Jennifer Chen, MD

View details for DOI 10.1016/j.jdin.2023.04.017

View details for PubMedID 37592975

Abstract

Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent.To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN.A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement.In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated.This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.

View details for DOI 10.1001/jamadermatol.2023.1347

View details for PubMedID 37256599

View details for DOI 10.1016/j.jaad.2022.12.051

View details for PubMedID 36775101

View details for DOI 10.1007/s13671-023-00381-0

View details for Web of Science ID 000922316700001

View details for DOI 10.1016/j.jaad.2023.01.016

View details for PubMedID 36682723

View details for DOI 10.1016/j.jaad.2022.08.042

View details for Web of Science ID 000927902100013

View details for DOI 10.1016/j.jdcr.2022.04.031

View details for PubMedID 36582488

View details for DOI 10.1016/j.jaad.2022.11.031

View details for PubMedID 36427663

Abstract

This case series describes the development of morbilliform drug eruption after breast surgery.

View details for DOI 10.1001/jamadermatol.2022.4458

View details for PubMedID 36383358

Abstract

BACKGROUND: Allergic contact dermatitis (ACD) is a common dermatologic disease. Patch testing remains the criterion standard for diagnosis. In clinical practice, avoidance may be limited by patient occupation or noncompliance, the pervasive nature of the culprit agent, or barriers to expert care because of socioeconomic, cultural, or geographic factors. Thus, ACD is frequently chronic and/or recurrent; however, the comorbidities associated with ACD are not well characterized.OBJECTIVE: The aim of the study is to identify associations between ACD and psychiatric, sleep health, cardiovascular, and infectious conditions.METHODS: In this study, we used a large US claims database to identify comorbidities associated with ACD diagnosed after patch testing, including psychiatric, sleep health, cardiovascular, and infectious conditions. We also stratified these associations by chronicity of disease.RESULTS: We identified associations between ACD and psychiatric, sleep-related, cardiovascular, and infectious comorbidities. We also found that more chronic ACD was associated with more infectious comorbidities. All of these associations remained significant on further subanalysis when patients with AD and venous stasis were excluded.CONCLUSIONS: Allergic contact dermatitis is associated with multiple comorbidities. Further study is required to corroborate these findings, determine causality, and to explore the impact of possible interventions in the workup and management of this common and often debilitating disease.

View details for DOI 10.1097/DER.0000000000000964

View details for PubMedID 36255394

View details for DOI 10.1016/j.jaad.2022.08.041

View details for PubMedID 36041554

View details for DOI 10.1097/DER.0000000000000873

View details for PubMedID 35318977

Abstract

Environmental, or exogenous, dermatitis is comprised of irritant and allergic contact dermatitis, which account for 80% and 20% of cases of contact dermatitis, respectively. Contact dermatitis is extremely common, and failure to diagnose this entity may result in overlooking a potentially curable driver of disease. In this review, we describe how clinical features, such as morphology or history, can assist in distinguishing exogenous from endogenous causes of dermatitis, and allergic from irritant contact dermatitis. Additionally, we provide an overview of common contact allergens and how dermatitis distribution can suggest possible culprit allergens. Patch testing is needed to confirm contact allergy.

View details for DOI 10.1016/j.iac.2021.04.002

View details for PubMedID 34225895

View details for DOI 10.1016/j.jaad.2021.07.029

View details for PubMedID 34314748

View details for DOI 10.1016/j.jdcr.2021.01.011

View details for PubMedID 33665278

View details for DOI 10.1016/j.jdcr.2020.10.023

View details for PubMedID 33354610

View details for DOI 10.1016/j.jaad.2021.05.038

View details for PubMedID 34058279

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.jdcr.2020.02.010

View details for PubMedID 32258302

View details for PubMedCentralID PMC7109358

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

Abstract

The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods.The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses.Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored.Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed.There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.

View details for DOI 10.1097/DER.0000000000000699

View details for PubMedID 33273243

Abstract

Prolonged wear of facial protective equipment can lead to occupational dermatoses.To identify important causes of occupational dermatoses from facial protective equipment.A systematic review following PRISMA guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks and/or N95 respirators.344 articles were identified; 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in healthcare workers. Allergic contact dermatitis was reported to the elastic straps, glue, and formaldehyde released from the mask fabric. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (greater than 6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare.Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies.This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment including potential offending allergens. This work may help in the diagnosis and treatment of healthcare workers with facial occupational dermatitis.

