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Incontinence-associated dermatitis, previously and sometimes still referred to as moisture lesions or moisture damage, is a commonly seen contact dermatitis that is a reactive response of the skin to chronic contact to urine and faecal matter. Understanding the etiology is fundamental to creating a skin care plan and successfully prevention. Systemic reviews and studies have shown that the continued variability in management results from a combination of knowledge base, observation, diagnosis, and product selection. This article aims to improve clinicians' understanding of incontinence-associated dermatitis and its management. [ABSTRACT FROM AUTHOR]

We present an unusual case of contact dermatitis of the face following the use of formocresol. A 23-yearold man presented to our hospital, 3 days after his dental appointment, with moderate pain and a burning sensation related to a patch of darkly discolored skin. Questioning his dentist revealed that he used formocresol as an intracanal medicament. The root canals had been extirpated and formocresol had been placed into tooth #26 as a medicament. The dentist admitted that he accidentally touched the patient's face with his formocresol-contaminated hands. Formocresol was removed from the canals and calcium hydroxide was placed. Then, a dermatology consultation was requested and it was diagnosed as irritant contact dermatitis. Complete healing was observed with appropriate drug therapy. The present case urges us to pay attention to preventive isolation methods and not to prefer formocresol, which can cause serious clinical manifestations, as an intracanal medicament. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the relationship between the professional environment and hypersensitivity reactions to various contact allergens, the features of the clinical course, and the type of allergic contact dermatitis (ACD) in 35 hairdressers. The analysis was based on data on length of professional experience, localization of rashes, clinical diagnosis and allergens, and the cause of positive reactions in patch testing. Skin changes most often affect the hands, palms, face, and neck. The frequency of ACD diagnosed was 46%, followed by dyshidrotic eczema (DE) - 34%. The highest percentage of contact dermatitis (68%) was seen in the upper extremities, followed by dermatitis of the face and hands (26%). Of the patients investigated, 34% had a history of illness up to 3 years. A negative correlation was found between professional experience and "hand eczema" (p=0.005). Patch tests showed that the most frequent positive reactions were to Nickel (II) sulfate hexahydrate (Nickel, 15 times) and p-Phenylenediamine (PPD, 14 times). These contact allergens are directly correlated with hand eczema. We compared the results with those published in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Poison ivy (toxicodendron) dermatitis (TD) resulting from contact with poison ivy, oak, or sumac is a common form of allergic contact dermatitis that impacts millions of people in the United State every year and results in an estimated 43,000 emergency department (ED) visits annually. Our objective in this study was to evaluate whether healthcare utilization outcomes are impacted by prescription practices of systemic corticosteroids. Methods: We used a health claims database from 2017-2018 of those treated for TD. Descriptive statistics and logistics regression models were used to characterize trends. Results: We included in this analysis 115,885 claims from 108,111 unique individuals (93.29%) with 7,774 (6.71%) return claims within 28 days. Of the return claims, 470 (6.05%) were to the ED. Emergency clinicians offered no oral corticosteroid prescription 5.27% (n = 3,194) of the time; 3276 (86.26%) prescriptions were for a duration of 1-13 days, 410 (10.80%) were for 14-20 days, and 112 (2.95%) were for >21 days. Further, we found that shorter duration oral corticosteroids (odds ratio [OR] 1.30; 95% confidence interval 1.17-1.44; P <0.001) and initial treatment for TD at the ED compared to primary care clinicians (OR 0.87 [0.80, 0.96]; P <0.001) and other non-dermatologists (OR 0.89 [0.80, 0.98]; P = 0.01) places patients at an increased risk for return visits with healthcare clinicians when controlling for drug group, duration of treatment, and initial treatment location. Conclusion: Despite recommendations to treat TD with oral steroids for at least 14 days, most emergency clinicians offered this treatment for shorter durations and was associated with return visits. Emergency clinicians should consider treatment of two to three weeks when providing systemic steroid coverage when there are no limiting contraindications, especially as patients who present to the ED may do so with more severe disease. Additional education may be needed on appropriate treatment pathways for TD to reduce healthcare utilization associated with undertreatment. [ABSTRACT FROM AUTHOR]

Atopic dermatitis and allergic contact dermatitis are two dermatoses associated with eczema and pruritus, accompanied by hypersensitivity reactions. However, the etiopathogenesis of these diseases is different, therefore also their diagnostic and therapeutic procedures vary. Atopic dermatitis, a skin-epidermal barrier defective disorder, is a more characteristic for children, although it also occurs in a small percentage of adults. Contact allergy, in which epidermal patch tests are the diagnostic tool, is diagnosed in children and in as many as 20% of adults. Atopic dermatitis and allergic contact dermatitis may coexist in the same patient. Etiologically different types of hand eczema often coexist. In addition, contact allergy may relate to substances used in the treatment of atopic dermatitis, such as emollients or, less frequently, antiseptics and glucocorticosteroids. For this reason, epidermal patch tests may be useful in this group of patients. [ABSTRACT FROM AUTHOR]

A continuing professional development (CPD) test on managing nappy rash in babies and urinary dermatitis in adults and on supporting parents and carers is presented.

