Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology.

BACKGROUND: Data regarding teledermatology for patch testing are limited. OBJECTIVES: Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS: Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS: Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION: For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.

Developmental assays using invasive cane toads, Rhinella marina, reveal safety concerns of a common formulation of the rice herbicide, butachlor.

Identifying the adverse impacts of pesticide exposure is essential to guide regulations that are protective of wildlife and human health. Within rice ecosystems, amphibians are valuable indicators because pesticide applications coincide with sensitive reproductive and developmental life stages. We conducted two experiments using wild cane toads (Rhinella marina) to test 1) whether environmentally relevant exposure to a commercial formulation of butachlor, an acetanilide herbicide used extensively in rice, affects amphibian development and 2) whether cane toad tadpoles are capable of acclimatizing to sub-lethal exposure. First, we exposed wild cane toads to 0.002, 0.02, or 0.2 mg/L of butachlor (Machete EC), during distinct development stages (as eggs and hatchlings, as tadpoles, or continuously) for 12 days. Next, we exposed a subset of animals from the first experiment to a second, lethal concentration and examined survivorship. We found that cane toads exposed to butachlor developed slower and weighed less than controls, and that development of the thyroid gland was affected: exposed individuals had smaller thyroid glands and thyrocyte cells, and more individual follicles. Analyses of the transcriptome revealed that butachlor exposure resulted in downregulation of transcripts related to metabolic processes, anatomic structure development, immune system function, and response to stress. Last, we observed evidence of acclimatization, where animals exposed to butachlor early in life performed better than naïve animals during a second exposure. Our findings indicate that the commercial formulation of butachlor, Machete EC, causes thyroid endocrine disruption in vertebrates, and suggest that exposure in lowland irrigated rice fields presents a concern for wildlife and human health. Furthermore, we establish that developmental assays with cane toads can be used to screen for adverse effects of pesticides in rice fields.

Are Rubber Gloves Marketed as Accelerator-Free Truly Free of Accelerators?

BACKGROUND: Allergic contact dermatitis to rubber accelerators in gloves has been well described in the literature. In response to this, glove manufacturers have recently marketed "accelerator-free" gloves. Little research has been done, to confirm whether these gloves are truly free from the accelerators known to cause contact dermatitis. OBJECTIVE: The aim of the study was to verify use of accelerators in reportedly accelerator-free/low-dermatitis-potential gloves. METHODS: A total of 16 commercially available medical gloves touted as "accelerator-free," "sensitive," or "low dermatitis potential" were obtained and analyzed via mass spectrometry (liquid chromatography heated electrospray ionization tandem mass spectrometry and liquid chromatography heated electrospray high-resolution tandem mass spectrometry) to determine whether any of the 9 known rubber accelerators were present (thiurams, carbamates, mercaptobenzothiazole, and diphenylguanidine). RESULTS: Despite marketing claims to the contrary, all tested gloves had at least 1 accelerant detected. Dipentamethylenethiuram disulfide, a thiuram, was found in all 16 gloves. Half of the gloves (8/16) contained more than 1 accelerator, with 1 glove having 5 rubber accelerators present. CONCLUSION: Patients with allergic contact dermatitis to accelerators should be aware potentially sensitizing accelerators may be present in gloves that are reported to not contain them.

Opposing effects of bacterial endophytes on biomass allocation of a wild donor and agricultural recipient.

Root endophytes are a promising tool for increasing plant growth, but it is unclear whether they perform consistently across plant hosts. We characterized the blue grama (Bouteloua gracilis) root microbiome using two sequencing methods, quantified the effects of root endophytes in the original host (blue grama) and an agricultural recipient, corn (Zea mays), under drought and well-watered conditions and examined in vitro mechanisms for plant growth promotion. 16S rRNA amplicon sequencing revealed that the blue grama root microbiome was similar across an elevation gradient, with the exception of four genera. Culturing and Sanger sequencing revealed eight unique endophytes belonging to the genera Bacillus, Lysinibacillus and Pseudomonas. All eight endophytes colonized corn roots, but had opposing effects on aboveground and belowground biomass in each plant species: they increased blue grama shoot mass by 45% (19) (mean +/- SE) while decreasing corn shoot mass by 10% (19), and increased corn root:shoot by 44% (7), while decreasing blue grama root:shoot by 17% (7). Furthermore, contrary to our expectations, endophytes had stronger effects on plant growth under well-watered conditions rather than drought conditions. Collectively, these results suggest that ecological features, including host identity, bacterial traits, climate conditions and morphological outcomes, should be carefully considered in the design and implementation of agricultural inocula.

