ImportanceIndividuals with allergic contact dermatitis to one topical corticosteroid may also react to other corticosteroids. Corticosteroid classification models have been proposed to predict such copositivity, recommend representative screening corticosteroids, and guide allergen avoidance.ObjectiveTo use patient data to determine copositivity patterns between corticosteroids and evaluate against previous corticosteroid classification models.Design, Setting, and ParticipantsThis qualitative study included a retrospective analysis of the Mayo Clinic Contact Dermatitis Group corticosteroid patch test data from 2010 to 2019. Among patients undergoing patch testing with the Mayo Clinic’s standard or steroid series who consented to research participation, 5637 patients were included in the analysis. Copositivity rates were determined between corticosteroids and analyzed by hierarchical clustering for comparison to previous classification models.Main Outcomes and MeasuresThe frequency of patch test positivity to each of the analyzed corticosteroids was noted and compared with previously published patch test positivity rates. Copositivity rates between each pair of corticosteroids were determined, and overall copositivity patterns were analyzed and evaluated against known steroid classes.ResultsA total of 49 472 individual patches were applied to 5637 patients, testing 18 corticosteroids. Patch test positivity rates ranged between 0.3% and 4.7%. The fluocinonide positivity rate corresponded to the highest copositivity rate with other corticosteroids (mean [SD], 50.7% [26.1%]). Tixocortol-21-pivalate, 0.1%, and tixocortol-21-pivalate, 1%, positivity rates corresponded to the lowest copositivity rates (mean [SD], 4.1% [1.7%] and 3.6% [1.4%], respectively). Hierarchical clustering elucidated patterns that did not support previous corticosteroid classification models.Conclusions and RelevanceIn this qualitative study, copositivity rates were variable between corticosteroids, and overall patch test positivity for allergy to topical corticosteroids was rare. Previously published corticosteroid classifications are not supported by real patient-derived data and may not be accurate in predicting corticosteroid copositivity.
The data represent the largest series of biologic dressings in cutaneous surgery and demonstrate the applicability and safety of porcine xenografts. We recommend consideration of porcine xenografts in the appropriate clinical context, to augment secondary intention.
Trichothiodystrophy is a rare autosomal recessive disorder resulting in a broad range of systemic abnormalities. Polarizing microscopy of the hair reveals the pathognomic "tiger tail" of alternating light and dark bands, but the need for a microscope prevents rapid bedside diagnosis. We describe a new technique for the bedside diagnosis of trichothiodystrophy using a handheld polarizing dermatoscope, precluding the need for microscopic examination. that encode a helicase subunit of transcription/repair factor TFIIH.Mutations in C7ORF11, RNF113A, and GTF2E2 result in similar conditions without photosensitivity. 2 In all mutations, low sulfur levels in the hair shaft cause structural abnormalities. With polarizing light microscopy, distinct "tiger tail" banding, consisting of alternating light and dark bands, are seen that are pathognomonic for the disorder. Trichoscopy, dermoscopic analysis of hair, has been used in the diagnosis of multiple hair shaft disorders, including monilethrix, trichorrhexis invaginata, pili torti, woolly hair, and pili annulati, 4 but TTD cannot be diagnosed using simple trichoscopy. Nonspecific surface abnormalities have been reported that may aid in selecting hairs for closer analysis. 5 We describe new methods for the bedside trichoscopic diagnosis of TTD. | CASE REPORTA 2-year-old girl presented with ichthyosis and neurologic decline.Her gestation had been complicated by preeclampsia, resulting in induced delivery at 31 weeks. She was erythrodermic at birth, which self-resolved. She subsequently demonstrated significant delays in growth and cognitive development, ataxia, coarse ichthyosis of the back, and brittle, short hair with periods of significant hair loss.Funduscopic examination was normal. | METHODSTo assess her hair rapidly for TTD, we developed two techniques to mimic polarizing microscopy that we call polarized transilluminating dermoscopy. Hairs with surface irregularities seen using normal in vivo dermoscopy were clipped and placed on a glass slide. 5 In the first method, a light-emitting diode from a cellular telephone was projected through a polarizing dermatoscope to create polarized light (intensity adjusted using tissue paper). After placing the specimen for transillumination, a second polarizing dermatoscope was then used to view the hair sample ( Figure 1A).In the second method, the specimen was placed on a mirror.When simply viewing the specimen using a polarizing dermatoscope, polarizing light reflects off the mirror to transilluminate the target ( Figure 1B).In contrast to simple trichoscopy using a polarizing dermatoscope (Figure 2A), polarizing transilluminating trichoscopy revealed distinct light and dark bands characteristic of trichothiodystrophy ( Figure 2B, C).
This cohort study examines factors that may contribute to whether patients address physicians differently through electronic messaging
Background: Patch tests are read between days 5 and 7, because most hypersensitivity reactions occur within 7 days. Later reactions can occur after day 8, which may be missed.Objective: The aim of the study was to review all late delayed positive (LDP) reactions that have occurred after day 8 at Mayo Clinic from 2001 to 2020.Methods: Mayo Clinic records were reviewed for patients who had patch test readings performed at greater than day 8. Late delayed positive reactions were defined as any patch tests that were initially negative from days 4 to 7 yet became positive after day 8.Results: Two hundred seventy-four patients developed 439 LDPs to 89 allergens. Fourteen allergens had LDPs in at least 2% of patients: gold (gold sodium thiosulfate-3 concentrations, gold chloride, potassium dicyanoaurate), cobalt (cobalt sulfate, cobalt chloride hexahydrate), beryllium, palladium, acrylates (2-hydroxypropyl methacrylate, 2-hydroxyethyl methacrylate, 2-hydroxyethyl acrylate), dodecyl gallate, and gentamycin. Late delayed positive reactions to gold allergens were the most frequent reactions. Up to 90% of relevant gold allergen LDPs were positive by day 15.Conclusions: Positive patch test readings after day 8 are uncommon, but allergens most likely to be positive are metals (gold, cobalt, palladium, beryllium), acrylates, dodecyl gallate, and gentamycin. Gold allergens showed the highest LDP rates and relevance, with most reactions occurring by day 15.
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