Dermatitis®

Abstract: Personal care product usage is becoming increasingly prevalent among men due to evolving attitudes surrounding appearance, aging, and masculinity. Given the specific characteristics of male skin compared with female skin and varying product use between males and females, the occurrence of allergic contact dermatitis (ACD) due to men’s personal care products needs to be better characterized. The purpose of this review was to identify specific product types and ingredients causing ACD in males. PubMed search was conducted from conception to present day using keywords pertaining to male personal care product use. Case reports, case series, and case–control studies reporting a diagnosis of ACD due to a personal care product ingredient were analyzed. Products resulting in ACD included aftershave, cologne, deodorant, hair dye, hair gel, hair loss preparation, hand cleanser, lip balm, moisturizer, shampoo, and sunscreen. Although >90 allergens resulting in ACD were identified, the 5 most common allergens included para-phenylenediamine, minoxidil, musk ambrette, methylisothiazolinone, and cocamidopropyl betaine. Following this review, clinicians should be better able to recognize men’s personal care products that commonly result in ACD, as well as specific allergens present across multiple product types. Doing so will lead to improved diagnosis and treatment of ACD due to personal care product usage in men and, in doing so, guide both clinical practice and future investigation in this area.

Abstract: Chronic pruritus, a common symptom of dermatologic diseases, impairs quality of life. No review exists that evaluates the efficacy of emerging therapies based on a single standardized scale. We assessed efficacy and adverse effects of novel treatments available for pruritus in patients diagnosed with common pruritic diseases using the proportions of patients experiencing a ≥4-point reduction as a standardized efficacy measure between studies. We searched PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials for phase II or III trials reporting change in numerical rating scale following interventions for pruritus from 2015 to 2023. The strongest improvements in pruritus were seen from ustekinumab (RR 4.30 [2.88; 6.41]) and ixekizumab (RR 4.42 [3.32; 5.88]) for psoriasis and upadacitinib (RR 5.54 [95% CI: 4.53–6.78]), abrocitinib (RR 3.76 [95% CI: 2.97–4.76]), and baricitinib (RR 3.63 [95% CI: 2.36–5.58]) for atopic dermatitis. Nemolizumab (RR 3.06 [95% CI: 1.63–5.74]) and dupilumab (RR 2.11 [95% CI: 1.30–3.41]) were most effective for prurigo nodularis, though fewer studies were available for comparison. Adverse effects were mild and similar between agents; discontinuation rates were low. This review evaluates efficacy of emerging pruritus treatments based on a single standardized measurement, highlighting the role of novel agents in the treatment of chronic pruritus.

Abstract: Panthenol, a vitamin B5 derivative, is a key precursor in the synthesis of fatty acids that maintain epithelial function. Its ability to aid in moisturization, skin barrier restoration, and wound healing has led to its frequent incorporation into personal care products and pharmaceuticals—many of which are marketed to be hypoallergenic. While contact allergy to panthenol is rather uncommon, rates of positive reactions are on the rise, increasing from 0.2–0.7% to 1.2% in recent years. In this article, we discuss panthenol’s chemical functionality and provide a list of commonly encountered gentle skin care products that may potentiate exposure. In addition, we include a review of the existing cases of panthenol-related allergic contact dermatitis and contact urticaria. Many of these cases involved initial positive reactions to a personal product tested “as-is,” with subsequent testing of the individual constituents of these products revealing contact allergy to panthenol. These cases highlight the importance of testing for personal products and suggest potential utility in more routine patch testing to panthenol. Overall, the information presented aligns with several recent calls in the literature to test this allergen more frequently. As more consumers favor hypoallergenic skin care products, patch testing dermatologists may need to consider including panthenol in the baseline or extended allergen series. Furthermore, patients who transition to using hypoallergenic skin care products and continue to experience dermatitis symptoms may benefit from patch testing to panthenol.

Abstract: Background: Concern was raised within the International Contact Dermatitis Research Group (ICDRG) regarding the scoring of weak allergic versus doubtful patch test reactions.

Objective: To investigate the degree of uniformity in patch test reading.

Methods: Five series of fictive contact dermatitis cases were written up by the study organizer and presented to expert participants. Each series was sent electronically to participants one by one. All dermatitis cases underwent patch testing, and the test result was a reaction characterized by erythema and infiltration. Within each case series, there were 5 subcases that differed only in the size of the test area showing erythema and infiltration. Three nearly identical case series had 1 crucial difference: the result of a repeated open application test (ROAT), both in the cases and controls. The experts had to determine whether the patch test reaction indicated contact allergy, defined as an immunologically acquired delayed hypersensitivity. All other reactions (negative, doubtful, and irritant) were classified as no contact allergy.