Isothiazolinone Content of US Consumer Adhesives: Ultrahigh-Performance Liquid Chromatographic Mass Spectrometry Analysis.

BACKGROUND: There are limited data regarding the prevalence and concentration of isothiazolinone preservatives in consumer adhesives. OBJECTIVES: The aim of this study was to determine the prevalence and concentration of 5 specific isothiazolinones (methylisothiazolinone [MI], methylchloroisothiazolinone [MCI], benzisothiazolinone [BIT], butyl BIT, and octylisothiazolinone) in US adhesives. METHODS: Thirty-eight consumer adhesives were analyzed using ultrahigh-performance liquid chromatographic-mass spectrometry. Fisher exact tests were used to test for isothiazolinone content and: 1) glue format (2) application purpose and 3) extraction method. RESULTS: Nineteen adhesives (50%) had at least 1 isothiazolinone, and 15 contained 2 isothiazolinones. Frequencies and concentrations were as follows: MI (44.7%; 4-133 ppm), MCI (31.6%; 7-27 ppm), BIT (15.8%; 10-86 ppm), and octylisothiazolinone (2.6%; 1 ppm). Butyl BIT was not detected in any of the adhesives. Format (stick vs liquid) was not statistically associated with isothiazolinone presence. At least half of adhesives in the following application purposes had at least 1 isothiazolinone: shoe, craft, fabric, and school. All-purpose glues had a statistically significant lower concentration of MI and MCI, whereas craft glues were associated with higher concentrations of MI and MCI. Compared with other glues, fabric adhesives were associated with a higher risk of containing BIT. CONCLUSIONS: Half of the tested adhesives contained at least 1 isothiazolinone. Methylisothiazolinone and MCI were the most common. Consumers and dermatologists should be aware of adhesives as a source of isothiazolinones.

Isothiazolinone in Residential Interior Wall Paint: A High-Performance Liquid Chromatographic-Mass Spectrometry Analysis.

BACKGROUND: There is limited information regarding isothiazolinone content in residential wall paints in the United States. OBJECTIVE: The aim of this study was to evaluate the prevalence of 5 isothiazolinones-methylisothiazolinone (MI), methylchloroisothiazolinone, benzisothiazolinone (BIT), butyl BIT, and octylisothiazolinone-in US residential wall paints. METHODS: Forty-seven paints were obtained from retailers in Minneapolis/St Paul, Minnesota. Paint samples were assessed for the presence of the 5 isothiazolinones using high-performance liquid chromatographic-mass spectrometry. RESULTS: At least 1 isothiazolinone was detected in all 47 paints. However, no paint contained butyl BIT, and only 1 paint had octylisothiazolinone. The MI and BIT were found in 96% and 94% of the paints, respectively. Methylisothiazolinone ranged in concentration from 17 to 358 ppm, whereas BIT varied from 29 to 1111 ppm. Methylchloroisothiazolinone was found solely in oil-based paints. Isothiazolinones were declared in 15% of Safety Data Sheets but did not correlate with high-performance liquid chromatographic-mass spectrometry. One "preservative-free" paint had BIT at 71.5 ppm. Paint sheen was not statistically associated with BIT or MI concentrations. Unpigmented paints and paints with volatile organic compound claims had significantly lower concentrations of MI, but not BIT. CONCLUSIONS: All paints contained at least 1 isothiazolinone. Methylisothiazolinone and BIT were the most common. Safety Data Sheets are insufficient for ascertaining isothiazolinone content in US paints.

Rubber Accelerators in Medical Examination and Surgical Gloves.

