Prevalence and interest in the practice of scratch testing for contact urticaria: a survey of the American contact dermatitis society members.

BACKGROUND: Contact urticaria (CU) is the development of a wheal and flare on the skin after topical exposure to a particular chemical or compound. It can be diagnosed through a variety of techniques. Many chemicals that cause a type IV allergy can also cause CU. The incidence of CU to these chemicals is unknown. OBJECTIVE: The aim of this study was to evaluate the opinions of the American Contact Dermatitis Society members regarding CU and scratch testing. METHODS: We distributed an electronic survey to the American Contact Dermatitis Society members regarding observed prevalence of CU, frequency of scratch testing in clinical practice, and interest in learning about scratch testing in diagnosing CU and other skin contact conditions. RESULTS: We distributed 508 surveys and received 133 responses. Seventeen percent reported that CU was extremely rare, 32% reported that CU was rare, and 38.9% reported that CU was infrequent. Alternatively, 10.7% believed that CU was common, and 1.5% believed that CU was extremely common. A minority, 19.1%, performed scratch testing on patients with suspected CU. Most respondents, 54.6%, were interested in learning about scratch testing. CONCLUSIONS: Additional education regarding scratch testing could increase comfort and use of scratch testing in clinical practice. Further studies are needed to evaluate the prevalence of CU in the general population and better guide the use of testing for dermatologic patients.

Opioid prescribing patterns after Mohs micrographic surgery and standard excision: a survey of American Society for Dermatologic Surgery members and a chart review at a single institution.

BACKGROUND: Little is known about postoperative opioid prescribing patterns among dermatologic surgeons. OBJECTIVE: To better understand postoperative opioid prescribing patterns among dermatologic surgeons in the United States. MATERIALS AND METHODS: Two-part analysis consisting of a retrospective chart review of 233 dermatologic surgery patients at a single institution and an e-mail survey of American Society for Dermatologic Surgery (ASDS) members. RESULTS: (1) Retrospective review: 35% (82/233) of the patients received an opioid prescription. Larger defect size, repair of the defect, perioral and nasal site, and surgeon A or B performing surgery predicted opioid prescription. (2) E-mail survey: 556 ASDS members practicing within the United States responded. Sixty-four percent (357/556) reported prescribing opioids after ≤10% of cases. Surgeons younger than 55 years old, male surgeons, and surgeons in the southern and western United States were more likely to prescribe opioids after >10% of cases. Seventy-six percent (397/520) believed patients used ≤50% of the opioid pills prescribed. CONCLUSION: The retrospective review suggests that opioid prescribing is predicted by characteristics of the surgery (i.e., size, defect repair type, and anatomic location) and characteristics of the surgeon (i.e., age, sex, and practice location) with significant heterogeneity in prescribing habits. The national survey results raise the possibility that patients might not take all prescribed opioid pills after dermatologic surgery. Further investigation is warranted to determine how patients are actually using prescription pain pills to balance pain control with patient safety.

Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients.

OBJECTIVE: To better understand postoperative opioid use after dermatologic surgery. DESIGN: Prospective observational study. SETTING: Academic dermatology department. PATIENTS: The study included 212 adults (1) who were undergoing a single skin excision (including Mohs micrographic surgery), (2) who consented to participate,and (3) who were able to be reached by telephone on postoperative day 3 or 4. Patients who did not meet these criteria and those referred to another physician for further surgical treatment or repair were excluded. MAIN OUTCOME MEASURES: The study examined(1) the incidence of opioid prescription after dermatologic surgery, (2) the percentage of prescribed opioid pain medications used in the postoperative period, and (3) patient and surgical characteristics associated with opioid pain medication prescription and use. RESULTS: Opioids were prescribed to 72 of the 212 patients(34%). Twenty-five of the 72 patients (35%) who were prescribed opioids did not use them. Forty-nine of 57 patients (86%) who filled an opioid prescription had leftover pills, and 26 of the 49 patients (53%) planned to keep them. Only maximum pain score was significantly associated with opioid use. CONCLUSIONS: Opioids were over prescribed after dermatologic surgery. Patients who had left over opioids did not dispose of them properly, which could lead to potential misuse and abuse.

