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Vezakis IA, Lambrou GI, Kyritsi A, Tagka A, Chatziioannou A, Matsopoulos GK. Detecting Skin Reactions in Epicutaneous Patch Testing with Deep Learning: An Evaluation of Pre-Processing and Modality Performance. Bioengineering (Basel) 2023; 10:924. [PMID: 37627809 PMCID: PMC10451716 DOI: 10.3390/bioengineering10080924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Epicutaneous patch testing is a well-established diagnostic method for identifying substances that may cause Allergic Contact Dermatitis (ACD), a common skin condition caused by exposure to environmental allergens. While the patch test remains the gold standard for identifying allergens, it is prone to observer bias and consumes valuable human resources. Deep learning models can be employed to address this challenge. In this study, we collected a dataset of 1579 multi-modal skin images from 200 patients using the Antera 3D® camera. We then investigated the feasibility of using a deep learning classifier for automating the identification of the allergens causing ACD. We propose a deep learning approach that utilizes a context-retaining pre-processing technique to improve the accuracy of the classifier. In addition, we find promise in the combination of the color image and false-color map of hemoglobin concentration to improve diagnostic accuracy. Our results showed that this approach can potentially achieve more than 86% recall and 94% specificity in identifying skin reactions, and contribute to faster and more accurate diagnosis while reducing clinician workload.
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Affiliation(s)
- Ioannis A. Vezakis
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.A.V.); (G.I.L.)
| | - George I. Lambrou
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.A.V.); (G.I.L.)
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, 8 Thivon & Levadeias St., 11527 Athens, Greece
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, 8 Thivon & Levadeias St., 11527 Athens, Greece
| | - Aikaterini Kyritsi
- First Department of Dermatology and Venereology, “Andreas Syggros” Hospital, National and Kapodistrian University of Athens, 5 Ionos Dragoumi St., 11621 Athens, Greece; (A.K.); (A.T.); (A.C.)
| | - Anna Tagka
- First Department of Dermatology and Venereology, “Andreas Syggros” Hospital, National and Kapodistrian University of Athens, 5 Ionos Dragoumi St., 11621 Athens, Greece; (A.K.); (A.T.); (A.C.)
| | - Argyro Chatziioannou
- First Department of Dermatology and Venereology, “Andreas Syggros” Hospital, National and Kapodistrian University of Athens, 5 Ionos Dragoumi St., 11621 Athens, Greece; (A.K.); (A.T.); (A.C.)
| | - George K. Matsopoulos
- Biomedical Engineering Laboratory, School of Electrical & Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou St., 15780 Athens, Greece; (I.A.V.); (G.I.L.)
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Kiecka A, Macura B, Szczepanik M. Modulation of allergic contact dermatitis via gut microbiota modified by diet, vitamins, probiotics, prebiotics, and antibiotics. Pharmacol Rep 2023; 75:236-248. [PMID: 36729361 PMCID: PMC10060339 DOI: 10.1007/s43440-023-00454-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
Allergic contact dermatitis is one of the most common recorded occupational diseases. There are many different substances that the skin comes into contact with on a daily basis and that can cause ACD, e.g., preservatives, surfactants, and antimicrobial agents. The development of a mouse model of ACD has provided insight into the immune mechanisms involved. Drugs used in the treatment of skin diseases have many side effects. Therefore, alternative methods of suppressing the immune response to reduce the symptoms of skin diseases are being sought. In recent years, high hopes have been placed on dietary modulation and supplementation to affect the intestinal microbial composition and promote anti-inflammatory responses. In addition, other studies have shown the crucial role of intestinal microbiota in many immune-mediated diseases. Recognition and characterization of pro- and anti-inflammatory nutrients and supplements may be crucial to support the treatment of diseases such as atopic dermatitis, acne vulgaris, psoriasis, and allergic contact dermatitis.
