Congenital red hair heterochromia in the background of blond scalp hair.

We report a case of isolated patchy red hair heterochromia of the scalp in a healthy 6-year-old boy. Isolated patchy scalp hair heterochromia is the presence of two or more colors of hair in the same individual, thought to be due to genetic mosaicism although no specific etiology has been widely accepted. We have outlined a basic approach to diagnosing different types of heterochromia for clinical application.

Systemic Treatments for Allergic Contact Dermatitis.

Allergic contact dermatitis is a common disease within the family of delayed-type hypersensitivity reactions. In more severe cases of allergic contact dermatitis, topical steroids may prove insufficient, and systemic therapeutic agents are often used. Even when systemic therapies such as cyclosporine lead to improvement, withdrawal of these agents is challenging and can lead to undesirable morbidities. Currently, there are no systemic treatments indicated for the treatment of widespread recalcitrant contact dermatitis. This review discusses the targets of in-use off-label systemic medications and potential therapeutics in the pipeline.

Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler.

PURPOSE OF REVIEW: The environment for the developing children is complex as they are exposed to a variety of activities and settings where potential environmental allergens may be encountered. Recent evidence supports the clinical benefit of patch testing young children suffering from recalcitrant dermatitis. While patch testing has been recently approved by the Food and Drug Administration in children ages 6-18 years old, patch testing strategies for young children of preschool age (between 2 and 6 years old) have yet to be defined. RECENT FINDINGS: Allergic contact dermatitis is underdiagnosed among pediatric patients, particularly those suffering from concomitant atopic dermatitis as the interplay between the two diseases is complex. Recent reports in literature supported the clinical value, safety, and efficacy of patch testing pediatric patients. This review provides an overview of specific pediatric allergens, special considerations, practical modifications, and systematic exposure-driven guidance approaches toward patch testing preschoolers.

Propylene Glycol in Contact Dermatitis: A Systematic Review.

Propylene glycol (PG), an emollient and emulsifier found in cosmetics, medications, and food, has been granted the dubious honor of being named the American Contact Dermatitis Society's Allergen of the Year for 2018. Contact, systemic, and irritant cutaneous reactions have been documented for PG, which has become an increasingly common ingredient. Propylene glycol is as contentious as it is ubiquitous because it acts as both a weak sensitizer and an irritant, confounding the results of positive patch tests. This review serves to delve into what we know about PG from previous reports and studies so that providers will have a better understanding of PG contact dermatitis.

Propylene Glycol.

Propylene glycol (PG), an emollient and emulsifier found in cosmetics, medications, and food, has been granted the dubious honor of being named the American Contact Dermatitis Society's Allergen of the Year for 2018. Allergic and irritant contact dermatitis and systemic cutaneous reactions to PG, which has become an increasingly common ingredient, have been documented. Propylene glycol is as contentious as it is ubiquitous because it acts as both a weak sensitizer and an irritant, confounding the results of positive patch tests. This report serves to increase awareness about PG sensitization and appropriate testing and evaluation of PG patch tests.

Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis.

Importance: Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients. Objective: To use data from the Pediatric Contact Dermatitis Registry to elucidate the associations and sensitizations among patients with concomitant AD and ACD. Design, Setting, and Participants: This retrospective case review examined 1142 patch test cases of children younger than 18 years, who were registered between January 1, 2015, and December 31, 2015, by 84 health care providers (physicians, nurse practitioners, physician assistants) from across the United States. Data were gathered electronically from multidisciplinary providers within outpatient clinics throughout the United States on pediatric patients (ages 0-18 years). Exposures: All participants were patch-tested to assess sensitizations to various allergens; history of AD was noted by the patch-testing providers. Main Outcomes and Measures: Primary outcomes were sensitization rates to various patch-tested allergens. Results: A total of 1142 patients were evaluated: 189 boys (34.2%) and 363 girls (65.8%) in the AD group and 198 boys (36.1%) and 350 girls (63.9%) in the non-AD group (data on gender identification were missing for 17 patients). Compared with those without AD, patch-tested patients with AD were 1.3 years younger (10.5 vs 11.8 years; P < .001) and had longer history of dermatitis (3.5 vs 1.8 years; P < .001). Patch-tested patients designated as Asian or African American were more likely to have concurrent AD (odds ratio [OR], 1.92; 95% CI, 1.20-3.10; P = .008; and OR, 4.09; 95% CI, 2.70-6.20; P <.001, respectively). Patients with AD with generalized distribution were the most likely to be patch tested (OR, 4.68; 95% CI, 3.50-6.30; P < .001). Patients with AD had different reaction profiles than those without AD, with increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Patients with AD were also noted to have lower frequency of reaction to methylisothiazolinone, cobalt, and potassium dichromate. Conclusions and Relevance: Children with AD showed significant reaction patterns to allergens notable for their use in skin care preparations. This study adds to the current understanding of AD in ACD, and the continued need to investigate the interplay between these disease processes to optimize care for pediatric patients with these conditions.

Squamous Cell Carcinoma In Situ Overlying Merkel Cell Carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous neoplasm that has exhibited an exponential increase in incidence in the past 3 decades. Combined MCC and cutaneous squamous cell carcinoma (SCC/MCC) is an uncommon variant of MCC that exhibits worse prognosis than pure MCC. OBJECTIVE: To describe the clinical presentation, dermoscopy, and histology of an unusual subtype of combined SCC/MCC. METHODS AND RESULTS: A 73-year-old white woman presented with an ulcerated and violaceous 10-mm plaque on her right jawline that had been present for 2 to 3 months. On dermoscopy, the lesion was predominantly milky pink to red with peripheral crusting and large-caliber polymorphous vessels. Histology revealed SCC in situ above and adjacent to MCC. The tumor was excised with clear margins, and sentinel lymph node scintography was negative for nodal involvement.