Recommendation to update the British Society for Cutaneous Allergy corticosteroid series

BACKGROUND

Patch testing is an important investigation when dermatitis is unresponsive to, or worsened by, topical corticosteroid treatment. There is a balance to be struck between testing too many allergens, which is expensive, time consuming and risks causing sensitization, and testing too few, which risks missing the diagnosis. The current British Society for Cutaneous Allergy (BSCA) corticosteroid series comprises eight allergens and was last updated in February 2007.

AIM

To review and update the BSCA corticosteroid series.

METHODS

We retrospectively analysed data from 16 patch test centres in the UK and Ireland for all patients who were patch tested to a corticosteroid series between August 2017 and July 2019. We recorded the allergens tested, the number and percentage tested to a corticosteroid series and the number of positive results for each allergen. We identified the allergens that test positive in ≥ 0.1% of selectively tested patients.

RESULTS

Overall, 3531 patients were tested to a corticosteroid series in the 16 centres. The number of allergens tested ranged from 7 to 18 (mean 10). The proportion of patch test patients who were tested to a corticosteroid series ranged from 1% to 99%. Six allergens in the 2017 BSCA series tested positive in ≥ 0.1% of patients. Nine allergens not in the BSCA corticosteroid series tested positive in ≥ 0.1% of patients.

CONCLUSION

This audit demonstrates the importance of regular review of recommended series and the significant variations in practice. The new BSCA corticosteroid series that we recommend contains 13 haptens, with the addition of the patient's own steroid creams as appropriate.

Multiple painful skin papules, uterine leiomyomas and hysterectomy

A 38-year-old woman presented with multiple papules and nodules. Her mother and maternal grandmother had similar lesions, and all three women had undergone hysterectomy at a young age. Histopathogical analysis revealed dense dermal nodules composed of eosinophilic spindle cells, and exposed elongated cells with abundant eosinophilic cytoplasm arranged in fascicles.

Ideal proportion of the population to be patch tested: How many should we be doing?

BACKGROUND

How many patients should we be patch testing? A previous study suggested that the minimum proportion of a population to be patch tested for allergic contact dermatitis was 1:700 annually.

OBJECTIVES

To evaluate if the current minimum rate for patch testing has changed over the 20 years since the previous study in order to maximize the value.

METHODS

In cooperation with the British Society for Cutaneous Allergy, a proforma for collation of retrospective data between January 2015 and December 2017 was sent to patch-test centers in the United Kingdom (UK) and the Republic of Ireland (ROI). The number of positive tests was analyzed against the proportion of population tested to see what proportion of the population would yield the greatest number of positive results.

RESULTS

Responses from 11 centers showed that the minimum number needed to patch test had increased to 1:550 per head of population per year using the current criteria.

CONCLUSIONS

In agreement with previous studies, we should be patch testing more people than we are. We could reduce the threshold for referral of patients we patch test to derive the most benefit from this investigation.

Gravitational erythema

We report a case of gravitational erythema in a 13-year-old boy who presented with a blotchy erythematous rash affecting his arms when hanging down and legs and lower abdomen on standing. The cutaneous symptoms in the upper limbs would resolve rapidly on elevation of the arms, whereas the lower limb rash would disappear on lying flat. Although this is a benign condition, no effective treatment has previously been reported. Our patient was managed with compression stockings, which provided some symptomatic benefit.

[Multiple sebaceous tumors with colon cancer--Muir-Torre syndrome]

The Muri-Torre syndrome is an autosomal-dominant genodermatosis. The criteria of the diagnosis is the occurrence of at least one sebaceous skin tumour and at least one malignant internal tumour. Skin tumours must be considered as very important signs because they may precede visceral malignancies. The authors present the case of a 62 years old man. Three tumours were excised from three different locations of his trunk in the Plastic Surgery Ward of our hospital. The tumours proved to be sebaceous adenoma, sebaceous epithelioma and sebaceous carcinoma by histology. Because of this result, we had conducted a detailed tumour screening which found a non-symptomatic malformation of the proximal colon tract. Histology of the resected colon part revealed adenocarcinoma. With the presentation of this case the authors call attention on the fact, that in case of the diagnosis of a sebaceous skin tumour, careful tumour screening could be lifesaving.

Uraemic gangrene syndrome: is parathyroidectomy always necessary?

This report presents a case of uraemic gangrene syndrome with multiple ulcerations and calcium (Ca) deposits in the vessel walls. High-dosage oral calcium carbonate (CaCO3) treatment alone resulted in rapid wound healing with decreased serum phosphorus (P), Ca x P product and parathormone and only slightly increased Ca levels. We suggest that this should be the first choice of treatment in such cases because positive clinical response can achieve symptom-free status for the patient until kidney transplantation, thus making parathyroidectomy unnecessary.