The objective was to systematically review monetary data related to management of incontinence‐associated dermatitis (IAD) in an adult population. Six electronic databases were searched: MEDLINE, CINAHL, Web of Science, EMBASE, The Cochrane Library and EconLit. The search string combined index terms and text words related to IAD and monetary data. The quality of the articles was assessed using the consensus on Health Economic Criteria. Results were synthesised narratively because of methodological heterogeneity. Nine studies were included. Only direct medical costs were reported. The product cost per application for prevention ranged between $0.05 and $0.52, and for treatment between $0.20 and $0.35. The product cost per patient/day for prevention ranged between $0.23 and $20.17. The product cost of IAD prevention and treatment per patient/day ranged between $0.57 and $1.08. The cost to treat IAD did not consider the treatment of secondary infection. The calculation of labour cost and total cost differed considerably between studies. Summarising monetary data is a challenge because of heterogeneity in currencies, settings, samples, time horizons, health‐ and cost outcome valuation, IAD definition and measurements, and included costs. Procedures for health economic evaluations are to be clarified to guarantee valid interpretation and comparison with other studies. [ABSTRACT FROM AUTHOR]

The skin is one of the most important parts of the human body. It protects the underlying tissue from injury and is a valuable part of the homeostatic processes. The skin is delicate, and, therefore, dermatological intervention is an important part of patient care in the case of skin problems. Older people have more frail and aged skin, which must be treated correctly to avoid skin breaks, especially where there are any dermatological conditions present. Not only this, but where there is a wound, the dressing must be chosen and applied carefully, to treat the condition but also to avoid damage when it comes to removing the dressing, due to the risk of the skin tearing, which can be a common problem in older adults. Further, the thinner, drier skin of older people has moisture and barrier changes that lead to a higher susceptibility to eczema. This article provides an overview of the aetiological, diagnostic and treatment aspects of geriatric dermatology, with a focus on the common allergic skin conditions (dermatitis) seen in older adults. [ABSTRACT FROM AUTHOR]

Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics). To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population. This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high--nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel- avoidance strategies on both individual and global levels. [ABSTRACT FROM AUTHOR]

This case study describes the nursing management of one case of irritant contact dermatitis from faecal fluid around the peristomal skin of a patient with an ileostomy who presented to the outpatient department 1 month postoperatively. This postoperative complication occurred as a result of the stoma being located within wrinkles in the abdomen, causing the appliance to leak and skin ulceration to develop, which prevented firm adherence of the appliance base plate to the peristomal skin. Furthermore, the patient was very anxious as a result of these complications. In this patient's case, the initial goals were to assess and address the peristomal skin complications, provide an appliance with convexity that could be fixed with a belt to stabilise the appliance as early as possible, and finally commence strengthening psychological counselling and dietary guidance for the patient and her family. These nursing interventions were found to reduce the incidence of faecal dermatitis complications around the stoma, improve the patient's quality of life and thus worth applying. [ABSTRACT FROM AUTHOR]

Objective: Cannabinoid CB2 receptors (CB2Rs) are mainly present on immune cells including mast cells, which participate in 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD). In this study, we aimed to investigate whether inhibition of mast cell degranulation was involved in the anti-ACD effect of electroacupuncture (EA) at ST36 via CB2R. Methods: Sprague-Dawley rats were sensitised and challenged with DNFB following EA stimulation for 1 week. Ear swelling, serum IgE levels, local cytokine production and mast cell infiltration were evaluated. Additionally, rat peritoneal mast cells (RPMCs) were isolated and cultured for detection of CB2R expression, mitogen-activated protein kinase (MAPK) signalling activation and mast cell degranulation (including β-hexosaminidase and histamine release) in the presence or absence of CB2R antagonists. Results: EA treatment inhibited ear swelling, suppressed IgE and cytokine production, decreased the number of mast cells and curbed mast cell degranulation, which was associated with the inhibition of p38 phosphorylation in DNFB-induced ACD. Importantly, EA enhanced the expression of CB2R mRNA and protein in the RPMCs. CB2R antagonist AM630 but not CB1R antagonist AM251 effectively reversed the suppressive effect of EA on p38 activation, mast cell infiltration and degranulation. Conclusion: These findings provide more evidence to support the hypothesis that EA promotes CB2R expression in mast cells, which is followed by inhibition of the p38 MAPK pathway, potentially resulting in the anti-ACD effect of EA. This suggests that EA at ST36 may be an effective candidate therapy for treating inflammatory skin diseases such as ACD. [ABSTRACT FROM AUTHOR]

In this paper, we studied the results of the effectiveness of the ointment isolated from a new thick extract of the sum of flavonoids from local raw materials on a hydrophobic basis in an experiment on Guinea pigs with allergic contact dermatitis caused by 2,4-dinitrochlorobenzene. The results of the study showed that 5% ointment drug based on a thick extract of the sum of flavonoids, more effectively reduces the skin folds compared to 1%, 3% ointment based on a thick extract of the sum of flavonoids and antihistamine psilo-balsam and celestoderm'sglucocorticosteroid ointment. When analyzing the measurement of local temperature, the temperature in the 4-group of animals began to approach the initial level earlier than in other groups of experimental animals. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis (ACD) is a common dermatologic disorder that is estimated to affect 15-20% of the general population. Because of its prevalence, it may be expected that ACD should be easily recognized. However, it can present with many clinical variations that may complicate diagnosis. Although ACD is a treatable condition, patients from rural and underserved areas suffer if timely access to specialty care is limited. Dermatology Extension for Community Healthcare Outcomes (Dermatology ECHO) telemedicine sessions were created to mentor rural primary care providers (PCPs). To illustrate their benefit, we present the case of a 19-year-old female patient who suffered from worsening undiagnosed ACD for over nine months following a laparoscopic appendectomy. During that time, the surgeon and multiple PCPs treated her with antibiotics, antivirals, and Scabicide without improvement in her condition. The de-identified patient case was presented by her PCP during the Dermatology ECHO session. The Dermatology ECHO specialty team mentored and educated the PCP in the diagnosis and treatment of ACD. After making the diagnosis, the patient received new treatment and her condition improved significantly. Dermatology ECHO provides a knowledge-sharing network for participating PCPs that may improve patient outcomes and reduce patient suffering. [ABSTRACT FROM AUTHOR]