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Affiliation(s)
- Aneta Kiecka
- Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Jagiellonian University Medical College, Kopernika 7a, 31-034, Kraków, Poland.
| | - Barbara Macura
- Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Jagiellonian University Medical College, Kopernika 7a, 31-034, Kraków, Poland
| | - Marian Szczepanik
- Faculty of Health Sciences, Institute of Physiotherapy, Chair of Biomedical Sciences, Jagiellonian University Medical College, Kopernika 7a, 31-034, Kraków, Poland
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Hosseinpour S, Gaudin A, Peters OA. A critical analysis of research methods and experimental models to study biocompatibility of endodontic materials. Int Endod J 2022; 55 Suppl 2:346-369. [PMID: 35124840 PMCID: PMC9315036 DOI: 10.1111/iej.13701] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
Materials used for endodontics and with direct contact to tissues have a wide range of indications, from vital pulpal treatments to root filling materials and those used in endodontic surgery. In principle, interaction with dental materials may result in damage to tissues locally or systemically. Thus, a great variety of test methods are applied to evaluate a materials' potential risk of adverse biological effects to ensure their biocompatibility before commercialization. However, the results of biocompatibility evaluations are dependent on not only the tested materials but also the test methods due to the diversity of these effects and numerous variables involved. In addition, diverse biological effects require equally diverse assessments on a structured and planned approach. Such a structured assessment of the materials consists of four phases: general toxicity, local tissue irritation, pre‐clinical tests and clinical evaluations. Various types of screening assays are available; it is imperative to understand their advantages and limitations to recognize their appropriateness and for an accurate interpretation of their results. Recent scientific advances are rapidly introducing new materials to endodontics including nanomaterials, gene therapy and tissue engineering biomaterials. These new modalities open a new era to restore and regenerate dental tissues; however, all these new technologies can also present new hazards to patients. Before any clinical usage, new materials must be proven to be safe and not hazardous to health. Certain international standards exist for safety evaluation of dental materials (ISO 10993 series, ISO 7405 and ISO 14155‐1), but researchers often fail to follow these standards due to lack of access to standards, limitation of the guidelines and complexity of new experimental methods, which may cause technical errors. Moreover, many laboratories have developed their testing strategy for biocompatibility, which makes any comparison between findings more difficult. The purpose of this review was to discuss the concept of biocompatibility, structured test programmes and international standards for testing the biocompatibility of endodontic material biocompatibility. The text will further detail current test methods for evaluating the biocompatibility of endodontic materials, and their advantages and limitations.
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Affiliation(s)
- S Hosseinpour
- School of Dentistry The University of Queensland Herston QLD Australia
| | - A Gaudin
- Inserm UMR 1229 RMeS, Regenerative Medicine and Skeleton Université de Nantes ONIRIS Nantes France
- Université de Nantes UFR Odontologie Nantes France
| | - O A Peters
- School of Dentistry The University of Queensland Herston QLD Australia
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Bapat RA, Parolia A, Chaubal T, Dharamadhikari S, Abdulla AM, Sakkir N, Arora S, Bapat P, Sindi AM, Kesharwani P. Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry. Biomater Sci 2021; 9:3244-3283. [PMID: 33949464 DOI: 10.1039/d1bm00233c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.
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Affiliation(s)
- Ranjeet Ajit Bapat
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Tanay Chaubal
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Anshad Mohamed Abdulla
- Faculty, Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Nasil Sakkir
- Registrar Endodontist, Central Security Hospital, Abha, Kingdom of Saudi Arabia
| | - Suraj Arora
- Faculty, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Prachi Bapat
- Dentist, Modern Dental College, Indore 453112, Madhya Pradesh, India
| | - Amal M Sindi
- Faculty, Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Prashant Kesharwani
- Faculty, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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Jia Z. Management strategies for allergic reaction following implantation of nickel-containing devices. J Interv Med 2019; 2:139-140. [PMID: 34805889 PMCID: PMC8562263 DOI: 10.1016/j.jimed.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, 213003, China
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Lise MLZ, Feijó FR, Lise MLZ, Lise CRZ, de Campos LCE. Occupational dermatoses reported in Brazil from 2007 to 2014. An Bras Dermatol 2018; 93:27-32. [PMID: 29641693 PMCID: PMC5871358 DOI: 10.1590/abd1806-4841.20185314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/24/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil. OBJECTIVES To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns. METHODS We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses. RESULTS All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability. STUDY LIMITATIONS The amount of missing information for various items in the system draws attention. CONCLUSIONS Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.
