RESUMO
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.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Dermatite Alérgica de Contato/tratamento farmacológico , Imunossupressores/uso terapêutico , Adalimumab/uso terapêutico , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Azatioprina/uso terapêutico , Ciclosporina/uso terapêutico , Etanercepte/uso terapêutico , Humanos , Infliximab/uso terapêutico , Metotrexato/uso terapêutico , Ácido Micofenólico/uso terapêutico , Uso Off-Label , Talidomida/análogos & derivados , Talidomida/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
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.
Assuntos
Dermatite Alérgica de Contato/diagnóstico , Alérgenos/imunologia , Pré-Escolar , Dermatite Atópica/diagnóstico , Humanos , Testes do EmplastroAssuntos
Negro ou Afro-Americano/estatística & dados numéricos , Dermatite de Contato/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Criança , Dermatite Alérgica de Contato/epidemiologia , Humanos , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
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.
Assuntos
Alérgenos/efeitos adversos , Dermatite de Contato/etiologia , Emolientes/efeitos adversos , Propilenoglicol/efeitos adversos , Dermatite de Contato/diagnóstico , Humanos , Testes do EmplastroRESUMO
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.
Assuntos
Alérgenos/efeitos adversos , Dermatite de Contato/etiologia , Emolientes/efeitos adversos , Propilenoglicol/efeitos adversos , Dermatite de Contato/epidemiologia , Humanos , Testes do EmplastroRESUMO
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.