Results: There was a big intra- and inter-individual variation in the patch test reading. Nobody read according to any of the 2 existing ICDRG classifications. The ROAT results sometimes influenced the scoring.

Conclusion: A new ICDRG classification is needed.

Abstract: Background: The role of gut dysbiosis in the pathophysiology of atopic dermatitis (AD) through immune system (IS) imbalance is a novel line of investigation currently under discussion. This study aimed to characterize compare the composition and functional profile of the gut microbiota (GM) between adults with AD and healthy individuals.

Methods: Observational cross-sectional study, where fecal samples from 70 adults (38 patients and 32 controls) were analyzed using metagenomics and bioinformatics.

Results: Differences between the GM of patients with AD and healthy individuals were demonstrated. Reduced microbial diversity was found in subjects with AD. Bacterial species with lower abundance primarily belonged to the families Ruminococcaceae, Akkermansiaceae, and Methanobacteriaceae. Several microbial metabolic pathways were found to be decreased in patients with AD, including amino acid biosynthesis, vitamin biosynthesis, fatty acids and lipids biosynthesis, and energy metabolism.

Conclusion: Adults with AD exhibited a distinct GM compared to healthy individuals. Changes were demonstrated both compositionally and functionally. Further investigation is mandatory to elucidate the potential link and causal relationship between gut dysbiosis and AD, which may be crucial for a deeper understanding of the disease’s pathophysiology and the development of novel therapeutic approaches.

Abstract: Background: Patent Blue V (PBV) is extensively used in sentinel lymph node identification in cancer surgery, potentially leading to an increased incidence of hypersensitivity reactions.

Methods: A retrospective analysis was conducted on patients with suspected PBV hypersensitivity, at our center from 2010 to 2023. Skin prick tests (SPT) were performed on all patients, followed by intradermal tests (IDT) if SPT was negative.

Results: Of 160 patients with suspected perioperative hypersensitivity reactions (POH), 15 (9.4%) had received PBV. All patients were female, with a median age of 50 years. None had been previously exposed to PBV. In 2 cases, there was no registry of PBV use. In vivo tests were mostly performed 6–9 months after the index reaction (53%). PBV allergy was confirmed in 80% of cases via positive skin tests (SPT [n = 10] or IDT [n = 2]). In PBV allergic patients, anaphylaxis occurred in 7 patients (58%). A rising incidence of PBV allergy in the POH setting was observed from 2010 to 2023.

Conclusions: PBV is a significant allergen in POH, with increasing incidence. SPT is effective and frequent enough for diagnosis, suggesting an IgE-mediated mechanism. Despite its allergenic potential, PBV’s clinical utility supports its continued use with appropriate precautions.

Abstract: Background: Eczema and dermatitis are common inflammatory skin conditions with significant morbidity. Identifying drug-targetable genes can facilitate the development of effective treatments.

Methods: This study analyzed data obtained by meta-analysis of 2 genome-wide association studies on eczema/dermatitis (57,311 cases and 896,779 controls, European ancestry). We identified drug-targetable genes from the Drug–Gene Interaction Database and Finan et al’s findings. Cis-expression quantitative trait loci (eQTL) data from human blood and skin tissues were used for Mendelian randomization (MR) analysis. Bayesian colocalization, proteomic MR, and meta-analysis validated the causal relationships. Finally, protein–protein interactions (PPIs) and correlation analysis of potential drug targets and cytokines were performed.

Results: We identified 2532 drug-targetable genes; 3378 Single Nucleotide Polymorphism (SNPs) were associated with 1531 genes in blood cis-eQTLs, 664 SNPs with 667 genes in sun-exposed skin eQTLs, and 572 SNPs with 574 genes in nonsun-exposed skin eQTLs. Five genes (SLC22A5, NOTCH4, AGER, HLA-DRB5, and EHMT2) showed causal relationships with eczema/dermatitis across multiple datasets. Single-variable and multi-variable Mendelian randomization (SMR) and multi-SNP SMR analysis identified 8 genes (PIK3R4, DHODH, CXCR2, Interleukin (IL)18, LGALS9, RPS6KB2, SLC22A5, and AGER) across all tissues. Functional Summary Information for Variants in the Online Network (FUSION) analysis confirmed associations for SLC22A5 and AGER. Bayesian colocalization indicated AGER (PPH4: 0.95) as a shared causal variant. Proteomic MR and meta-analysis showed that increased AGER protein levels were associated with a lower risk of eczema or dermatitis (odds ratio: 0.995, 95% confidence interval: 0.997–0.993, P = 0.0002). A PPI network revealed interactions of AGER with NOTCH4 and multiple cytokines, whereas SLC22A5 showed no cytokine interactions.

Conclusions: This study identified potential drug-targetable genes, with AGER showing strong potential as a target for reducing eczema/dermatitis risk. These findings provide a basis for developing targeted therapies.