Patch tests are used to establish or rule out the diagnosis of contact dermatitis, and are the gold standard when it comes to testing. This article, by healthcare professionals working at the National Skin Centre, Singapore, looks at how they carry out patch testing in their clinic, including preparation, testing, patient care and diagnosis. The article also includes a short summary of differences between the Singapore model of patch testing and that carried out in the UK. [ABSTRACT FROM AUTHOR]

Increased aging of the general population is a well-known fact with serious effects on health systems worldwide. Skin aging involves various immunological and structural changes that increase the risk of numerous skin diseases such as contact dermatitis. Contact dermatitis is characterized by an inflammation of the skin caused by an interaction between the skin and external agents and is divided into irritant and allergic contact dermatitis. Irritant contact dermatitis occurs on skin areas directly exposed to irritant substances, which results in a stream of pro-inflammatory cytokines mediating the skin injury. Asteatotic and perineal irritant contact dermatitis are the most important subtypes of irritant contact dermatitis in the elderly. Allergic contact dermatitis is a T cell-mediated inflammatory reaction and requires a prior sensitization. The most common allergens responsible for allergic contact dermatitis in the elderly are fragrance mix, nickel, and balsam of Peru. Elderly patients with stasis dermatitis, chronic wounds, and chronic venous insufficiency have an increased prevalence of sensitization due to the frequent exposure to topical treatments. In this review, the most common types of contact dermatitis in the elderly are enumerated in order to assist dermatologists and other physicians to identify contact dermatitis in this distinct group of the population. [ABSTRACT FROM AUTHOR]

Summary: Background: Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects. Objective: To compare the efficacy of moisturizer containing 4‐t‐butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti‐inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis. Methods: This was a randomized, prospective, investigator‐blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4. Results: Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient‐assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2‐week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity. Conclusion: The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration. [ABSTRACT FROM AUTHOR]

Vesicular hand dermatitis is a type of eczema involving the fi ngers, hands, and sometimes the feet. It is common in primary care, requiring prompt treatment to prevent chronicity. The cause is often unknown, making the condition challenging to treat. Management consists of avoiding irritants and using emollients and topical corticosteroids. [ABSTRACT FROM AUTHOR]

Irritant contact dermatitis (ICD) and hyperpigmentation are the problems associated with skin. Topical curcumin (CUR) although effective in hyperpigmentation and ICD, is a challenging molecule due to low-solubility. Encapsulation of CUR into solid lipid nanoparticles (SLNs) makes it amenable to topical dosing as their small size promotes its penetration into the skin. CUR-SLNs were prepared using Precirol ATO5 and Tween-80 by probe ultrasonication method. Further, CUR-SLNs were incorporated into Carbopol gel and investigated for ex-vivo skin permeation, skin deposition and skin irritation studies. The potential of CUR-SLN gel was checked against hyperpigmentation through the inhibition of tyrosinase enzyme. It was further evaluated for possible effects on ICD using BALB/c mice. The optimized CUR-SLN showed the particle size of 51 nm and 93% EE. Ex vivo permeation of CUR-SLN gel exhibited controlled drug release up to 24 h, similarly in vitro drug deposition studies showed potential for skin targeting. In vitro tyrosinase inhibition assay indicates that the formulated gel has potential in skin depigmentation. The gel also confirmed proficient suppression of ear swelling and reduction in skin water content in the BALB/c mouse. Thus, the CUR-SLN gel would be a safe and effective alternative to conventional vehicles for treatment of ICD and pigmentation. [ABSTRACT FROM AUTHOR]

Background: The frequency of allergic contact dermatitis caused by (meth)acrylates is increasing worldwide, and isobornyl acrylate (IBOA) has been identified as a culprit sensitizer in FreeStyle Libre, a medical device used by diabetic patients. Objectives: To report on 4 patients sensitized to IBOA contained in OmniPod, a new, tubeless insulin pump, and to describe the clinical and chemical analytical work‐up. Method: Four patients with eczematous skin eruptions after using OmniPod, including 2 with previous adverse skin reactions to FreeStyle Libre, were patch tested with a baseline series and additional (meth)acrylates, including IBOA in several concentrations and/or vehicles. Gas chromatography‐mass spectrometry (GC‐MS) was used to identify the presence of IBOA in OmniPod. Results: All patients were shown to be sensitized to IBOA. GC‐MS identified IBOA in OmniPod, with the highest concentrations being found in the unit itself and not in the adhesive patch. Conclusions: The OmniPod tubeless insulin pump is another source of IBOA, and its use may lead to primary sensitization to this acrylate, or may provoke elicitation of allergic contact dermatitis in previously sensitized patients. Our cases highlight the need to obtain satisfactory cooperation from pharmaceutical companies involved in the manufacture of these widely used medical devices. [ABSTRACT FROM AUTHOR]

