Patch testing with expired Indian patch test kits: Results of a pilot study.

BACKGROUND: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. METHODS: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. RESULTS: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. LIMITATIONS: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. CONCLUSION: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation.

Clinical, Occupational and Allergological Profile of 455 Patients with Occupational Contact Dermatitis: A 5-Year Study from a Tertiary Care Center of North India.

OBJECTIVES: To evaluate clinical and occupational profile and common allergens in patients with occupational contact dermatitis (OCD). MATERIALS AND METHODS: The records of 455 (M:F 2:1) patients aged 18-85 years with allergic contact dermatitis were analyzed retrospectively. The diagnosis of OCD and patterns of dermatitis were defined by standard criteria. Indian standard series comprising 20 allergens and when suspected patient's own products were patch tested by Finn chamber method as per European Society of Contact Dermatitis guidelines and relevance of positive results was defined clinically. RESULTS: Airborne contact dermatitis (27.7%), acral dermatitis (14.1%), hand dermatitis (12.9%), acrofacial dermatitis (12.7%), and facial dermatitis (10.5%) were the common patterns. Agriculturists (51.2%), homemakers (27.9%), office workers (24.6%), and construction workers (4.6%) comprised the majority. Positive patch test results in 58% cases were from parthenium (31.7%), p-paraphenylenediamine (PPD) (22.9%), nickel (16%), fragrance mix (11%), potassium dichromate (10.7%), cobalt (7.6%), and mercaptobenzothiazole (4.9%). Hair colorants, shoe chips, and shaving cream also produced relevant positive reactions. Parthenium, PPD, fragrance mix, and potassium dichromate in agriculturists; nickel, parthenium, PPD, fragrance mix, and potassium dichromate in women, and potassium dichromate and parthenium in construction workers elicited the most positive reactions. PPD and hair colorants elicited positive reaction mainly in office workers. CONCLUSIONS: The agriculturists, homemakers, and construction workers have OCD most frequently. Parthenium in farmers, potassium dichromate in construction workers, nickel in women, and PPD in office workers were the major contact allergens. The study is limited by its retrospective design, small number of patients, and limited number of patch test allergens.

Adults with a more extensive body involvement, moderate to extremely severe vitiligo and a prolonged clinical course have an early onset in childhood in addition to other prognostic factors as compared to individuals with later-onset vitiligo.

BACKGROUND: The extent and disease severity, duration and other associated prognostic cofactors in vitiligo in adults may vary with the age of onset (before or after 10 years of age). OBJECTIVES: To compare extent and disease severity, duration and other cofactors in adults with early-onset and late-onset vitiligo. METHODS: The medical records of 408 (M:F 1:1.1) adults aged 20-75 years diagnosed with vitiligo between January 2016 and December 2019 were examined retrospectively. The extent and severity of vitiligo were defined. Characteristics of vitiligo with early onset and late onset were compared statistically and odds ratios calculated for risk assessment. RESULTS: 31 (7.6%, M:F 1:2.4) patients had early-onset vitiligo, and 377 (92.4%, M:F 0.8:1) patients had later-onset vitiligo. Compared to late onset, patients with early-onset vitiligo had a significant number of males (71% vs 45.9%), higher percentages of body surface area involvement and moderate to extremely severe disease (29% vs 10.6%), longer duration of disease (41.9% vs 9%), Koebner's phenomenon (48.4% vs 15.6%) and halo nevus (9.7% vs 1.9%). Differences between the two groups were not significant for types of vitiligo, family history of vitiligo and presence of cutaneous and systemic/autoimmune diseases. CONCLUSION: The adults, males in particular, with generalised vitiligo (>10% BSA involvement) appear to have an early onset and a prolonged clinical course. The presence of Koebner's phenomenon and halo nevus in patients with early-onset vitiligo was other poor prognostic factors compared to patients with late-onset vitiligo. The retrospective, hospital-based cross-sectional design and small sample size for stratification remain major limitations.

Characteristics of Vitiligo in Children and Adolescents.

Vitiligo in children and adolescents displays some distinct features, which may affect its clinical course, therapeutic outcome, and prognosis. We studied 579 children and adolescents with vitiligo, comprising 275 (47.5%) boys and 304 (52.5%) girls (male:female ratio [m:f], 1:1.1) aged between 2 and 19 years (mean ± SD 11.13 ± 4.23 years). The majority of children (301, 52%) were aged >5-12 years, and 221 (38.2%) were adolescents; onset of vitiligo in the above groups occurred between the ages of 2 and 19 years (mean ± SD 9.18 ± 4.08 years). The majority of patients (337, 58.2%) had developed vitiligo between 5 and 12 years of age, and 332 (57.4%) patients had a medical consultation within 1 year of the onset of the disease. The involvement of up to 10% of body surface area in 569 (98.3%) patients, generalized vitiligo in 328 (56.7%) patients, and focal vitiligo in 158 (27.3%) patients were the major presentations. Only 150 (15.9%) patients had family members affected by vitiligo, and associated systemic disorders, predominately thyroid abnormalities, occurred in three (0.5%) patients. Vitiligo was more frequent in children aged 5-12 years, and it affected girls with a slight preponderance, commonly presenting as generalized vitiligo and focal/localized vitiligo. Patients with a family history of vitiligo had an earlier onset but without a statistically significant difference. Local trauma is an important trigger, and screening for thyroid disorders appears important.