BACKGROUND: Rubber accelerators play a significant role in glove-related occupational contact dermatitis, especially among health care workers. Currently, there is limited information readily available outlining the accelerators used in specific medical examination and surgical gloves. OBJECTIVE: The aim of this study was to ascertain the accelerators used in medical examination and surgical gloves for major glove manufacturers within the United States. METHODS: An initial Internet-based search was performed to establish relevant manufacturers and product lines, with subsequent inquiry with each corresponding company regarding accelerators used in each medical and surgical glove line. RESULTS: Eleven glove manufacturers were identified and contacted. Responses were obtained from all manufacturers, but because of legal limitations, changes in product lines, or inability to supply necessary data, only 8 companies were able to be included in the final analysis, totaling data for 190 gloves. Carbamates were the most common accelerator, used in 90.5% (172/190) of gloves, whereas thiurams were used in only 11 gloves (5.8%). Eight companies surveyed are now advertising and offering touted accelerator-free gloves. CONCLUSIONS: Accelerators are used in most examination and surgical gloves; however, manufacturers are now expanding their product offerings to include accelerator-free options.

Contact Dermatitis Associated With Skin Cleansers: Retrospective Analysis of North American Contact Dermatitis Group Data 2000-2014.

BACKGROUND: There is limited information regarding contact dermatitis (CD) associated with skin cleansers (SCs). OBJECTIVE: The aim of the study was to evaluate the prevalence of allergic patch test (APT) reactions and irritant CD (ICD) associated with SCs. METHODS: A retrospective cross-sectional analysis was performed using North American Contact Dermatitis Group data, 2000-2014. RESULTS: Of 32,945 tested patients, 1069 (3.24%) had either APT reaction or ICD associated with SCs. Of these, 692 (64.7%) had APT reaction only, 350 (32.7%) had ICD only, and 27 (2.5%) had both. Individuals with APT reaction and/or ICD were more likely to have occupationally related skin disease (relative risk [RR] = 3.8 [95% confidence interval {CI} = 3.3-4.5] for APT reaction and 10.0 [95% CI = 8.2-12.2] for ICD, respectively, P < 0.0001). As compared with those without APT reaction to SC, individuals with APT reaction had significantly higher frequencies of hand (RR = 2.4 [95% CI = 2.1-2.7]) and arm dermatitis (RR = 1.3 [95% CI = 1.1-1.6], P ≤ 0.001). Irritant CD was strongly associated with hand dermatitis (RR = 6.2 [95% CI = 5.2-7.3], P < 0.0001). More than 50 allergens were associated with SCs including quaternium-15 (11.2%), cocamidopropyl betaine (9.5%), methylchloroisothiazolinone/methylisothiazolinone (8.4%), coconut diethanolamide (7.9%), fragrance mix I (7.7%), Myroxylon pereirae (5.9%), 4-chloro-3,5-xylenol (5.8%), amidoamine (5.5%), and formaldehyde (4.4%). CONCLUSIONS: Many allergens, especially preservatives and surfactants, were associated with SCs. Most cases involved the hands and were occupationally related.

Competition and pesticide exposure affect development of invasive (Rhinella marina) and native (Fejervarya vittigera) rice paddy amphibian larvae.

Increased pesticide use in rice agricultural ecosystems may alter competitive interactions between invasive and native amphibian species. We conducted an experiment with two rice paddy amphibians found in Luzon, Philippines, the invasive cane toad (Rhinella marina) and the endemic Luzon wart frog (Fejervarya vittigera), to determine whether exposure to a common herbicide, butachlor, drives competitive interactions in favor of the invasive amphibian. Our results revealed that competition had a strong effect on the development of both species, but in opposing directions; Luzon wart frog tadpoles were smaller and developed slower than when raised alone, whereas cane toad tadpoles were larger and developed faster. Contrary to our predictions, development and survival of endemic wart frog tadpoles was not affected by butachlor, whereas invasive cane toad tadpoles were affected across several endpoints including gene expression, body size, and survival. We also observed an interaction between pesticide exposure and competition for the cane toad, where survival declined but body size and expression of thyroid sensitive genes increased. Taken together, our findings indicate that the success of the cane toad larvae in rice fields may be best explained by increased rates of development and larger body sizes of tadpoles in response to competition with native Luzon wart frog tadpoles rather than lower sensitivity to a common pesticide. Our results for the cane toad also provide evidence that butachlor can disrupt thyroid hormone mediated development in amphibians, and further demonstrate that important species interactions such as competition can be affected by pesticide exposure in aquatic ecosystems.

