Common skin diseases were responsible for the majority of dermatology consultations. Most patients were not treated for their cutaneous conditions before the dermatology consultation. Dermatology consultations resulted in treatment changes in the majority of cases.

Owing to the delayed onset and variable recovery, RTE remains a diagnostic challenge. RTE should be included in the differential diagnosis of any patient presenting with erythema over the site of a previously implanted device.

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Background: Rubber gloves are one of the most frequent causes of occupational allergic contact dermatitis, especially in health care workers. Observations: We describe 23 patients with allergic contact dermatitis due to rubber accelerators in rubber gloves, some with disseminated dermatitis, treated during a 2-year period. Three had IgE-mediated latex allergies. Sixteen were health care workers from a single institution whose dermatitis was temporally related to the switch to latexsafe gloves. Each had positive patch test reactions to 1 or more rubber accelerators, including carbamates, thiurams, 2-mercaptobenzothiazole, and 1,3-diphenylguanidine. Chemical analysis of 6 glove samples identified 2-mercaptobenzothiazole in 4 and zinc diethyldithiocarbamate in 1. There were discordances between patch test results for glove chemicals and glove swatches and between available information on chemicals used during glove production and chemicals detected during glove analysis. Although these factors may complicate the search for culprit and alternative gloves, dermatitis cleared in each of 9 patients with follow-up data and for whom alternative gloves were provided based on published information of glove composition. Conclusions: Allergic contact dermatitis due to synthetic rubber gloves occurs even with the use of latex-safe products. More knowledge about chemicals present in these gloves, to which the skin is exposed during use, is necessary to prevent and treat allergic contact dermatitis.

Chronic wounds exhibit persistent inflammation with markedly delayed healing. The significant burden of chronic wounds, which are often resistant to standard therapy, prompts further research on novel therapies. Since the interleukin-17 family has been implicated as a group of proinflammatory cytokines in immune-mediated diseases in the gut and connective tissue, as well as inflammatory skin conditions, we consider here if it may contribute to the pathogenesis of chronic wounds. In this review, we discuss the interleukin-17 family's signaling pathways and role in tissue repair. A PubMed review of the English literature on interleukin-17, wound healing, chronic wounds, and inflammatory skin conditions was conducted. Interleukin-17 family signaling is reviewed in the context of tissue repair, and preclinical and clinical studies examining its role in the skin and other organ systems are critically reviewed. The published work supports a pathologic role for interleukin-17 family members in chronic wounds, though this needs to be more conclusively proven. Clinical studies using monoclonal interleukin-17 antibodies to improve healing of chronic skin wounds have not yet been performed, and only a few studies have examined interleukin-17 family expression in chronic skin wounds. Furthermore, different interleukin-17 family members could be playing selective roles in the repair process. These studies suggest a therapeutic role for targeting interleukin-17A to promote wound healing; therefore, interleukin-17A may be a target worthy of pursuing in the near future.

Contact allergy to methylisothiazolinone (MI) or to the combined formulation of methylchloroisothiazolinone and MI (MCI-MI) has increased significantly, with a frequency of as much as 11.1% in patients with dermatitis; however, few cohort studies in the US population have been reported. OBJECTIVE To investigate the prevalence of contact allergies to MI and MCI-MI and the outcomes of patients with positive patch test reactions to MI and MCI-MI. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of all consecutive patients (n = 703) presenting with possible allergic contact dermatitis and subsequently undergoing patch testing at a tertiary referral center from January 1, 2012, through November 30, 2014. Patch testing used the North American Contact Dermatitis Group standard series. The MCI-MI concentration was 100 ppm; the MI concentration in the screening series increased from 200 to 2000 ppm in January 2013. Demographic data, exposures, and outcomes were reported for patients with positive patch test reactions to MI and/or MCI-MI.

To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints. Design: Medical chart review. Setting: Tertiary care academic medical center. Participants: All patients who had patch testing for allergic contact dermatitis related to orthopedic implants. Intervention: Patch testing. Main Outcome Measures: The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up. Results: Patients with potential metal hypersensitivity from implanted devices (N=72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n=31) and postimplantation (n=41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decisionmaking process of the referring surgeon in all preimplantation cases (n=21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n=21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients). Conclusions: The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-bycase basis, as decided by the surgeon and patient.

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