Background: In our previous study, the extract of Trachyspermum copticum (L.) Link seeds on gene expression of IFN-ã and TGF-â1 in mouse model with irritant contact dermatitis (ICD), in comparison with cutaneous corticosteroids were evaluated. In that study, in addition to significantly increase of IFN-ã and TGF-â1 genes expression levels in skin samples of "mice with ICD" groups treated with extract in comparison to other groups, histopathologic findings showed substantial improvement of skin color, texture and thickness, and also significant increase in hair follicle number. Therefore, we have decided to study the levels of Interleukin-1 (IL-1) gene expression, which plays a major role in inflammation responses, and Keratinocyte Growth Factor/Fibroblast Growth Factor-7 (KGF/FGF-7), which has growth effect on cells and is an important endogenous mediator of hair follicle growth and development. Materials and Methods: We used autopsy samples of skin lesions obtained from "mice model with irritant contact dermatitis (ICD)" from the previous study. In that study, "mice with ICD" divided in 9 groups and were treated with three concentrations of Trachyspermum Copticum (L.) Link dried seeds, cutaneous hydrocortisone, and fluocinolone acetonide. Then from the first day until the 10th day of treatment, clinical signs and histopathologic investigations were investigated. In the present study, using Real-Time PCR, the levels of IL-1 and KGF/FGF-7 genes expression in skin samples of inflammation site in above mice groups were studied. Statistical analysis, using one-way ANOVA, were performed. Level of significance was set at 0.05. Results: The IL-1 gene expression showed a significant difference between groups: IL-1 gene expression levels in mice with ICD treated with extract and corticosteroids were higher than the other groups (p=0.0001). While in untreated "mice with ICD", no significant differences were observed. Also, during the treatment, there was a considerable increase in levels of IL-1 gene expression in groups treated with the extract at a rate of at least 2 to 3-fold in comparison with the "healthy untreated mice" group. The levels of KGF/FGF-7 gene expression in "mice with ICD" groups treated with the extract showed significance difference (p=0.014); also there was a meaningful difference in "mice with ICD" groups treated with cutaneous corticosteroids (p=0.004). While, in "untreated mice with ICD" group there were a significant decrease in the levels of KGF/FGF-7 gene expression in comparison with "healthy untreated mice" group (p=0.0001). Also, changes in the levels IL-1 and KGF/FGF-7 gene expressions in each group in different days were seen. Conclusion: In this study, significant changes in the IL-1 and KGF/FGF-7 genes expression levels in the skin samples with inflammation, were associated with an increase in the rate and speed of improvement of contact dermatitis, more favorable conditions of the healed skin (in terms of color, consistency, and thickness), and a remarkable increase in the number of hair grown on the site of dermatitis (compared with control groups, and even groups with corticosteroid therapy). [ABSTRACT FROM AUTHOR]

The article discusses the prevention and management of incontinence-associated dermatitis (IAD) in older people. Topics covered include factors that make incontinence more prevalent in older people, the contribution of age to skin fragility, and skin care regime for the prevention and management of IAD.

Contact dermatitis (CD) is caused by environmental agents, irritants, and allergens that penetrate the epidermis and lead to inflammation. An intact skin barrier prevents penetration and is important in maintaining healthy skin. Classical diagnosis of CD is made using the patch test, and traditional treatment strategies for CD promote skin barrier integrity and resolve the inflammatory component of the condition. This can be achieved by using emollient-based therapy, which is most important for skin barrier repair, and in addition to topical glucocorticosteroids, which are used in severe cases of CD and are most effective in reducing inflammation. Preventative measures, such as irritant and allergen avoidance in the workplace, also play a pivotal role in effective CD management. Moreover, CD management necessitates a holistic approach that incorporates prevention, barrier repair, and inflammatory resolution to ensure optimized efficacy. It is also important to consider potential barriers to optimal management when evaluating individuals with CD, such as limited patient education or poor access to care. Finally, key literature and our own clinical practice experience have highlighted the value of patient preference, as well as safety, efficacy and simplicity, in building the perfect emollient. [ABSTRACT FROM AUTHOR]

Objective To define the incidence of perianal dermatitis (PD) and determine the usage pattern and cost efficacy of diaper products among neonates admitted to a level IV neonatal intensive care unit (NICU) including those with a diagnosis of neonatal abstinence syndrome (NAS). Methods A retrospective cohort study to evaluate neonates with PD based on number of orders for Aquaphor, Bagbalm, Desitin, Flanders, or Nystatin. Various demographic and clinical parameters were recorded. Usage patterns of these five products were analyzed, and their costs estimated. Subgroup analysis was performed among infants with NAS. Results Of 1,241 admissions, 56.2% had at least one diaper product ordered during their NICU stay, while 52.6% hadmultiple products ordered. Only 23.0% of all neonates had appropriate documentation of PD. The most common product ordered first was Aquaphor (64.3%), followed by Desitin (19.2%). Note that 86% term NAS infants had PD compared with 28% term non-NAS infants. The estimated product cost was $14,139 over 2 years, averaging $20 per patient. Conclusion Over half of NICU neonates were exposed to one ormore diaper products, usually without documented PD diagnosis. Term NAS infants had three times higher incidence of PD than term non-NAS infants. The cost of diaper product use was significant, and possibly underestimated due to lack of documentation. [ABSTRACT FROM AUTHOR]

Background: Cabbage, Brassica oleracea var. capitata L., is one of the most common vegetables in the world. Because of its high levels of flavonoids and anthocyanins, cabbage has long been used as a herbal medicine. The antioxidant and anti-inflammatory properties of cabbage were also recently been reported. Objective: This study was designed to investigate the anti-inflammatory effects of cabbage in mice with contact dermatitis (CD). Materials and Methods: We investigated the effects of methanol extract of B. oleracea var. capitata L. (MEBO) on ear swelling, erythema, and histopathological changes in CD mice. Moreover, the effects on cytokine production and the spleen/body weight ratio were investigated. Results: Topical treatment with MEBO inhibited ear swelling and erythema significantly. MEBO also significantly inhibited epidermal hyperplasia and infiltration of immune cells. Furthermore, the levels of tumor necrosis factor-alpha, interferon-gamma, interleukin-6, and monocyte chemotactic protein-1 in inflamed tissues were effectively lowered by MEBO. Finally, MEBO did not affect body weight gain or spleen body weight ratio. Conclusions: These results indicate that cabbage can be used for the treatment of skin inflammation and that its anti-inflammatory activity is closely related to the inhibition of Th1 skewing reactions. Abbreviations used: AOO: Acetone and olive oil (4:1), CBA: Cytometric bead array, CD: Contact dermatitis, DEX: Dexamethasone, DNFB: 1-fluoro-2,4-dinitrofluorobenzene, GM-CSF: Granulocyte-macrophage colony-stimulating factor, ICAM-1: Intercellular Adhesion Molecule-1, LPS: Lipopolysaccharide, MEBO: Methanol extract of Brassica oleracea, MCP-1: Monocyte chemotactic protein-1, NO: Nitric oxide. [ABSTRACT FROM AUTHOR]

