Dermatitis®

Abstract: Multiple Janus Kinase (JAK) inhibitors were developed as potential treatments for moderate-to-severe atopic dermatitis (AD). There is a substantial amount of safety data from recent trials of oral JAK inhibitors in patients with AD. However, the vast majority of safety data for oral JAK inhibitors is derived from patients with rheumatoid arthritis and other immune-mediated disorders, and is primarily derived from tofacitinib, a pan-selective JAK inhibitor. This narrative review examines safety data for oral JAK inhibitors from studies in AD and other indications. The available data do demonstrate that rare but serious and life-threatening adverse events can occur with oral JAK inhibitor treatment and should be carefully considered in therapeutic shared decision making.

Allergic contact dermatitis (ACD) may occur secondary to devotional practices in various religions. A systematic review of PubMed was conducted from inception of database to September 9, 2022. Key terms were “contact dermatitis” or “devotional dermatosis” in association with major world religions including “Christianity,” “Islam,” “Hinduism,” “Buddhism,” “Sikhism,” and “Judaism.” Inclusion criteria were determined by presence of a religious practice and associated ACD. Articles referencing other cutaneous reactions such as chemical leukoderma were excluded. In total, 36 of 102 unique articles identified met inclusion criteria. Twenty-two articles referenced Hinduism, 8 referenced Judaism, 5 referenced Islam, 3 referenced Christianity, and 1 article each mentioned Buddhism and Sikhism. Four articles referenced multiple religions. Para-phenylenediamine was the most common contact allergen overall and is found in blackening ingredients mixed with henna for temporary tattoos. Henna tattooing is a cultural practice associated with Hinduism, Islam, and Judaism. Nine unique contact allergens associated with religious practices were identified. Increasing awareness of religious practices that cause ACD will facilitate culturally competent dermatological care.

Patient-centered communication positively impacts the clinical encounter. Multiple strategies exist to improve communication between providers and their patients; the application and impact of these strategies have been studied in multiple specialties, though little exists regarding communication best practices in the patch test clinic. Because the procedural components of patch testing often span the course of an entire week, effective communication with patients during the patch testing visit is important for not only technical success, but also patient understanding and experience. In this study, we highlight the value of beginning the patch testing visit with clear introductions and agenda setting, improving patient understanding and engagement through methods such as teach backs and cycles of questions and answers that create patient–provider dialogue, and using communication techniques to make expressions of empathy. We provide detailed examples regarding the application of these techniques to the patch testing process, aimed at enhancing the patch testing experience and improving clinical outcomes. Our review exemplifies how dermatologists can leverage communication tools to improve patient satisfaction and outcomes during patch testing.

Background: Although allergic contact dermatitis (ACD) is relatively common in the adult and pediatric populations alike, few studies describe the special features of contact sensitization among the Israeli pediatric populations, none of them is multicenter. Our study aims to describe and analyze patch test results and trends in 4 tertiary care centers between 2012 and 2022.

Methods: We assessed the results of 357 patch tests performed on children 0–18 years old between 2012 and 2022 in designated clinics in 4 tertiary medical centers. All patients were tested using the European baseline series and additional series as clinically indicated. We assessed the demographic features, atopic features, and influence, as well as the main allergens to cause sensitization and allergic contact dermatitis among the pediatric population.

Results: In total 69% of the study population were females, mainly 12–18 years old, 35% of the study population were previously diagnosed with atopic dermatitis, and 57% had an atopic diathesis. Females were more commonly sensitized (P < 0.05). Patients without atopic dermatitis were more commonly diagnosed with ACD and had more reactions on patch test (P < 0.05). The most common allergens to cause ACD are preservatives and metals, as previously described, however, acrylate sensitivity is an emerging group that has not been described among the Israeli pediatric population in previous studies. Fragrance mix 2 and Mroxylon pereirae are relatively rare allergens among the Israeli pediatric population, whereas linalool hyperoxide might be considered an emerging allergen. Methylisothiazolinone causes ACD more frequently among patients without atopic dermatitis (P < 0.05).

Conclusions: Among the Israeli pediatric population, ACD is more common in females without atopic dermatitis. Acrylates become a common culprit and should be included in baseline series. Patients with atopic dermatitis are less frequently sensitized by methylisothiazolinone.

Background: Patch testing to a standard series is used to identify culprit allergens in patients with contact dermatitis. The reaction rates evolve over time based on trends in cutaneous exposures by the general population.

Objective: The aim of this study was to analyze the patch test results of the Mayo Clinic standard series in patients tested from 2017 to 2021.

Methods: The patch test reactions of standard series allergens tested from 2017 to 2021 were retrospectively reviewed and compared with the results of our prior report from 2011 to 2015 as well as the North American Contact Dermatitis Group (NACDG) report from 2017 to 2018.

Results: Of 2667 patients tested, 1683 (63.1%) had at least 1 positive reaction. The 15 allergens with the highest reaction rates were hydroperoxides of linalool 1%, nickel (II) sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, hydroperoxides of linalool 0.5%, methyldibromo glutaronitrile, neomycin sulfate, cobalt (II) chloride hexahydrate, fragrance mix I, benzalkonium chloride, bacitracin, hydroperoxides of limonene, methylchloroisothiazolinone/methylisothiazolinone, p-phenylenediamine, and textile dye mix. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report.