Melanoma mimic: a case of multiple pagetoid Spitz nevi.

BACKGROUND: Differentiating Spitz nevi from melanoma can be difficult. Pagetoid spread of melanocytes is among the features making diagnosis difficult. Rare reports of isolated pagetoid Spitz nevi exist. OBSERVATIONS: We present a unique case of multiple pagetoid Spitz nevi initially diagnosed as multiple in situ melanomas. Germline karyotyping, CDK4 and CDKN2A sequencing, and comparative genomic hybridization of HRAS, BRAF, KRAS, RAF1, CDKN2A, Rb1, MAP2K1, MAP2K2, PTEN, and PTPN11 genes did not identify mutations in this case. Germline and somatic sequencing of BRAF exon 15 revealed no mutations at V600D/E/K. In addition, single-nucleotide polymorphism microarray analysis (330K) on lesional and normal skin revealed no genome-wide copy number changes or loss of heterozygosity. CONCLUSIONS: Clinicians should be aware of the occurrence of multiple pagetoid Spitz nevi to avoid morbidity associated with the misdiagnosis of multiple melanomas. The genetic mechanisms of pagetoid spread of melanocytes are not fully understood.

Severe retention hyperkeratosis occurring with Susac syndrome.

A 50-year-old woman presented for asymptomatic yellow hyperkeratotic plaques limited to her face. The plaques reportedly arose over the six months prior to her clinic visit. She was healthy prior to the diagnosis of Susac syndrome (retinocochleocerebral vasculopathy) two years before. A punch biopsy was performed and revealed retention hyperkeratosis. Retention hyperkeratosis is a benign and commonly seen skin condition in primary care and dermatology. Retention hyperkeratosis occurs when there is abnormality of routine desquamation that can be associated with poor hygeine. It can be associated with acne or ichthyosis. Our case of retention hyperkeratosis is unique because of the profound presentation in a setting of an untreated psychiatric condition. Treatment consisted of daily topical exfoliative care. We also encouraged her family members to help her to seek medical attention for Susac syndrome.

Influenza vaccination coverage among adult solid organ transplant recipients at three health maintenance organizations, 1995-2005.

Annual immunization against influenza is recommended for solid organ transplant (SOT) recipients. We used Vaccine Safety Datalink data from 1995 to 2005 to assess influenza vaccination during the first full vaccination season (September-February) following transplant among 1800 kidney, liver, and heart transplant recipients at three health maintenance organizations. Overall, 52% of recipients were vaccinated. Older age at transplant (age 50-64 years, OR 1.81, 95% CI 1.43-2.30; age > or =65 years, OR 1.94, 95% CI 1.39-2.69), receiving vaccination in the full season pre-transplant (OR 4.54, 95% CI 3.67-5.60), and year of transplantation were significant predictors of post-transplant vaccination. Although vaccine coverage increased during study years, SOT recipients are under-immunized against influenza. Efforts to understand barriers to vaccination and increase education of physicians managing patients while awaiting and after receipt of transplant are needed.

Relationships between State Health Departments and medical professional organizations regarding immunizations.

OBJECTIVE: To assess relationships between State Health Department (SHD) immunization programs and the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP). METHODS: Surveys were distributed to SHD immunization managers and AAP and AAFP chapter/district heads. RESULTS: Most AAP and AAFP respondents reported contact with the SHD (73% and 62%, respectively). Most SHDs reported contact with the AAP and AAFP (74% and 57%, respectively). More SHDs reported discussing immunization information with the AAP than the AAFP (83% and 61%, respectively, P = .02). SHDs rarely reported using e-mail to communicate with physicians (4%), while AAP and AAFP respondents commonly reported communicating with members via e-mail (80% and 72%, respectively). Most SHD respondents reported satisfaction with relationships with the AAP (78%) and AAFP (65%). Similarly, most AAP and AAFP respondents reported satisfaction with their SHD relationship (80% and 62%, respectively). The majority of SHD, AAP, and AAFP respondents expressed willingness to further strengthen relationships (86%, 79%, and 90%, respectively). CONCLUSIONS: Good relationships exist between medical professional organizations and SHDs and there is support for improvement of the partnerships. SHDs may consider enhancing e-mail communications with physicians and medical professional organizations.