Skin diseases in the vulvar area include a variety of disorders many of which have a chronic course with significant morbidity. It is important to be aware of the symptoms, signs and diagnostic tools in order to optimise treatment. Herein, the most common eczematous diseases of the vulvar area, i.e. lichen simplex chronicus, seborrhoeic dermatitis, atopic dermatitis, irritant contact dermatitis, and non-systemic and systemic allergic contact dermatitis are reviewed. Allergic contact urticaria is also described. [ABSTRACT FROM AUTHOR]

Summary: Background: Methotrexate, a folate antimetabolite, is used to treat atopic dermatitis and psoriasis. Although methotrexate's therapeutic efficacy has been noted in the literature, there are few data on the efficacy of methotrexate treatment for allergic contact dermatitis. Objective: To evaluate the efficacy and tolerability of methotrexate in treating allergic contact dermatitis at a single institution, and also to assess methotrexate efficacy in patients with chronic, unavoidable allergen exposure. Methods: We performed a retrospective chart review of 32 patients diagnosed with allergic contact dermatitis by positive patch test reactions, and who received treatment with methotrexate from November 2010 to November 2014. Demographic and treatment‐associated data were collected from electronic medical records. Ten patients were identified as allergen non‐avoiders secondary to their occupation, and were subgrouped as such. Results: Seventy‐eight per cent (25/32) of patients showed either a partial or a complete response. Methotrexate had a comparable efficacy rate in the allergen non‐avoiders subset, at 10 of 10. Of the 32 patients, 23% (5/22) had complete clearance of their dermatitis, and 1/10 of allergen non‐avoiders had complete clearance of their dermatitis. Conclusion: Methotrexate is a well‐tolerated and effective treatment for allergic contact dermatitis, and shows comparable efficacy to immunomodulatory agents such as cyclosporine and azathioprine, with robust efficacy despite persistent allergen exposure in patients with allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Introduction: A major clinical challenge in treating allergic contact dermatitis (ACD) is that the first line of treatment is based on the use of corticosteroids. In this study, we aimed to develop a formulation that is devoid of steroids. Methods: We used mouse ears treated with dinitrofluorobenzene (DNFB) to induce ACD. The efficacy of the test formulation to ameliorate and to prevent induced ACD was determined. Results: To treat this experimentally induced ACD, we developed a formulation containing BIPxine (a mixture of Rosa moschata and Croton lechleri (antioxidants) and Aloe vera and D-panthenol (moisturizers), and hydroglycolic solutions of disodium cromoglycate. Our results show that clear inhibition of ACD took place. The target of this formulation was PAR-2, TRPV4, and other mediators of the inflammatory and pain responses. However, this formulation must be evaluated in other models besides the mouse to confirm its effectiveness. Conclusion: The formulation presented here may provide new ACD therapies that do not involve the use of corticosteroids. [ABSTRACT FROM AUTHOR]

Background: Topical ointments containing fradiomycin sulfate, such as fradiomycin sulfate/methylprednisolone (F/M) and fradiomycin sulfate/betamethasone sodium phosphate (F/B), are known to cause allergic contact dermatitis (CD) in some patients, especially when used for the periocular region. F/M is commonly prescribed to patients for various conditions; however, there are no reports with respect to the incidence of CD caused by F/M in actual practice.Objective: The aim was to investigate the incidence of CD using a data-based retrospective cohort study.Methods: Using a Japanese health insurance claims database [MinaCare Co. Ltd. healthcare database (MinaCare HDB)], a comparative assessment was conducted of F/M and another combination drug (F/B) and two single-drug treatments (ophthalmic ointments with either an antibiotic or a steroid). The total data set consisted of 1,176,082 individuals in the MinaCare HDB, with 54,016 having received prescriptions for one of the four investigational drug regimens.Results: Overall, the incidences of CD were similar in three of the four groups in this study (F/M 0.091; F/B 0.092; steroids 0.102), while being lower in the fourth group (antibiotics 0.060). Even after confirmation of a diagnosis of CD, prescriptions for the investigational drugs were repeatedly filled for some patients.Conclusion: This study demonstrated that there was no clear difference in the incidence of CD after filling prescriptions for F/M, F/B, and ophthalmic ointment containing a steroid, while the incidence with antibiotics was lower by 0.03–0.04 compared with the other groups. Considering the observation that the investigational drugs were repeatedly prescribed even after the diagnosis of CD, it is critical that the risk of CD with these prescribed topical ointments is better understood by primary care physicians in order to take appropriate countermeasures. [ABSTRACT FROM AUTHOR]

