Faculty Bibliography

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.

BACKGROUND: Chronic actinic dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of chronic actinic dermatitis occurs over time in most patients. However, the natural history of chronic actinic dermatitis in patients in the United States has not been studied. OBJECTIVE: To study the natural history of chronic actinic dermatitis in patients in the United States. METHODS: We performed a retrospective chart review and telephone questionnaire after a 3- to 19-year follow-up period. RESULTS: Of 20 patients with chronic actinic dermatitis, 7 patients (35%) experienced resolution and an additional 11 patients (55%) experienced improvement of their photosensitivity to sunlight during the follow-up period. The proportion of patients experiencing improvement or resolution of their chronic actinic dermatitis increased at 5, 10, and 15 years after diagnosis. CONCLUSIONS: Our study demonstrates that abnormal photosensitivity to sunlight in chronic actinic dermatitis improves or resolves over time in most patients in New York. The rates of improvement or resolution in our patients in New York are similar to the rates in case series in Europe despite likely patient demographic differences.

We present a 67-year-old man with an ulcerated, indurated plaque on the right mid back with a presumed diagnosis of morphea that was complicated by an allergic contact dermatitis. Further clinical and histopathologic data elucidated the diagnosis of fluoroscopy-induced radiation dermatitis. We present a brief review of the common locations, clinical characteristics, pathophysiology, and management options for fluoroscopy-induced radiation dermatitis.

BACKGROUND: There is no known association between the development of keratoacanthomas and prurigo nodules. OBJECTIVE: We report a case series of 7 patients with a long-standing history of actinic damage, pruritus, and prurigo nodularis who developed widespread keratoacanthomas within the same affected area. METHODS: This was a retrospective case series assessing the clinical characteristics of patients with multiple keratoacanthomas arising in association with prurigo nodules. RESULTS: All 7 patients were elderly Caucasian women (mean age 79 +/- 3.7 years) with actinically damaged skin and a long-standing history of widespread pruritus and prurigo nodules. All patients had histologically confirmed keratoacanthomas, or squamous cell carcinomas with the clinical appearance of a keratoacanthoma, that developed within the field of prurigo nodules. All 7 patients had a clinical response to acitretin with a decrease in the number of lesions. Four patients had an associated eczematous dermatitis and were also treated with cyclosporine with improvement in pruritus and prurigo nodules and no increase in keratoacanthomas. LIMITATIONS: The retrospective design and small number of patients are limitations to this study. CONCLUSION: Our case series represents a distinct subset of elderly individuals with extensive actinic damage who we believe are predisposed to developing both prurigo nodules and keratoacanthomas.

Background Fentichlor elicits high rates of positive photopatch test reactions despite its currently unknown clinical relevance. Objective: To provide a comprehensive review of fentichlor, investigate the characteristics of patients with photosensitivity to fentichlor, and explore the current uses of fentichlor. Methods: A review of photopatch test studies involving fentichlor was performed. A retrospective chart review was conducted in patients with positive photopatch test reactions to fentichlor at our institution. Product inquiries were placed to manufacturers of fentichlor to elicit the current uses of fentichlor. Results: In selected photopatch test studies, positive reactions to fentichlor occurred in 0.0 to 11.8% of subjects. We found that 25 companies distribute or manufacture fentichlor worldwide, which includes two companies that sell 25 kg drums of fentichlor. The most common current uses of fentichlor are in research, in high throughput screening, and in antibacterial and antifungal creams. Conclusions: Our review of selected photopatch test studies demonstrates that fentichlor remains a potent photosensitizing allergen worldwide. The bulk quantities of fentichlor available for sale and the current uses of fentichlor suggest that fentichlor may be currently incorporated into consumer products. We recommend that fentichlor remains in the standard series of photopatch test allergens

