Faculty Bibliography

BACKGROUND: Retrospective chart reviews are periodically needed to update allergen series to detect changes in photoallergic contact dermatitis (PACD) over time. OBJECTIVE: We sought to evaluate photopatch test results during a 13-year period and extend the observations to 20 years. METHODS: A retrospective chart review was conducted in patients who were photopatch tested. RESULTS: In all, 76 patients were evaluated. A total of 69 positive photopatch and 45 positive patch test reactions were detected in 30 and 23 patients, respectively. The frequencies of the positive photopatch test reactions were sunscreens 23.2%, antimicrobial agents 23.2%, medications 20.3%, fragrances 13%, plants and plant derivatives 11.6%, and pesticides 8.7%. Of the positive photopatch reactions to antimicrobial agents, 60% were caused by Fentichlor. LIMITATIONS: This study was a retrospective chart analysis, and the number of patients was small. CONCLUSIONS: Sunscreens and antimicrobial agents were the most frequent allergens eliciting PACD, and there was a decrease in PACD caused by fragrances. The number of reactions to medications increased. This study also demonstrated that pesticides can be a cause of PACD. The detection of reactions to Fentichlor was unexpected and, although they have been attributed in some studies to cross-reactions to sulfanilamides and bithionol, such a robust association was not observed in this study. This study extends our experience of the changes in the allergens that elicit PACD to 20 years

A 48-year-old man presented with a two-year history of a generalized, pruritic eruption that was associated with numerous, dome-shaped papules and nodulocystic lesions. Biopsy specimens have shown keratoacanthomas and a lichenoid dermatitis. Evaluation for malignant conditions has been negative. Owing to the constellation of findings, a diagnosis of generalized eruptive keratoacanthomas of Grzybowski associated with lichenoid dermatitis and acneiform lesions is favored. The patient is currently on a trial of acitretin

Clinical trials for systemic psoriasis therapy typically enroll healthy patients and exclude patients with cardiovascular disease, latent tuberculosis, liver disease, histories of malignancies, viral infections, children, and pregnant or breast-feeding women. Physicians often require guidance for optimum management of severe psoriasis in patients that have a combination of underlying disease states. To provide treatment recommendations for complex psoriasis scenarios, a consensus panel comprising 15 experts in psoriatic disease convened to review and discuss available evidence-based data and to arrive at a consensus for treatment options of difficult cases. An application of the Delphi Method was used to select case scenarios, provide medical treatment options, present the case study with existing medical evidence, and anonymously vote on treatment options. The top 10 treatment options were ranked and statistically analyzed to compare the differences between treatments. The final rankings and analysis provide guidance for practical, safe, and efficacious treatment options in a number of complex psoriasis scenarios

BACKGROUND: Studies show that balsam-restricted diets result in significant improvement of systemic contact dermatitis in patients with contact allergy to balsam of Peru (BOP). While tomatoes have been implicated as a frequent cause of BOP-related dermatitis, the presence of BOP in tomatoes has never been confirmed. OBJECTIVES: High-performance liquid chromatography coupled with mass spectrometry (liquid chromatography [LC]-MS) and UV spectrometry (LC-UV) was used to detect the possible presence of BOP constituents in tomatoes. METHODS: Samples of beefsteak, cherry, and plum tomatoes were extracted in ethyl acetate and analyzed with LC-MS and LC-UV for the presence of the following sensitizing constituents of BOP: benzoic acid, benzyl alcohol, trans-cinnamic acid, cinnamic alcohol, cinnamyl cinnamate, coniferyl alcohol, eugenol, isoeugenol, and methyl cinnamate. RESULTS: The initial LC-MS analysis of each tomato extract showed multiple peaks. Two of these peaks had molecular weights of 134 and 180, which correspond to cinnamic alcohol and coniferyl alcohol, respectively. The analysis did not show peaks corresponding to the molecular weights of the remaining compounds. Cochromatography of tomato extract with cinnamic alcohol and coniferyl alcohol using LC-UV further suggested the presence of these compounds in the tomato extract. CONCLUSION: Coniferyl alcohol and cinnamic alcohol, constituents of BOP, are present in beefsteak, cherry, and plum tomatoes

A 71-year-old man presented with a six-year history of a pruritic, erythematous, blistering eruption of the face, chest, and arms. Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of chronic actinic dermatitis. The patient also had contact allergy and photocontact allergy to multiple allergens. A discussion of chronic actinic dermatitis is presented