Dendritic cell (DC) activation by contact allergens is one of the key steps in the development of allergic contact dermatitis (ACD). Recent evidence suggests that metabolic reprogramming is a prerequisite for the activation of DCs, macrophages and monocytes. Therefore, we used an integrated approach by combining proteomics and metabolomics to investigate the metabolism of human THP-1 cells in response to the strong contact allergen, 2,4-dinitrochlorobenzene (DNCB). Cells were treated with 5, 10 and 20 μM DNCB for 4, 8, and 24 h, respectively. Using a targeted metabolomics approach, we quantified levels of 188 endogenous metabolites, among them phospholipids, acylcarnitines, amino acids and hexoses. In addition, proteomic changes were analyzed using an untargeted quantitative approach based on stable isotope labeling with amino acids in cell culture (SILAC). We detected several alterations in the metabolome and consistently in the proteome indicating metabolic reprogramming of THP-1 cells by DNCB. In particular, we found an increase in phospholipids that was accompanied by an up-regulation of fatty acid synthase (FAS), a key enzyme in lipid synthesis. [ABSTRACT FROM AUTHOR]

Human cell-based approaches to assess defined key events in allergic contact dermatitis (ACD) are well-established, but lack cutaneous penetration and biotransformation as well as cellular cross-talk. Herein, we integrated in vitro -generated immature MUTZ-3-derived Langerhans-like cells (MUTZ-LCs) or monocyte-derived LC-like cells (MoLCs) into reconstructed human skin (RHS), consistent of a stratified epidermis formed by primary keratinocytes on a dermal compartment with collagen-embedded primary fibroblasts. LC-like cells were mainly localized in the epidermal compartment and distributed homogenously in accordance with native human skin. Topical application of the strong contact sensitizer 2,4-dinitrochlorobenzene (DNCB) induced IL-6 and IL-8 secretion in RHS with LC-like cells, whereas no change was observed in reference models. Increased gene expression of CD83, PD-L1, and CXCR4 in the dermal compartment indicated LC maturation. Importantly, exposure to DNCB enhanced mobility of the LC-like cells from epidermal to dermal compartments. In response to the moderate sensitizer isoeugenol and irritant sodium dodecyl sulphate, the obtained response was less pronounced. In summary, we integrated immature and functional MUTZ-LCs and MoLCs into RHS and provide a unique comparative experimental setting to monitor early events during skin sensitization. [ABSTRACT FROM AUTHOR]

Background Accumulating evidence suggests that Toll-like receptor (TLR)-3 signaling is involved in non-infectious immune and inflammatory reactions as well as in viral infections. The skin of patients with atopic dermatitis (AD) is often infected with virus and bacteria, leading to the aggravation of atopic symptoms. These findings suggest TLR3 signaling may be involved in the pathogenesis of AD, but the exact role of TLR3 in AD remains to be defined. Objective The purpose of this study was to investigate the role of TLR3 in chronic contact hypersensitivity reactions induced by repeated elicitation, resembling the features of AD. Methods Wild-type (WT) and Toll-like receptor 3 knockout (Tlr3 KO) mice were sensitized, and chronic contact hypersensitivity reactions were elicited in their ear skin via repeated application of a hapten, 2,4,6-trinitro-1-chlorobenzene (TNCB) or oxazolone. Results The Tlr3 KO mice exhibited less ear swelling, less leukocyte infiltration into the skin, and lower serum total IgE levels than WT mice after hapten challenge. The Tlr3 KO mice also displayed lower expression levels of inflammatory cytokines (interleukin (IL)-33, IL-4, IL-10, and interferon-ɤ in their TNCB-treated ear skin than WT mice. Conclusion These results showed that TLR3 deficiency suppressed the development of chronic contact hypersensitivity reactions, suggesting that TLR3 signaling may participate in the pathogenesis of AD. [ABSTRACT FROM AUTHOR]

The skin is an important site for local or systemic application of drugs. However, most of the drugs have poor permeability through the skin’s outermost layer, stratum corneum. The aim of this study was to develop a method to enable transdermal delivery of morin (3, 5, 7, 2, 4-pentahydroxyflavone), which is a poorly water-soluble drug with anti-inflammatory properties obtained from natural products. Morin phospholipid complex (MPC) was prepared and then loaded in Carbopol 940 hydrogel (MPC-gel), which can significantly increase the transdermal flux of morin based on the in vitro skin penetration data presented in this paper. To further enhance permeation, different compositions of penetration enhancers were dispersed in the gel and screened. After applied onto the mouse skin, MPC-gel showed apparent reduction of ear swelling in 2, 4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD). Further determination of cytokines levels, histopathological analysis and T lymphocytes proliferation indicates that the MPC-gel is potent enough to reduce the inflammatory response mediated by the DNFB in ACD mice model. Collectively, we anticipate that such an approach may provide a new treatment for topical ACD. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis (ACD) is a common T-cell mediated inflammatory skin condition, characterized by an intensely pruritic rash at the site of contact with allergens like poison ivy or nickel. Current clinical treatments use topical corticosteroids, which broadly and transiently suppress inflammation and symptoms of ACD, but fail to address the underlying immune dysfunction. Here, we present an alternative therapeutic approach that teaches the immune system to tolerate contact allergens by expanding populations of naturally suppressive allergen-specific regulatory T cells (Tregs). Specifically, biodegradable poly(ethylene glycol)-poly(lactic- co -glycolic acid) (PEG-PLGA) microparticles were engineered to release TGF-β1, Rapamycin, and IL-2, to locally sustain a microenvironment that promotes Treg differentiation. By expanding allergen-specific Tregs and reducing pro-inflammatory effector T cells, these microparticles inhibited destructive hypersensitivity responses to subsequent allergen exposure in an allergen-specific manner, effectively preventing or reversing ACD in previously sensitized mice. Ultimately, this approach to in vivo Treg induction could also enable novel therapies for transplant rejection and autoimmune diseases. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis is a common skin disease and the current treatment always along with frequent medication and side effect. In this research, poly(d,l-lactide-co-glycolide) microspheres encapsulating tacrolimus are first employed as a therapy of allergic contact dermatitis in mice model by subcutaneous injection. Allergic contact dermatitis is successfully induced in BALB/c mice by repeated painting of dinitrofluorobenzene on mice ear. Tacrolimus is efficiently encapsulated into poly(d,l-lactide-co-glycolide) microspheres by emulsion evaporation method, and then the microspheres are subcutaneously injected into dermatitis-suffered BALB/c mice. We find that the dermatitis mice treated with tacrolimus-loaded microspheres get a sustained suppression on ear swelling, dermatitis index, inflammatory cell accumulation, and serum immunoglobulin E concentration. The curative effect of tacrolimus-loaded microspheres is similar to daily tacrolimus injection and is even better in the inhibition of ear swelling. Dermatitis mice treated with blank microspheres get no curative effect during the whole experiment. The data suggest that subcutaneous injection of drug-loaded microspheres could be a potential candidate for the management of allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

