Faculty Bibliography

A 79-year-old woman presented with a history of peeling of the palms and soles that began in young adulthood, with exacerbation after exposure to water. Her mother, 2 sisters, and a female maternal cousin have similar symptoms. Physical examination showed scale and hyperlinearity of the palms. Brief exposure to water initiated the development of 1-to 2-mm, translucent, white papules that were distributed diffusely on the palmar surface, with a concentration at the palmar margins and pressure points. Histopathologic examination showed an acanthotic epidermis with a central depression that was filled with compact orthokeratosis. The physical examination and histopathologic findings are consistent with a diagnosis of hereditary papulotranslucent acrokeratoderma

BACKGROUND: The 'gold standard' for diagnosing allergic contact dermatitis is patch testing. Previous studies have not adequately addressed the validity and usefulness of the North American Contact Dermatitis Group (NACDG) Standard 65-allergen series alone as a screening tool in the evaluation of contact dermatitis. OBJECTIVE: The purpose of this study is to examine the usefulness of the NACDG series of 65 allergens as an exclusive screening method in the diagnosis of contact allergy. METHODS: A retrospective chart review of 794 patients referred for patch testing with the NACDG Screening Series with or without additional allergens was performed to determine the number of positive patch-test results. The study groups were analyzed to identify whether the positive reactions were to allergens in the NACDG Standard Series or to allergens in the supplementary group. RESULTS: Of the 794 patients patch-tested between July 1, 2004, and July 1, 2006, 590 (74.31%) had a positive reaction to either an NACDG patch-tested allergen or a supplemental allergen; 386 (65.42%) patients testing positive for an allergen were positive to an NACDG allergen only, and 534 (90.51%) of the total positive reactors were positive for at least one NACDG test allergen. CONCLUSION: As a screening tool, the NACDG Standard Series is substantially more efficacious than are more limited standard series when used exclusively in the evaluation of patients with allergic contact dermatitis. More extensive testing, including testing with suspected supplementary allergens determined by thorough history and physical examination, can improve upon the NACDG series as a means to investigate the full causes of contact dermatitis in any individual patient

Corticosteroids are used to treat a variety of medical conditions. While topical preparations are known to commonly cause allergic contact dermatits, systemic use of these drugs rarely causes cutaneous reactions. (This paper presents) Two cases of (systemic) injectable corticosteroid use resulting in delayed hypersensitivity reactions are presented

Vaccines are responsible for the control of many infectious diseases that were once common in the United States, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Haemophilus influenzae type b. National efforts to generate collaboration between federal, state, and local governments and public and private health care providers have resulted in record high levels of vaccination coverage in the United States. The high rate of US vaccinations is paralleled by growing concerns about the safety of their delivery. The variety of substances used in vaccines sometimes causes the development of cutaneous reactions in susceptible adults and children. This article will review adverse cutaneous events consistent with hypersensitivity reactions to the following ingredients in vaccines: aluminum, thimerosal, 2-phenoxyethanol, formaldehyde, and neomycin

BACKGROUND: Dermatologic surgery is a common practice among dermatologists; consequently, there is an increased number of exposures to potential contact allergens in the surgical setting. OBJECTIVE: The purpose of this article is to alert the clinician to the most common allergens associated with the use of surgical products. CONCLUSIONS: Increased awareness will lead to early diagnosis and allergen avoidance.

The bioterrorism-related anthrax outbreak generated unanticipated demand for dermatologic services. In this study we sought to perform rapid, efficient, cost-effective evaluation of patients suspected of having cutaneous anthrax. During the outbreak, we developed an anthrax evaluation system featuring clinical field examination by nondermatologist physicians, followed by rapid referral of selected high-risk patients to a centralized dermatology center. We excluded anthrax in 29 previously screened high-risk patients. All were examined within 24 hours, costing $272.07 per patient. Diagnoses were established quickly (median, same day; range, 0-15 days). Among 2259 at-risk postal workers, 144 (6.4%) self-identified new (< or =14 days) skin lesions and were examined in the field; 8 (5.6%) were referred to our system. Our system was not the only local dermatologic resource available during the outbreak. A system featuring initial nondermatologist examination with minimal laboratory evaluation, followed by rapid centralized referral of high-risk patients, functioned efficiently in this outbreak

A 54-year-old man presented with lip swelling, which was not altered by a trial of medication discontinuation. Patch tests showed reactions to bromonitropropane and gold, which were not clinically relevant. Treatment included topical and intralesional glucorticoids as well as tacrolimus ointment. Granulomatous chelitis an idiopathic disorder that is characterized by painless lip edema. It may be found as part of the triad of Melkersson-Rosenthal syndrome. Treatment includes intralesional glucocorticoids as well as systemic therapies