Perceptions and Practices Regarding Atopic Dermatitis: A Survey.

Parents (N = 392) completed a survey at the Minnesota State Fair in August and September 2015 addressing knowledge regarding the pathogenesis of atopic dermatitis (AD), basic skin care practices, and the perceived role of infection and food allergies in AD. Of participating parents, 82% identified food allergy or sensitivity in AD pathogenesis, whereas only 42% identified bacterial infection as an important factor in AD severity. Participants most often received education on skin health from their pediatrician (49%), followed by Internet-based sources (23%), rather than a dermatologist or pediatric dermatologist. Parents of children with AD overestimate the role of food allergies in this condition and are not as aware of the role of bacterial infection. Future educational directions from our specialty should focus on resources for pediatricians and families that emphasize these factors.

Utility of Store and Forward Teledermatology for Skin Patch Test Readings.

BACKGROUND: Teledermatology (TD) is the use of imaging technology to provide dermatology services at a distance. To date, studies assessing its application for grading skin patch test reactions have been lacking. OBJECTIVES: The aim was to compare conventional, in-person (IP) grading of skin patch test reactions with store-forward TD. METHODS: Patients undergoing patch testing to the North American Contact Dermatitis Group (NACDG) screening series were invited to participate in this repeated-measures study. Photographs of the NACDG screening series patch sites were obtained at 2 time points (48-hour and final readings). Teledermatology assessments were completed by the same staff dermatologist who performed the IP readings; 48-hour and final TD photographs were viewed at weeks 4 and 8 after the IP encounter, respectively, to prevent recall bias. Staff dermatologists were blinded to IP grading results. The main outcome was percent agreement. Eight categories of agreement were created according to possible pairings of TD and IP reading results. Three final outcome groups of "success," "indeterminate," and "failure" were defined based on clinical significance. RESULTS: One hundred one participants completed the study. There were 7070 comparison points between IP and TD final readings. Excluding negative/negative agreement, there was "success" of TD in 54% of final readings. "Indeterminate" agreement with possible clinical significance was present in 40% of final readings. There was "failure" (definite clinical significance) in 6% of final readings. CONCLUSIONS: Teledermatology may be a viable option for grading skin patch test reactions, particularly for clinicians who perform limited patch testing. However, a clinically significant "failure" rate of 6% and practical barriers to TD implementation may preclude its widespread use for skin patch testing in tertiary referral centers where large numbers of patches are tested per patient.

Quality of life in adults with facial port-wine stains.

BACKGROUND: Facial port-wine stains (PWS) are considered by some an aesthetic skin problem, yet impact on quality of life (QoL) has not been objectively documented. OBJECTIVE: We sought to (1) characterize the effect of PWS on QoL in adults, (2) to identify the clinical and demographic factors that affect QoL, and (3) to compare our results with QoL studies in other skin conditions. METHODS: In total, 244 adults with facial PWS completed an online QoL survey, which included the Skindex-29 instrument. RESULTS: QoL in adults with facial PWS was diminished, especially from an emotional perspective. Variables associated with reduced QoL in all Skindex-29 subdomains included comorbid depression, limited facial mobility, and presence of other skin conditions. Persons with hypertrophy had more emotional and symptomatic impairment. The composite dermatologic-specific QoL scores were similar to those of cutaneous T-cell lymphoma, rosacea, alopecia, and vitiligo. LIMITATIONS: Selection bias was a potential limitation, as participants were primarily recruited from patient support groups. CONCLUSION: Our analysis demonstrates that the presence of a facial PWS has a significant negative impact on QoL. Dermatologists caring for patients with PWS should inquire about QoL, provide appropriate support and resources, and consider QoL when discussing treatment options and obtaining authorization for these procedures.

Epidemiology and Co-Reactivity of Novel Surfactant Allergens: A Double-Blind Randomized Controlled Study.

BACKGROUND: Surfactants are cleansing agents used in products such as shampoos and soaps. OBJECTIVES: The aims of this study were to identify positivity rates to 3 novel amide-containing surfactants (sodium lauroyl sarcosinate, isostearamidopropyl morpholine lactate, and disodium lauroamphodiacetate) and evaluate co-reactivity with other surfactants in patients with known surfactant sensitivity. METHODS: Previously patch-tested, surfactant-positive patients were identified via chart review and invited to participate. Participants were patch tested to screening surfactants (cocamidopropyl betaine, amidoamine, dimethylaminopropylamine, cocamide diethanolamine [DEA], oleamidopropyl dimethylamine, and decyl glucoside), as well as 3 novel surfactants: sodium lauroyl sarcosinate 0.5% and 1.0% aq, isostearamidopropyl morpholine lactate 0.5% and 1.0% aq, disodium lauroamphodiacetate 1.0 and 2.0% aq, and a hypoallergenic liquid cleanser (tested semiopen). Participants and clinicians were blinded. The order of tested allergens was randomized. RESULTS: Forty-seven participants completed the study. Excluding doubtful reactions, positive reactions were most common to oleamidopropyl dimethylamine (34%) and dimethylaminopropylamine (34%), followed by isostearamidopropyl morpholine lactate (23%). Reactivity was not associated with history of childhood eczema. Co-reactivity was high among oleamidopropyl dimethylamine, dimethylaminopropylamine, cocamidopropyl betaine, amidoamine, and isostearamidopropyl morpholine lactate. None of the participants who reacted to cocamide DEA reacted to an additional surfactant. CONCLUSIONS: Isostearamidopropyl morpholine lactate may be an important emerging allergen with sensitivity rates comparable with those of oleamidopropyl dimethylamine and dimethylaminopropylamine. Co-reactivity among surfactants was frequent except for cocamide DEA.