Allergic Contact Dermatitis From Methylisothiazolinone in Residential Wall Paint.

A 33-year-old woman presented to our clinic for suspected photoallergic contact dermatitis with a recent episode of severe, vesicular dermatitis involving exposed skin and correlating with relocation to a new home. Biopsy results showed spongiotic and lichenoid dermatitis with eosinophils. Patch test results showed a very strong (+++) reaction to methylisothiazolinone (MI), mild (+) reaction to MI/methylchloroisothiazolinone, and no reaction to benzisothiazolinone. These allergens were found in several personal products. However, the patient was suspicious of 4 wall paints recently used in her home. Semiopen patch tests to 3 Behr interior paints showed positive results. Nine controls showed negative results. High-performance liquid chromatography demonstrated MI and benzisothiazolinone in all 4 paints at concentrations ranging from 50 to 100 ppm and 290 to 340 ppm, respectively. Although MI has been reported to cause occupational airborne contact dermatitis in European household painters, to our knowledge, this is the first documented case of paint-related MI allergy in the United States.

A meta-analysis synthesizing the effects of pesticides on swim speed and activity of aquatic vertebrates.

Pesticide contaminants are ubiquitous in aquatic environments and pose a threat to biodiversity. Pesticides also have diverse mechanisms of action that make it difficult to identify impacts on exposed wildlife. Behavioral measures represent an important link between physiological and ecological processes, and are often used to generalize sub-lethal effects of pesticide exposure. In order to bridge the toxicological and behavioral literature, and identify chemical classes that denote the largest threat, we conducted a meta-analysis summarizing the effects of pesticides on swim speed and activity of aquatic vertebrates. We found that exposure to environmentally relevant concentrations of pesticides reduced the swim speed of exposed amphibians and fish by 35%, and reduced overall activity by 72%. There were also differences in the magnitude of this effect across chemical classes, which likely reflect underlying physiological processes. Pyrethroids, carbamates, and organophosphates all produced a large decrease in swim speed, where as phosphonoglycines and triazines showed no overall effect. Pyrethroids, carbamates, organophosphates, organochlorines, and organotins also produced a large decrease in activity, while phosphonoglycines had no overall effect, and triazines had the opposite effect of increasing activity. Our results indicate that even sub-lethal concentrations of pesticides have a strong effect on critical behaviors of aquatic vertebrates, which can affect fitness and alter species interactions. We expect our synthesis can be used to identify chemical classes producing the largest sub-lethal effects for further research and management.

Comparative Study of Professional vs Mass Market Topical Products for Treatment of Facial Photodamage.

BACKGROUND: Many over the counter topical products claim to reverse the signs of cutaneous photo-damage. To date, the two most studied ingredients for improving the texture, tone, and pigmentation of the skin are topical retinoids and hydroquinone. OBJECTIVE: This split face study compares a mass market skincare regimen with a prescription skin care regimen for improvement in photo damaged skin. METHODS: Twenty-seven subjects with moderate photo damaged facial skin were enrolled. Each subject was consented and assigned with the mass market anti-aging system (Treatment A) to one side of the face and the prescription anti-aging system (Treatment B or Treatment C) to the other side of the face. Treatment B contained 13 subjects whom did not use 0.025% Retinol cream. Treatment C contained 14 subjects who used a 0.025% Retinol Cream. Subjects had 4 visits over 12 weeks for digital photography and surveys. Photographs were evaluated by blinded physicians. RESULTS: Physician objective analysis showed all three systems to have a statistically significant clinical improvement in photoaged skin seen in as little as 4 weeks of use. Participant's surveys rated the mass market system higher than both of the professional systems for visible skin changes, ease of use, and likelihood to recommend to a friend. Twelve of twenty-seven subjects preferred the mass market system for overall improvement while twelve thought each system gave the same improvement. CONCLUSION: This study demonstrates that a mass marketed skin care system can give similar clinical improvements in photo-aged skin as a professionally dispensed prescription system and the majority of participants preferred the mass-marketed system.