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Affiliation(s)
- Michelle Larissa Zini Lise
- Dermatology Service at Hospital São Lucas -
Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS) - Porto
Alegre (RS), Brazil
| | - Fernando Ribas Feijó
- Department of Social Medicine at the Universidade Federal de
Pelotas (UFPEL) - Pelotas (RS), Brazil
| | | | | | - Luis Carlos Elejalde de Campos
- Dermatology Service at Hospital São Lucas -
Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS) - Porto
Alegre (RS), Brazil
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Allergic Reaction following Implantation of a Nitinol Alloy Inferior Vena Cava Filter. J Vasc Interv Radiol 2016; 26:1375-7. [PMID: 26314647 DOI: 10.1016/j.jvir.2015.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/30/2015] [Accepted: 05/30/2015] [Indexed: 01/10/2023] Open
Abstract
A 67-year-old woman developed severe pruritus after implantation of a retrievable nitinol inferior vena cava (IVC) filter (55.4% nickel and 44.6% titanium). The pruritus resolved only after filter retrieval. The patient's hypersensitivity to nickel was confirmed by a positive skin patch test substantiating a systemic allergic reaction to the implanted nitinol IVC filter.
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Weintraub GS, Lai IN, Kim CN. Review of allergic contact dermatitis: Scratching the surface. World J Dermatol 2015; 4:95-102. [DOI: 10.5314/wjd.v4.i2.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/28/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
Contact dermatitis-including allergic contact dermatitis (ACD)-n and results in over four million lost work days per year in the United States alone. ACD is a classic example of a type IV delayed hypersensitivity reaction, and represents a significant burden on the health system, economy, and patient quality of life. Thorough history taking, clinical examination, histologic evaluation, and patch testing are keys to diagnosing contact dermatitis. Patch testing, especially with comprehensive and customized panels based on the patient’s exposure history, is particularly useful in identifying potential allergens in the case of allergic contact dermatitis. ACD management requires a combination of direct medical intervention, patient education, and appropriate environmental modification to prevent exposure to offending allergens in the home or workplace. Continuing advances in the study of ACD has led to an increased understanding of the disease processes, new methods for diagnosis, and improved management. This article reviews ACD-aiming to connect recent investigational data with the current clinical understanding of disease pathophysiology, diagnostic techniques, and management strategies.
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Wang R, Lu B, Gerard C, Gerard NP. Disruption of the complement anaphylatoxin receptor C5L2 exacerbates inflammation in allergic contact dermatitis. THE JOURNAL OF IMMUNOLOGY 2013; 191:4001-9. [PMID: 24043888 DOI: 10.4049/jimmunol.1301626] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The complement anaphylatoxin C5a is a critical mediator of allergic contact dermatitis, bridging essential aspects of innate and adaptive immunity. This anaphylatoxin functions by interacting with two 7-transmembrane segment receptors, the C5aR and C5L2. The C5aR is a classical G protein coupled receptor, whereas C5L2 is deficient in coupling to G proteins because of variations in the sequence. Our previous work in human neutrophils revealed a unique role for C5L2 in negatively modulating anaphylatoxin receptor mediated cellular activation through interactions with β-arrestin. When C5L2 is deficient, C5aR-mediated β-arrestin signaling is greatly enhanced. The work described in this study was undertaken first to determine the effect of C5L2 deficiency in a murine model of contact sensitivity, and second to determine whether the resultant exacerbation of inflammatory parameters reflects a negative modulatory function of C5L2 on the C5aR. First, we find dramatic increases in inflammation in C5L2(-/-) animals compared with wild type mice. Second, these increases are completely reversed following administration of mAb against the C5aR. Thus, in allergic contact sensitivity, as in isolated human neutrophils, C5L2 functions to suppress C5a-C5aR-mediated responses, further underscoring its role as a negative regulator of anaphylatoxin activity.
