Golara Honari, MD

Abstract

BACKGROUND: Photopatch testing is an important diagnostic tool in evaluating patients with suspected photoallergic contact dermatitis. Although protocols for photopatch testing have been described, there are no consensus recommendations by the American Contact Dermatitis Society (ACDS).OBJECTIVES: The aims of this study were to examine the common practices of photopatch testing among ACDS members and to review and compare commonly used photoallergen series.METHODS: We conducted a questionnaire-based survey among ACDS members via e-mail to inquire about their photopatch test methods. We compared the results with the European consensus methodology and reviewed photoallergen series reported by the respondents.RESULTS: Of the 791 members contacted, 112 members (14%) responded to the survey. Among these, 50 respondents (45%) perform photopatch testing, approximately half of whom (48%) determine minimal erythema dose before the test using UVA with or without UVB irradiation. Respondents use a total of 13 photoallergen series, alone or in any combination, as well as customized series.CONCLUSIONS: These results have potential to aid clinicians in identifying photoallergen series best suited for their patients and suggest a need for consensus recommendations by the ACDS.

View details for DOI 10.1097/DER.0000000000000535

View details for PubMedID 31905187

View details for DOI 10.1016/j.jaad.2019.12.054

View details for PubMedID 31923445

View details for DOI 10.1016/j.jaad.2020.04.021

View details for PubMedID 32289388

Abstract

Until recently, step-up therapy in atopic dermatitis (AD) included primarily off-label use of phototherapy, systemic immunosuppressants and/or corticosteroids. These broadly impact the immune system and show efficacy across a gamut of inflammatory skin diseases, albeit with potential serious adverse-events. Recently, dupilumab was approved as the first biologic agent in AD and demonstrated better efficacy and safety than prior off-label therapies.

View details for DOI 10.1111/jdv.16445

View details for PubMedID 32277506

View details for DOI 10.1016/j.jdcr.2020.02.010

View details for PubMedID 32258302

View details for PubMedCentralID PMC7109358

Abstract

Dupilumab targets IL-4Ralpha and is used for moderate-to-severe atopic dermatitis (AD). Prior reports have described new alopecia areata (AA),1 flaring of prior AA,2 as well as improvement or resolution of AA3 in patients treated with dupilumab. We conducted a retrospective cohort study to describe the natural history of prior or new inflammatory alopecia in patients on dupilumab.

View details for DOI 10.1111/jdv.16094

View details for PubMedID 31737955

Abstract

The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin - as well as the inducing factors. Avoidance of possible triggering factors and the use of well-tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin.

View details for DOI 10.1111/jdv.16000

View details for Web of Science ID 000492848800001

View details for PubMedID 31660659

View details for DOI 10.1001/jamadermatol.2019.0109

View details for Web of Science ID 000482127300017

View details for PubMedID 30989102

View details for PubMedID 31042259

View details for PubMedID 29332717

View details for DOI 10.1097/DER.0000000000000325

View details for Web of Science ID 000415753100012

View details for PubMedID 29135684

Abstract

The American Contact Dermatitis Society recognizes the interest in the evaluation and management of metal hypersensitivity reactions. Given the paucity of robust evidence with which to guide our practices, we provide reasonable evidence and expert opinion-based guidelines for clinicians with regard to metal hypersensitivity reaction testing and patient management. Routine preoperative evaluation in individuals with no history of adverse cutaneous reactions to metals or history of previous implant-related adverse events is not necessary. Patients with a clear self-reported history of metal reactions should be evaluated by patch testing before device implant. Patch testing is only 1 element in the assessment of causation in those with postimplantation morbidity. Metal exposure from the implanted device can cause sensitization, but a positive metal test does not prove symptom causality. The decision to replace an implanted device must include an assessment of all clinical factors and a thorough risk-benefit analysis by the treating physician(s) and patient.

View details for DOI 10.1097/DER.0000000000000210

View details for Web of Science ID 000384577700002

View details for PubMedID 27649347