A 20-year analysis of previous and emerging allergens that elicit photoallergic contact dermatitis.

BACKGROUND: Retrospective chart reviews are periodically needed to update allergen series to detect changes in photoallergic contact dermatitis (PACD) over time. OBJECTIVE: We sought to evaluate photopatch test results during a 13-year period and extend the observations to 20 years. METHODS: A retrospective chart review was conducted in patients who were photopatch tested. RESULTS: In all, 76 patients were evaluated. A total of 69 positive photopatch and 45 positive patch test reactions were detected in 30 and 23 patients, respectively. The frequencies of the positive photopatch test reactions were sunscreens 23.2%, antimicrobial agents 23.2%, medications 20.3%, fragrances 13%, plants and plant derivatives 11.6%, and pesticides 8.7%. Of the positive photopatch reactions to antimicrobial agents, 60% were caused by Fentichlor. LIMITATIONS: This study was a retrospective chart analysis, and the number of patients was small. CONCLUSIONS: Sunscreens and antimicrobial agents were the most frequent allergens eliciting PACD, and there was a decrease in PACD caused by fragrances. The number of reactions to medications increased. This study also demonstrated that pesticides can be a cause of PACD. The detection of reactions to Fentichlor was unexpected and, although they have been attributed in some studies to cross-reactions to sulfanilamides and bithionol, such a robust association was not observed in this study. This study extends our experience of the changes in the allergens that elicit PACD to 20 years.

Granuloma annulare, patch type.

A 64-year-old man was referred to the Bellevue Hospital Center Dermatology Clinic for evaluation of an asymptomatic eruption on his left inner arm, which had been present for 4 months and was unresponsive to topical anti-fungal therapy. One month after the initial eruption, 2 similar, asymptomatic lesions appeared on the right inner arm. The lesions were slowly expanding. A biopsy specimen from the left medial arm was consistent with interstitial granuloma annulare. The patient's clinical presentation was consistent with patch-type granuloma annulare. He was treated with a mid-potency topical glucocorticoid twice daily for 4 weeks without benefit. Since the eruption was asymptomatic, treatment was discontinued.

Segmental neurofibromatosis.

A 74-year-old man presented with skin-colored nodules in his left antecubital fossa. The lesions had been present for 35 years and were asymptomatic. Nodules elsewhere on the body, cafe-au-lait spots, axillary freckling, and Lisch nodules were absent. No family members had similar nodules. A diagnosis of segmental neurofibromatosis was made, and a biopsy specimen of a nodule showed a neurofibroma. As the patient had no complications of neurofibromatosis 1, no treatment was needed.

Melasma: a review.

OBJECTIVE: To better understand melasma, a review of its etiologic factors, classification, pathogenesis, and treatment was undertaken. METHODS: Articles discussing the above aspects of melasma were used to demonstrate what is currently known about the disease and how to treat it. RESULTS: Melasma is associated with many etiologic factors, most importantly, sun exposure. It occurs in three distributions and has four reported patterns of pigmentation. Among the many differences between melasma and normal skin, melasma skin contains increased melanin, melanocytes, and melanosomes, as well as increased synthesis of tyrosinase. Its pathogenesis remains largely unknown. Treatment consists of phenolic and nonphenolic depigmenting agents, chemical peels, lasers, and dermabrasion. CONCLUSION: Melasma is a common skin disorder. Although melasma has been studied, its pathogenesis remains largely unknown and its treatment is still met with difficulty. Randomized controlled trials involving larger numbers of patients and comparing treatments, as well as studying combination therapies, would be beneficial.

Changing paradigms in dermatology: tumor necrosis factor alpha (TNF-alpha) blockade in psoriasis and psoriatic arthritis.

Psoriasis is an inflammatory T cell-mediated disease characterized by epidermal hyperplasia and parakeratosis, resulting in lesional areas of thick and scaling skin. Elevated levels of proinflammatory cytokines, including TNF-alpha, are found in psoriatic lesions. TNF-alpha has many effects in producing an inflammatory response such as stimulating production of pro-inflammatory molecules (eg, IL-1, IL-6, IL-8, NF-kappaB) and adhesion molecules (eg, ICAM-1, P-selectin, E-selectin). As such, TNF-alpha is a target for immunotherapy in the treatment of psoriasis and psoriatic arthritis. The role of TNF-alpha in the pathogenesis of psoriasis is reviewed, along with clinical trials demonstrating the efficacy of new anti-TNF-alpha immunobiologics in the treatment of psoriasis and psoriatic arthritis.

TNF-alpha and apoptosis: implications for the pathogenesis and treatment of psoriasis.

TNF-alpha is a key cytokine in innate immune responses and is increased in psoriatic lesions. TNF-alpha has many effects, ranging from inflammation to apoptosis. These effects are reviewed to better understand the role of TNF-alpha as it relates to the pathogenesis and treatment of psoriasis. TNF-alpha increases production of pro-inflammatory molecules (e.g. IL-1, IL-6, IL-8, NF-kappa B, vasoactive intestinal peptide) and adhesion molecules (e.g. intercellular adhesion molecule-1, P-selectin, E-selectin). TNF-alpha promotes apoptosis through binding to the TNF-receptor 1; however, psoriatic lesions are hyperproliferative despite an increase in TNF-alpha. This paradox is partially explained as NF-kappa B activation seems to inhibit TNF-alpha-induced apoptosis. The importance of TNF-alpha and apoptosis in psoriasis is shown through the review of clinical trials using anti-TNF-alpha immunobiologics (e.g. etanercept, infliximab) and apoptosis-inducing treatments that result in clinical improvement of the disease.