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Patch testing while taking systemic immunosuppressants is sometimes unavoidable. Methotrexate (MTX) is the immunosuppressant currently considered least likely to negatively impact patch testing.The aim of the study was to characterize a cohort of patients patch tested while taking MTX.This is a retrospective review of patients patch tested at the University of North Carolina Dermatology in Chapel Hill, North Carolina, from 2010 to 2019, comparing patch test results of patients taking MTX with those of a control group.An overall 52.8% positivity rate (356/674) was observed. Sixty two of 674 patients were patch tested while taking MTX, with a 46.8% positivity rate (29/62) compared with 53.4% (327/612) in the control group. The control group experienced 975 reactions, including 637 1+ reactions, 291 2+ reactions, and 47 3+ reactions. The MTX group experienced 50 reactions, including thirty-two 1+ reactions, fourteen 2+ reactions, and four 3+ reactions. The difference between the distributions was not statistically significant. Mean weekly MTX dose was 15.6 mg, whereas mean total accumulated dose was 251.6 mg. There was no statistically significant difference between weekly dose and total accumulated dose in patients with positive or negative results.In our cohort, MTX had no discernible effect on patch test results, supporting use during patch testing with minimal false-negative risk.

Lichen amyloidosis is believed to be caused by damage to keratinocytes, often by chronic scratching. It has also been associated with autoimmune conditions, including thyroid disease. Dermatologic manifestations of poorly controlled thyroid disease are well described within the medical literature, within both hypothyroid and hyperthyroid states. Myxedema is a rare complication of Graves disease. We report a unique case of concurrent myxedema and lichen amyloidosis in a 63-year-old patient with uncontrolled hypothyroidism in the setting of post-ablative Graves disease.

Background Hidradenitis suppurativa (HS), also known as acne inversa, is a recurring, painful, chronic, and sometimes disfiguring inflammatory skin disease. Objectives Our objective was to report the baseline clinical characteristics, natural history, and associated outcomes of patients with HS from the ongoing, prospective, non-interventional UNITE registry that is collecting data regarding the natural history and associated outcomes of HS. Methods Patients with inflammatory HS lesions were enrolled, including adolescents (aged 12 to

Background Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners. Objective The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years. Methods We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference. Conclusions A baseline pediatric patch test panel was established through working group consensus.

Background Little is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed. Objective The aim was to quantify patch test results from providers evaluating US children. Methods The study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015-2016). Results One thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%). Conclusions This US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.