Background Application of haptens to the skin induces release of immune stimulatory ATP into the extracellular space. This “danger” signal can be converted to immunosuppressive adenosine (ADO) by the action of the ectonucleotidases CD39 and CD73, expressed by skin and immune cells. Thus, the expression and regulation of CD73 by skin derived cells may have crucial influence on the outcome of contact hypersensitivity (CHS) reactions. Objective To investigate the role of CD73 expression during 2,4,6-trinitrochlorobenzene (TNCB) induced CHS reactions. Methods Wild type (wt) and CD73 deficient mice were subjected to TNCB induced CHS. In the different mouse strains the resulting ear swelling reaction was recorded along with a detailed phenotypic analysis of the skin migrating subsets of dendritic cells (DC). Results In CD73 deficient animals the motility of DC was higher as compared to wt animals and in particular after sensitization we found increased migration of Langerin + DC from skin to draining lymph nodes (LN). In the TNCB model this led to a stronger sensitization as indicated by increased frequency of interferon-γ producing T cells in the LN and an increased ear thickness after challenge. Conclusion CD73 derived ADO production slows down migration of Langerin + DC from skin to LN. This may be a crucial mechanism to avoid over boarding immune reactions against haptens. [ABSTRACT FROM AUTHOR]

Objective: Preventing moisture damage and breakdown of the skin can be a particular challenge for patients with incontinence. The level of protection offered by various skin protectant products can vary according to the chemical nature of the formulation and can decrease following wash procedures. The aim of this study was to compare five silicone-containing skin barrier creams indicated for use on incontinence-associated dermatitis (IAD) in terms of their resistance to a standardised wash cycle in healthy volunteer subjects. Method: A skin surface hygrometer (Skicon 200EX) evaluated skin surface conduction non-invasively on 36 non-patient subjects using a high-frequency (3.5MHz) electric current. This provided an index of the degree of protection given by barrier products after a single application and also any reduction in barrier properties after a repeated wash procedure. Results: Medi Derma-S barrier cream (MDS), Cavilon barrier cream (CBC) and LBF barrier cream (LBF) all demonstrated statistically significant differences (p<0.001) in the Skicon values following the first moisture challenge compared with Medihoney (MH), Remedy barrier cream (RBC) and the untreated control. All other comparisons were not significant (p>0.05). Statistical analysis following four moisture challenges reflected the results following the first, whereby Skicon values following treatment with MDS, CBC and LBF was significantly different compared with MH, RBC and the untreated control. Again, all other comparisons were not significant (p>0.05). When expressed as percentage barrier effectiveness, the results show a similar pattern to the absolute Skicon values. Conclusion: The results of this study show that there were differences between the barrier creams in terms of the initial moisture challenge and the resistance to wash-off following a repeated standardised wash procedure. It was concluded that MDS, CBC and LBF barrier cream all showed significant and equally effective moisture barrier protection and wash-off resistance. [ABSTRACT FROM AUTHOR]

Acupuncture has shown beneficial effect in the treatment of multiple dermatologic conditions including dermatitis, pruritus, urticaria, and hyperhidrosis; however, the detailed mechanisms are still kept unclear. This study aimed to investigate if electro-acupuncture (EA) treatment prevents 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD) in rats and explore its underlying mechanisms. ACD was induced by sensitizing and challenging with DNFB topically. Rats were treated daily following bilateral subcutaneous stimulation of EA at Zusanli acupoint (ST36) for 1 week. Ear swelling and serum IgE levels were measured. The ear biopsies were obtained for histology. Inflammatory cytokines on the dermatological ear and local acupoint tissue were assayed. Spleen lymphocytes and the homogenized supernatant of local acupuncture area were used to co-culture for flow cytology and immune analysis, respectively. EA treatment at ST36 notably inhibited ear swelling and inflammatory cell infiltration on DNFB-induced ACD. EA also decreased serum IgE concentrations and alleviated the production of inflammatory cytokines in dermatological ear. Additionally, EA treatment attenuated the percentage of CD4IFN-γ and CD4IL-4 T cells associated with ACD. Interestingly, secretion of interleukin (IL)-10 in the local acupoint tissue following EA stimulation was increased and showed suppressive function when co-cultured with the spleen lymphocytes from DNFB group. Lastly, EA treatment demonstrably suppressed p38 MAPK activation in DNFB-treated rats. Our findings suggest that EA treatment at ST36 may ameliorate inflammation associated with DNFB-induced ACD via triggering local IL-10 production and inhibiting p38 MAPK activation, which provide an alternative and promising therapy for ACD. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis (ACD) is a chronic inflammatory skin disease. Topical corticosteroids are the first-line therapy for ACD despite their significant adverse effects. Acupuncture has been widely used in the treatment of various skin diseases, but its underlying mechanism remains unrevealed. In this study, we investigated the characteristics of acupuncture treatment based on effectiveness and mechanism. BALB/c mice received 1-chloro-2,4-dinitrobenzene (DNCB) application to build AD-like model. Results showed that acupuncture was an effective treatment method in inhibiting inflammatory conditions, serum IgE levels, and expression of proinflammatory cytokine Th2 (IL-4, IL-6), and Th2 (IL-1β, TNF-α) mRNA compared with DNCB treatment. Acupuncture treatment also inhibited nuclear factor-κB p65, phosphorylation of IκBα, and phosphorylation of occludin proteins expression. Furthermore, it could improve the expression of epidermal growth factor in both mRNA and protein levels. These results suggest that acupuncture, as an alternative therapy treatment for its no significant side effects, was effective in alleviating ACD by reducing proinflammatory cytokines and changing proteins' expression. [ABSTRACT FROM AUTHOR]