Conclusions: Hydroperoxides of linalool and hydroperoxides of limonene are new allergens that have been added to our standard series. These are associated with high reaction rates.

Occupational hand dermatitis (OHD) is an important health concern for health care workers (HCWs), yet there is a lack of accessible training materials on this topic.

Objectives: The objective of this study was to develop and evaluate an OHD training e-module for HCWs.

Methods: The e-module was created in collaboration with an expert advisory committee and tested by Ontario HCWs through pre- and post-training OHD knowledge tests, a usability survey, and a survey about intent to change work skin care practices. Analyses of survey results included means and paired t-tests.

Results: The 10-minute OHD training e-module for HCWs was tested by 254 HCWs and found to be highly usable, to increase OHD knowledge immediately and sustainably, and to change workplace skin care practices. Average OHD knowledge test scores significantly improved by 19% between the pretest (64.50%) and post-test (83.50%). Most 6-month follow-up survey respondents reported changing their skin care work practices (76.69%).

Conclusions: This research addresses the previous lack of accessible OHD training for workers in health care settings. The creation and evaluation of a no-cost accessible OHD training e-module for workers in health care settings showed promising results across knowledge increase, knowledge retention, skin care behavior changes, and usability.

Background: Eczematous dermatitis is a major cause of recalcitrant pruritic eruptions in older adults. Although some medications have been implicated, there are limited data demonstrating the utility of medication changes.

Objective: To investigate the utility and possible harms of drug cessation trials (DCTs) in chronic eczematous eruptions in the aging (CEEA).

Methods: This is a retrospective cohort study utilizing electronic health records of DCTs in adults older than 65 years with CEEA.

Results: We identified 646 patients >65 years with new onset eczematous eruptions, 89 (14%) of whom had no identifiable etiology. In this cohort, 35 patients underwent a total of 40 DCTs. Although there was mention of improvement in 17.5% (7/40), all patients sought tertiary care for their persistent rash. Negative outcomes occurred in 45% (18/40), all of which were due to exacerbation of a comorbidity that the medication was prescribed to treat.

Conclusion: Our experience suggests that patients with CEEA undergo DCTs that do not improve their dermatitis and can lead to dangerous worsening of underlying conditions. Further study of the etiology of CEEA is needed.

Background: Evidence-based recommendations for optimal showering/bathing practices are lacking for atopic dermatitis (AD) patients.

Background: There is currently limited insight into the broader impact of atopic dermatitis (AD) on mental health. Although studies indicate that AD patients may experience fatigue, no study has so far examined fatigue in more granular detail, for example, occurrence of general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue, or correlated fatigue measures with AD severity and symptoms intensity.

Objectives: To examine fatigue subtypes and their prevalence in adults with AD, as well as their possible association with AD severity.

Methods: A survey was conducted in adults with AD who had been managed in a hospital setting. The Patient-Oriented SCORing Atopic Dermatitis was used to determine AD severity. Patient reported outcomes, including multidimensional fatigue inventory, were included.

Results: Data from 2729 adults with AD were analyzed. The total and individual fatigue scores increased consistently with lower socioeconomic scores, higher AD severity, Dermatology Life Quality Index, itch, pain, and sleep scores. Increased fatigue scores were associated with AD severity in adjusted analyses.

Conclusions: Among adults with AD, fatigue scores increased with disease severity as well as intensity of AD symptoms. Fatigue is a hitherto underappreciated symptom of AD that clinicians should be cognizant about.

Objective: Patients with atopic dermatitis (AD) experience decreased quality of life (QoL). Here we describe the relationship between severity and QoL-related scores in patients with moderate-to-severe AD treated with dupilumab.

Patients and Methods: This was a real-life, retrospective, and observational study involving patients with AD treated with dupilumab. Treatment effectiveness was evaluated based on the changes in the eczema area and severity index (EASI), sleep quality numerical rating scale ,and pruritus numerical rating scale (PNRS), as well as the dermatology life quality index (DLQI). The relationship between each of them was analyzed. After the first data collection at baseline, patients were re-evaluated at 3 subsequent follow-ups (4, 8, and 12 months).

Results: A total of 52 patients were enrolled in the study. At 4 months, the change in DLQI is more correlated with PNRSs (r = 0.643, P < 0.001) than the other scores considered. At 8 months, however, the change in DLQIs correlates similarly both with PNRSs (r = 0.644, P < 0.001) and with the change in EASIs (r = 0.633, P < 0.001). At 12 months of treatments, however, the trend reverses and the correlation with EASIs becomes higher (r = 0.735, P < 0.001) than PNRSs (r = 0.0.659, P < 0.001).

Conclusions: The results of our study show that the reduction in the impact on QoL for AD patients in the first months of therapy with dupilumab correlates more with the control of pruritus than with the disappearance of skin lesions.