Allergic Contact Dermatitis to Ophthalmic Medications: Relevant Allergens and Alternative Testing Methods.

Allergic contact dermatitis is an important cause of periorbital dermatitis. Topical ophthalmic agents are relevant sensitizers. Contact dermatitis to ophthalmic medications can be challenging to diagnose and manage given the numerous possible offending agents, including both active and inactive ingredients. Furthermore, a substantial body of literature reports false-negative patch test results to ophthalmic agents. Subsequently, numerous alternative testing methods have been described. This review outlines the periorbital manifestations, causative agents, and alternative testing methods of allergic contact dermatitis to ophthalmic medications.

Incidental melanomas detected in veterans referred to dermatology.

BACKGROUND: Early detection of melanoma is integral to preventing morbidity and mortality. OBJECTIVE: We sought to characterize and compare incidental versus consult melanomas detected in veterans referred to the Minneapolis, MN, Department of Veterans Affairs Medical Center dermatology clinic. METHODS: We retrospectively reviewed charts of all dermatology consults between January 2004 and March 2012. RESULTS: Of the 28,405 consults sent during the study period, 17,174 met inclusion criteria. There were 231 melanomas identified in 221 patients. In all, 144 melanomas were identified on the consult and 87 melanomas were discovered incidentally. The incidental melanoma detection rate was 0.5% (84/17,174). Consult melanomas were more likely to be invasive than incidental melanomas (relative risk 1.51, 95% confidence interval 1.23-1.86, P < .0001) and less likely to have a Breslow depth of less than 1.00 mm (relative risk 0.73, 95% confidence interval 0.61-0.88, P = .0036). Incidental melanomas were smaller than consult melanomas (mean diameter 0.98 vs 1.3 cm, respectively) and thinner (mean Breslow depth 0.64 vs 1.74 mm). Consult melanomas were more likely to be detected on the head/neck (relative risk 1.25, 95% confidence interval 1.03-1.52, P = .0295). LIMITATIONS: Nondiverse patient population is a limitation. CONCLUSION: Melanomas detected during an in-person skin examination by a dermatologist were more likely to be detected at an earlier stage of disease.

Incidental lesions found in veterans referred to dermatology: the value of a dermatologic examination.

BACKGROUND: Few studies have evaluated the detection of incidental skin cancers. OBJECTIVE: We sought to evaluate the rate of incidental cutaneous malignancies in routine dermatology consults. METHODS: This was a retrospective chart review of all dermatology consults at the Minneapolis Department of Veterans Affairs Medical Center over 8.25 years. Inclusion criteria included an in-person clinic visit within 18 months of the initial consult date. Patients with an in-person skin examination by a dermatologist in the 18 months before consult date were excluded. RESULTS: Of 28,405 consults sent during the study period, 17,174 met inclusion criteria. In all, 2257 (13.1%) patients had 1 or more biopsied incidental lesions. Half (50.3%; n = 1674) of the 3328 biopsied incidental lesions were malignant, which included 1187 patients. The per-person detection rate for an incidental malignant lesion was 6.9% (1187/17,174). There were 87 incidental melanomas identified in 84 patients. The per-person detection rate for an incidental melanoma was 0.5% (84/17,174). The most frequent anatomical location for biopsied incidental malignancies was the head and neck (53.9%). Incidental melanomas were most frequently located on the back (33.3%). LIMITATIONS: Nondiverse patient population and conservative detection rate estimates are limitations. CONCLUSION: An in-person skin examination by a trained dermatologist is important for detection of skin malignancies. This may have implications for teledermatology.

Human milk cortisol is associated with infant temperament.

The implications of the biologically active elements in milk for the mammalian infant are largely unknown. Animal models demonstrate that transmission of glucocorticoids through milk influences behavior and modifies brain development in offspring. The aim of this study was to determine the relation between human milk cortisol levels and temperament of the breastfed infant. Fifty-two mother and infant pairs participated when the infants were three-months old. Milk cortisol levels were assessed and each mother completed the Infant Behavior Questionnaire (IBQ), a widely used parent-report measure of infant temperament. Analyses revealed a positive association between milk cortisol and the negative affectivity dimension of the IBQ (partial r=.37, p<.01). No correlation was found between elevated cortisol levels and the surgency/extraversion or the orienting/regulation dimensions. Further, the positive association between increased maternal milk cortisol and negative affectivity was present among girls (ß=.59, p<.01), but not among boys. (Although, the sex by milk cortisol interaction term was not statistically significant, suggesting that these results require replication.) Environmental factors such as maternal demographics and negative maternal affect (depression and perceived stress) at the time of assessment did not account for the positive association. The findings support the proposal that exposure to elevated levels of cortisol in human milk influences infant temperament. The findings further suggest that mothers have the ability to shape offspring phenotype through the transmission of biologically active components in milk.