Dermatitis®

Topical calcineurin inhibitors (TCIs) are widely used as an alternative to topical corticosteroids (TCSs) in treating of atopic dermatitis, but their risk versus benefit compared with TCSs remains unclear.

We performed a systematic review of the efficacy, safety, and cost-effectiveness of TCI compared with TCS and emollients.

Published meta-analysis, systematic reviews, and individual studies from January 2005 to January 2015 on the comparative efficacy, safety, and cost-effectiveness of TCI against emollients and TCS were included.

Tacrolimus is comparable to TCS in efficacy, safety profile, and cost-effectiveness. Pimecrolimus has a similar safety profile compared with TCS, emollients, and tacrolimus. It is superior to emollients but inferior to TCS and tacrolimus in efficacy and cost-effectiveness. The association of tacrolimus with malignancy remains uncertain.

Tacrolimus is an efficacious and cost-effective alternative to TCS, but its benefits need to be weighed against its still uncertain risk for malignancy. Pimecrolimus is appropriate for mild atopic dermatitis when TCS or tacrolimus is unsuitable.

Patients with allergic contact dermatitis to 1 antigen have been shown to be at increased risk of developing delayed type hypersensitivity reactions to additional antigens. Both environmental and genetic factors likely influence the risk of sensitization.

The aim of this study was to determine whether polysensitization occurs at a higher frequency than would be expected based on chance and whether polysensitization occurs more often in subsets of patients with hand involvement and atopic dermatitis.

From a database of patch test results from a single practitioner, the probability of having positive reactions to 3 or more unrelated allergens was calculated under the assumption that positive reactions are independent and compared with the observed proportion having positive reactions to 3 or more unrelated allergens. The analysis was repeated excluding patients with leg involvement as a proxy for venous insufficiency dermatitis. The proportion of patients from the polysensitized and nonpolysensitized cohorts with either hand involvement or a history of atopic dermatitis was also calculated.

Polysensitization occurs more often than expected based on chance. Polysensitized patients were more likely to have hand dermatitis. Atopic dermatitis was not significantly associated with polysensitization in this analysis. Polysensitized individuals may represent a phenotype with increased genetic susceptibility to sensitization.

Saffron, a bulbous perennial plant belonging to Iridaceae family, is the most expensive cultivated herb that is widely used for industrial and nonindustrial purposes. However, besides its attractive and valuable properties, contact dermatitis due to saffron is an uncommon reported entity.

The aims of this study were to determine the clinical pattern patch-testing profile of contact dermatitis in saffron workers and to identify the most common allergens/sensitizers.

One hundred ten saffron workers were patch-tested with 39 allergens, which included Indian standard series antigens, plant series antigens, and extracts from different parts of saffron flower.

The allergens in Indian standard series accounted for 52.44% of positive reactions. Plant series and different parts of saffron accounted for 47.56% of the positive reactions. Among those patients with positive responses to the supplemental saffron allergens, 83.3% were of present or past relevance.

The data observed in the present study confirm that the saffron dermatitis is a distinct clinical entity with characteristic clinical presentation and has a strong significance as an occupational allergen in those handling this plant. Patch testing with different parts of saffron flower has a role to play in finding out the etiological cause.

Depleted uranium (DU)–containing weapons have been used in military operations since 1991. There is interest in following veterans who were occupationally exposed to DU by either inhalation or retention of fragments. A cohort of DU-exposed Gulf War I veterans has been followed longitudinally at the Baltimore Veterans Administration Medical Center since 1993.

The aim was to monitor chronic dermatological findings associated with occupational DU exposure in the 2013 cohort.

Thirty-five veterans were evaluated. This study was reviewed and approved by the institutional review board and the Baltimore Veterans Administration Medical Center research service. Depleted uranium exposure was measured using creatinine-adjusted urine uranium concentrations (micrograms of uranium per gram of creatinine [μgU/gCrea]). Detailed medical histories, physical examinations, and exposure histories were performed.

Using a cutoff level of 0.1 μgU/gCrea, 11 veterans were placed in the high-uranium exposure group, whereas 23 veterans were placed in the low-uranium exposure group. Retained fragments were documented in 91% of the high-exposure group versus that in 13% of the low-exposure group (P < 0.001), and fragment-related scarring was significantly increased in the high-exposure group (P = 0.002). Other dermatological findings such as dermatitis were also assessed.

Fragment retainment and related scarring was significantly increased in veterans exposed to high levels of DU. Continuous monitoring of this cohort will yield interesting dermatological findings related to DU exposure.