Manu Shah

Patch testing in children and adolescents: Five years' experience and follow-up

BACKGROUND Allergic contact dermatitis in children is a significant clinical problem. Little information is available concerning the value of patch testing and the outcome in these children. OBJECTIVE Our purpose was to assess the value of patch testing in children and the outcome of allergic contact dermatitis in childhood. METHODS Clinical data on 83 children patch tested during a 5-year period were assessed. Clinical follow-up on 68 subjects was performed. RESULTS Overall, 41 children had one or more allergic reactions (49%). Reactions to metals, topical preparations, and food additives were common. The clinical outcome at 6 months was significantly better for 36 children with a relevant allergen on patch testing than in 32 with no allergen or no relevant allergen (p = 0.006). CONCLUSION Patch testing is useful in the management of children suspected of having an allergic contact dermatitis. Patch testing and subsequent allergen avoidance may improve the prognosis in children with a relevant contact allergen.

Contact sensitivity in pruritus vulvae: Patch test results and clinical outcome

BACKGROUND Persistent vulval pruritus is common and may not be associated with signs of a primary vulval dermatosis. Patients with established vulval disease may develop contact sensitivity as a secondary problem after the application of topical therapy. OBJECTIVE A retrospective study was performed to establish the prevalence of allergic contact dermatitis in patients with pruritus vulvae. In addition, the results of patch testing in women with vulval lichen sclerosus were compared with those in patients with primary pruritus vulvae and essential vulvodynia. METHODS Over a 5-year period, 121 women with vulval problems were patch tested to the European Standard Series, selected preservatives, perfumes, local anesthetics, medicaments, and a vulval battery. RESULTS Fifty-seven patients (49%) had one or more relevant allergic positive reactions. Medicaments or their constituents were the most common allergens to give reactions. Seven of the 16 patients (44%) with lichen sclerosus had positive reactions. Symptoms resolved or improved significantly in 67 patients (55.4%) overall. Six of the seven women with lichen sclerosus who had positive reactions noted an improvement in their symptoms. Patients who had a relevant allergy were much more likely to improve than those whose tests were negative (p < 0.001). CONCLUSION Patients with pruritus vulvae and lichen sclerosus are at high risk of contact sensitivity. Patch testing is useful in the management of these patients and many can be helped by allergen avoidance.

Prognosis of occupational hand dermatitis in metalworkers.

Hand dermatitis is common in workers employed in the cutting and grinding of metals. Previous studies have given conflicting results on the prognosis of this common occupational disease. This study was designed to determine the prognosis of hand dermatitis in metalworkers and the responsible allergens. A questionnaire survey was conducted on 64 patients seen between 1 and 5 years previously in the contact dermatitis clinic. Of the 51 patients responding, 82% still had hand dermatitis. There was no difference in outcome between those who continued to work with metals and oils, and those who had changed their occupation. Hand dermatitis in metalworkers carries a poor prognosis, with most workers remaining symptomatic even if they no longer had occupational exposure to metals or oils. This study also demonstrates that biocides are the most important allergen group in the aetiology of hand dermatitis in metalworkers.

Foot dermatitis in children: causative allergens and follow-up.

Allergic contact dermatitis from shoes may have a typical pattern of presentation, but we have found that the distribution of dermatitis is often unhelpful in establishing the diagnosis. In this study, we aimed to define the features of foot dermatitis in children and to assess its outcome, in comparison to adults with foot eruptions. Relevant allergens were found in 15 out of 29 children and 26 out of 57 adults with foot eruptions. The most common allergens in children were rubber chemicals and topical medicaments. Adults showed a similar pattern, but also reacted to clothing dyes. The prognosis in both groups was good, with the dermatitis improving or resolving in 2/3.

Contact sensitivity to food additives can cause oral and perioral symptoms

A 28-year-old woman was referred with an 18-month history of intermittent facial reddening related to her work as an animator, which involved various varnishes and glues. Although prescribed topical corticosteroids, she had never applied them. Patch testing to a standard series, a face series and some substances that she worked with was negative at 2 and 4 days, except for nickel, which was of past relevance. A diagnosis of irritant facial dermatitis was made. She returned 12 days after the last patch test reading with a 2-day history of localised erythema on her back. This area of papules and vesiculation correlated exactly with the application site of tixocortol piva1ate 1% pet. She was unwilling to be patch tested further. Discussion This is, to our knowledge, the 1st case of probable active sensitization to tixocortol pivalate. The patient discussed had no previously known contact with topical corticosteroids, and the patch test site had been examined at 2 and 4 days with no reaction recorded. Tixocortol pivalate is becoming a standard patch test marker for hydrocortisone contact allergy, and large numbers of reactions have been reported, with no active sensitization mentioned in previous reports ( 1 ). We have tested over 10,000 patients to tixocortol pivalate without detecting previous active sensitization. Therefore, although this can probably occur, it is likely to be rare.

Contact allergy in patients with oral symptoms: A study of 47 patients

BACKGROUND Patients may present with a range of unexplained oral symptoms, and there has been debate about the role of contact sensitivity in these patients. OBJECTIVE The aim of this study was to review patch test results in patients presenting with oral and perioral symptoms and to determine the relevance of positive reactions. METHODS Forty-seven patients with oral symptoms were studied. Patients were tested to the European Standard Series and a range of other allergens, including bakery products, dental materials, medicaments, and metals. RESULTS Sixty-four percent of the patients had one or more positive allergic reactions. In 14 patients (30%), the results were believed to be relevant to their clinical problem. Relevant allergens included metals, rubber chemicals, food additives, and dental products. Symptoms resolved rapidly in all of the 13 patients in whom the source of the offending allergen was removed. CONCLUSION Patch testing is a useful investigation in patients with unexplained oral and perioral symptoms. Avoidance of the relevant allergen can result in complete resolution of symptoms.

Scrotal pyoderma gangrenosum associated with dermatomyositis

Pyoderma gangrenosum (PG) of the scrotum is extremely rare. We report a case of scrotal PG associated with dermatomyositis. Initial healing was slow despite the use of oral prednisolone and azathioprine. Healing was accelerated by the local use of a potent topical corticosteroid. PG should be considered in the differential diagnosis of ulcerating lesions of the genitalia.

Cutaneous surgery: pre‐operative information and what the patient expects

To the Editor: Cutaneous surgery is an important part of dermatological practice. AH procedures carry a potential risk of complications such as post-operative pain, wound infection and wound opening. Although many surgeons recognise the major postoperative problems., they may be unaware of minor complications. In addition, little is known about what patients expect, their level of satisfaction and how much information about the procedure and its potential side-effects they need or would like to receive. We have conducted a survey which aimed to determine the incidence of complications experienced by patients. An assessment of patient satisfac-

An audit of the use of methotrexate in a dermatology department

Methotrexate is commonly used for the treatment of psoriasis. It has potentially serious side-effects and effective monitoring is essential. We conducted an audit to compare our current use of methotrexate with established guidelines and to highlight areas for improvement. The case notes of 40 patients on maintenance treatment with methotrexate were reviewed. There were inadequacies in documentation of alcohol history, baseline investigations and test dose of methotrexate. The riming of liver biopsies was not always based on cumulative dose of methotrexate. Information given to patients and general practitioners was felt to be inadequate. As a result of the audit, standard forms have been introduced to document details at the start of treatment, monitoring investigations and cumulative methotrexate dose. Information for patients and general practitioners have been designed and are used regularly. Increased awareness should result in increased patient compliance and earlier hospital referral should side-ef...