Background: Chronic actinic dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of chronic actinic dermatitis occurs over time in the majority of patients. However, the natural history of chronic actinic dermatitis in patients in the United States has not been studied. Objective: To study the natural history of chronic actinic dermatitis in patients in the United States. Methods: We performed a retrospective chart review and telephone questionnaire after a 3 to 19 year follow-up period. Results: Of 20 patients, 7 patients (35%) experienced resolution and an additional 11 patients (55%) experienced improvement of their chronic actinic dermatitis. The proportion of patients experiencing improvement or resolution of their chronic actinic dermatitis increased at 5, 10, and 15 years after diagnosis. Similar proportions of patients with skin types I to II and skin types III to VI experienced improvement or resolution. Conclusions: Our study demonstrates that abnormal photosensitivity to sunlight in chronic actinic dermatitis improves or resolves over time in themajority ofNew York patients. The rates of improvement or resolution in our New York patients are similar to the rates in case series in Europe, despite likely patient demographic differences

BACKGROUND: Fentichlor elicits high rates of positive photopatch test reactions despite its currently unknown clinical relevance. OBJECTIVES: The aims of this study were to provide a comprehensive review of fentichlor, to investigate the characteristics of patients with photosensitivity to fentichlor, and to explore the current uses of fentichlor. METHODS: A review of photopatch test studies involving fentichlor was performed. A retrospective chart review was conducted in patients with positive photopatch test reactions to fentichlor at our institution. Product inquiries were placed to manufacturers of fentichlor to elicit the current uses of fentichlor. RESULTS: In selected photopatch test studies, positive reactions to fentichlor occurred in 0.0% to 11.8% of subjects. We found that 25 companies distribute or manufacture fentichlor worldwide, which includes 2 companies that sell 25-kg drums of fentichlor. The most common current uses of fentichlor are in research, in high throughput screening, and in antibacterial and antifungal creams. CONCLUSIONS: Our review of selected photopatch test studies demonstrates that fentichlor remains a potent photosensitizing allergen worldwide. The bulk quantities of fentichlor available for sale and the current uses of fentichlor suggest that fentichlor may be currently incorporated into consumer products. We recommend that fentichlor remain in the standard series of photopatch test allergens.

Purpura annularis telangiectoides of Majocchi (PATM) is a clinical variant of pigmented purpuric dermatoses. It is characterized by asymptomatic or mildly pruritic, erythematous, annular patches that vary in size. The patches exhibit central clearing and peripheral cayenne pepper petechiae. It classically occurs on the lower legs but may be more generalized. Histopathologic features include a lymphocytic capillaritis with subsequent capillary leakage and extravasated erythrocytes, which is typical of all pigmented purpuric dermatoses. The pathogenesis of PATM is unknown, but it may uncommonly be associated with underlying diseases such as hematologic disorders and rarely cutaneous T-cell lymphoma. There is no standard effective treatment.

We present a case of cutaneous sarcoidosis in a 77-year-old woman without systemic disease, who presented with two subtypes of lesions: erythematous and hyperpigmented macules on the arms and anterior upper legs and erythematous, hyperkeratotic nodules, some crateriform, on the lower legs and feet. Whereas cutaneous sarcoidosis is present in up to one-third of cases and may present with a wide variety of lesions, verrucous sarcoidosis is uncommon. Diagnosis is by clinical and histopathologic exclusion of other entities, which include other causes of granulomatous inflammation such as infections and foreign-body reactions. Management options include topical, intralesional, or systemic glucocorticoids, antimalarials, tetracycline derivatives, and methotrexate.

Morbihan disease, which consists of solid facial edema, is a rare complication of rosacea, a common cutaneous disorder in middle-aged individuals. The characteristic features of Morbihan disease are its chronic course, typical clinical picture, lack of specific laboratory and histopathologic findings, and refractoriness to therapeutic measures. Since its initial description in 1957, only a small number of cases have been reported in the dermatologic literature. We report a 54-year-old man who developed a two-year duration of erythema and edema that affects the upper and mid face, with accentuation in the periorbital region. Patch tests excluded an allergic contact dermatitis and histopathologic investigation showed small, nodular clusters of epithelioid cells in the dermis that were consistent with sarcoidal granulomata. A diagnosis of Morbihan disease was made owing to the combination of clinical and histopathologic findings. Therapeutic options for the disease remain unsatisfactory and treatments reported in the literature include systemic glucocorticoids, oral tetracyclines, thalidomide, isotretinoin, ketotifen, and clofazimine. Our patient failed a six-to-seven months course of minocycline prior to presentation and has since experienced improvement on gradually-increasing doses of isotretinoin.