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Affiliation(s)
- Ruobing Wang
- Ina Sue Perlmutter Laboratory, Division of Respiratory Diseases, Department of Pediatrics, Children's Hospital, Boston, MA 02115
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Beriat GK, Akmansu SH, Doğan C, Taştan E, Topal F, Sabuncuoğlu B. Is pimecrolimus cream (1%) an appropriate therapeutic agent for the treatment of external ear atopic dermatitis? Med Sci Monit 2012; 18:BR135-43. [PMID: 22460087 PMCID: PMC3560827 DOI: 10.12659/msm.882615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In recent years, pimecrolimus 1% cream has been demonstrated to reduce symptoms of atopic dermatitis in patients when applied topically. Material/Methods In our study we compared the therapeutic effects of local 1% pimecrolimus to 1% hydrocortisone, and to a control group in a mouse model with atopic dermatitis in the external ear canals. Atopic dermatitis was created by application of Dinitrochlorobenzene in the external ear canals of mice. The development of atopic dermatitis was detected by clinical observation score and determination of total serum IgE levels. Pimecrolimus and hydrocortisone cream were topically applied to the external ear canal skin once a day for 14 days. Results There was no significant difference between the hydrocortisone and the pimecrolimus therapy groups, while there was a statistically significant difference between these 2 groups and the control group (p<0.05) Assessment of the clinical observation scoring carried out on the 14th day of therapy revealed that there was no difference between the hydrocortisone and pimecrolimus groups. Biopsies were taken on the 14th day following treatment. Tissue samples were histologically evaluated; contact dermatitis was observed microscopically in the control group, but in the therapy groups only minimal evidence of contact dermatitis was found. Conclusions The results of our study reveal that the therapeutic efficacy of 1% pimecrolimus was equivalent to 1% hydrocortisone treatment in the artificially developed atopic dermatitis model in external ear canals of mice. These results clearly demonstrate that 1% pimecrolimus cream can be an effective alternative therapeutic agent in cases where steroid treatment proves to be insufficient or in cases where treatment must be discontinued due to its adverse effects.
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Affiliation(s)
- Güçlü Kaan Beriat
- Department of Otorhinolaryngology, Ufuk University Medical School, and ENT Department, Ankara Training and Research Hospital, Ankara, Turkey
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Lusini M, Barbato R, Spadaccio C, Chello M. Aortic Valve Replacement in a Patient with Severe Nickel Allergy. J Card Surg 2011; 26:618-20. [DOI: 10.1111/j.1540-8191.2011.01320.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kim KH, Park JC, Yoon NS, Moon JY, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Kang JC. A case of allergic contact dermatitis following transcatheter closure of patent ductus arteriosus using Amplatzer ductal occluder. Int J Cardiol 2008; 127:e98-9. [DOI: 10.1016/j.ijcard.2007.04.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 10/22/2022]
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Bercovitch L. Patch testing and prick testing: A practical guide by Jean-Marie Lachapelle and Howard I. Maibach; Management of positive patch test reactions by J. E. Wahlberg, P. Elsner, L. Kanerva, H. I. Maibach; Irritant dermatitis by Ai-Lean Chew and Howard I. Maibach; Condensed handbook of occupational dermatology by L. Kanerva, P. Elsner, J. E. Wahlberg, H. I. Maibach. J Am Acad Dermatol 2007. [DOI: 10.1016/j.jaad.2007.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The objectives of this study were (i) to determine the frequency of dermatoses caused by use of cosmetics in patients with specific complaints of reaction to cosmetic products, and (ii) to observe the main skin conditions frequently misunderstood by users as cosmetic reactions. 176 patients seen in a private office from 1999 to 2006, with complaint of dermatoses caused by cosmetics were examined. The clinical history, physical examination, relation between site of reaction and use of cosmetics were assessed. Of the patients examined, 154 (87.5%) were women and 22 (12.5%) men. About 90 (52%) patients had no skin condition related to cosmetics, 80 (45%) had dermatoses associated with cosmetics, and 6 patients (3%) had inconclusive results. Melasma, contact dermatitis to other products, and acne were the conditions that users associated more often to cosmetics. 14% of patients had skin lesions caused by inappropriate cosmetic use. To conclude, the true adverse reaction to cosmetics was not very common. In this study, dermatitis was associated with cosmetics in only 31% of patients with specific complaint of dermatitis caused by cosmetics. Therefore, 52% of patients misdiagnosed the condition and had other dermatoses, and 14% made inappropriate use of cosmetics.