View details for DOI 10.1016/j.jaad.2020.09.074

View details for PubMedID 33011325

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

View details for DOI 10.1001/jamadermatol.2019.0109

View details for Web of Science ID 000482127300017

View details for DOI 10.1001/jamadermatol.2018.5605

View details for Web of Science ID 000464040200008

View details for PubMedID 30989102

View details for DOI 10.1016/j.jid.2018.11.013

View details for Web of Science ID 000456162000049

Abstract

Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners.The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years.We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference.A baseline pediatric patch test panel was established through working group consensus.

View details for PubMedID 29933256

Abstract

Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

View details for DOI 10.1097/DER.0000000000000208

View details for PubMedID 27427820

View details for PubMedID 27185438

Abstract

Idiopathic inflammatory myopathies (IIMs) involve inflammation of the muscles and are classified by the patterns of presentation and immunohistopathologic features on skin and muscle biopsy into 4 categories: dermatomyositis, polymyositis, inclusion body myositis, and immune-mediated necrotizing myopathy. Systemic corticosteroid (CS) treatment is the standard of care for IIM with muscle and organ involvement. The extracutaneous features of systemic sclerosis are frequently treated with CS; however, high doses have been associated with scleroderma renal crisis in high-risk patients. Although CS can be effective first-line agents, their significant side effect profile encourages concomitant treatment with other immunosuppressive medications to enable timely tapering.

View details for DOI 10.1016/j.rdc.2015.08.011

View details for PubMedID 26611554

View details for DOI 10.1001/jama.2015.13562

View details for PubMedID 26746461

Abstract

In 2001, gold was named Contact Allergen of the Year. More than a decade later, we continue to face several challenges in defining the role of gold in contact allergy. First, interpretation of gold reactions in the setting of epicutaneous patch testing may be difficult; in addition to being a common irritant, gold may be associated with significantly delayed and persistent reactions. Second, although gold compounds are commonly positive on patch testing, clinical relevance is relatively low and may be challenging to determine. Third, the complex interplay between gold and the human body is still poorly understood. In this review, we provide an overview of the literature concerning gold patch test positivity and present recommendations for epicutaneous patch testing with gold.

View details for DOI 10.1097/DER.0000000000000101

View details for Web of Science ID 000350912200003

View details for PubMedID 25757078

Abstract

Hand dermatitis is a common skin complaint. We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Patients with hand dermatitis may present to their allergist with this complaint. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute to the overall condition. Furthermore, the differential diagnosis of hand dermatitis is broad and the cause often multifactorial. Obtaining a thorough history and performing a focused examination may help the clinician differentiate between multiple causes of hand dermatitis. Numerous treatment options exist for hand dermatitis, and new potential treatments are in development as well. We aim to provide the allergist with a streamlined toolkit for help in the diagnosis and management of hand dermatitis.

View details for DOI 10.1007/s11882-014-0474-0

View details for Web of Science ID 000343644500005

View details for DOI 10.1016/j.jaad.2013.11.026

View details for PubMedID 25128123

View details for DOI 10.1016/j.jaad.2012.05.021

View details for Web of Science ID 000312131200015

View details for PubMedID 23158635

Abstract

Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.

View details for DOI 10.1016/j.jaad.2011.11.938

View details for Web of Science ID 000306368600026

View details for PubMedID 22305042

Abstract

To compare the utility of a search engine, Google, with other medical and non-medical, web-based resources for identifying specific medical information.This institutional review board-approved case cross-over study randomly assigned 89 medical student volunteers to use either Google or any other web-based resource (excluding Google) to research 10 advanced medical questions in a multiple choice exam. Primary outcome measures were resource efficiency (inversely related to number of links used to identify the correct answer for each question) and correctness (number of correct answers/total number of questions answered). For Google searches, the sites providing the information in question were also evaluated.The most frequently selected non-Google resources were Yahoo (n=531), Ask.com (n=110), and the interactive encyclopedia Wikipedia.com (n=74). Google was more efficient than all other resources (1.50 vs. 1.94 mean links, P<.0001), with no significant difference in correctness (97% [756/780] vs. 96% [747/780], P=.16). After a Google search, the four most common categories of sites that provided the correct answer were dictionary/encyclopedia sites, medical websites, National Library of Medicine resources, or journal websites. Yahoo was less efficient than Google (1.90 vs. 1.54 mean links, P<.0001). However, non-Google search engines were more efficient than web sites (eg, Wikipedia, medical websites) and PubMed (1.87 vs. 2.54 mean links, P=.0004).Google is an efficient web resource for identifying specific medical information, by guiding users to an array of medical resources.

View details for DOI 10.1016/j.acra.2008.02.010

View details for Web of Science ID 000259051700011

View details for PubMedID 18692758