In this second part of a series of articles on skin and soft tissue infections (SSTI), the entities of impetigo, folliculitis and erysipelas are explored. A case-based approach to the diagnosis and management of these infections for clinicians is provided. [ABSTRACT FROM AUTHOR]

Introduction: Contact dermatitis is a relatively common dermatosis reported among several population groups from all around the globe. However, the data from Kuwait is unavailable. Patch tests are essential for the diagnosis of contact sensitization. Aim: To determine a relative frequency and pattern of sensitizers to different allergens in patients of suspected contact dermatitis in Kuwait and, also to study the role of the commonest sensitizer in detail. Material and methods: Patch tests were performed in 2461 consecutive patients with a clinical diagnosis of contact dermatitis seen at our hospital between September 1, 2014 and August 31, 2015. Out of the total of 1381 (56.1%) patients with positive patch test results to at least one allergen, 546 (22.2%) patients with a single positive reaction to nickel only (single largest sensitizer) were selected as the study population for further detailed analysis. Results: At least one positive patch test reaction was found in 1381 (56.12%) patients. Nickel was found to be the most common sensitizer seen in 546 (40%) patients. The mean age was 37.3 ±13.8 years and the mean duration of disease was 27.3 ±13.8 months. Most (387/546) patients sensitized were females. The forearms/hands and wrists were the most prevalent sites (52.56% of the participants). In 58.91% of women, dermatitis was more often confined to other sites, mostly ears and the neck due to earrings and necklaces. Just more than half of the number (51.09%) of nickel allergic patients were found in the age group of 15-25 years. Hairdressers/beauticians were the most affected group followed by house workers (housewives, cleaners, housekeepers). Conclusions: Nickel is the single most common sensitizer found in our patients, and female sex, young age, occupation with long hours of contact to nickel are high risk factors. We recommend that a directive, which limits the release of nickel from products with extended skin contact, be approved in Kuwait. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study has been to evaluate the rate of contact sensitization to some rubber allergens and to bisphenol A (BPA) amongst students of dental medicine and dental patients.Material and Methods: A total of 50 participants were included in the study: 40 students of dental medicine exposed to the studied rubber allergens and BPA-based dental materials during the course of their education; 10 dental patients without occupational exposure to the latter substances served as a control group. All of them were patch-tested with the studied rubber allergens and bisphenol A.Results: Highest was the sensitizing action of carba mix, followed by benzoyl peroxide and mercapto mix. The sensitization rate for carba mix was significantly higher for dental students as well as for the whole studied population, if compared to the one for thiuram mix (Chi2 = 12.9, p < 0.001; Chi2 = 13.9, p < 0.001), bisphenol A (Chi2 = 8.9, p < 0.001; Chi2 = 11.9, p < 0.001), toluenesulfonamide formaldehyde resin (Chi2 = 10.7, p < 0.001; Chi2 = 13.9, p < 0.001) and benzoyl peroxide (Chi2 = 4.7, p = 0.03; Chi2 = 5.8, p = 0.016), and for dental patients, if compared to the one for mercapto mix (Chi2 = 7.07, p = 0.008). Concomitant positive skin patch-test reactions to carba mix and to benzoyl peroxide, and to all the studied allergens were established.Conclusions: Carba mix could be outlined as a sensitizer of paramount importance for dental students as well as for dental patients. Benzoyl peroxide was the second ranked sensitizer for dental students. Positive skin patch-test reactions to bisphenol A and toluenesulfonamide formaldehyde resin were established only among the group of dental students. Int J Occup Med Environ Health 2017;30(3):397-405. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage (MAD) is a term that has been introduced in order to determine the number of skin lesions caused by long-term exposure to moisture on the skin. This kind of change on the skin, caused by the prolonged contact with urine, stool, sweat, exudate, often occur in hospitalized patients. On the other hand, this problem is rarely presented in Polish medical publications. Very often the skin damage associated with moisture are confused by doctors and nurses with pressure ulcers. That is why it is important to be able to assess properly diagnose and make your choice of nursing and treatment MAD. [ABSTRACT FROM AUTHOR]

Nasal bird schistosomes can cause bilharziosis in birds and have the potential to cause swimmer's itch in humans. We determined the prevalence of bird schistosomes in 106 mallards ( Anas plathyrhynchos) from 11 water sources in Germany from 2014. Dissections were performed focusing on parasitic infections of the neural system. Infections with Trichobilharzia regenti (Horák et al. 1998) were found in 21% of the birds ( n = 22), whereas Bilharziella polonica (Kowalewski 1895) were found between the brain membranes (meninges) and the brain, in the spinal cord or in the intestine of 12% of the mallards ( n = 13). No significant influence of sex, age, and body condition between infected and non-infected animals was observed. Our study provides the first description of B. polonica from the neural system of birds and provides an epidemiological understanding of a parasite of human health concern. [ABSTRACT FROM AUTHOR]