed no relevant financial relationships. EDUCATIONAL OBJECTIVES Outline the clinical presentations and pathophysiology of both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). Review the most common allergens and products responsible for allergic contact dermatitis in children. Discuss the recommendations for management of children with suspected contact dermatitis including guidelines for referral for patch testing.