Rajani Katta

Contact Allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray.

ost primary care physicians see a large number of patients each year ith eczematous skin diseases. Although many of these patients have topic eczema, another extremely common cause of eczema is contact llergy. This subgroup of eczema patients is notably resistant to treatment nless the causative allergens can be identified and eliminated. It is stimated that allergic contact dermatitis (ACD) to topical products alone ccurs in 1% to 3% of the general population. Unlike respiratory and ood allergies, ACD is not histamine-mediated but is instead a T-cellediated delayed-type hypersensitivity reaction. The basic pathophysilogic process behind ACD is primary skin contact with an allergenic hemical which triggers an immune cascade and results in an eczematous eaction at the site of contact. On first exposure to low molecular weight chemical substances (haptens 500 Da), there is generally no skin reaction. During this first phase, hese haptens enter the epidermis and are recognized by antigen presentng cells, which in turn create signals that transform naive T cells into emory T cells, a process which typically takes 5 to 25 days. ubsequent reactions due to “challenge” with the same chemical subtance generally occur between 24 and 48 hours after exposure; however, eports of reactions occurring as early as 8 hours after exposure and as ong as 1 week after exposure are not uncommon.

Angioma serpiginosum with extensive cutaneous involvement

Angioma serpiginosum is a rare condition that involves both the proliferation and dilatation of superficial blood vessels in the skin. It classically begins in childhood, is more common in females, and is asymptomatic. Typical lesions appear on the extremities and are often asymmetric. We report a case of angioma serpiginosum involving extensive areas of the extremities and the trunk to emphasize that extensive cutaneous involvement must be included in the clinical spectrum of this condition.

Methylisothiazolinone: An Emergent Allergen in Common Pediatric Skin Care Products

Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children.

Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis

In the context of increasing popularity of “natural” alternatives to conventional medicine, several dietary supplements have gained the attention of researchers and consumers alike in the treatment of atopic dermatitis (AD). Readily available without a prescription and frequently perceived to have fewer side effects than traditional medications, these “natural” remedies may be featured in discussions with patients, and clinicians should therefore be familiar with their efficacy and safety. Based on trials to date, no dietary supplements can be recommended for routine use in the treatment of AD. However, some promising results have been noted from the use of probiotics and prebiotics taken in combination. Given significant differences in study design to date, however, further studies would be needed to clarify dose and strains of probiotics. Studies of vitamin D have been limited and have produced conflicting results, although further trials in selected subsets of patients may be indicated. Very limited data is available on fish oil supplements, while future studies on Chinese herbal medicine would require evaluation of comparable herbs and formulations. Finally, multiple trials of evening primrose oil and borage seed oil have shown improvement similar to placebo, and neither is currently recommended in eczema therapy.

Diet and hair loss: effects of nutrient deficiency and supplement use.

Patients presenting with hair loss should be screened by medical history, dietary history and physical exam for risk factors for nutrient deficiency. If warranted, laboratory studies may be performed. In patients with no risk factors, further laboratory evaluation searching for nutritional deficiencies is not warranted. For patients with nutritional deficiencies, it is clear that those deficiencies should be corrected. Further research is required to determine whether any benefit exists for nutrient supplementation in the absence of documented deficiency. At this time, patients must be informed that such research is lacking and that in fact some supplements carry the risk of worsening hair loss or the risk of toxicity.

Diet and rosacea: the role of dietary change in the management of rosacea

Dietary change may play a role in the therapy of rosacea. Certain foods and beverages may act as “triggers” for rosacea exacerbations. These may be divided into heat-related, alcohol-related, capsaicin-related, and cinnamaldehyde-related. One potential pathogenic mechanism may be via the activation of transient receptor potential cation channels, which result in neurogenic vasodilatation. Further research is needed on the role of the gut skin connection in rosacea. Epidemiologic studies suggest that patients with rosacea have a higher prevalence of gastrointestinal disease, and one study reported improvement in rosacea following successful treatment of small intestinal bacterial overgrowth. While further research is required in this area, patients may be advised on measures to support a healthy gut microbiome, including the consumption of a fiber-rich (prebiotic) diet.