Treatment of Facial Photodamage With Mass Market Topical Products vs Non-ablative Fractional Laser.

METHODS: In this split-face, evaluator-blinded study, 18 subjects were randomly assigned to receive either the SSR or NFL treatments on each side of the face. For the SSR facial sides subjects followed two morning-evening regimens. On the NFL sides subjects were treated 3 times with the 1927-nm laser at 4-week intervals. Three physician evaluators were asked to rate hyperpigmentation, global photoaging, and ne lines and wrinkles for each side of the face at baseline and at 3 months using a 5-point scale. RESULTS: The SSR and NFL treatments provided comparable results for each skin attribute. Improvement from baseline was signi - cant in both treatment programs for each skin attribute. The greatest 3-month improvement for both programs was in hyperpigmen- tation. For global photoaging and ne lines and wrinkles, positive responses were slightly greater in the NFL than in the SSR facial sides. Subject preference for the SSR over the NFL was greatest for ne lines around the eyes, ne lines around the mouth, smooth texture, radiant complexion, and overall improvement while the NFL was preferred for skin rmness and evenness. When the study was completed5 of 18 split-face subjects decided to undergo NFR laser treatment on the non laser treated side along with using the SSR product and 13 of the 18 subjects continued to use the SSR products to their full face after the study. CONCLUSION: The mass market skin care system of the present study provides improvement in hyperpigmentation, global photoaging, and ne lines and wrinkles comparable to that of a series of treatments with a non-ablative fractional laser. J Drugs Dermatol. 2016;15(11):1366-1372..

Normal and aging hair biology and structure 'aging and hair'.

Much like an individual's hairstyle, hair fibers along the scalp see a number of changes over the course of one's lifetime. As the decades pass, the shine and volume synonymous with youthful hair may give way to thin, dull, and brittle hair commonly associated with aging. These changes are a result of a compilation of genetic and environmental elements influencing the cells of the hair follicle, specifically the hair follicle stem cells and melanocytes. Telomere shortening, decrease in cell numbers, and particular transcription factors have all been implicated in this process. In turn, these molecular alterations lead to structural modifications of the hair fiber, decrease in melanin production, and lengthening of the telogen phase of the hair cycle. Despite this inevitable progression with aging, there exists an array of treatments such as light therapy, minoxidil, and finasteride which have been designed to mitigate the effects of aging, particularly balding and thinning hair. Although each works through a different mechanism, all aim to maintain or potentially restore the youthful quality of hair.

A randomized comparison of the efficacy of low volume deep placement cheek injection vs. mid- to deep dermal nasolabial fold injection technique for the correction of nasolabial folds.

BACKGROUND: Hyaluronic acid (HA) fillers are FDA approved for improving the appearance of the nasolabial folds. Previous reports on the use of HA for this treatment have focused on injections directly into the location of the desired correction. To our knowledge, a study has not been done evaluating the efficacy of injecting a low volume of HA into the adjacent area of volume loss to correct both volume loss and adjacent lines. OBJECTIVE: The objective of this study was to compare the effectiveness and safety of three HA injection protocols including deep dermal cheek injection, mid- to deep dermal local nasolabial fold injection, and both injections for the correction of nasolabial folds. METHODS: This was a split-face, randomized study evaluating the use of three injection techniques - (i) deep bolus injection into the mid- to lateral cheek, (ii) local mid- to deep dermal injection into the nasolabial fold, and (iii) both deep injection into the mid- to lateral cheek and local mid- to deep dermal injection into the nasolabial fold - for the treatment of moderate to severe nasolabial folds. Wrinkle severity and Global Aesthetic Improvement Scales were measured before and 4-6 weeks after treatment as assessed by a blinded investigator. RESULTS: Patient and physician observations showed improvement both globally and in wrinkle severity score with each technique used with no statistical difference between techniques. Patients showed a slight preference for injection to both the mid- to lateral cheek and nasolabial fold, which was associated with the greatest amount of filler product administered. No serious adverse events were reported. CONCLUSION: Injection of a dermal filler, at low volumes, into either the nasolabial fold or mid- to lateral cheek results in similar improvement to the correction of the nasolabial folds.