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Affiliation(s)
- Ida Duarte
- Sector of Allergy and Phototherapy, Clinic of Dermatology, Santa Casa de Sao Paulo Hospital and School of Medicine, Sao Paulo, Brazil.
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Abstract
OBJECTIVES/HYPOTHESIS To understand the role and efficacy of topical pimecrolimus in the treatment of refractory pruritus of the external auditory canals (EACs). STUDY DESIGN Retrospective chart review. METHODS Thirty-six patients with pruritic EACs who had failed conventional therapy with topical and systemic medications were treated with topical pimecrolimus 1% for a period of 3 months. Baseline and follow-up evaluation of the degree of pruritus among other variables was performed. A control group of 19 patients was instructed on aural toilet alone and was not treated with topical pimecrolimus 1%. RESULTS Of the 36 patients who were treated with topical pimecrolimus for their pruritic EACs, 34 patients had resolution of their symptoms. There was evidence of return of cerumen production in 86% of patients. In the control group, 16% of patients had improvement of their symptoms with aural toilet. This difference was statistically significant (chi, P < .0001). CONCLUSIONS Topical pimecrolimus appears to be more efficacious than aural toilet in the treatment of pruritic ears for chronic use without side effects.
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Affiliation(s)
- Hamid R Djalilian
- University of Illinois at Chicago and Academic Dermatology and Skin Cancer Institute, Chicago, Illinois, USA.
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Abstract
The roots of education in patch testing begin with Jadassohn and have been passed down through generations of dermatologists through didactic teachings and mentoring. Currently, we are faced with workforce economics tipping the balance of dermatology toward cosmetic and surgical practices. This imbalance is easily found in the subspecialty of contact dermatitis, where the current demand for patch test services is on the rise and the number of new dermatology-based patch test providers cannot keep up with the current demand. Steps are being made to remedy this discrepancy through societies and fellowships, yet the question remains: were the steps in time and were they big enough?
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Affiliation(s)
- Sharon E Jacob
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL 33136, USA.
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Abstract
The pathophysiology of ACD follows an intricate design and results in the characteristic, delayed inflammatory response. Although the astute physician may correctly diagnose ACD from its initial, classic history and presentation, alternative diagnoses should be considered and excluded. Patch testing performed with a relevant panel of contact allergens is the ultimate confirmatory test of ACD. Correctly identifying the inciting allergen permits appropriate personal avoidance. Corticosteroids remain the principal treatment options.
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Affiliation(s)
- Barry J Mark
- Division of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Lai DW, Saver JL, Araujo JA, Reidl M, Tobis J. Pericarditis associated with nickel hypersensitivity to the Amplatzer occluder device: A case report. Catheter Cardiovasc Interv 2005; 66:424-6. [PMID: 16208708 DOI: 10.1002/ccd.20497] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 38-year-old man with a history of migraine headaches with aura and one episode of ischemic stroke was found to have a patent foramen ovale (PFO). After percutaneous closure with the nickel-containing Amplatzer PFO occluder, the patient developed pericarditis, atrial fibrillation, and increased migraine headaches with aura that abated with oral prednisone. He tested positive for nickel hypersensitivity, which we conclude is the likely etiology of his pericarditis.
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Affiliation(s)
- Dominic W Lai
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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